Spine fractures — early management prevents complications
Dr R. Chadha

The spine comprises bones called the vertebrae which bear the weight of the body. Compression fractures occur when excessive pressure is exerted on the bones which become weak due to osteoporosis, cancer and some other diseases. Compression fractures cause spinal deformity leading to an exaggerated risk of fracture to the adjacent vertebrae.

Mal-alignment puts undue stress on the muscles, ligaments and bones of the spine. Mal-alignment accompanied with pain cause significant imbalance while walking. This forces an individual to walk less, and prolonged bed rest leads to varied medical problems.

Generally, patients are unable to recall occurrence of any significant trauma as in advanced cases of osteoporosis even simple forward bending can cause compression fractures of multiple vertebrae. This in turn leads to the loss of height and upper back hump.

Compression fractures may occur in certain cases of cancer which may have travelled from prostate, breast, lungs, etc. In such cases a part of vertebrae is destroyed leading to the weakening of the bone and its collapse causing numbness and tingling due to compression of the nerve at fracture site.

Factors causing osteoporosis:

l People over 65, especially lean and underweight (less than 120 pounds)

l Women after menopause.

l Smoking leads to loss in bone thickness faster.

l Osteoporosis is common where bone mass density T-score is minus 2.5 or below.

l Individuals on steroid therapy for a prolonged period, or those suffering from diabetes mellitus, hyperthyroidism, etc, are prone to fractures due to bone loss.

Treatment: Rest for a short period. Prolong bed rest can cause de-conditioning, bone loss, deep vein thrombosis, pneumonia, depression, etc.

l Analgesics are prescribed for pain control, keeping a careful eye on the individual’s bowel mobility.

Back brace is advised to avoid bending forward

l Prevention of osteoporosis by taking calcium supplements, vitamin-D, Bisphosphonate, etc.

l Calcitonin a naturally occurring hormone that helps regulate calcium levels in the body and can build bone and give pain relief.

l In women past menopause an estrogen replacement therapy slows bone loss.

Following exercises reduce the likelihood of bone fractures:

l Regular weight-bearing exercises — riding stationary bikes, using rowing machines, walking, jogging, etc, can cause muscles to pull on bones causing bones to retain and perhaps even gain density.

l Wall walk — stand facing the wall, arms at sides, raise both arms up the wall. Repeat 10 times.

l Shoulder blade squeeze — While sitting or standing, gently move shoulder blades backwards. Hold the position for a count of five. Return back. Repeat this exercise five to 10 times.

l Upper back lift — Lie face downwards, arms at sides, raise head and chest from the floor. Return to starting position. Repeat eight times.

Most patients make complete recovery or at least significant improvement from compression fractures after six to 12 weeks. Losing control on urination or stool, severe pain, numbness, high fever requires emergency treatment.

Surgery is indicated only in patients with intolerable pain or loss of neurological function. Surgery should be considered as the last option not due to the advance age of the patient but due to the high failure rate in patients with severe osteoporosis.

The writer is a former doctor/physiotherapist, Indian cricket team.

Factors behind gum disease
Dr H. S. Chawla

Most of us relate the health of our teeth solely to the presence or absence of dental cavities. A common question that a patient often asks the dentist is — “Are my teeth free from cavities?”  While the absence of cavities is an important indicator of dental health, no less important is the condition of soft tissue, i.e. gums surrounding them.

However, gum health is often ignored. Why? Firstly, because the visible part of the teeth is its white hard part, and that contributes to the looks of the individual; at a younger age, one is naturally concerned more with aesthetics. Secondly, the beginning of gum disease is painless, and its progression too is very slow. Thirdly, at the initial stages of gum disease, there are practically no warning signs. Thus, periodontal (gum) disease develops unnoticed. 

Gum disease is directly correlated with oral hygiene. When one ignores regular cleaning of teeth for one reason or another, gum disease sets in. It results from the presence of bacteria called dental plaque near the gums. Insufficient cleaning — or lack of cleaning — results in the piling up of these bacteria in large numbers. This piling up leads to depletion of oxygen supply to the deeper layers of the plaque: an ideal environment for the growth of the harmful anaerobic bacteria which, as its name implies, can live without oxygen.

The toxins produced by these bacteria damage collagen, the main binding structure of the gums. The gums become slightly puffy, while the gingival sulcus deepens and fills with bacteria. As there is no pain at this stage, the disease gets ignored. It progresses slowly, and manifests itself later as unprovoked bleeding from the gums, or bleeding during brushing noticed as pink to red colour in the spit. This is often accompanied by enlarged/puffy gums and foul smell from the mouth.

Gradually, as the disease progresses, it affects the underlying bone, which recedes in order to preserve the remaining healthy structure beneath it. This is precisely what gum or the periodontal disease is. It can be of two kinds: initially it is gingivitis — when the gum around the tooth is involved, and periodontitis when the disease has extended deeper into the bone. Both of these are chronic, i.e., long-standing diseases. With further progression of the disease, and bone destruction, the teeth lose hold of the bone, start migrating and develop spacing. A single tooth may show change in its normal position because of advanced gum disease.

Gum disease begins due to poor oral hygiene. Thus, it is directly related to brushing and flossing.

Any part of the tooth or surface that is not brushed effectively starts developing gum disease. However, brushing with the toothbrush alone is not enough. Dentists have observed that even the most diligent users of the toothbrush develop gum disease between the contacting surfaces of the teeth, also known as proximal surfaces, even though their gums on the other sides (facial and lingual) are relatively healthy. This is because the tooth brush cleans only the front and back surfaces of the teeth. It cannot reach the sides, which can be cleaned only with inter-dental brushes and dental floss.  

An alarming fact about gum disease is that the damage it causes is largely irreversible. The bone around the tooth, once destroyed, is gone forever. 

If one takes care of oral hygiene using toothbrush, dental floss and inter-dental brush effectively and right from the beginning, one can expect to be free from periodontal disease.  Initially, at a younger age, the inter-dental spaces are tight, and dental floss is recommended. Later in life, as inter-dental spaces become wider, inter-dental brushes can also be used along with dental floss. It must be kept in mind that without the use of dental floss and inter-dental brushes, one would sooner or later develop gum disease.  

If one has developed gum disease, with gum treatment procedures like scaling, curettage, gingivectomy, flap operation and bone grafting, depending upon the severity of the disease and its progression can help restore the gum to a disease- free state. What is important is that one maintains good oral hygiene by tooth brushing, flossing and the use of interdental brushing to reduce the risk of getting gum disease. It is also recommended that one regularly examines the oral cavity to see for any changes in the colour of the gums and for swelling and pink stain in the spit as they are the warning signs of gum disease. Also one must visit a dentist every six months to keep one’s 32 pearls in good shape.

The writer is a former Head, Oral Health Sciences Centre, PGI, Chandigarh Email. chawlahs@gmail.com

Health checks unveild for over 40
Jane Kirby

People aged 40 to 74 will be offered screening for illnesses that kill 170,000 people a year, UK Health Secretary Alan Johnson has announced.

Check-ups to help prevent heart disease, stroke, diabetes and kidney disease are being made available on the NHS to focus attention on prevention rather than cure.

The conditions affect the lives of more than four million people and account for around half the mortality gap between the rich and poor.

Government modelling suggests the new programme will prevent up to 9,500 heart attacks and strokes and save 2,000 lives every year.

In January, Mr Brown announced that people would be offered check-ups but the details will be announced later.

GPs have warned the Government has "not properly thought through" how such screening would be put into practice.

The British Medical Association (BMA) said in January that it would require a "significant expansion" of specialist staff and equipment in surgeries, and greatly increase the number of people needing hospital treatment.

Mr Johnson will set out the clinical case for a national programme to identify vulnerability to vascular diseases.

Everyone between the ages of 40 and 74 will be entitled to the checks, which will be based on things like age, sex, family history of disease, height, weight and blood pressure.

A blood test to measure cholesterol will also be included.

Patients will then receive a personal report which sets out their risk of developing disease and practical things they can do to reduce it.

For those at low risk, this may just mean general advice on how best to stay healthy.

But those who are overweight or obese may be referred to weight management programmes while smokers will be helped to quit.

People at highest risk will be given the cholesterol-busting drugs, statins, or treatment to lower their blood pressure.

The vascular check programme is likely to be introduced in 2009/10 following consultation with the NHS and voluntary sector on its implementation.

Smoking, a lack of exercise, high blood pressure and raised cholesterol are known to cause a build-up of fatty deposits in the body's blood vessels.

These deposits can lead to coronary heart disease (CHD), stroke, chronic kidney disease and diabetes.

—The Independent