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Thursday, May 31, 2012

How Dark Gums can be made Natural Pink

Having natural pink color gums is very important for good smile. Smile looks beautiful if one has beautiful teeth with natural looking pink gums. But that is not always possible. Generally the gums color is same as the skin color. The people from the west are fair and their gum color is also pink mostly. Dark gums are mostly seen in dark skinned people.  The gum discoloration may be present in patches.  The extent of gum discoloration and the intensity is different for different individuals. Dark pigmented gums don’t mean that they are unhealthy and are not an indication of a disease.


What are the causes of Dark Gums:

Racial or physiological gingival pigmentation: It is seen as the genetic trait. The main culprit behind this is the black pigment known as Melanin.
The production of melanin increases manifolds in the presence of sunlight. At the same time it is more in the persons having complexion towards darker side. The individuals who are involved in outdoor activity tend to have darker gums. Even the children who are more active outdoor and at the same time have gummy smile are more prone to have dark gums. Once the gums become dark during the childhood they tend to stay that way. The gums around the teeth tend to become dark but the part of the gums which is hidden under the lips has natural pink color.
In certain diseases like Addison’s disease, peutz jeghers syndrome, von recklinghausen’s disease, there is an increase in melanin pigmentation. In case of Addison’s disease, adrenal dysfunction produces isolated patches of discoloration varying from bluish black to brown.
Poor oral hygiene: Gum diseases can occur because of poor oral hygiene which may cause gums pigmentation. There is inflammation, redness and bleeding in case  of gum diseases which may cause darkening of the gums.

Smoking: Smoking also causes dark gums. Tobacco consumers also have darker gums in comparison to non-tobacco consumers.

Medications: Some medication like minocycline, antimalarial agents, tricyclic antidepressants can also cause dark gums.

Metallic fillings: The metallic fillings which get corroded can also cause dark gums.

Treatment of dark gums:

Treatment of the dark gums is possible. The blackness of the dark gums is merely superficial. When the outer dark colored layer is removed, the pink aesthetic looking gums appear.

Surgical method for making dark gums as natural pink:

  1. The most popular effective and simple method of removing the darkness of the gums is the surgical removal of the outer layer of the gums which gives the dark color to the gums.
  2. The procedure though surgical is a painless outdoor procedure carried out under local anesthesia.
  3. In this procedure the outer layer of gum epithelium is removed with a layer of underlying connective tissue. After the removal the connective tissue which is   left to heal by secondary intention. The new epithelium which is formed is devoid of dark pigmentation.
  4. The positive results can be seen within one to two days.
  5. After this procedure 20 to 30% of the pigmentation returns after 5 to 6 months and then stays as such.
  6. If few precautions like not exposing oneself for long hours to sunlight are observed then the gums stay pink and there is marked improvement in aesthetics.
  7. This surgical procedure can be repeated if the gums again become dark and looks bad.

               Patient with Dark Gums                     Pigment Layer Removed in   Maxillary   
                                                                              Anterior Gingiva

1 week post-operative picture                        6 months post-operative picture
Gum Bleaching for making Dark Gums as Natural Pink
1.   Another treatment to treat the dark pigmentation of gums is the gum bleaching which is done using the lasers known as the water lease system. Erbium:YAG is a safe and efficient treatment. It causes alteration of melanin pigment in gingival tissues and produces esthetic pink gums.
2.    It is quick, painless and gives good results.
3.    The dark gums can be made pink and healthy in a single one hour visit.
4.   The results are permanent. The melanin pigment which is the cause of the dark gums does not comeback.
5.   Before going for the treatment the cause of the discoloration should be known. If the gums are unhealthy and they have the signs and symptoms of gum disease like bleeding swelling or inflammation then first of all before going for the gum bleaching the underlying infection has to be treated.
6.   When the gums are healthy only then the gum bleaching should be carried out. If the person is a smoker, then he has to quit smoking before going for the gum bleaching.
7.    Benefits of Gum Bleaching:
There are many benefits of gum bleaching:
a.   In a single visit the dark spots or the dark looking gums can be given esthetically pleasant looking appearance
b.   It boosts the confidence of the patient. Now the patient can smile without looking embarrassed.
c.    It is quick, less time consuming and gives good results
8.    Procedure for Gum Bleaching:
a)    Procedure depends upon the extent, depth and type of discoloration.
b)     It is done under local anesthesia and is painless procedure.
c)    Depending upon the depth and extent of discoloration the gum bleaching is done with lasers.
d)     In some cases where the discoloration is not very deep no surgery is required but in some minor surgery is required.
e)     Healing is very quick and patient does not feel any discomfort afterwards.

   Before Lasers Treatment                                      Dark Pigmentation Eliminated by using
Complications and Recovery after going for Gum Surgery:
There are absolutely no complications after the gum surgery and there is no discomfort. The patient can talk and eat normally after the gum beaching procedure. In some cases where the gums are very sensitive the patient can feel minor discomfort but that to goes with healing which is very quick.
Post Operative Care after Gum Surgery:
There is no special post operative care after the gum bleaching. The good oral hygiene has to be maintained like proper brushing and flossing. Those who smoke has to quit smoking at least till the time the proper healing takes place.
Now with the treatment options like laser surgery for gum bleaching having pink gums is not a distant dream. One can easily have beautiful smile but maintaining them is essential.

source :net

Wednesday, May 30, 2012

Stem cell shield 'could protect cancer patients'

 Brain tumour  
The trial is being conducted on patients with brain cancer

It may be possible to use "stem cell shielding" to protect the body from the damaging effects of chemotherapy, early results from a US trial suggest.
Chemotherapy drugs try to kill rapidly dividing cancer cells, but they can also affect other healthy tissues such as bone marrow.
A study, in Science Translational Medicine, used genetically modified stem cells to protect the bone marrow.
Cancer Research UK said it was a "completely new approach".
The body constantly churns out new blood cells in the hollow spaces inside bone. However, bone marrow is incredibly susceptible to chemotherapy.
The treatment results in fewer white blood cells being produced, which increases the risk of infection, and fewer red blood cells, which leads to shortness of breath and tiredness.
Researchers at the Fred Hutchinson Cancer Research Center, in Seattle, said these effects were "a major barrier" to using chemotherapy and often meant the treatment had to be stopped, delayed or reduced.
'Protective shields' They have tried to protect the bone marrow in three patients with a type of brain cancer, glioblastoma.
One of the researchers, Dr Jennifer Adair, said: "This therapy is analogous to firing at both tumour cells and bone marrow cells, but giving the bone marrow cells protective shields while the tumour cells are unshielded."
Bone marrow was taken from the patients and stem cells, which produce blood, were isolated. A virus was then used to infect the cells with a gene which protected the cells against a chemotherapy drug. The cells were then put back into the patient.
The lead author of the report, Prof Hans-Peter Kiem, said: "We found that patients were able to tolerate the chemotherapy better, and without negative side effects, after transplantation of the gene-modified stem cells than patients in previous studies who received the same type of chemotherapy without a transplant of gene-modified stem cells."
The researchers said the three patients had all lived longer than the average survival time of 12 months for the cancer. They said one patient was still alive 34 months after treatment.
Cancer Research UK scientist Prof Susan Short said: "This is a very interesting study and a completely new approach to protecting normal cells during cancer treatment.
"It needs to be tested in more patients but it may mean that we can use temozolomide [a chemotherapy drug] for more brain tumour patients than we previously thought.
"This approach could also be a model for other situations where the bone marrow is affected by cancer treatment."

Source :

Monday, May 28, 2012

Medical Miracle:Blind man restored vision after having a TOOTH implanted into his eye

Martin Jones, a 42-year-old builder, was left blind after an accident at work more than a decade ago. But a remarkable operation - which implants part of his tooth in his eye - has pierced his world of darkness. The procedure, performed fewer than 50 times before in Britain, uses the segment of tooth as a holder for a new lens grafted from his skin.

Mr Jones, from Rotherham, South Yorkshire, married his wife Gill, 50, four years ago.
By that time he had already spent eight years without his sight after a tub of white hot aluminium exploded in his face at work in a scrapyard.
He suffered 37 per cent burns and had to wear a special body stocking for 23 hours a day. He also had his left eye removed.
But surgeons were able to save the right eye, even though he was unable to see through it.
At first specialists in Nottingham tried to save his sight using stem cells from a donor but the attempt failed.
It was only when a revolutionary new operation was pioneered at the Sussex Eye Clinic in Brighton that he was given a chance to have his sight back.

During the procedure, a minute section of a patient's tooth is removed, reshaped and chiselled through to grip the man-made lens which is then placed in its core.
It is implanted under an eyelid where it becomes covered in tissue.
The process requires a living tooth as an implant because doctors suggest there are chances the eye would reject a plastic equivalent.
So a canine - which is the best option due to its shape and size - was taken out of Mr Jones' mouth.

A patch of skin is then taken from the inside of the cheek and placed in the eye for two months, where it gradually acquires its own blood supply.
The tooth segment is finally transplanted into the eye socket. The flap of grafted skin is then partially lifted from the eye and placed over its new sturdy base

Source: net.

Saturday, May 26, 2012

Evidence for the Oldest known Toothache

Not only human beings, but also animals have to deal with toothache once in a while. A team of researchers from the University of Toronto Mississauga went on to examine the jaw of Labidosaurus hamatus, a terrestrial reptile that lived 275 million years ago, and found evidence of bone damage due to oral infection. This is a great finding as it shows the reptile’s susceptibility to oral infections.
The team of scientists, led by paleontologist Professor Dr Robert Reisz, found out more about the terrestrial vertebrates that lived around 250 to 315 million years ago and the their jaws. They were able to study this from several well-preserved specimens of Labidosaurus hamatus. The one that they studied showcases missing teeth and associated erosion of the jaw bone. With the aid of a computer tomography scanning the team was able to find enough supportive evidence of a massive infection. This was the cause of the loss of several teeth, bone destruction in the jaw in the form of an abscess and internal loss of bone tissue.

Reisz and his team put forward that as ancestors of advanced reptiles adapted to life on land. In order to do so, many evolved dental and cranial specializations to feed more efficiently on other animals. This was also to incorporate high-fiber plant leaves and stems into their diet.
The primitive process in living amphibians and reptiles is to have a continual process of growing new teeth in each socket. As these teeth grow, the old ones fall out. The primitive dental pattern in which teeth were loosely attached to the jaws and continuously replaced, changed in some animals. Teeth became strongly attached to the jaw, with little or no tooth replacement as this worked to be greatly beneficial for some reptiles. The diversity of the Labidosauris and its kin was greatly beneficial in the evolutionary success.

However, it is conceivable that the likelihood of infections of the jaw, resulting from damage to the teeth, increased over a period of time in these reptiles. When they were exposed to these infections it harmed the dental pulp cavity of heavily worn or damaged teeth. This had a greater impact on the reptiles as they were not able to replace their teeth like the other amphibians and animals. This was according to the evolution of meat and animal eating creatures.

Thursday, May 24, 2012

(MDS) course in forensic dentistry in India

The Dental Council of India has approved a three-year master of dental surgery (MDS) course in forensic dentistry.
Forensic dentistry or forensic odontology is the proper handling, examination and evaluation of dental evidence.
"The proposal to have MDS in forensic dentistry has been approved by the Dental Council of India at a meeting on May 14 at Chandigarh. The proposal will now be sent to the central government for an issuance of notification," said Dr Ajit Dinkar, professor at Goa Dental College, who is also a member of Dental Council of India.
Dental Council of India is a statutory body incorporated to regulate dental education and the profession of dentistry throughout India.
Dr Dinkar explained that forensic dentistry is the need of the hour and there are hardly any qualified forensic dentists in the country. Forensic dentists are responsible for six main areas of practice which include identification of human remains, identification in mass fatalities, assessment of bite mark injuries, assessment of cases of abuse (child, spousal, elderly) and age estimation.
The evidence that may be derived from teeth is age (in children) and identification of the person to whom the teeth belong. This is done using dental records including radiographs, antemortem (prior to death) and postmortem photographs and DNA. "In Goa, we get several cases of drowning deaths, which are referred to us for forensic dentistry," said Dr Dinkar.
The other type of evidence is that of bite marks left on either the victim (by the attacker), the perpetrator (from the victim of an attack), or on an object found at the crime scene. Bite marks are often found on children who are abused.

Thursday, May 17, 2012

Toothless No More – Researchers Using Stem Cells to Grow New Teeth

                          Polymer scaffolds guide stem cells growth into customized sizes and shapes.

It may be hard to remember what it was like to lose a tooth as a child, but many adults get an unpleasant reminder as they age when their teeth begin to fall out (even those who don’t play hockey) and must consider dentures or dental implants. For years, researchers have investigated stem cells in an effort to grow teeth made for a person’s own cells. Toward this end, endodontics professor Dr. Peter Murray and colleagues from the College of Dental Medicine at Nova Southeastern University (NSU) have developed methods to control adult stem cell growth toward generating dental tissue and “real” replacement teeth.

The NSU researchers’ approach is to extract stem cells from oral tissue, such as inside a tooth itself, or from bone marrow. After being harvested, the cells are mounted to a polymer scaffold in the shape of the desired tooth. The polymer is the same material used in bioreabsorable sutures, so the scaffold eventually dissolves away. Teeth can be grown separately then inserted into a patient’s mouth or the stem cells can be grown within the mouth reaching a full-sized tooth within a few months.
So far, teeth have been regenerated in mice and monkeys, and clinical trials with humans are underway, but whether the technology can generate teeth that are nourished by the blood and have full sensations remains to be seen. Teeth present a unique challenge for researchers because the stem cells must be stimulated to grow the right balance of hard tissue, dentin and enamel, while producing the correct size and shape.
As Dr. Murray explains it, humans already have two sets of teeth, baby and adult sets, over the course of their lifetimes, so “All we are trying to do is copy nature and give the person the third option to re-grow their teeth.” Not only could this be important for replacing lost teeth, but it could become a standard treatment when extreme orthodontics is necessitated. And if the tooth is malformed or fails, it can be extracted and a new one put into place.
To date, the NSU researchers have received about $1.7 million in grants for their dental stem cell research.
Dr. Murray believes that if they can demonstrate control over tooth re-growth and prove that the technology is safe, these teeth will be the first to see widespread adoption in the US. He also reports that interest has been high from the public and even fellow dentists, as evidenced by the recent selling out of his “Regenerative Endodontic Procedures” presentation at the American Dental Association conference in Las Vegas.
You can check out a news piece about NSU’s research here.
Just as developments in embryonic stem cell research launched umbilical cord banks, the promise that dental stem cell therapy holds has led to the rise of tooth banks, such as BioEden, StemSave, and Store-A-Tooth (StemSave, for instance, charges $2,430 to store a child’s tooth for 20 years.) Stem cell therapies are being actively used to repair bone damage, facial bones, and even organs like a heart, but skeptics continue to scoff at the potential of stem cells, oft citing nightmare scenarios or runaway tissue growth. Furthermore, research progress is often clouded by the politics surrounding embryonic stem cell research.
But the one therapy that could silence the naysayers is tooth regeneration.
The statistics on tooth loss are a bit staggering: 7 out of 10 adults age 35 to 44 have lost at least one tooth and a quarter of those aged 65 or older (or about 20 million people) have lost all their permanent teeth. Additionally, side effects from medications can effect oral health, such as changing properties of the saliva that helps fight bacterial growth. And increased tooth loss leads to poor dietary habits even among dentists, according to a recent study, which leads to secondary health effects. Add to this high sugar diets contributing to the obesity epidemic and increasing cases of periodontal disease due to neglect and you can see that the market for tooth replacement is enormous and expected to grow.
Having a full set of functional teeth is increasingly important as an aging population seeks to maintain an active lifestyle. And the growth of social media has led to people’s faces being plastered all over Facebook, Twitter, and YouTube. So how your teeth look is more important than ever, especially with more people carrying high quality cameras built into their mobile devices.
Dentists are at the front line of the increased demand for perfect teeth. A 2009 nationwide survey by NSU revealed that 96% of the dentists polled expected stem cell regeneration to dominate the future of dentistry. Additionally, more than half predicted that the technology would be available within the next decade.
In mice, stem cells grew into a tooth (in green) that had similar properties to natural teeth.

Research into using stem cells to regrow new teeth has been around for at least 10 years. In 2002, Professor Paul Sharpe at the Dental Institute of King’s College in London received a $500,000 Wellcome Trust grant to translate tooth regrowth with stem cells in mice into regenerative dentistry for humans. A company was formed, Odontis, and in 2010 seemed ready to launch its BioTooth technology, but has since fallen off the radar and had its website shut down possibly suffering the same fate that led to Geron Corporation abandoning stem cell research last year. Researchers from Tokyo University in 2009 reported success with implantation of stem cell tooth germs in mice which grew into fully functional teeth within a few months. Scaffolds were also successfully used to regrow anatomically correct teeth in nine weeks by researchers at Colombia University Medical Center.

Although the promise of stem cell therapies remains to be realized, there’s little doubt that researchers at NSU and around the world will continue in their efforts to use stem cells for regenerative medicine.
Dr. Murray remains optimistic: “When dental stem cell therapies become routine it will be historic, and the most fantastic time to practice as a dentist.”

Source: WWW

Do you need braces ?

Who is a Candidate for Braces?  

Why Do I Need Braces?  

These are some of the questions, which we will be answering in this article.

Who is a Candidate for Braces?

Some  recommend that children should be seen for their first orthodontic consultation no later than age 7. While the age of 7 may seem unusually early to consider braces, this pre-screening will give the orthodontist the opportunity to use preventative measures to possibly correct situations that may lead to braces in the future, and /or advise the parent on future orthodontic treatment planning. Adults seeking orthodontic treatment may consult with their dentist at any time, since it is never too late to consider correcting your teeth.

The initial consultation with the orthodontist is typically a visual evaluation of the patient’s teeth and facial structure, with discussion to follow. If the orthodontist requires more in-depth information, or the patient agrees to begin treatment, diagnostic records are then taken of the patient. These diagnostic tools, consisting of x-rays, models of the patient’s teeth, and photographs of the patient’s face and teeth, are used by the orthodontist to study and formulate a treatment plan to present to the patient. Although most orthodontists do not require a referral from your general dentist, it may be helpful if you obtain one when it comes time to choosing a dentist that is right for you...

Why Do I Need Braces?

Braces are used to move teeth into the ideal position and align how they bite together, known as occlusion. Malocclusion is used to describe the misalignment of teeth between the upper and lower dental arches, using the first molars as a reference point. There are three different types of misalignment, defined by the Angles Classification Method. Developed by Dr. Edward Angle, considered by many the founding father of orthodontics, this method of classification is widely used by dentists around the world:
  • Class I - Considered the ideal relationship between the upper and lower teeth. Crowding or spacing may be present with Class I bite.
  • Class II - Commonly known as “over bite.” The patient’s lower first molar is positioned posterior, or more towards the back of the mouth. The upper jaw, or maxilla, appears to protrude forward. Class II bite has two sub classes that also describe the position of the upper front teeth, but in both cases, the molar relationship is the same.
  • Class III - The patient’s lower first molar is positioned anterior, or closer to the front of the mouth. The lower jaw, or mandible, protrudes forward, and is best described as an “under bite.”
While some patients may have the ideal bite, they may suffer from varying degrees of crowding or spacing, another factor associated with a misaligned bite. Crowding is a condition that causes the teeth to overlap, rotate, and in some cases, grow into the incorrect position in the mouth, or in more extreme cases, cause the tooth to become trapped in the bone. Crowding may be caused because the dental arch is too small for the adult teeth, or the adult teeth are larger than normal. Crowding may also be caused by losing the primary or baby teeth early, or retaining them in the mouth longer than normal. These factors may inhibit the adult tooth, forcing it to erupt or grow into an incorrect position. Crowding makes it difficult to brush and floss the teeth correctly, possibly resulting in tooth decay or gingivitis.
Alternatively, varying degrees of spacing may be present, due to smaller teeth or jaw size. The most obvious example of spacing is the diastima, a space between the upper two front teeth, known as the centrals, made famous by Madonna.

More Than Just Straight Teeth

Misaligned teeth and an incorrect bite may affect more than just the appearance of your smile. The following conditions may potentially be corrected by orthodontics:
  • Speech impediments
  • Jaw or TMJ pain
  • Difficulty chewing and eating
  • Sleep apnea caused by mouth breathing and snoring
  • Grinding or clenching of the teeth
  • Gum disease and tooth decay
Patients experiencing any of the above symptoms should contact their dentist to determine the cause of their condition. Aesthetics do, however, play an important role when it comes to deciding if braces are right for you. Self confidence may improve for patients that have concerns with the appearance of their teeth or facial shape. Many treatment options are available for correcting the look of your teeth and smile.

Talk to Your Dentist

Healthy teeth and gums, improved facial structure, and enhanced self esteem are just few of the many benefits of correcting your teeth with braces.Talk to your dentist

Wednesday, May 16, 2012

Cone Beam CT in Endodontic Diagnosis

Cone Beam Computed Tomography (CBCT) is a valuable radiographic tool in endodontic diagnosis. With traditional 2D radiography, you see only a coronal view. Historically in endodontics, we have taken the shift shots to try and give us an "angled" view of the tooth. Remember the rule of SLOB?

With CBCT, you can evaluate the tooth from sagittal, coronal & axial views. You also have a volume of data that can be manipulated by the computer to rotate the tooth 360 degrees and look at the tooth from any angle. The longer I use this technology, the more convinced I become of its importance and value.

The following case demonstrates the benefit of CBCT in endodontic diagnosis.

LinkThis patient presented to Superstition Springs Endodontics with chief complaint of "pressure to biting and sensitive to brushing". Root canals on #14 and #15 were done approximately 10 years ago.

Our exam found mild palpation tenderness over #14 and #15. Both teeth were percussion sensitive and perio probings were normal. A large pa lesion was noted on the palatal root of #14, but since #15 was also so symptomatic, we decided to take a CBCT for more detailed radiographic exam.

This CBCT slice through #14 shows the extent of the pa lesion on the palatal root. It also shows the elevation of the floor of the sinus and the thickened adjacent sinus membrane. This appears to be a sinusitis of dental origin.

This CBCT slice through #15 shows a definite pa lesion on the MB root of #15. This also exhibits a halo effect. This image confirms the diagnosis of Symptomatic Apical Periodontitis on #15. Without this image, I would have recommended initiating treatment on #14 only. This image allows us to make a more confident diagnosis on #15 and treat both teeth simultaneously.

As an interesting side note, an inverted, impacted wisdom tooth is noted. This made the original radiograph difficult to read and see the MB lesion.

Saturday, May 12, 2012

Question of the day

A 52-year-old female presents with heat intolerance, increased appetite, diarrhea, and weight loss. He has a history of hepatitis C, and is currently on ribavirin and interferon-alfa. On examination, there is a non-tender swelling on the front of his neck that moves with swallowing. On eye examination, there is no exophthalmos, ophthalmoplegia, lid lag, or chemosis. Labs reveal elevated total T3 and T4 levels, low TSH level, decreased radioiodine uptake, and increased serum thyroglobulin levels. Which of the following is the most appropriate next step in the management of this patient?

A. Treatment with a beta-blocker
B. Treatment with propylthiouracil
C. Treatment with NSAIDs
D. Treatment with prednisolone
E. Treatment with radioiodine

Friday, May 11, 2012

Question of the day

A 16-year-old boy presents in the emergency department (ED) with an acute exacerbation of bronchial asthma and receives nebulized albuterol and 60 mg of prednisone, after which he feels better. He is discharged from the ED after four hours with a prescription of 60mg prednisone daily. He contacts you after six days and asks if he can stop using prednisone because he now feels completely normal. What is the best response to this patient's question?

A. He needs to taper prednisone use over 2months.
B. Prednisone can be discontinued rapidly.
C. Prednisone should be switched to hydrocortisone, and then gradually tapered.
D. He should start taking prednisone on alternate days and then taper it very gradually.
E. Prednisone can be rapidly tapered; however, he will require stress doses of glucocorticoids during the next three months if he develops any infection.

Question of the day

Check out our new section ::: QUESTION OF THE DAY.

Bring along those buzzing minds to crack some mind blowing questions !!

Starts from 20 th May . STAY TUNED .

We have introduced this new section . Every day an intersting question will be put up.. For YOU to crack it !!!

So.. Bring out the NERD IN YOU ! 

Monday, May 7, 2012

Insight on Dental implant materials

A dental implant is a "root" device, usually made of titanium, used in dentistry to support restorations that resemble a tooth or group of teeth to replace missing teeth.

Materials used :

Metals - stainless steel
               Cobalt-chromium-molybdenum based                    
               Titanium and its alloys 
              Surface coated titanium

Ceramics - Hydroxyapatite
                   Aluminum oxide 

Polymers and composites
Others- Gold,tantalum,carbon etc .

TITANIUM : Commercially pure titanium is currently the most widely used material for implants.

Basically because  :

1.Low density ( 4.5 gm/cm2) but high strenght)
2. minimal biocorrosion due to its passivating effect
3. biocompatible

Titanium also has good stiffness. Although its stiffness is only half that of steel,it is still 5-10 times higher than that of bone.

These may be bioactive or bioinert.
Limited application due to their low tensile strength and ductility.

Bio active : Hyroxyapatite,bioglass

Bio inert : Aluminium oxide is used either in the polycrystalline form or as a single crystal.


 Austentic  steel is used as an implant material.
High strenght and ductility 


As hookah becomes in, it raises health concerns

From being a centre-point of village gatherings to gracing plush joints in metros, the hookah has made a comeback in social space. But its return has sparked concern among cancer experts who say Indian youth are getting addicted to the hubble-bubble in the mistaken belief that it is a healthy alternative to cigarettes.

According to the Global Adults Tobacco Survey (GATS) 2009-10, India accounts for over seven million hookah users among a total of 274.9 million tobacco users. While tobacco is the leading cause of cancer deaths in India, experts say hookah smokers are prone to lung cancer, oral cancer, heart diseases and respiratory disorders.
"Over the last two years, hookahs have penetrated urban space and gained enormous popularity among youngsters. Without knowing the harmful effects, youth are addicted to the hookah because of a fashion quotient associated with it," said Dhirendra N. Sinha, regional advisor, Surveillance (Tobacco Control) at the World Health Organisation (WHO), Southeast Asia.
"Making hookah smoking seem fashionable is an innovative approach of the tobacco industry to make the youth population addicted to tobacco," Sinha told IANS.
Experts attribute the impressive return of the hookah to hookah parlours that have been positioned as 'hangout zones of the elite'. The Arab-lounge like ambience at such bars - dimly lit corners, reclining couch, soothing music and exotic flavours - have helped the hookah grip metropolitan residents.
"In cities, hookah parlours have become symbols of socio-economic prosperity. They are easily available and being at a hookah parlour looks cool to youngsters and urban rich," P.K. Julka, professor of clinical oncology at the All India Institute of Medical Sciences (AIIMS), told IANS.
While Bangalore, Rajasthan, Punjab and Haryana have banned hookah parlours under the Cigarettes and Other Tobacco Products (Prevention) Act 2003, Delhi is yet to take any action to curb hookah smoking or mushrooming hookah parlours.
Hookah or waterpipe smoking uses a technique where specially-made tobacco is heated, and the smoke passes through water to be drawn through a mouthpiece. Experts say the tobacco in a hookah pipe is no less toxic, and the water in the hookah does not filter out the toxic ingredients in the tobacco smoke.
"While we also get cancer patients from rural areas, the young hookah-related cancer patients coming to us have a myth. They think hookah is less harmful than cigarettes due to its water base," informed Julka.
An evening spent at a popular hookah bar in south Delhi's Defence Colony makes the picture clear. Faint candlelight coupled with woodworked interiors, the bar is abuzz with the young and hip waiting for hookah sessions. Each session ranges from an hour to two hours.
On a couch tucked away in a corner sits a group passing the mouthpiece for their favourite flavour 'treasure trail' - an alcoholic hookah. For an hourly session starting at Rs.250, hookah or sheesha comes in different flavours mixed with bases of alcohol, juice or water.
But the hookah smokers seem oblivious to the harm while they sift through the menu card to try more "thrilling flavours". It is a preferred way to unwind after work, says 24-year old Asmita Marwah as she puffed away smoke from her fruity hookah.
"Well, I think it's better than puffing away 20 cigarettes at work. I always hang out with my colleagues at this hookah parlour to relax after a long day of work," Marwah, a public relations executive, told IANS. Her colleagues nod in agreement.
According to WHO, a hookah smoker may inhale as much smoke per session as a cigarette smoker would inhale from over 100 cigarettes. Sharing the same mouthpiece for smoking can also cause serious communicable diseases such as tuberculosis and hepatitis, the global health body informs.
Occasionally, hookah laced with alcohol or marijuana is also ordered.
"Hookah smoke is already full of addictive nicotine and toxic compounds that affect the lungs and the body. But alcohol with tobacco is a deadly combination," Julka said.
At hookah joints teeming with youngsters, people exposed to secondhand hookah smoke are at equal risk.
Experts feel there is more needed than just a ban.
"Banning hookah bars is an incomplete solution as anyone can buy a hookah, a pipe, flavours and tobacco from a paan shop. What we need is awareness and of course stricter norms," said Bhawna Sirohi, head of medical oncology at Artemis hospital, Gurgaon.


Wednesday, May 2, 2012

Oral Health in Dementia: Dental Professionals and Patients With Dementia

The use of behavior management techniques will greatly assist the practitioner in obtaining cooperation and compliance of the patient with dementia, particularly in the early stages of the condition. Many patients, who are in earlier stages of dementia than Mrs. K, can be managed by:
  • Providing a friendly and caring atmosphere (smiling, approachable demeanor);
  • Offering a reassuring and comforting approach (tone of voice, gentle touching, etc);
  • Making eye contact and facing the patient;
  • Speaking in a calm, deliberate manner;
  • Eliminating/minimizing distractions (noises, quick movements, etc);
  • Allowing the caregiver to be present, if appropriate;
  • Avoiding forcing the patient to comply; consider rescheduling as a "desensitizing" or "familiarizing" opportunity; and
  • Assessing usefulness of psychotropic medications, such as Ativan (lorazepam) or Xanax (alprazolam), to provide mild sedation, in consultation with the patient's primary care provider.

Patient Management and Stage of Dementia

After assessing and assimilating all available patient information, a rational treatment plan can be formulated that allows the provider to perform the most appropriate care for the patient, considering the overall health, cognitive status, and prognosis of the patient.[9]
In the early stages of dementia, the patient may have relatively good cognition and memory and may be compliant in the dental environment. However, as the dementia progresses, a disruption of normal thought processes and lack of concern for general and oral hygiene are typically evident. Oral health can rapidly decline. With an ever-increasing number of us living well into our 80s and beyond, the ADA has recognized this critical issue, and hosted the National Consensus Conference on the Oral Health of Vulnerable Older Adults and Persons with Disabilities in November 2010 to identify strategies to address this concern.[10] The ADA also has resources for the dental practitioner on the management of the oral health needs of older adults.[11]
Stages of dementia. Dementia is often classified as having 3 stages: early, moderate and severe (terminal). Patient management is influenced by the advancement of the disease process (Table 2).
Table 2. Dental Management by Stage of Dementia
Early Stage - MMSE score 21-24
• Most patients are appropriately responsive and cooperative
• Ask questions that can be answered by either "yes" or "no"
• Provide short, simple instructions
• Repeat instructions, if necessary
• Use the "tell, show, do" technique
• Use a mouth prop, if appropriate
• Most dental procedures can be tolerated at this stage
• Short, morning appointments are often better tolerated
• Emphasize to patient and caregiver(s) the importance of excellent oral
  hygiene and regular dental visits in maintaining oral health
• Consider prescribing adjunctive measures (eg, fluoride toothpaste and
  rinses, chlorhexidine gluconate rinse, salivary substitutes, etc)
• This is the appropriate stage for the dentist to develop a rational treatment
  plan, considering the patient's prognosis, and to provide as much
  treatment as possible to establish optimal oral health
Moderate Stage - MMSE score: 10-20
• Increased loss of cognitive abilities results in diminished ability to perform
  activities of daily living and increased dependence on caregiver(s) to do
• Patient may still be in relatively good physical health
• Primary goal of dental management in this stage is oral health
  maintenance and the elimination of pain and infection
• Patient may not be able to identify source of dental pain
• Signs of dental problems in a dementia patient may include:
    -Rubbing of the face
    -Flinching when face is touched or when eating
    -Inability to eat/drink hot and/or cold items
    -Increased irritability
    -Not wearing removable dental appliances
• Patient's ability to cooperate when conscious may be lacking and may
  necessitate intravenous sedation or general anesthesia in the appropriate
  facility and with trained personnel[7]
Severe (Terminal) Stage - MMSE score: ≤ 9
• Physical as well as cognitive abilities rapidly deteriorate
• Caregiver is completely responsible for patient's well being, including daily
  oral hygiene and compliance with regularly scheduled dental
• Optimal treatment includes prevention of pain and infection
• Any invasive treatment would most likely require intravenous sedation or
  general anesthesia

Management of Mrs. K. At the return visit, with Mrs. K under anesthesia, multiple dental restorations were performed to maintain several reasonably healthy teeth, preserve some masticatory function, and avoid complete edentulism. Most of her teeth, however, required extraction owing to extensive dental decay. Mrs. K. tolerated the procedure without incident and was discharged from the ambulatory care center later that day in the company of her husband. After this treatment, Mrs. K's husband started an oral hygiene and topical fluoride regimen recommended by Mrs. K's dentist to reduce the accumulation of dental plaque and the rate of dental caries. Unfortunately, Mrs. K's neurologic condition continued its rapid deterioration, and she died 8 months following her dental treatment.
In hindsight, perhaps, the method and treatment rendered for Mrs. K was extreme, given that she succumbed so soon afterward. However, such an outcome cannot be predicted, and all parties (Mrs. K's healthcare proxy, her physician, and her dentist) agreed to treat her. Reducing tooth-related pain near the end of life is an important goal. This case points out the unpredictability of dementia and emphasizes the importance of early restorative and preventive care.

The Challenge of Dementia

The patient with dementia presents many challenges for the oral health practitioner. Early intervention and treatment of the patient before the dementia advances to a moderate or severe stage is vital. Proper interdisciplinary consultation, rapport with family and caregivers, practical patient management techniques, rational treatment planning, and timing of the provision of care are necessary to establish the optimal long-term oral health of these patients.

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