mouth ulcers

mouthful of pain Your Health DR GITA MATHAI At any given time, 20 per cent of the population is suffering from one or more mouth ulcers (aphthous ulcers). These can develop inside the cheeks, tongue, on the roof of the mouth or the inside of the lips. They may be one or many, small or large. Usually such ulcers are less than 10mm in size and three in number. There may be also be enlarged painful lymph nodes below the jaw. The mucosa in the mouth is abundantly supplied with nerves so mouth ulcers are extremely painful. Contact of hot or spicy food increases the pain so those suffering from mouth ulcers are often unable to eat. Unfortunately, no clear single cause for the ulcers has been identified. Children can develop mouth ulcers due to a viral infection, teething, fungus or an injury. In some adults, ulcers may start after a swollen area in the mouth is inadvertently bitten. Usually, around adolescence, ulcers start to “just appear” several times a year, spontaneously and mysteriously. Women are more likely to suffer from such ulcers. Stress, illness, antibiotic use and general debility may also precipitate mouth ulcers. The viruses implicated in mouth ulcers are Herpes, Coxsackie, Cytomegalovirus and Hepatitis C . The Herpes virus tends to produce multiple ulcers. Adults with herpetic ulcers may be diabetic, immunocompromised, or have cancer. These ulcers respond well to antiviral medication. Fungal infection with candida (monilia) produces a red sore mouth and cheeks with white curd-like patches. If the patches are scrubbed clean, a raw red surface is seen. Children who use feeding bottles usually suffer from such an infection, even if the nipple is apparently sterilised adequately. Those who use pacifiers are even more prone to it. Such a child finds it difficult to swallow and may lose interest in feeding. In adults, monilial infection can occur with uncontrolled diabetes, prolonged antibiotic use, cancer and its treatment. It is one of the markers for HIV infection. Constant trauma to the mucosa of the mouth can also cause ulcers. This may be due to abrasive, poorly aligned dentures or broken irregular teeth with rough and jagged edges. Failure to brush the teeth morning and evening causes build up of hard yellow plaque on the inside of the teeth near the gums. Once this has occurred, vigorous brushing no longer removes the tartar. Bacteria are able to gain a foothold in the crevices resulting in recurrent mouth ulcers with accompanying bad breath. Food, particularly fast food, is often coloured with red or yellow dyes. These are often contaminated, substandard and non-food grade. They can cause contact allergy, damage to the mucosa as well as ulcers. Smoking as well as chewing tobacco, paan, gutka, supari and Pan Parag (all of them are toxic) can damage the lining of the mouth. Continuous use can cause loss of pigmentation (leukplakia), visible as white patches on the inside of the mouth. This condition can be precancerous. It needs a diagnostic biopsy, expert evaluation and follow up. Illnesses like ulcerative colitis and SLE (Systemic lupus erythematosus, a long-term autoimmune disorder) affect the immune system of the body and can produce chronic mouth ulcers. Deficiency of iron, zinc and the B group of vitamins can cause a red sore mouth with a smooth tongue and fissured lips. The mucosa becomes thin and delicate. It is easily traumatised producing ulcers. The response to treatment is difficult to assess as ulcers spontaneously disappear in 2-3 weeks even if untreated and do not scar. Ulcer treatment Sucking on an ice cube before eating numbs the pain. Local anaesthetic ointments dull the pain. Mix equal quantities of antacid and benedryl syrup and swirl it in the mouth several times a day. Steroids (if prescribed) can be applied locally (They will aggravate ulcers due to infections). Ulcers due to the herpes virus respond to a short course of antiviral medication. Any ulcer in the mouth which does not heal after two weeks of treatment needs a biopsy to rule out cancer. Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in Share on emailShare on printShare on facebookShare on twitterMore Sharing Services

cigarettes the cancer sticks

In the Sixties and Seventies, puffing on what we now call the cancer stick was considered sophisticated by adults and “cool” by the younger generation. Movie stars, politicians, doctors, academics — they all smoked. My professors in medical college disappeared into the canteen at 10 am every day for a smoke and a coffee.

Forty years have gone by. One professor has developed lung cancer and another has succumbed to it. The world has belatedly woken up to tobacco addiction in its myriad forms (puffs, chews or snuff). The Indian government has passed a few laws but not only is it too little too late, the enforcement too is rather lax.

We know the effects of addictive drugs such as cannabis and heroin. They have been banned. If the tobacco industry had not managed to conceal the dangerous and addictive nature of tobacco for so many years, it too would have joined the list of banned drugs.

Tobacco grows in India, has always been freely available and its use is widespread, often starting in the teenage years. Males tend to smoke cigarettes or beedis while women seem to prefer chewing tobacco, gutka or snuff. Some female addicts begin their day by brushing their teeth with tobacco and then placing a wad of it in a corner of the mouth. Social acceptance has resulted in more young urban women openly smoking.

Tobacco use varies from state to state. In India 30-50 per cent of males and 20-30 per cent of females above the age of 15 use tobacco regularly. Many more, particularly children, are affected by exhaled second hand smoke.

There are more than 4,000 chemicals in tobacco, most of which are harmful. The main constituent is nicotine, which immediately makes the heart beat faster and pushes up the blood pressure. It crosses over into the brain where it affects certain chemicals. There is a pleasurable feeling of relaxation and reduction of tension and stress. As the nicotine is cleared from the blood stream, the tension and stress return, producing a craving for “another fix”. As the body enzymes become more efficient at removing this poison, the cravings return at shorter intervals. The consumption of tobacco perceptibly increases. Other harmful chemicals in tobacco are ammonia, acetone, cadmium, vinyl chloride, naphthalene and carbon monoxide. In short, imagine eating or inhaling smoke from a burning concoction of paper, moth balls, old batteries, toilet cleaner and nail polish remover!

Smoking causes long term changes in the lung tissue. Their function and air exchange is compromised with perpetual breathlessness, chronic obstructive airways disease and emphysema. Smoking or inhaling second hand smoke causes 90 per cent of lung cancers. It is responsible for 1.4 million deaths annually worldwide.

The chemicals in tobacco affect every organ in the body. Cancers can occur in the oral cavity, pharynx, larynx, oesophagus, pancreas, stomach, urinary tract, and blood (acute myeloid leukaemia).

Even if cancer does not develop, the teeth become yellow, plaque ridden, loosened from the sockets and may eventually fall out. Conversation becomes difficult because of halitosis (bad breath). The bones weaken, leading to early osteoporosis. The body metabolism changes, precipitating glucose intolerance and eventually diabetes. Atherosclerotic plaques build up in the blood vessels, leading to heart disease, paralysis, stroke and vascular disease. Blocks develop in the peripheral blood vessels. Walking becomes painful. Numbness, burning and tingling in the limbs interferes with sleep.

The IQ (intelligence quotient) falls with tobacco use and cognitive skills decline. This places users at risk for early dementia and Alzheimer’s.

Women who use tobacco tend to be less fertile, have smaller babies, weaker bones and reach menopause two to three years earlier. They also tend to have small babies who may develop Attention deficit -hyperactivity disorder (ADHD). They may have supernumery or less than five digits. Fingers and toes may be stuck together.

Tobacco use shortens the life span considerably. The death rate from related causes is 60 per cent higher in both sexes between the ages of 30 and 70.

The bad news is that addiction gets established within a year. By that time, the brain receptors change. The craving for nicotine may be present lifelong.

The good news is that you can stop and reverse many harmful body changes. No matter what your age, it’s high time you said bye to that stick.

Time to stop

• You can do it on your own—the mind is a very powerful tool.
• Set a date and stick to it.
• Avoid areas and friends who use tobacco.
• The government as well as private organisations run programmes to help de-addiction.
• Cravings can be reduced with nicotine patches and aversion produced by some medication.
• Regular aerobic exercise (running, walking, swimming or cycling), and yoga, improve fitness and lung capacity and reverse the negative effects.

Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in

hair loss and gain

Hair today, gone tomorrow

Your Health DR GITA MATHAI

Everyone would like a full head of hair, and, when it begins to fall at an alarming rate, anxiety and consternation set in. Hair loss appears to be a common problem, and its treatment a lucrative business, if the number of advertisements for oils, shampoos and revitalising products are to be believed. Hair growth and loss has its own natural cycle. Scalp hair grows about half an inch a month during a long growing phase that lasts from two to six years. This is followed by a resting phase that lasts two to three months. At the end of the resting stage, the hair is shed. Losing 75-100 hairs a day is normal. At any given time, 10 per cent of hair is in the resting and 80-90 per cent in the growing phase. After hair is shed, a new hair grows from the same follicle, starting the cycle once more. As people age, their rate of hair growth slows. Some of the hair follicles die and the number of follicles shows a gradual decline. If the loss is greater than 150 hairs per day, there is a pathological process affecting the normal hair renewal process. This needs medical evaluation. The affected person alone may be sensitive to his or her hair loss. It may be within the normal spectrum and may not be taken seriously by the doctor. Also, 50 per cent of hair needs to fall before it becomes obvious to the doctor. Hair loss may be due to dietary factors with sub-clinical malnutrition. This may be the result of fad or crash diets, with an accompanying deficiency of proteins, vitamins and minerals, particularly iron and zinc. Hormonal imbalances cause increased hair loss, with the hair also becoming thin, brittle and lacklustre. The hormonal balance can go awry because of malfunction of any of the endocrine glands. Thyroid hormones are notorious for this. Androgens (male hormones) cause male pattern baldness. If a women has excess androgens for any reason, she tends to become bald. The female to male hormone ratio can be altered as part of the natural changes at menarche, pregnancy, lactation and menopause. The predisposition to lose hair after a certain age is genetically transmitted in families. It usually affects males, but females can also start going bald. Hair loss can occur in well-defined, circular patches. Expert evaluation is required to rule out conditions likealopecia areata. Local treatment can initially reverse the process. One it progresses to alopecia totalis (loss of all hair) treatment is not very successful. Hair loss may be may be due to “hair pulling” or trichotillomania where people, particularly children, twist and pull out their own hair, eyebrows, or lashes. It is a habit precipitated by psychological and social stress. There is spontaneous improvement with psychiatric help if the stress factors are removed. Chemotherapy causes reversible hair loss. Radiation injury and surgical scars cause permanent hair loss. Medical treatments are available to reverse hair loss. Applications of minoxidil solution (two per cent in women and 5 per cent in men) to the scalp twice a day results in improvement in about six months. Once the application is discontinued, the new hair falls out within a few weeks. Finasteride, when taken regularly, blocks the formation of the active male hormones in the hair follicle and causes hair growth in men. It cannot be used in women. Hair transplantation is a plastic surgery procedure which can be used in men and women and provides permanent hair replacement. It involves moving hair from donor sites to recipient sites with simultaneous removal of the bald skin. For proper care and maintenance of normal hair a few tips need to be followed. • Mix half kg coconut oil, half kg sesame oil and 100ml castor oil. Boil the mixture after adding a bunch of curry leaves, a clove and 20 peppercorns. If you need to darken the hair, mix in henna leaves or powder and petals of red hibiscus. Massage this oil into the hair twice a week using the tips of fingers (not nails). Vigorous massage may break the hair at the roots • Use only half a teaspoon shampoo to wash hair. Apply shampoo on the hair shaft and not the scalp.  • Blow-drying damages hair. If a dryer has to be used, cover the head with a towel and allow the air to heat the towel instead of applying it directly to the hair • Heat and chemical treatments for curling or straightening hair eventually damage it. Crinkling and curling can be safely done at home by plaiting wet hair tightly and leaving it overnight Dr Gita Mathai is a paediatrician with a family practice at Vellore. Question