Tag: Treatment

What is Tooth Wear? It’s Classification, Issues and Treatment

Article

February 20, 2022
/ Leave a Comment on What is Tooth Wear? It’s Classification, Issues and Treatment

6 min
2 years
1,027 word

Tagged dental caries, GERD, Tooth Decay, tooth wear, Treatment

What is Tooth Wear? It’s Classification, Issues and Treatment

Tooth wear in around 97% of the population is a relatively prevalent problem. It is a natural physiological process that occurs over a lifetime.

Keywords: Tooth Wear, Dental Caries, Treatment

Author: Dr. Saumya Lal

Introduction

Tooth decay or dental caries is a mechanism other than dental caries for the loss of tooth material. Tooth wear in around 97% of the population is a relatively prevalent problem. It is a natural physiological process that occurs over a lifetime. But the frequency of non-carious tooth surface losses has also increased with the increase in personal life and increased retention of teeth. Denture wear varies considerably between persons and societies and is becoming increasingly prevalent in archaeological materials with severe attrition and enamel fractures or erosion.

The typical physiological wear of the tooth after 10 years of human life is around 20-30 micrometers a year or 1 millimeter; especially when a person is older than 30 years. Tooth wear shall be closely managed and monitored if it crosses a particular limit.

Teeth Classification

Attrition is caused by physiological contact between teeth and most frequently occurs on the chewing surfaces and edges of the front teeth. The crushing and grinding of teeth causes stress and anxiety and speeds up tooth deterioration. Teeth and biting surfaces diminish and flatten.

Erosion is another important source of chemical dental deterioration. Intakes of excessive acid food, such as cola drinks, fizzy drinks, and meals, lead to chemical wear of teeth. However, digestive system disorders, such as GERD, allowing acids to flow in from the stomach to the mouth may lead to erosive wear. Erosion causes cupping of the chewing surfaces.

Abrasion occurs when a foreign item regularly comes into contact with tooth surfaces. The item offensive might be brushed with hard teeth that rub strongly the teeth. Not only does overzealous tooth cleaning remove the dirt, but it also destroys the tooth enamel that causes teeth to wear. Biting of the nail, pin, and pencil may also produce abrasive wear of the tooth.

Abfraction or stress corrosion is a particular kind of tooth deterioration involving unfair or eccentric occlusion or biting force on teeth. Teeth areas along the gum line in these situations become weak and fade out.

Tooth Wear Issues

Natural human teeth must be checked and frequent dental consultation should be carried out to overcome the harmful impact of this natural and gradual wear. Worn teeth are viewed as short or decreased in length when the enamel becomes thin or entirely removed with the yellowing of surfaces.

Various issues with tooth surface loss or tooth wear may be categorized as,

Aesthetic impairment,
Compromised smile and appearance,
Short teeth,
Loss of fullness of mouth,
Fractured and unattractive teeth,
Chipping of teeth,
Discoloured teeth,
Multiple restorations,
Fractured restorations,
Inability to chew and bite properly,
Difficulty in proper mouth functioning,
Mastication problems,
Lip and cheek biting,
Tongue biting,
Stress and anxiety,
Bruxism due to grinding and clenching of teeth,
Pain and discomfort,
Hypersensitive teeth,
Failure of bonded restorations,
TMJ pain disorder,
Small mouth opening causes breathing difficulties.

Managing worn-down teeth owing to tooth surface loss only rely on the precise as well as prompt detection of the particular reason. Teeth that are worn down by erosion cannot be controlled by the treatment plan for abrasive tooth wear prevention.

Steps to Diagnose

Different steps to diagnose accurately include,

Complete clinical history,
Comprehensive examination,
Intra-oral radiographs,
Diagnostic mockups,
Sensibility tests,
Salivary analysis,
Well-articulated study models and casts,
Computer imaging

Tooth Wear Treatment

DNA appliance therapy can correct the underlying cause of tooth clenching
Zirconia crowns and metal-free implants
Porcelain Veneers
Occlusal Splint Therapy
Night Guard
holistic removal of root canals teeth if necessary.

To prevent tooth wear, the exact cause of tooth loss is a function. Various actions can be done in this connection, as, Dental density therapy is very beneficial. Not only to lower sensitive and uncomfortable teeth by erosive wear but also to decrease the potentials of low PH cola beverages and erosive juice; in the dissolution of dental enamel that leads to severe tooth surface loss. Therapies like MI paste will harden the face of teeth and reduce the deterioration of the tooth.

It is strongly recommended that teeth brushing should be avoided immediately after acidic challenges such as ingesting cola beverages or after vomiting. Remineralization of toothpastes and gels that can harden acid-exposed areas of the tooth is useful in those with hypersensitive teeth because of worn teeth. The use of a 0.7% fluoride solution in the dental chirurgic, followed by 0.4% stannous fluoride treatment at home, was successful. Not everyone agrees that fluoride use is safe and there are numerous alternatives.

Tooth Mousse ACP (GC) includes an active component of the case that has been demonstrated with characteristics that can stimulate the re-mineralization of used tooth surfaces. Casein (part of a protein found in cow milk)

Prevention

The prevention of wear is useful in dietary advice and modified intake of beverages. Calcium added to some beverages can reduce the erosive impact of drinks. Reduce acidic fruits, fruit juices, carbonated drinks as well as cola beverages in quantities and frequency is good. Cheese containing meals or milk products will also assist to reduce the harmful effects of erosive foods, after acidic beverages.

Tooth wear is greater when the production of saliva in a person is less important. In such individuals measures for the prevention of tooth surface loss to increase the saliva have to be taken. It is important to suggest gums and lozenges that promote saliva production. Habitual modifications like the consumption of acidic drinks through broad bore straw and prevention of swinging drinks in the mouth will certainly assist to reduce the tooth wear rate. It is highly useful to prevent excessively tight teeth brushing, the use of less abrasive toothpaste, and avoid using tooth powders and behaviours like pencil biting;

Hard acrylic spline must be given to avoid attrition of the teeth in nocturnal patients who suffer from night-tooth grinding. Splint therapy is the treatment of these individuals’ choices. Dentine bonding agents and dentine restorations must be provided in eroded chewing surfaces to prevent tooth surface loss. In these fields when patients are suspected of certain systemic conditions like GERD erosive wear or depression as well as anxiety, reference is made to a medical specialist for musculoskeletal treatments.

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Article

February 10, 2022
/ Leave a Comment on Life Sustaining Treatment – An Overview

6 min
2 years
1,015 word

Tagged end-of-life, life expectancy, Life Sustaining, Medical Condition, patient

Life Sustaining Treatment – An Overview

Life Sustaining Treatment is any treatment that serves to prolong life without reversing the underlying medical condition. Examples of this are CPR

Keywords- Life, Sustaining, Treatment

Author: Lavanya Murali

Life Sustaining Treatment

Life Sustaining Treatment is any treatment that serves to prolong life without reversing the underlying medical condition. Examples of this are CPR, mechanical ventilation, hemodialysis, left ventricular assist devices, antibiotics, artificial nutrition and hydration. Physicians often encounter patients of all ages with terminal illnesses. So termination of life support is an important intervention that every physician needs to be aware of. Any patient who has reached an ‘end-of-life’ stage and consenting to it would qualify for its initiation.

End-of-Life Patients

An “end-of-life” patient has a life expectancy of 12 months or less and physicians must be well versed in end-of-life care. They should consider the comfort measures in the back of their mind while treating severely ill patients; who are admitted to a hospital or come in for outpatient consultations. This is especially important while treating acutely sick patients with multiple organ failure. Including those in respiratory failure on mechanical ventilation or patients who are diagnosed with advanced-stage cancer or neurodegenerative diseases.

Patients who are nearing their death should be informed of the goals of care and should be asked about their preferences for their end-of-life care. This needs to be dealt with in a sensitive, empathetic manner. Make sure to keep in mind any cultural or religious differences that might exist; and provide realistic expectations and honest information. It is preferable to communicate this directly to the patient. But if not possible due to various medical conditions; the legal surrogate of the patient must be provided with the information.

Legal Status of Surrogate

The legal status of the surrogate must be confirmed before engaging in any medical conversation or decision making if the patient is unable to confirm it themselves. Sometimes the patient may be alert and conversant, but their decision-making capacity may seem questionable. If the patient is disagreeing with a choice that the clinician feels is the best option, it may seem irrational. So it is critical to talk to the patient and understand their point of view to understand their state of mind and make sure they are competent to make decisions.

Of course, this may not coincide with the legal determinants of competence, which are evaluated by the court in a standardised, formal manner. To avoid unpleasant run-ins with legal terminology, it is better to claim that the patient is competent enough for decision making and that they are fully capable of making choices. The determination of this is based on four domains:

Whether the patient understands the clinical information that is presented
The patient appreciates their situation, including consequences that follow the refusal of treatment.
Patient can coherently display reason in deliberating about their choices
The patient is able to communicate their choice in a clear, effective, assertive manner.

End-of-Life Care

End-of-life care aims to relieve any physical and psychological pain or symptoms while mitigating emotional and spiritual distress. There should be open support and empathy for the patient’s preferences and the level of care must be explained and adjusted according to that. The family members should be informed about what the dying patient may look, sound, and smell like after the initiation of comfort care. The palliative care team can be constructive in guiding this conversation. The organ donation team should discuss the possibility of donation at this time. This must specifically be done by the organ donation team and not the clinical team to avoid conflicts of interest. The funeral planning and financial arrangements can be discussed by a social worker.

Decision to withhold or withdraw

Decisions to withhold or withdraw life sustaining treatments can be tremendously challenging. These treatment can be emotional as well as ethical domains to all those involved. However, any patient who is capable of making decisions is allowed to request the termination of certain medications or ask that any medical intervention be stopped. Even when that decision would lead to their death in the foreseeable future.

Many clinicians feel that it is easier to not start (withhold) a treatment, such as mechanical ventilation than to stop (withdraw) it. There may be an emotional difference between withdrawing treatment that could prolong a patient’s life and withholding it entirely, but there is no clear ethical difference between the two. When a treatment no longer helps to achieve the patient’s goals for care or desired quality of life, it is ethically appropriate for physicians to withdraw it. This is a very important aspect of palliative care, where the caretaker often leaves out painful treatments or medications to keep the patient comfortable until they pass.

Withdrawing or withholding of life sustaining treatment is also considered euthanasia but passively. Rather than inducing death by introducing substances into the body, the treatment that could keep the body alive is removed. In some situations, it may be a conundrum as to whether the act of withholding or withdrawing treatment can be considered passive euthanasia or a part of palliative care. Since palliative care involves keeping a patient as comfortable as possible until the end of their life. A palliative care doctor might advise someone who is approaching death to stop taking certain medications. If they cause unpleasant side effects; or they may allow someone to take a much higher dose of a medication to treat severe pain. This is standard in palliative care and is generally not considered euthanasia or assisted suicide.

Conclusion

Understanding the patient, and curating an end-of-life plan for them involves a lot of emotional turmoil for all those in interaction with the process – the patient, family and even the clinicians. It is a time of preparing to let go of the patient. To understand the option that would keep them comfortable until they pass away. The necessity and competence of the patient or surrogate in making this decision must also be evaluated carefully. To avoid letting go of someone who could have, or would have wanted to live. Termination of life sustaining treatment, hence, is a sensitive issue that requires large amounts of patience, empathy and understanding.

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Alzheimer’s Disease – Causes, Symptoms, Treatment and Prevention

Medical

July 24, 2021
/ Leave a Comment on Alzheimer’s Disease – Causes, Symptoms, Treatment and Prevention

6 min
2 years
1,176 word

Tagged Alzheimer, Causes, Prevention, Symptoms, Treatment

Alzheimer’s Disease – Causes, Symptoms, Treatment and Prevention

Alzheimer’s disease is the most common type of dementia, accounting for around 60% of all dementia cases. Alzheimer’s disease affects 28,000 New Zealanders, and the number is expected to rise to 70,000 by 2031.

Alzheimer’s Disease – Causes, Symptoms, Treatment and Prevention

AUTHOR : NEHA SHARMA

There is no known cure for Alzheimer’s disease, nor are there any effective ways to prevent it from developing. Support and symptom management are the main goals of treatment.

In the end, the situation is resolved.

Causes

Brain cells begin to degrade in Alzheimer’s disease.The body produces a protein called amyloid to try to stop the process. However, as amyloid deposits accumulate in the brain, the condition worsens. These amyloid deposits are known as “plaques,” and they cause brain cells to shrivel up and create “tangles,” which leads to structural alterations in the brain and cell death.Plaques and tangles block the generation of neurotransmitters, which are crucial brain chemicals. The brain shrinks over time due to the loss of brain cells.

Alzheimer’s disease has no known origin, but some experts now believe that a combination of environmental and genetic risk factors causes an aberrant chemical process in the brain that leads to Alzheimer’s-type dementia over decades. The following are some of the known risk factors for getting the disease:

Increasing age
Down’s syndrome
History of a head injury
Risk factors for blood vessel disease such as smoking
Family history of Alzheimer’s disease
Obesity
High blood pressure
High cholesterol
Insulin resistance.

There is evidence that females have a somewhat higher prevalence of Alzheimer’s disease than males, however this could be due to their longer life expectancy.

According to research, the following elements may play a significant influence in the development of the condition:

1. Genetic factors, such as the presence of specific genes or variations in their expression.

2. Environmental variables, such as long-term exposure to certain solvents in the environment, such as insecticides, glues, and paints.

3. Autoimmune factors and specific viruses are also being investigated..

Signs and Symptoms

Alzheimer’s disease causes degenerative changes in the parts of the brain that control thought, memory, and language, resulting in a gradual deterioration of a person’s behaviour and mental function.Physical functions like bowel and bladder control are frequently disrupted.

Individual differences in the nature of symptoms and the rate at which deterioration progresses are common in Alzheimer’s disease. For each person, the types of behaviour changes and the amount of time symptoms are present are distinct. Alzheimer’s disease usually has a gradual onset of symptoms. The time between the commencement of the disease and death can be anything between five and twenty years.

Symptoms commonly experienced during the early stages of Alzheimer’s disease include:

Mild forgetfulness – especially short-term memory loss
Mood changes, including irritability and anxiety
Difficulty processing new information and learning new things
Loss of spontaneity and initiative
Confusion about time and place
Communication difficulties
Decline in ability to perform routine tasks

As Alzheimer’s disease progresses the following symptoms may develop:

Increasing short-term memory loss and confusion
Difficulty recognising family and friends
Shorter attention span and feelings of restlessness
Difficulty with reading, writing and numbers
Possibly neglectful of hygiene
Loss of appetite
Personality changes (eg: aggression, significant mood swings)
Requires increasing assistance with daily tasks

Towards the later stages of the disease the following symptoms may be experienced:

Inability to understand or use speech
Incontinence of urine / faeces
Inability to recognise self or family
Severe disorientation
Increasing immobility and sleep time

For family members and acquaintances, the changes brought on by Alzheimer’s disease can be increasingly distressing. It becomes even more challenging as the person’s condition worsens and they lose their ability to recognise loved ones.

Although a person’s talents deteriorate as the disease progresses, it’s generally beneficial to concentrate on the ones that remain, such as touch and hearing, as well as the ability to respond to emotion.

Diagnosis

Alzheimer’s disease cannot be diagnosed with a single test. To rule out other probable reasons, the diagnosis entails a thorough examination of medical and psychological history. As a result, a number of tests are needed to make a definitive diagnosis, which may include:

A neurological and physical examination
Blood and urine tests
Brain scans
Mental status assessment to determine the level of mental deterioration
Caregiver interview to determine the level of dependency

Brain scans to determine the anatomy and function of the brain may be recommended. CT (computerised tomography) and MRI (magnetic resonance imaging) are two types of scans that may be employed (magnetic resonance imaging).

Treatment

Because Alzheimer’s disease has no known cure, treatment focuses on symptom management and providing support to the patient and their family. This could involve the following:

Treating medical conditions that may contribute to confusion or physical decline eg: lung disease or anaemia.
Encouraging stimulating activities in order to encourage the person to continue their normal activities as much as possible.
Providing memory aids and memory triggers such as calendars and written reminders.
Encouraging social interaction to help prevent feelings of loneliness and depression.
Contacting support groups that may be able to offer family/caregivers assistance.
Encouraging regular routine to reduce confusion.
Not smoking.

Medications

Medications like sleeping pills and tranquilizers can help reduce symptoms like insomnia and agitation. However, because they frequently produce more uncertainty, their use should be limited.

In certain people, a class of drugs known as cholinesterase inhibitors has shown some promise in reducing the advancement of the disease. These drugs work by preventing the breakdown of acetylcholine, a memory-enhancing neurotransmitter. Donepezil (Donepezil-Rex), rivastigmine (Exelon), and galantamine are cholinesterase inhibitors that are accessible in New Zealand (Reminyl).

Another medicine, memantine (Ebixa), has lately become available in New Zealand. Memantine differs from cholinesterase inhibitors in that it aims to prevent an excessive quantity of calcium from entering brain cells. Calcium levels in the brain cells are higher than normal, which damages them and inhibits them from receiving messages from other brain cells. Donepezil is the only medicine that is currently subsidised by the government for the treatment of Alzheimer’s disease.

Other drugs for the treatment of Alzheimer’s disease are still under development. Therapies that prevent the formation of amyloid deposits in the brain are being explored, as well as the usage of anti-inflammatory and hormone medications. Alternative medicines, such as antioxidants like Vitamin E, selenium, and herbal extracts, are also being studied (ginko baloba in particular).

Prevention / Risk Reduction

There are no known strategies to prevent Alzheimer’s disease from developing. Epidemiological data suggests, however, that living a healthy lifestyle helps lower the incidence of Alzheimer’s disease. Regular physical activity and exercise may have a protective effect on brain health and may decrease Alzheimer’s disease progression. Although there are no specific dietary guidelines for Alzheimer’s disease, a Mediterranean-style diet (which includes plant foods like vegetables, fruits, beans, whole grains, nuts, olives, and olive oil, as well as some cheeses, yoghurt, fish, poultry, and eggs) has been shown to reduce the risk of Alzheimer’s disease, as well as cardiovascular disease and type 2 diabetes. For more diet information, refer to our Healthy heart diet.

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