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                    D e n t a l    F o l l i c l e               

             The        Monthly     E - Journal                  Vol - I I I      Number-    X I    April  2009


In this Issue:

  • Editorial

  • News

  • DentistryUnited @ Rank 3 on GOOGLE

  • Laughter - The best Medicine

  • Burning Mouth Syndrome - Part 3  - Dr.Gazala Danish . United Arab Emirates

  • Study finds new evidence of periodontal disease leading to gestational diabetes

  • DentCare announces its next Implant course in Pune-India

  • Research confirms untreated perioontal patients end up paying higher medical bills in Diabetes and storke

  • Inhalation of Sulphuric ether prior to dental extraction - Published 26/June/1847 THe courier -Australia under Construction

Editorial :

      Dear Fellow Dentist,

                                        Periodontology has become a vital sign in diagnosing various systemic conditions and the list increases day by day. Recently Harvard researchers claim to have found evidence of obesity occurring prior to periodontal disease in a large group of people and suggest the two are connected. A  16 year study indicated that those who were obese at the beginning of the study had 25-29% more risk of periodontal diseases. Perhaps If the cause of obesity is frequent over eating then , it could have even lead to a lot of dental decay due to the fact the salivary pH level remained lower.

Very soon dentists would play a major role in systemic diseases diagnosis and maintenance.

I hope you enjoy this issue of Dental Follicle.  

Click here to join DentistryUnited
Click to join DentistryUnited

Yours truly

Dr. Syed  Nabeel

Editor of Dental Follicle & WebMaster




          DentistryUnited Ranks 3 on Google  for key word "Dentistry"



Laughter - The Best Medicine :


A man went to his dentist because he feels something wrong in his mouth. The dentist examines him and says, "that new upper plate I put in for you six months ago is eroding. What have you been eating?" The man replies, "all I can think of is that about four months ago my wife made some asparagus and put some stuff on it that was delicious ... Hollandaise sauce. I loved it so much I now put it on everything --- meat, toast, fish, vegetables, everything." "Well," says the dentist, "that's probably the problem. Hollandaise sauce is made with lots of lemon juice, which is highly corrosive. It's eaten away your upper plate. I'll make you a new plate, and this time use chrome." "Why chrome?" asks the patient. To which the dentist replies, "It's simple. Everyone knows that ... there's no plate like chrome for the Hollandaise!"


Burning Mouth Syndrome - Part 3


Dr.Gazala Danish BDS . MDS

Oral Diagnostician and Radiologist

United Arab Emirates


Clinical manifestations

Women experience symptoms of burning mouth syndrome seven times more frequently than men do. 10%-15% of women show these symptoms after menopause. The prevalence is more 3-12 years after menopause.

Burning pain often occurs at more than one oral site.

 Tongue, typically the anterior 1/3rd of the dorsal surface, is most commonly affected followed by the lips. The palate, gingiva and oropharynx are less commonly involved.

According to Main and Baskar, the tongue and upper denture bearing tissues are affected in up to 68% of cases, lips in up to 35%, lower denture bearing tissues in up to 25%, buccal mucosa in up to 20%, oropharynx in up to 8% and floor of the mouth in 4%.

Some authors report that without exception, all patients describe the burning sensation as occuring bilaterally. Most of the patients suffer from the syndrome for a relatively long time, ranging from months up to 18 years. The onset was reported to be gradual for 63% of the subjects and sudden for the others.

If the patient complains of unilateral involvement, the trigeminal neuralgia or other cranial nerve neuralgia should be ruled out as a source of pain. A thorough examination of the mucosa should be done to rule out candidiasis, lichen planus and other mucosal conditions. If the patients complain of burning sensation along with dryness of mouth and says that there is difficulty in swallowing hard food without sipping water along, a thorough examination of salivary glands should be done. When indicated laboratory tests should be done to detect undiagnosed diabetic neuropathy, anemia, deficiencies like iron, folate, Vitamin B12.

Although patients experience a distinct burning sensation, clinical examination often reveals few clinical abnormalities. As a result, most patients have consulted several health care providers in an attempt to find relief.

The burning sensation can be intermittent or continuous. The characteristic feature is that the burning sensation reduces while eating, drinking, placing candy, chewing gum. This is contrast to conditions like neuralgia and other oral mucosal lesions where burning sensation is felt on eating. Generally patients are anxious. Symptoms of depression like loss of appetite, insomnia and loss of interest in daily activities are seen.

Burning pain is constant throughout the day or begins by mid-morning and reaches maximum intensity by early evening, but is not usually present at night and does not disturb sleep (Gorsky et al. 1987, Grushka 1987). Many studies indicate, however that BMS patients have difficulty falling asleep (Grushka 1987, Lamey and Lamb 1988, Zilli et al. 1989).



Goal of treatment

The goal of treatment for BMD is to reduce oral burning symptoms by eliminating the cause(s) of the disorder. Efforts should focus on the identification of factors known to cause oral burning. Initial management should target the correction of identifiable systemic or local oral abnormalities. Secondary lines of treatment address potential neuropathologic mechanisms that may contribute to the oral burning.


Drug choice

Primary line of treatment

When the diagnostic workshop fails to identify the clinical or laboratory abnormality and/or initial therapies are unsuccessful, treatment should be initiated with low doses of neuroleptic agents. Clonazepam (0.25mg to 3mg) taken orally in the evening is effective and helps with depth and breath of sleep. The lowest effective dose should be used. Escalation by 0.25mg on a weekly basis is recommended. Alternatively, chlordiazepoxide may be prescribed.

 Secondary line of treatment

Studies support the use of tricyclic antidepressants in low dosages as the secondary line of therapy for patients with burning neurolgic pain. Norpromine initiated with 10mg at bed time, and escalating by 10mg weekly upto 50mg or until symptoms resolve, had proven benificial. Dosages above 50mg may result in unwanted adverse effects. Although amitriptyline can be prescribed, norpramine is less drying and therefore, advantageous for BMD patients, who also complain of dry mouth. Low dosages of clonazepam combined with norpramine can provide additional improvement.

 Tertiary line of treatment

Gabapentin can provide symptomatic relief in selective BMD patients. Topical capsiacin has been used as desensitizing agent, but may be unpleasant for many BMD patients. 

Topical application of capsiacin for treatment of oral neuropathic pain and trigeminal neuralgia has been reported by Epstein and Marcoe. Capsiacin is found in plants of the Solanaceae (Red pepper) family. Capsiacin enhances the release of and inhibits re-uptake of substance P, which results in depletion of substance P in the central and peripheral nervous system. Desentitization of C-nociceptors has been demonstrated with topical and systemic application of capsiacin.

A short term pilot study conducted by Petruzzi et al. on systemic capsiacin in burning mouth syndrome has given positive results.

An open labeled, dose escalation pilot study of the effect of clonazepam in BMS was conducted by Grushka M, Epstein J and Mott A. the results suggest that clonazepam may be helpful in BMS, in as much as 70% of patients experienced pain reduction with effects at low doses. These findings suggest that the mechanism of action of clonazepam may be specific and separate from the anxiolytic effect of the benzodiazepines and that clonazepam may represent a useful therapy in a subset of patients with BMS.


1)      Bergdahl J, Anneroth G. Burning Mouth Syndrome- Literature review and model for research and management. Oral Pathol Med 1993; 22: 433-38.

2)      Wall PD, Melzack R. Textbook of Pain. 3rd ed. New York: Churchill Livingstone; 1994: 576-77.

3)      Shafer WG, Hine MK, Levy BM. A Textbook of Oral Pathology. 4th ed. Philadeiphia: W B Saunders Company; 1983: 857.

4)      Ploeg HMVD, Wal NVD, Eij KMAJ, Waal VD. Hot tongue Syndrome, Psychological aspects of patients with Burning Mouth Syndrome. Oral Surg Oral Med Oral Pathol 1987; 63: 664-68.

5)      Ell I. Oral Psychophysiology- Stress, Pain and Behavior in Dental Clinics. London: CRC Press; 2000: 100-101.

6)      Greenburg MS, Glich M. Burket’s Oral Medicine and Treatment, 10th ed. Noida: Gopson Papers Limited; 2003: 332-33.

7)      Cibirka RM, Nelson SK, Lefebvre CA. Burning Mouth Syndrome- A review of etiologies. J Prosthet Dent 1997; 78: 93-7.

8)      Whitley BD, Holmes AR, Sheperd MG, Ferguson MM. Peanut sensitivity as a cause of burning mouth. Oral Surg Oral Med Oral Pathol 2001; 72: 671-74.

9)      Lamey PJ, Lamb AB. The usefulness of the HAD scale in assessing anxiety and depression in patients with burning mouth syndrome. Oral Surg Oral Med Oral Pathol 1989; 67: 390-92.

10)  Rhodus NL, Carlson CR, Miller CS. Burning mouth (syndrome) disorder, Quintessence Int 2003; 34: 587-93.

11)  Epstein JB, Marcoe JH. Topical application of capsiacin for treatment of oral neuropathic pain and trigeminal neuralgia. Oral Surg Oral Med Oral Pathol 1994; 77: 135-40.

12)  Petruzzi M, Lauritano D, Benedittis AD, Baldoni M, Serpica R. Systemic Capsiacin for burning mouth syndrome- short-term results of a pilot study. J Oral Pathol Med 2004; 33: 111-14.

13)  Grushka M, Epstein J, Mott A. An open-label, dose escalation pilot study of the effect of clonazepam in burning mouth syndrome. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998; 86: 557-61.









Study finds new evidence of periodontal disease leading to gestational diabetes

                                               A Study A new study by NYU dental researchers has uncovered evidence that pregnant women with periodontal (gum) disease face an increased risk of developing gestational diabetes even if they don't smoke or drink, a finding that underscores how important it is for all expectant mothers – even those without other risk factors – to maintain good oral health. 

                          Dr.Ananda P Dasanayake , Prof of Epidemiology & Health promotion in collaboration with the faculty of Dental Sciences At the university of Peradeniya , Srilanka conducted the study on a population in Sri Lanka. The study was followed by 256 woman @ NY's Bellevue Hospital Center through their first six  months of pregnancy. More than one-third of the women in the new study, which was conducted over the course of one year, reported having bleeding gums when they brushed their teeth. The women were given a dental examination and a glucose challenge test, which is used specifically to screen for gestational diabetes.Gestational diabetes is characterized by an inability to transport glucose -- the main source of fuel for the body -- to the cells during pregnancy. The condition usually disappears when the pregnancy ends, but women who have had gestational diabetes are at a greater risk of developing type 2 diabetes. The study was published in the April edition of journal Of Dental Research.



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DentCare announces its next Implant course in Pune-India

The Next Implant Course by DentCare in Pune will be conducted on 13-14 June (Sat/Sun).

The course is a 2 day program with lectures in the morning (10-1) and surgeries in the evening (2-7).Lecture consists of information about different implant cases, implant systems and implantology in general. This is the only course in India where you get to see 15 live cases said Mr.Promeet Nanda.Adding  he mentioned that the 15 patients all in different stages of the implant - from extraction to implant placement to prosthetic part. The Course will have both 1 and 2 piece Implant systems and participants will also get a phantom mandible to practice on . Each participant will be awarded 2 certificates after completion of the course. (1 from kos & 1 from leone)

Participant can also place the implant under supervision of the faculty. The fee for the course is Rs.20,000/-. A discount is also offered on purchase of implant system and on group bookings.

Contact Mr.Promeet Nanda on 98231-79349 / 26345791/



Research confirms untreated perioontal patients end up paying higher medical bills in Diabetes and storke

               CIGNA (NYSE:CI), a global health services company, dedicated to helping people improve their health, well-being and security in its preliminary results presented at the recent IADR meeting . the study supports the strong association between untreated periodontal disease and the increased medical costs of the patients being treated for diabetes and stroke.The length of the study period was three full years, 2005 to 2007. It included an examination of medical and dental claims of over 30,000 individuals aged 18-62 .The medical cost analysis included 1,136 patients from this group who received treatment for diabetes or cerebrovascular accident (stroke) and received concurrent treatment or maintenance care for gum disease during the three year study period. The individuals in the first group recieved inintial dental treatment for periodontal conditions in the first year of study and the  second groups recieved the treatmet prior to the first year and maintenence in the following years. Lower medical costs were observed in the patients who recieved second group



Inhalation of Sulphuric ether prior to dental extraction - Published 26/June/1847 THe courier -Australia

Sulfuric inhalation application in Dentistry and amputation surgery a revolutionalising discovery.