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IDAK Council 2016 -17
Council
Standing (L to R) :
Dr. Jijan Sam Thomas
Dr. Roshila M. Mathew
Dr. Dilip George
Dr. Aju Wilson
Sitting (L to R) :
Dr. Shaheer Malik
Dr. Shalin Anna Simon
Dr. Jitendra Ariga
Dr. Roy Francis
IDAK Council President :
Dr. Jitendra Ariga
Past President :
Dr. Roy Francis
President Elect :
Dr. Shaheer Malik
Vice President :
Dr. Shalin Anna Simon
General Secretary :
Dr. Jijan Sam Thomas
Joint Secretary :
Dr. Aju Wilson
Second Joint Secretary : Dr. Roshila M. Mathew Treasurer :
6 ORAL HEALTH GUIDE 2016 Volume 5
Dr. Dilip George
IDAK Council 2016 -17
Executive Committee Chairpersons
Standing (L to R) :
Dr. Bobby Joseph Thomas Dr. Sreekrishnan Nair Dr. Krishna Kumar K Dr. Abraham Thomas Dr. Natesh Kumar Dr. Siby Thomas
Sitting (L to R) :
Dr. Thomas Thomas Dr. Jijan Sam Thomas
Dr. Shajahan V.M.
Dr. E.T. Roy Dr. Jitendra Ariga Dr. Prathap C. Unnithan
Committee Chairpersons Community Welfare Committee : Dr. Prathap C.Unnithan Cultural Committee :
Dr. Abraham Thomas
Editorial Committee :
Dr. Natesh Kumar
Event Management Committee : Dr. Bobby Joseph Thomas Finance Committee :
Dr. Shajahan V.M.
Liaison Committee :
Dr. E.T. Roy
Membership Committee :
Dr. Krishna Kumar K
News And Media Committee :
Dr. Siby Thomas
Sports Committee :
Dr. Thomas Thomas
Scientific Committee :
Dr. Sreekrishnan Nair
ORAL HEALTH GUIDE 2016 7 Volume 5
IDAK Executive Committees
Advisory Committee
Standing (L to R) :
Dr. Jijan Sam Thomas
Dr. Jitendra Ariga
Dr. Sudhir Walvekar
Sitting (L to R) :
Dr. Jacob Kurien
Dr. Milind Gaidhane
Dr. David Gnanasekhar
Advisory Committee Editorial Committee :
Dr. Milind Gaidhane
Finance Committee :
Dr. Sudhir Walvekar
Sports Committee :
Dr. Jacob Kurien
Scientific Committee :
Dr. David Gnanasekhar
8 ORAL HEALTH GUIDE 2016 Volume 5
IDAK Executive Committees
Community Welfare Committee
Standing (L to R) :
Dr. Subu Thomas
Dr. Krishna Rao
Sitting (L to R) :
Dr. Prashanthy Prasad
Dr. Prathap C. Unnithan
Dr. Sowmya Natesh
Cultural Committee
Standing (L to R) :
Dr. Renjit George
Dr. Shankar Babu T.P.
Dr. Revathi Srikanth K
Sitting (L to R) :
Dr. Devipriya Biju Mahadev
Dr. Abraham Thomas
Dr. Aysha George
ORAL HEALTH GUIDE 2016 9 Volume 5
IDAK Executive Committees
Editorial Committee
Standing (L to R) :
Dr. Lini Mathew
Dr. Niveditha Jarugula
Dr. Seema Samuel
Sitting (L to R) :
Dr. Milind Gaidhane
Dr. T. Natesh Kumar
Dr. Nino John
Dr. Joe Daniel
Event Management Committee
Standing (L to R) :
Dr. Sudhin Thomas
Dr. Santosh C. V.
Sitting (L to R) :
Dr. Deepesh Sreekantan
Dr. Bobby Joseph Thomas
10 ORAL HEALTH GUIDE 2016 Volume 5
IDAK Executive Committees
Finance Committee
Standing (L to R) :
Dr. Fawwaz Ali Khan
Dr. Sudhir Walvekar
Sitting (L to R) :
Dr. Laiju Zachariah
Dr. Shajahan .V.M.
Dr. Vikas Kathuria
Liaison Committee
Standing (L to R) : Dr. Jijan Sam Thomas Dr. Roy Francis
Dr. Jitendra Ariga
Sitting (L to R) :
Dr. John Joy
Dr. E.T. Roy
Dr. David Gnanasekhar
Dr. Rajesh Alexander
ORAL HEALTH GUIDE 2016 11 Volume 5
IDAK Executive Committees
Membership Committee
Standing (L to R) :
Dr. Subbarayadu Alapati Dr. Neena Augustine
Dr. Deenadayal Mittapalli Dr. Nadia Shoukat
Dr. Divya Rajappan Dr. Dolly Chopra
Sitting (L to R) :
Dr. Sudeep P.T. Dr. Binu Sugunan
Dr. Shibu George Dr. Saurabh Chandra
Dr. Krishna Kumar K.
News & Media Committee
Standing (L to R) : Dr. George P. Alex Sitting (L to R) :
12 ORAL HEALTH GUIDE 2016 Volume 5
Dr. Sunil Gupta
Dr. Shashikiran Prabhu Dr. Siby Thomas
Dr. Johncen George Dr. Femi Thomas
Sports Committee
Standing (L to R) : Dr. Kirthan Ganapathi Dr. Vinod Sam Sitting (L to R) :
Dr. Jacob Kurien
Dr. Rahul P.
Dr. Thomas Thomas
Scientific Committee
Standing (L to R) : Dr. Jayashree Dexit Sitting (L to R) :
Dr. Shyama Sundari Maddi Dr. Srikanth Reddy
Dr. George Menacherry Dr. David Gnanasekhar Dr. Sreekrishnan Nair
Dr. Krishnamurthy Gowda
Ambassador’s Message
ORAL HEALTH GUIDE 2016 15 Volume 5
Ministry of Health
ORAL HEALTH GUIDE 2016 17 Volume 5
Ministry of Health
ORAL HEALTH GUIDE 2016 19 Volume 5
Kuwait University
ORAL HEALTH GUIDE 2016 21 Volume 5
Kuwait University
ORAL HEALTH GUIDE 2016 23 Volume 5
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ORAL HEALTH GUIDE 2016 25 Volume 5
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IDAK President
PRESIDENT’S MESSAGE Namaste, Being part of a group like IDAK is a source of inspiration and pride to most of us. IDAK continues to inspire new members as they move into its fold. As IDAK steps into a new decade, we can confidently look back and feel satisfied and proud of what we have achieved as a group during the last 10 years. IDAK has walked the “classic path” of evolution as an organization. During these years IDAK has had its share of disagreements, rebellions, financial turmoil, identity crisis, etc. Team IDAK has faced these issues head on and emerged with flying colors. The fact that our membership has increased with each passing year proves that our predecessors did most of the things right in the best interest of IDAK. Today, IDAK is on the threshold of having a membership of 300! There is greater responsibility on the executive and senior members to keep this group together and plan activities that benefit our members. Emphasis is laid to involve new members in our activities and make them “feel at home”. Any IDAKian should be proud of the activities they are exposed to, be it Community services, Scientific, Sports or Sociocultural, IDAK provides ample opportunities to its members and families to prove their talent and interact with other members of IDAK family, and this ultimately improves their “quality of life” in the State of Kuwait. So far during 2016, with the support of our members we have successfully organized most of the planned events. I must congratulate and thank the executive in general and the concerned committees in particular for making these events happen. Mega “Decennial Event” waits as we come to the end of 1st year in office. As we are set to release 5th volume of our official publication Oral Health Guide (OHG), I must congratulate our very efficient editorial team for choosing a very apt theme “Lifestyle and Oral health” for this issue. In today’s fast world, lifestyle plays a major role in the initiation of many unhealthy conditions including that of oral health. This issue of OHG should go a long way in educating the public to achieve their oral health goals by following healthy lifestyle. I must complement our editorial team for their untiring efforts. The fact that our OHG has articles in English and Arabic, will be handy in educating the bilingual population of Kuwait. Many thanks to all the authors and translators for making this possible. Our Decennial celebrations will climax with cultural extravaganza “Reflections 2016”; I would like to wish our talented cultural team and all the participants good luck. Big thank you to all the volunteers. We move into 2017 as a bigger and more confident unit with a lot of renewed hopes for a better future. As the saying goes, “The future belongs to those who believe in the beauty of their dreams” - Eleanor Roosevelt.
Dr. Jitendra Ariga President, IDAK
ORAL HEALTH GUIDE 2016 27 Volume 5
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IDAK General Secretary
GENERAL SECRETARY’S MESSAGE
It’s been a decade! What started out as the dream of a handful of pioneering stalwarts has now become the proud reality for close to 300 dental professionals of Indian origin in the State of Kuwait! And of course it took more than just “Dreaming” to reach there. The tireless & selfless toil of many a magnanimous soul....some with a vision, others with talent, yet others willing to sacrifice at so many different levels.... in so many different ways. And ALL of them, brimming with unbridled dedication.....to go that extra mile that will take IDAK to greater heights! THAT’S what it took to get us where we are now. A big salute to all of them! As we stand at the Decennial year, I feel both honored & humbled at the same time, to be a part of this clan or family if you will, called IDAKians. We have grown by leaps & bounds over the years. Both, in numbers as well as in the variety of activities we organize. From the Scientific Symposium to the IDAK Members’ Congress or Clinical Photography course, there are many firsts. And then of course there’s the customary Oral Health Guide. This will be the 5th volume and will cover advice on dental health care through the different stages of life. Under the able guidance of my good friend & literary wizard Dr.Natesh & team the articles have all as usual, been authored by our own members who are specialists in their own fields and carefully, painstakingly translated into arabic as well, for the benefit of a wider population. I am sure that as in the previous years, this volume will also be of significant benefit & interest to the general public. I thank and join all those who have toiled & contributed towards the production of this magazine, in blessing & offering it as yet another tool for spreading dental healthcare awareness, from IDAK. Read it, educate yourself & take good care of that smile.
Dr. Jijan Sam Thomas General Secretary, IDAK
ORAL HEALTH GUIDE 2016 29 Volume 5
IDAK Editor
EDITOR’S NOTE Over the last decade, IDAK has presented four Oral Health Guides aimed at enhancing awareness in oral health. Our bilingual publications elucidate measures to prevent and treat common oral ailments. They are distributed to schools, dental clinics & other establishments in Kuwait. The public and the healthcare fraternity of Kuwait have expressed appreciation and encouragement for our enterprise. Oral disease is one of the most common public health issues worldwide with significant socio-economic impacts. Although significant scientific advances have been made in dental treatment modalities and prevention protocols, preventable noncommunicable maladies such as tooth decay and gum disease continue to be the major bane on our public health system. Emerging treatment strategies highlight the need to integrate oral health into the global health agenda via the common risk factor approach. Oral diseases and non-communicable diseases (such as diabetes, heart disease) are closely interlinked through sharing common risk factors (e.g. excess sugar consumption and tobacco use). The elimination of the obvious causes of illness is the only way to healing and health. Most of these causes are due to unhealthy choices we make during our lifetime, leading to ‘Lifestyle diseases’. Our decennial year publication, the Oral Health Guide, Volume 5, is titled ‘Lifestyle & Oral health.’ It is our continued effort to promote long-term sustainable good oral health. We appreciate the efforts of our authors, who have covered a broad range of lifestyle related oral health concerns. The articles are written in simple language and some in dialogue style to make the information interesting. The names of patients mentioned are fictive and all pictures are for illustration only. We acknowledge the immense help of our colleagues, Dr.Eman Al-Menezaa, Dr.Zeyad Al-Weher, Dr.Nafeth Al-Najjar and Dr.Mohmad Khurdi who helped to translate and proof read these articles. This publication would not have been possible without our esteemed sponsors and we express our sincere gratitude for their support. Mr. Michael Muthu, Mr. Omar Sokar & Mrs. Uma Anand of Lucky Press deserve a special mention for their efforts and valuable inputs that helped bringing our composition in print. I thank the IDAK council and all my team mates in the editorial committee for their commitment to accomplish this gratifying task. While it is our mission to promulgate oral health awareness, the success of our endeavour lies firmly with choices our readers make.
‘Love yourself enough to live a healthy lifestyle’. Dr.T. Natesh Kumar Editor, IDAK.
ORAL HEALTH GUIDE 2016 31 Volume 5
IDAK Sponsors
Thank you Sponsors Platinum Sponsor - Advanced Technology Company (ATC) Gold Sponsor - Ultramed Silver Sponsor - Al Tijari (Commercial Bank of Kuwait)
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BACK PACK
Table of Contents
INTRODUCTION • Healthy Lifestyle – Key to a Happy Lifetime
37
SECTION : PREGNANCY • Can a Mother’s Diet and Oral Health Define her Baby? • Effect’s of Pregnancy on Oral Health
41 45
SECTION: CHILDHOOD AND ADOLESCENCE • Healthy Me for a Healthy Smile • An Orthodontist’s Diary
51 57
SECTION: ADULTS • Tobacco Smoking and its Effect on Oral Health • Work Hard & Party Harder….Really??? • Botox and Fillers: Broadening the Horizon of Dentistry
65 71 77
SECTION: GERIATRICS • “Smile On” – Ageing Gracefully • Taking Care of Your Smile in Sunset Years
89 95
ORAL HEALTH GUIDE 2016 35 Volume 5
Introduction
Healthy Lifestyle – Key to a Happy Lifetime Dr. Sowmya N. Kumar. MDS
Endodontist, Adan Specialized Dental Centre.
“Don’t worry, be happy!”. A tune that rings so often in our mind. While being happy may have different interpretations, good health is undisputedly the foundation on which it can be achieved. Like happiness, good health can be shared and spread with a little awareness. It’s an accepted fact that lifestyle is an important determinant of your health. Your interests, opinions and behaviour form your lifestyle. Your way of living or life style is a result of the interplay between socio-cultural factors and personal characteristics. Simply put, if you are aware and lead a healthy lifestyle it will not only improve the quality of your life, but will influence everyone around you in a positive way. Good Nutrition
Adequate
Clean
physical
personal
activity
LifeStyle Positive and healthy environment
habits
Emotional/ mental Stress balance
Factors that mark lifestyle include eating habits, sleep and rest, exercise and physical activity, weight control, smoking and drinking alcohol, immunization against diseases, adjustment to stress, and the ability to utilize family and community support. As defined by World Health Organization (WHO), lifestyle refers to individuals’ way of life with a full reflection of social values, behaviours and activities. Studies reveal that 53% of causes of death are related to lifestyle, 21% to environmental factors, 16% to genetic factors and 10% to the healthcare system. ORAL HEALTH GUIDE 2016 37 Volume 5
Introduction Numerous studies have shown that 8% of heart diseases and 90% of diabetes type II can be prevented by making a change in the above factors. In addition, one third of cancer cases can be prevented by improving nutrition, weight control, and performing physical activities and another one third can be prevented by avoiding smoking and changing one’s lifestyle. The food & activity pyramid given in the previous page is a guideline for optimal nutrition and physical activity. Oral health is a window to your overall health. Simple oral conditions such as tooth decay, gum disease and tooth loss affect 3.9 billion people. The Global burden of disease study by the Bill & Melinda Gates foundation reported that the number of productive hours lost annually to common oral problems are 19,62,240 hours in a population of 100,000. This means that on an average each one of us lose nearly 20 hours in a year due to preventable oral diseases. Most people still think of an annual dental examination as a luxury. You may be surprised to know that 90% of all diseases including diabetes, kidney disease, heart disease, pancreatic and blood cancer have oral manifestations.
Few oral conditions that may indicate a systemic disease Sudden onset of gum disease, Lichen Planus (erosive or discoloured patches in the oral mucosa)
Diabetes
Tooth loss, ill fitting dentures, bone loss
Osteoporosis
Tooth erosion, tooth sensitivity
Acid reflux & eating disorders.
Unexplained left sided sore/painful jaw especially in middle aged high risk individuals.
Impending heart attack
Unexplained bleeding gums
Leukaemia /blood disorders
TMJ (Jaw joint) pain, dry burning mouth, canker sores, Bruxism (nocturnal grinding of teeth)
Stress, Anxiety and psychological conditions.
This issue of IDAK’s Oral Health Guide is dedicated to creating awareness about lifestyle and oral health. The articles are categorised into four phases of human life.
1. Pregnancy
2.Childhood & Adolescence
3. Adults
4. Geriatrics
As professionals, our practice has become more comprehensive and inclusive. We now follow a holistic approach in making our treatment protocols, keeping in mind the social and psychological dynamics that govern lifestyle. While prevention, interception and treatment of disease continues to be our mainstay, few modern clinics have evolved into dental spas, providing cosmetic dental and facial aesthetic treatment. Our lifestyles are impacted by the social, environmental, technological changes that surround us. It is in our hands to keep it simple and safe. Making positive lifestyle modifications will help us lead a healthy and happy life. 38 ORAL HEALTH GUIDE 2016 Volume 5
Pregnancy
Pregnancy
Can a Mother’s Diet and Oral Health Define her Baby? Dr. Susmitha Rechal David. MDS Pedodontist, Balsam Dental Care Centre, Jleeb Al Shoyoukh
Pregnancy is a time of constant change as the new baby develops in the mother’s womb.
However, one has to consider what food the mother eats during pregnancy as it can affect her child’s health even decades later. Adequate nutrition is imperative during pregnancy as nutrition is an important factor in the health, growth and development of both the mother and the fetus. Nutrition is the intake of food, considered in relation to the body’s dietary needs. A nutritious diet is essential for the development and maintenance of healthy teeth and soft tissue throughout life. Nutrient deficits can impact tooth development, the soft tissue and composition of saliva. Protein calorie malnutrition and deficiencies of Vitamins C, A, D and iodine have been documented to have an impact on tooth development and maintenance.
Prenatal and Perinatal Nutrition and Tooth Development
The perinatal period is defined as the period around the time of birth, from 21st to the 28th week of pregnancy ending one to four weeks after birth. Perinatal oral health plays a crucial role in the overall health and well being of the pregnant mother. Many expectant mothers are unaware of the implications of poor oral health for themselves, their pregnancy and their unborn child. Nutrition directly impacts the development of the permanent and milk teeth during fetal growth. Mothers with poor oral health and high levels of cariogenic (decay causing) bacteria are at a greater risk of infecting their children with the bacteria and increasing their child’s caries risk at an early age. Early dental decay and tooth enamel defects (hypoplasia) found in infants and children in developing countries are associated with malnutrition or under nutrition during the perinatal period. ORAL HEALTH GUIDE 2016 41 Volume 5
Pregnancy
Maternal Oral Health Concerns in Pregnancy Routine oral health care is important to a pregnant woman’s overall health status and to the future oral health of her child. Educational interventions prior to and during pregnancy can promote disease prevention and positive oral health behaviours and nutrition habits. Dental caries during pregnancy is of unique concern because of the maternal child linkage. Caries develop when cariogenic bacteria normally present in our mouth interact with fermentable carbohydrates ( bread, cereal, pasta, sweet, cookies, etc.). Mothers who have extensive tooth decay are more likely to have high titers of mutans streptococci, a known oral bacteria, resulting in a higher risk of early dental decay in their children
Maternal Protein Energy Malnutrition The 2002 Daily Recommended Intake (DRI) for protein necessary to provide adequate needs for the developing fetus and pregnant woman aged 20 – 39 years is 1.1 g/ kg/day of body weight. An additional 25g/day is needed for older women. PEM (Protein Energy Malnutrition) of a mother is associated with a child’s delayed tooth eruption, with altered tooth size and with possible decreased enamel solubility, all of which influence the child’s caries risk. Low birth weight and preterm delivery are associated with tooth enamel defects (hypoplasia) of the child’s permanent and milk teeth.
Maternal Vitamin and Mineral Nutrition Maternal nutritional status affects tooth development of the fetus pre-eruptively; whereas posteruptively the impact is due to local effects of diet. Table 1 depicts the effects of nutrient deficiencies on infant / child tooth development and Table 2 shows a list of Vitamins and Minerals recommended during pregnancy.
Table 1: Effects of prenatal nutrient deficiencies on tooth development Nutrient
Effect on tissue
Effect on caries
Protein – energy malnutrition
Tooth eruption delayed Abnormal tooth size
Yes
Vitamin A
Tooth alterations Increased defects in enamel
Yes
Vitamin D / Calcium / Phosphorus
Late tooth eruption patterns
Yes
Ascorbic acid
Dental pulp alteration
No
Fluoride
Enamel defects
Yes
Iodine
Delayed tooth eruption Tooth disorders
No
Iron
Slow growth of tooth
Yes
42 ORAL HEALTH GUIDE 2016 Volume 5
Pregnancy
Table 2: Daily Vitamin and Mineral recommendations for pregnant women Vitamin
Recommended intake
Recommended food sources
A
770 RE
Fish oils, green leafy vegetables & colored (red / orange) fruits
B1
1.4 mg
Green leafy vegetables, soy milk, enriched whole grain breads and cereals
B2
1.4 mg
Green vegetables, eggs, milk, meat
B6
1.9mg
Wheat germ, cereals, legumes
B12
2.6µg
Meats, poultry, fish, shellfish, milk, eggs, cheese
C
85 mg
Green vegetables, citrus fruits
D
5µg
Fortified milk, egg yolk, fatty fish
E
15mg
Polyunsaturated plant oils, wheat germ, tofu, avocado, sweet potatoes
K
90mg
Leafy green vegetables, cabbage, cheese
Folate
600µg
Green leafy vegetables, beans, peas, lentils
Niacin
18mg
Peanut butter, lean ground beef, chicken, tuna, shrimp
Iron
27mg
Red meat, spinach, broccoli, tofu, shrimp, iron fortified cereals
Calcium
1000 –1300mg
Dairy products, leafy vegetabls, almonds
Phosphorus
700-1250mg
Meat, fish, eggs, milk
Zinc
11-12mg
Lentils, shrimp, crab, turkey, eggs, tofu
Throughout pregnancy, infancy and childhood, nutrition and diet play a significant role in oral health status. Assuring adequate nutrition of the mother and fetus throughout pregnancy and into childhood will increase the likelihood of establishing health behaviours that will promote positive health outcome.
“To nourish is to flourish” ORAL HEALTH GUIDE 2016 43 Volume 5
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Pregnancy
Effects of Pregnancy on Oral Health
Dr.Prashanthy R. MDS, FICOI
Periodontist & Oral Implantologist, Al - Hekma Specialized Dental Centre, Mirgab.
A healthy pregnancy depends upon a healthy mom to be. During pregnancy, eliminating habits like smoking and drinking, following a healthy diet, and seeking prenatal care are widely accepted measures to ensure your baby’s health. What some women may not know is that oral health also plays a key role in a healthy pregnancy. Though further research is necessary to fully understand the impact of gum disease on pregnancy, healthcare professionals and dentists agree that any active infection in a mother’s body is a threat to fetal health. Gingivitis and Periodontitis Gum disease is a living, active infection in your mouth for which immediate treatment is essential in preventing complications to your pregnancy. When gum disease is in its early stages, it is known as gingivitis, or inflammation of the gums. If gingivitis goes untreated, it can develop into periodontitis, literally meaning “inflammation around the tooth”, which damages the soft tissue and bone that supports the tooth. If left untreated, it can lead to the loosening and subsequent loss of teeth. A lot of studies have been conducted proving a strong link between pregnancy and periodontal diseases which when left untreated, progress to affect the patient systemically. During pregnancy, hormonal levels rise dramatically. High concentration of these hormones in gingival tissues, saliva and serum exaggerates the body’s response to the toxins (poisons) that result from dental plaque. Other than bacterial plaque, factors like smoking, ORAL HEALTH GUIDE 2016 45 Volume 5
Pregnancy diabetes mellitus, stress and genetics also play a significant role. As a Periodontist (Gum specialist), a few of the common gum problems I see in my patients who are pregnant are Pregnancy gingivitis The occurrence of pregnancy gingivitis is extremely common in pregnant women. Amongst the many pregnant patients I have treated for pregnancy gingivitis, I recollect one patient of mine who had severe gingivitis. She was unique because she was an ideal patient – every dentist’s dream. She got her dental checkups very regularly, followed all the oral hygiene instructions after getting her teeth and gums cleaned and had a thorough home care schedule for her teeth. This patient approached me in her third month of pregnancy suffering from severe redness, swelling of gum and increased bleeding of gums while brushing. I explained to her the cause and effects of pregnancy on oral health and vice versa. I also explained the consequences of increased tissue swelling which may lead to increased pocket depth and may be associated with transient tooth mobility. Gum inflammation around the front teeth can be exacerbated by increased mouth breathing, primarily in the third trimester and pregnancy rhinitis. She was treated symptomatically for her condition, and responded well. Pyogenic Granuloma of pregnancy / Pregnancy tumor Another common gum condition in pregnancy patients is a pregnancy tumor. • Appears most often during the second / third month of pregnancy. • Bleeds easily and becomes hyperplastic and nodular. • Ranges in color from purplish red to deep blue depending on the vascularity of the lesion and degree of venous stasis. • Lesion classically occurs in an area of gingivitis and is associated with poor oral hygiene and calculus. Other Oral manifestations of Pregnancy Halitosis : Halitosis or Bad breath, means that you have an unpleasant smell in your breath that other people notice when you speak or breathe out. Tooth mobility : Presence of loose teeth. Xerostomia : A frequent complaint among pregnant women, meaning “dryness of the mouth” resulting from reduced or absent saliva flow. Perimylosis : Is acid erosion of teeth and occurs when “morning sickness or oesophageal reflux” is severe and involves repeated vomiting of the gastric contents.
46 ORAL HEALTH GUIDE 2016 Volume 5
Pregnancy Tooth sensitivity : A consequence of acid erosion. Apart from the above conditions, research has shown an alarming increase in the association of periodontal diseases with preterm labor resulting in Preterm Low Birth Weight Babies. Pregnant women who have periodontal disease may be seven times more likely to have a baby that is born too early and too small. Any infection is a concern for pregnant women because it poses an increased health risk for the fetus and is equally stressful to the mother’s health. Especially, because of the increased levels of hormones present in tissue fluid an alteration in the bacterial composition of subgingival plaque occurs during pregnancy. During the second trimester, gingivitis and gingival bleeding increases without an increase in plaque levels. If a dental professional does not treat these red and swollen gums, the condition can deteriorate to periodontal disease, which can attack the gums and bone surrounding the teeth and eventually lead to tooth loss. The natural space between your teeth and gums becomes infected. Pockets can form where bacteria thrive. This makes taking care of any existing gum infection prior to conception and maintaining optimal oral health an important factor. How will I know if I have a gum disease? You may not normally experience pain with gingivitis or periodontal disease, but there are other symptoms like : • red, swollen, or tender gums • bleeding gums when you brush or floss • gums that seem to have pulled away from the teeth • loose teeth • a change in your bite • pus between teeth and gums • persistent bad breath As a Periodontist, I always counsel my patients about the importance of maintaining oral hygiene as the mouth is the gateway to the body. Good brushing habits and regular dental checkups are the key to maintaining good oral health during pregnancy. Apart from brushing teeth, flossing is also critical as it physically removes plaque (food debris laden with bacteria) in between the teeth. Visit your dentist without fail during pregnancy to avoid unwanted complications of dental problems during pregnancy.
ORAL HEALTH GUIDE 2016 47 Volume 5
Pregnancy
Childhood & Adolescence
ORAL HEALTH GUIDE 2016 49 Volume 5
ITHRONE
R
Azithromycin 500g
Scored tablets
Once Daily for all odontogenic infections
E PANDS
YOUR E PECTATION AMOUN
HIBIOTIC 1gm Amoxicillin875mg + Clavulanic Acid 125 mg
Tablets
High Power In Depth
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Dental Infections
The Power of Injection in Oral Form
Childhood & Adolescence
Healthy Me for a Healthy Smile
Dental Health in Children and Adolescents Dr. Vidya Thomas. MDS Periodontist
Lifestyle is a term used to denote the habits, attitudes, tastes, moral standards, economic
level, etc., that together constitute the mode of living of an individual or group. Oral diseases are closely linked to lifestyle. Dental health encompasses the likelihood of making healthy choices in relation to diet, smoking, oral hygiene and utilization of dental health services. An example of a common concern in adolescents. Fourteen year old Susan waited at the dentist’s clinic with her mother. She was worried about her teeth and gums. That morning, while brushing her teeth she had noticed some bleeding from her gums and her gums seemed to be swollen. Her mother had immediately taken an appointment with their dentist. After the examination, Susan was relieved when her dentist told her that there was no reason to worry. She was showing initial signs of gum disease, called gingivitis and her doctor explained in detail about how to take care of her gums and teeth. If we thought that gum disease is something that only happens to people of our grandparents’ age, then we have to think again. Children and teenagers can get gum disease too, and it can cause problems from bleeding and bad breath to pain and tooth loss. Susan asked her dentist “What is gum disease?” Gum disease is also known as periodontal disease. Periodontal disease is an inflammation of the tissues and bone that support the teeth. The word comes from the Greek terms peri, meaning “around” and odont, meaning “tooth.” ORAL HEALTH GUIDE 2016 51 Volume 5
Childhood & Adolescence The periodontium keeps the tooth firmly in place. It is made up of four parts: • Tooth socket • Periodontal ligament • Cementum • Gums (gingiva) Mildest form of gum disease is called gingivitis. Gum disease is usually caused by a buildup of plaque, an invisible sticky layer of germs that form naturally on the teeth and gums. Plaque contains bacteria, which produce toxins that irritate and damage the gums. “Why is there increased gum disease in adolescence?” Hormonal changes related to puberty can put teenagers at greater risk for getting gum disease. During this period, an increased level of hormones, causes increased blood flow to the gums. This may cause an increase in the gum’s sensitivity and lead to a greater reaction to any irritation, including food particles and plaque. During this time, the gums may become swollen, turn red and feel tender. This tendency of the gums to swell in response to irritants will lessen. However it is very important to follow a good dental hygiene regimen at home, including regular brushing and flossing. In some cases, a dental professional may recommend periodontal therapy to help prevent damage to the tissues and bone surrounding the teeth. “So, how do we know that we have gum disease?” Four basic signs will alert you to periodontal disease in your child:
Bleeding
Bleeding gums during tooth brushing, flossing or any other time.
Puffiness
Swollen and bright red gums.
Recession
Gums that have receded away from the teeth, sometimes exposing the roots.
Bad breath
Constant bad breath that does not clear up with brushing and flossing. “Who
is at risk?”
Certain things can make a person more likely to develop gum disease. Though some may inherit this tendency from their parents, our daily “LIFESTYLE” also plays a very important role. DIET - The snacks you eat can also put you at risk of developing gum disease, especially if you grab fries and a soda after school and aren’t able to brush immediately after eating them.
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Childhood & Adolescence According to the American Dental Association, it only takes 24 hours for enough bacteria to form in the mouth to start causing gum disease. A healthy diet including fruits and vegetables is important for good oral health. STRESS - Do children and adolescents suffer from stress too? Unfortunately they do. Too little sleep, and too much stress leaves us more vulnerable to infection anywhere in the body, including our gums. Psychological stress can cause the body to release inflammatory hormones that may trigger or worsen gum disease. SMOKING - Not only does smoking lead to bad breath and stained, yellow teeth but smoking also is a leading cause of gum disease. Smoking can cause bone loss and gum recession even in the absence of gum disease. According to the American Dental Association (ADA), people who smoke cigarettes and chew tobacco are more likely to have plaque and tartar buildup and to show signs of advanced gum disease. ORAL HYGIENE - The best way to prepare a child for a lifetime of good oral hygiene is to establish good habits early on. It is important for parents to act as a consistent role model and schedule regular checkups for professional assessment and cleaning. The stronger the habits of brushing and flossing are in young children, the more likely they are to continue these habits through adolescence and adulthood. Along with gum disease, the doctor explained about another very common dental disease – CAVITIES. “What is a cavity?” A cavity is a hole that can grow bigger and deeper over time. A cavity develops when a tooth decays. Cavities are also called dental caries and it’s important to get them repaired. Caries is caused by plaque. The bacteria in the plaque produce acids which can eat away at the outermost layer of the tooth, called the enamel. If left untreated, the acids can continue to make their way through the enamel, to all the way inside the tooth involving the inner layer called dentin and the innermost part called the pulp, where the nerve endings are. Though cavities can be repaired, it is important to try to avoid them by taking care of the teeth. Susan’s dentist concluded by saying that both gum disease and dental caries is preventable. Just take care of your teeth, starting now. Here is what you need to do. • B rush twice a day and floss daily. If you’re not sure whether you’re brushing or flossing properly, your dentist can show you the best technique. • Use a toothbrush with soft, polished bristles, as these are less likely to irritate or injure gum tissue. • B e sure to replace your toothbrush at least every 3 to 4 months — a worn out toothbrush can injure your gums. • E at a healthy diet. Avoid snacks and junk foods packed with sugar that plaque causing bacteria love to feed on.
ORAL HEALTH GUIDE 2016 53 Volume 5
Childhood & Adolescence • D on’t smoke! Cigarettes and chewing tobacco cause mouth irritation and are very unhealthy for gums and teeth. • R egular dental care is extremely important in helping to keep your mouth healthy. Visit your dentist for routine care at least twice a year. The dentist also stressed on the importance of protecting the teeth while playing because sports injuries are the main source of tooth and mouth injuries in both children and young adults. It is extremely important to protect your teeth as is the rest of your body.
How to Protect Your Teeth 1. Wear a Helmet
If you are participating in any sport, such as bike riding or football remember to always wear a helmet. Wearing a helmet can help protect your head and mouth from fast and forceful impact. 2. Wear a Custom Mouth Guard In order to prevent injury to your mouth, gums, and teeth, wearing a custom mouth guard is necessary. These mouth guards are made by your dentist to fit your mouth perfectly to feel comfortable during play. 3. Can knocked out teeth be repaired? Yes, knocked,out teeth can be repaired, and the sooner you can get to your dentist’s office, the better. Knocked,out teeth with the highest chances of being saved are those seen by the dentist and returned to their socket ideally within 30 minutes to one hour of being knocked out. If a tooth has been knocked out, gently rinse any debris from the root with water and attempt to place it back into the socket. If that’s not possible, hold it in the mouth (next to the cheek) or if all else fails, keep the tooth in cold milk until you get to the dentist’s office. It is thus possible to ensure oral health into adulthood by following the dental health care tips and incorporating dentist’s advice in the daily routine.
“If you don’t take care of your body, where are you going to live?”
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Childhood & Adolescence
An Orthodontist’s Diary Dr. Rino Roy. MDS
Orthodontist, Jahra Specialized Dental Centre.
In the daily working of a busy orthodontic practice, I frequently get asked a lot of questions
about long term treatment related to Orthodontics and Dentofacial Orthopedics. Potential patients, parents and relatives need to know more about pre orthodontic care. Preparing for an orthodontic treatment is almost like a ‘lifestyle change’ that requires behavior modification involving •oral hygiene (increase in frequency of brushing, flossing, mouth rinse) •oral habit corrections (finger sucking, pen/pencil biting, clenching, bottle cap opening using teeth) •diet changes (consumption of vitamins C, D and calcium, decrease soft drinks and hard foods) Recently, a concerned Kuwaiti mother brought her teenage children, Sarah and Ahmed, to the department. All three of them were concerned about their smile, teeth and profile. What was interesting and challenging was that they presented three different types of malocclusion and treatment challenges. Sarah (13 years old) had forwardly placed upper front teeth with highly placed canine and was very shy to smile. It was tough to keep her lips closed as well due to her pushed out teeth. This became a cause for being teased by her peers. Her mother was also concerned about her daughter’s bleeding gums especially while brushing (Figure A). Figure A: This patient shows gingival inflammation, bleeding spots and inadequate crown height in the lower back teeth. This situation will benefit from braces after improved oral hygiene.
ORAL HEALTH GUIDE 2016 57 Volume 5
Childhood & Adolescence As for Ahmed (11 years old), she was more concerned about his facial appearance with his lower jaw more prominent than the upper jaw. His teeth showed a cross bite and deciduous teeth with slightly narrow upper and lower arches (Figure B). Figure B: This young patient has mixed dentition with unerupted permanent teeth. This condition will benefit from pre-orthodontic trainer treatment prior to fixed orthodontic treatment. The mother (36 years old), presented with some crowded upper teeth, edge to edge bite and highly placed canines. She revealed to me that she was pregnant and was slightly diabetic. Earlier, she had good oral hygiene, however, of late she was having sensitive, bleeding gums since a few months of pregnancy (Figure C). Figure C: This adult patient has hypersensitive gums related to pregnancy. This scenario will benefit from improved oral hygiene practices and braces treatment after giving birth.
In one consultation, it was possible to address pre-orthodontic requirements for patients who are considering fixing orthodontic appliances. It also brings out certain challenges that most orthodontists face in preparing their patients teeth and gums before braces Highlighted below are certain pre-requisites for patients to consider before embarking on fixed orthodontic treatment in order to make them ‘Ortho - ready’.
Pre - Orthodontic Preparations and Precautions a. Oral hygiene status The main pre-requisite before the start of the treatment for braces is having clean, healthy teeth and gums. Ideally, the gums should appear pink in color and have curved contours with no puffiness / swelling and bleeding. If there is gingival infection, like for Sarah and her mother, undergoing fixed orthodontic treatment can lead to deeper problems like periodontitis. This eventually causes increased mobility and relapse of the final result. Without good oral hygiene practices like brushing, flossing, mouthwash rinses and gingival gel usage, any orthodontic treatment can lead to complications In cases of persistent poor gum disease, stains or calculus buildup, the orthodontist cannot start his treatment. It may have to be postponed until all the risks, like damage to enamel, caries, gum infections and stains are taken care of by the patients’ oral hygiene practices. 58 ORAL HEALTH GUIDE 2016 Volume 5
and stains are taken care of by the patients’ oral hygiene practices. Before the start of any orthodontic treatment, caries should be filled with permanent restorations. Deep Childhood & Adolescence caries may require Root Canal Treatment (RCT), while badly damaged crowns or heavily filled teeth may require porcelain crowns before commencement of braces. Quite frequently, the patient may be referred forstart crown procedures if gums excessively cover crowns and is not sufficient for Before the of lengthening any orthodontic treatment, caries should be filledthe with permanent restorations. bondable attachments. Orthodontists may refer to another specialist for these disease control Deep caries may require Root Canal Treatment (RCT), while badly damaged crowns or heavily measures.
filled teeth may require porcelain crowns before commencement of braces. Quite frequently, A patient should be highly self-motivated and mentally prepared to practice frequent brushing, regular the patient be referred crown lengthening procedures if gums excessively cover flossing andmay medicated mouth for wash usage before wearing braces. Additionally, it is important to the show healthy gums, tongue and teeth condition before fixing braces to gain the trust and confidence of his / crowns and is not sufficient for bondable attachments. Orthodontists may refer to another her orthodontist for an overall smooth treatment experience. specialist for these disease control measures.
Gums are pink, wellcontoured and not bulky or bleeding on pressure.
Restorations completed prior to fixing braces.
Ideal oral hygiene conditions before starting
Adequate crown length, clean teeth and stain-free crown surfaces.
any Fixed Orthodontic treatment.
Figure D
A patient should be highly self motivated and mentally prepared to practice frequent brushing, regular flossing and medicated mouth wash usage before wearing braces. Additionally, it is Pre- Orthodontic important totraining show healthy gums, tongue and teeth condition before fixing braces to gain the young patients, likeconfidence Ahmed, who are showing signs for of malocclusion of trust and of his / her orthodontist an overall smooth th or jaw discrepancies, a ‘Pre-Orthodontic TRAINER’ is a practical early treatment experience.
atment of choice for the following problems with teeth, bite or jaws gure E,F)
b. Pre-Orthodontic training
ese medical grade appliances help to shape the arches in natural shape. For young patientsdentition like Ahmed, who are signs of ey guide teeth to a normal with good bite showing and alignment. aring the Trainer brings about a slow arch expansion to improve dental malocclusion of teeth or jaw discrepancies, a ‘Pre-Orthodontic d facial profile. The Trainer actively places the tongue in normal position Trainer’ is aIt practical early of choice for thethe following d stops tongue thrust. also forces thetreatment child to breathe through nose her than theproblems mouth. Itwith can teeth, correctbite defective lower jaw growth or jaws (Figure E,F). and correct gue position. Due to its myo-functional position and dental corrections, it uces need These for complex orthodontic treatmenthelp andtomay prevent the need medical grade appliances shape the arches into extractions of teeth for fixed orthodontic teeth.
natural shape. They guide teeth to a normal dentition with good Medically compromised bite and alignment. patients Wearing the Trainer brings about a slow arch to improve dental facial profile. Thelike Trainer actively s common expansion to see many patients withand medical problems diabetes, Figure E,F: Combined with the diac abnormalities, respiratory and infectious diseases, the places the tongue indisorders normal position and stops tongueinthrust. prevention of tongue thrusting, y practice of a dentist. During the initial visits, it is important to reveal the forcing nasal breathing, passive It also forces the child to breathe through the nose rather than erity and duration of one’s medical condition. Each medical problem can arch expansion, correct jaw positioning, bite trainers may ect dental treatment unique manner. Medications prescribed for a the mouth.inIt acan correct defective lower jaw growth and correct reduce the need for braces. dical condition might produce an interaction during the administration of tongue position. Due to its myo-functional position and dental al anesthetic, or interact with pain killers or antibiotics prescribed by the it reduces need with for complex orthodontic treatment hodontists. corrections, For example, in the patient uncontrolled diabetes needing emergency oral surgery acute infections, dental procedures need to be modified. In certain heart conditions, use of and may prevent the need for extractions of teeth for fixed orthodontic teeth.
biotics before or during orthodontic procedures is important to avoid complications. In certain severe ctious diseases, the doctor will need to take additional infection control and special sterilization of ruments and equipment’s before and after orthodontic procedures. Laboratory tests may be essary prior to treatment including complete blood count and tests for hemostasis, hepatitis B 2016 and 59 ORAL HEALTH GUIDE HIV and infective endocarditis. Volume 5
Pregnancy
b. Pre- Orthodontic training
For young patients, like Ahmed, who are showing signs of malocclusion of teeth or jaw discrepancies, a ‘Pre-Orthodontic TRAINER’ is a practical early Childhood & Adolescence treatment of choice for the following problems with teeth, bite or jaws (Figure E,F)
c. Medically compromised patients These medical grade appliances help to shape the arches in natural shape. They guide teeth to to a see normal dentition biteproblems and alignment. It is common many patientswith withgood medical like diabetes, cardiac abnormalities, Wearing the Trainer brings about a slow arch expansion to improve dental respiratory disorders infectious in in the daily practice and facial profile. The Trainer and actively placesdiseases, the tongue normal position of a dentist. During the initial and stops tongue It also forces the the severity child to breathe through the nose visits, it isthrust. important to reveal and duration of one’s medical condition. Each medical rather than the mouth. It can correct defective lower jaw growth and correct problemDue canto affect dental treatment in a unique manner. Medications prescribed for a medical tongue position. its myo-functional position and dental corrections, it reduces condition need for complex orthodontic treatment during and may the needof local anesthetic, or interact might produce an interaction theprevent administration for extractions of teeth for fixed orthodontic teeth. with pain killers or antibiotics prescribed by the orthodontists. For example, in a patient with
c. Medically compromised patients uncontrolled diabetes needing emergency oral surgery for acute infections, dental procedures
It is common to be seemodified. many patients with medical problems diabetes, before or during orthodontic need to In certain heart conditions, uselike of antibiotics Figure E,F: Combined with the cardiac abnormalities, respiratory disorders and infectious diseases, in the prevention of tongue thrusting, procedures is important to initial avoidvisits, complications. In to certain infectious diseases, the daily practice of a dentist. During the it is important revealsevere the forcing nasal breathing, passive severity and duration of one’s medical condition. Eachcontrol medical problem doctor will need to take additional infection and specialcan sterilization of instruments and arch expansion, correct jaw positioning, bite trainers may affect dental treatment in a unique manner. Medications prescribed for a equipment’s before and after orthodontic procedures. Laboratory maythebe necessary reduce need for braces. prior medical condition might produce an interaction during the administration oftests local anesthetic, or interact withcomplete pain killers or antibiotics by the to treatment including blood count andprescribed tests for hemostasis, hepatitis B and C, HIV orthodontists. For example, in the patient with uncontrolled diabetes needing emergency oral surgery and infective endocarditis. for acute infections, dental procedures need to be modified. In certain heart conditions, use of antibiotics before or during orthodontic procedures is important to avoid complications. In certain severe d. Pregnancy infectious diseases, the doctor will need to take additional infection control and special sterilization of instruments and equipment’s before and after orthodontic procedures. Laboratory tests may be Pregnancy is the most life altering and wonderful experience in a woman’s life. During pregnancy, necessary prior to treatment including complete blood count and tests for hemostasis, hepatitis B and conditions gingivitis, halitosis and calculus accumulation can be more severe on wearing C, HIV and infectivelike endocarditis.
braces (Figure G). d. Pregnancy
Reports and studies highlight correlation between ingum Pregnancy is the most life altering and wonderful experience a woman’s life. During pregnancy, conditions like gingivitis, halitosis disease and increased risk of pre-term low birth weight and calculus accumulation can be more severe on wearing babiesG). and pre-eclampsia. Pain killers / anti-inflammatory braces (Figure
are usually not advised between during pregnancy and Reports drugs and studies highlight correlation gum disease and increased risk to of more pre-term low birth/ pain weight and of prethis leads discomfort onbabies activation the eclampsia. Pain killers / anti-inflammatory drugs are usually not appliances. Radiographic imaging such as advised orthodontics during pregnancy and this leads to more discomfort / pain on panoramic activation offilm theand orthodontics appliances. Radiographic periapical films used to assess root imaging such as panoramic film and periapical films used to inclinations, impactions cannotbebe assess root inclinations, impactionsand and mini-implants mini-implants cannot done during pregnancy. Tooth extractions needed for orthodontic treatment is not advisable during this time.
Figure G: Chronic gingival inflammation, gingival recession, calculus accumulation and periodontal disease may increase as a result of wearing braces during pregnancy.
During pregnancy some may choose to wait until after delivery to address any local healthcare needs. It is important to know if you are possibly pregnant, before embarking on a long term treatment like fixed orthodontics. Rigorous oral hygiene regimen maintained at home and professional dental cleaning will ensure excellent oral health for orthodontic patients during pregnancy.
Final Note With high incidences of gum disease, caries, calculus and malocclusion, patients are faced with multidisciplinary treatment referrals before orthodontic treatment. Primary care treatment like cleaning, restorations, gum surgeries, RCT’s and medical health care is usually a common requirement for a richer and smoother orthodontic experience. Patients must be aware and responsible of pre-orthodontic preparations for an excellent and comprehensive treatment result. 60 ORAL HEALTH GUIDE 2016 Volume 5
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Adults
Adults
Tobacco Smoking and its Effect on Oral Health Dr. David Gnanasekhar. M.Sc-Perio Periodontist, Al Zahra Health Centre.
A particular way by which an individual, a group of people or even a culture live is referred to as a lifestyle. Lifestyles can begin at any stage in the life cycle of a person, and it is learnt from parents, siblings, mass media and from the environment that the person lives in. A wealthy person living a lavish life is following a lifestyle, a laborer taking all the precautions to sleep 6 to 8 hours per day without fail is also following a lifestyle. An individual adhering to a strict vegetarian diet and another person consuming fast food everyday are also following their own lifestyles. A person who takes a healthy diet and exercises regularly is obviously following a healthy lifestyle. So, lifestyle can be beneficial or harmful to one’s health and it should come as no surprise that having a healthy lifestyle reduces the risk of developing several long term (chronic) diseases. Smoking tobacco, whether it is just a habit or an addiction is considered as part of a lifestyle. This article will help you understand, how smoking within a lifestyle can negatively affect the health of the mouth (oral cavity).
Harmful Effects of Smoking Most smokers start this habit as a teenager and prevalence of this habit is the highest in the 20 to 24 year old age group. According to World Health Organization (WHO), tobacco smoking epidemic is one of the biggest public health threats the world has ever faced. Currently, the world has more than a billion smokers. About half the number of all smokers die due to smoking related illnesses, which accounts for about 6-7 million every year. Unfortunately about 10% of those are non-smokers exposed to passive (second-hand) smoke. Second-hand smoke causes more than 600,000 premature deaths every year. Even in adults, second-hand smoke causes serious heart and lung diseases, including lung cancer. Almost half of all the children regularly breathe air polluted by tobacco smoke in public places. In infants, second hand smoke causes sudden death and it affects ORAL HEALTH GUIDE 2016 65 Volume 5
Adults pregnant women by making them to deliver children with low birth weight. One cannot overlook the harmful effect of second-hand tobacco smoke that fills restaurants, offices or other enclosed spaces where people burn tobacco products such as cigarettes, bidis and water-pipes. There is no safe level of exposure to second-hand tobacco smoke. People in general associate cigarette smoking with lung cancer, bad breath, and stained teeth. But in recent years it has been very clearly shown that tobacco smoke affects almost every organ in the body (Figure 1), including the mouth. So how does tobacco, whether it is chewed or smoked be so harmful? Tobacco smoke is a very complex mixture of more than 4000 chemicals, of which 250 are known to be harmful and more than 50 of them are known to cause cancer, including cancer in the mouth.
The mixture includes nicotine, the main addictive Figure 1: Smoking affects almost all organs in the body. and psychoactive chemical, along with carbon monoxide, hydrogen cyanide, and other substances. Tobacco, when smoked as a cigarette, or in a pipe, brings about several changes in the mouth; such as • increase in mouth temperature • adhering of some of the tobacco constituents on the teeth • reduction of the oxygen concentration in the mouth • penetration into the tissues of the mouth by the hazardous constituents from tobacco smoke. These changes in the smoker’s oral cavity (mouth) either independently or in combination cause several mouth disorders and diseases, such as those given below. Smoker’s Breath: Many of the constituents from cigarette smoke produce an unpleasant mouth odor. In order to avoid experiencing this bad mouth odor, peers and some family members of the smokers often try to keep their distance from the smokers or try to put up with the unpleasant experience. This is the first and perhaps the mildest oral disorder caused by smoking. Staining of Teeth: Everybody likes to have clean, white and properly aligned teeth. And it is very rare to find teeth of smokers without any of the smoking related brownish stains on them (Figure 2). The severity of teeth staining is directly proportionate to the frequency and duration of cigarette smoking. The more one smokes, the more their teeth become stained. Some smokers, with the intention of removing these stains, brush their teeth more vigorously and frequently, which although reduces the staining, will only make the teeth become worn out
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Adults and sensitive to hot and cold food items. These stains can be removed almost completely, and periodically by regular visits to the dental clinic. Teeth staining by cigarette smoking is more of a cosmetic problem, and is perhaps the least harmful effect of cigarette smoking.
Figure 2a: The smoker’s teeth with brownish black stains on them.
Figure 2b: The same teeth after they have been professionally cleaned.
Gum (Periodontal) Disease: Periodontal disease is a very common disease, and it occurs in individuals with poor oral hygiene. Many studies have shown that people who smoke have poorer oral hygiene than non-smokers, and periodontal disease is also more prevalent and more severe in smokers. Perhaps many smokers after seeing their stained teeth, and being unable to remove these stains by normal oral hygiene procedures, lose their interest to keep good oral hygiene. As a result, layers of bacteria called “bacterial plaque” are allowed to accumulate on teeth surfaces. The reduced oxygen concentration in the smoker’s mouth provides a suitable environment for certain harmful bacteria to greatly increase in number. Smoking also has a profound negative effect on certain white blood cells in the body’s infection fighter (immune) system. These affected white blood cells loose much of their capacity to protect the body
and allow the harmful bacteria to penetrate the gum and bone surrounding the roots of teeth
Figure 3: Smoker’s teeth and gums affected by periodontal disease. Notice the staining, accumulation bacterial deposit, red swollen gums and teeth drifting away with reduced bone supporting their roots.
(periodontal tissue), and they in turn along with bacteria release their own harmful products into the body. All these factors play a role not only to initiate periodontal disease, but make it to rapidly progress by separating the gums away from the teeth and gradually destroying the underlying bone that support the teeth (Figure 3). The teeth then become loose, and if not adequately treated will need to be extracted or just fall off. Smoking also does not permit the periodontal tissue to heal well after treatment.
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Adults Oral Cancer: Tobacco’s greatest threat to health is its association with oral cancer. Tobacco smoke has more than 50 cancer causing chemicals and combined with the smoker’s weakened immune system, it can cause cancer in any part of the mouth (Figure 4). Smokers are six times more likely than nonsmokers to develop oral cancer. The risk of developing oral cancer increases as people smoke or chew tobacco more often or for a longer period of time. Many of the oral cancers, even when they are detected early can be quite difficult to treat. Oral cancer patients often do not survive for more than five years. Cancer treatment often ends by surgical removal of the cancerous tissue leaving behind a scarred, deformed area. Figure 4: Oral cancer of the lower jaw and part of the lower lip. For this patient much of the lower jaw and part of the lip have to removed. Later a reconstruction surgery has to be done to improve the function and appearance of this smoker's jaw and lip.
Smoker’s Palate: The average temperature in the smoker’s mouth is 42oC. If this temperature is sustained for long periods of time, the mouth (oral cavity) becomes dry and the surface layer of the tissue that lines it undergoes changes such as thickening, structural changes within some of the cells and even death of many of its cells. The palate appears pale or may have a white coating on it, and this is called the smoker’s palate (Figure 5).
Figure 5a: "Smoker's palate" with the typical thickened, white surface. This smoker also complained of dry mouth, and burning sensation in the palate
Figure 5b: Two months after the smoker quit smoking the palate has almost returned to its normal condition.
Quit Smoking: Cigarettes, pipes, cigars and chewing tobacco, all adversely affect the oral health of smokers. No tobacco product is better than the other and even occasional smoking is harmful. Just remember that the tobacco smoke damage begins in the mouth and then the other organs in the body get affected. A good decision that any smoker can make, is to quit smoking. It is interesting to note that when groups of smokers were interviewed, more than 70% of them wanted to quit smoking, but most failed in their attempt to do so. In recent years electronic 68 ORAL HEALTH GUIDE 2016 Volume 5
Adults cigarettes known as “e-cigs” are being used by many as substitute for real cigarettes. E-cig is a hand held device that heat and vaporize e-liquid that is flavored with nicotine, propylene glycol and other substances, and delivers the vapor to the lungs via inhalation. Using an e-cig. is referred to as “vaping.” Although it has a reputation as a tool to help smokers to quit, research suggests that they may be as addictive as traditional cigarettes. It is not Federation Drug Administration (FDA) approved for any therapeutic use. For smokers who want to quit cigarettes there are FDA approved treatments which have been proved to be safe and to work, including: “Nicotine gum” and “Nicotine skin patches.” It takes a serious commitment and effort to quit smoking. Nicotine is addictive, and nearly all
smokers when they try to quit have some feelings of nicotine withdrawal. Being aware of this will help deal with withdrawal symptoms that can occur, such as bad moods and the desire to smoke again. Understanding the harmful effects of smoking that have been mentioned above, by sincerely answering all the questions given below, and trying to live up to them will help to quit smoking. Do you want to: • have better health? • set a good example for your children? • protect your family from breathing other people’s cigarette smoke? • be around long enough for your loved ones? I’m sure you want to, then YOU MUST QUIT SMOKING. Conclusion: A recent study showed that men and women who have never smoked, ate a healthy diet, participated in physical activity and were not obese (with a body mass index (BMI) less than 30), were 78% less likely to develop chronic diseases such as heart disease or diabetes. The same study also showed that participants who followed at least one of these four healthy life styles had a reduced risk of chronic diseases by 50%. The dental community has long been aware of the link between oral diseases and tobacco and it has always encouraged tobacco users to kick this unhealthy habit and live a healthy lifestyle.
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Adults
Work Hard & Party Harder ….. Really ? ? Dr. Ashwin Prabhakar Surve. MDS
Conservative dentistry & Endodontics, Al Muhallab Dental Centre, Riggae.
Today we are in the 21
century. This is the age of technology, speed & competition. Humans have constantly shed their skin to adapt to the new challenges of their era. Unlike yesteryears, man today doesn’t find himself any time. To sustain in the grueling competition of professionalism he has started relishing the less dietary value junk foods. Similarly, to achieve higher gains there have been extended working hours which deprive the body from the minimal sleep required. st
Thus to sum up, man today has given,up his peace of mind & body to adopt an unhealthy standard of living. To make up for the lost fun during the whole working day or week, people try to catch up at nights, trying to spend time together at clubs, restaurants, etc which eventually disturbs their health further. It is rightly said, “excess of anything is not joy but joylessness”. Therefore, it becomes a matter of great debate today whether we should really “ work hard & party harder ?” With such sedentary lifestyle comes many unseen health problems like diabetes, insomnia, mental irritability, anorexia, altered blood,pressure levels, anxiety, etc. Behaviors such as smoking, alcohol consumption, diet, social contacts and work style are important contributing
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Adults factors. All these factors penultimately precipitate into poor oral health, causing : tartar, foul odor, bleeding gums & loss of teeth. This article will highlight the overall health & oral health perspective of a less talked about health related disorder, which has been observed prominently in such stress related lifestyle. “Reflux Disorder”. Let’s learn the 3 W’s of this disorder :
WHAT IS THIS DISORDER ??? Approximately one third of the population in industrialized countries has occasional or continuous upper gastrointestinal disorders. Gastroesophageal reflux disease (GERD), is defined as involuntary muscle relaxing of the upper esophageal sphincter, which allows refluxed acid to move upward through the esophagus into the oral cavity (gastro = related to stomach, esophagus = part of throat, gastro esophageal = food tract connecting mouth to stomach). Transient relaxation of the lower esophageal sphincter (membranous barrier which opens & closes to allow passage of ingredients) is believed to be the primary mechanism of the disease although the underlying cause remains uncertain.
WHAT ARE THE SYMPTOMS ?? • Heartburn • Regurgitation • Localized or diffused chest pain • Abdominal discomfort • Sleep disturbance • Postprandial fullness • Upper abdominal distension • Inability to eat a full meal / bloating • Hoarseness and sore throat • Difficulties in swallowing • Asthma • Sinusitis • Nausea & Vomiting
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Adults
WHAT ARE THE CAUSATIVE FACTORS ??? Risk factors for developing gastroesophageal reflux disease can be :
• Obesity • Smoking • Age • Family history of gastrointestinal diseases • Esophageal stricture • High cholesterol diet • Lung transplantation
Treatment : Management of Gastroesophageal reflux has two parts. Firstly it is highly
important to get a thorough medical checkup under the guidance of a specialist. Medical and surgical treatment options are best discussed with the consulting doctor. Secondly, but a very important part of the treatment would be lifestyle modifications like :
• Losing weight (if overweight) • Avoiding alcohol, chocolate, citrus juice, and tomato based products • Avoiding peppermint, coffee and possibly the onion family • Eating small, frequent meals rather than large meals • Waiting 3 hours after a meal to lie down • Refraining from ingesting food (except liquids) within 3 hours of bedtime • Elevating the head of the bed 8 inches • Avoiding bending or stooping positions Oral Health Perspective In Reflux Disorders Here we will try to understand the facts by learning the 3 H’s about this disorder :
HOW DOES IT AFFECT THE TEETH ??? Teeth erosion (loss of tooth structure due to chemical means) has been reported with varying prevalence in the population and may be as high as 42%. In adults, GERD is a highly prevalent disease with rates ranging from 21% to 56% in different countries. The degree of erosion will depend upon how long the disease has been present and the frequency and quantity of regurgitation. If wear from other factors such as attrition (loss of tooth structure due to heavy biting force) occurs at the same time as erosion, tooth wear increases. Combinations of erosion, attrition and abrasion (types of tooth wear) are synergistic and may be responsible for the loss of tooth structure. It is recognized that refluxed acid attacks the palatal surfaces (surfaces facing palate) of the ORAL HEALTH GUIDE 2016 73 Volume 5
Adults upper incisor teeth first, later, if the condition continues, erosion of the posterior teeth in both arches can result from an extended period of acid reflux. The lower teeth are not affected in the early stages as the tongue provides some protection. In more severe cases however, the protection from the tongue is overwhelmed and the pattern of erosion may be more widespread, usually with the occlusal and buccal surfaces of the lower teeth being eroded next.
HOW TO RECOGNIZE THE SYMPTOMS ???
Front View
Occlusal View
Occlusal View
Oral symptoms associated with GERD are burning mouth syndrome, dental sensitivity, shortening of the length of the teeth, and esthetic problems. Tooth wear is a multi-factorial process. The impact of wear is usually progressive but can be slow. The wear results in shortened tooth size and in conjunction with alveolar (bony) compensation complicates treatment.
HOW TO TREAT IT ???
Today, dentistry offers many treatment options, from conservative to invasive for tooth loss: direct resin composite restorations, laboratory made adhesive restorations (resin composite, all ceramic and metal alloys), laboratory made full crown restorations (metal, metal-ceramics and all ceramics). However, the ultimate line of treatment in such disorders could be porcelain fused to metal crowns or newly developed all ceramic restorations.
Front View
Occlusal View
Occlusal View
Thus, looking at such dire consequences of the improper lifestyle patterns it becomes a matter of introspection whether we should lead a life on the principles of “Work Hard & Party Harder” or “Eat The Best, Leave The Rest” & “Early to Bed and Early to Rise Which Makes Man Healthy, Wealthy and Wise.” 74 ORAL HEALTH GUIDE 2016 Volume 5
Adults
BOTOX AND FILLERS: BROADENING THE HORIZON OF DENTISTRY Dr. Dolly Chopra. MDS
Prosthodontist, Farwaniya Specialized Dental Centre.
In today’s world, people are constantly striving to achieve a healthier, prettier lifestyle. People
want to look better, feel better and live longer. Gym memberships, diet centers, tanning spas, and yoga centers have all become the vogue and are enabling us to accomplish this goal. In contemporary society, physical appearance has an ubiquitous and compelling effect on both social life and professional success. Needless to say, an appealing smile is indispensable for an aesthetically pleasing personality. No doubt, the younger generation seems to be fascinated with the “HOLLYWOOD SMILE”. Here is the account of one such young lady, named Maryam. Maryam was utterly disappointed after her rejection at the modelling assignment. She had dreamt since childhood to be a model on the TV screen. Several rejections had left her heart broken. Age had also taken its toll on her once impeccable young wrinkle free face. While critically analyzing every aspect of her face in the mirror, it struck her that her gummy smile was the major culprit that made her look unattractive. Without losing another moment, she fixed an appointment with the leading cosmetic dentist in town, Dr. Dawson. Once in the dental office, Dr. Dawson explained to her the various options available to rectify her gummy smile. The traditional option was to cut her gums and/or bone to a desirable level, reduce her front teeth and cover them with new crowns. But Maryam wanted a less invasive treatment option. ORAL HEALTH GUIDE 2016 77 Volume 5
Adults Maryam: Dr, Is there any other better and less aggressive method available to hide those ugly gums of mine? Dr Dawson : Of course. Modern science has provided us with a great tool to enhance the looks of our patients through Botox and Fillers therapy. These procedures are quite conservative, and do not involve any drilling or cutting down of teeth. Moreover, the recovery time is either nil or very limited. Maryam was extremely excited but a bit apprehensive to hear about this option. Maryam : Dr Dawson, could you please elaborate on this topic? It sounds quite promising. Dr Dawson: For an attractive smile, soft tissues that ring our mouth are as important as beautifully restored teeth. It is essential to achieve a symmetrical smile and restore lost facial volume in order to optimize dental cosmetic outcomes. Botox and Filler therapy helps the cosmetic dentist to accomplish these goals easily. Maryam: What is Botox, Dr Dawson? Dr Dawson: BOTOX is a trade name for Botulinum toxin which comes in the form of a purified protein. BOTOX A is the most commonly used form with several thousand articles in the medical and scientific literature supporting its use. The mechanism of action for Botox is really quite simple. Botox is injected into the facial muscles but it really does not affect the muscle at all. There is no loss of sensation in the muscles. Botulinum toxin blocks the transmitters between the motor nerves that innervate the muscle. Once the motor nerve endings are interrupted, the muscle cannot contract.When that muscle does not contract, the dynamic motion that causes wrinkles in the skin will stop. The skin then starts to smooth out, and in approximately three to ten days after treatment, the skin above those muscles becomes wrinkle free. The effects of Botox last for approximately three to four months, at which time the patient needs retreatment.
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Adults Maryam: How can Botox help me with my excessive gummy smile show? Dr Dawson: With judicious use of Botox therapy and lip augmentation with dermal fillers, the muscles surrounding the lip are weakened, so the patient cannot raise the lip as high as before to expose the excessive gums.
Gummy smile correction with Botox Maryam: That is interesting. Are there some other ways in which a dental patient can benefit from these innovative procedures? Dr Dawson: Botox can be used as an adjunctive therapy in several dental procedures. Some of the common applications are as follows: Improving wrinkles around the mouth: The younger looking , bright new crowns delivered to a middle aged patient must blend harmoniously with his facial contours. As people get older, the corners of the mouth begin to droop down. Botox injection can be given in a specific muscle (depressor anguli oris) bilaterally to relax the muscle and in turn, to raise the corners of the mouth. Also Botox can be used in smoothening the wrinkles around the lips . In this way, Botox helps to complement the esthetic dentistry outcomes. TMD (Temporomandibular Dysfuntion) and facial pain: Botox is a muscle relaxant and when given in half the dosage used for facial wrinkle smoothing treatment, it can greatly reduce the intensity of the muscle contractions that contribute to TMJ and facial pain and give the patient significant relief. Bruxism : Bruxism is a term that is used both for clenching and grinding of teeth. It leads to the destruction of healthy dentition along with aggravation of periodontal disease. Bilateral injections of Botox are given in specific muscles (masseter and temporalis ) to decrease their power of contraction. It leads to a significant relief of symptoms. Orthodontic Therapy: Relapse after orthodontic treatment (braces ) is a continual problem, especially with patients having a very strong chin muscle (the mentalis muscle). Botox can be used to reduce the intensity of this muscle post orthodontic treatment and retrain it to a more physiological movement, thus helping to prevent relapse to some extent. Removable Dentures: Patients who have been without teeth for a long time, find it extremely difficult to hold their new dentures in the mouth ,even if the dentures are extremely well fitting. This happens because of strong irregular muscle contractions. Muscle training with Botox can help provide relief in such patients. ORAL HEALTH GUIDE 2016 79 Volume 5
Adults Sialorrhea ( Excessive Saliva Production): Drooling or inability to hold saliva in the mouth can be treated with Botox injection into the salivary glands, leading to controlled saliva reduction and thus helping the patient tremendously. Oromandibular Dystonia : It is a muscular dysfunction of oral region which leads to unintentional movements of the mouth in various directions. It can interfere with normal eating and talking and can cause involuntary biting of lips and cheek tissue. This stressful condition can be helped by Botox injections in specific muscles. Trigeminal Neuralgia: It is a sharp lancinating unilateral facial pain related to the nerve that carries sensation from the face to the brain. This pain is considered by the medical experts as one of the most painful conditions known. Botox therapy has been used as an efficient strategy for the treatment of this disease with very promising results. Maryam: Thanks for this wonderful information. How can I know if I am a suitable candidate for Botox therapy? Dr Dawson: Botox has been approved for people aged 18 to 65. But it should not be used in case of : • Allergies to any ingredients in Botox injection vial • Skin infection or other condition in the injection area. • Any disease that affects the muscles or nerves eg Myasthenia gravis, Lambert - Eaton syndrome. • Breathing problems, such as asthma. • Difficulty in swallowing. • Bleeding issues. • Plan to undergo surgery. • History of facial surgery. • Weakness in forehead.
muscles of
• Drooping eyelids. Botox is not expected to travel far enough through the body to affect a fetus or breastfeeding infant. However, for ethical reasons, clinical studies have not been done on expectant or lactating mothers. So, there is lack of scientific evidence regarding its safety in this respect.Therefore, you should not have Botox injections if you are planning or trying to conceive, are pregnant, are planning to breastfeed or are currently breastfeeding. Maryam: Dr Dawson, how long does it takes for the Botox injection to start working ? Dr Dawson: The injections take about 10 minutes, and there is no downtime afterwards. Normally, improvement can be seen within a few days. Botox requires two to four days for it to attach to the nerve ending that would normally stimulate the muscle to contract. The maximum effect usually occurs at about 10-14 days. Therefore, whatever effect is obtained two weeks after the injections should be considered the maximum effect that is going to occur. 80 ORAL HEALTH GUIDE 2016 Volume 5
Adults Maryam: Is Botox painful ? Dr Dawson : Any injection can hurt, but the needles used for Botox injections are very small, so pain is usually minimal. The area can be numbed with a topical anesthetic cream or cold pack 10-20 minutes before the injections, so the patient may not feel much pain. Maryam: How often should one get Botox injections? Dr Dawson: For most people the effects last for three to four months, depending on : • Age, as older people with less muscle tone can expect the results to diminish sooner than those with younger, firmer facial muscles. • Facial structure and expressions. • Diet and smoking habits. • Skin care such as facials, micro dermabrasion or other resurfacing methods. • Sun exposure and extent of sun damage of the skin. It is not recommended to have injections in the same injection site more frequently than every three months. As with the injection of any medication, your body’s immune system can develop antibodies to the medication, which render the drug less effective or possibly cause development of an allergy to the drug. However, the risk of antibodies (allergy) depends on frequency and quantity of the drug taken. Maryam : Does Botox have any side effects too? Dr Dawson: Potential Botox side effects include pain at the injection site, infection, inflammation, swelling, redness, bleeding and bruising. However, usually they are very short lived. Some patients may develop an allergic reaction like itching, wheezing, asthma, rashes and dizziness. The doctor should be immediately contacted if you develop any breathing issues or a dizzy feeling. Always get Botox or fillers at a medical set up with a trained professional as any side effects can be treated immediately. At times, side effects can occur because of the inadequate training of the practitioner. This includes symptoms such as numbness, droopy eyelids, muscle spasms and migration of the substance. It is possible for the Botox to spread a little beyond the intended injection site and affect surrounding tissues. For example, if you receive injections into the forehead close to your eyebrows or your upper eyelids, they could be affected and may droop temporarily. The trained practitioners know the correct sites of injection to avoid side effects such as droopy eyelids. This underscores the importance of finding a practitioner who has a proper training with giving Botox injections. Though the list of possible side effects is a long one, it would be extremely rare for anyone to have all of them. The safety record of Botox is nearly unparalleled. Maryam: That’s a wonderful piece of advice, Dr Dawson. What is a filler ? Is it also a form of Botox? Dr Dawson: Botox and fillers are two separate things. ORAL HEALTH GUIDE 2016 81 Volume 5
Adults Botox blocks the nerve impulses that cause muscles to contract and cause wrinkles. However, it would not be effective for facial lines that exist when the face is totally relaxed. These lines are better handled by FILLERS. Fillers are materials that are injected beneath the skin to add volume, smoothing out folds around the mouth and areas of reduced volume. Two kinds of dermal fillers are usually suggested for the face: semi-permanent and non-permanent. The semi-permanent type (e.g. Radiesse and Sculptra) lasts up to 18 months. The non-permanent fillers, such as, Hyaluronic Acid (HA) derived Juvederm and Restylane, last for around 6-12 months. The non-permanent fillers are much more safer and advisable to be used. Dermal fillers are supplied in a pre-filled sterile syringe for injection. They are commonly used to add volume to the face in the nasolabial folds, oral commissures, lips, and marionette lines. As we age, collagen is lost in these facial areas and these lines start to deepen. These dermal fillers are injected right under the skin to plump up these areas so that these lines are much less noticeable. Dermal fillers are also used for lip augmentation and are used by dentists for high lip line cases, uneven lips and to make the area around the mouth more esthetic. Maryam: Are there any adverse effects?. Dr Dawson: Many thousands of dermal filler treatments have been carried out in the world, with few serious or lasting side effects. Most people can return to their normal daily life immediately after the treatment. The most common side effects are of short duration (one to three days) and occur only at the injection site. These can include slight bleeding and mild bruising or swelling around the area. Allergic reactions to dermal filler treatment are very rare but can include: redness, itching, swelling, and hardness, or small bumps under the skin. Maryam: That’s a huge amount of information, Dr Dawson. However, I would like to know if every dentist is qualified to practice Botox and filler therapy? Dr Dawson: In nearly half the United States, state dental boards allow dentists to provide Botox and dermal fillers to patients and this number is increasing very rapidly. TRAINING IS THE KEY. Hands on training is absolutely essential in learning how to provide these procedures and intertwining them with dental treatment plans. With proper training, dentists are usually more proficient than any other healthcare professions in providing these treatments to patients, both for dental and cosmetic needs. It significantly expands the treatment choices that they can offer to their patients. Maryam: Thanks Dr Dawson. I would definitely like to pursue the botox and filler treatment plan for my gummy smile. AUTHOR’S OPINION : Botox and Fillers therapy are very significant tools in the hands of a well trained cosmetic dentist. They can help achieve esthetic perfection and can contribute immensely to the psycho social well being of the patient. 82 ORAL HEALTH GUIDE 2016 Volume 5
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Geriatrics
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Geriatrics
“Smile on!” – Ageing Gracefully. Dr. Ligy Mathew. MDS
Prosthodontist, Jahra Specialized Dental Centre.
Ageing
is inevitable. However with a little awareness,
acceptance and a few lifestyle changes elderly adults can enjoy life and age gracefully.In our youth oriented culture, many people look at ageing as losing their looks, their health and their value in society. Remember, how we age is greatly influenced by lifestyle factors. The foods you eat, the daily decisions you make, how you take care of your body, can all have a huge impact on how you age. Ageing is a normal life process, not a disease. It is another stage of life that for some, is easier than others. The factors that make a difference with this vary from person to person. With regular dental care and good daily habits, you’ll likely have your teeth for a lifetime. As you get older, however, natural changes in both your mouth and general health can put you at risk of dental problems. The geriatric population (age 65 and older) is the fastest growing segment globally. In view of the altered lifestyle of geriatric patients, a few conditions which require special attention are • Impairment of memory • Depression • Disorientation • Medication • Economic status
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Geriatrics A good healthy mouth and teeth help you look good, eat delicious and nutritious foods, speak clearly and confidently. Keeping your mouth healthy is essential for a good dental lifestyle.
To keep your mouth full of natural teeth in your golden years, you need to make the right moves
now. You know you should brush your teeth at least twice a day and floss at least once, but it’s also important to see your dentist on a regular basis. A dental visit involves a comprehensive checkup that extends beyond your teeth. Dentists can screen for oral cancer, diabetes and more.
Checklist of the information to share with your dentist – 1. The last date you visited a dentist and the reason for it. 2. If you have noticed any recent changes in your mouth. 3. If you have noticed any loose or sensitive teeth. 4. If you have noticed any difficulty in tasting, chewing or swallowing. 5. If you have any pain,discomfort, sores or bleeding in your mouth. 6. If you have noticed any lumps, bumps or swellings in your mouth. 7. If you wear dentures or other appliances,your dentist will ask a few questions about when you wear your dentures and when you take them out and about any related pain.
With increase in dental awareness and improved dental treatments, there is a decline in
edentulism (complete loss of all natural teeth) yet still there are oral health conditions that persist with age; such as caries, tooth loss and increased needs for prosthodontic dental treatment. Some common conditions in old age and their treatment options: If you have one or more missing teeth, the treatment options are Removable Partial Denture (RPD) A removable partial denture usually consists of replacement teeth attached to pink or gum colored plastic base. Depending on your needs,
your dentist will design a partial denture for you. A partial denture may have a metal framework and
clasps that connect to your teeth, or they can have other connectors that are more natural looking.
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Geriatrics Fixed Dental Bridge A bridge is a common dental restoration that can replace one or more missing teeth by literally
bridging the gap they left behind. To connect the bridge to the neighboring natural teeth, the natural teeth must be prepared/reduced. The biggest downside to this process is that it is
irreversible. Once the natural teeth are modified, they cannot be used as regular teeth ever again.
Implants For many years, the only treatment options available for people with missing teeth were bridges and dentures. But, today, dental implants are available. What are Dental Implants ? A dental implant is an artificial tooth root that is placed into your jaw to hold a replacement tooth / bridge / denture. Advantages of Dental Implants Improved appearance : Dental implants look and feel like your own teeth. And because they are designed to fuse with bone, they become permanent.
Improved speech : With poor fitting dentures, the teeth can slip within the mouth causing you to mumble or slur your
words. Dental implants allow you to speak without the worry that teeth might slip.
Improved comfort : Because they become part of you, implants eliminate the discomfort of removable dentures. Easier eating : Sliding dentures can make chewing difficult.
Dental implants function like your own teeth, allowing you to eat your favorite foods with confidence and without pain.
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Geriatrics Improved self esteem : Dental implants can give you back your smile and help you feel better about yourself.
Improved oral health : Dental implants don’t require reducing other teeth, as a tooth supported bridge does. Because nearby teeth are not altered to support the implant,more of your own teeth are left intact,improving long term oral health. Individual implants also allow easier access between teeth, improving oral hygiene. Durability : Implants are very durable and will last many years. With good care, many implants last a lifetime time. Convenience : Removable dentures are just that; removable. Dental Implants eliminate the embarrassing inconvenience of removing dentures, as well as the need for messy adhesives to keep them in place. Dental implants cannot be used in uncontrolled diabetes, tobacco addiction, head and neck radiotherapy, active chemotherapy, severe renal disorder and osteoporosis in oral cavity If you have lost all your natural teeth, the treatment options are Complete Denture (CD) • Implant Supported Denture Your doctor will decide on the best treatment option for you depending on your oral / general health. As the population ages and an increasing proportion becomes institutionalised or homebound, there will likely be an increase in undertreatment of caries, periodontal disease, and partial and complete edentulousness. The underestimation of oral health care need by the elderly is a major block in their oral health care. Age should never be considered a barrier for any dental treatment.Part of ageing well is embracing ageing, without being conned by the numbers, or the stories in our heads about what ageing looks like. I believe that age is a mind trip, a numbers game. In fact, we can create a new model for ageing! Do this by listening to the wisdom of your body, noticing what you eat, enjoying yourself while you walk, run, play, stretch, do yoga, dance, swim, learn new skills. Pay attention and embrace what you love to do, and then DO IT! You have the ability to slow down the ageing process with exercise, good nutrition and self care. So take charge of how you age by making better lifestyle choices today.
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Geriatrics
Taking Care of Your Smile in Sunset Years Dr. George P. Alex. MDS
Endodontist, Farwaniya Specialized Dental Centre.
“74 years young, Abdulla is healthy and quiet active for his age with some early signs of memory loss. These days, his forgetfulness has become a deterrent in his daily routine. When he is up and ready to go out on a cool evening to meet his friends in the diwaniya, he forgets something. The spotless white ‘dishdasha’ (long dress worn by Arab men) is ironed, his head robe is perfect, his black Merc is shining and waiting for a spin and the driver is ready, but Abu Nasser alias Abdulla is furious he can’t remember where he kept his dentures. Without his “smile”, he is not going anywhere that evening.” Dental health plays a major role in the lives of the elderly in a way much different from the time when they were young. For some it may be the reason to believe they are still young and strong, for some it is the knowledge that they can still chew and enjoy the most primitive pleasures of life which keeps them going and for some like Abdulla, their social standing among their peers is strongly related with their facial aesthetics. Whatever be the reason, every human being in this world has the right and need to keep their teeth in good health as long as they live. With the advancement of medical sciences and general wellbeing of the population in many developed and developing countries of the world, the number of older adults (65 years or more) is growing rapidly and is estimated to be one fifth of world population by year 2030. Catering to this major chunk of the world population is turning out to be a momentous task for the medical and dental fraternity. Geriatric dentistry or geriodontics is the delivery of dental care to older adults involving the diagnosis, prevention, and treatment of problems associated with normal ageing and age,related diseases as part of an interdisciplinary team with other health care professionals. Good oral hygiene practiced from a young age will help you to have a good set of teeth in later stages of life. As years pass by, like any other part of the body, teeth and related structures also undergo changes which may warrant regular dental consultations and treatments.
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Geriatrics Common Medical Conditions in Old Age Most frequent medical conditions affecting older individuals are hypertension, arthritis, heart disease, cancer, osteoporosis and diabetes. Other common health related conditions are hearing loss, cataracts, back & neck pain, depression and dementia. Many of the elderly will be on 4 or 5 medications ranging from hypertensive drugs to cholesterol lowering statins.
Overall health related issues may also require associated dental treatments. For example a patient undergoing chemotherapy or radiation protocol as part of his / her cancer therapy may experience dryness of mouth which in turn increases the chances of caries of teeth. Also an Alzheimer’s patient may completely forget his oral hygiene practices and may end up with poor oral health. Medications and hospitalizations associated with poor medical condition will also cause deteriorating effect on the teeth and surrounding structures. Oral Health and Dental Considerations in Senior Citizens Calculus and poor oral hygiene: Accumulated plaque and calculus due to poor oral hygiene can lead to bad breath, gingival inflammation and loosened teeth. Regular dental visits are advised in old age especially for those who cannot follow good oral hygiene practices due to their physical conditions. Sharp teeth or fractured edges of dental appliances: Sharp edges of teeth or dental prosthesis can irritate tongue, cheek or other parts of oral mucosa. Constant irritation can cause ulcers and if left unresolved can even lead to oral cancer. Loose tooth or dental prosthesis: They can cause accidental swallowing of the same during chewing, sleeping or during any medical intervention through oral cavity and hence should be replaced as early as possible.
Abrasion: Abrasion is caused by continuous practice of improper brushing techniques or teeth cleaning methods followed for a long period of time. The enamel in the cervical part of the 96 ORAL HEALTH GUIDE 2016 Volume 5
Geriatrics teeth, near the gums wears off rapidly exposing the underlying dentin causing sensitivity. If left untreated it can cause the pulp to be exposed resulting in pain and infection. Dry mouth: Dry mouth or Xerostomia is a common condition due to low salivary production and affects 30% of patients older than 65 years and up to 40% of patients older than 80 years It is primarily an adverse effect of medication, although it can also result from diabetes, Alzheimer’s disease, or Parkinson’s disease. Xerostomia, while common among older patients, is more likely to occur in those with an intake of more than 4 daily prescription medications. Dry mouth can lead to inflammation of oral mucosa (mucositis), caries, cracked lips and fissured tongue. Recommendations for individuals with dry mouth include drinking or at least sipping regular water throughout the day and limiting alcoholic beverages and beverages high in sugar or caffeine, such as juices, sodas, tea or coffee (especially sweetened). Attrition: Attrition of teeth is the simple wear and tear caused due to the constant chewing or grinding over the years. Sensitivity can develop in otherwise healthy tooth due to exposure of dentin and pulp as the outer coating of enamel wears down. Bruxism or clenching of teeth during sleeping, will also cause attrition. Root Caries: Older adults are at increased risk for root caries because of both increased gingival recession that exposes root surfaces and increased use of medications that produce xerostomia. Adoption of good oral hygiene which includes use of powered toothbrushes, the use of topical fluoride and attention to diet can help prevent root caries. Cognitive limitations affecting dental care and self-care: Patients with severe cognitive impairment, including dementia, are at increased risk for caries, periodontal disease and oral infection because of decreased ability to engage in self-care. Education of the caregiver, as well as the patient is an important part of the prevention and disease management phase of dental care. Osteoporosis: Osteoporosis is a common medical issue, which causes bones in the body to become less dense and more likely to fracture. Women who have already gone through menopause are at the highest risk for developing the disease. When bone density in the jaw decreases, teeth can become loose. Women with osteoporosis are 3 times more likely to lose a tooth than women without osteoporosis. Many people who have osteoporosis are given antiresorptive medications to prevent or treat this condition. Tips to Maintain Optimal Oral Health in Old Age 1) Brush twice daily: Use a soft bristled tooth brush and fluoridated tooth paste. Use of sensitivity reducing tooth paste is helpful in patients with complaints of tooth sensitivity. In elders with poor cognitive features, use of motorized tooth brushes is highly recommended. 2) Floss daily: Use of floss regularly helps you to keep the area between two teeth, clean and devoid of any food debris which may lead to caries or bad breath. Nylon floss is readily available in all medical pharmacies and flossing can be mastered with minimal practice. Use of ORAL HEALTH GUIDE 2016 97 Volume 5
Geriatrics hard tooth picks are not recommended. 3) Use of mouth washes: Many kinds of mouth washes are available and combining daily mouth rinsing with medicated mouth washes or simple salt water helps in keeping gum inflammation under control. Flouridated and anti-sensitivity mouth washes are also available. 4) Use of auxiliary cleaning aids: Miniature inter dental brushes or high speed water jet picks also can be used to keep the mouth clean especially in individuals with lot of gaps and spaces between teeth.
5) Avoid tobacco: Tobacco in any form has been linked to an increased risk of mouth and throat cancer, not to mention heart disease and other serious conditions. Chewing tobacco can even lead to more decay, as many tobacco formulations contain sugar. 6) Increase oral hydration: Ask your doctor if you can substitute your medication for one that doesn’t produce dry mouth. If this is not possible, then drink plenty of water, chew sugar free gum, and avoid alcohol which tends to dehydrate your body. 7) Reduce the intake of sugar: Keep a check on your sugar intake and snacks. Try to brush or rinse after a snack to reduce the risk of caries and root caries. 8) Take care of dental prosthesis: Any dental prosthesis, whether removable or permanently fixed has to be maintained religiously. Care has to be taken if you are wearing any dentures, especially while sleeping or getting admitted to a hospital. 9) Regular dental check up: Regular visit to the dentist is a must as he/she can advise you about the condition of your oral cavity and warn you in advance about any impending danger. “Later that evening, Abdulla decided he is going to see his dentist the next morning and do something about his removable dentures. Next day he visited Dr. Mohammed at his clinic and doctor advised him two implants in the place of his missing front teeth. Appointments were scheduled, implants were fixed and crowns which looked exactly like his old natural teeth were placed in no time. Today Abdulla is happy, relaxed and jovial as he is ready for the evening diwaniya. But a new problem has come up. He cannot find his spectacles…!!”
98 ORAL HEALTH GUIDE 2016 Volume 5
Al Nahil Int’l Clinic HEALING HANDS AND LOVING CARE
Dr. Shajahan V.M. BDS,MDS
Dr. Ayham Askar. BDS
Dr. Saud Abdurahman BDS
Dr. Prabhu Raj. BDS,MDS
Dr. Patricia. BDS
Farwaniya - Beside Maghatheer Complex, Opp.Police Station, Habib Munawer Street. Phone: 24734000 - Fax: 24767990 Fahaheel - Life Tower , Makka Street. Phone: 23919020 / 30 - Fax: 23919011 Jleeb Al Shuyoukh - Police Station Road. Phone : 24347090
www.facebook.com/DrKtRabeeullah Email: info@shifaaljazeera.com.kw / info@alnahilclinic.com - www.shifaaljazeera.com.kw
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PHOTO GALLERY Oral Health Guide Release 2014 Faces 2014-The Cultural Nite Scientific Activities 2nd Study Club 2015 3rd Study Club 2015 Scientific Symposium 2015 Study Club 2016 Basic Life Support Course 2016 Dental Photography Course 2016 IDAK Members’ Congress 2016
Fun @ IDAK Kidzania 2015 Cool Cruise 2015 Paintball 2015 Picnic and Masterchef 2015 Meet And Greet 2016
Sports Cricket 2015 Football 2016 Volleyball and Throwball 2016
Community Welfare Activities 2015 & 2016 Meeting With Officials 2016 Farewell 2016 IDAK In The News 2014 - 2016 ORAL HEALTH GUIDE 2016 105 Volume 5
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Oral Health Guide Release 2014
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Faces 2014 The Cultural Nite
ORAL HEALTH GUIDE 2016 107 Volume 5
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Faces 2014 The Cultural Nite
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Scientific Activities
2nd Study Club 2015
3rd Study Club 2015
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Dr. Neel Bhatavadekar BDS, MS, MPH, Dip Periodontology
Prof. Dr. Gopi Krishna MDS, FISDR
Prof. Dr. David P Tauro MDS, FIBOMS, FIAOMS, Dip. IBOMS.
Prof. Dr. Vinod Krishnan MDS, M.Orth RCS, FDS RCS, Ph.D
Prof. Dr. Deepak Nallaswamy MDS, MS, MLE
Scientific Symposium 2015
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Study Club 2016
ORAL HEALTH GUIDE 2016 111 Volume 5
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Basic Life Support Course 2016
Dental Photography Course 2016
112 ORAL HEALTH GUIDE 2016 Volume 5
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IDAK Members’ Congress 2016
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Fun @ IDAK
Kidzania 2015 114 ORAL HEALTH GUIDE 2016 Volume 5
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Cool Cruise 2015
ORAL HEALTH GUIDE 2016 115 Volume 5
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Paintball 2015
Picnic and Masterchef 2015
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Picnic and Masterchef 2015
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Meet And Greet 2016
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Sports
Cricket 2015
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Football 2016
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Volleyball and Throwball 2016
ORAL HEALTH GUIDE 2016 121 Volume 5
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Community Welfare Activities 2015 & 2016
Ideal School Camp 2015
Friends Of Kannur Expatriates’ Association 2015 122 ORAL HEALTH GUIDE 2016 Volume 5
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AAM Camp 2016
KKMA Camp 2016
FBSG Camp 2016
Yoga Day At Embassy 2016 ORAL HEALTH GUIDE 2016 123 Volume 5
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Meeting With Officials 2016
H.E. MR. SUNIL JAIN - Indian Ambassador to Kuwait
Meeting with DR. SABIHA AL MUTAWA Director, Dental Administration, Ministry of Health, Kuwait
Meeting with DR. YOUSEF SALEH AL DUWAIRY
Assistant Under Secretary, Dental Affairs Ministry of Health, Kuwait
Meeting with DR. JAWAD BEHBEHANI Dean, Faculty & Dentistry, Kuwait University
Meeting with DR. SAMI AL MANEA Chairman - Kuwait Dental Association
124 ORAL HEALTH GUIDE 2016 Volume 5
for fighting extremist ideology
Gallery
KUNA chief reiterates news agencies’ role on reliable source of info BAKU, Nov 16, (KUNA): The Federation of Arab News Agencies (FANA) on Wednesday called on world news agencies to pursue ongoing work with high responsibility to promote news and information that promote tolerance, freedom, to achieve peace and reject terrorism and extremism.
A file photo from the previous conference.
MEED’s 12th Kuwait Projects forum set for Nov 28
Crucial PPP routes under spotlight as Kuwait focuses on projects delivery
This came in the final KUWAIT CITY, Nov 16: Delivering fast statement of FANA’s 44th and efficient development and procuresaturday— (all times are kuwait local) Congress, which was delivment of Public Private Partnerships (PPP) 17:30 bayern vs hoffenheim/soccer bein sports 5hd ered by Director General of will be....under spotlight at MEED’s 12th 17:30 hamburg vs dortmund/soccer ... bein sports 9hd Kuwait Projects KUNA and FANA chairman 18:00 city vs m’brough/soccer... bein sports 2hd, forum. 11hd Mutlaq 18:15 sociedad vs atletico/soccer ....... beinAl-Sanei, sports 3hd General Manager, Sheikh Mubarak Al-Duaij Al19:00 monaco vs nancy/soccer .......... bein sports 6hd Authority for Partnership ProjIbrahim Al-Sabah, and in line Kuwait 20:00 torino vs cagliari/soccer ......... bein sports 4hd ectsbein (KAPP) will announce upcoming ARAB TIMES, MAY 11, 2015 20:30 chelsea vs evert/soccer.... sports 2hd, 11hd with the International Day for MONDAY, 22:45 napoli vs lazio/soccer .............. bein sports projects and 4hd will explain what these Tolerance, which coincides PPP partnerships mean for the private sector on Nov 16. and how they can be a part of key projects
contracts worth KD 1 billion ARAB ($3.4TIMES, bil-SATURDAY, NOVEMBER 5, 2016 40 lion), up 15 percent by KD 129 million ($426 million) over the previous quarter. The total value of contracts awarded so far this year has risen to KD 3.6 billion ($12 billion). $27bn worth of utility projects are currently in the pre-execution stage in partnership with the private sector. Last month, Kuwait invited two private sector bidders into talks for the second The statement stressed the phase of its Az-Zour North power genin pipeline. importance of religious toler32 eration and desalination project, which With $136 billion worth of planned ance and cooperation among covers design, build, finance, operations, projects in Kuwait (MEED Projects), world nations to deter terrorand transfer. most seeking to involve the private secist thoughts, where absence of Held with support from Kuwait’s Mintor, streamlining and improving the PPP tolerance would lead to extremistry of Electricity and Water, the forum process in order to deliver vital projects Dr Prasad Chitra conducting the course in dental photography. ism to be spread on intellectual, will host key government decision makon time and within budget has become political, social and cultural ers, industry leaders, major project develmore crucial and imperative than ever. levels. Around 70 dentists from Kuwait attend one-day event opers and owners on Nov 28 at Regency “This year, we have tailored a proMedia and internet enjoy a Hotel in Kuwait City. gramme that will examine the private large degree of freedom, where at risk. Exhaustion surrounds you. Tonight: Nap **** You have the ability to see the big picture. surrounds your finances. Communication will be better and better. Dr Khaled Mahdi, Secretary General, sector financing model, stabilizing projthey publish views and ideas of (Octdelivery 23 - Nov 21) necessary once you decide which way to go. Others How you handle a situation could change after some first; decide later. Supreme Council for Planning and Deect timelines, optimizing entity seem to be somewhat combative in your daily life. detachment. You’ll gain new information through extremists to attract **** viewers, (Mar 21 Apr 19) Stay close to home. In fact, if you can work velopment will deliver a keynote address coordination and presenting key opportuFind out why. Tonight: You don’t need to go far to new insights. Observe a tendency to get frustrated which in turn drive people to (Aug 23 Sept 22): 16:Don’t TheloseIntistry Clinics, Jabriya. from home, you could be much more content and Chitra was very much appreciated have a deep conversation. KUWAIT CITY, Nov**** when others don’t seem to get your message. on the country’s projects market role in nities across the Kuwait projects market. your focus. You can accomplish happier. Anacts, associate might be challenging you a litmore violence and terrorism Tonight: Inincluded the limelight. by all the participants dian Dentists’ Alliance in Kuwait lecture orgaa tremendous amount if you justThe keep your attention session the economic diversification strategy The Work conference will encourage successful **** and Try another approach or do something very too much for your taste. with the person’s the statement said. tle (Jan 20 - Feb 18) on with the matter at hand. Use three care withlectures a neighborby or Dr Prasad Chitra. (IDAK) in affiliation Kuwait nizers. The event differently ended from withhowall you have done it in the recent ideas rather than negate them. The results will be followed by insights on key economic project delivery practices to attract key sibling, as misunderstandings could start up from 21 - July 22) Therefore, FANAbetter. callsTonight: on allAll smiles. past. A boss looking could start becoming more argumenta**** You will be readyDental to head in Association a new direc(KDA), They topics such as intro-(Junethe participants eagerly opportunities and challenges, Dr Firas international funding to the Kuwait projout of the blue.conTonight: Take someincluded much needed tive and difficult. You might news want to agencies distance your-and media outlet tion. An issue could arise that you and ayour“Hands-on associ**** Relate photo one person directly, and make personal time. ducted Course on duction and history of dental forward to applying their newly Raad, Country Manager, Kuwait, Middle ects sector through focused keynote preates don’t agree on. You probably will have to stall self, as this person needs to work through (Nov 22 - Dec 21) around thea personworld not to promote sure that your message is properly conveyed. Not East & North Africa, World Bank, Sheikh sentations and panel discussions,” said Dental Photography “ on 28th Octography, equipment needed for on photography some in order to maintain a cohesive bond. Be graeveryone attaches the same gained symbolismknowledge to a word. al issue. Tonight: Out late. inciting news that would spread (Apr 20 - May 20) **** You are likely to notice someone get quite cious. It is better to move ahead with support. Dr Meshaal Jabar Al-Ahmad Al-Sabah, Alexander Bencini, Conference Director, ways likely tober 2016 at Jabriya. The course dental photography Reiterating such asa statement DSLR several indifferent their dental practices. Dr Prasad extremism, and to promote hostile or angry in a situation, whether it happens peace Tonight: Clear out some shopping. will add power to your words. Tonight: Respond to **** Others seem to be cameras, asking a lot ofthe you.lenses, For Director General, Kuwait Direct Invest(Sept 23 - Octpeoples. 22) director was Dr Prasad Chitra, ring flash andidea. Chitra was felicitated by Dr Jitennow or in the next fewMEED. weeks. A person who reacts among an odd but interesting reason, you’ll feel obligated to meet each that strongly probably feels insecure or judged. Itbudgets being chalment Promotion Authority, Eng. Saad With government and Head some of the depart-Slow other accessories. It also involved dra Ariga, President of (FebProfessor 19 - Mar 20) Taking media seriously andto give him request or challenge. down and look at what ****IDAK, You couldand be more in touch with a problem would be wise or her some space for Saud Muhailibi, Director of Master Plan lenged in the current economic envi(July 23 Aug 22) you really want Colto do. You could be overwhelmed by ment of Orthodontics, Army topics on technical aspects of den- a beautiful memento presentthan was you are aware. You canlaunching make light of it, but now. Tonight: Head home early. campaigns against *** Play it low-key throughout the day. You will Department, Kuwait Municipality and ronment, alternative project financing others. A late afternoon meeting will be significant. ultimately you will need to ideas deal with issue at lege of Dental Sciences, Secunder- tal photography. ❑ ❑ ed as a token of appreciation. note an intense, busy pace in the morning that could of the extremism, especially by❑ **** You might be concerned about an associate Tonight: Hang with a pal. The victorious teams Central Commandos, Team Eastern Eagles pose with organizers of the Kuwait tournament and fans afterof the awarding ceremonies. President, Society Engineers methods increasingly being adopted to A conversation dear friend will give Born today: Football playeris Cam Newton become frantic by midday. abad, A problem with a family a special loved one. suddenlywas hand. India. This was followedor by 3 hours of Much information The event sponsored bywith anews agencies, will give positive you another perspective to work with. Tonight: and more. ensure (1989), painter Salvador Dalitimely (1904),delivery. actress KAPP is playing member is likely to flare up. Someone close to you could come forward. A friend will want things to go results, with a confirmation that Around 70 dentists from Kuhands-on training. For this, the par(May 21 June 20) dental & medical equipment dealCentral Commandos, Team Eastern shine in IDAK tournaments Key sponsors include: Shamal Azzour Make sure to get enough exercise. his or her way, which is likely to put your friendship Natasha Richardson (1963) could decide to put on war paint. Tonight: You feel a critical roleEagles in Kuwait’s diversification these campaigns are not directed wait attended this one-day course. ticipants were divided into batches, ers Safwan Company and photo(Silver Sponsor), Mushrif (Lunch Sponplan by bringing the private and public any particular IDAK’s second sports event ofreligion, the Commandos” proved their mettle to led by Dr Sharno Varghese and mettle and dominance by defeating The evening was filled with an Prizes for the football tournament The course was conducted in two and the techniques to take both fa- graphic equipment dealers AAB against sor), Parsons, AlWinning Tamimi & Co,of ASAR playersin together. Decennial 2016 was between held remain unbeaten league and “Poly Pirates” by Dr Eldho George. “Poly Pirates” in the finals. atmosphere fun and frolic and were also distributed. The IDAK BEC to year distinguish sessions. The first was the lecture cial and dental photos of patients World. IDAK wishes to thank Dr but aims recently, at Qadsiya sports com- final matchesAccording in volleyball. Intoa MEED Earlier inProjects the round robin league team was captained by Dr PrashanthyConsultants these events were witnessed in large rolling trophy and runners up trophy Legal, Engineering Group tracker, who respect human Volleyball tournament for menrights nerve-racking final, the “Central both these teams defeated “Eastern Sreejith and Poly Pirates was cap- numbers by IDAK members with were given away for volleyball and session at the KDA lecture hall in were taught individually to all the Sami Al Manea, Chairman, KDA thoseplex. (Bronze Sponsors), and their Thefamilies. United Pro-distribution throwball. This event was organized Kuwait’s projects market maintained its tained and throwball for ladies and boysit for Commandos” marched ahead of Eagles” captained by Dr Nino John. by Mrs Fene Abraham. Both The prize from those who exploit Jabriya, followed by the hands-on participants. and Dr Jawad Behbehani, Dean, less than 15 years were organized. determinedrelatively “Poly Pirates” to win momentum The women’s throwball threw these teamsfordefeated “Central ceremony graced by the pres- by IDAK sports committee led by Dr ducers General Trading & was Contracthealthy in theevent third political or personal purpose, it Three designated teams took part the IDAK BEC volleyball tournasome spectacular performances. Commandos” captained by Dr Devi ence of the IDAK President Dr Thomas Thomas. IDAK wishes to session, which was organised in the The passion, in depth knowl- Faculty of Dentistry for all their concluded. ing (Exhibitor). quarter with the government awarding in both the events. Team “Central ment. “Central Commandos” was Team “Eastern Eagles” proved their Priya Mahadev enrouted to the finals. Jitendra Ariga and council members. thank BEC for their support.
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Significance
Warriors IDAK In The Durant, News 2014 -2016 silence Thunder Genuine steps taken on ‘Al-Khafji oilfield’
News agenciesARAB have TIMES, gained MONDAY, reNOVEMBER 7, 2016 markable significance as a major KUWAIT CITY, Nov 16: Kuwait Petroabling entry and exit of employees to the and a reliable source of informaleum Corporation (KPC) has started takSaudi side sharing production with Kution worldwide, KUNA Chair24improve the situation ing genuine steps to wait. They explained that passage cards man and Director General Sheikh of employees working at Al-Khafji oilwill be renewed or updated at the oilfield Mubarak Al-Duaij Al-Sabah, has James scores 30 as Cavs improve to 5-0 field, which is jointly operated by Kuwait next December, noting production will said. Gulf Oil Company (KGOC) and Saudi’s resume at Al-Khafji oilfield in 2017. four from long range on the way to 18 Addressing 5th News OAKLAND, theCalifornia, points in the Warriors’ fourth straight Chevron Company, reports Al-Shahid It is worthy of note that activities were Agencies World Congress Nov 4, (AP): Kevin Durant win. daily.128, Celtics 122 suspended at Al-Khafji oilfield early last matched his career on Wednesday, whichhigh is or- Cavaliers with in seven 3-pointers and AZ-In Cleveland,The quoting reliable sources year to pave way for maintenance work ganized Baku by the LeBron daily James scored a scoredNews 39 points, coolly season-highnoted 30 pointsthe and move the reigning is in the framework of enand other amendments. ERTAC Agency, Sheikh NBA champion Cavaliers stayed undeknocking long jumpMubarak alsodown warned that the beating the Celtics. ers while thoroughly feated, non-stop progress of Russell the multi-James moved within two points of embarrassing passing Hakeem Olajuwon for 10th media, and the and free his flowoldof inplace on the NBA’s all-time scoring Westbrook list. Olajuwon had 26,946 points, a formation, O k l a h have o m a “facilitated the total James will likely surpass Saturday spread inaccurate and false Cityofteam in night in Philadelphia. miltonia spectabilis var moreliana sunglasses that suit you tomatoes are 5-0 for the first Gchicken o l Unfortunately, d e n and cherry news.” thisThe Cavaliers Beacon M28 - 4ft SE Prayer Timings time since 1976-77 when they started State’s 122negatively affects4the audience, Beacon N6 27 16 - 4ft SE 8-0. breasts, Fajr ........................................................ 04:51 Oval faces – More frames look good with this face Miltonia spectabilis var moreliana are cylindrical, comIngredients: - 6 chicken skinned and 96 rout of the Love scored 26 points, also a Qaruh Island 27 24 25 4ft SE and thus,1/2 relying on agencies isKevin Sunrise .................................................. 06:13 shape than any other, as long as the size of the frame is pressed pseudobulbs, each with 2 linear, oblong, boned; cup flour; 4 tsp olive oil; 1/2 tsp salt; 1/4 tsp season high, while Kyrie Irving added Thunder on Umm Al-Maradim 28 23 - 4ft SE Dohr ....................................................... 11:33 increasing for the more “solid, the Cavaliers. in proportion to the face. oblong-linear, or oblong-lance-shaped, apical leaves. freshly chopped fresh or Tristan Thompson T h uground r s d a y black pepper; 231fortbsp Asr ......................................................... 14:32 Sea Island Buo - -ft Oblong faces – Long narrow faces are similar to Leaves are slightly leathery, thin, hairless, and pale to dried rosemary; 1/4 cup balsamic 2 cups chercredible and objective” news vinegar; night. Maghreb ................................................ 16:52 Salmiyah 30 21 - 4ft SE square faces in that chin and cheek are of nearly the dark green. Decorative, fragrant flowers are produced in ry tomatoes. they provide, This rematchSheikh Mubarak BASKETBALL Isha ........................................................ 18:12 same width. Facial length, however, is far greater than usually erect racemes from the bases of the pseudobMethod: Cut the James chicken into bite sized cubes or fillet. of theCongress. Western told the 4 days forecast - Marine the width. Frames should cover as much of the center of ulbs. Toss with flour oil Conference Fi- to coat the chicken. Heat 2 tsp of the Weather objectives ofAdd thistheconrecorded a to double-double the first Thursday, Nov 17 the face as possible in order to minimize the length. Site: Avoid direct sun except for very early or late in inThe anals large pan. chicken the pan,inthen the wonfrying by the Warriors in seven half, finishing with 15 points and 14 weather for the next 24 Expected weather .......................Partly cloudy ference are enhancing distribuKUNA photo quickly turnedrosemary. into the KD Cook Round faces – To play down the roundness, select the day. Provide humid condition with partial shade, salt,games pepper and and Expected stir chicken until Kuwaiti male shooters and other winners on the podium. Sea state ........................... Slightcelebrate to moderate showimpartial atRemove sold-out news, Oracle Arena, tion of supportframes with straight or angular plenty of fresh air. cooked. chicken and rebounds. set aside. Add vinegar hours: Photos from thelines. event Deep color such as Isaiah Thomas scoredthe 30 points and where OKC (4-1)heat. took itsAdd first loss Wave height............................................ 2-5 ft Night: with light to moderate south black or tortoise also minimizes fullness. Temperature: Day temperature 70° - 80°F, night temto the pan and the remaining 2hadtsp of the oilCool to the Avery BradleyBy 26 for Celtics, ing the principle of free press, to leave LeBron James and the Max Temp.................................................31C win 4 medals in 6th Asian Shotgun Champ’ship easterly southerly speed ofshooters 12-32 who played without twotostarters, Square faces – Compliment a square face with frames perature 58-60° IDAK F. panchampion andabreast add theascherry and cook for center aboutwind, withKuwaiti keeping the tomatoes major Cavalierswith the league’s organizes ‘basic life support’ course Min Temp..................................................12C Al Horford (concussion) andserve. forward km/h and some scattered clouds will appear. that are slightly curved. The top of the frames should sit Water: Water freely all year, sparingly in winter. another minute. the chicken mixture and lone unbeaten team. Wind Direction ........................................ Jae (sprained left ankle). developments inAdd theto field of Crowder Kuwaitilight male variable shooters have swept four medals: two gold, one silver Al-Fayhan won theS-SE gold, silver and second and the Lebanese had the By Day: Sunny with wind high enough on the face to downplay the jawline. Misting is necessary once or twice a day. So much for this one being just like Wind 15-38 km/h trap competitions in theeasterly second day and one Speed bronze in.................................. the individuals bronze medals respectively. third place. This takes the number 125, The course was tochanging only 10Pacers dentists perto sesto observe students, provide feedback and guide The Basic Life Support (BLS) for Healthcare ProIDAK (Indian Dentists’ Alliance in Kuwait) is an alto 106 light moderate south media, andgame letting people un- Bucks any stuother for Durant. Even herestricted the km/h 6th Asian Shotgun and teams trap contests. In the teams’ competitions, the of Kuwaiti medals in the Asian tourFriday, Nov 18 sion thus being an intensive rigorous traindents’ acquisition of skills. viders (HCP) Course is a video-based, Instructor-led liance of dental professionals of Indian origin who In and Milwaukee, Giannis wind, withhalf-day speed of of08-30 and some knew itthe would certainly mean more derstand content ofThis imporChampionship, currently held in the In the trap individuals’ national team, which comprises the nament up to six. On Thursday, Expected weathercategory, .......................Partly cloudy course gives enormous confidence The key concepts covered during the training includcourse that teaches both single-rescuer and team are working in Kuwait. It is now into its 10th year of Antetokounmpo and Jabariclouds Parker each once the ball ing was program. tipped, a matchup scattered will appear later on. Arab Emirates (UAE). Kuwaiti shooters Khaled Al-Mudhaf, same three shooters, grabbed the Kuwaiti women won two medals in tant events intothe world, KUNA theeverywhere dentists to tackle situations. ed Critical concepts of high-quality CPR, the AHA chainon calendars basic life support. This course trains participants to formation and among the various events organized, Sea state ........................... Slight to moderate hademergency 27 points to lead the Bucks past the United circled from Station Max Min Al-Rasheedi and Abdulraman gold medal. The Indian Eachthecandidate of survival, 1-Rescuer CPR and AED forchief adult, child promptly recognize several life-threatening emerrecently a Basic Life Support (BLS) course was orgaPacers.successfully completed the The national shooters snatched Talal thesaid. moment he joined Warriors in who Wave height............................................ 1-4 ftteam came trap category. (KUNA) Rec PaulCourse George Completion scored 23 points, course received a BLS Certifi- Exp and infant, 2-Rescuer CPR and AED for adult, child gencies, give high-quality chest compressions, denized for its members. The training was conducted July. an Max Temp.................................................30C Kuwait 18 Sheikh out reserveUSA, C.J. Miles City added 19, valid Jeff forwould 32 Westbrook was held 20 points cate andtopointed card from AHA, internationally infant, differences between adult, child and infant res- Mubarak liver appropriate ventilations and prove early use of by the Gulf CPR Training Institute which is an Americoast to their third win of the two freeTemp..................................................14C throws and Thaddeus Young added 17 to lead the Magic to a victory double with 13 points and 10 rebounds, Min Airport 13 Teaguealso hadKuwait 16 and Myles Turner yes,child that’snews right2 after coming as the years. Thein course was accredited with 515,CMEseason.32 cue techniques, bag-mask techniques forthat adult, an Automated External Defibrillator (AED). BLS for can Heart Association authorised training centre. hit a basket, the Bucks’ lead was over the Kings.VRB-SE Arab agencies, which while reserve Jeff Green scored 15 Wind Direction ................................... but course it wasn’t enoughmanaged as the Pacers scorer averaging 37.8of this Abdaly 31 had other ideas and closed 11 Logistics was by the Indiana and infant, rescue breathing for adult, child andNBA’s infant,leadingpoints. Healthcare Providers teaches skills using the AmeriThe training was given to around 60 IDAK members nine. In one of their better offensive points. The Magic (2-3) won back-toWind Speed .................................. 08-28 km/h he represents in the conference,of IDAK to 0-3 on the road. points. Bubyan 31 Scientific Committee slipped under the prominent relief of choking for adult, child and infant and CPR with can Heart Association’s (AHA) proven Practiceover a period of 2 weeks from Sept 16, 2016 to Oct Magic 102, Saturday, Kings 94 flurry led by George who14 hit a games Nov 19this season, the Magic had five back games for the first time this seaWhen Parker hit from in close and with a 33 Stephen Curry added 21 points “remain loyal to the principles leadership of Drand SreeKrishnan Nair. an advanced airway While-Watching technique, which allows Instructors 1, 2016. Jahra 17 score in double figures with son as they returned home from a In Orlando, weather Fla, evan ...................... Fournier players Mostly seven assists while Klay Thompson then from beyond the arc to open the 3-pointer with 9:28 to go, cutting the Expected sunny Failaka Island and goals of the world congress to 95-82. When Turner 16 made scored 29 points and Serge Ibaka Aaron emerged from his 3-point funk to make fourth quarter, contributing a double- three-game trip. it looked like the Bucks deficit 30 Sea state ........................... SlightGordon to moderate Salmiyah 30 21 and strive competitions on not publishing Wave height............................................ 2-4 ft Various planned Ahmadi 28 20 Max Temp.................................................28C any news or information that Nuwaisib 32 15 NBA Results/Standings Min Temp..................................................12C may offend others or producWafra 33 13 Wind Direction .......................................... NW Salmy 32 15 ing inaccurate or biased news.” Wind Speed .................................. 10-32 km/h WASHINGTON, Nov 4, (RTRS): Results and standings from the NBA games on Thursday Sunday, Nov 20 Moreover, he stressed keen4 days forecast – Weather Orlando 102 Sacramento 94 Cleveland 128 Boston 122 Expected weather .......................Partly cloudy ness by the Arab agencies on Milwaukee 125 Indiana 107 Golden State 122 Oklahoma City 96 Sea state ........................... Slight to moderate Thursday, Nov 17 Denver 102 Minnesota 99 maintaining respectful and Wave height............................................ 1-4 ft Expected weather .......................Partly cloudy Eastern Conference Western Conference professional relations with the Max Temp.................................................27C Max Temp.................................................31C Atlantic Division Northwest Division Min Temp..................................................11C Min Temp..................................................12C world’s fellow news outlets W L PCT GB W L PCT GB KUWAIT CITY, Nov 6: Indian Muslim AsWind Direction .......................................... Wind Direction ........................................ S-SE Toronto 3 1 .750 - NW Oklahoma City 4 1 .800 ona 15-day honorable sociation (IMA) hasbased organized Cam- work conWind Speed Boston .................................. 3 2 .600 10-30 0-1/2 km/h Utah 3 2 .600 1 Wind Speed .................................. 15-38 km/h paign on the Subjectventions ‘Quran for All’ Nov thatfrom restrict journalist Brooklyn 2 3 .400 1-1/2 Denver 2 2 .500 1-1/2 Friday, Nov 18 4 to Nov 18, 2016. A launching program has NY Knicks 1at Shuwaikh 3 .250 Port 2 Portland 2 3 .400 2 Tide times behavior. Expected weather .......................Partly cloudy Philadelphia 0 4 0 3 Minnesota 1 3 .250 2-1/2 been held at the Grand Mosque (Masjid Al1st high tide: .......................................... 13:30 Max Temp.................................................30C He expressed sincere hopes Kabeer) Kuwait. This campaign is intended to Central Division Pacific Division 2nd high tide: ......................................... 00:30 Min Temp..................................................14C clear the misunderstandings associated with the W L PCT GB W L PCT GB for further cooperation between 1st lowCleveland tide:............................................ Wind Direction ................................... VRB-SE Holy Quran and Islam. This will help promote 5 0 1.000 -07:15 Golden State 4 1 .800 the world newsamong agencies to boost 2nd lowChicago tide: .......................................... 3 1 .750 1-1/219:15 LA Clippers 3 1 .750 0-1/2 Wind Speed .................................. 08-28 km/h an environment of better understanding A photo from the event Detroit 3 2 .600 206:12 LA Lakers 2 3 .400 2 Sunrise: ................................................. different faiths andtheir communities. The role, cam- namely disessential Saturday, Nov 19 Milwaukee 3 2 .600 2 Sacramento 2 4 .333 2-1/2 Sunset: .................................................. 16:53 paign will advance the very purpose of uniting Expected weather ...................... Mostly sunny semination of culture, promoting Indiana 2 3 .400 3 Phoenix 1 4 .200 3 IDAK holds dental symposium humankind under universal message of peace, Max Temp.................................................28C Southeast Division Southwest Division knowledge and awareness, and Tranquility and Friendship as emphasized in Golden State Warriors’ Stephen Recorded yesterday at Kuwait Airport Min Temp..................................................12C W L PCT GB W L PCT GB Curry (30) lays up NW a shot over the Holy Book. Thefighting Holy Quran carries an in- ideologies, extremist Max temp ..................................................31C Wind Direction .......................................... Atlanta 3 1 .750 San Antonio 4 1 .800 Oklahoma City Thunder guard credible message of truth, compassion, goodThe first IDAK (Indian dentists Alliance in Kuwait) aspects of clinical dentistry with emphasis on recent India. Min temp ...................................................11C Charlotte 3 1 .750 Houston 3 2 .600 1 Wind Speed .................................. 10-32 violence and towards terrorism, in addiVictor Oladipo (5) km/h during the first will and tolerance leading humankindNallaswamy 2 2 .500 1 47% Memphis 3 2 .600 1 Scientific symposium was held on the May 1, at The advances. Dr Deepak gave a brief overview about the Novhalf20of an NBA basketball game Max RhMiami .................................................... Sunday, tion to IMA contributing Orlando 2 3 .400 1-1/2 Dallas 0 4 0 3-1/2 a peaceful & successful life. through this to achieving California. Min RhWashington ..................................................... Regency Kuwait. The event surpassed expectations with The guests of honor for the event were DrCampaign, Yusuf Al changing trends Dental Education In India, especially in on Nov 3, in Oakland, Expected weather .......................Partly cloudy 0 3 0 2-1/2 16% New Orleans 0 5 0 4 would humbly request forand the in supworld peace stability, as well (AP) Max Wind....................................... W 18 km/h Max Temp.................................................27C over 300 dentists of different nationalities, registering for Duwairy—Assistant Undersecretary, Dental Affairs MOH Saveetha University with various port from the people towards this noble cause. where collaborations A flyer of Temp..................................................11C the event Total Rainfall in 24 hrs ........................... 0 mm as consolidating values of peaceMin the event. Kuwait, Dr Sabiha Al Mutawa-Director of During Dental Western in the field of Dentistry are underway. the campaign peopleuniversities from different Wind Direction NW fulThe cultural faiths and religions will be coexistence, participating. Smalland with Fabulous prizes beFIRST given the.......................................... winners A photoDr from the event.Administration MOH Kuwait, Dr Jawad Behbehani-Dean The speakers for the event, Dr GopiKrishna, Neel event concluded vote ofwill thanks byto the chair-LANGUAGE DAILY Dolphin THE IN FREERecorded KUWAIT yesterday at South Published by: Arab Times Publishing House Wind Speed ENGLISH .................................. 10-30 km/h and meets willof be IDAK arrangedscientific where of committee these competitions. communication between differBhatavaderkar, Dr Vinod Krishnan and Dr David Tauro, Faculty of Dentistry Kuwait University and Drgatherings Deepak man Dr Unnikrishnan folMin/Max Air Temp ...............................20/30C the Scholars and Intellectuals from Muslims Indian Muslim Association (IMA) is a preshared with the audience their knowledge in different Nallaswamy-Director Of Academic Saveetha University lowed dinner Maha ballroom. Advertising: Tel: 24816326/7 Annual 20/80% Subscriptions: ent nations. Editorial Office: Telephone: 24813566 & 24849144 Editor-in-Chief Marine Forecast Min/Max Rel Hum ............................... NSH Global Village Harmony launches ‘Future Pillars’ as well as Non-Muslims willby address and at con-the mier Indian Embassy affiliated, religious, soTel: 24919620 Individuals KD 45/- Companies and Official Airport Road, Shuwaikh Fax: 24833628 Fax: 24818267 Wind Direction/Wind Speed..........NW/19km/h tribute towards the success ofAHMED the campaign. A Sheikh Mubarak apprecicial welfare organization in Kuwait, strives AL JARALLAH Departments KD 75 Airmail charges extra for over- Fax: 24839487 Station Max E-mail: Min arabtimes@arabtimesonline.com Sea Today’s Box 2270, 13023 Safat,closely Kuwait leading Scholar fromated India,the Iqbal Mullaefforts Sahab of Prev Wave Dir/Max Wave Ht .................N/2ft E-mail: advt@arabtimesonline.com hard to inculcate values. It works seas great the AZ-P.O.moral NSH Global Village Harmony has announced the formation of With the formation of NSH’s Future Pillars program, our association will address the concluding programs of the Min/Max Sea Surface Temp .................. 22/23 amongst Indian expatriates living in Kuwait. Exp Rec Surf Waves Future Pillars, a social responsibility initiative. NSH continues to is happy to contribute for the development of the children, said Vice to ensure campaign on Nov 17ERTAC & 18, 2016.News AgencyIMA is trying to develop sense of responsibility Sea Current .....................................Upwelling support Kuwait ambitions with the awareness events such as antiPresident Sabu, and added that it would be instrumental in bringing Ht Direction The copies of thethat Holy the Quranconference with transla- would among men turn& women alike with a special focus alcohol program in connection with the United Nations International out the talented. Performances such as singing, mono act, drama, — Directorate General of Civil emergency number 112 South Dolphin 29 20 22 4ft SE tions in various languages onevent youth ofin new generation so that they would Day against Drug Abuse, UNESCO’s International Literacy Day, speech, drawing, story telling was very thrilling. Earlier, HR Manager out towillbebe amade keyavailworld able for free distribution. An Exhibition disappropriately represent beloved nation 27 in World Heart Day, Master Brain, Partners of Environmental protecPani J. Anthony handled the session on developing self confidence. Aviation, Meteorological Dept. Umm our Mudayrah 23 - 4ft SE playing the messagethis of thefield. Holy Quran will be this foreign land. tion, Knowledge Development and Sharing, etc. This recent initiaThis is an ongoing event to hone the skills of the kids by NSH held during the campaign. Another prime objective of IMA is to protive, Future Pillars will enlighten the children and will be an inspiring Global Village Harmony, an association registered in the Indian He also voiced gratitude and Civil ID info: 1889988 Site for checking travel ban www.kuwaitcourts.gov.kw/mojweb/NGeneral/Main.jsp Various competitions will be held during the force to horn their skills. Embassy in Kuwait. mote IIham goodwill and friendship among people to isPresident campaign. An essayappreciation writing competition beof different communities, faiths & cultural Adnan Abdullah Omar Al Asfour, 65 years old, buried. Condolences: (Men) Qadsiya, Block sponsoring this coning arranged during Aliyev the ‘Quranfor for All — Camgroups/organization residing in Kuwait through 9, Street 91, House No. 2, Tel: 66858883, (Women) Surra, Block 4, Hamad Al Roumi Street, paign’.On Where faiths are envarious social, religious awareness events and his attendance Items for the What’s pagestudents canference, be from sent all saying House No. 563; Sarah Sulaiman Al Qudhaifi, 89 years old, widow of Jassim Abdulmohsen Al couraged to participate. The handwritten essays round the year. 9-program June 20, has started at the become a monumental sculpture, assum“will emphasize the 2015) ■ ‘Gold Reflection’ exhibition: Dar Al be mailed at essay@imakuwait.org Abwa, buried. Condolences: (Men) Mishref, Block 5, Street 12, House No. 20, Tel: 66656618, directly to the toArab Times, P.O. Box surely (May For information on the ‘Quran for All’ CamCenter. ing new dimensions. New monumental Online Quiz Competition is also organized at conference importance ofAWARE this Funoon will hold an exhibition titled “Gold paign Mansur can be reached onMubarak Cellular Num(Women) Al Abdullah, Block 2, Street 202, House No. 59, Tel: 66699797; Abdulrahim 2270, 13023,the Safat or faxed link www.imakuwait.org/quiz We will beginner’s mornber 69901154. sculptures are in progress. Fahadweekday Abdulrahman Al Zaid, 67 years old, buried. Condolences: (Men) Abdullah Salem, Block Reflection” by Rose Morant. Opening whichto concentrates onoffer instiing and evening weekend 3, Streetand 34, House No. 2, Tel: 99802222, (Women) Nuzha, Block 2, Street 22, House No. 6, Tel: 24818267 or e-mail tutions to that focus Gallery hours: Sunday to Thursday: 10 today at 7 pm and continuing through mainly on courses; 22562222; Khaled Hussain Ahmad BuHamad, 59 years old, buried. Condolences: Daiya, Husmorning course. am - 1 pm and 4 - 8 pm. Thursday, May 21, 2015. arabtimes@arabtimesonline.com.distributing To attend various events credible, objective sainiya al BuHamad, Tel: 96667311. For all course details and registration, Saturday: by appointment Rose Morant, born in Paris in 1963; andasimpartial news and inforAll items on this page are published a please visit: Getting to the Gallery: Al-Watiah, based in Hong Kong. Following ethnologiNov 16, 2016 mation”. www.aware.com.kw/class.aspx courtesy to the public. These announceBehbehani Compound, House No. 28. cal and social studies, Rose Morant For more details, do not hesitate to conentered the creative side of fashion and For further information call +965 2243 ments can include birthday greetings, tact us by email: saleha@aware.com.kw simultaneously traveled extensively 3183. www.daralfunoon-kw.com weddings, social functions or any other or through: 2533 5280 KUWAIT CITY, Nov 6: Universally renowned Nov’16 for almost 40 days. throughout Asia. She became a creative ❑ ❑ ❑ non-commercial Urdu events. Poet Photographs and Writer AfrozofAlam- Vice PresiIn first will travel to Bho❑leg of the❑plan, he❑ supplier to the very best European luxury dent of Maurya Kala Parisar, Kuwait and mempal (MP) for participating in International Mus■ BBBC weekly services: Bible brands due to her expertise of Asian crafts all events are welcome. Father’s Love Int’l Ministries: Have ■visit ber of Writers’ Forum Kuwait, is all set to haira organized by Indian Congress.
Kuwait Today
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IMA announces launch of ‘Quran for All’ campaign
what’s on today
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Alam on literary visit to India
Believers’ Baptist Church (BBBC) in and skills. Research and development India for attending various literary events. he willweek? attend theWant seminarto‘Afroz you had aThereafter, challenging hear Mangaf invites you to visit us for our weekAfroz Alam is a well Alam; his art and personality’ by his have been her primary activities for the something different for afollowed change? email faithful.stewards@gmail.com known Urdu poet, popuinterview on ETV (MP). After completion of ly services in English. Friday morning from the event. last twenty years parallel to having her Photos Something positivehe will andproceed energizing? At lar writer and hilarious these activities, to Jhansi (UP) Bible teaching starts at 10:30 am. The own accessories brand Rose Morant in ❑ anchor ❑ of Indian ❑ origin FLIM, you find all this andto much more and will Hyderabad (Telangana) participate in Sermon and Children’s Church begins at Paris.Indian Her very deep interest in traditional Embassy marks Rashtriya Ekta Divas based in Kuwait. literary activities. ... Love,other laugher, life and liberty. You will ■ AWARE summer Arabic We noon. On Monday evening we hold our savoir-faire and techniques led her to Some of hiscourses: books; Second phase the tour, which starts on find a community of ofGod-loving believers, are pleased to announce that registration Alfaz Kay saye (Poetry), 19th Oct’16 comprises of International Musprayer meeting and Bible 7 pm. patientlyEkta revive crafts that were Auditorium Rashtriya Diwasancestral was celebrated in the Embassy from Intergrated Indian study School,at Indian Educational School, Delhi who come every Friday, Saturday, Monday Kay courses Alam me (Pohairas in Gorakhpur (UP), Motihari (Bihar) and morePublic details, please 66220416 or(Senior for Wing-Salmiya) the Summer I Dhup Arabic schedule on Nov 3, 2016 on giving the occassion Anniversary of For Sardar School, Indiancall Community School disappearing, her a141st rareBirth specializaand Wednesday to praise and worship etry), Fsl-e-Taza (Book Gopalganj (Bihar). Vallabhbhai Patel. The objective was to recall Sardar Patel’s conand Indian Community School — Khaitan emphasized contribution tion and highly appreciated know-how. together. After There always word ofthird blessing on Poetry of young Urdu spending first atwo days of phase tribution to India’s freedom struggle and to the founding of united of the “Iron Man of India”. In 2012, Rose Morant started to create Poets in Kuwait), Kuof tour starting on 28th Nov’16 in Kolkatato and edification for everyone who comes and Independent India. A 40-minute documentary film, titled, “A Man of silence” was wait Kay Ahl-e-qalam (WB) he plans to travel to Patna (Bihar) to The function wasart attended by more than 150 persons. contemporary pieces - sculpture, furni- Speakers screened. Some photographs are attached. the Father’s House. So, don’t be left out! Alam (book on poetry of forty attend eminar in Arabic-Farsi University, ture and jewelry. Her work is nourished by Come join the on family! You will be restored, Urdu writers of Kuwait), Seminar Prem Chand in Gorakhpur (UP) her long experience and intimate knowljog or just stroll. Registration is now open, Rehabilitation Institute (FSRI) announces that its received, renewed greatly rewarded! Rashid Mewati: fun-o-shaksiyayt (Critic) are & several otherand literary activities in Delhi; and participants can sign up via the official annual RunQ8 charity event will be held this edge of materials and rare techniques. very famous among Urdu literature lovers. His Seminar organized by Delhi Urdu Academy, Father’s Love Encounter Service on website (runq8.org). You can also call FSRI (at on Saturday Nov 12 at The Scientific Center latest book ‘Kuwait me Adabi Peshraft’Friday (His- at Seminar by Kirori Materials are at the heart of her workyear - lac11:00organized am to 2:00 pm Mal Collageclick 25720338 or 25721757) for more information. tory of Urdu Literature in Kuwait) is an authenDelhi, International Mushaira in Delhi are quer, gold leaf, metal, wood, fabrics,Kuwait. pre-event aims to support children with Saturday at 7:00 pm This year the race enjoys the support of a The tic document for History of Urdu literatureAfrican in fewservice of them toon name. cious stones, flower Latest powder... She isdisabilities, also raising awareness and funds number of local companies and organizations, to 9:00 pm Kuwait. He plans to return to Kuwait on 12th Dec’16. but the door is still open for anyone looking to support FSRI’s non-profit Children’s constantly driven to giving new life toto sec-
ORAL HEALTH GUIDE 2016 125 Volume 5
Gallery
Farewell -2016
Dr. Mohammed Rizwanullah
Dr. Unnikrishnan
Dr. Zachariah Mathew & Dr. Reny Thomas
Dr. Riyaz Ahmad Mantur
“True friends don’t say goodbye, they just take extended leave of absence from each other.”
126 ORAL HEALTH GUIDE 2016 Volume 5
95% 97% 99.9%
UP TO UP TO
said it was easy to use* showed improved gum health** plaque biofilm removal in the treated area***