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About Us
Clinic Profile
Jaipur Dental College
Dental Care
&
Treatments
Glossary
Magazine
HINDI Language
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Dr. Rajendra Tela
Tela Dental Clinic & Research Centre Pvt. Ltd.
Kesar Ganj, Ajmer-305001 (India)
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HIV - AIDS .
Dental Anxiety And Fear .
Dental Care in Pregnancy and Nursing Mothers
Hepatitis .
History of Dentistry .
Hyper Sensitivity .
Neuralgia
Pain .
TMJ (Temporomandibular Joint Disorder) .
Oral SubMucous Fibrosis .
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HIV
AIDS have been the scourge of the world in recent times. It has significant impact on health.
The country is now estimated to have about 3 million people infected with HIV.This infection is on the rise in South Asia and Southeast Asia.By 1990 about half a million people were suffering from AIDS in the world. There is still abysmal ignornance about the disease.
HIV or Human Immunodeficiency Virus is transmitted through contact with blood and other body fluids. This disease was identified in June 1981 and has been the plague of the 20th century. The first virus discovered in the developed world was named as HIV 1 the virus belongs to the Retrovirus Family under the subfamily Lentiviridae. The initial HIV infection progresses into a more severe and debilitating condition where it is associated with a variety of other infections and is called AIDS or Acquired Immunodeficiency Syndrome.
HIV infection can be diagnosed by
- Serology
- Antigen detection
- Co cultivation of the virus
- Molecular biological technique
Out of all diagnostic modalities available today, the serological tests remain the best procedure of HIV diagnosis. Serological tests are the assay that identify antibodies produced as a result of stimulation of the immune sytem of the human host by the viral antigens.
Oral lesions associated with HIV infection and AIDS are :
- Leukoplakia
- Kaposi's sarcoma and
- Candidiasis.
Other than the common oral conditions there will be systemic conditions such as protozoal infections, fungal infections, other viral infections and mycobacterial infections. It is absolutely essential to understand that post exposure protocols must be followed to reduce the probability of seroconversion, by taking antiviral drugs immediately after exposure to a patient infected with HIV.
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| D E N T A L A N X I E T Y A N D F E A R S
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There are patients who continuously cancel appointments, don't come in for checkups and delay necessary treatment until they have a much more serious probIem. People who never see a dentist are the true dental phobics, are very apt to end up toothless!Sometimes no matter how hard we try to prevent, the fear of going to the dentist is there. It can happen for no apparent reason, or as the result of an accident that required difficult and extensive treatment or an earlier unpleasent exprience of a friend or a known person. It's important to avoid this happening in future or at later ages, A chiId's dental experiences have to be as pleasant as possible. Frightened child patients grow up to be fearful adult patients, and that can be detrimental to one's dental health.
With modern equipment and techniques; dentistry is now virtually painless. If you are fearful, tell this to your dentist his first goal is to provide you with the best dental care possible.
You should not hesitate in asking questions about procedures that cause you anxiety. If you know and understand what is going to happen, you'lI have Iess reason ta worry.
Eat a Iight meal before your visit and try not to drink coffee, teas or colas as they stimulate you instead of relaxing you. Eating a rich protein snack will help stabilize your blood sugar and reduce irritability.
Distract yourself in the dental chair by using walkman to listen to the radio or to music you find relaxing. This will muffle noises that may bother you.
To stop a procedure raise your hand (instead of closing your mouth or holding the dentist's hand as that may cause injury to the tissues in the oral cavity). It will make you more confident and itwill give you a chance to ask for more anaesthetic if you feel any discomfort.
The ways you deal with stress outside the dental clinic will work inside too! Try to think of pleasant images, deep breathing or relaxing your muscles one by one.
Some or aII of these techniques may heIp you feeI more at ease but above aII, don't be afraid to ask you dentist to help you overcome your fear and anxiety. When all other means of relieving anxiety fail, Premedication with mild anti anxiety drugs becomes essential. It has to be used cautiously under strict medical supervision, and all side effects should be checked before the drug is taken. It may be used as the last choice for putting a fearful mind at ease. All other ways should be tried before Anti anxiety drugs are used.
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Many pregnant mothers get very worried about their teeth, so here are a few hints which will help you keep your teeth healthy.
- Look after your gums
The gums may bleed when you brush during pregnancy. This is not unusual; during pregnancy, the gums become more sensitive to irritation and bleed more easily. The best way to cope with this problem is to make sure you clean your teeth thoroughly every day. Your dentist will advise you on this and can scale and polish your teeth, which will be a great help.
- Visiting the dentist
Dental check up is good for pregnant women. Make sure you get a checkup in the early months of your pregnancy.
- Can the teeth lose calcium?
No. It is impossible for calcium from your teeth to be drawn off and given to baby. Your growing baby will get calcium from your diet -just make sure you follow your doctor's advice on diet.
- Snacks containing sugar
Avoid sugary snacks between meals. so that you don't gain extra weight and it helps prevent decay.
| DRUGS TO BE AVOIDED IN FIRST TRIMSTER OF PREGNANCY |
ADVERSE EFFECTS |
| IBUPROFEN | TO BE USED WITH CAUTION |
| THALIDOMIDE | PHOCOMELIA |
| CYTOTOXIC | MULTIPLE CONGENITAL EFFECTS |
| WARFERINS | HYPOPLASIA OF NOSE |
| BARBITURATES | POSSIBILITY OF RISK |
| SEX HORMONES | VIRILIZATION OF FEMALE FOETUS |
| ANDROGENS | FEMINIZATION OF MALE FOETUS |
| ESTROGENS | HYPOTROPIC TESTES |
| TETRACYCLINE | STAINING OF TEETH |
| METRONIDAZOLE | MALFORMATION OF FOETUS |
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| COMPARITIVELY SAFER DRUGS IN PREGNANCY | ADVERSE EFFECTS |
| ANTIBIOTICS | PENICILLEN,AMPICILLEN,ERYTHROMYCIN |
| ANTIPYRETIC/ANALGESIC | PARACETAMOL,ASPIRIN(For a short period) |
| ANTITUBERCULAR | ISONIAZID,RIFAMPICIN |
| ANTIMALARIAL | CHLOROQUIN(for a short period) |
| CARDIOVASCULAR | DIGOXIN, HYDRALAZINE, ALPHA-METHYLDOPA, NIFEDIPINE, NITREDEPINE |
| MISCELLANEOUS | INSULIN,BARBITURATES,THIODNACIL(for a short period) |
Nursing mothers
Having a new baby in the home certainly causes a commotion - frequent feeds and a whole new routine to get used to. As you are probably overtired, here is some dental advice which is very simple and won't upset the daily routine.
- Feeding
If you give the baby fruit juice, always dilute it with water. Never let your baby suck,
- it's a sure way to get dental decay Never put your baby to bed with a bottle containing fruitjuice or milk
- Teething
Teething can cause problems and your baby can become quite irritable There are several preparation available in the market which can work as teethers . Your dentist or doctor will be able to advise you on the appropriate pain relievers and relaxants which will help your baby and you get a good night's sleep. The age at which the baby teeth come through is very variable - but the first one usually comes through at six months and, by 2.5 to 3, all 20 teeth will be in the mouth.
- Toothbrushing
Let baby watch you brush. Children love copying. As soon as four front teeth are through, put a smear of toothpaste on a brush and let him/her play with the toothbrush. It is important to try and encourage the toothbrushing routine from an early age.
- Look after yourself
Although you are very busy, don't neglect your own teeth. Have a check up done. 5. Fluoride
Fluoride gives your child unbeatable protection against germs and cavities, so let your child use a toothpaste containing fluoride.
- Baby teeth
Some of the baby teeth will last till the age of 11 and they are important in helping to make sure that the second teeth come in correct position, so make sure you help your child to look after them.
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HEPATITIS-B
Hepatitis-B is a disease of liver caused by the infection of the Hepatitis B virus. It is also known as the Australian Antigen and it's only natural host is man. It is atleast 100 times more infectious than HIV. This virus causes destruction of liver tissue and may lead to Hepatocellular Carcinoma in later life. Hepatitis B is prevalent throughout the world particularly in Africa and Asia and reported to be leading killer as every 2 million deaths are reported.
It is reported that one in every 20 people in India is a carrier of this deadly virus. Approximately 49-68% of chronic liver disease. 80% of all liver cancers and about 1% of all adult deaths can be traced to Hepatitis B.
India has second largest pool of carriers in the world i.e. 43 million chronic carriers out of which 10% are highly infectious.
Hepatitis C virus or the parenterally transmitted non-A-non-B virus is an RNA virus, usually seen in association with blood transfusions and contact with blood and other body fluids. Over 60% of the infected may develop chronic liver disease.
PEOPLE AT RISK?
- High Risk
Due to profession Dental, medical and paramedical personnel because their profession exposes them to the risk of dealing with blood and body fluids of patients who may be carriers.
Due to illness
- Patient like Thalassemics and Haemophillies who receive blood related products.
- Patients on dialysis.
Due to sexual or social habits
- Heterosexual with multiple sex partners
- Homosexuals and prostitutes.
- Intravenous drug users.
- People who undergo tattooing.
Others
- Infants born to Hepatitis-B infected mothers.
- Family members of Hepatitis-B carriers.
Modes of transmission This virus is primarily transmitted through infected blood, saliva, semen, tears, vaginal secretions and sweat.
HBV is transmitted both percutaneously and nonpercutaneously.
Percutaneously through cut and open wound.
Nonpercutaneous transmission includes transfer of infectious bodily secretions, such as saliva, blood and crevicular fluid.
Major routes of transmission
- Perenteral / Percutaneous
During transfusion of infected blood and through infected needles.
- Horizontal
Between person to person because of accidental contact.
- Vertical
From infected mother to child.
- Sexual
Between sexual partners.
Course of infection
Incubation period between 40 - 180 days and onset is gradual. Once an individual is infected 90% develop acute Hepatitis B.
Symptoms
- General Malaise
- Nausea
- Vomiting
- Fever
- Headache
- Fatigue
- Anoerxia
- Abdominal Pain
In many patients the disease is not accompanied by jaundice while minority develop significant jaundice. Most patients recovers uneventfully but in a few patients the disease follows as severe course known as fulminant Hepatitis.
Risk of developing of fulminant Hepatitis are:
- Age more than 60 days
- Females
- Pregnancy
- Recurrent infections
- Immuno-compromised state
DIAGNOSIS is done by Serological tests.
TREATMENT
There is no effective treatment. The only treatment reported with variable succes is through the use of Interferons.
PREVENTION
- Stringent screening procedure of blood in blood banks.
- Use of disposable syringes and needles.
- Wearing of masks and gowns by Medical and Paramedical personnel.
- Proper sterilization of medical equipment.
- Practice of safe sex.
- Routine Hepatitis B vaccination.
It is heartning to mention that many Philanthropic Organisations have started organising Hepatitis B vaccination camps for masses as they have realised this menace should be tackled at national level making it a mass movement. Prevention of transmission through immunophylaxis. There is is no cure for this infection. The only solution is prevention.
Prevention may be achieved by one of the two means:
a) Active immunization through the administration of a vaccine against Hepatitis B.
b) Passive immunization through the administration of a Hepatits B Immunoglobulin (HBIG)
The vaccine available are:
- Plasma derived vaccines.
- Genetically Engineered vaccines.
- Engerix-B - Should be injected intra-muscularly.
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The history of dentistry is as old as the history of man. There is evidence of tooth decay in skulls of Cro-Magnon people who inhabited the earth 25,000 years ago.The earliest recorded reference to oral disease is from an ancient (5000 BC) Sumerian text which describes "tooth worms" as the cause of tooth decay.
The Ebers Papyrus written between the 1700 and 1500 BC contains references to prescriptions for substances such as olive oils, dates, onions, beans and green lead to be mixed and applied "against the throbbing of the bennut blisters in the teeth".
Aesculapius, a Greek physician, who lived between 1300-1200 BC is credited with the concept of extracting diseased teeth. Hippocrates and Aristotle (500-300BC) wrote of ointments and cautery with a red hot wire to treat diseases of teeth and oral tissues. Prehistoric Era (around A. D. 1000)
It has been traced that endosseous implantation of animal teeth and artificial teeth carved of ivory was performed on court women of the ancient Egyptian dynasties.
History goes baczk to 6Q0 A.D.; when implant denitistry was practiced by Mayas in the region af modern Honduras.
In 1931, Dr. and Mrs. Wilson Popenae while excavating at the Playa de los Muertos in the Ulva RYer ' Valley of Honduras discovered a skull of Mayan oiigin with three tooth shaped pieces of shell implanted in the Sockets -of missing lowerincisors.
In 1862 Gaillardot on excavation of a grave site near the ancient city of Sidon discovered a prosthodontic appliance dating to 400 B.C., consisting of four natural lower teeth holding between them two carved ivory teeth as replacements for two missing incisors, all held together by gold wire.
Albucasis also known as Abdul kasim an Arab Surgeon (936-1013) fabricated implants made from ox bone.
From the middle ages to the early 1700s much dental therapy was provided by the so-called "barber surgeons". During the l8th century, France led the Dental field and Pierre Fauchard was given the retrospective title of "The Father of Dentistry" for his comprehensive work `Le Chiururgien Dentiste', which covered almost everything connected with the subject of dentistry in the l8th century.
Greene Vardiman Black (1831-1915) was the leading reformer of American dentistry who devised the foot driven drill, standardised cavity preparation and amalgam manufacture in 1895.People had a great fear in mind about dentist's as treating methods were very crude and painful.
It is obvious that as the need for dentistry escalated with social development, the role of a dentist evolved from a trade or craft governed by a guild to a sophisticated profession.
HISTORY OF DENTISTRY IN INDIA
Most of our knowledge of early Indian dental treatment comes from the Sushruta Samhita (Sushruta collection). According to Sushrutha, tumours and other growths of the palate and over the wisdom teeth were excised rather than cauterized. He considered cauterization was the best method for the treatment of a tumour on the gums or tongue. A surgeon in ancient India was using a specially designed iron tool, whose flattened ovoid end was heated red hot: Similarly fluids like honey oil or wax brought to the boiling point were also used to Cauterize the oral tumors.
The fractures of the jaws were treated by complicated bandaging. Mandibular dislocations were reduced by heating the region around the joint and the jaw was brought into its correct position. A light bandage was applied under the chin and a drug was administered to drive out the evil wind.
Caries was more prevalent in the upper class of people, probably due to their diet, which was rich in carbohydrates.
According to Vagbhata, filling of the cavity in a carious tooth with wax and then burning it out with a heated probe, was the ideal treatment. If this failed to relieve the pain, he recommended the extraction of such teeth by using a specially designed forceps, the beaks of which were shaped like an animals head.
The surgical instruments as described by Sushrutha, were of two kinds i.e. Yantra or `blunt' and sahstra or `sharp'. As mentioned in his (Sushrutha's) work, there were about one hundred and one (101) Yantras. Furthermore, there was a special forceps called as danta sanka for the extraction of teeth. However, Sushrutha preferred to extract the mobile teeth with a specially designed arrow shaped forceps with a flattened tip.
According to Vagbhata, the teeth appear in the eighth month or later if the child is healthy. If children suffered from pain caused by teething at an early age, their devlopment cannot be normal.
Sushrutha and Vagbhata advocated the need for removing calculus from the teeth using a special instrument.
Even in ancient times, Indians never liked to use the brushes made of animal hairs. They considered such brushes rather unhygienic and barbaric. They used to use wooden twigs of Neem,Babool, miswak and other trees with medicinal properties called "datun" twig always varied according to the time of the year and the user's temperament. Similarly, the length of the twig ideally about 6 inches but also varied according to the user's choice. One end of the twig, crushed, liberating an extract being bitter but having astringent quality. The crushed end resembling like a brush was being used for cleaning the teeth. Aromatic herbs and spices were used for rinsing the mouth.
Infact Indian Medicine was so well known that even Greek doctors were familiar with Indian mouth washes for bad breath. In "On Diseases of Women", Hippocrates describes an "Indian preparation" made by pounding together Anise, Dill and Myrrh in white wine.
Both medical and religious beliefs have done much to focus the attention of the Indians on their teeth. Maintenance of oral hygiene was part of daily ritual for the Indians who considered the mouth to be the gateway to the body and therefore insisted that it should be kept clean.
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Hypersensitivity is a common intermittent chronic sensation affecting, people when they eat, drink, touch their teeth, or when there is a cotd blast of air.The may cause psychological tension that can further reduce the tolerance threshhold.
Causes
Sensitivity is not encountered in teeth where the enamel and cementum are intact. When the underlying dentin is exposed by enamel loss or denudation of root surface, it can lead to dentin hyper sensitivity.
- Enamel loss (occlusal wear) - Dietary erosion
- Toothbrush abrasion:
- Aging
- Gingival recession
- Incorrect tooth brushing habits
- Tooth abnormally positioned in the arch.
- Chronic periodontal disease
- Periodontal surgery Root preparation.
- Treatment depends on:
- Age
- Oral hygiene
- Diet (Frequency of ingestion of acidic foods and beverages(COLAS)
- Chemical
- Antiinflaammatory e.g. silver nitrate, zinc chloride
- Tubule occluding e.g: strontium chloride
- Tubule sealants e.g. - Calcium hydroxide, potassium nitrate, fluorides, fluoride iontophoresis and potassium oxalate.
- Physical agents
- Composite resins
- Glass
- Ionomers
- Varnishes
- Sealants
- Soft tissue grafts
- Laser sealing of the tubules
- Other approaches
Once the cause of hypersensitivity is ascertained; explain the problem and its causes to the patient. Correct any preventable causes like, accumulation of plaque excessive tooth brushing with a hard tooth brush, and periodontal disease. if the patient has a high frequency of ingestion of acidic foods and beverages(COLAS), nutritional counselling should be part of the treatment. A tooth paste containing potassium nitrate should be advised for a 2 to 6 weeks trial. Most patients respond well to this initial treatment, which can be assessed in about four weeks.
If the teeth remain sensitive after the initial treatment, use clinical treatment with potassium oxalate solution, sodium fluoride or calcium hydroxide.
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The pain of neuralgia is described as intense, sharp, stabbing, burning, or electric like.It is typically unilateral. The trigeminal and glossopharyngeal cranial nerves are most frequently involved in paroxysmal neuralgia of the orofacial region.Its duration may be from a few seconds to minutes, and there may be a refractory period between attacks. Neuralgic pain is episodic. Attacks may occur for a few weeks or months and then enter a period of remission, which may last months or years.
- Greater Occipital Entrapment Neuropathy
- It is a potential source for head pain. Inflammation or entrapment of this nerve results in referral of moderate to severe frontal headache, which may simulate migraine headache. It may be relieved by anesthetic block.
- Trigeminal Neuralgla
- It was first discribed by John Locke in 1677.
It is commonly referred to as tic douloureux,It is a paroxysmal facial pain disorder that occurs unilaterally in the distribution of the trigeminal nerve. It usually begins after age 40 and involves women more than men in a 3:2 ratio. The mandibular division is most frequently involved followed by the maxillary division.
CAUSES
- Majority of cases are idiopathic.
- Compression of root of trigeminal nerve due to pathological lesions.
- Glossopharyngeal Neuralgias
- It is a rare condition that occurs in its somatosensory branches and the vagus nerve. Men and women are equally represented. The pain of glossopharyngeal neuralgia is felt in the ear, pharynx, tonsil, and retromandibular areas. Although similar in quality to trigeminal neuralgia, it may not be as severe and cutaneous, and mucosal trigger points are rare. Chewing, talking, and swallowing, especially cold liquids, may precipitate the pain.
TREATMENT
Medical Treatment
Many drugs like Baclofen, Carbamazepine, Phenytoin, Chlorphenesin, Tizanidine, etc. are used for treatment for neuralgia.
Destructive Procedures
A.Injection of Alcohal,Hot water,Phenol in wax or glycerene along the Trigeminal Nerve pathway, or Gasserian Ganglion produces releif in pain.
Surgical Treatment(Peripheral Neurectomy)
Between 25 to 50 percent of patients eventually fail on drug therapy and need neurosurgical treatment like Local Avulsion of peripheral nerves and wide section of sensory roots of the trigeminal nerves.
Radio Frequency Rhizotomy(Thermocoagulation)
It is done placing an electrode under radiographic control in the root of trigeminal nerve
MicroVascular Compression is done by compressing the trigeminal root closed by the brain stem. For this a formal craniotomy is required.
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TOOTHACHE (Pain that can spread right across the face)
Common symptoms and causes
- Infection of a tooth
- Pain starts as a mild throb, but within hours seems to involve half of your face and several teeth; the affected tooth is tender when you bite on it and sensitive to hot or cold drinks; after a few hours, the part of your jaw or face nearest to the affected tooth swells.
- Sinusitis
- A feeling of pressure and pain across the upper face following a cold; worse on bending forwards; often accompanied by aching in several upper teeth and the loss of smell and taste.
- Bruxism
- People under stress often clench their teeth during sleep, and wake with discomfort in several teeth rather than pain in a single tooth.
- Less likely symptoms and causes
- Toothache is usually unmistakable; neuralgia is a possibility if there is recurrent, stabbing pain that lasts only a few seconds each time. Gingivitis (inflammation of the gums) causes recurrent tenderness of the gums and bleeding when the teeth are brushed.
FACIAL PAIN (Pain affecting the whole face)
Common symptoms and causes
- Neuralgia
- Sudden pain is easier to diagnose than recurrent chronic pain. Nagging pain without other symptoms.
- Sinusits
- Pain above, below or behind the eyes, accompanying a cold; worse on leaning forwards.
- Dental pain
- Recurring facial ache, followed by nausea, headache, flashing lights in the eyes - migraine. Tender teeth or gums; throbbing pain.
- Tempero-Mandibular joint pain
- Pain when biting or chewing in the joint where the upper and lower jaws hinge together in front of the ear.
- Shingles
- A crusted rash forms across the face after several days of pain and tingling.
- Less likely symptoms and causes
- Facial nerve palsy (Bell's palsy): the face suddenly droops on one side, there is an ache rather than pain. Trigeminal neuralgia: recurrent brief pains shoot across face. Tumours of the sinuses, nose or ears: pain lasts for weeks, the face swells.
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The jaw joint or TMJ is the joint by which the lower jaw bone is connected to the upper jaw. The joint movement can be felt by placing a finger infront of the ear while opening and closing the mouth.The temporomandibular joint (TMJ) is a joint that slides and rotates just in front of your ear, consisting of the temporal bone (side and base of the skull) and the mandible (lower jaw). Mastication (chewing) muscles connect the lower jaw to the skull, allowing you to move your jaw forward, sideways, and open and close.
The joint works properly when the lower jaw and its joint (both the right and left) are synchronized during movement. Temporomandibular Disorder (TMD) may occur when the jaw twists during opening, closing or side-motion movements. These movements affect the jaw joint and the muscles that control chewing.
What is Temporomandibular Disorder?
TMD describes a variety of conditions that affect jaw muscles, temporomandibular joints, and nerves associated with chronic facial pain. Symptoms may occur on one or both sides of the face, head or jaw, or develop after an injury. TMD affects more than twice as many women than men and is the most common non-dental related chronic orofacial pain.
SYMPTOMS
- Locked or stiff jaw when you talk, yawn or eat.
- Jaw pain or soreness that is more prevalent in the morning or late afternoon.
- Jaw pain when you chew, bite or yawn.
- Clicking when opening and closing your mouth.
- Difficulty opening and closing your mouth.
- Sensitive teeth when no dental problems can be found.
- An earache without an infection.
DIAGNOSIS These disorders are diagonised by X-Rays, Arthography and MRI (Magnetic Resonance Imaging).
- CLICKING
- This is considered normal but if it becomes painful or the sound becomes too loud, then requires to be treated. Clicking is due to displacement of Miniscus disc within the joint. Pain can be referred to nearby structures such as ear, nose, teeth, temple and eyes.
CAUSES
- Injury to the jaw.
- Long standing TMJ muscle dysfunction
- Jaw deformity
- Loss of many posterior teeth
- Bruxism
- Mental stress and anxiety
TREATMENT
- Surgical - Repositioning of Miniscus disc.
- Medicinal - By giving Analgesics (pain killers), Muscle relaxants and Anti-inflammatory drugs.
- TMJ Exercises
- Wearing of Night Guards
- Treatment of Mental Stress and Anxiety
- Dentures wearers should ensure that they wear a properly fitted prosthesis with a perfect bite.
- ANKYLOSIS (CLOSED LOCK)
- When the mouth opening is less than 35mm it is considered abnormal.
CAUSES
- Inflammatory - a. Juvenile, b. Rheumatoid Arthritias
- Trauma
- Infection
TREATMENT - Arthroscopy.
- DISLOCATION OF TMJ (OPEN LOCK)
- When the jaw opens far too wide and cannot be closed, it is known as Open Lock or Dislocation of TMJ.It can be corrected by the patients on their own or by the dentist. But in cases of pain surgical intervention is needed i.e. Arthroscopy.In recurrent dislocation cases Injection of BOTULINUM TOXIN TypeA (BTA)are given in external pterygoid muscle and the superficial part of the masseter muscle.
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It is a condition very common in India and 9 out of 10,000 people are suffering from this and this number is increasing day by day. The first case was noticed by Amesur in Karachi as far back as 1929, This disease affects any part of the oral cavity like cheek, retromolar triangle, soft palate,uvula, base of the tongue and lips including vermilion border and some times the pharynx, occasionally preceded by vesicle formation, always associated with fibrous bands fibro elastic change leading to stiffness of the oral mucosa, trismus and inability to eat."
CAUSES
The aetiology of the disease is obscure but researchers have now clearly established that oral habits including Betelnut, Tobacco, Pan, Gutka. Pan Masala chewing and eating of spices chillies.
SYMPTOMS
- Restricted mouth opening.
- Burning sensation in the mouth.
- Whitish colour change of the oral mucosa.
- Restricted protrusion of the tongue.
- Restricted retrusion of the tongue.
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Restricted mouth opening |
TREATMENTS
- There is no specific therapy, though various treatment modalities have so far been tried with varying degree of success, such as:
- Injection of cortisones
- Collagenase enzymes
- Injection of Placentrex"
- Application of 4% Acetic Acid (vinegar).
- Injection of Vit C.
- Inj. of whole Liver Extract.
The corticosteroids play a definite role in relieving the symptoms in the early stage of the disease, but, there is a relapse after the withdrawal of the drug. Moreover, cortisone has its own hazards if used for a long period of time. Hyaluronidase is a valuable drug but its prolonged use may cause degeneration of the neighbouring tissues. The use of Placentrex has certainly proved helpful in alleviating the symptoms with almost no side effects,but is not capable of providing complete relief. Many a times a combination of above mentioned drugs is used and results have shown considerable improvement. But most important of all treatments is to give the habits causing this dreaded disease.
The disease is not fatal in itself unless it is influenced by carcinomatous involvements. The normal mouth function is impaired due to the disease which causes starvation. It also has a serious effect on oral hygiene and makes dental treatment very difficult and at times virtually impossible 'SUB MUCOUS FIBROSIS is considered a PRECANCEROUS LESION hence habits causing this should be discouraged.
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