At Times Teeth Are Sacrificed Without Any Fault

During our dental college days we used to be taught in details about the trigeminal neuralgia and its management. Our great teachers used to tell us that this condition is often ignored and goes undiagnosed.

In Trigeminal neuralgia, the facial pain is very severe and neuralgic and patient think that it is due to his bad teeth. These patients somehow find some dentists, at times quacks, who start pulling out their healthy teeth one by one till these patients are rendered totally toothless.

Then these patients narrate this tale that due to this excruciating pain, they got their all the teeth removed but there is no relief.

There are effective way to tackle this pain due to trigeminal neuralgia by various means…medicines, surgery, injection etc.

This thought caught me yesterday after a young man in his early twenties came to me with severe pain in his teeth for the last 7-10 days. He told me that pain is so severe that he is unable to sleep.

IMG_20160728_104231 (1)

Herpes Zoster needs treatment with Anti-viral medicines for few days…he didn’t receive any treatment


I noticed these scars on his face. Since i found his teeth and gums in perfectly healthy condition, i was curious to know about these blister scars on his face.

He told me that about 15 days ago he got severe pain in his ears for about a week which was followed by the blisters on the face which were very painful. While travelling in train, he covered these blisters with his hanky. He noticed that it became all wet and he thought it was the cause of problem. I reassured him.

After that, those blisters started to heal.

Looking at the distribution of the blisters on his face, I suspected that he suffered from Herpes zoster. This condition is viral in nature and it involves the body area supplied by a particular nerve, in this case it was facial nerve.

He just took some medicines from here and there and some injection from some neighborhood doctor. Somehow he passed time till the teeth start aching very badly and he came to me.

He was referred to physician who also suspected Herpes zoster and prescribed some medicines for nerves, nerve-tonics type of medicines along with some strong pain-killer so that he could sleep during night.

This is one of the complications of herpes zoster infection – after the infection, the residual nerve pain continues for variable periods of time — may be weeks, months and years even. He has been advised and reassured accordingly.

This post is just to remind that self medication is dangerous and whenever there is some health issue, it is always prudent to consult a qualified doctor so that proper treatment can be given to ‘nip the evil in the bud’.

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Areca nuts- Smokelss tabacco play havoc with young lives

IMG_20160728_124146This is the dental photograph of a 23 year young man who had come to me with swelling of  face on his right side (involving lower jaw).

IMG_20160728_124041It was noticed that he is not able to open his mouth properly. There was restricted mouth opening as you can see in this picture. The swelling was primarily due to an erupting third molar tooth – this swelling will go away in 3-4 days with a course of antibiotics and analgesic-anti inflammatory medicines. But the trismus (decreased mouth opening) would stay on!

This man had used some products – Pan Masala (mainly comprises of areca nuts or commonly called betel nuts) and Gutkha (made of powdered tobacco). This is a deadly combination. The use of these two products is quite rampant in India.

Because of this habit, people in younger age group are suffering from Oral submucous fibrosis – a precancerous oral condition in which oral opening starts getting lesser and lesser and the oral tissues become very hard -just like dry leather. The patients also develop all type of ulcers in the mouth for which they keep on trying all sorts of gels and drops without any results.


Oral tissues become pale, blanched out and hard like dry leather- this young man is 23 years old

With times, the oral opening becomes so less… that it becomes difficult to even take meals. Some of the youngsters have to switch over to semi-solid or liquid foods. The other day I saw a young man who was pushing food into the mouth with the help of his fingers.


This young man also started using these products when he was around 15 years, used it for around 7-8 years, about 10 packets per day. He says he has left this habit about a month ago when he noticed that he is not open his mouth fully.

Inside his mouth, you can notice the oral mucosa has turned pale and has blanched appearance. It becomes so tight and hard that even oral examination becomes quite difficult.

The persons suffering from oral sub mucous fibrosis have difficulty in having any spicy food. It is definitely a precancerous condition and if this harmful habit of areca nut chewing and smokeless tobacco is not kicked off, it can develop into oral cancer.

People hardly listen. They only listen when they are unable to take food or develop oral cancer- generally it is too late by then.

We refer many such cases to the oral and maxillofacial surgeon who is the best person to treat such condition. Regarding treatment, first of all i counsel them to stop this habit. It definitely helps but i don’t remember when i saw any person totally cured of this condition.

What to do? The treatment is quite expensive. Even though we reimburse the full cost of treatment to our patients, with time they are almost always lost to follow-up. Perhaps they get fed up with lengthy treatment which requires lot of perseverance.

I always tell youngsters to stay away from such habits…prevention, prevention, prevention and very early diagnosis when the inside of mouth starts feeling hard is the best policy. Once the problem sets-in, it is just ‘sugar-coated’ talking, nothing beyond that perhaps.

Seeing such patients is definitely a very depressing experience for doctors howsoever we may act ‘detached’!  All the possible warnings- pictorial and graphic- are printed on pouches of these products declaring clearly that its use can cause oral cancer and this habit is lethal.


This author trying to learn some selfie tricks last night!

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Avoid going to Unqualified Chinese Dentists

Since my childhood days, i have been hearing about china dentists in India. Perhaps in all the cities some chinese dentist are having ‘dental shops’.

I have nothing against chinese doctors who are qualified in Dentistry and have a professional qualification. However, i have noticed during the last few decades that the chinese dentists (china dentists) who are quite popular in some towns are without any qualifications- they have just learnt the art of dentistry.

But practice of dentistry was never a mechanical can never be! It is all about bio-mechanics. We are dealing with human beings and delicate tissues and surrounding structures.

So-called unqualified but “trained-on-job” type of fake dentists dont know anything about biology…just pulling a tooth, packing something in cavities, and fixing the most crude type of dentures is not dentistry. It is butchery– that’s a mild term. We are seeing such quacks daily on Indian road-side.

A qualified and trained dentists knows his limits, he respects the tissues and treats them gently. He takes all the precautions to ensure prevention of cross infection. Otherwise, non knowing ABC of sterilization and asepsis can be lethal for patients.

Such road side dentists are playing with lives by exposing them to deadly diseases like hepatitis B, hepatitis C and HIV infection – just to name a few!

Problem is educated class in India also shy away from road-side quacks but as I said earlier even affluent Indian are quite Ok with chinese doctors (unqualified quacks, some of them with modern dental clinics).

We must remember that these quacks may be very good craftsmen, but that is dangerous if it not supported by sound knowledge of medical sciences.


Broken tooth in a 27 year old man

Today there was a patient about 27 years old, who fell down 16 years ago and fractured his upper front tooth as you see in this picture. He went to a china doctor in his hometown in Patna and got this crown fitted. This crown became shaky for the last one month and just came out yesterday.


An Indigenous type of Dowel crown which served him for 16 years..

When i was looking at this crown, i was appreciating the workmanship of that china doctor. The crown has some issues (which are beyond the scope of this post), nevertheless, an artificial crown which served this young man for the last 16 years.

I offered to re-cement it for the time being. But the young man wanted some second opinion is some higher dental centre, since it is quite old now!


This post is just to highlight the fact that china doctors can be great ‘mechanics’ but as with any non-qualified doctor/dentist, our overall well-being is at stake. We are exposed to so many hazards when we are in their hands.

Take care! Always go to professionally qualified and trained doctors. Your health is in your hands!

PS…I have nothing as such against any qualified dentists from any country. Just felt like sharing my views on dental quacks which sometimes are quite popular amongst Indian people.

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Teeth Wearing Away -Common problem

In India, wearing away of teeth is a big problem…perhaps it might be global problem but I can say with certainty that in India this problem is very rampant.

There are definite reasons for that. Common causes are incorrect use of toothbrush, using highly abrasive and poor-quality tooth powders and toothpastes, and in some cases even the improper contact of upper and lower teeth also contributes towards this problem.

Badly worn out teeth due to improper clenching

Badly worn out teeth due to improper clenching

I came across this patient few days ago. He has been using abrasive tooth powders – definitely it must have enhanced this wearing away of tooth structure. But in this middle-aged person the main reason is traumatic bite – i mean the improper way in which upper and lower teeth meet.

In dental terms, it is called Closed Bite which has destroyed lower teeth as seen in the above pic.

In dental terms, it is called Closed Bite which has destroyed lower teeth as seen in the above pic.

You can see the closed bite in this picture – i mean when he is asked to clench his teeth, his upper teeth almost cover his lower teeth. This is not a healthy arrangement of teeth.

Actually, there is so much lack of awareness about such conditions. Even if a person is made aware they hardly opt for corrective treatment saying that it is not an issue. Even this patient said that there is no problem because of closed bite or worn out teeth, just one lower tooth on his right side hurts for which he had come to me.

Needless to repeat once again that the oral health status of indian population is more or less very bad. Tobacco habits particularly smokeless tobacco add fuel to the fire!


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Dear Mom’s Recommendation..

We are big fans of writings of a great writer — Rev. Khuswant Singhji. ( i hate when we stop writing ji with names of great personalities).

My elder son enjoyed Singh’s works while in college. Younger son prefers Khushwantnama to his Chemistry lessons.

I do enjoy his all writings. I greatly admire his honesty! May he live long and healthy life!


Yesterday my mom handed over Khushwantnama (The lessons of my life by Khuswant Singh) to me with a folded page and narrated to me the Punjabi translation of a paragraph from the same book…..can i reproduce it here?

“At school, i was hopeless at all subjects. And although i was very keen on sports, I wasn’t any good at games either. The only bright point was a comment from my English teacher in my report card. Miss Budden, who had come from England to teach in Modern School for two years, wrote that i had the possibility of making it as a writer. Even then, i was a good storyteller, the family jester, narrating events with a punchline in a way that none of my brothers could. The comment from Miss Budden more than amused my father, who had already decided that i was going to be lawyer because i was such a chatterbox.”

(from Chapter: What it takes to be a writer… in Khushwantnama).

My mom is a very good writer. She rightly trusts that writing is a good therapy and a great outlet. My maternal grandfather, a teacher by profession, was a ghost-writer – he never got into any limelight. My father was an outstanding letter writer (urdu and english)  — he used to write long, straight-from-heart type of letters with handwriting which i envy till date.

My elder son has been writing letters on various subjects –God bless him, he has trained himself to speak his mind to a piece of paper and i get so very charged by his writings. That’s personal!…….i often tell him that whenever i feel low, i just take out some of his letter written (to himself) to recharge myself!

Edited (one day later!)…. [ I have realised my writing it is okay if i find uncomfortable to write names of ‘biggies’ without ‘ji’….but while talking at home we all refer to him as Khuswant Singh…so, that’s real me!]

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Childhood Lost..

Yesterday i had gone with my son to attend Parent-teacher meet.

1078After we were done with PTM, he told me that there is an Art & Craft Exhibition in the Auditorium. He was not sure whether we would be able to go there. However, i encouraged him that one must admire art.

When we were about to enter that Exhibition, we found there were some kids standing at the entrance. They were intently looking at people and things displayed there. At the first cursory glance, it appeared similar to the scene outside banquet halls where such kids line up waiting for ‘generosity’ of passer-bys to trickle down.

Just in a minute, we could understand why they were standing outside. I felt extremely bad about all this and my son’s reaction was even vocal.. “Why can’t they go inside and enjoy?”

Had to feel these flowers to know if they are real or craft work!

3I asked them to come inside …no, they won’t move from their place. Again i asked them. No movement.

There was so much hesitation. Then i thought that if they dont come inside and if i think that i have done my duty by inviting them, then i would sound like a politician’s Election manifesto.

Third time i had to literally accompany them inside that hall clearly saying —“Move around, this is yours” (i addressed them in Hindi).

After that they started enjoying that exhibition. Their happiness increased our happiness many fold.

4When we find such kids, we feel very bad about our education system.

These tender minds must be having some questions –Why are we not inside? These are the real people who are in need of a number of welfare schemes (including reservation) . Do you think that they would ever avail it? ….No, they won’t.

When they were enjoying the exhibition, my son told me that those were the kids of masons who were doing some construction work in the school.

Don’t we see so many such kids playing here and there around construction sites but we just move on. Like their exploited parents, in coming years they would go through the same grind. God bless them!

I always say that to improve our education and health care system, we should have ‘earmarked’ schools and hospitals— ok, if you are living in this area –be it a peon’s son or a DC’s kids—they can enrol in that school only. Similar should be the case with hospitals. Why availability of  money in a parent’s wallet would decide the education/fate of his brilliant kids? …No, it should not ideally in a civilized society.
5When i think about these kids, their curious eyes, i am quite sure that they are no less artists –no less painters– no less creative thinkers than yours and mine——sad part is that they have never been taken care of! Rather such kids exhibit much better life skills where our pampered ones just lag behind! It is a hard fact!

When we were coming out, we saw them also moving out of that hall. Hopefully, they enjoyed their short, cold stay amongst so- called so many members of ‘enlightened’ class (really?).

My son handed over some money to the eldest of those kids to have some snacks. I felt satisfied to see my son’s conduct — he is down-to-earth, very humble, empathetic ——-and for me the most satisfying thing is that i am very much sure that he won’t exploit anyone in his life. I can swear it on an affidavit – the type of emotional maturity he has at 16. May goodwill prevail upon all !

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Delayed Extraction Wound Healing? — take it easy!

DSC09169I want to illustrate this point with the help of an example. This lady got her tooth extracted from a dental quack. Dental quack does not know how to respect the dental tissues. They just know how to cause harm to their poor patients.

When this lady came to me about a week ago, she was in terrible pain. You can look at inside her mouth in this dental picture. The extraction wound was quite big and infected. On the inner side of the wound the whitish thing that you are seeing is the dead bone chip.

Such infected wounds are known to be very troublesome. She was unable to literally take anything orally.

I had given her some antibiotics (Amoxycillin) and analgesic/anti-inflammatory medicines (Ibuprofen+Paracetamol tabs)- and reassured her that it would take time say 2 weeks for this thing to heal completely. She was reassured — she seems to have a lot of faith in what i was saying. Some patients just trust blindly what we say. I advised her to do frequent hot saline mouthrinses -sometimes with saline, at times with slight Alum added in hot water. She followed my instructions quite religiously.

same photograph (without flash) showing the dead white bone.

Same photograph (without flash) showing the dead white bone.

She came to me 2-3 times during the last week and everytime i used to irrigate her wound with just normal saline. But generally i do such irrigation with hydrogen peroxide followed by normal saline.

She took medicines for 5-7 days. When she came to me today, i was very happy to see her wound — it was showing healthy healing and she told me that she is feeling quite comfortable now. She has started eating her meals also. After i irrigated her wound today, a small piece of bone came out. Ya, it is OK, the white, dead bone would come out on its own in a few days, otherwise we can remove it immediately too. But she was not ready for the time being. No issue, it would shed off on its own. Once again i reassured her that everything would be fine in a week’s time.

As always i am once again reminded of Mother Nature’s so many bounties — living beings have been blessed with tremendous healing powers. Only we need to TRUST  and have faith in the carrier through which bounties are coming to us!

I forgot to take her oral photograph today to show you how healthy it was looking today. Never mind, next time …if she comes back!

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