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Tuesday, 15 May 2012
Thursday, 5 April 2012
FREE ORAL CANCER SCREENING & DENTAL HYGIENE CONSULTATION
In honor of Oral Cancer Awareness Month, SURREY DENTAL HYGIENE CLINIC will be offering free oral cancer screenings for the month of April and May. Oral cancer is not a rare disease. Approximately 40,000 people will be diagnosed with oral cancer every year in the US. It kills one person every hour of every day, and over 100 new individuals will be diagnosed with it each day. The good news is that it can often be found early in its development, through a simple, painless, and quick screening.
Who should get screened?
Every adult. Oral cancer can often be caught early, even as a pre-cancer. With early detection, survival rates are high and the side effects are from treatment are at their lowest. Like other screenings you engage in such as cervical, skin, prostate, colon and breast examinations, oral cancer screenings are an effective means of finding cancer at its early, highly curable stages. Make them part of your annual health check-ups.
What are the risk factors?
There are two distinct pathways by which most people come to oral cancer. One is through the use of tobacco and alcohol, a long term historic problem and cause, and the other is through exposure to the HPV16 virus (human papilloma virus version 16), which is now the leading cause of oral cancers in the US, and the same one, which is responsible for the vast majority of cervical cancers in women. The quickest growing segment of the oral cancer population are young, healthy, non-smokers due to the connection to this virus.
Early Indicators:
Red and/or white discolorations of the soft tissues of the mouth.
Any sore which does not heal within 14 days.
Hoarseness which lasts for a prolonged period of time.
A sensation that something is stuck in you throat.
Numbness in the oral region.
Difficulty in moving the jaw or tongue.
Difficulty in swallowing.
Ear pain which occurs on one side only.
A sore under a denture, which even after adjustment of the denture, still does not heal.
A lump or thickening which develops in the mouth or on the neck.
An oral cancer screening should be conducted every year, so take advantage of this free offer and get screened today. Call RONNIE SINGH @ 7789870219 to make an appointment for your complimentary screening.
For more information about oral cancer, please log onto The Oral Cancer Foundation’s official website at www.oralcancer.org. Thursday, 1 March 2012
Thursday, 18 August 2011
TOOTH JEWELLERY( LATEST IN FASHION) NOW AVAILABLE AT SURREY DENTAL HYGIENE CLINIC
Popularized by singers such as Pink, Tooth Jewellery is the latest in fashion accessories today. Tooth Jewels are glass crystals designed specifically for dental use. The crystals have a special coating on the back and their facet cut reflects the light and makes it sparkle like a diamond.
Unlike earlier methods which involved drilling and setting the Jewel into the tooth, a little bit of dental composite material attaches the crystal onto the teeth (similar to braces) and can last up to a year or longer.
- It’s temporary
- It’s painless
- It’s fun
- No drilling or holes
- Does not harm the tooth
NOW AVAILABLE AT SURREY DENTAL HYGIENE CLINIC CALL RONNIE @7789870219
Friday, 22 July 2011
Wednesday, 29 June 2011
Oral Manifestations of a Systemic Disease
A 16-year-old boy with fever (38.9°C) and sore throat for the last 8 days was unresponsive to antibiotics. He was febrile and anemic and had generalized lymphadenopathy and hepatomegaly. Oral examination revealed painful, bilateral extraoral herpetiform lesions adjacent to the vermilion border of the lower lip (Fig. 1). These lesions appeared as clusters of encrusted vesicles. Intraoral ulcerations, suggestive of herpes simplex infection were present on the marginal and interdental gingiva on the buccal and palatal aspects of all teeth as well as on the lateral borders of the tongue (Figs. 2 and 3). These deep, “punched-out” ulcerations were covered with curdy, milky-white patches suggestive of oral candidiasis. The colour of the gingiva varied from pale to purplish red; loss of normal contour and stippling of gingiva and purple bruising were observed on the posterolateral aspect of the palate (Fig. 2). Candidiasis was also noticed on the posterior third of the tongue (Fig. 3). The pericoronal gingivae on the erupting mandibular left and right second molars were inflamed and covered with oral thrush (Fig. 4). There were generalized stains and calculus.
Figure 1: Bilateral extraoral herpetiform lesions with vesicles and encrustation. 
Figure 2: Palatal bruising; markedly swollen, friable and erythematous gingiva; soft, raised, curdy, milky-white plaques interdentally suggestive of candidiasis. 
Figure 3: Ulceration, candidiasis and bruising (ecchymosis due to hemorrhage) on the tongue. 
Figure 4: Herpetic ulcers; enlarged, edematous, reddened pericoronal flaps superimposed with candidiasis, which is evident on the tongue and interdental areas.
States of Immunodeficiency
Defects in the functioning of the immune system are characterized by increased susceptibility to frequent, severe and recurrent infections of the respiratory tract, skin and mucous membrane. These are classified by type of cell affected, i.e., defects of B-lymphocytes, T-lymphocytes, phagocytic cells or a complement cascade. Infections with major gram-positive organisms occur frequently in B-cell immunodeficiencies, whereas severe viral and fungal infections occur in T-cell immunodeficiencies.
Acquired immunodeficiencies are the result of extrinsic causes, such as malnutrition, aging and medications, e.g., cancer chemotherapy, steroids and immunosuppressive drugs used by organ transplant recipients and in auto-immune disease. Chronic infections, such as AIDS caused by HIV, also impair the functioning of the immune system. HIV destroys CD4 helper/inducer T cells and affects both humoral and cell-mediated immunity making the patient highly susceptible to opportunistic infections. Manifestations of overall progression of the disease are more common in children because of their immature immune system. A prolonged history of fever, chronic recurrent diarrhea, oral hairy leukoplakia and Kaposi’s sarcoma may be some of the differentiating factors. CD4+ T-lymphocyte values should be obtained if a child has a positive virologic test for HIV.
Hematologic Malignancies
This group of immunocompromised states may result from an underlying hematologic malignancy or the use of chemotherapeutic drugs. Myeloid leukemias are characterized by infiltration of blood, bone marrow and other tissues by neoplastic cells of granulocytic series; in lymphoblastic leukemias, the bone marrow is replaced with small, immature lymphoblasts. The diagnosis is established by bone marrow aspiration and cytology, immunophenotyping, immunohistochemistry, molecular analysis and cytogenetic analysis. Lymphomas are usually diagnosed after microscopic examination of lymph node biopsies, immunohistochemistry and the absence of peripheral blood involvement.
Viral Infection
Infectious mononucleosis, caused by Epstein-Barr virus, is characterized by fever, lymphadenopathy, hepatosplenomegaly and abnormal blood lymphocytes. It can be differentiated from acute leukemia by the distinctive morphology of reactive lymphocytes and lymphoblasts and elevated viral titers. Moreover, in viral disease, lymph nodes, liver and spleen are often soft and ill-defined, whereas in acute leukemia, they are firm and discrete.
Immunosuppressive Therapy
Immunosuppressive drugs include glucocorticoids and cancer chemotherapeutic agents; these produce deficiencies in the host defense system and make a child more prone to infections by opportunistic organisms.
Genetic Causes
Wiskott-Aldrich syndrome (WAS) is an inherited disorder of the immune system that affects only males and is characterized by recurring severe opportunistic infections, eczema and thrombocytopenia. The diagnosis is confirmed by demonstrating a decrease or absence of the WAS protein in blood cells or the presence of a mutation in the gene that codes the WAS protein. Moreover, WAS platelets are significantly smaller than normal platelets.
Systemic Conditions
Aplastic anemia is a rare blood dyscrasia, in which peripheral blood pancytopenia results from reduced or absent blood-cell production in the bone marrow, and normal hematopoietic tissue in the bone marrow is replaced by fatty marrow. Sepsis and hemorrhage are the main causes of death in these patients as a result of neutropenia and thrombocytopenia, respectively. The lymphadenopathy, hepatosplenomegaly and skeletal changes associated with leukemia are not seen. Bone marrow aspiration or biopsy confirms the diagnosis.
Systemic lupus erythematosus is a multi-organ system autoimmune disease characterized by widespread vasculitis and the presence of various auto-antibodies. Fever, joint symptoms, mild anemia and oral ulcers are usually present in active disease. Children with lupus frequently have lymphadenopathy and hepatosplenomegaly. Non-erosive, symmetric and polyarticular arthritis, typical erythematous “butterfly” rash over the malar area and discoid rash with a history of photosensitivity over the face and chest are pathognomonic. Prominent laboratory findings include lymphopenia, thrombocytopenia, low serum complement levels, a high-titered positive antinuclear antibody test and abnormal urinary sediment.
Cyclic neutropenia, an autoimmune disease, is characterized by cyclic fluctuations in neutrophil count. The cycle averages 21 days (14–36 days) with severe neutropenia (neutrophil count < 0.2 × 109/L) lasting 3–10 days. During the period of neutropenia, bone marrow aspirate shows signs of maturation arrest at the myelocytic stage. Cyclic neutropenia is associated with fever, recurrent oral ulcerations, pharyngitis, cervical lymphadenopathy and skin lesions. Intraoral features include severe recurrent gingivitis, loss of periodontal attachment, deep periodontal pocket formation and marked alveolar bone loss, often causing loss of teeth.
Early bone marrow transplantation is the treatment of choice for acute myeloid leukemias. The patient has been undergoing chemotherapy at a nearby hematology centre and is currently in the consolidation phase. He is awaiting bone marrow transplant.
Leukemia is accompanied by febrile neutropenia, which is defined as the presence of fever (≥ 38.3°C) and a low neutrophil count. Neutropenia is classified as mild (ANC 1.0–1.5 × 109/L), moderate (ANC 0.5–1.0 × 109/L) or severe (ANC < 0.5 × 109/L). Severe neutropenia increases susceptibility to bacterial or fungal infections and impairs resolution of these infections. Leukemia also brings about defects in cell-mediated immunity that may increase the possibility of infection by an inherently present latent virus, such as herpes simplex virus (HSV), which manifests on the oral and circumoral mucosal surfaces. Confirmation of both herpetic gingivostomatitis and candidiasis by appropriate laboratory means is mandatory, even when prior empirical treatment is being contemplated.
Systemic antifungal therapy is indicated for patients who are at high risk of candidemia or are relatively resistant to topical antifungal agents. Nystatin in the form of a mouthwash or suspension or clotrimazole troche can be recommended for the treatment of oral candidiasis. If oral candidiasis is accompanied by an immunocompromised state, fluconazole or caspofungin is effective. The prophylactic use of the antiviral drug acyclovir is known to reduce the incidence of oral infections caused by HSV in patients with acute myeloid leukemia. Patients afflicted with hematologic malignancies are at a high risk of developing life-threatening septicemia due to odontogenic bacteria. Dental extractions and any other oral surgical procedures should be performed at least 3 weeks before the start of cancer chemotherapy. An ANC greater than 1.0 × 109/L and a platelet count of at least 60 × 109/L are acceptable for performing oral surgery.
This case demonstrates the importance for dental practitioners of recognizing mucocutaneous manifestations of systemic diseases. The oral cavity is an important portal of entry for microorganisms, which, in immunosuppressed patients, can lead to a systemic involvement accompanied by life-threatening complications. If such lesions are undetected and untreated, they often lead to a fulminant infection causing death. Dental prophylaxis and treatment of caries and gingivitis are necessary to eliminate the oral source of infection.
Figure 1: Bilateral extraoral herpetiform lesions with vesicles and encrustation. Figure 2: Palatal bruising; markedly swollen, friable and erythematous gingiva; soft, raised, curdy, milky-white plaques interdentally suggestive of candidiasis. Figure 3: Ulceration, candidiasis and bruising (ecchymosis due to hemorrhage) on the tongue. Figure 4: Herpetic ulcers; enlarged, edematous, reddened pericoronal flaps superimposed with candidiasis, which is evident on the tongue and interdental areas. What is the condition?
Differential Diagnosis
The differential diagnosis included immunodeficiency, hematologic malignancies, viral infection, immunosuppressive therapy, genetic causes and systemic conditions, including aplastic anemia, systemic lupus erythematosus and cyclic neutropenia.States of Immunodeficiency
Defects in the functioning of the immune system are characterized by increased susceptibility to frequent, severe and recurrent infections of the respiratory tract, skin and mucous membrane. These are classified by type of cell affected, i.e., defects of B-lymphocytes, T-lymphocytes, phagocytic cells or a complement cascade. Infections with major gram-positive organisms occur frequently in B-cell immunodeficiencies, whereas severe viral and fungal infections occur in T-cell immunodeficiencies.
Acquired immunodeficiencies are the result of extrinsic causes, such as malnutrition, aging and medications, e.g., cancer chemotherapy, steroids and immunosuppressive drugs used by organ transplant recipients and in auto-immune disease. Chronic infections, such as AIDS caused by HIV, also impair the functioning of the immune system. HIV destroys CD4 helper/inducer T cells and affects both humoral and cell-mediated immunity making the patient highly susceptible to opportunistic infections. Manifestations of overall progression of the disease are more common in children because of their immature immune system. A prolonged history of fever, chronic recurrent diarrhea, oral hairy leukoplakia and Kaposi’s sarcoma may be some of the differentiating factors. CD4+ T-lymphocyte values should be obtained if a child has a positive virologic test for HIV.
Hematologic Malignancies
This group of immunocompromised states may result from an underlying hematologic malignancy or the use of chemotherapeutic drugs. Myeloid leukemias are characterized by infiltration of blood, bone marrow and other tissues by neoplastic cells of granulocytic series; in lymphoblastic leukemias, the bone marrow is replaced with small, immature lymphoblasts. The diagnosis is established by bone marrow aspiration and cytology, immunophenotyping, immunohistochemistry, molecular analysis and cytogenetic analysis. Lymphomas are usually diagnosed after microscopic examination of lymph node biopsies, immunohistochemistry and the absence of peripheral blood involvement.
Viral Infection
Infectious mononucleosis, caused by Epstein-Barr virus, is characterized by fever, lymphadenopathy, hepatosplenomegaly and abnormal blood lymphocytes. It can be differentiated from acute leukemia by the distinctive morphology of reactive lymphocytes and lymphoblasts and elevated viral titers. Moreover, in viral disease, lymph nodes, liver and spleen are often soft and ill-defined, whereas in acute leukemia, they are firm and discrete.
Immunosuppressive Therapy
Immunosuppressive drugs include glucocorticoids and cancer chemotherapeutic agents; these produce deficiencies in the host defense system and make a child more prone to infections by opportunistic organisms.
Genetic Causes
Wiskott-Aldrich syndrome (WAS) is an inherited disorder of the immune system that affects only males and is characterized by recurring severe opportunistic infections, eczema and thrombocytopenia. The diagnosis is confirmed by demonstrating a decrease or absence of the WAS protein in blood cells or the presence of a mutation in the gene that codes the WAS protein. Moreover, WAS platelets are significantly smaller than normal platelets.
Systemic Conditions
Aplastic anemia is a rare blood dyscrasia, in which peripheral blood pancytopenia results from reduced or absent blood-cell production in the bone marrow, and normal hematopoietic tissue in the bone marrow is replaced by fatty marrow. Sepsis and hemorrhage are the main causes of death in these patients as a result of neutropenia and thrombocytopenia, respectively. The lymphadenopathy, hepatosplenomegaly and skeletal changes associated with leukemia are not seen. Bone marrow aspiration or biopsy confirms the diagnosis.
Systemic lupus erythematosus is a multi-organ system autoimmune disease characterized by widespread vasculitis and the presence of various auto-antibodies. Fever, joint symptoms, mild anemia and oral ulcers are usually present in active disease. Children with lupus frequently have lymphadenopathy and hepatosplenomegaly. Non-erosive, symmetric and polyarticular arthritis, typical erythematous “butterfly” rash over the malar area and discoid rash with a history of photosensitivity over the face and chest are pathognomonic. Prominent laboratory findings include lymphopenia, thrombocytopenia, low serum complement levels, a high-titered positive antinuclear antibody test and abnormal urinary sediment.
Cyclic neutropenia, an autoimmune disease, is characterized by cyclic fluctuations in neutrophil count. The cycle averages 21 days (14–36 days) with severe neutropenia (neutrophil count < 0.2 × 109/L) lasting 3–10 days. During the period of neutropenia, bone marrow aspirate shows signs of maturation arrest at the myelocytic stage. Cyclic neutropenia is associated with fever, recurrent oral ulcerations, pharyngitis, cervical lymphadenopathy and skin lesions. Intraoral features include severe recurrent gingivitis, loss of periodontal attachment, deep periodontal pocket formation and marked alveolar bone loss, often causing loss of teeth.
Diagnosis of Patient
The patient’s history and clinical examination suggested a hematologic malignancy, and this diagnosis was further corroborated by results of a peripheral blood smear. The hemogram revealed hemoglobin level of 87 g/L, platelet count of 48 × 109/L, elevated total leukocytic count (210.5 × 109/L) and an increase in the number of myeloblasts (98% of the total leukocyte count) with a concomitant decrease in the lymphocyte count (2% of the leukocyte count). The peripheral blood smear revealed severe neutropenia (absolute neutrophil count [ANC], 0 × 109/L). Bone marrow biopsy and immunophenotyping confirmed the diagnosis of minimally differentiated acute myeloid leukemia.Early bone marrow transplantation is the treatment of choice for acute myeloid leukemias. The patient has been undergoing chemotherapy at a nearby hematology centre and is currently in the consolidation phase. He is awaiting bone marrow transplant.
Leukemia is accompanied by febrile neutropenia, which is defined as the presence of fever (≥ 38.3°C) and a low neutrophil count. Neutropenia is classified as mild (ANC 1.0–1.5 × 109/L), moderate (ANC 0.5–1.0 × 109/L) or severe (ANC < 0.5 × 109/L). Severe neutropenia increases susceptibility to bacterial or fungal infections and impairs resolution of these infections. Leukemia also brings about defects in cell-mediated immunity that may increase the possibility of infection by an inherently present latent virus, such as herpes simplex virus (HSV), which manifests on the oral and circumoral mucosal surfaces. Confirmation of both herpetic gingivostomatitis and candidiasis by appropriate laboratory means is mandatory, even when prior empirical treatment is being contemplated.
Systemic antifungal therapy is indicated for patients who are at high risk of candidemia or are relatively resistant to topical antifungal agents. Nystatin in the form of a mouthwash or suspension or clotrimazole troche can be recommended for the treatment of oral candidiasis. If oral candidiasis is accompanied by an immunocompromised state, fluconazole or caspofungin is effective. The prophylactic use of the antiviral drug acyclovir is known to reduce the incidence of oral infections caused by HSV in patients with acute myeloid leukemia. Patients afflicted with hematologic malignancies are at a high risk of developing life-threatening septicemia due to odontogenic bacteria. Dental extractions and any other oral surgical procedures should be performed at least 3 weeks before the start of cancer chemotherapy. An ANC greater than 1.0 × 109/L and a platelet count of at least 60 × 109/L are acceptable for performing oral surgery.
This case demonstrates the importance for dental practitioners of recognizing mucocutaneous manifestations of systemic diseases. The oral cavity is an important portal of entry for microorganisms, which, in immunosuppressed patients, can lead to a systemic involvement accompanied by life-threatening complications. If such lesions are undetected and untreated, they often lead to a fulminant infection causing death. Dental prophylaxis and treatment of caries and gingivitis are necessary to eliminate the oral source of infection.
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