Cure for Gutkha-Panmasala Problems!

I have shared a number of case reports of youngsters- some of them in their teens- on this blog about the serious problems being faced by the people who are hooked to Pan-masala and Gutkha.

Mouth cancer is an extreme – it is almost always preceeded by warning signs which are mostly ignored by the Gutkha chewer. Most frustrating is to find youngsters unable to take food as their mouth is almost closed or mouth opening is so small that it is good enough only for taking liquid diet.

Every other day I get an email from one youngster or the other asking for its cure as their mouth opening has reduced drastically.

So, once again this morning i thought of sharing some facts about the cure of the problems caused due to all these pan-masalas and other smokeless products.

The referral and reimbursement system is quite satisfactory in the organisation for which I am working. However, it is regretted that in spite of this except oral cancers (caused due to tobacco products), I seldom come across people who have been cured of problems like decreased mouth opening etc (with some exceptions of course). Either they don’t take complete treatment and leave mid way or they are unable to leave this deadly habit.

A person who has landed into this problem, just out of ignorance, feels that like most of other health issues, these mouth problems would also vanish with some magic wand in the form of costly medicines for applying in the mouth or by taking some medicines orally.

In fact, they are under the impression that they can continue the habit and simultaneously take treatment. It NEVER works that way, guaranteed ! Still, leaving the habit early and taking necessary treatment from a qualified specialist definitely helps and I have seen improvement in mouth opening in such cases and also healing (to some extent) of chronic oral ulcerations.

When a youngster sends an email to me, I motivate him to kick the habit immediately. Then, he should head towards some nearby Dental College & Hospital where they have all the oral health specialists under one roof who then do treatment planning for the patient. Oral Surgeon is the best specialist to manage such “closed” mouths.

Trust me, if you want, the problems caused by the above habits are so debilitating in some people that they start surviving only on liquids and even are not able to clean or rinse their mouth. Subsequently, even cancer of mouth can develop in these individuals.

In the above paras, i mentioned somewhere that oral cancer can be cured. Of course, it is true, but if detected in time and the person is ready to kick the bad tobacco and pan-masala habits. Even otherwise, after complete treatment of oral cancer, the person suffers so much facial disfigurement and dependence on “feeding by tube”etc,  just to name a few, i swear a reader of this blog can’t even imagine most of these problems.

Having said all this I must remind the readers – “Hope lasts with life.” Nature is great with abundant healing capacity. So, first of all the youngsters should kick this habit and then should be examined by a Dental expert who would refer them to a qualified oral surgeon, if needed. He should meticulously follow the advice of the specialist by taking medicines and applying some medicaments over the “sore” (ulcerated) areas in the mouth. The patient is required to refrain from tobacco in all forms (Bidi/Cigarette also) and take a well balanced diet rich in vitamins. It is advisable to take abundant Vit C in natural form like citrus fruits, gooseberry (Amla) etc. and the patients are advised accordingly.

I wonder if these youngsters listen ..indeed it is quite disappointing to see youngsters waiting at petrol pumps on their motorcycles and putting 2-3 pouches of gutkha/panmasala in one go into their mouth.

God bless them!

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Betel-quid, Pan Masala & Gutkha Banned in UP Govt. Offices

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I came to know about this great news this afternoon.

It is a very bold decision. Great indeed. It requires a lot of courage and conviction.

Being a dental professional, sometimes I do come across dental patients who have their pan, pan-masala, tobacco or gutkha (some of the forms of smokeless tobacco) parked in their cheeks.

They are asked to spit it out and then come back for dental check-up. But my health attendant is very strict in discouraging such tobacco chewers to spit in clinic wash basin.

Not even this, some of the attendants/relatives accompanying the patients are also chewing some of these products when i am attending their patients .

This great news regarding ban of Pan, Pan Masala & Gutkha in Govt Offices of Uttar Pradesh in India was being telecast this afternoon.

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As always happens, reactions also started coming up. Some people were saying that the cleaning process should have started with the Members of Chief Minister’s cabinet, some of whom are quite  fond of all such stuff.

It would surely be a challenge to see in Uttar Pradesh how this ban gets implemented where this pan/gutkha chewing habit has become socially acceptable.

I am working in Lucknow city for the last four years and I have three concerns – first, when I driving my two wheeler and some one travelling in a 2/4 wheeler gets rids of his ‘chewed’ stuff, and I get some droplets on my face, it is damn irritating. Second, when in an office, when I have to speak to a person whose mouth is ‘full’ of this stuff, at that moment, more than the dangers of this habit on his health, I am ‘worried’ about my new shirt getting droplets of his red-coloured saliva. Third, seeing some doctors and medical workers chewing Pan Masala/Gutkha is all the more frustrating.

By the way, right now  i am all the more frustrated due to mosquitoes which are biting me and in between I take a break to ‘get rid of’ one or two such irritants.

Feeling sleepy…goodnight, take care!

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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.

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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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