Fighting oral Cancer Is Our Goal. We Can Do It It’s In Our Soul!

Fighting oral Cancer Is Our Goal. We Can Do It It’s In Our Soul!

Hello all….. Warm greetings…… today we are back with a new topic related to oral precancerous lesions which can lead to oral cancers….

A premalignant lesion is a disease, syndrome, or finding that, if left untreated, may lead to cancer. Precancerous lesions of oral mucosa, known as potentially malignant disorders in recent years, are consists of a group of diseases, which should be diagnosed in the early stage. Oral leukoplakia, oral submucous fibrosis, and oral erythroplakia are the most common oral mucosal diseases that have a very high malignant transformation rate.

Now, our first question is that do anyone of you noticed white patches on your oral mucosa?

If the answer is yes……. Then it can be a precancerous condition…. In this type of cases, after your first notice it’s better to visit the dentist, get the exact diagnosis and accordingly treatment plan.

Long-term outcomes associated with oral cancer and its management over the past several decades has caused concern and the value of mass oral cancer screenings has come under scrutiny. Though not all oral carcinomas are preceded by premalignant lesions as clinically visible morphological alterations occur secondary to the cellular or molecular changes, certain high risk lesions have been identified. Their management remains controversially polarized between surgical excision to prevent malignant change and conservative medical or surveillance techniques. Though oral cancer is one of the “major killers” of modern times, there seem to be no widely accepted criteria for decision making in clinical practice, the evidence base is scanty and uncertainty persists throughout investigation, diagnosis, and treatment.

Common precancerous lesions include…….

• Leukoplakia and erythroplakia or erythroleukoplakia, when both coexist are two very common clinical lesions
• Oral submucous fibrosis (OSMF)
• Lichen planus (very low risk of turning malignant)
• Other lesions (smokeless tobacco keratosis, leukoedema, and leukoderma)

Varied appearances of these lesions make it extremely difficult to classify them into a said group and are likely to be interpreted subjectively by the clinician. A histopathologic diagnosis is generally more indicative of premalignant change than clinically apparent alterations

1. Leukoplakia: a white patch or plaque that cannot be characterized, clinically or pathologically, as any other disease”. These lesions are potentially premalignant and vary in size, shape, and consistency, and macroscopically said to be homogenous and nodular.

2. Erythroplakia: It is a red or erythematous patch of the oral mucosa and is associated with significantly higher rates of dysplasia, CIS, and invasive carcinoma than leukoplakia.

3.   Oral submucous fibrosis (OSMF): It is a chronic, debilitating disease characterized by inflammation and progressive fibrosis of the submucosal tissues (lamina propria and deeper connective tissues). It results in marked rigidity and an eventual inability to open the mouth. The buccal mucosa is the most commonly involved site, but any part of the oral cavity can be involved, even the pharynx. The condition is well recognized for its malignant potential and is particularly associated with areca nut chewing, the main component of betel quid.

4. Oral lichen planus

In cases of oral lichen planus, the mucous membranes inside your mouth are the only area affected. Oral lichen planus presents symptoms different from other cases of lichen planus. Instead of a rash, people may experience swollen tissues, white patches, and open sores. Oral lichen planus isn’t contagious, and it can’t be spread to another person.

RISK FACTORS which include……

    Genetic predisposition

    tobacco chewing,

    tobacco smoking and

    alcohol intake

The treatment options include the following

Chemoprevention

“Chemoprevention” should be considered in a patient if the size of the lesion, its location, or the medical status would make surgical removal difficult to try to prevent progression to carcinoma. However, although antioxidant supplements have shown promise, they have an uncertain success rate and no long-term results.

Beta-carotene and the retinoids are the most commonly used antioxidant supplements for chemoprevention of oral cancer.

The other options include

·        careful watching (active surveillance) and frequent follow-up

·        surgery

·        cryosurgery

·        laser surgery

Overall, the take home point is that if anyone of you is suffering from white patches in oral cavity…. Be alert it can be a precancerous condition…… so please hurry me and take our expert advice.

For any other quires please contact

Dr.Dilip Kumar BDS, MDS (Oral and Maxillofacial Surgeon)

Certified Implantologist (Noble Bio-care Germany)

Certified Smile Care Dentist (New York University)

Hyderabad Smiles Dental Hospital

Phone Number: 9247864642, 8801627272.

Is chronic irritation in oral cavity is a risk factor for oral cancer…….

Hiiii… warm greetings to you all….. today we will look through  the most neglected causes of oral cancer.

Oral mucosa could host many lesions originated by Chronic Mechanical Irritation (CMI) either from teeth or dentures. The most common of CMI lesions are as follows

      tongue/cheek biting,
      frictional keratosis,
       sharp/broken teeth
      indentations,
      chronic traumatic ulcer,
      papillary hyperplasia,
      denture-induced fibrous hyperplasia and
      focal fibrous hyperplasia.

CMI is produced through low-intensity, sustained, and repeated action of an oral deleterious agent. The mechanic damage can be caused by teeth, dentures, and functional alterations, either through separate or combined action.

There are three types of CMI factors: 

v  DENTAL FACTORS which include malpositions, sharp/broken teeth, and/or rough or defective restorations.
    In adults traumatic ulcers results from fractured, carious, malformed teeth/sharp/broken teeth and ill-fitting dentures.Surface ulcerations usually heal within 10-14 days but it can persist for a longer time due to systemic disorders.Sites of traumatic ulcerations can vary according to etiology. Usually presentation is well defined erythematous area with raised margins surrounded by erythematous halo and floor covered with yellowish or greyish pseudomembranous slough.

v  PROSTHETIC FACTORS which include ill-fitting dentures, rough/sharp/overextended flanges, and lack of retention/stability and 

v  FUNCTIONAL FACTORS which include swallowing, occlusal, and other dysfunctional disorders.

Is chronic mechanical irritation is a risk factor for oral cancer…….

The notion is that chemically induced carcinogenesis with CMI that showed an increase in cancer occurrence, higher malignancy grade, and a shorter latency period. CMI per se may not be able to produce genetic mutations but may prompt epigenetic changes that ultimately inhibits DNA reparation and apoptosis. This suggests that CMI could at least play a role as promoter and progressor in oral carcinogenesis. Thus, if a cancer has eventually started from another cause, CMI will probably hasten the process.

Clinical findings……

Chronic Traumatic Ulcer (CTU) is a relevant clinical finding because it represents the effect of a low-intensity and persistent CMI. The cause (mechanical agent) and effect (lesion) relationship is usually clear. It often appears in regions that are easily injured by teeth or dentures, such as lip, tongue and buccal mucosa.

In denture wearers it may also be found on floor of the mouth and on the mucobuccal fold. CTU usually exhibit a yellow base, whitish elevated margins, and a roughly oval shape that resembles the causative agent. Induration, often associated with CTU borders, is due to scar formation and chronic inflammatory cell infiltration.

CTU may clinically resemble a squamous cell carcinoma, so it would be proper to analyze it apart from other oral CMI lesions. Previous studies have shown a clear link between persistent inflammation and cancer, through the overexpression of genes regulating proliferation, angiogenesis, and immune evasion. So, CMI could also play a role promoting a continuous inflammatory state.

The following links may also helpful for you..... please go through

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5397630/
http://www.sbdmj.com/172/172-03.pdf
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5398106/

We, the team of Hyderabad Smiles Dental Hospital...... are always open for any sort of doubts and we explained above the common causes, clinical features of chronic traumatic ulcer which can cause oral squamous cell carcinoma and the factors which can aggravate the oral cancer. For any other quires please contact the below address.

Regards,

Dr.Dilip Kumar BDS, MDS (Oral and Maxillofacial Surgeon)

Certified Implantologist (Noble Bio-care Germany)

Certified Smile Care Dentist (New York University)

Hyderabad Smiles Dental Hospital

Phone Number: 9247864642, 8801627272.

CONFUSED WITH YOUR KIDS DENTITION....... WE WILL ACKNOWLEDGE YOU ABOUT THE NEED FULL

Good evening all,,, warm greetings to you all…. We are back with a new topic which will mostly sort out the issues related to your children’ oral health.

 

                                            MIXED DENTITION

·         Dentition containing both primary and adult secondary teeth.

·         Usually occurs between 6 and 13 years of age also called “transitional dentition.”

Now let’s discuss the features of mixed dentition and what’s normal and abnormal in children’s dentition and some frequently occurring doubts in parents mind about their children’s dentition………

Is spacing is normal in your child’s teeth?

The answer is exactly yes…..  Spacing is normal between the anterior teeth in the deciduous    dentition. Lack of spacing in the deciduous dentition may be a cause for concern, since crowding of the permanent dentition is a likely sequel.

The transition from deciduous to mixed dentition……….

The transition from the deciduous to the mixed dentition begins at around the age of six with the eruption of the lower central incisors of the first group of permanent teeth to erupt, the most likely to go astray is the upper central incisor. The permanent incisors and canines are usually larger than the corresponding deciduous teeth, whereas the premolars are smaller (leeway space). The combined mesio-distal widths of the upper permanent teeth are about 3mm greater than the deciduous teeth; the lower permanent teeth are about 1mm larger than their deciduous predecessors. The extra size of the permanent teeth is accommodated in three ways:

i) Spacing of the deciduous dentition.,

ii) Growth of the alveolus and

 iii) The eruptive path of the upper incisors.

“Crooked teeth………”    WORRY about that

In the majority of children, the permanent incisors erupt into mildly crowded positions and anxious parents first become aware of CROOKED TEETH. Their alignment frequently improves with subsequent alveolar growth. Reassurance may be all that is required at this stage.

There are other aspects of normal development that can occur in some individuals:

i)                    More severe lower incisor imbrication may improve following the exfoliation of the deciduous canines and in most cases it is too early to consider the extraction of deciduous canines.

ii)                  The "Ugly Duckling" stage: described as "a fanning out of the crowns of the upper permanent incisors, particularly the lateral incisors, sometimes with a median diastema". It is caused by the position and convergence of their roots prior to the eruption of the permanent canines. The spacing usually closes spontaneously following eruption of the canines.

It is important for the general dental practitioner to recognise these characteristics of normal development so that the patient and their parents can be reassured. It is important to differentiate between a median diastema associated with the “ugly duckling” stage and other possible causes of median diastema (listed below).

 These may prompt further investigations:

i) Family/racial characteristic

 ii) Unerupted supernumeraries

 iii) Basal narrowness of maxilla

 iv) Small teeth, large jaws

v) Developmentally (congenitally) missing

 vi) Misplaced due to crowding

 vii) Peg-shaped

viii) Proclination

 ix) Abnormal fraenum

Mixed dentition period is between six to twelve years of age during which both deciduous and permanent teeth are present. During this period one can make accurate and specific prediction of future dental development and also can assess whether there will be spacing or crowding of teeth in the dental arch. In interceptive orthodontics treatment planning, it is important to predict space required and available for unerupted canine and premolars in the arch and this determination of tooth size must be done before eruption of canine and premolars by a method called Mixed Dentition Space Analysis

WHAT TO REFER FOR SPECIALIST ADVICE OR TREATMENT

The types of problems that specialists namely would prefer to see early (i.e. at 7-9 years of age), rather than late, are listed below:

1. Delayed eruption of permanent incisors, whether or not related to supernumerary teeth. Always refer to an orthodontic professional.

 2. Supplemental incisors - if you are unsure which tooth to extract.

 3. Developmental (congenital) absence: commonly affects lower central and upper lateral incisors and second premolars. Consideration must be given to the eventual position of the upper canines, if lateral incisors are absent.

4. One or more upper incisors in crossbite. This may indicate a developing Class III jaw relationship which would benefit from early orthopaedic treatment.

 5. Impaction or failure of complete eruption of one or more first permanent molars.

 6. Severe crowding.

7. Severe skeletal discrepancies - especially Class II (small lower jaw) and Class III (small upper jaw) children.

POSSIBLE INTERCEPTIVE MEASURES ……. What can be done at best….

Interceptive treatment is often the first stage of a more complex treatment plan. The aim is to aid the development of an ideal occlusion and minimize any deviation from normal. Inappropriate intervention may, in fact, complicate matters, especially if excessive space loss has been allowed to occur. If in any doubt, seek further advice.

1. Extract deciduous teeth displacing their permanent successors.

2. Balance the loss of one deciduous canine with the extraction of the contra-lateral tooth to prevent the centre line shifting to the side of the missing tooth.

3. Observe the effects on centre lines of the loss of first deciduous molars. Consider extracting the contra-lateral deciduous canine if this occurs.

4. Appliances to discourage thumb sucking at this stage are found to be less valuable than gentle discussion, encouragement and advice.

Early orthodontic assessment is used to monitor:

 1. Normal eruption of permanent incisors and first permanent molars and to investigate causes of failure of eruption. A tooth will normally erupt within six months of its contra-lateral number.

2. Presence of malocclusion i) Crowding of incisors ii) Significant displacement of incisors labially or lingually (incisors inside the bite) iii) Posterior crossbites iv) Coincidence of upper and lower centre lines v) Severe skeletal discrepancies – especially Class II cases; these may be suitable for functional appliance treatment in the late mixed or early permanent dentition.

3. Long term prognosis of first permanent molars

 4. Trauma to permanent incisors

 5. Persistent thumb or finger sucking habits

Finally, we discussed the common problems encountered with your children and for any other quires please contact the below number.

Regards,

Dr.Dilip Kumar BDS, MDS (Oral and Maxillofacial Surgeon)

Certified Implantologist (Noble Bio-care Germany)

Certified Smile Care Dentist (New York University)

Hyderabad Smiles Dental Hospital

Phone Number: 9247864642.

LASERS IN DENTISTRY........

Lasers in dentistry: An innovate tool in modern dental practice….

No drill, no pain…..

Hello all, hope you all doing well…… today we are back with a non-invasive treatment procedure i.e., lasers and their importance in dentistry.

The term LASER is an acronym for ‘Light Amplification by the Stimulated Emission of Radiation’. The laser has seen various hard and soft tissue applications and in last two decades, there has been an explosion of research studies in laser application. In hard tissue application, the laser is used for caries prevention, bleaching, restorative removal and curing, cavity preparation, dentinal hypersensitivity, growth modulation and for diagnostic purposes, whereas soft tissue application includes wound healing, removal of hyperplastic tissue to uncovering of impacted or partially erupted tooth, photodynamic therapy for malignancies, photostimulation of herpetic lesion. Use of the laser proved to be an effective tool to increase efficiency, specificity, ease and cost and comfort of the dental treatment.

Lasers

APPLICATIONS OF LASERS

Oral Surgery

• ·         Surgery (major & minor)
• ·         Treatment of abscess
• ·         Aphthous ulcer
• ·         Hemostasis
• ·         Curettage
• ·         Removal of hyper plastic tissue
• ·         Bacterial reduction
• ·          Excisional biopsy
• ·         Retention cyst
• ·         Exposure of impacted teeth
• ·         Ankyloglossia

Periodontics

• ·         Flap surgery
• ·         Frenectomy
• ·         Gingival contouring/ Gingivectomy
• ·         Pocket treatment
• ·         Bacterial reduction
• ·         Curettage
• ·         Pocket reduction
• ·         Operculectomy

Pedodontics

• ·         Removal of caries in deciduous teeth
• ·         Pulpotomy and Pulpectomy procedure

Endodontics  

• ·         Bleaching
• ·         Caries removal
• ·         Canal irrigation

Prosthodontics

• ·         Sulcus deepening
• ·         Vestibuloplasty
• ·         Crown contouring
• ·         Crown lengthening
• ·         Smile designing

 How laser works on the teeth

The laser is directed on the rotten area, which contains more water molecules than rest of the tooth

Water molecules in the decay are heated rapidly. Pressure increases and the rotten area “explodes” making a popping sound

 

The laser kills bacteria in the area leaving the tooth surface sterile

Why lasers used mostly ……. THE REASONS INCLUDE

• ·         No anesthesia, no drill
• ·         Less blood loss and less pain
• ·         Hemostatic and analgesic effect.
• ·         Reduce post –operative edema
• ·         Less post-operative scarring.
• ·         Initial healing, rapid regeneration, reduce post sensitivity in restorations 
• ·         Dressing & suturing is not required for wound closer. 
• ·         Less chances of metastasis
• ·         Sterilization of treatment site.
• ·         Laser exposure to tooth enamel causes a reduction in caries activity. 
• ·         The patient becomes free of fear & anxiety. 
• ·         Advantageous for medically compromised patients and the patient becomes free of fear & anxiety.

We, the team of HYDERABAD SMILES DENTAL HOSPITAL…… provide the best dental treatment with complete patient satisfaction.  We are well equipped with laser units in our hospital providing patients various dental treatments with no pain and post-operative complications.  We have all the required dental diagnostic in house equipment which includes digital x-ray i.e., RVG, OPG.

We will take care of medically comprised patients, understanding their problems and treating them with high level of safety. Mainly lasers can reduce their stress levels during the treatment procedure as lasers are painless…..

We will provide the all possible options related to your particular problem and go home with happy smile……

For any other queries, please contact

Dr.Dilip Kumar BDS, MDS (Oral and Maxillofacial Surgeon)

Certified Implantologist (Noble Bio-care Germany)

Certified Smile Care Dentist (New York University)

Hyderabad Smiles Dental Hospital

Phone Number: 9247864642.