DentistryUnited @ Rank
Laughter - The best
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
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.
dentists would play a major role in systemic diseases diagnosis and
I hope you
enjoy this issue of Dental Follicle.
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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
Burning Mouth Syndrome - Part 3
Dr.Gazala Danish BDS . MDS
Oral Diagnostician and Radiologist
United Arab Emirates
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
pain often occurs at more than one oral site.
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%.
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.
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.
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.
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.
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.
Primary line of treatment
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
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
term pilot study conducted by Petruzzi et al. on systemic capsiacin
in burning mouth syndrome has given positive results.
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.
Bergdahl J, Anneroth G. Burning Mouth Syndrome- Literature
review and model for research and management. Oral Pathol Med 1993;
Wall PD, Melzack R. Textbook of Pain. 3rd ed. New
York: Churchill Livingstone; 1994: 576-77.
Shafer WG, Hine MK, Levy BM. A Textbook of Oral Pathology. 4th
ed. Philadeiphia: W B Saunders Company; 1983: 857.
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.
Ell I. Oral Psychophysiology- Stress, Pain and Behavior in
Dental Clinics. London: CRC Press; 2000: 100-101.
Greenburg MS, Glich M. Burket’s Oral Medicine and Treatment,
10th ed. Noida: Gopson Papers Limited; 2003: 332-33.
Cibirka RM, Nelson SK, Lefebvre CA. Burning Mouth Syndrome- A
review of etiologies. J Prosthet Dent 1997; 78: 93-7.
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.
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.
Rhodus NL, Carlson CR, Miller CS. Burning mouth (syndrome)
disorder, Quintessence Int 2003; 34: 587-93.
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.
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.
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
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
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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/ firstname.lastname@example.org
Research confirms untreated
perioontal patients end up paying higher medical bills in Diabetes
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
inhalation application in Dentistry and amputation surgery a