Pre-cancerous lesions of the mouth
Dr H.S. Chawla

Pre-cancerous legions of the mouth are technically identified as leukodema, leukoplakia, stomatitis nicotina, hyperkeratosis of mucous membrane, lichen planus and sub-mucous fibrosis. Essentially, these lesions appear white in colour against the normal pink background of the mucous membrane of the oral cavity, and are commonly referred to as “white lesions” of the mouth.

Most of these lesions are, however, reversible if the etiology — the factors causing these problems —is discontinued.

The first pre-cancerous lesion that needs mention is white smoky appearance of the inside of the cheeks. This is normally the result of thermal trauma because of the intake of very hot beverages such as tea/coffee. This is known as “leukodema”. This can also result from the heat emitted from smoke in the case of smokers, particularly if the smoke is retained in the cheeks before throwing out. The characteristic feature is that when the cheek is stretched for examination, the smoky manifestation turns to normal pink colour.

If thermal trauma is continued, the mucous membrane of the mouth can turn white permanently. At this stage, even on stretching, the colour stays white and does not change to pink. This is called “leukoplakia”. Leukoplakia can also result from chronic irritation such as from pan chewing or betel nut chewing. Pan pasand /masala are other etiological agents. In fact, it may develop on the side of the cheek where these items are kept for a longer time for getting lingering taste by letting them dissolve slowly. The betel nut in the pan is known to contribute to the development of this lesion - leukoplakia.

In addition to the thermal trauma caused by cigarettes, their nicotine content also promotes the development of leukoplakia. In individuals who indulge in reverse smoking- smoking with the lighted end inside the mouth-enlargement of sebaceous glands occurs on the posterior part of the palate. This condition is technically called Stomatitis Nicotina

Another factor which is worth mentioning is the trauma from the sharp margins of the teeth. The sharp margins can cut into the cheek as well as the tongue. Initially, it is very painful. If ignored, you get used to the pain; it distracts you less. But the injury continues because of sharp cutting margins of teeth. A continuous trauma from a prickly tooth is well documented to cause cancer. If you have a sharp tooth hurting you, you should not delay consulting your dentist. Rounding off the sharp margins of the teeth must be done immediately.

On the inside of cheeks, sometimes the biting marks corresponding to the meeting of the upper and lower teeth are observed. This can result from the habit of placing the palm of your hand or fist on your cheeks while being engrossed in listening or in any work or during sleep. It can also happen in individuals keeping beard if, to roll the beard, the thread is tied very firmly. The treatment is to discontinue these lifestyles. Secondly, fill air into your mouth and keep it under pressure before releasing it. Perform this exercise of the cheeks 20 times at least three times a day.

Lichen planus is another white lesion of the mouth. It appears as a white lesion with bluish striate. The exact cause for this white lesion is not well understood. The contributing cause is “stress”. De-stressing measures undertaken are helpful. Medical advice should always be taken.

Sub-mucous fibrosis is another mucosal lesion that affects the mouth. It is caused by the intake of spices, particularly the green chilly. It is seen in the countries where individuals consume green chilies regularly. It is seldom seen in the western countries since this commodity is rarely used. Consumption of pan masala is also known to cause this lesion. The sub-mucous fibrosis, once it develops, does not regress on its own even if the etiological factors are stopped.

If you follow simple preventive measures, you can keep the pre-cancerous and cancerous lesions of the mouth at bay. These are:

l No smoking,
l Avoid taking very hot food stuffs and beverages,
l Only mild red/green chilies in diet
l Avoid eating green chilies excessively
l Never ignore a pinching tooth or an ill-fitting artificial denture
l Limit pan chewing
l No betel nut/pan masala

All said and done, it is advisable to consult your dentist if there is a suspicion of any such lesion in your mouth.

The writer, a former Professor and Head, Oral Health Sciences Centre, PGI, Chandigarh, is Chief Consultant, SukhIqbal Dental Center, Chandigarh. Email: chawlahs@gmail.com 

EYESIGHT
Why is vision loss in the elderly?
Dr Mahipal Sachdev

Mr Saxena, 70, attributed his progressive decrease in vision to cataract and delayed visiting an ophthalmologist for surgery. When he visited his ophthalmologist again, he was shocked to learn that his visual loss was primarily because of Exudative ARMD, where one of his eyes had progressed to an advanced stage of degeneration and was beyond treatment.

Luckily, his other eye was still treatable. One year later, Mr. Saxena is thanking his stars for taking treatment and saving his eye from going blind due to ARMD. With the advancement in medical sciences, there has been considerable improvement in life expectancy in recent years. The size of the elderly population in India was around 84 million in 2001, and it is expected to increase significantly in the next two decades because of an improvement in socio-economic conditions. While this is a positive trend, with ageing come age-related illnesses, and like every other part of the body; degeneration also takes its toll on the most tender part of the body — the eyes.

Age-related macular degeneration (ARMD) is a disease that causes progressive degeneration to the macula which is the central part of the retina that allows us to see fine details. This condition, the commonest cause of blindness in the western world after the age of 65, is now becoming common in our country too. In the past, treatment for ARMD was limited but extensive research on the subject has made its management possible, thereby helping the elderly retain their vision and improve their quality of life.

FORMS OF MACULAR DEGENERATION

The two common types of ARMD are:

l DRY (Atrophic/involutional): Accounts for 90 per cent of all ARMDs and causes thinning of the tissues of the macula.

l WET (exudative/ haemorragic): This form is characterised by the development of abnormal blood vessels beneath the retinal pigment epithelial layer. These vessels can bleed and eventually cause scarring, leading to profound loss of central vision. There are many such cases where treatment for ARMD is being given successfully. Those suffering from macular degeneration may be candidates for laser treatment. The treatment can successfully eliminate the abnormal blood vessels in approximately 50 per cent of these patients. Another modality is a type of cold laser which is used in the patients on whom the neo-vascular membrane is below the central point of the eye. PDT helps in stabilising vision.

Anti-vegf treatment

The latest development for treating Exudative ARMD is the availability of specific drugs called VEGF inhibitors. These drugs have created a revolution in the management of ARMD and can help improve vision in upto 40 per cent cases, specially if detected early.

Combination therapy

Most patients of ARMD require combination treatment which includes treatment with laser/PDT and VEGF Inhibitors. Let your ophthalmologist decide what is best for your eyes.

Facts about ARMD:

l Dry ARMD causes gradual vision loss.
l Wet ARMD causes severe, painless, irreversible vision loss.
l If detected early, Wet ARMD is treatable.
l Regular eye check-up and early detection can prevent blindness due to ARMD.
l Nutritional supplements with Vitamin C, E, beta carotene and zinc can lower the risk of developing advanced-stage ARMD.
l PDT can stabilise vision in the majority of the cases.
l Anti-VEGF therapy helps salvage and improve vision.

The writer is Chairman and Medical Director, Centre for Sight, New Delhi. Email: drmahipal@gmail.com

Ayurveda & You
Factors that cause the malabsorption syndrome
Dr R. Vatsyayan

Broadly defined as the body’s inability to absorb essential nutrients it needs from food, the malabsorption syndrome is a condition which can affect any person irrespective of age and gender. Even though his or her diet may be adequate, an individual with malabsorption develops various deficiencies like that of vitamins, minerals and other necessary energetics. Ayurveda views this condition as “mandagni” or the weakening of the digestive fire.

Factors that contribute to malabsorption are adopting dietary extremes for a long time, excessive alcohol consumption, food allergies, a diet low in B vitamins that are needed to produce digestive enzymes and diseases of gallbladder, liver and pancreas. Use of some prescription medicines and antibiotics and abuse of laxatives also damage the intestinal flora, leading to a condition where nutrients aren’t absorbed into the bloodstream even if food has been digested. Chronic anxiety and depression and most of the wasting diseases are also known to lead to intestinal malfunction.

Major symptoms of the malabsorption syndrome include recurrent diarrhoea or constipation, abdominal discomfort, gas and bloating, fatigue and weight loss. The patient complains of variable appetite, unpredictable digestion and poorly formed stool with undigested food particles. Alternate diarrhoea and constipation make the patient take symptomatic medicines which further complicate the problem. Muscle cramps, thinning of hair, anaemia, frequent psychological upheavals and menstrual problems in the case of females are some of the other complications faced by the persons who suffer from malabsorption. Paradoxically, in some persons obesity also results due to the mismatch of intake and consumption of a diet which makes fat to deposit in the tissues.

Ayurvedic masters have stated that starting from the duodenum, the small intestine is the site of “agni” and it is the place where most of absorption of the dietary nutrients takes place. In order to rekindle the digestive fire, the first step should be to make the patient adopt a dietary discipline by staying away from all types of heavy, fried, greasy and late-to-digest food items. Irregular eating hours and a diet which is too hot or too cold, stale, is of junk nature or is made of refined items like “maida” should be avoided.

Curd and buttermilk strengthen the intestinal flora and to enhance absorption some of the spices such as cumin, fresh ginger, cardamom, cloves, long pepper and fennel are recommended to be used after personalising the patient’s diet plan. Small but frequent meals usually help the patient avoid frequent digestive upsets. Fruits such as apple, banana and pomegranate or a small amount of citrous fruit juice can be recommended.

In more chronic and debilitated cases, strengthening herbs like ashwagandha, amla and asparagus bear good results. If malabsorption is superadded by conditions like anxiety and depression then giving brahmi and jatamansi, which are psychotropic herbs, makes the patient calm and comfortable. Classic ayurveda offers a number of preparations like the legendary Chyavanprash, Avipattikar Churna, Trikatu, Shankh Vati, Sanjivani Vati and Pravalpanchamruta Rasa which can be safely and effectively given to tackle the malabsorption syndrome. Medicines containing gold salts should be used to enhance immunity or when other therapies have failed.

The writer is a Ludhiana-based senior ayurvedic physician. Email- yourhealth@rediffmail.com.