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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     March   2009

                      

In this Issue:

  • Editorial

  • News

  • DentistryUnited @ Rank 3 on GOOGLE

  • Laughter - The best Medicine

  • Burning Mouth Syndrome - Part 2  - Dr.Gazala Danish . United Arab Emirates

  • HPV16 Oral Cancer Link Tied to E6 and E7 Oncogenes

  • Dentists Say Bad Economy Is Causing Tooth Pain

  • General harrison looses a tooth - the New York Times -Published sep/07/1895

www.DentalFollicle.com under Construction

Editorial :

      Dear Fellow Dentist,

                                        It was the evening of 28th November 2008 , I was sitting in my Dental Office  " Smile Maker" when I received  a call from a patient of mine. He said, Hey doc , look up the sky , its smiling at you. I was like - what exactly this good gentleman means by it . But I did turn to my window and I captured it on my Olympus what I saw there.

                                       India had just come out of the catastrophe that had hit its financial capital Mumbai and indeed we were looking for a better day. The smile in the sky indeed was a "Smile Maker" for all of us. I read in newspaper later that it was Venus, Mars and the crescent that was positioned to smile at us.

                                         Getting you some articles which may help you all make your patients smile is this edition of Dental Follicle. I hope you enjoy this issue.

 

Please  add Info(at)dentistryunited.com  / dentistryunited(at)gmail.com to your friends list in e- mail in box settings.

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Yours truly

Dr. Syed  Nabeel

Editor of Dental Follicle & WebMaster www.DentistryUnited.com

 

         

 

          DentistryUnited Ranks 3 on Google  for key word "Dentistry"

 

 

Laughter - The Best Medicine :

 What's the difference between a dentist and a New York Yankee fan?
A: One yanks for the roots and the other roots for the Yanks.

 

Burning Mouth Syndrome - Part 2

 

Dr.Gazala Danish BDS . MDS

Oral Diagnostician and Radiologist

United Arab Emirates

   Systemic factors
                                  Deficiency diseases, hormonal and immunologic disturbances and pharmacotherapeutic side effects have been implicated in producing burning mouth syndrome symptoms.


                                  Deficiency diseases- iron deficiency anemia, vitamin B12, B1, B2, B6 deficiencies, folic acid deficiency.
                               

                           Perimenopausal and postmenopausal women demonstrated estrogen deficiency which were diagnosed with oral symptoms of burning alone (43%), strange tastes (27%) and both (30%).


                                  Grushka et al. found nearly 50% of patients with BMS were found to have some clinically evident immunologically mediated disease. Antinuclear antibody and rheumatoid factor imbalances were noted. HIV and AIDS afflictions have also been correlated with BMS. Xerostomia has also been reported as a frequent symptom in patients with immunologic disorders and has been associated with the diagnosis of BMS.

       Psychogenic factors
                                       
After deficiency disorders, depression has been noted as the next most frequent etiologic factor. Browing et al. found that 44% of patients with BMS demonstrated a psychiatric diagnosis of which depression and generalized anxiety were the two most common diagnoses. A complex spectrum of social and psychological disturbances were found in patients with BMS with linked diagnoses. Cancerphobia and anxiety have been documented as etiologic factors.


                     A study conducted by Lamey and Lamb on 74 patients using Hospital Anxiety and Depression (HAD) scale found that the somatic symptoms of burning mouth are at least partly the psychological result of restlessness, tension and an inherent to relax.

        Other etiologic factors
Many alternative causes have been proposed for the burning mouth symptoms experienced by patients, inclusive of inflammed lymphoid tissue within the lingual foliate papillae, temporal or giant cell arteritis, myeloblastic syndrome, reflux esophagitis, acoustic nerve neuroma and referred myofacial pain. However, no direct causal relationship to these factors has been supported.

Contributing factors of oral burning sensations

Condition

Features associated with oral burning

Evaluation

Therapy

 

 

Common

 

Candidiasis

Visible atrophic, erythematous or speudomembranous lesions

Fungal culture from oral swab or collected saliva

If culture is positive treat with antifungal medication

 

 

Drugs

Use of antihypertensive, antidepressants drugs, onset related to prescription

Review of medications and identify potential adverse effects

If xerostomic drug or ACE inhibitor taken, consult with physician to change medication

 

Hyposalivation

Fissured tongue, cervical caries, altered taste, enlarged major salivary glands, difficulty in swallowing food, mouth breathing

Expectorated salivary flow rate

If low, rule out medications and Sjogrenís syndrome. Institute protocol to alleviate low salivary flow (Eg; sialogogues) and complications

 

Mucosal disturbance

White, red or ulcerative mucosal lesion present

Clinical examination

If mucosal abnormality is identified, biopsy to obtain histologic diagnosis

 

Diabetes mellitus

Dry mouth, frequent urination, change in weight, parasthesia, blurred vision

Fasting blood glucose

If > or =126mg/dl, refer to endocrinologist

 

 

Nutritional deficiency

Fatigue, skin pallor, atrophic mucosa, bald tongue

Complete blood count (CBC), vitamin B levels

If anemic, consult with physician to rule out deficiency states and endocrinopathies

 

Less common

 

Gastroesophageal reflux disorder (GERD)

History of stomach acid reflux, erosion of tooth enamel

Gastric reflux studies

If abnormal, refer to physician for appropriate treatment

 

Hypersensitivity

White or red mucosal lesion or ulcer

Allergy testing by physician

Eliminate allergen from oral environment

 

Oral prosthesis

Traumatic ulcer or lesion adjacent to prosthetic defect

Clinical examination

Correct defect or fabricate new prosthesis

 

Parafunctional habit

Tooth clenching, attrition, sharp enamel edges of incisors, scalloped tongue, lip licking, lip pressure

 

Clinical examination

Awareness and habit elimination, bite guard

Psychologic

Potential or elevated level of anxiety, depression or somatization

Psychometric screening

If abnormal, obtain psychologic evaluation


 

                                                                                                    To Be Continued  -

 

             

  

 

 

 

 

 

HPV16 Oral Cancer Link Tied to E6 and E7 Oncogenes
 

                                               The Journal of notional cancer institute in its March 18th issue reported " Repressing E6 and E7 oncogene expression on the malignant phenotype of human papillomavirus (HPV)-16-positive oropharyngeal cancer cell lines induces apoptosis" .The team found that by using retroviruses that expressed short hairpin (sh) RNA targeting the E6 and E7 genes, they were able to infect human oropharyngeal squamous cell cancer harboring integrated HPV-16 DNA. Control cells were exposed to scrambled-sequence shRNA. There was a greater than 85% reduction in E6 and E7 mRNA levels and restoration of p53 and retinoblastoma protein expression in the targeted cells. Moreover, apoptosis, which was as low as 3.3% in controls, reached as much as 84.3% in infected lines. The role of HPV-16 in disabling the supressor pathways may have the potential to treat these cancers.

 

 

 

 

 

 

Dentists Say Bad Economy Is Causing Tooth Pain

               Dentists across Massachusetts have reported that more and more patients are reporting with teeth attrition since the days of recession have started. The nations recession has started showing signs on oral health. Dental attrition which could further lead to associated problems like headaches and TMD's are the next big worries people could face.

                     Further such oral findings by our esteemed readers of Dental Follicle could take this story further.

           

    

General harrison looses a tooth - the New York Times -Published sep/07/1895

Surgical removal of an impacted tooth has been an issue of concern among patients. Such was the situation in 1895 where removal of an impacted tooth to was a headline.