system reacts to upsetting information while you are eating, your digestive system may not function as well

as usual.
Legal and Ethical Implications
Oral health is a necessary component for overall general health. New research is pointing to associations between
chronic oral infection and heart and lung disease, stroke, low birth weight, and premature birth. An association has
been recognized between periodontal disease and diabetes. An individual cannot be healthy without oral health. Oral
health and general health are not separate entities. Risk factors that affect general health, such as tobacco use and
poor nutrition, also affect oral health.
In this country today, inequities and disparities may prevent people from achieving optimal oral health. Barriers to
oral health include lack of access to care, whether because of limited income or lack of insurance, transportation
difficulties, and lack of flexibility to take time off from work to see a dentist. Individuals with disabilities and those
with complex health problems may face additional barriers to care. Many challenges remain for eliminating social,
political, and economic barriers to oral health and general well-being.
Eye to the Future
As a dental assistant, you need a strong foundation in anatomy and physiology. This information can help you both
personally and professionally. For example, it is important for you to understand how the muscular system works, so
you can protect the muscles in your neck and back from fatigue and strain while assisting during long procedures.
Also, you will see patients with muscular problems who will need your understanding and assistance.
You will be better prepared to assist during a medical emergency in the dental office when you understand the
circulatory and respiratory systems. Prescription medications may adversely affect a patient’s dental treatment. You
should be alert for signs and symptoms of various systemic disorders in yourself and in your family members, as
well as in your patients.
Critical Thinking
1. The respiratory system is exposed to the atmosphere and is susceptible to airborne infection, contaminants, and
irritants. What can you do to protect your respiratory system?
2. If a patient with severe arthritis in her hands came into your dental office, what dental treatment–related
difficultiesmicroorganisms from a person’s dental plaque (Fig. 13.1). The relationship of oral biofilm and
periodontal disease is discussed in Chapter 55. If toothbrushing and flossing are not thorough, the oral biofilm
remains attached to the oral surfaces. Even self-cleansing movements of the tongue or rinsing and spraying of the
mouth with water or even mouthwash will not dislodge the biofilm.
If you were to look at biofilm under a microscope, you would see colonies of bacteria embedded in an adhesive
substance called the pellicle. Formation of plaque on a tooth concentrates millions of microorganisms on that tooth.
A milligram of wet plaque may contain as many as 200 to 500 million microorganisms. A similar amount of saliva
flowing through the oral cavity contains less than 1% of this number of organisms, so it is clear that bacteria in
plaque attached to the tooth are a major part of the problem.
Enamel Structure
To gain an understanding of how bacterial infection leads to the caries process, it is important to review the structure
of enamel. Enamel is the most highly mineralized tissue in the body, and it is stronger than bone. Refer to Chapter 8
for an in-depth discussion of the structure of enamel.
Enamel consists of microscopic crystals of hydroxyapatite arranged in structural layers or rods, also known as
prisms. These crystals are surrounded by water, and primary teeth are made up of slightly more water than are
permanent teeth. The water in enamel allows acids to flow into the tooth and minerals to flow out of the tooth.
Carbonated apatite, a mineral in enamel, makes it easier for the tooth structure to dissolve.
RECALL
3. What is the soft, sticky bacterial mass that adheres to the teeth?
4. What is the mineral in the enamel that makes the tooth structure