Tremendous advancement in oral hygiene

by Shanika Sriyananda

Good health habits - brushing teeth twice a day and wide public awareness on taking care of teeth have made a significant progress in dentistry in Sri Lanka. The tendency to consult a doctor even for a tiny cavity on a tooth has showed a change and more people seek medical help even for minor dental problems.

According to a latest survey done in every district has revealed that the oral hygiene among Sri Lankans has improved during the last decade.

"This is mainly because of the improved facilities and wide public awareness on the importance of having healthy teeth", Deputy Director Dental Institute of the Colombo National Hospital Dr. S. R. U. Wimalaratne said.

Dental Institute (DI), that old building with archaeological value, built in 1927, is a bee hive during the day time and sometimes even at night. Coming from the four corners of the country, over 111,000 new patients had registered with the Institute last year.

Functioning with eight Consultants and 92 doctors, DI carries out services in four major specialities of dentistry - Maxillo facial surgery, Orthodontics, Restorative Dentistry and Community Dentistry.

Being one of the major institutes in Dentistry, the Colombo DI provides almost all the major surgeries in dentistry. "We treat patients with the simple tooth ache to major treatments like correction of irregular teeth, which costs over Rs. 80,000 in private sector, free-of-charge", Dr. Wimalaratne said.

OPD is the largest service unit in the Dental Institute. It consists of an emergency treatment unit, and the 12 OPD clinics which function on all working days of the week. OPD is the entry point to take treatment at Dental Institute.

Screening of patients, provision of general dental treatments such as extractions fillings, scaling, referral of needy patients to specialized units are taken place at the OPD which is manned by non specialised Dental Surgeons. On average about 700 patients including children are given treatment at the OPD on a working day.

Dental and Maxillo-Facial Surgery Units (OMF units): There are 4 such units functioning at present at the Dental Institute. Each unit is staffed with a Consultant Mazillo-Facial Surgeon, a Senior House officer and two House Officers.

In addition one or two postgraduate trainees are assigned to some units. The patients with fractures in the oro-facial region, oral carcinoma, dentofacial pathology and developmental anomalies are given care at the OMF units. In a week each OMF unit provides outdoor clinic services for five days and undertake routine operation list on a day.

Orthodontic Unit: There is only one Orthodontic unit at the Dental Institute. This unit is staffed with a Consultant Orthodontist. The unit deals with correction of various types of malocclusions, and cleft lip and palate and other jaw deformities and provides services on all working days of the week. Patients from all over the island are attending this clinic.

There is a long waiting list for treatment and it extends up to year 2010.

Restorative Dentistry Units: There are 2 such units at Dental Institute. Restorative, Periodontal, Padodontics and Prosthodontic treatments are carried out in these specialist units. These units are open for patients on all six working days of the week.

Community Dental Unit: Similar to other specialized units this unit is staffed with a Consultant and provides services on all working days of the week. This unit mainly deals with research, service and training activities. The preventive dental clinic operating at the unit is the only such clinic available at a government hospital in Sri Lanka.

The medical staff, including a dentist at the emergency treatment unit at the DI, provides a 24-hour service. Patients with simple tooth ache to swelling, tooth fractures to tooth injuries seek emergency treatment.According to Dr. Wimalaratne, the DI is popular among the public as it has all the facilities to treat any problem related to dentistry.

"The number of patients has also increased due to the safety and the sterilization process of the equipment of the DI. Now we have commenced building of our own sterilization plant in the premises and it is under the latest technology, which is used in developed countries", he said.

Preventing child abuse

by Dr. R. A. R. Perera

The most frequent form of violence in the home remains relatively hidden from public scrutiny, is battering of a child by his or her parents.Violence has long been a part of family life. A research conducted by a social psychologist called Straus revealed that an individual stands a greater chance of being struck and or injured by a family member in the home that by anyone else in any other place.

At lease three major factors seem to be involved in these instances:

*Many psychologists believe that common stress is an important source of child abuse. Stress from great many source piles up during the day, and people often can do little to alleviate it. A worker cannot express anger against an employer easily, for fear of being fired. Traffic snarls allow drivers little in the way of retaliation.

As a result, an exhausted and angry adult may engage in displacement of aggression - that is, he or she may attack some target other than the one that is producing the stress.

Often the children are the targets of displacement not only because they are available, but also because they are defenceless against attack.

Studies have found statistical associations between various indicators of stress and child abuse. A large proportion of mothers who abused their children were experiencing economic stress and were without supportive resources.

* Even when they are experiencing great stress, most adults would not batter their children unless there were cultural sanctions for this kind of behaviour. Adults do not, for example, attack their neighbour's children or pets. Strong informal rules prohibit such actions. However, beating one's own children is an action that has long been sanctioned in the society.

Certain people are more likely to react to stress by battering their children than any others. In some cases the aggressive parent may be imitating models in his or her own family. A number of studies show that many parents who abuse their children were themselves abused in childhood or observed violent adult models.

However, modelling may not account for all incidents of child beating. Many child abusers suffer from severe emotional problems or other social problems such as social isolation.

If child abuse is to be reduced, one approach might be to attack the cultural rules that sanction it. If physical punishment becomes socially unacceptable, it is more likely to be monitored in the community and reduced through shame.

Underfoot fractures help to detect osteoporosis

Early warning of osteoporosis may be underfoot unexplained fractures of the foot may provide a new means of detecting osteoporosis in its earliest stages, says researcher Rodney L. Tomczak of Ohio State University. "This is important for the possible prevention of more serious hip and spine fractures," said Tomczak, a podiatric surgeon and assistant professor in the university's department of orthopedics.

Tomczak and colleagues followed 21 women and men who suffered from small fractures of the metatarsals, or long foot bones. None of the fractures was known to be caused by injury or repetitive movements that might overstress the foot.

Some patients reported a sudden painful snap while walking; others had unexplained nagging pain in their foot bones. To determine whether osteoporosis might be an underlying cause of the fractures, Tomczak conducted standard bone density testing.

He was surprised-as were his patients-to find "strong evidence" that 19 of the 21 had "significant bone loss." In nine patients the hidden bone loss was high enough to be classified as osteoporosis in their hips and spine.

The minor foot fractures were the "first outward sign of bone loss," said Tomczak, who presented his findings at the recent meeting of the American College of Foot and Ankle Surgeons.

Osteoporosis, or porous bone disease, is a progressive but silent deterioration of bone structure that can put a person at significantly increased risk of serious, sometimes life-threatening, fractures.

There are about 1.5 million osteoporosis-related fractures annually in the United States, including one million of the hip and spine, according to the National Osteoporosis Foundation. An estimated 10 million Americans have osteoporosis, 80 percent of them women, and another 18 million have low bone mass.

Tomczak recommended that bone density testing for osteoporosis be considered for patients with unexplained foot fractures.

Obesity in children

Obesity describes being seriously overweight, to a degree that has important implications for health.

Obesity in childhood is particularly important for many reasons - it predicts whether a child will be obese in adult life and is linked to childhood complications.

What effects does it have? These include problems with the joints and bones (such as slipped femoral epiphysis, bow legs), a condition called benign intracranial hypertension (with headaches and eye changes), hypoventilation (leading to drowsiness and poor performance during the day, snoring, heart failure), gall bladder disease, polycystic ovary syndrome, high blood pressure, high levels of blood fats, and diabetes. There are also marked psychological effects leading to low self-esteem.

Symptoms of obesity range from tiredness, backache, headaches, joint problems and poor sleep to problems at school, emotional difficulties and psychological problems.

What causes it? Obesity is caused by two simple factors - an unhealthy diet (typically too rich in sugar and fats) and not doing enough exercise to burn off the calories consumed.

Occasionally, there are other factors, for example in a rare genetic condition called Prader-Willi syndrome there may be problems with controlling hunger. Hypothyroidism and Cushing's syndrome can also cause obesity.

Who's affected? More and more children in the UK are becoming obese - it's been described as a modern epidemic. About 20 per cent of children are now overweight and 2.5 per cent are severely overweight or obese. Research suggests that the main problem is a continual reduction in the amount of exercise children take. Many overweight children have overweight parents - it's often a matter of family lifestyles.

A child's BMI is calculated using the same method as for adults - weight in kilograms divided by height in metres squared - but adult BMI figures must not be used to determine whether a child is overweight or obese. Specific age-adjusted charts are needed.

If you're worried that your child is overweight, talk to your doctor and ask for help from a dietician. Avoid starting your child on an aggressive diet. Instead, make long-term changes to healthy eating for all the family, and get your child involved in sport or exercise. Aim to increase their intake of fresh fruit and vegetables (they should be having five portions a day and reduce fat intake.

Try to find healthy snacks they like, and sit down together at least once a day for a balanced meal. Talk to teachers at their school about what can be done there. Because being overweight is often a family problem, measure the BMI of everyone in the family, and start making changes together for a healthy family lifestyle.

BBC Health

Reply to Dr. Atukorale :

AAMS epidemic

I am very grateful to Dr. D.P. Atukorale for the letter written to the Sunday Observer few weeks ago with reference to the recent article on Accelerated Atherocoronary Metabolic Syndrome.

It is encouraging to observe a real dialogue on this syndrome, which of serious national concern, building amongst the major stakeholders in the field of cardiology in Sri Lanka. It is anticipated that such a dialogue would facilitate greater national interest leading to more public awareness and badly needed major policy changes in the healthcare sector.

The said article clearly highlighted the lack of data and original research work on this issue that has been generated from within Sri Lanka. However there has been some research work that has been carried out in the West on Sri Lankan expatriates that makes the relevance of the facts highlighted in the article to the local context.

However there has been some large scale research carried out amongst people of southern Asian origin living in many countries in the West as well as some developing countries like Fiji, Mauritius and the West Indies.

In my article I stated that the traditional risk factors amongst southern Asians though common, are not as prevalent as amongst the white Caucasians and the relative disease incidence and prevalence amongst the Southern Asian ethnics is out of proportion to the prevalence of those risk factors.

This is a fact that has been repeatedly observed in scientific investigations. (Enas et al. Indian Heart Journal 1996;48:343-353, Chadda et. al Indian Journal of Medical Research 1990;92(B):424-430, Begom et al. Acta Cardiologica 1995;3:227-240). This fact was further confirmed by an epidemiological study I conducted amongst three Sri Lankan population cohorts from rural Sri Lanka, urban Sri Lanka and Sydney Australia (Heart Foundation of Australia 1994).

In a similar manner the precise prevalence of the novel coronary risk factors such as hyperhomocysteinaemia and high LP(a) levels in Sri Lanka has not been clearly described due to the lack of original research and the prohibitively high cost of routinely carrying out these investigations in local coronary patients.

However many scientific articles have been published testifying to its very high prevalence amongst South Asians including Sri Lankans. Some studies have demonstrated a prevalence of more than 75% of hyperhomocysteinaemia in India (Refsum et al. American Journal of Clinical Nutrition 2001;74:233-241).

Many studies have also highlighted the presence of high levels of LP(a) in many Asian Indians from different parts of the world. (Enas et.al.Indian Heart Journal, 1994;46 suppl:185(abstract), Chuang et al. Indian Heart Journal 1998;50:285-291, Low et al. Paediatric Research 1996;40:718-722). The high prevalence of these risk factors seems to better correlate with the high prevalence of coronary artery disease among Southern Asians in comparison to the white Caucasians.

It is important to note that epidemiological and clinical (including the angiographic appearance of the coronary anatomy) features of coronary artery disease among South Asian populations do not seem to vary across geographic locations.

Thus it is scientifically rational to project what is widely observed in similar populations elsewhere to the Sri Lankan context.

Anecdotal evidence suggests that there is low HDL levels in some Sri Lankans and this is no different to that in white Caucasians. Thus once again this risk factor per se does not explain the high prevalence of CAD in Sri Lanka.

It is well agreed that there is a critical paucity of original research carried out amongst Sri Lankans living in Sri Lanka. This fact highlights the pressing need for original studies to be carried out at the earliest, giving this a high priority in the health care agenda of the country.

It is very likely that once original data is generated within the country it would mirror those generated amongst Sri Lankans and South Asians from elsewhere due to the shared traditional gene pool of the South Asian (Asian Indian) race and their shared socio-cultural and environmental factors.

It should be noted that the epidemic of AAMS associated coronary disease is not confined to Sri Lanka but common to all South Asians world-wide. The call of the hour is to establish a consensus that there is a epidemic of coronary artery disease in Sri Lanka just as it is in South Asians (Asian Indians) all over the world and based on this conviction to investigate the true causative factors behind this and device appropriate remedies and therapeutics.

Investigative and therapeutic principles developed to manage heart disease in the White Caucasian have failed to control the spread of the AAMS epidemic and the resultant heart disease in the South Asian. Therefore it is important to acknowledge the unique nature of this disorder and navigate the future strategies at curbing this disorder guided by this fact.

(Rohan Jayasinghe, Professor of Cardiology, School of Medicine, Australia.)

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