Wednesday, December 9, 1998

Trauma of brittle bones
Menopause is a period which is dreaded by all women not only because one gets grey hair, wrinkled skin, loose teeth and overall weakness but because of the series of internal changes which take place in the body of a woman due to the depletion of an important hormone — oestrogen.

Laser-treated teeth
All forms of light are electromagnetic waves of varying lengths. It is this "wave length" which determines the colour of the light. Laser light is an artificial form of light, and all its waves are identical

Polio should cripple no more

Poliomyelitis, also called polio, is a serious infection caused by a virus. The disease is sometimes called infantile paralysis because it may strike infants or children and lead to paralysis. In the past, epidemics of polio were common and were greatly feared because the disease left many of its victims paralysed for life. In the 1950's, however, a vaccine against the disease was introduced. Since then, polio has been nearly eliminated in developed countries.

Kinds of poliomyelitis: A polio virus may attack the nerve cells of the brain and the spinal cord, causing paralysis. However, infection by a polio virus does not always result in severe illness. Some patients show only mild symptoms, such as fever, headache, sore throat and vomiting. These symptoms may disappear after about 24 hours. Such symptoms are common in many kinds of ailments, and the doctor may not be able to diagnose the illness definitely as polio.

Severe polio attacks begin with the same symptoms as the mild attacks. The symptoms, however, do not disappear. Stiffness of the neck and back develops. The muscles become weak, and movement is difficult. Pain may occur in the back and legs, especially when these parts are stretched or straightened. If paralysis develops, the person may not be able to stand or walk.

Most people who develop polio do not become permanently paralysed. Paralysis can occur in many degrees and combinations. Spinal poliomyelitis is probably the most common form of polio. It occurs when polio viruses attack the nerve cells that control the muscles of the legs, arms, trunk, diaphragm, abdomen and pelvis. Bulbar paralysis is the most serious form of the disease. It results from damage to the nerve cells of the brain stem. Some of these nerves control the muscles for swallowing and for moving the eyes, tongue, face, and neck. The nerves that control breathing and the circulation of body fluids may also be affected.

Some polio patients suffer new symptoms about 30 years or more after the initial attack. These symptoms include fatigue, muscle weakness, pain in the joints, and difficulty in breathing. Doctors are not sure what causes this condition, called post-polio syndrome.

Cause of poliomyelitis: There are three viruses that cause polio. They are called types 1, II and III.

Polio viruses can grow only in living cells. They get into the body through the nose and mouth and are carried to the intestines. Then they travel along the nerve fibres or are carried by the blood to the central nervous system. There, they enter a nerve cell and multiply so rapidly that they damage or kill the cell. Paralysis results when many cells are destroyed.

Scientists do not know exactly how polio spreads or why epidemics occur. Most authorities believe that the virus spreads from the nose, throat and intestines of infected people. People who become infected by the virus do not always get polio. The virus has been found in apparently healthy people, especially during epidemics.

Prevention of poliomyelitis: There are two polio vaccines, and both protect against all three types of polio viruses. The first vaccine, developed by the American researcher Jonas E. Salk, is given by means of injection. It was declared safe and effective in 1955. The other polio vaccine was developed by Albert B. Sabin, another American researcher. It came into use in the early 1960's. The Sabin vaccine is an oral vaccine — that is, it can be taken by mouth.

Doctors recommend vaccination against polio early in life. Polio vaccine is typically administered in four doses — at two months of age, four months, 18 months, and just before children enter school, at four to six years of age.

Treatment of poliomyelitis: No drug has yet been found that can kill the polio virus or control its spread in the body. But the degree of recovery of many patients depends on immediate medical attention and good nursing care.

Complete rest in bed is perhaps the most important treatment. Doctors believe that fatigue may make the disease more severe. They use simple treatments, such as hot, moist bandages, to relieve pain. After the fever goes down, physiotherapists may gently move the patient's limbs to prevent deformities and painful tightening of the muscles. Later, more intensive exercises help strengthen and retrain the muscles. Even extensively paralysed patients can often develop enough movement to carry on many activities. Less severely disabled people usually resume most of their previous activities. Some may need splints, braces, or crutches to help them move about.

When breathing muscles are paralysed, doctors may use a mechanical device such as a respirator to help the patient breathe. About two-thirds of such patients recover their natural breathing. (Next week: What is immunisation?)

Courtesy: Scott Fetzer Company, Sydney

Trauma of brittle bones
By Dr Kanwarjit Kochhar

Menopause is a period which is dreaded by all women not only because one gets grey hair, wrinkled skin, loose teeth and overall weakness but because of the series of internal changes which take place in the body of a woman due to the depletion of an important hormone — oestrogen. The most common problems faced by women after menopause are osteoporosis leading to fractures, coronary heart disease, Alzheimer's disease and dementia, causing depression and inability to think and make decisions.

Out of all these, osteoporosis is the most common factor. It is responsible for the highest rate of morbidity and mortality — 25% of the patients die within 12 months and at least 50% are unable to walk independently and return to the lifestyle to which they were accustomed previously.

According to reports in 1985, in the UK over 43,000 people suffered hip fractures. Approximately 4000 National Health Service Hospital beds are occupied daily by hip fracture cases and 500 million pounds is the estimated annual patient management cost. In the USA and Canada, it affects more than 25 million women above 45 years of age. In the States, it is estimated conservatively, that it costs $ 10 billion annually to care for and rehabilitate women who suffer from this disease.

Menopause and osteoporosis are directly proportionate to each other. It is not that osteoporosis does not affect men in their old age but women are more prone to it. It will not be wrong to say that one out of every two women suffers from osteoporosis after menopause.

Osteoporosis literally means porous bones, weak bones or fragile bones. It is a silent disease which makes bones fragile and prone to fracture. To be more precise, menopause without osteoporosis will be much less dreadful. Osteoporosis is caused due to a reduction in the bone mass as the age increases. The maximum bone mass occurs between 20 and 30 years of age. After 30, the bone mass gradually decreases. In women, after menopause, the bone mass shrinks faster. This increases the risk of fractures. Besides fractures, osteoporosis also causes a stooped posture, chronic pain and disability.

In most cases, there are no symptoms at all; it progresses painlessly until the bones become so fragile that even routine activities like coughing or sneezing can cause a fracture. This disease is more common among women than a stroke, a heart attack and breast cancer combined.

Fractures of the hip spine and the wrist are the most common consequences. Hip fracture is more serious because the patient becomes bed-ridden and is unable to move freely. This, in turn, can lead to bed sores and other complications.

When the spine is affected, a simple action like bending or making the bed can be enough to cause a "crush fracture". This causes humped back, decreased height and chronic pain. A fall that would just sprain the average person can easily break one or more bones in the body with severe osteoporosis.

Risk factors such as aging, excessive alcohol intake, renal disease, immobilisation, corticosteroid therapy and a life-time diet low in calcium and vitamin D can affect both sexes. Small, thin-boned women are at greater risk than normal or overweight women.

Another factor in the causation of osteoporosis is increased longevity in men and women. The average age of menopause is about 50 years. The average age of women in India is 62. This means that women spend about one sixth of their life in the menopausal period.

It is difficult to diagnose osteoporosis. X-rays are useful at imaging changes as a result of fractures, but they are insensitive to changes in bone density as 30% of the bones must be lost before osteoporosis becomes radiologically apparent.

The bone mineral density test can diagnose osteoporosis at an early stage when its development can be halted with effective treatment. It is a non-invasive, painless test which takes only a few minutes to diagnose osteoporosis. This test is now available in India.

Building strong bones by physical activity especially before the age of 35 can be the best prophylaxis against osteoporosis. A healthy life-style can be very important for strong bones.

To help prevent osteoporosis:

lEat a balanced diet rich in calcium;

lExercise regularly with weight-bearing activities like walking;

lDon't smoke and limit the use of alcohol.

Women after menopause should consult their doctor as they don't have the protective benefit of oestrogen due to natural or surgical menopause. Your doctor may suggest bone density measurement before putting you on hormone replacement therapy which prevents osteoporosis.

Oestrogen therapy: Post-menopausal ailment can be reduced by taking low-dose oestrogen and progestestorone. According to the available data, HRT reduces heart disease by 50% and colon cancer by 50%, and the thickness and elasticity of the skin, the genital and urinary muscles and other tissues. It is supposed to reduce ocular degeneration causing blindness.

It is better to prevent osteoporosis than to treat it. Awareness and avoidance of the risk factors are very important.

Dr (Mrs) Kochhar is a well-known gynaecologist with a sound background of research.

Laser-treated teeth
By Dr Vivek Saggar

All forms of light are electromagnetic waves of varying lengths. It is this "wave length" which determines the colour of the light. Laser light is an artificial form of light, and all its waves are identical (that is to say, of the same wave length and phase). Laser light does not disperse in the way in which ordinary light sources do. For this reason the energy concentration of laser light is much higher than that of other light forms. It is this concentration that enables laser light to penetrate the skin or mucous membranes and act on oral tissues.

Lasers have been used in medicine and dentistry for more than 20 years. Only recently, however, has the advent of low-level laser therapy (soft lasers) made it possible to use laser light for the treatment of painful condition in the teeth, the mouth and the face as it does not give rise to any heat generation.

Low-level lasers are basically IR diode lasers formed from minute chips of gallium arsemide, not larger than a grain of salt. The semiconductor laser diodes have proved their reliability in everyday products such as office laser printers and home compact disc players.

Benefits to the patient: Low level laser therapy (LLLT) offers new treatment options that were not available to the dentist earlier. It serves as an adjunct to the regular treatment, simplifying some procedures, saving time in some and enhancing the outcome in many others.

LLLT provides immediate relief from severe pain. This function is temporary and the cause of dental pain should be found and proper treatment done for permanent relief. Teeth sensitive to heat and cold due to abrasions or attritions are treated for two minutes and the sensitivity is completely removed.

Similar are the results in hyperaemic teeth. In severe cases, more than one sitting may be needed. Oedema due to infection gets reduced within hours after the application. The normal medication has to continue.

LLLT, when used as an adjunct to root canal therapy, reduces the patient's discomfort and treatment time. Tooth tenderness is reduced drastically. The patient can start biting with the involved tooth faster as compared to other modes of treatment.

LLLT, when used immediately after tooth-extraction, prevents bleeding as the bleeding stops on the dental chair itself. There is less post-extraction pain and faster healing at the extraction site. This is of importance especially for patients of diabetes and hypertension. LLLT, when used along with the normal treatment of bleeding and swollen gums or mobile teeth, improves the prognosis by better and quicker reduction in inflammation and faster healing (due to increased collagen formation). Results have been highly positive when LLLT has been used in deep cavities, before the filling was done.

Painful mouth ulcers caused by trauma, and herpez, heal within two days (normal 5-11 days) with a marked reduction in pain. Sub-mucous fibrosis is a disease caused by the long-term use of pan or pan masala, wherein fibrosis in cheeks and mouth cannot be opened fully. The normal course of treatment has not been successful. The use of LLLT has been effective to the extent of providing relief from symptoms. It is also effective in the treatment of abscesses, narcotising gingivitis, surgical extraction of the wisdom tooth, maxillary sinusitis, geographical tongue, arthritic mandibular joint, myositis and typical or atypical trigeminal neuralgia.

In neuralgia, where surgical removal of the involved nerve has been a routine practice, LLLT has helped a lot. Initially, there is an increase in pain for two or three sittings. After that the pain disappears. After seeing the immense potential of soft lasers in the dental, orthopaedic, ENT and skin fields, one is forced to think: how does it act so magically? To understanding this we need to understand the basic action of LLLT on the cell.

Laser emission on the cell causes a photodynamic effect whereby there is activation of the mitochondrial function, the oxidation-reduction process and a decrease in the permeability of cytoplasmic membrane. LLLT reduces swelling by the increased activity of micro and macrophages, increased oxygen consumption, activation of tissue respiration and suppression of anaerobic process, thereby facilitating the regeneration of the damaged tissues. LLLT reduces pain by the reduction of bioelectric activity.

LLLT is a completely harmless procedure, having no side-effects. There is no feeling of discomfort to the patient during and after the procedure. The only precaution during its use is that the beam should not be directed towards the eye. LLLT is a new concept in dentistry and is basically meant to provide fast relief. It is well within the reach of everyone as the treatment is not expensive. It saves money, time and and repeated visits to the dentist.

It also reduced the use of antibiotics. Its effectiveness has been beyond my imagination and I have seen it in the relief and smiles of my patients. It is going to be a part and parcel of normal dental practice.

Dr Saggar, MDS, is a reputed paedodontist and implantologist.