Our social:

Latest Post

Thursday, 16 April 2015

ORAL CANCER

                     Oral cancer

Oral cancer or mouth cancer, a type of head and neck cancer , is any cancerous tissue growth located in the oral cancer.

It may arise as a primary lesion originating in any of the tissue in the mouth, by metasis from a distant site of origin, or by extension from a neighboring anatomic structure, such as the nasal cavity. Alternatively, the oral cancers may originate in any of the tissues of the mouth, and may be of varied histologic types: teratoma, adenocarcinoma derived from a major or minor salivary gland, lymphoma from tonsillar or other lymphoid tissue, or melanoma from the pigment-producing cells of the oral mucosa. There are several types of oral cancers, but around 90% are squamous cell carcinomas, originating in the tissues that line the mouth and lips. Oral or mouth cancer most commonly involves thetongue. It may also occur on the floor of the mouth, cheek lining, gingiva (gums), lips, or palate (roof of the mouth). Most oral cancers look very similar under the microscope and are called squamous cell carcinoma, but less commonly other types of oral cancer occur, such as Kaposi's sarcoma.
In 2013 oral cancer resulted in 135,000 deaths up from 84,000 deaths in 1990. Five year survival in the United States are 63%

Signs and symptoms:

Skin lesion, lump, or ulcer that do not resolve in 14 days located:
  • On the tongue, lip, or other mouth areas
  • Usually small
  • Most often pale colored, may be dark or discolored
  • Early sign may be a white patch (leukoplakia) or a red patch (erythroplakia) on the soft tissues of the mouth
  • Usually painless initially
  • May develop a burning sensation or pain when the tumor is advanced
  • Behind the wisdom tooth
  • Even behind the ear
Additional symptoms that may be associated with this disease:
  • Tongue problems (moving it)
  • Swallowing difficulty
  • Pain and paraesthesia are late symptoms.
  • Hoarseness, chronic sore throat, or change in voice
  • A change in the way your teeth or dentures fit together
  • Dramatic weight loss.

CAUSES:

According to the American cancer Society, men face twice the risk of developing oral cancer as women, and men who are over age 50 face the greatest risk. It's estimated that over 40,000 people in the U.S. received a diagnosis of oral cancer in 2014.

Risk factors for the development of oral cancer include:
  • Smoking. Cigarette, cigar, or pipe smokers are six times more likely than nonsmokers to develop oral cancers.
  • Smokeless tobacco users. Users of dip, snuff, or chewing tobacco products are 50 times more likely to develop cancers of the cheek, gums, and lining of the lips.
  • Excessive consumption of alcohol. Oral cancers are about six times more common in drinkers than in nondrinkers.
  • Family history of cancer.
  • Excessive sun exposure, especially at a young age.
  • Human papillomavirus (HPV). Certain HPV strains are etiologic risk factors for Oropharyngeal squamous cell carcinoma(OSCC)
It is important to note that over 25% of all oral cancers occur in people who do not smoke and who only drink alcohol occasionally.

Oral Cancer Diagnosis:

As part of your routine dental exam, your dentist will conduct an oral cancer screening exam. More specifically, your dentist will feel for any lumps or irregular tissue changes in your neck, head, face, and oral cavity. When examining your mouth, your dentist will look for any sores or discolored tissue as well as check for any signs and symptoms mentioned above.
Your dentist may perform an oral brush biopsy if he or she sees tissue in your mouth that looks suspicious. This test is painless and involves taking a small sample of the tissue and analyzing it for abnormal cells. Alternatively, if the tissue looks more suspicious, your dentist may recommend a scalpel biopsy. This procedure usually requires local anesthesia and may be performed by your dentist or a specialist. These tests are necessary to detect oral cancer early, before it has had a chance to progress and spread.


TREATMENT:

Surgical excision (removal) of the tumor is usually recommended if the tumor is small enough, and if surgery is likely to result in a functionally satisfactory result. Radiation therapy with or without chemotherapy is often used in conjunction with surgery, or as the definitive radical treatment, especially if the tumour is inoperable. Surgeries for oral cancers include
  • Maxillectomy (can be done with or without orbital exenteration)
  • Mandibulectomy (removal of the mandible or lower jaw or part of it)
  • Glossectomy (tongue removal, can be total, hemi or partial)
  • Radical neck dissection
  • Moh's procedure or CCPDMA
  • Combinational e.g. glossectomy and laryngectomy done together.
  • Feeding tube to sustain nutrition.

Owing to the vital nature of the structures in the head and neck area, surgery for larger cancers is technically demanding. Reconstructive surgery may be required to give an acceptable cosmetic and functional result. Bone grafts and surgical flaps such as the radial forearm flap are used to help rebuild the structures removed during excision of the cancer. An oral prosthesis may also be required. Most oral cancer patients depend on a feeding tube for their hydration and nutrition. Some will also get a port for the chemo to be delivered. Many oral cancer patients are disfigured and suffer from many long term after effects. The after effects often include fatigue, speech problems, trouble maintaining weight, thyroid issues, swallowing difficulties, inability to swallow, memory loss, weakness, dizziness, high frequency hearing loss and sinus damage.

Survival rates for oral cancer depend on the precise site, and the stage of the cancer at diagnosis. Overall, 2011 data from the SEER database shows that survival is around 57% at five years when all stages of initial diagnosis, all genders, all ethnicities, all age groups, and all treatment modalities are considered. Survival rates for stage 1 cancers are approximately 90%, hence the emphasis on early detection to increase survival outcome for patients. Similar survival rates are reported from other countries such as Germany.

Following treatment, rehabilitation may be necessary to improve movement, chewing, swallowing, and speech. Speech and language pathologist may be involved at this stage.

chemotherapy is useful in oral cancers when used in combination with other treatment modalities such as radiation therapy. It is not used alone as a monotherapy. When cure is unlikely it can also be used to extend life and can be considered palliative but not curative care. Biological agents, such as cetuximb have recently been shown to be effective in the treatment of squamous cell head and neck cancers, and are likely to have an increasing role in the future management of this condition when used in conjunction with other established treatment modalities.

Treatment of oral cancer will usually be by a multidisciplinary team, with treatment professionals from the realms of radiation, surgery, chemotherapy, nutrition, dental professionals, and even psychology all possibly involved with diagnosis, treatment, rehabilitation, and patient care.

Root Canal Treatment

Root Canal Treatment
Endodontic treatment (“endo” – inside; “dont” – tooth), commonly known as root canal treatment, is needed when the pulp becomes inflamed or infected. The causes could be deep tooth decay, repeated dental procedures on one tooth (replacing a large filling, for example), or traumatic damage such as a crack, chip or even a root fracture. Gum disease can also give rise to root canal problems necessitating root canal treatment.

Any of these issues can result in acute inflammation of the pulp, which causes swelling and pressure inside the tooth (that has nowhere to go), leading to tooth pain and, eventually, irreversible damage to the pulp. Once the pulp dies, the pain may subside initially, sometimes to return as an acute (painful) infection spreading into the periapical tissues (“peri” – around; “apex” – end), particularly the bone. It could also become a chronic (long-standing) infection with symptoms ranging from mild to severe.

Generally speaking, whatever the cause of root canal or pulpal disease, root canal or endodontic treatment will be necessary to save the tooth. All dentists receive training in endodontic treatment and can perform root canal procedures, but often a general dentist will refer individuals who need endodontic treatment to an endodontist, a root canal specialist.

Endodontists are dentists who have completed an additional two or more years of advanced residency training in the diagnosis and management of diseases and disorders of the dental pulp, and in the diagnosis of dental pain; their focus is therefore on saving teeth. In order to make a proper assessment and accurate diagnosis of which tooth is affected and exactly what is causing the pain, a thorough history and examination is necessary, together with a radiographic picture (x-ray) of the tooth or area.

Your dentist or endodontist will check your medical history and current medications to ensure your health and treatment safety. If you are very nervous, an oral sedative or anti-anxiety medication may be helpful — discuss the options with your dentist or endodontist ahead of time.



Root Canal Treatment, Step By Step :

Preliminary treatment to remove the decay and the source of infection of the pulp is necessary, along with a determination of whether the lost tooth structure can be restored. If a fracture of the tooth has reached the pulp, or infection is associated with gum disease, it could be more difficult, if not impossible, to save the tooth.
The general sequence of a root canal procedure is as follows:


Step 1


Local anesthesia is administered via injections to numb the tooth to be treated and the surrounding tissues. If the pulp in a tooth is acutely inflamed, and therefore very painful, it may take a while to get it numb, but your dentist will not start the treatment until it is.


Step 2


A dental dam — a thin sheet of rubber or vinyl — will be placed over the affected and adjacent teeth. The tooth undergoing treatment protrudes through a hole punched in the dam, isolating it from the rest of the mouth. This allows the root canal treatment to be carried out in a sterile environment free from contamination by bacteria found in saliva or the rest of the mouth.


Step 3


A small access hole is drilled through the biting surface of an affected back tooth or from behind a front tooth, allowing access to the pulp chamber and root canals for treatment.


Step 4


The diseased and dead pulp tissue is removed from the tooth with specially designed instruments used to clean out the root canals and pulp chamber. This is not painful; the area is numb and the tissue being removed is either dead or dying. Once the pulp, along with the nerves contained in it, is removed, the tooth itself can no longer feel pain.


Step 5


The canals are disinfected with antiseptic and antibacterial solutions.

 Step 6
The canals are then shaped with tiny flexible instruments to allow them to receive root canal fillings and sealers. The canals are washed and cleaned again to remove root canal debris prior to sealing them.


Step 7


Root canal fillings are selected that will exactly fit into the freshly prepared
canals. Usually a rubber-like material called gutta-percha is used to fill the canal space. It is a thermoplastic material (“thermo” – heat; “plastic” – to shape), which literally is heated and then compressed into and against the walls of the root canals to seal them. Together with adhesive cement called a sealer, the gutta-percha fills the prepared canal space. Sealing the canals is critically important to prevent them from becoming reinfected with bacteria.


Step 8


A temporary or permanent filling material will then be placed to seal the access hole that was made to treat the canals, and the dental dam is removed. If the tooth lacks sufficient structure to hold a restoration (filling) in place, the dentist or endodontist may place a post (either metal or a very strong plastic) in one of the canals inside the tooth to help retain it.

Step 9

 After the procedure, an antibiotic may be prescribed to treat or prevent infection. Be sure to follow the instructions of your dentist or endodontist carefully. After-effects of treatment are minimal, generally lasting from a couple of days to about a week. It is normal to have some minor discomfort after treatment including slight soreness that can usually be managed with over-the-counter (aspirin, ibuprofen) medications or prescription (codeine-type) drugs, or a combination of the two.


Step 10


Your tooth will need a permanent restoration — a filling or a crown — to

replace lost tooth structure, and provide a complete seal to the top of the tooth. Your endodontist will send you back to your general dentist to determine which type of restoration is best for you. This step is of particular importance since many studies show that if the filled root canals are recontaminated with bacteria from the mouth, there could be a recurrence of infection around the tooth.


Almost like the root system of a plant, the root canals of a tooth have a main branch and many smaller side branches, and the whole system needs to be sealed during root canal treatment to be successful long term. Since root canals are very small spaces, they require a great deal of precision and care to treat well. Therefore, most endodontists today use state-of-the-art technology including digital (radiographic) imaging to diagnose root canal problems, and after treatment to verify that the canals are properly sealed; ultrasonic instrumentation to remove old canal fillings and posts and clean canals; and operating microscopes to accurately locate, visualize and seal root canal systems; it really is quite high-tech.

I have found that people who are nervous tend to lack information about endodontic (root canal) treatment; knowledge gives them the power to understand what's to come and to eliminate their fears. I hope that this step-by-step explanation will alleviate any apprehension. Root canal treatment really does relieve pain, not cause it — and saves teeth.

Wednesday, 15 April 2015

Cleft lip and palate..

                  

                      Cleft lip and palate
Cleft lip (cheiloschisis) and cleft palate (palatoschisis), which can also occur together as cleft lip and palate, are variations of a type of clefting congenital deformities caused by abnormal facial development during gestation. A cleft is a fissure or opening—a gap. It is the non-fusion of the body's natural structures that form before birth.

Clefts can also affect other parts of the face, such as the eyes, ears, nose, cheeks, and forehead. In 1976, Paul Tessierdescribed fifteen lines of cleft. Most of these craniofacial clefts are even rarer and are frequently described as Tessier clefts using the numerical locator devised by Tessier.
A cleft lip or palate can be successfully treated with surgery, especially so if conducted soon after birth or in early childhood.
Approximately 1 in 700 children born have a cleft lip or a cleft palate or both. Cleft lip and palate resulted in about 3,300 deaths in 2013 down from 7,600 deaths in 1990. In decades past, the condition was sometimes referred to a sharelip, based on the similarity to the cleft in the lip of a hare, but that term is now generally considered to be offensive.

Symptoms:
  • A split in the lip and roof of the mouth (palate) that can affect one or both sides of the face
  • A split in the lip that can appear as only a small notch in the lip or can extend from the lip through the upper gum and palate into the bottom of the nose
  • A split in the roof of the mouth (palate) that doesn't affect the appearance of the face
Less commonly, a cleft occurs only in the muscles of the soft palate (submucous cleft palate), which are at the back of the mouth and covered by the mouth's lining. This type of cleft often goes unnoticed at birth and may not be diagnosed until later when signs develop. Signs and symptoms of submucous cleft palate may include:
  • Difficulty swallowing
  • Nasal speaking voice
  • Recurring ear infections
A cleft lip and cleft palate are usually apparent at birth, and your doctor may start coordinating care at that time. If your baby has signs and symptoms of a submucous cleft palate, such as difficulty with feedings, make an appointment with your child's doctor.

Cause:


The development of the face is coordinated by complex morphogenetic events and rapid proliferative expansion, and is thus highly susceptible to environmental and genetic factors, rationalising the high incidence of facial malformations. During the first six to eight weeks of pregnancy, the shape of the embryo's head is formed. Five primitive tissue lobes grow:
a) one from the top of the head down towards the future upper lip; (Frontonasal Prominence)
b)two from the cheeks, which meet the first lobe to form the upper lip; (Maxillar Prominence)
c) and just below, two additional lobes grow from each side, which form the chin and lower lip; (Mandibular Prominence)
If these tissues fail to meet, a gap appears where the tissues should have joined (fused). This may happen in any single joining site, or simultaneously in several or all of them. The resulting birth defect reflects the locations and severity of individual fusion failures (e.g., from a small lip or palate fissure up to a completely malformed face).
The upper lip is formed earlier than the palate, from the first three lobes named a to c above. Formation of the palate is the last step in joining the five embryonic facial lobes, and involves the back portions of the lobes b and c. These back portions are called palatal shelves, which grow towards each other until they fuse in the middle.This process is very vulnerable to multiple toxic substances, environmental pollutants, and nutritional imbalance. The biologic mechanisms of mutual recognition of the two cabinets, and the way they are glued together, are quite complex and obscure despite intensive scientific research.
Genetics:
Genetic factors contributing to cleft lip and cleft palate formation have been identified for some syndromic cases, but knowledge about genetic factors that contribute to the more common isolated cases of cleft lip/palate is still patchy.
Many clefts run in families, even though in some cases there does not seem to be an identifiable syndrome present, possibly because of the current incomplete genetic understanding of midfacial development.
A number of genes are involved including cleft lip and palate transmembrane protein andGAD1,one of the glutamate decarboxylases. Many genes are known to play a role in craniofacial development and are being studied through the facebase initiative for their part in clefting. These genes are AXIN2, BMP4, FGFR1,FGFR2, FOXE1, IRF6, MAFB (gene), MMP3, MSX1, MSX2 (Msh homeobox 2), MSX3, PAX7, PDGFC, PTCH1, SATB2, SOX9, SUMO1 (Small ubiquitin-related modifier 1), TBX22, TCOF (Treacle protein), TFAP2A, VAX1, TP63, ARHGAP29, NOG, NTN1, WNT genes, and locus 8q24.[24]

Syndromes
  • The Van der woude syndrome is caused by a specific variation in the gene IRF6 that increases the occurrence of these deformities threefold.
  • Another syndrome, Siderius X-linked mental retardation, is caused by mutations in the PHF8 gene (OMIM 300263); in addition to cleft lip and/or palate, symptoms include facial dysmorphism and mild mental retardation.
In some cases, cleft palate is caused by syndromes which also cause other problems.

Environment:
Environmental influences may also cause, or interact with genetics to produce, orofacial clefting. An example for how environmental factors might be linked to genetics comes from research on mutations in the gene PHF8 that cause cleft lip/palate (see above). It was found that PHF8 encodes for a histone lysine demethylase, and is involved in epigenetic regulation. The catalytic activity of PHF8 depends on molecular oxygen,a fact considered important with respect to reports on increased incidence of cleft lip/palate in mice that have been exposed to hypoxia early during pregnancy. In humans, fetal cleft lip and other congenital abnormalities have also been linked to maternal hypoxia, as caused by e.g. maternal smoking, maternal alcohol abuse or some forms of maternal hypertensiontreatment.Other environmental factors that have been studied include: seasonal causes (such as pesticide exposure); maternal diet and vitamin intake; retinoids — which are members of the vitamin A family; anticonvulsant drugs; alcohol; cigarette use; nitrate compounds; organic solvents; parental exposure to lead; and illegal drugs (cocaine, crack cocaine, heroin, etc.).
Current research continues to investigate the extent to which folic acid can reduce the incidence of clefting.

Tests and diagnosis:


Most cases of cleft lip and cleft palate are immediately apparent at birth and don't require special tests for diagnosis.
Ultrasound to diagnose cleft lip and cleft palate before birth
Increasingly, cleft lip and cleft palate are being diagnosed by ultrasound before the baby is born. An ultrasound is a test that uses sound waves to create pictures of the developing fetus. When analyzing the pictures, a doctor may detect an abnormality in the facial structures.


Cleft lip may be detected with ultrasound beginning around the 18th week of pregnancy. As the fetus continues developing, it may be easier to accurately diagnose a cleft lip. Cleft palate that occurs on its own is more difficult to diagnose using ultrasound, since it can be difficult to see inside the fetus' mouth.



If fetal ultrasound shows a cleft, your doctor may offer a procedure to take a sample of amniotic fluid from your uterus (amniocentesis). Analyzing the fluid may reveal abnormalities that indicate the fetus has inherited a genetic syndrome that can cause other birth defects. However, most often cleft lip and cleft palate occur on their own.


The Treatment for Cleft Lip and Cleft Palate:


A cleft lip may require one or two surgeries depending on the extent of the repair needed. The initial surgery is usually performed by the time a baby is 3 months old.
Repair of a cleft palate often requires multiple surgeries over the course of 18 years. The first surgery to repair the palate usually occurs when the baby is between 6 and 12 months old. The initial surgery creates a functional palate, reduces the chances that fluid will develop in the middle ears, and aids in the proper development of the teeth and facial bones.
Children with a cleft palate may also need a bone graft when they are about 8 years old to fill in the upper gum line so that it can support permanent teeth and stabilize the upper jaw. About 20% of children with a cleft palate require further surgeries to help improve their speech.
Once the permanent teeth grow in, braces are often needed to straighten the teeth.
Additional surgeries may be performed to improve the appearance of the lip and nose, close openings between the mouth and nose, help breathing, and stabilize and realign the jaw. Final repairs of the scars left by the initial surgery will probably not be performed until adolescence, when the facial structure is more fully developed.

Dental Care for Children With Cleft Lips and/or Palates:

Generally, the preventive and restorative dental care needs of children with clefts are the same as for other children. However, children with cleft lip and cleft palate may have special problems related to missing, malformed, or malpositioned teeth that require close monitoring.
  • Early dental care Like other children, children born with cleft lip and cleft palate require proper cleaning, good nutrition , and fluoride treatment in order to have healthy teeth. Appropriate cleaning with a small, soft-bristled tooth brush should begin as soon as teeth erupt. If a soft children's toothbrush will not adequately clean the teeth because of the modified shape of the mouth and teeth, a toothette may be recommended by your dentist. A toothette is a soft, mouthwash-containing sponge on a handle that's used to swab teeth. Many dentists recommend that the first dental visit be scheduled at about 1 year of age or even earlier if there are special dental problems. Routine dental care can begin around 1 year of age.
  • Orthodontic care. A first orthodontic appointment may be scheduled before the child has any teeth. The purpose of this appointment is to assess facial growth, especially jaw development. After teeth erupt, an orthodontist can further assess a child's short and long-term dental needs. After the permanent teeth erupt, orthodontic treatment can be applied to align the teeth.
  • Prosthodontic care. A prosthodontist is a member of the cleft palate team. He or she may make a dental bridge to replace missing teeth or make special appliances called "speech bulbs" or "palatal lifts" to help close the nose from the mouth so that speech sounds more normal. The prosthodontist coordinates treatment with the oral or plastic surgeon and with the speech pathologist.

Copyright 2015. All Rights Reserved

Blogger Templates Design By Premium Blogger Templates