Facultatea de Medicina Dentara,

Craiova

PROIECT LA LIMBA ENGLEZA

Profesor, Student,
Stefanescu Oana Cotulbea Cornelia
Tehnica Dentara
An 2 , gr 3
 Cuprins

1. Discussion Prognosis: How Much Do You Want To Know? Talking To

Patiens Who Are Prepared For Explicit Information

a. Speak About: Realism, Optimism And Avoidance When Discussing

Prognosis ………………………………………………………………pag 3

b. How Much Do You Want To Know About Prognosis …………..…pag 7

2 Implantology…………………………………………………………………..pag
11

3. Taste Disorder …………………………………………………pag 17

Exercices…………………………………………..……………… pag 20
1. Discussion Prognosis: How Much Do You Want To Know? Talking To
Patiens Who Are Prepared For Explicit Information

a. Speak About: Realism, Optimism And Avoidance When

Discussing Prognosis

Optimal communication with health professionals (HPs) has been

identified by patients and their families as a critical aspect of end-of-life
(EOL) care. Patients in developed countries are increasingly expressing a
preference to be well informed about their diagnosis and prognosis and to
be involved with decisions about their care. Having a doctor who is willing
to talk about dying and who is sensitive to when patients are ready to
discuss this issue has been identified by patients and their families as one of
the most important needs at the EOL.

Choosing how and when to raise EOL issues with terminally ill
patients is difficult for HPs. Previous studies suggest that many patients feel
it is up to the doctor to initiate discussion of EOL issues, yet doctors may be
reluctant to raise the topic for fear of upsetting the patient.

Strategies with unintended consequences :realism, optimism, avoidance

The useful feature of realism is that prognostic information helps

patients and physicians to make sound medical decisions. Both bioethical
reasoning and empirical evidence support the importance of accurate
patient understanding of prognosis. Yet patients also report that realistic
prognostic discussions can be blunt and sometimes brutal. A physician who
presents prognosis realistically, but without structuring the conversation
before the information or responding empathetically afterwards, can be
perceived as uncaring.
 Optimism can play a useful role in supporting a patient's hopes and
many patients report that they want a doctor who is hopeful. In discussions
about prognosis, however, physicians who deliberately exaggerate or
overemphasize optimistic information may risk losing the trust of patients
who later discover that the information they received was not entirely true.
Moreover, patients whose are overly optimistic about their chances of
survival are more likely to choose life-sustaining therapies in the last 6
months of life often when these therapies are least effective. A third strategy
is to avoid prognostication altogether, often by emphasizing individual
differences, unpredictability of disease course, or exceptional outliers.
Avoidance is based on reasonable concerns.

How much do you want to know?

The approach proposed for discussing prognosis is based on work in

negotiation and patient-centered communication and the research available
on what patients want to know about prognosis. In addition to the finding
that most patients want detailed information, surveys demonstrate that there
are many different possible prognostic questions that could be answered.
Discussing prognosis is more complex than other communication tasks, such
as giving bad news, because it requires a synthesis of communication skills
and biomedical content knowledge. Not all patients want to be fully
informed or to discuss their prognosis. Some physicians tell patients and
their carers early on that they are happy to answer questions about the
future at any stage. Other physicians said they endeavor to raise issues
about the future indirectly or provide a space for it to come up in the
conversation..

These doctors and nurses perceived a great fear among patients and
their families in discussing these issues. They said patients and carers may
find it difficult to initiate the discussion themselves and needed permission
to feel comfortable in raising the topic. In addition, there was a sense of
professional responsibility in giving patients and their families the
opportunity to talk about EOL issues so they could decide how they wished
to spend their remaining lives, be adequately prepared, make arrangements
within the family for their care, and be less fearful. Peoples' unspoken fears
about dying were felt to be frequently worse than reality. Some patients and
carers said that it is important that the doctor knows you and is sensitive,
then it would be acceptable for him or her to offer to discuss prognosis
 How do you want to know about prognosis ?

Because studies show that a majority of patients want to discuss

prognosis, it is recommended that physicians ask explicitly how patients
want to talk about prognosis. Because many patients may not understand
the term prognosis, an alternative is to ask, "How much do you want to
know about the likely course of this illness? These questions invite a
response that goes beyond yes or no. A physician could even normalize a
range of patient interest: "Some people want lots of details, some want the
big picture, and others prefer that I talk to their family. What would be best
for you?" There are three kinds of answers to this question: the patient (1)
wants information; (2) does not want information; (3) is ambivalent.
Occasionally the patient will say that they want a lot of information, and yet
their body language will contradict them. A patient who says "yes" but is
hesitating, looking down, shifting in his seat, or has a facial expression
indicating distress may also be saying "no" nonverbally.

Patients who want information

The principle underlying this kind of discussion is that patients are

more likely to try to understand and retain information they want.

Who and When to Initiate Discussions About Prognosis and Eol Issues

Patients, carers, and HP participants had diverse views regarding

who and when to initiate discussions about prognosis and EOL issues. In
general, participants preferred one of four main approaches: wait for the
patient/carer to raise the topic; HPs to offer all PC patients and their carers
the opportunity to discuss the future; HPs to initiate the discussion when the
patient/family needs to know; or HPs to initiate the discussion when the
patient/family seems ready. Some patients, carers, and a few HPs felt it
should be up to patient and/or carer to initiate the discussion. These HPs
said they would be directed entirely by patient or carer questions and would
not normally offer to discuss the topic. The reasons why HPs said they may
be reluctant to raise the discussion included fear of upsetting the patient or
imposing information on the person that they are not ready to hear. In
addition, some doctors said the inherent uncertainty of prognostic
predictions made them concerned about volunteering inaccurate estimates
that may only scare the patient. A few patients and carers spoke of the
patient's right to be protected and not have painful discussions about
prognosis. One patient said it would be intrusive if the doctor offered to
discuss prognosis.

Initiate the Discussion When the Patient and/or their Family Need to
Know

Some doctors said they would only offer to discuss EOL issues if the
patient had unrealistic expectations and/or there was an important decision
to be made or if patient was rapidly deteriorating. Likewise, all nurses said
they would be more comfortable raising a discussion about EOL issues or
prognosis if they perceived a particular reason to do so. One physician said
he would only offer to discuss prognosis or EOL issues if it was necessary
for an immediate clinical decision, such as the need for a ‘do not
resuscitate' order. In addition, the nurses said they would talk about the
future with patients or families for the purposes of discharge planning when
there had not been open acknowledgment that the person was dying and it
was not clear how they would manage at home.

Initiate the Discussion When the Patient and/or their Family Seem Ready

Some patients, carers, and HPs said that HPs should initiate the
discussion when they think the patient is ready. Most HPs emphasized the
importance of knowing the patient as a person and developing a trusting
and caring relationship so that the person would feel comfortable discussing
their future. The importance of listening and providing emotional support,
while not feeling that you have to solve all problems, was highlighted. The
value of having a calm, unhurried, warm, and gentle manner was raised in
particular by allied health staff. Some doctors pointed out that the HP
themselves needs to be comfortable in discussing EOL issues—that is, they
have the knowledge base and have faced their own mortality. The use of
humor was also mentioned by a few HPs. Patiants said that it is vital for the
HP to show compassion and respect and to ensure that adequate support is
present. Some HPs also said they asked the patient what they thought was
the answer to their question, for example, how long they had to live or what
may happen.. Most patients and carers, if they wanted to have the discussion
at all, wanted to discuss prognosis and EOL issues with a doctor or nurse.
Another patient requested that the family be told first and for the family, not
the doctor, to be the one to tell him.

Physicians sometimes selectively convey prognostic

information to support patient’s hopes.However,the relationship between
prognostic disclosure and hope is not known.Although physicians sometimes
limit prognosis information to presive hope. Instead disclosure of
prognosis by the physician can support hope,even when he prognosis is
poor.Physician and patients alike believe that the best medical
communication allows for hope ,no matter how difficult the situation .

The meaning of hope may not be tied to a cure in every

situation;instead patient with realistic perceptions of prognosis can
transform hopes to reasonable possibilities such as a meaningful enf of life
period.

Conclusion

Commonly used strategies for disclosing prognosis, including

realism, optimism, and avoidance, have unintended consequences that do
not always serve patients, family members, and physicians. Asking patients
how much they want to know can facilitate an explicit discussion that meets
individual patient needs. These patients may want to know information about
their prognosis even if it is disappointing or upsetting.
 b. How Much Do You Want To Know About Prognosis

The sharing of medical information and opinions is a problem both

for the doctors and the patients (and their families). But if you explain how
much truth you want to hear and how you would like to receive this
information, then your doctors will be able to communicate with you better.
This is a good place in your Advance Directive to tell your doctors
exactly how much you want to know about your medical situation.

Often doctors do not know how much truth the patient wants. Can the
doctor hint at the truth without 'tipping off' everyone that the facts are much
worse than everyone had assumed? If your doctor asks, "Do you want the
whole truth?", he or she has already suggested that the situation might be
bleak. Doctors often face the puzzle of how much to share—and with whom.

But if you say in writing how much you want to know, then this
hinting-and-guessing game can be avoided. You can decide how much you
want to know in advance,
completely independent of the medical facts that might develop later.

You might decide you want the whole, unvarnished truth. Or you
could instruct your doctors to tell your proxies first, who would then decide
the best time to share the information with you. Perhaps you want a
'softer' version of the truth. For example, if you are dying, perhaps you do
not want that information. You would prefer to continue to be treated as if
you would recover.

And when you discuss this Question in advance with your doctor,
before any health crisis emerges, your doctor can help you to clarify just
how much you want to know. It might even be necessary to re-write your
Answer to this Question so that both you and your doctor understand just
when and how medical information will be communicated.

Such a prior agreement will simplify communication later — when the

doctor has discovered some definite facts about your health. You and your
doctor will not need to dance around the truth, the doctor trying to 'feel out'
just how much you want to know and you trying to 'read between the lines'
of what the doctor says to see if there is something further that is not being
disclosed.

Dialogue between a doctor and a patient

PT: Good morning,dr Smith!

MD: Good morning!What brings you here today?
PT: I want to know exactly what is happening with me?Please tell me
more about my desease
MD: Are you the kind of person who want to hear all the information,both
good and bad about this illness?
PT: Yes,doctor I want to know everything about my desease
MD: Then let begin… The body is made up of different types of cells that
normally divide and multiply in an orderly way. These new cells replace
older cells. This process of cell birth and renewal occurs constantly in the
body.
Colon cancer is a common type of malignancy (cancer) in which there is
uncontrolled growth of the cells that line the inside of the colon or rectum.
Colon cancer is also called colorectal cancer.
The colon, also known as the large intestine, is the last part of the
digestive tract.
The rectum is the very end of the large intestine that opens at the anus.
Cancer or malignant growths occur when:
-Some cells in the body begin to multiply in an uncontrolled manner.
-The body's natural defenses, such as certain parts of the immune system,
cannot stop uncontrolled cell division.
-These abnormal cells become greater and greater in number.

In some types of cancer, including colon cancer, the uncontrolled cell

growth forms a mass, also called a tumor. Some tumors are benign, which
means that they are not cancerous. Cancerous or malignant tumors grow
out of control and can invade, replace, and destroy normal cells near the
tumor. In some cases, cancer cells spread to other areas of the body.

There are two kinds of growths that occur in the colon:

noncancerous growths, such as polyps

Malignant or cancerous growths. Colon cancer usually begins with the

growth of benign growths such as polyps.

MD: Did that make sense to you?

PT : Yes, I understand what you say

MD : If you have some question you can ask now?

PT: Yes I have: What causes colon cancer?

MD: The biggest risk factor is age. Colon cancer is rare in those under 40
years. The rate of colorectal cancer detection begins to increase after age
40. Most colorectal cancer is diagnosed in those over 60 years.
Have a mother, father, sister, or brother who developed colorectal cancer
or polyps. When more than one family member has had colorectal cancer,
the risk to other members may be three-to-four times higher of developing
the disease. This higher risk may be due to an inherited gene.
Have history of benign growths, such as polyps, that have been surgically
removed.
Have a prior history of colon or rectal cancer.
Have disease or condition linked with increased risk.
Have a diet high in fat and low in fiber.

PT: What are the symptoms of colon cancer?

MD: The symptoms of colon cancer can be confused with those of a number
of digestive disorders:- Bleeding from the rectum.

_ Changes in bowel habits

- Pain in the abdomen or rectum

- A feeling that a bowel movement cannot be completed
 - Unexplained weight loss, unusually low red blood cell counts or
anemia, paleness, fatigue, or a yellowish coloring of the skin or
whites of the eyes.

PT: Why isn't everyone screened for cancer?

MD: Screening for colorectal cancer is in its early stages. Not all doctors
screen for colorectal cancer, or some patients may be reluctant to go for
testing.

PT: Don't hemorrhoids, not colon cancer, cause rectal bleeding usually?

MD: True, hemorrhoids are a common cause of rectal bleeding. But a

symptom of colon cancer is bright red blood in the stool. Could you say
something about now you are feeling about what we have discussed?

PT : I feel a little scared but I’m fine.I want to know how can colon cancer
be prevented?
MD: Schedule regular colorectal cancer screening tests with your doctor.
Avoid diets high in fat, alcohol, protein, calories, and red and white
meat.
The use of nonsteroidal anti-inflammatory medications (such as
aspirin) may decrease the risk of colon cancer.
Eat foods rich in fiber
PT: I Understand ,now I want to discuss with you “How Is Colon Cancer
Treated”?
MD: Three types of treatment are available for individuals with colon
cancer: Surgery is an operation that involves removing the cancerous
section of the colon. This is the primary treatment for colon cancer for most
individuals.
Chemotherapy involves treatment with drugs that destroy fast-growing
cells, like cancer cells. This treatment is given to persons with advanced
cancers that have spread outside of the colon.
Radiation therapy is a specialized treatment using radiation to destroy
rapidly growing cancer cells. This is usually reserved for treatment of rectal
cancer and may be given before surgery, often in combination with
chemotherapy. This treatment may shrink the tumor and improve the
chances of avoiding a permanent colostomy in select persons.
PT: In my case what treatment did you recomand to me?
MD: In your case I am agree with the first option:the surgery
PT: Not the chemotherapy?
MD: No,because your cancer is not so advanced,you are one lucky person
PT : Thank you dr…I have a last question to ask
MD: Please
PT: What is the follow-up care for colon cancer?
MD: Follow-up exams are important after treatment for colon cancer. The
cancer can recur near the original site or in a distant organ such as the
liver or lung. In addition to checking for cancer recurrence, patients who
have had colon cancer may have an increased risk of cancer of the
prostate .
PT: I understand now.
MD: Is there anything else?
PT: No ,it’s enough
MD: I have a question to you now! Who are you going to tell about this visit
when you get home?
PT: I tell to my family,because they are very important to me and they
always supporting me
MD: How do you feel now ?
PT : I’m not scary ,because now I know a lot of information about my
cancer and I know what to do exactly before and after the treatment.
MD: I’m very impressed by your reaction about it. Congratulations. As you
should be all the patient.
PT: Thank you dr.Smith for the information this help me very much!
MD: With pleasure. I expect you next week.
PT : I will certainly. Good bye and have a nice day.
MD: Good bye and you too.
Implantology

Main article: Dental implant

Currently, implants are almost all made of titanium. The most
commonly used are of the endosteal types; in most cases they are
left submerged under the gum for a time period depending on their
position. Dental implantology is subdivided in endosteal and
justaosteal. This last one utilizes only grid shaped implants with an
exposed fixed head. Depending on how they are loaded, they may be
made of chrome-cobalt-molybdenum if they are not destined for
osteointegration, or they may be made of titanium and inserted with
appropriate surgical techniques to favor the formation of bone above
their structure.
Endosteal implantology is much more widespread, uses cylinder or
cone-shaped implants, more or less threaded on the outside and with
variously shaped internal connections to support emerging
abutments. Less frequently, implants are cylinders or cones without
external threads, but with similar internal connections to support
abutments, or screws with emerging heads machined as single
pieces, therefore without any connections, or blades, or needles.
Based on surgical protocol, we may have submerged or
transmucosal implantology. Based on the time of use we may have
immediate, early or deferred load.
Endosteal implantology is basically subdivided into two important
schools: the Italian school and the Swedish school. Italian school
implantology historically preceded the Swedish school, is less
widespread, but conceptually just as important as the Swedish one.
The Italian school introduced the first implant specifically designed for
immediate load, titanium for implant fabrication (Stefano M.
Tramonte), the concept of biological space around implant bodies,
and the intraoral welder (PL. Mondani).
The Swedish school introduced the osteointegration method, first
developed by Invar Branemark, based on deferred load and aiming at
making the implantological surgery more predictable. It utilizes
endosteal, screw shaped implants with prosthetic connection,
deferred load, which imposes a waiting time of 3 to 4 months in the
mandible and 5 to 6 months in the maxilla. The original Branemark
protocol and the implants utilized have been modified in various ways
to shorten implant waiting times, and, in general, treatment times.
The Swedish school has introduced very important innovations in
production and surgical techniques: surface treatments for implant
surfaces, tissue regeneration techniques for bone and mucosa,
vertical and horizontal augmentation techniques. In general, the
Swedish school has introduced surgical techniques aimed at making
implant sites more adequate for the placement of their implants,
because, by their very nature, they are less adaptable to anatomical
conditions than the Italian school implants.
The material most frequently used for implant production is titanium,
in commercially pure form or in its dental alloys. This is a
biocompatible material that does not elicit any reaction from patient’s
tissues (commonly known as rejection). Implants, positioned in the
patient’s bone, are strongly incorporated in it by physiological bone
regeneration actions, bringing to osteointegration, both in the case of
deferred load (Swedish school) and in the case of immediate load
(Italian school). History
The history of the beginning of implantology is lost far back in time,
and we do not know exactly when the idea of inserting an artificial
tooth in a socket first started. We only know for sure that it was done.
We have very interesting ancient archaeological findings displaying
insertions of pieces of carved shells, minerals or bones. In more
recent times, in the 19th century, the attempts to realize
implantological surgeries multiplied, but where inevitably stifled by
inadequate materials, primitive surgical techniques and anesthetics,
the absence of antibiotics, the total ignorance of occlusal principles.
In the first half of the 20th century we witness a great variety of
attempts that are definitely more concrete, and the registration of
numerous patents. We should remember the patent by Adams in
1938 regarding the first submerged implant, very similar to the
subsequent one by Branemark, and the experiments by Formiggini,
considered as the father of modern implantology (1947). In 1961 the
first implant specifically designed for immediate load was produced
(Tramonte), presenting a biological space, and 1964 saw the
introduction of titanium in implantology (Tramonte). In the years 60s
and 70s important histological studies where made by Pasqualini. In
1972 Garbaccio formulated the theory of bicorticalism and designed
the related implant. In 1975 Mondani designed the intraoral welder
(syncrystallizer), and at the end of the 70s the Branemark submerged
implant became more frequently used, solving some of the prosthetic
issues presented by immediate load implants. From then on,
submerged implantology became widespread, thanks to its ease of
use by inexperienced implantologists. Submerged implants
multiplied, and were modified at a very rapid pace, in the attempt of
correcting the few chronic shortcomings affecting them, in spite of
their great success.
Reconstructive surgery was developed at the same time, to solve
many of the bone problems greatly limiting the use of submerged
implants. Modern implantology, with immediate or deferred load, is a
well tested and reliable discipline, capable of solving almost all
edentulism problems, both functional and aesthetic.
Types
Osteointegration and fibrous integration
With our current knowledge, we attribute to the word osteointegration
the meaning of union between bone and implant which remains
stable under load, and guarantees chewing functionality without
clinical signs or symptoms. We call fibrous integration a partial failure
that allows the implant suffering it to function for a few years with a
progressive loss of stability and increase of related issues (pain on
pressure, soft tissue inflammation, etc.)
Implants can have different shapes: cylindrical body and prosthetic
connection, threaded cylinder, conical, threaded conical, single piece
without prosthetic connection, blade, needle, net. These last ones are
much less used because of their inherent difficulty, but they adequate
to solve particularly difficult situations where bone reconstruction
techniques cannot be used.
Endosteal implants using deferred load protocols are the most commonly
used, the most thoroughly clinically tested and the most verified with
international protocols published on the most important scientific journals.
However all implants osseointegrate, provided they are made of titanium.
The word “osseointegrated” referred to the surgical technique in the past,
to distinguish the deferred load the protocol producing osteointegration, as
opposed to immediate loading protocol producing fibrous integration,
therefore implant failure, can no longer be used with this meaning. Today
we know that both implant surgeries, performed according to deferred load
protocol and according to immediate loading protocol, result in
osteointegration, provided that titanium implants are used. Titanium
produces that particular union between implant and bone defined as
osteointegration.
Implantology methods
Implantology methods consist mostly of two surgical techniques:

 two stage: the first stage is “submerged”, where the implant is

inserted under the mucosa, which is then sutured. Then, after 2 to
6 months, the mucosa is reopened and an abutment is screwed
on the implant;
  one stage: the implant is inserted, but its head is protruding out
of the mucosa. It is then left to heal (always from two to six
months) by osteointegration, or it can be loaded immediately, with
an appropriate temporary or permanent prosthesis, depending on
the case. Of course, single piece implants are only one stage,
immediate loading implants.

Professional qualifications
Normally, a dentist or a surgeon trained as a dentist is dealing with
dental implants. In Italy the professional specialty of “Implantologist”
does not exist. In France, for instance, there is the “University
diploma of surgery and implant prosthesis” (DUCPI), so that a non-
specialized dentist should not position any implants beyond the
maxillary sinus. Pre-prosthetic and pre-implantar surgery, which is
the preparation of the alveolar bone for dental implant and prosthesis
placement, are performed by the dentist, or, in some cases, by a
maxillo-facial surgeon. Since these surgeries are specialized, it is a
good practice to verify that the specialist chosen to perform them is
properly qualified, by checking his/her qualifications in the Italian
national federation website (www.fnomceo.it), or by checking his/her
curriculum studiorum on the order of physicians site of the related
province.
Some European insurance companies demand proof of experience
from the dentist who places implants in order to provide insurance
coverage for the patient and the professional.
Surgery protocols
The “implantologist” and/or surgeon creates a site in the patient’s
bone (corresponding to the new tooth to be placed or replaced), by
using a set of calibrated burs, then inserts an endosteal dental
implant. For the implant to osseointegrate, it is necessary to achieve
a good primary stability, with no mobility or movement limited to a few
microns (according to Brunsky et al.). The bone-implant interface is
of the order of a few millimicron, otherwise the implant does not
support its load and must be removed.
According to some implantologists (Linkow), fibrous integration (a
body defense phenomenon that surrounds the foreign body with a
fibrous capsule) may be acceptable for loading a crown. Technically
the implant has failed and the surgery has not been successful, but,
in some cases, implants with fibrous integration can be functional for
years with full patient satisfaction. However, fibrous integration is a
failure.
Currently, the most commonly used implants are the ones of the
Swedish school, that can be inserted with a deferred load protocol,
with surfaces treated by various technologies, to facilitate the control
of all parameters and the highest degree of implant success
predictability. Generally, functional load with a fixed prosthesis is
applied later, after 3 to 4 months for the mandible, and after 5 to 6
months for the maxilla. In some cases, but not all, it is possible to
immediately load the implants, but to be able to do it some basic
criteria must be followed:

 the presence of a certain amount of bone,

 primary stability of the implants after placement,
 good gingival support,
 absence of bruxism (teeth grinding) and of serious
malocclusion,
 presence of a good occlusal balance (a correct occlusal plane).

Clearly, a serious specialistic evaluation is also necessary, to

examine the coexistence of all these factors, otherwise the choice
should fall on a traditional technique (of a submerged or non-
submerged type), using implants that require a longer, but safer
waiting time before the application of a functional load.
Italian school immediately loading implants, and the related surgical
techniques, give success percentages comparable to the ones
obtained with deferred loading, but involve a longer learning curve
and require greater experience. However, this system allows the
patient to have fixed temporary teeth at the end of the implant
surgery session even in cases where a deferred load would have
been necessary with Swedish school implants.
Implants have an almost unlimited lifetime (the longest studies span
25 years), if daily maintenance is performed. The greatest risks for
implants are:

 immediately after placement peri-implantitis can set in; this is

an inflammation and infection of the structures surrounding the
implant, followed by failed osteointegration
 incorrect load of the implants, with incorrect crowns or
prostheses, that can create bone resorption in time, with bone loss
reaching the deepest implant threads, possibly causing implant
loss. In order to avoid such implant failures, it is necessary to build
good fixed or removable prostheses, with well balanced occlusion,
to maintain a good daily hygiene, and undergo regular checkups.

Also, it must be pointed out that smoking and diabetes can

compromise osteointegration and implant duration. Implants can
replace a single tooth by placing a crown over an implant, a group of
contiguous teeth (bridge on implants), a full arch, or they may be
used to stabilize an upper or lower overdenture.
Implant success criteria

 Absence of persistent pain at implant site

 Absence of recurring infection
 Absence of implant mobility
 Absence of radiolucency around the implant

References
Bibliography

 Clinica Implantoprotesica di Ugo Pasqualini, Marco Pasqualini,

Ariesdue, 2008,
 Insuccessi in implantologia: definizioni, cause, classificazione,
terapia, aspetti medico-legali. Odontoiatria pratica, di Antonio
Pierazzini, UTET, 2001.
 Il successo in implantologia, di Enrico G. Bartolucci, C.
Mangano, Masson, 2004.
 Osseointegrazione clinica: i principi di Brånemark, di Gian
Antonio Favero, Masson, 1994.
 Annali di Stomatologia - Su alcuni casi particolarmente
interessanti di impianto endosseo con vite autofilettante - Vol XV -
Aprile 1966
 Taste Disorders

How common are taste disorders?

Many of us take our sense of taste for granted, but a taste disorder can have
a negative effect on a person's health and quality of life. If you are having a
problem with your sense of taste, you are not alone. More than 200,000
people visit a doctor each year for problems with their chemical senses,
which include taste and smell.

The senses of taste and smell are very closely related. Some people who go
to the doctor because they think they have lost their sense of taste are
surprised to learn that they have a smell disorder instead.

How does our sense of taste work?

Our ability to taste occurs when tiny molecules released by chewing,

drinking, or digesting our food stimulates special sensory cells in the mouth
and throat. These taste cells, or gustatory cells, are clustered within the
taste buds of the tongue and roof of the mouth, and along the lining of the
throat. Many of the small bumps on the tip of your tongue contain taste
buds. At birth, we have about 10,000 taste buds, but after age 50, we may
start to lose them.

When the taste cells are stimulated, they send messages through three
specialized taste nerves to the brain, where specific tastes are identified.
Each taste cell expresses a receptor, which responds to one of at least five
basic taste qualities: sweet, sour, bitter, salty, and umami. Umami, or
savory, is the taste we get from glutamate, which is found in chicken broth,
meat extracts, and some cheeses. A common misconception is that taste cells
that respond to different tastes are found in separate regions of the tongue.
In humans, the different types of taste cells are scattered throughout the
tongue.

Taste quality is just one aspect of how we experience a certain food.

Another chemosensory mechanism, called the common chemical sense,
involves thousands of nerve endings, especially on the moist surfaces of the
eyes, nose, mouth, and throat. These nerve endings give rise to sensations
such as the coolness of mint and the burning or irritation of chili peppers.
Other specialized nerves give rise to the sensations of heat, cold, and
texture. When we eat, the sensations from the five taste qualities, together
with the sensations from the common chemical sense and the sensations of
heat, cold, and texture, combine with a food's aroma to produce a
perception of flavor. It is flavor that lets us know whether we are eating a
pear or an apple.

Many people who think they have a taste disorder actually have a problem
with smell. When we chew, aromas are released that activate our sense of
smell by way of a special channel that connects the roof of the throat to the
nose. If this channel is blocked, such as when our noses are stuffed up by a
cold or flu, odors cannot reach sensory cells in the nose that are stimulated
by smells. As a result, much of our enjoyment of flavor is lost. Without smell,
foods tend to taste bland and have no flavor.

http://www.medicinenet.com/taste_disorders/article.htm

Exercices:

1. Read the second paragraph and translate it

2. Complete the text below with the following words:

Stimulated, tastes, receptor, Umami, glutamate, misconception, scattered

When the taste cells are…, they send messages through three specialized
taste nerves to the brain, where specific … are identified. Each taste cell
expresses a … , which responds to one of at least five basic taste qualities:
sweet, sour, bitter, salty, and umami. … , or savory, is the taste we get from
… , which is found in chicken broth, meat extracts, and some cheeses. A
common … is that taste cells that respond to different tastes are found in
separate regions of the tongue. In humans, the different types of taste cells
are … throughout the tongue.

3. Imagine a dialog between a dentist and a pacient about „ What are

the taste disorders?”. 10 to 20 lines
4. Use this 4 words in one sentence: sweet, sour, bitter, salty.
 5. Choose the right word:
Aspect, chemosensory, sensations, irritation, texture, chemical, food's,
know

Taste quality is just one … of how we experience a certain food. Another …

mechanism, called the common chemical sense, involves thousands of nerve
endings, especially on the moist surfaces of the eyes, nose, mouth, and
throat. These nerve endings give rise to … such as the coolness of mint and
the burning or … of chili peppers. Other specialized nerves give rise to the
sensations of heat, cold, and … . When we eat, the sensations from the five
taste qualities, together with the sensations from the common … sense and
the sensations of heat, cold, and texture, combine with a … aroma to
produce a perception of flavor. It is flavor that lets us … whether we are
eating a pear or an apple.

6. Put the word in the wright time and form to complete the text below:

Many people who … they have a taste disorder actually have a problem with
smell. When we chew, aromas are released that … our sense of smell by way
of a special channel that connects the roof of the throat to the nose. If this
channel is… , such as when our noses are stuffed up by a cold or flu, odors
cannot reach sensory cells in the nose that are … by smells. As a result,
much of our enjoyment of flavor is lost. Without smell, foods tend to taste
bland and have no flavor.

Words: think, activate, block, stimulate.

7. Write you’re opinion about „Why are the taste important?” (5 to 10

lines)
8. Choose the best answer in order to complete the following sentences:
When the taste cells are ... , they send messages through three
specialized taste nerves to the brain, where specific tastes are identified.
a. stimulate
b. stimulated
As a result, much of our enjoyment of flavor ... .
a. is lost
b. are lost

More than 200,000 people … a doctor each year for problems with
their chemical senses, which include taste and smell.
 a. visited
b. visit

9. Write the correct word (from the list on the right) to describe each
picture:

sweet, sour, bitter, salty

10. Compose a text of 10-15 lines about “The senses of taste”.