HERPES SIMPLEX INFECTION

It is also called ” cold sore” , “fever blister”. It occurs in patients with no prior infection with HSV-I.

TRANSMISSION:

* Close contact- it occurs during personal close contact, in which exchange of saliva or other secretion happened.

* Newborn infection- primary infection of newborn is believed to be caused by vaginal secretions during birth, which results in viremia and disseminated infection of brain, liver, adrenals and lungs.

* Socioeconomic status- incidence varies according to socioeconomic groups. Person who is having lower economic status will have earlier exposure.

CLINICAL FEATURES:

*Age- it develops in both, children and young adults. It can be seen in high school and college students where it is transmitted by kissing and sexual contact.

*Incubation period- 5-7 days.

*Symptoms- fever, headache, malaise, nausea, vomiting, and within a few days mouth becomes painful. There is also irritability, pain upon swallowing and regional lymphadenopathy.

*Location- the lesion mainly occurs on the hard palate, attached gingiva and dorsum of the tongue. In some cases lesion may be presented on the skin.

*Appearance- small vesicles which are thin walled surrounded by inflammatory base are formed they quickly rupture leaving small, shallow, oval shaped discrete ulcers.

*Size- the individual ulcers differs in size form 2-6mm. As the disease progresses, several lesion may coalesce, forming larger, irregular lesions.

*Base- the base of the ulcer is covered with grayish white or yellow plaque.

*Healing- the disease is self limiting and lesion begin healing in a week to 10 days and leave no scar.

HERPES SIMPLEX INFECTION IN ADULTS:

it is seen in patients who do not acquire HSV infection and immunity during childhood. In such cases, primary herpes simplex infection is often acquired via new sexual partner and primary HSV gingivostomatitis and pharyngitis can occur. It usually occurs due to HSV-I.

MANAGEMENT:

*Pain control measures- topical anesthetics like 2% lidocaine, 0.1% diclonine hydrochloride, 0.5% benzocaine hydrochloride are used.

*Topical anti infective agents- it is given to prevent secondary infection. Agents used are 0.2% chlorhexidine gluconate, tetracycline mouth wash and elixir or diphenylhydramine.

*Supportive care- fluid is given to maintain proper hydration and electrolyte balance. Antipyretics can also be given to control the fever.

*Good oral hygiene- oral hygiene should be properly maintained to avoid any secondary infection.

*Acyclovir- inhibits DNA replication in HSV infected cells reducing the duration of illness. The optimum oral dosage of Acyclovir is 1000-1600mg daily for 7-10 days.

*Valacyclovir- it is prodrug of acyclovir and it has far better biocompatibility as compared to acyclovir. It should be used in combination with famciclovir.

 

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LE-FORT FRACTURES

Introduction

Le Fort fractures account for 10-20% of all facial fractures. They result from exposure to a considerable amount of force. Motor vehicle accidents are the predominant cause; other causes include assaults and falls. With seatbelt laws and the increased use of airbags by auto manufacturers, the overall incidence of midface fractures has decreased.

 

Globally, the epidemiologies of midface fractures are similar. Young males are the typical patients, with motor vehicle accidents and assaults being the most common overall causes of facial and midfacial trauma. Male patients with midface fractures outnumber female patients with midface fractures by 5 to 1. Typically, these fractures affect younger males.

The incidence of midface fractures is far lower in children than in adults, owing to anatomic differences and the overall elasticity of children’s tissues.1,2,3

In a study from United Arab Emirates, the average age of patients with facial fractures was 26.5 years.4The majority of patients (83%) were males. The most common cause was motor vehicle accidents (59%), followed by falls (21%). Of all the patients with facial fractures, 33% had isolated midface fractures, and 14% had a combination of midface fracture and mandibular fracture.

In a study from China, 78.6% of midface fractures occurred in males; motor vehicle accidents were the leading cause (33%), followed by assaults (25%).

In a study by Motamedi from Iran, 89% of maxillofacial trauma patients were male.5Motor vehicle accidents were the number one cause (31%), followed by assaults (10%). Le Fort II fractures were the most common (55%), followed by Le Fort I fractures (24%) and Le Fort III fractures (12%).

In a Turkish study on maxillofacial trauma by Aksoy et al, 83% of fractures occurred in males.6The most common causes of facial fracture were motor vehicle accidents (90%) and assaults (3%).
Presentation

Because of the degree of force required to produce midface fractures, such injuries are often associated with a high incidence of serious intracranial and ophthalmologic injury. Le Fort fractures are often comminuted and are often associated with frontal or mandible fractures.

Because of the accompanying injuries to the entire body, the standard trauma protocol of ABCs must be strictly followed before any intervention. Often, the midface fracture is of less immediate concern because of the severity of intracranial injury and associated bodily injuries. Because about one half of midface fractures are associated with significant cerebral edema and a low Glasgow Coma Scale score (<5), and because such patients have a poor prognosis, it is important to understand the goals of the family and the other medical teams involved in the care of the trauma patient.

First of all, it is important to evaluate the airway early to rule out intraoral hemorrhage, edema, loose teeth, and posteroinferior displacement of the maxilla. Establishment of a safe airway is a priority; a tracheostomy may be needed if intubation proves to be impossible or unsafe for the patient.

Bleeding may complicate midface fractures. If the bleeding is severe enough, packing of the midface vessels and temporary reduction of the fracture may be necessary. Angiography may be necessary to locate arterial bleeding from the internal maxillary before embolization.

Obvious clinical signs of facial skeleton compromise include malocclusion, subcutaneous emphysema, abnormally mobile skeletal structures, and palpable step-offs. Crepitus may be a result of paranasal sinus air leaking into the soft tissues of the face. Palpable step-offs are seen especially with zygomatic fractures. Associated facial fractures must be evaluated and ruled out.

The patient’s visual status, before and after traumatic insult, is vital in the treatment algorithm of midface fracture. There is a high incidence of visual problems associated with midface fractures, including enophthalmos, diplopia, entrapment, and epiphora. Epiphora occurs in 4% of Le Fort II or III fractures.

CSF leakage is also seen, especially in Le Fort III fractures. Any persistent, clear rhinorrhea should be tested appropriately for CSF fluid leak. Patients may complain of paresthesias of the upper jaw because of damage to the superior alveolar nerve.

As with all facial fractures, it is important to assess malocclusion. Patients may present with trismus and mouth pain. Palatal fractures often include a lip laceration and/or lacerations of the gingival and palatal mucosa. Patients with a palatal fracture may have an anterior open-bite deformity.

Facial edema may obscure the facial examination, and step-offs may not be palpable. It is important to assess fracture mobility by palpating the anterior maxilla between the thumb and forefinger. Motion at the level of the anterior nasal spine without simultaneous motion is a sign of a Le Fort I fracture. Le Fort I fractures may be associated with gingival crepitation.

Le Fort II fractures result in motion of the nasal pyramid along the medial orbit rims. The patient may have midface flattening and elongation. Le Fort II fractures often are associated with infraorbital paresthesias.

In Le Fort III fractures, motion is seen at the zygomaticofrontal suture (craniofacial dysjunction). The patient may have anosmia resulting from fracture at the cribriform plate, as well as severe edema, or lengthening; this is known as a dish-face deformity. This is a result of the lack of sagittal projection from the face, causing it to lose its contours and look spherical.

Midface fractures are usually not confused with other phenomena. The main concern is whether associated fractures are present. Examples include nasoethmoidal and orbitozygomatic fractures. These associated fractures are typically evident on examination or CT scanning A history of trauma to the face and proper suspicion of imaging results should lead to the proper diagnosis.7,8

Denture wearers typically have additional protection from midface fracture. However, when fractures do occur, unusual fracture patterns are common.

Lack of repair of the overlying soft tissue may result in descent and diastasis of the soft tissue of the face, leaving a flat or depressed area of the face.

Hypesthesia of the infraorbital nerve is a common complaint. The infraorbital nerve is entirely sensory. If a neuroma develops or if the patient’s pain becomes intolerable, resection of the nerve may be required

Malocclusion is a common complaint. Molar occlusion is based on the angle classification of the first maxillary molar in relationship with its corresponding mandibular molar. When malocclusion occurs, additional osteotomies or orthognathic work may be required.

Infection of the bone is always a concern. Any fracture with mucosal involvement of the nose, sinus, or mouth should be considered a compound fracture. These should be treated with the appropriate antibiotic coverage to prevent further complication.
Le Fort classification system

Rene Le Fort described the classic patterns of fracture in his 1901 work. Le Fort’s experiments consisted of dropping cadaver skulls from several stories or striking them with a wooden club. He found 3 distinct fracture patterns, which he termed the linea minoros resistentiae. Simply stated, in the Le Fort I fracture, the palate is separated from the maxilla; in the Le Fort II fracture, the maxilla separates from the face; and in the Le Fort III fracture, craniofacial dysjunction is present.

 

 

The Le Fort I fracture is a low transverse fracture that crosses the floor of the nose, pyriform aperture, canine fossa, and lateral wall from the maxilla, resulting in separation of the palate from the maxilla.

The Le Fort II fracture crosses the nasal bones on the ascending process of the maxilla and lacrimal bone and crosses the orbital rim. Only the Le Fort II fracture violates the orbital rim. Because of this proximity to the infraorbital foramen, type II fractures are associated with the highest incidence of infraorbital nerve hypesthesias. The Le Fort II fracture extends posteriorly to the pterygoid plates at the base of the skull. A Le Fort I fracture is characterized by a low septal fracture, whereas a Le Fort II fracture results in a high septal fracture.

Finally, the Le Fort III fracture traverses the frontal process of the maxilla, the lacrimal bone, the lamina papyracea, and the orbital floor. This fracture often involves the posterior plate of the ethmoid. Because of their location, Le Fort III fractures are associated with the highest rate of cerebrospinal fluid (CSF) leaks.9,10,11

Shortcomings of the Le Fort classification system

Despite its shortcomings, the Le Fort fracture classification system is still the most accepted method of classifying fractures and the location of osteotomies of the midface. However, recent studies have demonstrated that this classification system may be imprecise.

The Le Fort fracture system is deficient in addressing most midface fractures because most midface fractures do not follow the simple Le Fort pattern of fracture; rather, a combination of Le Fort fractures is usually encountered. In addition, most midface fractures have some degree of comminution and are complicated by fractures and displacement not addressed in the Le Fort system. These midface fractures include palate, medial maxillary arch, dentoalveolar, and anterior maxillary fractures.

Other classification systems

Sagittal fractures of the palate occur in as many as 25% of all patients with fractures of the midface. They are not classified in typical Le Fort fracture terminology. However, Rene Le Fort did describe traumatic injuries to the palate in his series of papers on maxillary fractures. Palatal fractures were classified by Hendrickson et al, who described 6 types of palatal fractures, including the following: I, anterior and posterolateral alveolar; II, sagittal; III, parasagittal; IV, para-alveolar; V, complex; and VI, transverse. Palatal fractures are associated with Le Fort I fractures 100% of the time and with either Le Fort II/III or mandible fractures 50% of the time.

There are many other classification systems for describing midface fractures. In the system of Donat et al, the face is divided into a matrix of vertical and horizontal beams, creating a lattice of 11 unilateral and 22 bilateral sites; this lattice is used to describe midface fractures.12According to their preliminary data in 87 patients with midface fractures, this scheme enabled accurate transcription and communication among physicians 98% of the time.

Another classification system is the Wassmund system. This system classifies fractures into grades I-V. A Wassmund I fracture is equivalent to a Le Fort II fracture. A Wassmund IV fracture is equivalent to a Le Fort III fracture. A Wassmund III fracture is characterized as a Le Fort III fracture without inclusion of the nasal bones.

Manson described a facial fracture classification system on the basis of CT findings.13He divided fractures into low- and high-impact fractures. His schema is described further in the CT scan section below.


Anatomy and natural history

The maxilla has 4 processes: zygomatic, frontal, palatine, and alveolar. The maxillary sinus is housed within the maxilla and varies in size, depending on the degree of pneumatization.

The midface can be thought of as a grid of horizontal and vertical buttresses that provide support for the face. The 3 paired vertical buttresses of the midface are the nasomaxillary, zygomaticomaxillary, and pterygomaxillary structures. The nasomaxillary buttress is formed by the lower maxilla, the frontal process of the maxilla, the lacrimal bone, and the nasal process of the frontal bone. The zygomaticomaxillary buttress is formed from the lateral portion of the maxilla, zygoma, and lateral portion of the frontal bone. The final buttress extends along the pterygoid plates to the skull base. The lone unpaired, vertical support mechanism is the nasal septum/ethmoid complex.

The horizontal buttresses are composed of the alveolus, the hard palate, the inferior orbital rim, and the frontal bar. Horizontal buttresses have coronal and sagittal components. The sagittal buttresses are vital for facial projection. The midface is relatively deficient in sagittal buttresses. The skull base is at a 45° angle relative to the occlusal plane of the maxilla and may act as an axial buttress as well.

Nahum revealed that low forces may create a fracture in the midface. This is partly the result of the presence of the large, air-filled sinus cavities. Therefore, the midface acts as a shock absorber. The midface is relatively resistant to vertically oriented forces (anteroposterior [AP] direction). The lateral forces may fracture the obliquely directed force vectors.

The fractures may be of significant functional and aesthetic importance. Functional problems may lead to disorders of occlusion, nasal obstruction, and trigeminal-nerve sensation. Aesthetic losses include decreased midface height, facial width, facial projection, and malar eminence. These losses may lead to a dish-face deformity.14
Treatment

All patients with midface fractures are given antibiotics, because these fractures are considered open or compound. Violation of the paranasal sinus or alveolus and open soft tissue wounds are inevitable sequelae of midface fractures. Antibiotics have been shown to decrease the incidence of infection after midface fractures.

Typically, the earlier the repair of a midface fracture, the better the surgical result. This creates a dilemma for the midface reconstructive surgeon in that most patients with a midface fracture also have serious bodily injury. On the other hand, early repair prevents soft tissue scarring and memory from insetting, as well as fibrous malunion between the bony fragments.

A long surgical procedure in a terminal patient is not desirable for the patient, the patient’s family, or the surgeon. Also, an additional procedure in a patient who is in unstable condition may not be in the patient’s best interests. Piotrowski and Brandt have elucidated some parameters for reconstructive surgeons to allow for safe early repair. If the intracranial pressure is less than 15 mm Hg, midface repair—early, intermediate, or late—does not negatively affect the patient’s recovery.

The radiologist and the reconstructive surgeon must communicate about the specific location of the fracture. Exposure is crucial in repair of the midface fracture. Generally speaking, a Le Fort I fracture is approached from a sublabial exposure; a Le Fort II fracture is approached with a combination of sublabial and periorbital exposure; and a Le Fort III fracture requires a combination of sublabial and bicoronal fracture for adequate exposure.

The surgical approaches to fractures of the midface have changed radically in the past 20 years. The technology has now evolved to allow for miniplate fixation to the midface instead of bulky external hardware. Complex internal wiring was the standard of care 10 years ago, but because of poor cosmetic results and extended periods of IMF, newer technologies have replaced it. Miniplate technology involves the placement of strong titanium plates to bridge the fractured areas. The principle is similar to that of bridge making: Stable areas are fixed to unstable areas until the overall stability of the area has been secured. If large deficiencies are present, bone grafting may be necessary.

For fractures involving large, displaced segments, the displaced segment may need to be pulled forward with a hook or index finger. If the fracture is impacted into adjacent bone and is immobile, a Rowe forceps may be useful. Nondisplaced midface fractures require little intervention. Usually, a short period of IMF is all that is needed. With any displacement, an open approach is typically required. A variety of midface fractures may be addressed effectively with a closed technique. Patients with nondisplaced, noncomminuted fractures are ideal candidates for a closed approach.15,16,17,18,19,20

Repair in pediatric patients is a controversial area. Midface fractures are relatively rare in children because of their flexible skeleton, underdeveloped sinuses, unerupted dentition, and proportionally large frontal bone and mandible. Unerupted dentition results in several challenges for the surgeon.

The use of rigid fixation remains debatable. Animal experiments have shown that rigid fixation can lead to growth abnormalities. Some additional concerns are that an injury to the eyes or brain may happen due to slow movement of the plates. The counter-argument is that not treating the bony injury can lead to significant permanent deformities.

TOP 10 CORRUPTION SCAMS IN INDIA

This is the season of scams and the biggest ever corruption cases in India have been unearthed more recently. So, we decided to dig deep to see which scams were the biggest and most damaging to the country and its citizens alike.

In our daily life, most of us must have been a witness to or a victim of the corruption thriving in some or the other part of the country. It could be in the form of a taxi-driver manipulating the meter to jack-up the reading or a government officer taking bribery to promptly transfer your file to the next department or even yourself offering bribe to a traffic police on breaking a signal.

An average Indian citizen is hard working and diligent, but it is the people in charge of the system (The Babu’s) or with whom the power lays, that act as a cancer spreading the venom, slowing down progress and what all not. But, somewhere down the line, we ourselves are responsible for allowing and being taken for a ride by these people, aren’t we?

However, it is during a multi-thousand crore scam, that a tax-payer actually realizes the heartburn of being cheated from his valued contribution of funds towards the development and well-being of the nation. But, that’s what a scam, be it big or small, means – the act of swindling by some fraudulent scheme or action.

The Top Scams in India

1) 2G Spectrum Scam

We have had a number of scams in India; but none bigger than the scam involving the process of allocating unified access service licenses. At the heart of this Rs.1.76-lakh crore worth of scam is the former Telecom minister A Raja – who according to the CAG, has evaded norms at every level as he carried out the dubious 2G license awards in 2008 at a throw-away price which were pegged at 2001 prices.

2) Commonwealth Games Scam

Another feather in the cap of Indian scandal list is Commonwealth Games loot. Yes, literally a loot! Even before the long awaited sporting bonanza could see the day of light, the grand event was soaked in the allegations of corruption. It is estimated that out of Rs. 70000 crore spent on the Games, only half the said amount was spent on Indian sportspersons.

The Central Vigilance Commission, involved in probing the alleged corruption in various Commonwealth Games-related projects, has found discrepancies in tenders – like payment to non-existent parties, will-ful delays in execution of contracts, over-inflated price and bungling in purchase of equipment through tendering – and misappropriation of funds.

3) Telgi Scam

As they say, every scam must have something unique in it to make money out of it in an unscrupulous manner- and Telgi scam had all the suspense and drama that the scandal needed to thrive and be busted.

Abdul Karim Telgi had mastered the art of forgery in printing duplicate stamp papers and sold them to banks and other institutions. The tentacles of the fake stamp and stamp paper case had penetrated 12 states and was estimated at a whooping Rs. 20000 crore plus. The Telgi clearly had a lot of support from government departments that were responsible for the production and sale of high security stamps.

4) Satyam Scam

The scam at Satyam Computer Services is something that will shatter the peace and tranquillity of Indian investors and shareholder community beyond repair. Satyam is the biggest fraud in the corporate history to the tune of Rs. 14000 crore.

The company’s disgraced former chairman Ramalinga Raju kept everyone in the dark for a decade by fudging the books of accounts for several years and inflating revenues and profit figures of Satyam. Finally, the company was taken over by the Tech Mahindra which has done wonderfully well to revive the brand Satyam.

5) Bofors Scam

The Bofors scandal is known as the hallmark of Indian corruption. The Bofors scam was a major corruption scandal in India in the 1980s; when the then PM Rajiv Gandhi and several others including a powerful NRI family named the Hindujas, were accused of receiving kickbacks from Bofors AB for winning a bid to supply India’s 155 mm field howitzer.

The Swedish State Radio had broadcast a startling report about an undercover operation carried out by Bofors, Sweden’s biggest arms manufacturer, whereby $16 million were allegedly paid to members of PM Rajiv Gandhi’s Congress.

Most of all, the Bofors scam had a strong emotional appeal because it was a scam related to the defense services and India’s security interests.

6) The Fodder Scam

If you haven’t heard of Bihar’s fodder scam of 1996, you might still be able to recognize it by the name of “Chara Ghotala ,” as it is popularly known in the vernacular language.

In this corruption scandal worth Rs.900 crore, an unholy nexus was traced involved in fabrication of “vast herds of fictitious livestock” for which fodder, medicine and animal husbandry equipment was supposedly procured.

7) The Hawala Scandal

The Hawala case to the tune of $18 million bribery scandal, which came in the open in 1996, involved payments allegedly received by country’s leading politicians through hawala brokers. From the list of those accused also included Lal Krishna Advani who was then the Leader of Opposition.

Thus, for the first time in Indian politics, it gave a feeling of open loot all around the public, involving all the major political players being accused of having accepted bribes and also alleged connections about payments being channelled to Hizbul Mujahideen militants in Kashmir.

8) IPL Scam

Well, I am running out of time and space over here. The list of scandals in India is just not ending and becoming grave by every decade. Most of us are aware about the recent scam in IPL and embezzlement with respect to bidding for various franchisees. The scandal already claimed the portfolios of two big-wigs in the form of Shashi Tharoor and former IPL chief Lalit Modi.

9,10) Harshad Mehta & Ketan Parekh Stock Market Scam

 

MOUTH CANCER !!!!

Mouth cancer is caused by an uncontrolled growth of cells in the mouth. Mouth cancer includes cancer that starts anywhere in the mouth, including:

  • lips
  • tongue
  • gums
  • floor of the mouth or under the tongue
  • inside the cheeks and lips
  • roof of the mouth (the palate)
  • area behind the wisdom teeth

Types of mouth cancer

Nine out of 10 mouth cancers are squamous cell carcinomas. They develop in the flat, skin-like cells that cover the inside of the mouth. Other, rarer types of mouth cancer include:

  • salivary gland cancer – starts in the salivary gland cells
  • lymphoma – starts in lymph tissue near the base of the tongue and tonsils
  • melanoma – starts in skin pigment cells around the mouth or on the lips

Symptoms of mouth cancer

Most people with mouth cancer have no early symptoms at all, but others may have:

  • an ulcer in the mouth or on the lip that won’t heal
  • constant pain or soreness
  • red or white patches in the mouth
  • a lump on the lip, tongue or in the neck
  • bad breath
  • unexplained bleeding in the mouth
  • numbness in the mouth
  • loose teeth

These symptoms aren’t always caused by mouth cancer but if you have them, visit your GP or dentist.

Causes of mouth cancer

Doctors don’t fully understand why mouth cancer develops. However, certain factors make mouth cancer more likely.

  • Smoking any form of tobacco – cigarettes, cigars and pipes, as well as bidis or hand-rolled cigarettes containing cannabis.
  • Chewing tobacco, such as betel quid, gutkha and paan.
  • Drinking excessive alcohol, especially at the same time as smoking or chewing tobacco.
  • Having already had cancer of the head and neck.
  • Exposure to the sun or UV light – this increases the risk of lip cancer.
  • A weakened immune system – people who have HIV/AIDS, or who are taking medicines that suppress the immune system, are more likely to develop mouth cancer.

Diagnosis of mouth cancer

The earlier mouth cancer is diagnosed, the better the chances of recovery. Your dentist may spot mouth cancer in its early stages during a routine check-up, so it’s important to visit your dentist regularly.

Your doctor or dentist will ask you about any symptoms, and examine you using a small mirror for harder-to-see areas. He or she will feel your neck and face for swellings. You may then be referred to an ear, nose or throat specialist for further tests.

You may have the following tests to confirm diagnosis.

  • Mouth and throat examination – your doctor may use a special instrument called a laryngoscope to look inside your mouth and throat.
  • Biopsy – a sample of cells or tissue is removed and sent to a laboratory for diagnosis.

Staging the cancer

If the biopsy shows that you have cancer, you will have further tests to find out how far it has spread and to help decide the type of treatment you will need. This is called staging the cancer. The tests may include the following.

  • X-rays of the upper and lower jaw (Panorex X-ray), or the chest, or both.
  • Barium swallow – this test involves swallowing a drink containing barium (a substance which shows up on X-rays). The X-rays will show up any unusual growths in the throat.
  • Scans – these may include ultrasound, MRI or CT scans. These are done to check the muscles, organs and tissues in your face, throat and chest.
  • Further biopsies of nearby lymph nodes. Lymph nodes are glands throughout the body that are part of the immune system.

Treatment of mouth cancer

Treatment depends on the type of mouth cancer, where it is and how far it has spread. Your doctor will discuss your treatment options with you. There are three main treatments for mouth cancer.

Surgery

Surgery (including the use of lasers) involves removing just the affected tissue. How much surgery is needed depends on how much tissue is affected. Surgery is sometimes followed by chemotherapy or radiotherapy treatment to make sure all the cancer cells are destroyed.

Non-surgical treatments

  • Radiotherapy – radiation is used to kill cancer cells.
  • Chemotherapy – anti-cancer drugs are used to destroy cancer cells. They are usually injected into a vein but sometimes may be given as tablets.
  • Biological therapy – special manufactured monoclonal antibodies (cetuximab) are used to block areas on the surface of cancer cells that can trigger growth. Radiotherapy is then used to destroy the cancer cells. Cetuximab is a new treatment and is approved for use only in advanced squamous cell cancer of the head and neck.

Prevention of mouth cancer

Simple lifestyle changes can reduce your risk of mouth cancer.

  • Visit your dentist for regular check-ups.
  • Look for any changes in your mouth such as, sore patches or ulcers that don’t heal and report them to your GP.
  • Don’t smoke.
  • Don’t chew tobacco.
  • Drink only in moderation.
  • Eat a healthy diet with at least five portions of fruit and vegetables a day.
  • Protect your skin from sunlight and other UV exposure such as sunbeds. Wear sunblock on your lips, stay out of the sun between 11am and 3pm and wear a wide-brimmed hat to protect your face.

ROOT CANAL TREATMENT !!

Root canal treatment

Definition

Root canal treatment, also known as endodontic treatment, is a dental procedure in which the diseased or damaged pulp (central core) of a tooth is removed and the inside areas (the pulp chamber and root canals) are filled and sealed.

Purpose

An inflamed or infected pulp is called pulpitis. It is the most common cause of a toothache. To relieve the pain and prevent further complications, the tooth may be extracted (surgically removed) or saved by root canal treatment.

Demographics

Root canal treatment has become a common dental procedure. According to the American Association of Endodontists, more than 14 million root canal treatments are performed every year, with a 95% success rate.

Description

Inside the tooth, the pulp of a tooth is comprised of soft tissue that contains the blood supply, by which the tooth receives its nutrients; and the nerve, by which the tooth senses hot and cold. This tissue is vulnerable to damage from deep dental decay, accidental injury, tooth fracture, or trauma from repeated dental procedures such as multiple fillings or restorations over time. If a tooth becomes diseased or injured, bacteria may build up inside the pulp, spreading infection from the natural crown of the tooth to the root tips in the jawbone. Pus accumulating at the ends of the roots can form a painful abscess that can damage the bone supporting the teeth. Such an infection may produce pain that is severe, constant, or throbbing. It can also result in prolonged sensitivity to heat or cold, swelling, and tenderness in the surrounding gums, facial swelling, or discoloration of the tooth. In some cases, however, the pulp may die so gradually that there is little noticeable pain.

Root canal treatment is performed under local anesthesia. A thin sheet of rubber, called a rubber dam, is placed in the mouth and around the base of the tooth to isolate the tooth and help to keep the operative field dry. The dentist removes any tooth decay and makes an opening through the natural crown of the tooth into the pulp chamber. Creating this access also relieves the pressure inside the tooth and can dramatically ease pain.

The dentist determines the length of the root canals, usually with a series of x rays. Small wire-like files are then used to clean the entire canal space of diseased pulp tissue and bacteria. The debris is flushed out with large amounts of water (irrigation). The canals are also slightly enlarged and shaped to receive an inert (non-reactive) filling material called gutta percha. However, the tooth is not filled and permanently sealed until it is completely free of active infection. The dentist may place a temporary seal, or leave the tooth open to drain, and prescribe an antibiotic to counter any spread of infection from the tooth. This is why root canal treatment may require several visits to the dentist.

Once the canals are completely clean, they are filled with gutta percha and a sealer cement to prevent bacteria from entering the tooth in the future. A metal post may be placed in the pulp chamber for added structural support

During a root canal, the diseased pulp of a tooth (A), is removed (B). The remaining empty tooth is filled and sealed with a filling or crown. (

Illustration by GGS Inc.

)

port and better retention of the crown restoration. The tooth is protected by a temporary filling or crown until a permanent restoration may be made. This restoration is usually a gold or porcelain crown, although it may be a gold inlay, or an amalgam or composite filling (paste fillings that harden).

Diagnosis/Preparation

Signs that a root canal treatment is necessary include severe pain while chewing, prolonged sensitivity to heat or cold, or a darkening of the tooth. Swelling and tenderness of the gums or pimples appearing on the gums are also common symptoms. However, it is also possible that no symptoms will be noticed. The dentist will take an x ray of the tooth to determine if there is any sign of infection in the surrounding bone.

Aftercare

Once a root canal treatment is performed, the recipient must have a crown placed over the tooth to protect it. The cost of the treatment and the crown may be expensive. However, replacing an extracted tooth with a fixed bridge, a removable partial denture, or an implant to maintain the space and restore the chewing function is typically even more expensive.

During the time when antibiotics are being used, care should be taken to avoid using the tooth to chew food. The tooth has been structurally weakened and may break, or there is a possibility of the interior of the tooth becoming reinfected.

If the tooth feels sensitive following the procedure, a standard over-the-counter pain medication such as ibuprofen or naproxen may be taken. This sensitivity will fade after a few days. In most cases the patient can resume regular activity the following day.

Risks

There is a possibility that a root canal treatment will not be successful the first time. If infection and inflammation recur and an x ray indicates a repeat treatment is feasible, the old filling material is removed and the canals are thoroughly cleaned out. The dentist will try to identify and correct problems with the first root canal treatment before filling and sealing the tooth a second time.

In cases where an x ray indicates that another root canal treatment cannot correct the problem, endodontic surgery may be performed. In a procedure called an apicoectomy, or root resectioning, the root end of the tooth is accessed in the bone, and a small amount is shaved away. The area is cleaned of diseased tissue and a filling is placed to reseal the canal.

Normal results

With successful root canal treatment, the tooth will no longer cause pain. However, because it does not contain an internal nerve, it no longer has sensitivity to hot, cold, or sweets. Because these are signs of dental decay, the root canal recipient must receive regular dental check-ups with periodic x rays to avoid further disease in the tooth. The restored tooth may last a lifetime. However, with routine wear, the filling or crown may eventually need to be replaced.

Morbidity and mortality rates

In some cases, despite proper root canal treatment and endodontic surgery, the tooth dies and must be extracted. This is relatively uncommon.

Alternatives

The only alternative to performing a root canal procedure is to extract the diseased tooth. After restoration or extraction, the two main goals are to allow normal chewing and to maintain proper alignment band spacing between teeth. A fixed bridge, a removable partial denture or an implant will accomplish both goals. However, these are usually more expensive than a root canal treatment.

ABOUT MOUTH CANCER !!!

About mouth cancer

Mouth cancer is caused by an uncontrolled growth of cells in the mouth. Mouth cancer includes cancer that starts anywhere in the mouth, including:

  • lips
  • tongue
  • gums
  • floor of the mouth or under the tongue
  • inside the cheeks and lips
  • roof of the mouth (the palate)
  • area behind the wisdom teeth

Types of mouth cancer

Nine out of 10 mouth cancers are squamous cell carcinomas. They develop in the flat, skin-like cells that cover the inside of the mouth. Other, rarer types of mouth cancer include:

  • salivary gland cancer – starts in the salivary gland cells
  • lymphoma – starts in lymph tissue near the base of the tongue and tonsils
  • melanoma – starts in skin pigment cells around the mouth or on the lips

Symptoms of mouth cancer

Most people with mouth cancer have no early symptoms at all, but others may have:

  • an ulcer in the mouth or on the lip that won’t heal
  • constant pain or soreness
  • red or white patches in the mouth
  • a lump on the lip, tongue or in the neck
  • bad breath
  • unexplained bleeding in the mouth
  • numbness in the mouth
  • loose teeth

These symptoms aren’t always caused by mouth cancer but if you have them, visit your GP or dentist.

Causes of mouth cancer

Doctors don’t fully understand why mouth cancer develops. However, certain factors make mouth cancer more likely.

  • Smoking any form of tobacco – cigarettes, cigars and pipes, as well as bidis or hand-rolled cigarettes containing cannabis.
  • Chewing tobacco, such as betel quid, gutkha and paan.
  • Drinking excessive alcohol, especially at the same time as smoking or chewing tobacco.
  • Having already had cancer of the head and neck.
  • Exposure to the sun or UV light – this increases the risk of lip cancer.
  • A weakened immune system – people who have HIV/AIDS, or who are taking medicines that suppress the immune system, are more likely to develop mouth cancer.

Diagnosis of mouth cancer

The earlier mouth cancer is diagnosed, the better the chances of recovery. Your dentist may spot mouth cancer in its early stages during a routine check-up, so it’s important to visit your dentist regularly.

Your doctor or dentist will ask you about any symptoms, and examine you using a small mirror for harder-to-see areas. He or she will feel your neck and face for swellings. You may then be referred to an ear, nose or throat specialist for further tests.

You may have the following tests to confirm diagnosis.

  • Mouth and throat examination – your doctor may use a special instrument called a laryngoscope to look inside your mouth and throat.
  • Biopsy – a sample of cells or tissue is removed and sent to a laboratory for diagnosis.

Staging the cancer

If the biopsy shows that you have cancer, you will have further tests to find out how far it has spread and to help decide the type of treatment you will need. This is called staging the cancer. The tests may include the following.

  • X-rays of the upper and lower jaw (Panorex X-ray), or the chest, or both.
  • Barium swallow – this test involves swallowing a drink containing barium (a substance which shows up on X-rays). The X-rays will show up any unusual growths in the throat.
  • Scans – these may include ultrasound, MRI or CT scans. These are done to check the muscles, organs and tissues in your face, throat and chest.
  • Further biopsies of nearby lymph nodes. Lymph nodes are glands throughout the body that are part of the immune system.

Treatment of mouth cancer

Treatment depends on the type of mouth cancer, where it is and how far it has spread. Your doctor will discuss your treatment options with you. There are three main treatments for mouth cancer.

Surgery

Surgery (including the use of lasers) involves removing just the affected tissue. How much surgery is needed depends on how much tissue is affected. Surgery is sometimes followed by chemotherapy or radiotherapy treatment to make sure all the cancer cells are destroyed.

Non-surgical treatments

  • Radiotherapy – radiation is used to kill cancer cells.
  • Chemotherapy – anti-cancer drugs are used to destroy cancer cells. They are usually injected into a vein but sometimes may be given as tablets.
  • Biological therapy – special manufactured monoclonal antibodies (cetuximab) are used to block areas on the surface of cancer cells that can trigger growth. Radiotherapy is then used to destroy the cancer cells. Cetuximab is a new treatment and is approved for use only in advanced squamous cell cancer of the head and neck.

Prevention of mouth cancer

Simple lifestyle changes can reduce your risk of mouth cancer.

  • Visit your dentist for regular check-ups.
  • Look for any changes in your mouth such as, sore patches or ulcers that don’t heal and report them to your GP.
  • Don’t smoke.
  • Don’t chew tobacco.
  • Drink only in moderation.
  • Eat a healthy diet with at least five portions of fruit and vegetables a day.
  • Protect your skin from sunlight and other UV exposure such as sunbeds. Wear sunblock on your lips, stay out of the sun between 11am and 3pm and wear a wide-brimmed hat to protect your face.

 

DOWNS SYNDROME !!

What is Down Syndrome?

Down syndrome (DS), also called Trisomy 21, is a condition in which extra genetic material causes delays in the way a child develops, both mentally and physically. It affects about 1 in every 800 babies.

The physical features and medical problems associated with Down syndrome can vary widely from child to child. While some kids with DS need a lot of medical attention, others lead healthy lives.

Though Down syndrome can’t be prevented, it can be detected before a child is born. The health problems that can go along with DS can be treated, and there are many resources within communities to help kids and their families who are living with the condition.

What Causes It?

Normally, at the time of conception a baby inherits genetic information from its parents in the form of 46 chromosomes: 23 from the mother and 23 from the father. In most cases of Down syndrome, a child gets an extra chromosome 21 — for a total of 47 chromosomes instead of 46. It’s this extra genetic material that causes the physical features and developmental delays associated with DS.

Although no one knows for sure why DS occurs and there’s no way to prevent the chromosomal error that causes it, scientists do know that women age 35 and older have a significantly higher risk of having a child with the condition. At age 30, for example, a woman has about a 1 in 900 chance of conceiving a child with DS. Those odds increase to about 1 in 350 by age 35. By 40 the risk rises to about 1 in 100.

How Down Syndrome Affects Kids

Kids with Down syndrome tend to share certain physical features such as a flat facial profile, an upward slant to the eyes, small ears, and a protruding tongue.

Low muscle tone (called hypotonia) is also characteristic of children with DS, and babies in particular may seem especially “floppy.” Though this can and often does improve over time, most children with DS typically reach developmental milestones — like sitting up, crawling, and walking — later than other kids.

At birth, kids with DS are usually of average size, but they tend to grow at a slower rate and remain smaller than their peers. For infants, low muscle tone may contribute to sucking and feeding problems, as well as constipation and other digestive issues. Toddlers and older kids may have delays in speech and self-care skills like feeding, dressing, and toilet teaching.

Down syndrome affects kids’ ability to learn in different ways, but most have mild to moderate intellectual impairment. Kids with DS can and do learn, and are capable of developing skills throughout their lives. They simply reach goals at a different pace — which is why it’s important not to compare a child with DS against typically developing siblings or even other children with the condition.

Kids with DS have a wide range of abilities, and there’s no way to tell at birth what they will be capable of as they grow up.

Medical Problems Associated With DS

While some kids with DS have no significant health problems, others may experience a host of medical issues that require extra care. For example, almost half of all children born with DS will have a congenital heart disease

Kids with Down syndrome are also at an increased risk of developing pulmonary hypertension, a serious condition that can lead to irreversible damage to the lungs. All infants with Down syndrome should be evaluated by a pediatric cardiologist.

Approximately half of all kids with DS also have problems with hearing and vision. Hearing loss can be related to fluid buildup in the inner ear or to structural problems of the ear itself. Vision problems commonly include amblyopia (lazy eye), near- or farsightedness, and an increased risk of cataracts. Regular evaluations by an audiologist and an ophthalmologist are necessary to detect and correct any problems before they affect language and learning skills.

Other medical conditions that may occur more frequently in kids with DS include thyroid problems, intestinal abnormalities, seizure disorders, respiratory problems, obesity, an increased susceptibility to infection, and a higher risk of childhood leukemia. Upper neck abnormalities are sometimes found and should be evaluated by a physician (these can be detected by cervical spine X-rays). Fortunately, many of these conditions are treatable.

Prenatal Screening and Diagnosis

Two types of prenatal tests are used to detect Down syndrome in a fetus: screening tests and diagnostic tests. Screening tests estimate the risk that a fetus has DS; diagnostic tests can tell whether the fetus actually has the condition.

Screening tests are cost-effective and easy to perform. But because they can’t give a definitive answer as to whether a baby has DS, these tests are used to help parents decide whether to have more diagnostic tests.

Diagnostic tests are about 99% accurate in detecting Down syndrome and other chromosomal abnormalities. However, because they’re performed inside the uterus, they are associated with a risk of miscarriage and other complications.

For this reason, invasive diagnostic testing previously was generally recommended only for women age 35 or older, those with a family history of genetic defects, or those who’ve had an abnormal result on a screening test.

However, the American College of Obstetrics and Gynecology (ACOG) now recommends that all pregnant women be offered screening with the option for invasive diagnostic testing for Down syndrome, regardless of age.

If you’re unsure about which test, if any, is right for you, your doctor or a genetic counselar can help you sort through the pros and cons of each.

Screening tests include:

  • Nuchal translucency testing. This test, performed between 11 and 14 weeks of pregnancy, uses ultrasound to measure the clear space in the folds of tissue behind a developing baby’s neck. (Babies with DS and other chromosomal abnormalities tend to accumulate fluid there, making the space appear larger.) This measurement, taken together with the mother’s age and the baby’s gestational age, can be used to calculate the odds that the baby has DS. Nuchal translucency testing is usually performed along with a maternal blood test.
  • The triple screen or quadruple screen (also called the multiple marker test). These tests measure the quantities of normal substances in the mother’s blood. As the names imply, triple screen tests for three markers and quadruple screen includes one additional marker and is more accurate. These tests are typically offered between 15 and 18 weeks of pregnancy.
  • Integrated screen. This uses results from first trimester screening tests (with or without nuchal translucency) and blood tests with second trimester quad screen to come up with the most accurate screening results.
  • A genetic ultrasound. A detailed ultrasound is often performed at 18 to 20 weeks in conjunction with the blood tests, and it checks the fetus for some of the physical traits abnormalities associated with Down syndrome.

Diagnostic tests include:

  • Chorionic villus sampling (CVS). CVS involves taking a tiny sample of the placenta, either through the cervix or through a needle inserted in the abdomen. The advantage of this test is that it can be performed during the first trimester, between 8 and 12 weeks. The disadvantage is that it carries a slightly greater risk of miscarriage as compared with amniocentesis and has other complications.
  • Amniocentesis. This test, performed between 15 and 20 weeks of pregnancy, involves the removal of a small amount of amniotic fluid through a needle inserted in the abdomen. The cells can then be analyzed for the presence of chromosomal abnormalities. Amniocentesis carries a small risk of complications, such as preterm labor and miscarriage.
  • Percutaneous umbilical blood sampling (PUBS). Usually performed after 20 weeks, this test uses a needle to retrieve a small sample of blood from the umbilical cord. It carries risks similar to those associated with amniocentesis.

After a baby is born, if the doctor suspects DS based on the infant’s physical characteristics, a karyotype — a blood or tissue sample stained to show chromosomes grouped by size, number, and shape — can be performed to verify the diagnosis.