Thumb-sucking bad for teeth
Dr H.S. Chawla

A habit is a mode of behavior which, with the passage of time, becomes completely involuntary and is unconsciously repeated. Some oral habits which develop during childhood influence the alignment of the teeth, and a dentist’s help is needed to get rid of them. Of these, thumb-sucking is the most common and bothersome.

A child develops the sucking habit instinctively right at birth. It is a useful instinct as it helps the child take milk from the mother’s breast. At this stage, the child puts everything in its mouth to get a feel of it. Likewise, he puts his thumb in the mouth, and if he is hungry, gets satisfaction upon sucking. According to the Freudian model of psychological development, the oral phase continues till the age of two. Thumb-sucking begins at this stage, and is normal for this age. If the habit continues after three years, it is a matter of concern as it effects the alignment of teeth.

Thumb-sucking during the early years of life is considered by psychologists to be beneficial as it fulfills the sucking desire, and this satisfaction is believed to be necessary for the normal psychological development of the child. To check that this habit does not become permanent, the following two measures are important. Firstly, it is important to feed the child in a timely manner. Secondly, even before three years of age, a mild attempt should be made to divert the child’s attention from thumb-sucking by giving him something to play in the same hand that he is sucking. The thumb should not be forcibly taken out of the mouth, because the moment the thumb is taken out, the child immediately re-inserts it in his mouth. This act of the parents does not help; rather, it reinforces the habit.

After three years of age, children automatically wean off from thumb-sucking as there are other attractions and things for them to do. Some, however, keep sucking the thumb even after this age.

If the habit of thumb-sucking continues beyond three years, initially an earnest effort should be made by the parents themselves by talking it over with the child, explaining that if the idea is to look beautiful/handsome, he/she should stop sucking the thumb, otherwise the teeth would stick out making her/him look like a monkey. A story can be concocted about the child of a king and queen who was told by the parents to stop thumb-sucking. The child did not do so and grew up ugly. This is narrated in a different manner and style to the child each day before putting the child to bed. It is important not to use punishment to stop the habit.

If thumb-sucking continues, a dentist should be consulted, as continued thumb-sucking habit leads to the protrusion of teeth, requiring braces later in life. The dentist at this stage gives a simple habit- breaking appliance which the child wears on the upper teeth. The appliance works on the principle that the pleasure of thumb-sucking comes from the thumb making contact with the palate. Thus, the main function of anti-tongue thrust appliances is to obstruct the contact of the thumb with the palate. With this contraption given by the dentist, the child does not get the gratification of sucking, so the habit weans off. In uncooperative children, the appliance is fixed on the upper teeth in such a manner that the child cannot remove it.

Digit-sucking is another habit in which the child sucks fingers in place of the thumb. Its management is the same as that for thumb-sucking.

A thumb-sucking habit is a fairly common problem across the world and fortunately in most cases it is either self-limiting or can be addressed by the parents over time. However, it is important that prolonged thumb-sucking be addressed timely as it can lead to the need for dental treatment in later years, and this is both costly and time-consuming for the parents and their wards.

The writer is Head, Dental Department, The Apollo Clinic, Chandigarh. Email: chawlahs@gmail.com

Hip arthritis — early treatment prevents surgery
Dr Ravinder Chadha

Arthritis applies to pain within a joint, and hip arthritis is very common being a weight-bearing joint. The causes of hip arthritis affliction are varied — degenerative arthritis (due to wear and tear which occurs with age), traumatic arthritis (secondary to an injury), obesity, rheumatoid arthritis, aseptic necrosis and certain congenital deformities. Hip arthritis leads to uniform loss of articular cartilage resulting in bones rubbing against each other causing a lot of pain and loss of mobility.

Symptoms: During the initial stages the patient experiences little discomfort and stiffness in the groin, buttock or thighs, particularly on waking up.

l Pain aggravates during activity and is alleviated during rest.
l Experiencing difficulty, pain on rotation, flexion/ extension of the hip. There could also be a feeling of instability.
l Fear of pain leads to inactivity, rendering the muscles controlling the hip joint weak and thereby the limping.

Treatment: Although it is impossible to reverse the effects of arthritis, early treatment helps avoid pain/disability.

l Rest the hip joint and prevent overuse.
l Use non-steroidal anti-inflammably medication.
l A cane held in the opposite hand helps to unload the hip significantly.
l Sleeping on the healthy hip joint side with a pillow placed between the legs is advisable.

EXERCISES: Various exercises help increase the range of motion as stiffness is more prominent as compared to pain in cases of hip arthritis.

WALKING is the ideal exercise for the patients of hip arthritis. Fortyfive minutes’ walk five times a week works wonders. Individuals with moderate-to-severe symptoms can start for a minimum duration of one minute several times daily, gradually increasing to 45 minutes four to five times a week.

Leg rotation — Lying on the back with legs straight, roll legs and feet out and then in 10 times.

Leg raise — Holding on a chair/table while standing for a support, raise and lower the affected leg to the front and back in a swinging motion for a minimum of ten times. Thereafter move sideways 10 times.

Side kicks: Lie sideways, lift the leg straight as high as possible. Hold on for a few seconds and then lower it slowly. Repeat 8-10 times. Turn on the other side and perform the side kicks with the other leg.

Manipulation and mobilisation of the hip joint is very effective during the early stages of hip arthritis. Hence patients with mild symptoms should receive physical therapy once/twice a week. In cases of moderate-to-severe symptoms, physical therapy daily for one to two weeks is helpful in the beginning, later reducing it to three times a week and then once a week. Hip arthritis is treatable if the exercise regimen is meticulously adhered to in the early stages of the disease.

The writer, Director, Medical Services (Power Utilities), Haryana.

Eyesight
Hope at the end of the tunnel
Dr Mahipal S. Sachdev

Some patients suffering from retinitis pigmentosa, glaucoma, optic atrophy and age-related macular degeneration do not gain good functional vision despite the best of medication, surgery or glasses. However, these patients, with a permanent functional vision loss, need not feel disheartened as there is still hope for them.

Low-vision aids are the devices which help to maximise the visual potential for these patients so that they may carry out their daily living activities and lead an independent life.

You’ll need to experiment to see what works best for you. Use high contrast for reading and writing, write in large letters with a broad felt tip pen on white or light paper, and use a hand-held magnifier.

Low-vision aids are commonly available as hand-held or stand magnifiers, telescopes and CCTVs with various modifications. Hand-held magnifiers, also known as “Magnifying glasses”, come in many shapes and sizes, and provide magnification between 1.5-20 times. Some styles can be folded up for easy transport in a pocket or handbag, and some are equipped with battery-operated lights. Hand-held magnifiers may be difficult to use if your hands tire easily or tend to shake. Stand magnifiers are similar to hand-held magnifiers, but they have a base that is used to rest the magnifier on the reading page.

Illuminated stand magnifiers can be plugged into an electrical outlet or fitted with batteries to provide the patient with direct illumination of the reading material.

Telescopes can help people with low-vision to improve distance vision. Distance vision includes seeing a chalkboard in a classroom, seeing a menu board at a fast-food restaurant, or seeing the stage at a concert or action at a sporting event. Typical magnification powers for low vision telescopes range from two to eight times. A hand-held telescope may be monocular or binocular.

Clip-on telescopes allow the user to slip the telescope over his or her glasses for hands-free use. The clip-on telescope works well for the person who needs to use the telescope for extended time periods, such as for watching TV, a movie, or a live stage performance. The user can remove the clip-on telescope and use it as a hand-held telescope for quick viewing tasks.

Spectacle-mounted telescopes are made by cutting out a hole in the conventional lenses and inserting a telescope. A bioptic is a special pair of glasses with a telescope permanently mounted in the lens. While looking straight ahead, a bioptic user sees a normal, unmagnified image through the glasses. Then by dipping one’s head slightly, the bioptic user instantly sees a magnified image through the telescope. This “bi-optical” system allows the user to rapidly switch between a normal view and a magnified view without ever using his or her hands.

Video Magnifiers (CCTVs) use a stand-mounted video camera to project magnified objects onto a video screen. These devices are very useful for reading, writing and looking at photographs. CCTVs are available in black-and-white as well as colour models, and come in various sizes.

Use of such low-vision aids can help people with low vision get the most out of their vision and realise their personal goals and dreams.

The writer is Chairman and Medical Director, Centre for Sight, New Delhi. Email: msachdev@bol.net.in