Any decision concerning the health of its masses is taken by the Governments considering recommendations of World Health Organisation by weighing all the pros and cons of the issue. When the sale of non-iodised salt was banned five years ago in this country, this decsion was widely acclaimed.

Deficiency of iodine leads to a wide range of health problems. Optimum supply of iodine is regularly required for the normal functioning of thyroid gland which is responsible for many physiological processes.

Deficiency of iodine is particularly detrimental for the well-being of women and their little ones. Deficiency state leads to goitre and there are problems with pregnancy and the intellect of the new borns or the deficiency state can lead to stillbirth.

Yesterday, i saw a news item in the vernacular print media. Its caption was — Ban on the sale of Common Salt is illegal (please read common salt as un-iodised salt). The reach of vernacular press in India naturally is quite wide and such media reports are expected to presnt facts based on available scientific evidence.

The news was that the Supreme Court has asked the Centre to review within six months its policy of allowing only iodised salt sales while retaining the ban on the non-iodised variety till then. However, the Supreme Court refused to enter into a debate on the pros and cons of forcing everyone to consume iodised salt saying it was an issue that health experts should decide. But it struck down a rule that banned sale of common salt only on the ground that food adulteration rules had such a provision.

The Centre will have to review its policy and if it decides to still retain the existing system of only permitting iodised salt for human consumption, it will have to bring in a fresh law, the judges said earlier this week while disposing of PILs filed by NGOs.

The Academy of Nutrition Improvement, one of the NGOs, argued that the sale of iodised salt should be restricted to iodine-deficient pockets. Section 44H of the Prevention of Food Adulteration Rules, 2005, says: “No person shall sell common salt for direct human consumption unless the same is iodised.” The NGOs urged the court to declare the rule unconstitutional.Although the Centre had propagated the use of iodised salt since 1962 to check iodine-deficiency disorders such as goitre, it was optional for states till May 27, 1998, when the non-iodised variety was banned across the country.

Law will take its own course — the learned judged have rightly said that the issue of going into positives and negatives of “forcing” everyone to consume iodised salt should be deliberated upon by the expert groups. I wonder if it really possible in this country to supply iodised salt to only iodine deficient areas. There could be number of problems.

Do we think that the WHO expert groups must not have thought about all this? By the way, have we done exact Iodine Mapping in this country? So, the universal availability of iodised salt is in the best interest of public. Naturally, a question crops up –suppose somebody takes iodine in excess, what would happen to him? I was looking for its answer and then i got reply to this question.

As per senior Endocrinologist, when taken in ugms(micrograms) and found in excess by the body, kidneys will throw it out on daily basis, and no side effects. When iodised salt is used, iodine intake is in micrograms, in whatever excess amount salt is taken, hence it is never harmful. So, in the light of current literature be rest assured to use iodised salt only.

By the way, there is so much evidence to support that Iodised salt is a boon for the overall well being of communities, more so women folk. However, while i tried to look at the website of the NGO filing this PIL, and declaring that some people are facing problems with iodised salt, i could not locate their site only. Is there some data substantiating this fact/view?

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Iodine for all

Deadline to review iodised salt rule

Instead of commenting on the contents of this news story, I am directing you to a link giving information about Hepatitis People take everything damn seriously whatever appears in print and it is all the more true in case of English print media.
It is clear that like Hepatitis A, the spread of Hepatitis E is also through oro-faecal  route.  Poor sanitation and contamination play a big role in the spread of disease. Most of the time it is self-limiting. It is not that it can’t be prevented owing to a lack of vaccine, it can be controlled to a large extent by following simple rules of personal hygiene and access to clean, drinking water which is becoming a challenge for the countries world over.
I wish if you have already read this news story in today’s paper, then you should also have a cursory look at the WHO website for getting authentic information about this disease.
Hepatitis E should be suspected in outbreaks of waterborne hepatitis occurring in developing countries, especially if the disease is more severe in pregnant women, or if hepatitis A has been excluded. If laboratory tests are not available, epidemiologic evidence can help in establishing a diagnosis.
Hepatitis E is a viral disease, and as such, antibiotics are of no value in the treatment of the infection. There is no hyperimmune E globulin available for pre- or post-exposure prophylaxis. HEV infections are usually self-limited, and hospitalization is generally not required. No available therapy is capable of altering the course of acute infection.
By the way , what are your views about the news story which has appeared in today’s Times of India?

WHO : Hepatitis E
PS…. I had to put here a scanned image of the report as i could not find out the same in the online edition.

In the latest incident of Doping, there were raids on the chemist shops located outside the National Institute of Sports at Patiala. I wonder if these knee-jerk reactions would help in the long run. After all, we keep on hearing about these Doping incidents quite regularly.
Yesterday I was looking at this news item—Outside Patiala NIS, buy dope off the shelf. No doubt it is an eye-opener.  It enlightens the readers that drugs like Anabolic steroids can be purchased like an OTC drug—without any prescription.
We all know that buying any medicine in any corner of this country is virtually not a problem. That’s why I was thinking that it is not only NIS, there are so many outlets in all the cities and towns where all such “dubious” stuff is freely on-sale.
In the morning, I was trying to follow what Saina Nehwal said about this in today’s Times of India.  When she was asked if she was aware about the availability of banned drugs at medical stores, she said, “ I don’t know because I don’t take it.” However, she felt that lack of awareness about medicines was the major reason behind athletes testing positive for banned drugs in the country.

She further said that it’s really sad they don’t know what they are taking. She said she was sure everyone knows WADA (World Anti-Doping Agency) rules, it is very common. They have a website which mentions the banned medicines. She further said that it is just that they don’t know. Many athletes and weightlifters are not very educated so they consume whatever their coaches give,” she said.
I agree with Saina that many athletes are not much educated and  the lack of awareness about consuming these dangerous food supplements (“fortified” with all those banned drugs) lands them into trouble. Had there been awareness, why would anybody take any chances knowing well that they would have to go through Dope Test.
Anyway, that does not absolve anybody of any unfair practice. These Sports Institute are eminent places where these players are required to be made aware of all such stuff.
This was Doping in athletes which comes in light when they are subjected to certain tests. But do we really bother about everyday Doping that is happening in every city and town of this country.  Many of the so-called Gyms patronized by today’s youth get some “Body-Building Powders” from their coaches. Most of such stuff is laced with “banned” drugs but who cares? – They want quick results nevermind  at the cost of their health in the longrun.
Even patients ask for Deca-Durabolin injections just for getting some more “Power”. If a qualified medical practitioner does not oblige him, there are so many “quacks” and some unscrupulous chemist shops who are just waiting for him.
This Doping is just the tip of iceberg— it is just the tip of the bigger problem which is spreading its tentacles so rapidly. Govt is doing its part……but ultimately awareness is the best solution and exemplary punishment to the people selling such stuff (without medical prescription)  just for the sake of making some extra bucks.
Even American Food & Drug Administration keeps on warning its people to stay away from so and so Food supplements etc which are at times found laced with “banned” power-enhancing drugs/anabolic steroids.

In my earlier article I narrated the tale of a 10-year old girl and her toothbrush which was in really bad shape …. forget any cleaning, it just appeared to cause gum injury to already swollen gums. In this picture, you can see her brush.

Incidentally, my next patient had also come with his toothbrush, tooth-powder and tongue-cleaner.  “Horrible” is the word which describes the condition of his toothbrush. He has been using it for the last two years. But he has done a nice thing that he has tied his tongue-cleaner with his brush only. I liked this idea.

Generally,in a  household toothbrushes are lying separated from tongue-cleaners. So, there is always a risk of using someone else’s tongue-cleaner.  I have liked his idea but to me it appears cumbersome. I asked him as to whether it causes any discomfort during brushing. He responds quickly –“not at all.”

You see this brush is badly injured – with lots of bruises and discoloration. He is using some indigeniously manufactured toothpowder from Kanpur ( a place in India) which appeared quite abrasive . One of the factors responsible for poor oral hygiene of Indians is that they just rely too much on the indigenously prepared tooth-powder –literally having blind faith in the “miraculous nature” of these stuffs. However,  there are seldom any quality controls in place, some of the manufacturers don’t hesitate putting tobacco in these powders which opens pandora’s box of oral problems. Even otherwise, high abrasivity of some of these powders just “abrades” healthy tooth covering which leads to hypersensitivity.

This is the photograph of a toothbrush used by some lady patient of mine. She says she has been using it for a longtime.

Now the big question— How frequently the toothbrush should be changed? I remember our Professor used to teach us that it should be changed every 2-3 months. So, I kept on following that advice for telling to my patients. Further, we were taught that if the bristles start “fraying” earlier, it means one is using “excess” pressure while “just bought” look of a brush after 3-4 months means that “little” pressure is being used.

With time, i have evolved my own way – I put all efforts to teach correct method of toothbrushing to my patients ‘cos if the technique is ok, then one will just use “optimal” force –neither more nor less. And regarding this periodicity of changing brushes, I don’t have any hard and fast rules – actually in a country like ours there are so many variations –quality of brushes, quality of tooth-powders and toothpastes used –some are highly abrasive… and things like that. When I don’t need to change my toothbrush so frequently, how can I preach that ? So, I just tell them when the bristles start getting “frayed”, it is time for a change …..like for “frayed nerves” we seek some change and meditate!!

She had come to me for painful gums on the upper left side. At this age, it is quite rare to find teeth with calculus (tartar) deposits – the “dirt” that is visible on girl’s left upper teeth.

Her father pointed to the first permanent molar. The surrounding gum of that particular tooth had chronic inflammation and perhaps that it is the reason she was not using her left side for mastication. The two milk teeth (“deciduous molar”) lying infront of the permanent molar are also shaky. That is quite normal at this age because this is the age for their natural “shedding” for making room for erupting permanent teeth.

Even in the lower jaw, it was noticed that two premolars were erupting and the surrounding gums appear swollen.  All said and done, the net result of all her problems is that she is not using her left side for chewing.

When I told her to bring her toothbrush next day, i found her brush is just a bunch of frayed bristles. She was instructed to take proper care of cleanliness of her teeth. Her condition is quite easy to manage- she would be alright in just 3-4 days of thorough oral prophylaxis in which all those tartar deposits will be removed.

This small case report highlights the importance of bilateral chewing. If a person stops using one side (due to any reason) permanently, she is bound to have some problems. Mastication is also a nature’s cleansing mechanism for mouth because rubbing of food items, fibrous foods tend to clean teeth surfaces to some extent.

This is the dental photograph of a 14-year old boy who is bothered for the last 3-4years by an extra tooth above his upper canine on his left side of the mouth. You can see in this photograph this is affecting his looks and smile. I have seen that many children of this age seldom smile heartily …just to conceal that unsighthl extra tooth which is just a spoil-sport.

Such extra-teeth in this region ie above the upper permanent canines are quite rare. When these are present above or in-between the upper front teeth (central incisiors) these are called Mesio-dens.(Extra tooth is also called Supernumerary)
This time his mother brought to me for removal of that extra-tooth. It was out in no time ….you can see this somewhat conical shaped extra tooth in this photograph.

And the final result — this photograph of that boy taken 15 minutes later clearly shows the positive impact the removal of this tooth had on his smile …..he was happy to see the mirror …so was I ……keep smiling— they say it improves your face value !

Gutkha-Stained Teeth

This picture is a typical picture of oral cavity of Gutkha chewer. He has been chewing Gutkha for the last four years. Can you make a wild guess about the number of pouches he might be consuming daily? – it is beyond your imagination- he has been daily chewing fifteen pouches of Gutkha. He also smokes one packet of Bidi (Indigenous cigarettes… see the picture).. Inspite of so much indulgence in tobacco products his oral cavity was not showing any visible signs of tobacco-related oral lesions.

I told him quite frankly that this time you are lucky that inspite of so much tobacco insults, you appear to be quite alright. I told him not to worry but first he should quit this habit before getting treatment of his “stained” teeth. He promised that would leave it—let’s see ! Most of the times, this brain-washing definitely helps.

Oral Mucosa in Gutkha-Chewer

I told him that your mouth (oral cavity) is alright does not mean that everything is fine with your body. Oral cavity is the visible part, other inner parts can’t be seen with naked eye . Chewing tobacco and Beedi smoking plays havoc with user’s body. Can any reader draw an inference from the above lines that Gutkha, if chewed, for just four years is harmless. Not at all, it was just an isolated case ….. we see so many teenagers suffering from ravages of this notorious Gutkha.  When there is a warning on the pouch itself, hardly there is any need to put our destiny to test !

Oral health personnel are at an advantageous position because persons using tobacco in any form visit their dentist even for unrelated dental complaint. Since the iron is hot at that time, it is so very much easy to hit at this habit because patient at that time is very receptive to whatever we are saying.  Just a few minutes spent on counseling can help the tobacco user in getting convinced to kick this habit.

Child's First Dental Visit

This 13-month cute baby had come to me with his mother, she had some dental complaint. Since he was running here and there, we made him sit for a while on the chair and he is so comfortable with dental assistant. Look at his curiosity …and he is of course happy to be centre of attraction.  I came to know that his mother is ignorant about the dental care at this age. So, I told her to come next day with a baby brush.

No, i dont need anybody's help

The lady came today with his toddler. I explained to her and demonstrated the brushing technique for this baby. No tooth paste is to be used. The brush is to be used very gently. She understood the technique. You can see in this picture that the child became so interested that he also started trying his hand. All kids do this – so, it is always advisable to keep two baby brushes. One of these will be used by a parent for cleaning toddler’s teeth while the other is to be given to the little one when he cries for getting that brush.
The reason for keeping the second brush is that the kids tend to bite on the baby brush , so it gets spoilt within a week.  The brush that is being used by the parent for cleaning his teeth is never to be handed over to him. After the parent has finished cleaning and the kids insists on grabbing that brush, just hand over the second one to him for a little while say a minute or so – he will get bored soon and return it happily.
How is the trick? – I advise parents of little kids to try it out to see if it works.

Gum recession is an important sign of periodontal disease. The tragedy with most of populations is that there is hardly any concept of regular periodic dental check-up. They almost always go to a dentist when in pain. This is a typical Indian scenario— pyorrhea (layman’s term for periodontal disease) keep on progressing, gum recession continues unchecked, teeth keep on getting shaky and when all this becomes unmanageable (by the patient) , then dental extractions are done. And this goes on till the mouth is got rid of all those teeth.

Right Upper Molars Showing Gum Recession

In this photograph you can see the upper teeth of a 50+ lady who has come to me with complaint of dental pain in a upper molar tooth (back tooth) which is shaky. Otherwise she says she does not have any dental problem. For such conditions generally patients indulge in self-medication and take all those antibiotics and painkillers with the hope that it would solve their problem.  However, these medicines have little effect on the clinical course of such dental conditions.

Left Upper Molars With Marked Gum Recession

In this photograph you can see the upper left teeth of the same patient. The molars are afflicted with advanced gum disease (“pyorrhea”). There is marked gum recession as a result of which the roots of affected teeth get exposed. Very thin layer of cementum (outer covering of roots) gets exposed and is soon gets abraded thereby exposing the sensitive portion of root. It leads to dental sensitivity to hot, cold, sweet, and sour. As this gum recession invites food impaction, it leads to plethora of other problems. If left untreated, such teeth meet the same fate —just extraction. It is the most common treatment  for such shaky teeth.

The tragedy with dental diseases is that most of these are symptomless to begin me and even in later stages the symptoms are so much vague/mild that people just indulge in self-medication. However, the final outcome almost always is tooth loss. It underlines the importance of regular periodic check up after six months.

Don’t be surprised to know that many patients seek fillings for all these gaps developing due to gum recession.  The dental quacks are ever willing to “manage”such cases.

Is there treatment for pyorrhea? –yes, there is definitive treatment for periodontal disease (“pyorrhea”) which can be undertaken by  qualified dentists. Howsoever perfect the treatment might be, the long-term success depends upon patient’s compliance with respect to daily meticulous dental home care.