ANALGESICS IN TRAUMATIC DENTISTRY

Analgesics are drugs that selectively relieve pain by acting in CNS or on peripheral pain mechanisms without significantly altering consciousness.

Analgesics are mainly divided into 2 groups:

1. Opioid Analgesics
2. Non Opiod Analgesics and NSAIDS

OPIOID ANALGESICS

• Natural Opium alkaloids

                        -Morphine & Codeine

•  Semi synthetic opiates

                        -Diacetylmorphine

                        -Pholcodeine

•  Synthetic opioids

            -Pethidine

             -Fentanyl

             -Methadone

            -Dextropropoxyphene

            -Ethoheptazine

             -Tramadol

NON OPIOID ANALGESICS ; NSAIDS

-          Salicylates – Aspirin, Salicylamide, Benorylate, Diffunisal.

-          Pyrazolone derivatives – Phenyl butazone, Indomethacine, Oxyphenyl-butazone.

-          Propionic acid derivatives – Ibuprofen, Naproxen, Ketoprofen, Fenoprofen, Flurbiprofen, Oxaprozin.

-          Indole derivatives – Indomethacin, Sulindac.

-          Anthranilic acid derivative – Mephanimic acid, Enfenamic acid, Flufenamic acid.

-          Aryl acetic acid derivative – Diclofenac, Tolmetin, Phenyl acetic acid derivative.

-          Oxicam derivative – Piroxicam, Tenoxicam.

Another classification:

Agonists             - Morphine and compounds

Partial agonists -Buprenorphine                                                                                 

Mixed agonist-antagonists

                           -Nalbuphine

                           -Pentazocine

                           -Meptazinol

                           -Butorphanol

Oral Piercing and its Complications

Oral piercing is the most happening fashion trend in youngsters now a days. A dentist should be well informed about such procedures as it is invasive in nature and is carried out without the use of anaesthetics. It involves the use of needles in order to create a hole in the following structures i.e. tongue(most common),lips, eyebrows, cheeks for inserting metals in the form of studs, rings or barballs. It can turn out to be dangerous as the various neural supplies of the tongue may get hampered while performing such procedures. This post will focus on some short and long term oral complications related to oral peircing

Short- term complications:

1. Immediately after the operation certain complications may arise including:
2.    Infection is the major concern after such procedure if the needle used are not properly sterilized and placed in antiseptic solutions. Life-threatning complications like the transmission of HIV and hepatitis viruses can take place.
3.    Postoperative pain is present.
4.   The tongue usually swells after piercing. In some cases it can be so massive leading to obstruction of airway and dyspnoea.
5.    Aspiration of the inserted jewellery can take place thereby asphyxia and death of the person can take place.
6.    Slight/excessive bleeding can occur depending on the severage of the blood vessels.

        Long-term complications:

1. Chipping and fracture of teeth occurs in due course of time due to constant trauma to teeth by the barbells and studs in tongue. Cracked tooth syndrome is a characterstic feature resulting in microscopic cracks in teeth making it difficult to masticate and is extremely painful. The tooth may have to be finally removed if it does not respond well to some splinting techniques.
2. Neural deficiencies can arise due to incorrect piercing techniques like facial paralysis, ageusia/dysgeusia, disarticulation of speech, eye problems, loss of deglutition reflex etc.
3. The gums and buccal mucosa experience continuous irritation from the jewellery which may lead to the following lesions in the oral cavity like irritational keratosis, frictional keratosis, lichenoid reaction, lichen planus, peripheral giant cell granulomas, fibroma, epulis fissuratum, carcinoma etc.
4. There is a risk of infection due to foreign debris and bacteria accumulating in the pierced site.  
5. Hypersensitivity and galvanism may occur due to interaction between other restorations in the teeth and allergy due to a particular metal in gums.
6. Due to untreated or unknown infections the pain and swelling may exacerbate and take a different route to reach and create complications systemically like infective endocarditis etc.

Safety measures :

The risk of oral complications can be minimised by following these suggestions:

·         Oral piercing should be get done by a professional who is well aware of the anatomy of the oral cavity.

·         The place should be completely hygienic and disposable needles and gloves should be used. All the procedures should be carried out with sterilized instruments and accessory equipments.

·         Ice packs should be applied on the site of inflammation to reduce swelling and bleeding.

·         Immediate referral to a medical hospital should be done to avoid any systemic complications and ensure safety of the patient.

·         Blood tests should be performed before doing piercing to decrease the chance of inadvertent infections.

·          Generally pain subsides within 4-6 weeks of piercing, if it does not reduces seek medical advice.

·         One should prefer wearing plastic jewellery in place of metal ones to avoid potential damage to the teeth, gums, palate.

·         Remove all the inserted elements before sleeping and playing sports.

·         Once u are stabilized with the piercing, a must visit to a dentist to evaluate if the piercing has caused any trauma to the oral cavity in any way.

ELECTRONIC MEDICAL RECORDS

Digital/Computer /electronic records:

The manual medical records of patients can subsequently be digitized or the digitized records are themselves generated directly by keyboarding. These records act as a nerve centre for digital radiograph imaging ( Radiovisiography), record charting and digital photographic record keeping. They are easy to identify, locate and authentic. These can be stored in small devices e.g. Cd’s, pen drive and given to the patient for record and self re assessment by the patient. These records cover the episodic care provided by one institution. They can be integrated and are flexible to use. E.g. DENPLAN EXCEL is the latest version of electronic record.

Internet records:

Internet security is one of the key aspects that have challenged the doctors and designers of internet based medical records software.

There are companies which provide the doctors and the patients with web space to save their individual data which is pass word protected. The patient can access this data from anywhere in the world. Since many executives travel all over the world such records have been found to be useful.

They provide graphical representations of the patients data (medications, lab results etc).These record can be sent to patients and other doctors via emails n blogs.

Practice management softwares in US like the Dentrix, EagleSoft, and SoftDent, require paper forms and data transcription. With the Medic Talk DentForms system, patients can complete questionnaires online and digitally sign treatment plans, consent forms, and medical history updates. DentForms safely retrieves key information from the Practice Management program, eliminating the need for paper records altogether.

Medical Smart cards:

The card contains a computer chip, which summarizes the patient's medical record -- general information about the patient, medications, allergies, medical problems, lab results, radiographs.

All these types of records have bought a revolutionary change in technical medicine.

DENTAL CARE MONTH -STRENGTHENING ROOTS IN INDIA

As said-"Oral cavity is the mirror of the human body", it is very important to maintain good oral hygiene in order to acquire a healthy and balanced life. Earlier medicine was not focused on the oral cavity, but due to asthetics and its relevance with the nutrition, smoking,systemic diseases dental care is gaining global attention with the emergence of dental camps, primary health centres, free dental treatment in rural as well as urban areas in India.

Rural India is indulged in various ways of smoking eg- bidis, chutta, hukka, snuff and pan and betel nut chewing etc. with compromised nutrition and sub-standard living conditions leading to the development of precancerous and cancerous lesions which are life threatening conditions. Due to lack of knowledge, money and careless attitude towards dental care villagers are suffering from oral lesions like periodontitis, leukoplakia, smokers melanosis, erythroplakia, OSMF , carcinomas etc.

Through these Dental Camps and the accomplishment of National Dental Care Month , dentists are creating awareness about the hazardous effects of the usage of such products and the importance of dental check up. Government of India, in alliance with different companies like colgate and many private institutions are conducting and providing facilities like free dental check up ,biopsies , medications and further refferal to the dental hospital for subsequent follow up.

Urban India mainly faces the problems related to dental caries, malocclusion , teething disorders,developmental anamolies and certain lesions like lichenoid reaction, recurrent apthous ulcers, gingivitis etc. Dentists are providing significant information about maintainence of proper oral hygiene by explaining accurate brushing techniques, frequency of brushing, nutrition, asthetic considerations, free of cost and giving a proper diagnosis thus satisfying the patient in everyway through these camps.

Oral health is also related to systemic diseases like diabetes , asthma, aspiration pneumonia, tuberculosis, hypothyroidism etc in various ways. Here are some complications related to diabetes mellitus as a review to show the relation between oral heath and other systems:

for eg. If a person is suffering from unknown diabetes mellitus of age less than 35 years and no habits, he will dipect these specific features in the oral cavity giving the dentist a clear indication to suspect for diabetes mellitus and refer the patient for investigations. And the level of diabetes decrease if oral hygiene is maintained. This is known as indirect approach.

Oral manifestations of Diabetes Mellitus:

• Chronic generalized periodontitis
• Xerostomia
• Burning mouth syndrome
• Candidiasis
• Delayed and abnormal wound healing
• Increased affinity to infection(caries)
• Diminished salivary flow and salivary gland enlargement
• Difficulty in swallowing
• Acute nectrotising ulcerative gingivitis
• Gingival inflammatory hypertrophy
• Multiple periodontal abscesses
• Dry atrophic cracked oral mucosa, angular chellitis
• Mucositis, ulcers
• Desquamative gingivitis.

Therefore, history taking and clinical examination play a major role in the diagnosis of a particular oral and systemic disease along with their co-relations.

To conclude, with the collaboration of governmental policies and indian dentists, India is progressing in creating awareness and delivering service to humanity.

Dental Pain and Proprioception Pathways

Over The Counter Banned Drugs In India

Over the counter banned drugs continue to make their space in the Indian market while they have become obsolete overseas due to their toxic effects in the body. One of the most controversial drug is NIMESULIDE. Indiscriminate use of Nimesulide poses an alarming situation for India, due to its potential to cause hepatotoxicity along with other diseases likecholestasis, pruritis, colon cancer, coagulopathy, potential seizures in smokers over a period of time. It is especially contraindicated in children, medically compromised patients and pregnant ladies.

Nimesulide is available in the market popularly by the name of Nise, Nodard plus, Nimulid etc. The market value of nimesulide ranges over 250 millions forcing the multinational companies to increase the production rather than cease its manufacture. But due to media’s scrutiny and health awareness the end of nimesulide has begun leading to the withdrawal of various pediatric preparations of the drug from the market (nimegesic drops).

Other OTC Banned Drugs are as follows:

ANALGIN

• Generic name :Metamizole sodium
• Indications: Toothache, headache, arthralgia, neuralgia, myositis, visceral pain, high fever.
• Reasons for ban:

Agranulocytosis,

Leucopenia,

Thrombocytopenia,

Proteinuria,

Interstitial nephritis.

In sensitive patients rashes, urticaria, edema, asthmatic attacks, and very rarely anaphylactic shock may occur.

• Brand name: Novalgin, Dipyrone, Melubrin

CELECOXIB

• Non steroidal anti inflammatory drug
• Indications: Osteoarthritis, rheumatoid arthritis, familial adenomatous polyposis, dysmennorhea
• Reasons for ban:

Heart attack

Stroke

Allergies

• Brand names: Celebrex, Celcoxx

DEPENDAL-M

• Generic name: Furazolidone
• Indications: Travellor’s diarrhoea, cholera, salmonella infection
• Reasons for ban:

Cancer

Convulsions,

Peripheral neuritis,

Gastrointestinal disturbances,

Depression of spermatogenesis.

• Brand names: Furoxone, Lomofen

FURACILIN

• Generic name: Nitrofurazone

• Indication: Anti-bacterial cream

• Reasons for ban:

Cancer

G.I/ liver

Reproductive toxins

Sense organs toxicity

TANDEARIL

• Generic name: Oxyphenbutazone

• Non steroidal anti inflammatory drug.

• Indications: Analgesia, antipyresis

• Reasons for ban:

Bone marrow depression,

GIT ulcers

• Brand name : Sioril

D’COLD

• Generic name: Phenylpropanolamine

• Indications: Cold and cough, hay fever, sinus irritation

• Reasons for ban:

Haemorrhagic stroke

Allergy (difficulty breathing; closing of your throat; swelling of your lips, tongue, face)

Seizures

Hallucinations

An irregular or fast heartbeat.

• Brand name: Vicks Action – 500, Propagest

INAPSINE

• Generic name: Droperidol

• Indications: Antidepressent, neuroleptic

• Reason for ban :

Arrythymias

CISAPRIDE

• Indications: Acidity, constipation.

• Reasons for ban :

Irregular heartbeat

Teratogenicity

Hypokalemia

Liver toxicity

• Brand name : Ciza, Syspride

AGAROL

• Generic name: Phenolphthalein

• Indication: Laxative

• Reason for ban: Carcinogenicity

ENTERO QUINOL

• Generic name : Quiniodochlor

• Indications: Amoebic dysentery, colitis

• Reasons for ban:

Optic neuritis,

Optic atrophy

Peripheral neuropathy

Anal irritation.

Other drugs like oxytetracycline, fenfluramine, dexfenfluramine, thalidomide and 82combination formulations are banned by the government of India. The use of these medicines is strictly prohibited.

BANNED DRUGS-"A FALSE DILEMMA"

Medical tourism is a remarkable achievement of India over other countries due to its hospitality, low cost and quality treatment plans. As India’s position strengthens its roots across the globe it becomes a responsibility of the Indian medical and pharmacy council to provide with the best quality drugs and accessory medical equipments for use. Despite of an increased vigilance towards the production, marketing, resource allocation, India is becoming a hub for the availability and usage of banned and spurious drugs.

India leads in the pharmaceutical sector as compared to other developing countries due to easy research methodologies & less medicolegal implications, the latest invention being the development of H1NI vaccine. As no drug is completely safe, a drug is banned on the basis of risk versus benefit ratio which is evaluated through post marketing surveillance and adverse drug reaction reporting systems which is a combined effort of the government, medical professionals and pharmaceutical companies.

In subsequent posts I will make an attempt to look into a multidimensional insight of over the counter (OTC) banned drugs, controversial drugs, abused drugs by sportspersons & college students. It sheds light on the efficacy and dangers related to allopathic medicines, performance enhancing drugs, study drugs, ayurvedic medicines & dietary supplements.

The analysis views the fact that the medical profession is getting defamed and crippled in India because of various factors, some of them being self medication, availability of banned drugs, pharmaceutical boom, inefficient government policies, unethical drug promotion, medical commercialization and lack of knowledge among doctors. Until such issues are not sorted out the existing situation would prevail.