The truth about edible oils
A.R. Sharma

Edible oils are an important ingredient of human diet. They help in mobilisation and absorption of fat-soluble vitamins such as Vitamin A, D, E and K. They are the source of essential fatty acids known as Omega6 and Omega3, which help in controlling blood pressure, blood clotting, inflammation, cholesterols, etc. But one has to be particular about the quantity and quality of these oils.

Now let us see how the various edible oils/fats should be used to ensure the desired intake of various types of fatty acids and their ratios as per the latest recommendations.

Butter/butter oil (desi ghee): Butter/butter oil (desi ghee) has a very high content of saturated fatty acids. It also contains undesirable cholesterols. It can be used in very small quantities along with vegetable oils.

Palm oil/palmolein: Palm oil/palmolein has a high content of saturated fatty acids. It should be used along with soyabean oil in an equal proportion to ensure an ideal fat intake.

Kardi oil/sunflower oil/corn oil/sesame oil/cottonseed oil: These oils have a very high content of polyunsaturated fatty acids than the recommended levels. All these oils also have a higher ratio of omega6/ omega3. These oils should be used in combination with equal quantities of palmolein and mustard oil or canola oil to ensure an ideal fat intake.

Soyabeen oil: Although the EFA ratio of soyabean oil is quite ideal due to a higher content of Omega3 in this oil, the polyunsaturated fatty acid content is much higher than the recommended levels. So, the use of soyabean oil needs to be coupled with the use of equal quantities of palmolein to ensure an ideal fat intake.

Mustard oil/rapeseed oil: Mustard oil has the near ideal sfa/mufa/pufa ratio as well as EFA ratio. However, in view of the controversy about the erucic acid present in Mustard oil, it is advisable to use it in a combination with other vegetable oils.

Canola oil: Canola oil is a modified variety of mustard oil found in Canada which has very low erucic acid. It is also an ideal oil. But canola oil has very poor frying stability due to very high alpha linolenic acid in it and, therefore, cannot be advised as sole cooking medium in Indian context as we use oils for frying, not for salad dressings.

Olive oil: Olive oil also has an ideal fat composition. It is the preferred edible oil of the Europeans for salad dressing. But, unfortunately, olive oil has a very low smoke point and as such it can also not be advised as sole cooking medium in Indian context.

Groundnut oil: This oil has an ideal fat composition. However, the EFA ratio is higher than the recommended levels. So, the use of groundnut oil needs to be supplemented with 20 to 30 per cent mustard oil or canola oil, to ensure the ideal EFA ratio.

Rice bran oil: Rice bran oil is a unique edible oil produced from the oily layer of nutritious brown rice. It has naturally balanced fat composition and near ideal EFA ratio. Using rice bran oil as a cooking medium could significantly reduce bad cholesterol without adversely affecting the good cholesterols due to presence of a unique component in this oil know as “Oryzanol”, not found in any other vegetable oil.

Why dental implants?
Dr H.S.Chawla

When a tooth is lost due to any reason, it is important that it should be replaced by an artificial tooth to maintain the integrity of the natural teeth set. If it is not replaced, the adjacent teeth on either side gradually move into the empty space. The tooth in the opposite arch also moves out of the socket towards the empty space. This affects the whole integrity of the arch leading to the loosening of contacts between teeth. It results in food getting frequently lodged between teeth, gradually leading to the formation of dental cavities and gum disease.

Of the various options available, replacement with an implant-supported crown / bridge is the most advantageous one, and is gaining in popularity.

What are the dental implants? It is very important to understand that a dental implant replaces the root portion of the missing tooth, and a crown is fitted later on the implant to complete the tooth.

The implant is made of titanium, which is a biocompatible (inert) material. Implants come in different lengths and diameters to suit the different availability in height and width of the jaw-bone. The placement of an implant, to draw a crude analogy, can be likened to the placement of a screw in a thin, cemented wall.

The implant placement is normally carried out under local anaesthesia and is painless. It consists of making an appropriate -size hole, to the dimensions of the implant to be inserted, into the bone at a pre-determined position. This is achieved by sequentially enlarging it to an exact size needed with drills under strict sterilization. The various steps of drilling a hole in the bone are specialised procedures involving different implant-drills and engine speeds for each step.

The implant, pre-sterilised and packed, is taken out of its housing and is inserted at the pre-drilled hole with the help of an implant driver fitted on a special micro-motor drill hand piece run at a very slow speed. It is either slowly screwed or tapped into this hole in the bone, depending on the type of the implant being used, to a depth so that the whole implant immerses in bone with its top portion flush with the top of the bone.

The final implant insertion is carried out at a particular snug-fit (torque) in the bone, neither more nor less. The implant is left in this position for roughly three months to osteo-integrate, i.e. fix well with the bone.

Right at the centre of the implant is a hole with threads. Into this implant hole, a mini tooth-like structure, made of metal, is screwed. It stands out of the gum. On this structure a crown is custom-made and fixed so that it fits snugly with the adjacent teeth and those in the opposite arch.

The crown can be made either of (i) porcelain fused with metal, which is the least costly option and is aesthetically quite acceptable, (ii) zirconia (white gold) fused with porcelain, costlier than the former, but aesthetically more appealing, or (iii) gold fused with porcelain; this has better aesthetics and biocompatibility and is the costliest of the three.

Advantages of Implant

Fitting a bridge is the traditional practice for restoring a missing tooth. The bridge derives support from teeth on either side of the missing tooth, and the replacement tooth is hung from the centre of the bridge. The dentist grinds the adjoining teeth to the thickness of the material he wants to rest on them. Thus when a bridge is given, two additional teeth get ground to replace a single missing tooth.

The advantage of an implant is that the teeth on either side of the missing tooth/teeth are not touched. The support for the tooth - or, strictly speaking, the upper part of the tooth --- is from the titanium implant that is placed in the bone. The additional advantage of an implanted tooth over a natural tooth is that it does not develop caries, being made of titanium and ceramic.

The implant with the crown works like a natural tooth. With a good colour match, it cannot be distinguished from a natural tooth. The care needed is the same as for a natural tooth to keep the gum around it healthy.

Getting an implant is as yet a costly proposition, but worthwhile, as it improves chewing efficiency to almost normal without telling on the adjacent teeth. With the increasing demand and manufacturing volumes, the cost is expected to come down, as it happens with all new technologies.

The writer, Head of the Dental Department, The Apollo Clinic, is a former HOD, Oral Health Sciences Centre, PGI, Chandigarh.

Be cautious about surgery in heel pain
Dr Ravinder Chadha

Heel pain occurring early in the morning while getting out of bed or after prolonged rest indicates “plantar fascitis”. Heel performs an extremely important role during walking. It absorbs the shock as the foot strikes the ground initiating the next step when the heel begins to lift off. The tension built in the plantar fascia is approximately twice the body weight. This tension increases in obese individuals and also when there is a lack of flexibility in the calf muscles.

Structurally, heel contains a strong bone — calcaneum. Below the bone there are a large number of fat linings, which are responsible for absorbing the shock. The heel is attached to the foot by a strong ligament — plantar fascia. In individuals afflicted with “plantar fascitis”, this fascia becomes inflamed, causing pain.

In most cases, pain disappears for several weeks only to reappear after an aerobic workout.

Plantar fascitis is a common occurrence in sports --- athletes, basket ball players, volleyball players, tennis players, etc. It is also commonly encountered in people spending a lot of time standing or becoming suddenly overactive after a prolonged rest.

There is a myth that heel spur that appears on X-ray is the main cause of heel pain. Spur formation is related to the progression of age and constitutes deposits of calcium at the site where plantar fascia is attached to the heel.

Mostly heel pain is due to the stress on the plantar fascia, which causes irritation and inflammation and leads to heel pain. Therefore, one should be cautious if somebody advises surgery of heel spur.

The causes

Obesity

Prolonged standing

Lack of flexibility of calf muscles.

Wearing worn-out shoes/ shoes with lesser cushion.

Individuals having flat feet/ high arch.

Loss of fat pad under heel.

Sudden increase in training intensity.

Treatment: Rest is crucial. It is advisable not to walk in pain. Use a silicon heel. U/S massage with stretching. Usage of sports shoes (with more cushion/ flexible and raised heel). Exercise every morning prior to ambulating and repeating 4-5 times per day. Hot pad application and massage.

Self-stretch: While sitting, place the foot on the opposite knee, put all five toes into extension with expiration. Hold for 30 seconds. Repeat five times.

Toe taps: Keeping the heel on the floor, lift the toes off the floor. Tap only the big toe to the floor while keeping the rest in the air, and alternate by keeping the big toe in air and tap the other four toes. Night splint: Injection Corticosteroid/ weight reduction. Heel pain should not be ignored otherwise it becomes a serious problem and takes a long time to treat.

The writer is Director, Medical Services, HPU, Panchkula.