Category: Top to Toe

Table for Two and a Half

May 7, 2022 Return

After a month or two of nursing and caring for your baby at home, you may wish to leave the house once in a while, perhaps for a meal at a favourite restaurant. More importantly, bringing your baby out for a meal can be a learning experience for your curious little one – it is a good way to expose your baby to fascinating sounds and sights as well as to introduce the little darling to your friends or other family members. There are also times when you have to bring your baby along, such as when there is an important social function to attend and all the babysitters on your contact list are not available.

However, you may feel intimidated by the thought of your baby throwing a loud tantrum while other diners cast disapproving looks at you. Well, don’t worry, with some preparations, you can minimize the chances of your baby making a fuss. Or, if your baby does make a fuss despite your best efforts – babies can be unpredictable, after all – how you can make a fast getaway with your sanity and dignity intact.

Is it safe for the baby to go out?

There is actually no medical reason to keep a healthy baby sequestered at home until a certain age. If you are worried about germs, avoid bringing your baby to crowded areas. A clean and spacious restaurant should be fine.

Now, where to eat?

Picking the right restaurant is important. With a baby in tow, you have to consider a few more things aside from whether the food tastes great.

The best choice of restaurant is a ‘baby-friendly’ one, which is a restaurant where both its staff and other customers are used to having babies and young children around the place. Such places usually have comfortable baby seats and the people there will not get too upset if your baby makes a fuss. You can ask other family members or friends with young children to recommend a few such restaurants to you.
If you anticipate the need to breastfeed your baby in the restaurant, check and see whether the restaurant either allows you to breastfeed at the table or there is a clean private area available for you to breastfeed your baby.
Choose a place to eat that is clean, spacious and have plenty of space for you to carry your baby and walk around in case he or she starts acting up. If there are distractions such as aquariums in the restaurant or a playground nearby, even better.
Some establishments, especially the five star ones, may frown on customers bringing in babies and young children. If you are unsure, call ahead to check.
Avoid places that are too loud, bright or have strong smells – all of these could agitate your baby.

Getting ready to eat out

Now that you have picked what you believe to be the right place to eat, a little preparation beforehand will not hurt.

Prep yourself! Accept that there is a possibility that you will not be able to enjoy a full meal. You will be going out with your baby for the experience, rather than the food.
Feed your baby before you leave, as a cranky, hungry baby will more likely make a big fuss! If you are hungry, have a quick bite too.
Bring along your best ‘secret weapons’. If you anticipate staying out late (such as when you have to attend someone’s wedding and there is no babysitter available to care for your baby), bring a stroller along. If you are unsure that there will be a baby chair in the restaurant, bring your own as back up. Bring along also your baby’s favourite toys, so that your baby will not be bored in the restaurant. Just like a cranky and hungry baby, a bored baby is prone to making a fuss. However, avoid loud or flashy toys that may annoy other diners.
Leave at the right time. Try to avoid going to a restaurant during peak hours. This is because a crowd may upset your baby. Also, meals may be prepared slower during peak hours, and the wait may cause your baby to become bored or cranky.
Also, make sure you bring enough diapers (in case your baby decides to do some ‘business’), baby wipes and even a change of clothing (for yourself and your baby). Your baby has not learned that it is rude or inappropriate to throw up, drool, make a mess or require a diaper change during mealtimes, after all!

In the war zone

If you manage to reach the restaurant with minimum fuss, relax. The best has yet to come!

Take a corner table. Such a location will reduce the likelihood of exposing your baby to sounds or sights that can agitate the little darling, and to also put you out of other customers’ way if your baby acts up. You will also get more privacy in case you need to breastfeed or clean up a mess.
Ask for your drinks to be in take-away cups. This way, you can still have something to drink on your drive home after an aborted meal. Take it from us – this helps to lessen the disappointment.
Order simple, less elaborate meals. Your baby has a short attention span, so try to enjoy, have fun, and eat within 1 hour.
The art of having a fun meal is to keep your baby occupied as much as possible. While you may have brought a few toys to amuse your baby, show them one at a time, so that you do not run out of distractions quickly. If you run out of distractions (or, horror, the iPad runs out of power at an inopportune moment), you can even put some crunchy food pieces on a plate and let your baby play with them. There is no right or wrong when you are out of options – it’s called being creative!
If your baby’s fussiness develops into a loud meltdown, take the little darling to someplace quiet (such as in your car) for a break.
If your baby becomes too much of a handful, perhaps it is best to request for the remaining food to be packed for take-away and bring your baby home as soon as possible.
If you notice that your baby acts up and makes a big fuss every time you bring him or her out of the house, perhaps the little darling is not ready for such an experience yet. You can wait a while until your baby is a little older before bringing the little darling out again.
Also, there is no harm in being extra nice to the staff of the restaurant, especially if you wish to return there with your baby in the future. The staff will be more tolerable to messes and loud noises, and they may even help to distract your baby.

Don’t feel too upset or disappointed when your baby makes it impossible for you to enjoy a peaceful meal. Your baby still finds the world a curious and even frightening place at times, so it is only understandable that the little darling may act up in the restaurant. Relax – there will be more meals to enjoy with your baby in the future. For now, you have given your baby a new experience, and mealtimes outside the house will only get better with time.

References: 1. Mom365.com. Available at www.mom365.com 2. Parents.com. Available at www.parents.com 3. The Bump. Available at www.thebump.com

If you like this article, do subscribe here.

Start from Young, Good for Life

May 7, 2022 Return

Dr Rohaida Abdul Halim Lecturer/Paediatric Dentistry Specialist, Faculty of Dentistry, University Teknologi MARA

Just like all good habits, good eating habits and oral hygiene – such as daily cleaning of the mouth and teeth – should be taught to children from a young age. The earlier they start, the more likely they will adopt these good habits for life.

Before your child’s teeth arrive

You should clean your child’s mouth regularly even before his teeth erupt. This helps to create a clean environment for the primary teeth to emerge into. You can start during the first few days after birth; this will get you and your child into the habit of keeping the mouth clean.

Lay your baby on a comfortable place (such as on your lap). Make sure that you can see clearly into your baby’s mouth.
Use a soft baby brush or a clean damp washcloth wrapped around your finger to gently wipe all parts of your baby’s gums. Do not use toothpaste until your child has his teeth.

After your child has his first tooth

Now that your child has his teeth, you can use baby toothpaste to clean his teeth.

When your child is under three years old, apply just a smear of toothpaste on either a dry toothbrush or one moistened only with water.
When your child is three to six years old, the amount of toothpaste can be increased to a pea-sized portion.

Brushing steps

Hold the toothbrush at a 45-degree angle to the teeth. Point the bristles to where the gums and the teeth meet.
Using gentle circular motions (do not scrub), clean every surface of the tooth. For the front teeth, use the front part of the toothbrush to brush it. Do not brush too hard because this can hurt the gums.

A note on children’s toothbrush and toothpaste

The best kind of toothbrush for children is the soft kind, with rounded bristles. The toothbrush should be able to fit your child’s mouth properly.
Toothbrushes should be changed either every three to four months or when the bristles are bent and worn down (whichever comes first). Bent or worn down bristles not only will not clean your child’s teeth properly, they may end up hurting the gums.
Pick toothpaste containing 1,000 ppm (parts per million) fluoride. You can read information given on the box to make sure that you are buying the right toothpaste.

Your child should be able to brush his own teeth once he can write his own name.

However, you should still check to make sure that he is doing it correctly. Children under six should always be supervised when brushing their teeth.
Always make sure your child spit out the excess toothpaste after brushing. Excessive swallowing of toothpaste by young children may result in dental fluorosis. This condition causes the enamel (the outer layer of the tooth) to show white spots and, in severe cases, brown stains, pitting, or mottling.

How often to brush?

Children should brush their teeth twice a day, especially right before bed (after the last meal/drink). The last is important because, when the child is asleep, less saliva or spit is produced in the mouth to clean and protect the teeth. As a result, there is a higher risk of cavities or tooth decay when a child does not brush his teeth before bedtime.

Don’t forget the check-up

The Oral Health Division, Ministry of Health Malaysia, recommends that a child should have his first dental visit before the first or second birthday.

In addition to checking for tooth decay and other problems, the dentist will teach the parents proper techniques to clean the child’s mouth as well as evaluate for any negative habits such as thumb-sucking. This is also important in building a lifetime of good dental habits.

When it comes to dental problems, it is better to catch them early and fix them before they become worse. Therefore, you should bring your child to a dentist every six months. On top of finding out whether the cleaning done at home is working or not, these visits will let the child learn the importance of going to the dentist to prevent dental problems.

If you like this article, do subscribe here.

To Vaccinate or Not to Vaccinate?

May 7, 2022 Return

Dato Dr Musa Mohd Nordin Consultant Paediatrician & Neonatologist

Datuk Dr Zulkifli Ismail Consultant Paediatrician & Paediatric Cardiologist

John Lennon was once quoted as saying, “There are two basic motivating forces: fear and love.” And it couldn’t be more apt in the case of Megan Sandlin who first took a stance against vaccination when her daughter turned four months old.

It started innocently enough. “One day, I was talking with a friend who told me I should be wary of vaccines,” the mother of two recalls in an interview with Voices for Vaccines. “I was curious so I looked up vaccine ingredients online. I didn’t know any better so I clicked on the first few websites which my online search yielded. I didn’t understand much of what I read, but the ingredients sounded nasty and scary. I was confused with all that information and my friends insisted that vaccines were harmful so I decided against getting my daughter vaccinated when her six-month check-up came up.”

Initially, Megan felt relieved thinking she had made the right choice – and her anti-immunisation stance only grew stronger. “I started “liking” anti-vaccine pages on social media – websites which I now know masquerade as “information portals”. I was added to Facebook groups such as “Great Mothers Questioning Vaccines.” My friends were supportive and constantly assured me that my child was fine; that my breast milk was keeping her safe from diseases.”

But as time went by, Megan began having doubts. “I started noticing how several of these friends would believe in the most questionable controversies. That was my turning point. Soon, I was questioning their anti-vaccine stance.” She then seeked out “real science”, as she puts it. What she discovered confirmed her suspicions. “My friends told me that better sanitation – and not vaccines – was the reason for the drastic decline in disease incidences but I found graphs and statistics on the Center for Disease Control and Prevention (CDC) website which proved otherwise. I realised then that vaccine researchers weren’t out to scam us of our money. Vaccines are good.”

When her second daughter turned 10 months old, Megan decided enough was enough; it was time to begin vaccinating again. Now, she couldn’t be more relieved. “Both my kids are fine. I’m proud to be an immunising mum, to be giving my kids the best shot at a healthy life.”

Megan is just one of many parents who have been duped into taking an anti-vaccine stance. But some, unlike Megan still tightly cling on to their beliefs – stubbornly refusing immunisation for their little ones. Why is this so? How did these misconceptions arise in the first place? And how is the situation closer to home?

East meets West

Consultant Paediatrician & Paediatric Cardiologist Datuk Dr Zulkifli Ismail explains, “Many grow hesitant about vaccination when they read anti-vaccine lobbies on social media. Evidence-based information on sites like the CDC and Immunise4Life are either overlooked or taken out of context. People are more ready to accept the unconventional.” This readiness has led to certain Malaysian communities concluding that vaccines contain ‘haram’ contents. “Some Muslims shun vaccines once any ‘was-was’ (doubt) arises. This is further fuelled by conservative religious scholars who pass religious edicts prohibiting vaccination. But rest assured, all vaccines in Malaysia are permissible from a religious perspective. In fact, I talked about this in the recently published Immunisation Controversies: What You Really Need to Know book, so do give it a read.”

Consultant Paediatrician & Neonatologist Dato’ Dr Musa Mohd Nordin adds, “With the advent of the internet, we are akin to a global village where trends from the West are merely a Twitter or Facebook share away. The internet is saturated with news on vaccines and most people don’t check the authenticity of the news they read. Webmasters of anti-vaxxers utilise SEO and Google Analytics to ensure their websites are top-ranked in search engines. Most of these sites are either selling products (e.g. supplements, programmers or alternative medicines) or subscribe to ‘pay-per-click’ online programmers. The vaccination debate is a great way to make money and gain a huge following quickly. Hence, more Malaysian parents are leaning towards an anti-immunisation stance.”

What’s myth? What’s fact?

It doesn’t help that parents are concerned about the potential side effects which vaccines bring. “Some parents are concerned that too many vaccines being introduced to their babies at a given time can be harmful. Although some children do experience side effects from vaccination, these are typically mild such as fever, fussiness, malaise or swelling at the injection site. In extremely rare circumstances, the vaccines may experience allergic reactions but the incidence is probably less than one in a million. The truth is, the immune system is robust and the human body takes in far more antigens from the environment daily than it does from vaccines. In fact, the ‘toxins’ found in vaccines are also present in breast milk – and in even larger quantities. So, their fears are unfounded,” Dr Musa assures.

“Additionally, some believe vaccines are not necessary anymore because we no longer see children being infected with the terrible effects of vaccine-preventable diseases. We have actually become victims of our own success; immunisation has done so well in the previous generation that today’s generation is taking good health for granted, forgetting that our parents and grandparents vaccinated us in the past to protect us from infectious diseases. We don’t have to wait too long to see the consequences of parents opting out of vaccines. Already, diseases which were once almost wiped off (e.g. measles and mumps) are returning to some communities.”

Dr Zulkifli agrees. “There are those who are caught up in conspiracy theories, thinking that vaccines were invented by the Americans or Jews to subjugate the rest of the world. If this is true, why do the American and Israeli immunisation schedules contain more vaccines than those of our country’s? Ludicrous as it sounds, there are people who believe in anti-vaccine propaganda.”

The Autism- Vaccine Link

In 1998, a study by British surgeon and medical researcher Andrew Wakefield was published in The Lancet, claiming to have a found a link between autism and vaccines. This sparked a wave of panic among the masses resulting in a drastic drop in vaccination rates and the birth of the anti-vaccine movement.

Dr Musa is quick to dispel this notion. “The association between autism and vaccination is one of the biggest myths in the world of medicine. Researchers who referenced as many as 67 scientific papers have unequivocally debunked Wakefield’s claim. His paper was found to be fraudulent and was retracted by The Lancet in 2012. The UK General Medical Council subsequently revoked his practicing license.”

But what about some parents’ claims that vaccines gave their kids autism? Dr Musa says, “A multi-centre US research team has identified 65 genes which contribute to autism. Autism is largely a genetic disorder.” Dr Zulkifli agrees. “The incidence of autism has been reviewed in numerous countries and no link with vaccination has been shown. In fact, kids are more likely to develop autism from prolonged television watching when aged below two years old than from immunisation.”

Vaccines are good for you!

Dr Musa stresses, “It’s illogical to avoid all forms of medical intervention solely because one wants to avoid risks. This paradigm of thought is incoherent and irrational because doing nothing (i.e. refusing vaccination) is also associated with risks, namely the heightened risk of acquiring vaccine-preventable diseases which may lead to disease outbreaks and an increase in hospitalisations, disabilities and deaths.”

“And not only is your own child at risk but other kids as well.” He cites an example. “An unvaccinated child is 6-35 times more likely to be infected with measles. Hence, they can easily pass on the infection to others. For instance, a measles outbreak occurred mainly among unvaccinated children in Malaysia several years back. This was traced back to the decline in MMR (mumps, measles and rubella) vaccine uptake. Remember, freedom of choice is a good thing but the freedom to harm others isn’t.”

“Vaccines are safe,” Dr Zulkifli assures. “No vaccine is ever released and approved by the National Regulatory Authorities (NRA) without first undergoing trials which usually take 10-15 years and involve tens of thousands of volunteers. Even after their release, these vaccines are constantly monitored. If any adverse reaction is detected, the vaccine will be recalled.” Dr Musa adds, “Creating a vaccine is a highly complex and regulated process. The exhaustive volume of scientific evidence speaks for itself that vaccines are safe and effective. So, there’s no need to worry.”

Dr Zulkifli concludes, “Take infectious diseases like smallpox, diphtheria and polio for example. Because of vaccination, they are now either eliminated or have decreased significantly. The World Health Organisation (WHO) puts it best: ‘Vaccination is the greatest achievement in public health, second only to safe water supply.’ Therefore, vaccination isn’t something to be feared but to be welcomed.’”

Now that you have heard from Dato’ Dr Musa Mohd Nordin and Datuk Dr Zulkifli Ismail, are you curious to find out what other key opinion leaders have to say on the matter? If you are, you will be glad to know that we are giving away copies of “Immunisation Controversies: What You Really Need to Know” for free! Write in to us at enquiry@my.healthtoday.net or visit our Facebook page at www.facebook.com/HealthToday – and you can stand a chance to win a copy!

If you like this article, do subscribe here.

What Everyone Should Know About IVF (But Usually Doesn’t)

May 7, 2022 Return

WORDS LIM TECK CHOON

Dr Agilan Arjunan

Consultant Gynaecologist & Fertility Specialist

Infertility is an ugly word for many people, especially for those who are hoping to start a family. Yet, it is an undeniable fact that many of us are settling down later than before, at a time when our fertility is usually on a downturn. Thus an increasing number among us are having problems conceiving a child despite our best efforts.

It may be due to some issues with the woman’s reproductive ability, but it may also be due to the man’s. Sometimes, it could be due to both partners. Nonotheless, nobody is at fault here; often, it may just be because our biology has not caught up with the changes in our lifestyles, and we aren’t as fertile as we used to be by the time we are ready to start a family.

Research and technology have evolved over time to allow those of us having problems conceiving on our own to still have a baby with the help of modern, science-based miracles. Therefore, we can still hold our hopes afloat. However, like with most things in life, having the right attitude and knowledge can make a significant difference between success and disappointment.

This month, consultant gynaecologist and fertility specialist Dr Agilan Arjunan shares some useful advice for those of us who are ready to embark on a journey with a fertility specialist to make our dreams come true.

FIRST, LET’S RECAP WHAT IVF IS.

In-vitro fertilization (IVF) is a series of procedures that help overcome a couple’s problems in conceiving.

Actual details of the procedure may vary as the technology improves over time, but the basic principles are as follow:

The woman is induced to produce a number of mature eggs, and these eggs are collected by the fertility specialist.
The fertility specialist extracts the man’s sperm.
The best sperm and eggs are chosen, and the eggs are then fertilized by the sperm in a laboratory.
The resulting fertilized egg or eggs will be transferred into the female partner’s womb.
If all goes well, the female partner will eventually deliver a healthy baby.

While this sounds simple on paper, in real life not every IVF attempt will be successful. It is not unheard of for a couple to have to go through a few cycles of IVF before they finally have a baby of their own.

4 THINGS WE SHOULD KNOW ABOUT IVF

Fact #1

IVF is not necessarily the “final solution” or “last resort”. It can also be the first option to successful conception.

Many couples consider IVF only after they have exhausted all other means or have been trying to conceive naturally for so long. This does not have to be the way. In fact, adopting this attitude can lead to stress and heartaches that can threaten the fragility of a relationship.

Therefore, don’t wait. Dr Agilan advises couples wishing to have a child to undergo a fertility check first. The results will give the couple a clearer picture of their chances of success in conceiving naturally, or whether IVF is a better option to maximize the chances of a successful conception.

Fact #2

IVF is NOT the “magic cure” that will solve all our fertility problems.

Dr Agilan points out that fertility problems can be caused by many factors, age being one of them. “Therefore, if a 40-year-old woman comes in for IVF, her chances of success will still be lower than that of a woman in her twenties,” he offers as an example.

Other possible causes for infertility include health conditions that affect the functions of the reproductive organs (blocked fallopian tubes), issues with the man’s sperm quality and more. Sometimes, we may not know why we have problems conceiving a child or carrying a child to full term despite having gone through all possible methods of diagnosis.

“IVF is a technique to help us conceive a child, but it does not affect the quality of our eggs or sperm,” Dr Agilan points out. Therefore, the fertility specialist may typically run tests to identify the possible causes of our infertility first and address these causes before initiating IVF.

DON’T TREAT IVF AS THE LAST RESORT. IF YOU HAVE PROBLEMS CONCEIVING, EXPLORE YOUR BEST OPTIONS WITH A FERTILITY SPECIALIST.

Fact #3

IVF is not a long procedure that will disrupt the couple’s normal routine. In fact, it’s quite flexible these days!

Dr Agilan shares that many couples commonly ask him whether they need to take a long leave from their jobs before going for IVF. “There’s no need,” he clarifies.

While the exact duration for the entire journey varies from couple to couple, IVF has come a long way with recent innovations. “These days, with the current level of technology, IVF is very ‘couples-friendly’,” Dr Agilan goes on to elaborate. “We can transfer a fertilized egg or embryo into the woman’s womb at a time most suitable or convenient for her and her partner.”

Fact #4

IVF is NOT only a “woman’s issue”. It’s a journey to be made together by both partners.

Our fertility in general is affected by many things, including age (this is especially true for women) and as well as the presence of conditions that may affect the function of the reproductive organs. This applies to both men and women, and male infertility exists.

Dr Agilan explains that it takes two to make a baby – a sperm cell must fertilize a mature egg to form a fertilized egg that will eventually develop into a baby. Therefore, when a couple have difficulties conceiving, it may be due to the quality of the egg, the sperm, both … or possibly something else altogether.

Therefore, the fertility specialist will examine both the partners to identify possible reasons for the difficulties in conceiving a child. Even then, this is not to pin the blame on anyone – rather, this is a step necessary to rectify the causes, if possible, and improve the chances of success in IVF. Just like everything else in a relationship, IVF is a journey shared by both partners rather than a burden carried by a single person.

“The male partner should play a supportive role, as his partner will be the one who will undergo the bulk of the procedures in IVF (such as the stimulation of mature eggs and the implantation of the fertilized egg into her womb),” says Dr Agilan. HT

If you like this article, do subscribe here.

Oh, the Nerve!

May 7, 2022 Return

You try to ignore the pain in your lower back at first. But as time progresses, so does its intensity. When you bend down to pick up your laundry basket, you feel the familiar dull ache radiating over your lower back. When you reach for a book on the upper shelves, you feel the pain again. Come bedtime, your sweet slumber isn’t so sweet anymore due to you being woken up by the pain at random times in the night. It seems to be seeping into every aspect of your daily routine. Aargh!

But not all’s gloom and doom! There are things you can do to alleviate and maybe, even rid yourself of the suffering. Here are some suggestions.

Work it off

Contrary to popular belief, exercise does work. Low-impact exercises like swimming and brisk walking can actually help with back pain. A study reported that its 30,000 participants who exercised 2-3 hours weekly experienced a 20% reduction in back pain. It could be that exercising releases endorphins (natural painkillers) and causes blood vessels to expand. This allows more blood to flow through – hence, nourishing damaged nerves.

Put it to bed

Your sleeping position can have a significant impact on your back. A good position is sleeping on your side with your knees bent in a relaxed, fetal-like position. Additionally, wedge a pillow between your legs to prevent the top leg from sliding forward – which can twist your lower back. To maintain your spine’s alignment as much as possible, placing a small pillow under your neck also helps.

The right ergonomics

Most people spend at least 9 hours a day at their jobs, constantly hunched over their desks so it’s no surprise if poor ergonomics are giving you lower backache. Place your monitor at least 50 centimetres away from you; ensure your wrists, forearms and hands are parallel to the floor as much as possible; allow your upper arms to hang down in a loose, natural manner; relax your shoulders and position your feet firmly on the floor.

Little details count

Don’t overlook the little details in your daily routine. Instead of bending at the waist when picking up heavy objects, bend at the knee. Carry your backpack on both shoulders, not one. Trade your stilettos for comfortable flats or low-heeled shoes (less than 2.5 centimetres high). When standing, don’t bend sideways or slouch.

OTC treatment

Over-the-counter ointments, patches and painkillers can usually do the trick if the pain is mild. Remember to inform your pharmacist if you are on other medications or have a certain medical history.

Seek medical help

If your pain persists even after trying the above steps, consult a doctor as your backache may hint at a more serious condition (e.g. diabetic neuropathy or degenerative disc disease) and requires immediate medical attention. Treatment may involve a combination of medication (e.g. anti-convulsants), physiotherapy and lifestyle modifications.

References:

Healthline. Available at www.healthline.com

MedicineNet.com. Available at www.medicinenet.com

WebMD. Available at www.webmd

If you like this article, do subscribe here.

Lost Your Front Tooth?

May 7, 2022 Return

Dr Siti Mariam Ab Ghani Deputy Dean (Academic & International), Universiti Teknologi MARA

Our teeth are not just for eating. As seen in people who have lost most or all of their teeth, the ability to speak effectively also can be affected by the loss of teeth. Losing a tooth, especially the front tooth may also lead to a loss in self-confidence, affecting our ability to socialize with other people.

Missing a front tooth?

It is very important to replace the missing anterior tooth. Not only will this restore our ability to eat and communicate normally, as well as our self-esteem, it is only necessary to prevent future oral problems.

You see, the empty space formerly taken up by the missing tooth will allow neighbouring teeth to move into that space. This can eventually cause problems such as tilting and overgrowth of these neighbouring teeth.

Therefore, if you are missing a front tooth, you should visit a dentist as soon as possible to explore your options. Here are three of the most commonly recommended options. These options are not arranged by the best sequence as each option has its own advantages and disadvantages.

Removable Partial Denture (RPD)

RPD is more commonly known as false teeth or plastic teeth. It is one of the cheapest and simplest prosthesis to fabricate in order to replace missing teeth.

It is considered the best option when the person is missing all of his or her teeth (upper and lower). However, it may not always be the best option for people who are just missing a single front tooth.

An RPD will have a base made from cobalt-chromium (metal) or acrylic (plastic) covering the palate (upper arch) attached to the artificial tooth with metal clasps to hold the removable prosthesis in place. All these components will occupy the tongue space, have high tendency to accumulate plaque and the bulkiness of the prosthesis will cause discomfort to the patient.

Dental Bridges

A dental bridge is a prosthesis device with a false tooth (known as pontic) linked to it. It is permanently cemented to cover the gap left by the missing tooth.

There are two types of dental bridges: conventional bridges and resin-bonded bridges. The main difference between the two types is the tooth preparation needed to allow the bridge to be set into place.

For conventional bridges, the neighbouring tooth structures are removed to provide sufficient space for a caps (crowns). The pontic is linked between the two caps (crowns) to fill in the area left by the missing tooth.

To fabricate resin-bonded bridges, none or very minimal removal of neighbouring tooth structures are required. It has a more conservative approach and works primarily on the principle of adhesion. The bridges will have wings (retainers) that will be attached to the neighbouring tooth surfaces to hold a pontic in place. However, as the wings are usually metallic, it can be very obvious when one is wearing such dental bridge – something that certain patients may not appreciate. However, the aesthetic can be improved by placing the metal wing at the palatal (back) surface of the anterior teeth.

Dental implant

An increasingly favoured option, this involves the insertion of a titanium-based prosthesis into the jawbone of the missing tooth area, to act as a root and to hold an artificial tooth (implant-crown). This prosthesis is expensive and the procedure must be performed by a dentist trained in implantology.

Anyone seeking dental implant must be fit and healthy to undergo surgery under local anaesthesia. Once the titanium implant has integrated with the jawbone, the next stage of the treatment is to provide the artificial tooth (implant-crown) for the implant.

The main advantage of this prosthesis is that the neighbouring teeth will not be touched or altered. The implanted crown will only occupy the space left by the missing tooth, and is highly tolerated by patients due to the natural shape and design of the prosthesis.

So, which option is best for you?

Only your dentist can give you the answer, as the best option for one person may not be the best for another person. Each case of missing tooth (or teeth) should be thoroughly assessed by a dentist in order to decide on the best treatment. Therefore, if you are missing a front tooth, visit your dentist for advice.

Figure 1: Removable Partial Denture

Figure 2: Conventional Dental Bridges

Figure 3: Resin-Bonded Bridges

Figure 4: Dental Implants

If you like this article, do subscribe here.

Vitamin Much In D-mand

May 7, 2022 Return

In many ways, Vitamin D is an important nutrient for both children and adults. It helps our body absorb calcium from the food we eat, an essential step in the formation and development of strong and healthy bones. Vitamin D also helps our muscles, heart, lungs and brain function properly, in addition to helping us fight infections.

It is also an easily obtained vitamin – our body can make it when we expose our skin to sunlight. Since it is sunny all year round in Malaysia, we tend to take for granted that our skin can make enough vitamin D. However, this is not as simple as it sounds. Our body needs sunlight’s ultraviolet ray B (UVB) to make vitamin D, so you would have to be out in the midday sun in order for your body to produce more vitamin D. Not exactly the kind of sunlight exposure that many of us would enjoy!

Foods rich in vitamin D

Now, there is no need to rush out to stand and sweat under the midday sun. There is a far more pleasant source of vitamin D – milk!

Nutritionists are recommending that children, and even adults, drink two servings of milk daily – that is 200 ml twice a day. We need 5 mg of vitamin D daily and two servings of milk fortified with vitamin D provide that amount. Therefore, milk is an easy and convenient way to fulfil your daily vitamin D needs. Best of all, it can be enjoyed by the whole family!

In addition to milk, you can also eat foods rich in vitamin D including fatty fish like mackerel (ikan kembung), sardine, tuna and salmon. Other foods like mushrooms, egg yolk, beef liver and dairy products such as yoghurt, butter and cheese, also have vitamin D. Nowadays, many brands of orange juice, margarine and breakfast cereals are fortified with vitamin D.

Soak up the sun!

Since sunlight is free, you may be tempted to soak up the rays as much as possible to get enough vitamin D. Before you grab your sunscreen, first let us take a look at some common misperceptions about getting vitamin D from sunlight.

No glasses, please. UVB cannot pass through glass, so lazing by a window with the air-conditioner switched on will not work (unfortunately). You need to be out there, under the sun.
Just a little while. You only need to spend 10 to 15 minutes (the darker your skin, the more time you may need to spend under the sun) for 3 times a week to meet your body’s vitamin D requirement.
Watch the sunscreen. Sunscreen helps to keep your skin from prematurely wrinkling and it also helps to cut down the risk of skin cancer. However, keep the skin of your face, arms, back, or legs sunscreen-free when you are soaking up the UVB, as sunscreen blocks it from reaching the skin.

References:

Nair S. (2010). Vitamin D deficiency and liver disease. Gastroenterology & Hepatology (N Y); 6(8):491-3.

Medline Plus. Available at www.nlm.nih.gov

Poh, B.K., et al (2013). Nutritional status and dietary intakes of children aged 6 months to 12 years: findings of the Nutrition Survey of Malaysian Children (SEANUTS Malaysia). British Journal of Nutrition; 110 Suppl 3:S21–35.

4. Vitamin D Council. Available at www.vitamindcouncil.org

5. WebMD. Available at www.webmd.com

If you like this article, do subscribe here.

ConvOSAtions on Snoring

May 3, 2022 Return

Dr Michelle Clare Mah Lecturer, Faculty of Dentistry, Universiti Teknologi MARA

Snoring describes the loud snorts a person makes while asleep. While you may not be aware that you are a snorer, your bed partner or housemates certainly will!

Snoring is more common than you think. About half of the world population has snored at some point in their life. Men usually snore more than women, with 4-in-10 male snorers out there compared to 3-in-10 female snorers.

It can also be hereditary: if you snore, you could blame your parents as snoring is hereditary in 70% of cases!

What causes the loud snoring sound?

Snoring happens when the tissue at the back of your throat vibrates as air is inhaled through an obstructed airway. This happens when the tissue is too relaxed, when there is an excessive accumulation of fat tissue at the soft palate or even in children with large tonsils. Any obstruction in the nasal airways such as a deviated septum, when you have a cold or a sinus infection may also result in snoring.

Consumption of sleeping pills, antihistamines and alcohol as well as obesity has also been identified as factors that can lead to snoring.

Why should I be worried?

Other than causing sleep deprivation and restless nights for your partner, snoring may be a sign that you might be suffering from obstructive sleep apnoea (OSA).

What is OSA?

OSA is a serious sleep disorder where breathing repeatedly stops and starts during sleep due to obstruction of the airway. This lowers the amount of oxygen levels in the blood and causes the heart to work harder to increase the oxygen saturation. The increased exertion on the heart elevates blood pressure, increasing the risks for heart attack and stroke.

How do I know if I have OSA?

Common signs of OSA include excessive daytime sleepiness, restless sleep and loud or severe snoring. Other less common signs include headaches, trouble concentrating and mood changes such as irritability and anxiety.

Who should I see?

You can see a medical doctor if you experience any of these symptoms and they will examine the nose, mouth, palate, throat and neck for any abnormalities.

If they suspect that you may have OSA, they will refer you to a Sleep Specialist or an Ear, Nose and Throat (ENT) Specialist. You may also be advised to undergo a sleep study either in a laboratory or at home to determine if you suffer from OSA.

How is OSA treated?

Treatment depends on the cause, the severity of the condition and the level of the airway obstruction.

Lifestyle modifications.

Avoiding alcohol, smoking, sedatives and muscle relaxants will help prevent over-relaxation of the tissue in the airway. Weight loss is also recommended for those who are overweight.

Sleeping positions.

Sleeping slightly higher at a 30 degree elevation of the upper body or on the side is recommended as opposed to sleeping on the back.

Non-surgical intervention.

The most common treatment for OSA is the CPAP (Continuous Positive Airway Pressure) machines which pump air into your mouth during sleep to keep the airway open.
Another option is an oral appliance or splint – a mouth guard that is designed to reposition the lower jaw forward during sleep to prevent the tongue from falling back and obstructing the airway.

Surgical intervention.

The aim of surgery is to remove the cause of the airway obstruction or to attempt to widen the airway. This is dependent on the cause of the OSA and the level of the airway obstruction. This may involve soft tissue surgery such as adenotonsillectomy (removal of enlarged adenoids and tonsils), uvulopalatoplasty (reducing part of the tissue at the soft palate or uvula) and palatal stiffening operation (tightening of the tissue at the soft palate) or surgery on the bone such as maxillomandibular advancement where the upper and lower jaws are moved forward to increase the airway space.

References:

Azagra-Calero, E., et al. (2012.) Obstructive sleep apnea syndrome (OSAS). Review of the literature. Medicina oral, patologia oral y cirugia bucal 17 (6): e925–9. doi:10.4317/medoral.17706. PMID 22549673.

Neill A. M., et al. (1997.) Effects of sleep posture on upper airway stability in patients with obstructive sleep apnea. Am. J. Respir. Crit. Care Med. 155 (1): 199–204. doi:10.1164/ajrccm.155.1.9001312. PMID 9001312

Nakano H., et al. (2003.) Effects of body position on snoring in apneic and nonapneic snorers. Sleep 26 (2): 169–72. PMID 12683476.

Loord H., Hultcrantz E. (2007.) Positioner – a method for preventing sleep apnea. Acta Otolaryngol. 127 (8): 861–8. doi:10.1080/00016480601089390. PMID 17762999

Szollosi I., et al. (2006.) Lateral sleeping position reduces severity of central sleep apnea / Cheyne-Stokes respiration. Sleep 29 (8): 1045–51. PMID 16944673.

The American Academy of Head and Neck Surgery. Available at www.entnet.org.

The British Snoring and Sleep Apnoea Association. Available at www.britishsnoring.co.uk

If you like this article, do subscribe here.

Understanding Sleep

May 3, 2022 Return

Sleep is a basic physiological drive; to feel a need for it is as natural as feeling hungry and thirsty. Just like how nutritious food nourishes the body, sufficient quality sleep is necessary to rest and rejuvenate both mind and body. It is not an exaggeration to say that our survival, proper daily functioning and overall well-being depend upon getting regular optimal sleep.

In fact, sleep deprivation is linked to a number of serious short and long-term health issues. Yet, when our hectic lives get the better of us, getting enough eye-shut often becomes an afterthought.

To truly understand the importance of sleep, we need to understand what actually goes on from the time we drift off to dreamland. We can then work around the factors that govern the natural sleep-wake drive to accommodate our lifestyle, and ensure we catch enough Zs.

The Architecture of sleep

There are 5 stages of sleep that passes through from the moment a sleeper drifts away from wakefulness. These stages – 1, 2, 3, 4, and Rapid Eye Movement (REM) sleep – are categorised based on changes in brain activity, as reflected in measurements of brain waves. They progress in cycles, from Stage 1 to REM and back again, repeating four to five times throughout the course of a typical night’s sleep with each cycle lasting an average of 90 to 110 minutes.

Stage 1: Light sleep –

A few minutes into relaxation, the sleeper drifts from wakefulness. Body temperature begins to drop, muscles gradually relaxed, awareness of surroundings begins to fade and bran waves slowed into a pattern called theta waves. Stage 1 lasts for only about 5 minutes, and if disrupted, the sleeper is easily stirred back into wakefulness without being able to recall falling asleep at all.

Stage 2: Establish sleep –

Eyes stop moving, heart rate, breathing and brain waves became slower from the waking state. The sleeper can still be awakened by external or internal stimuli, such as loud noises nearby or being shaken.

Stage 3: Deep sleep –

At this stage, the sleeper’s blood pressure and pulse dropped to about 20-30% below waking rates and the brain becomes unresponsive to external stimuli. It now becomes very difficult to rouse the sleeper. If forcefully awakened, one will feel extremely tired and groggy.

Stage 4: Moving deeper into delta sleep –

This is the time for the body to renew and repair itself. The pituitary glands releases growth hormone to stimulate tissue growth and muscle repair, and the immune system also receives a boost.

REM sleep –

The sleeper enters the dreaming stage. The eyes dart back and forth under closed lids, breathing becomes rapid, while body temperature, heart rate, blood pressure and brain activity fluctuate to levels similar to wakeful state. Other than minor twitching, the body hardly moves, because all muscles besides those responsible for breathing and eye movement are temporarily paralyzed to prevent the sleeper from acting out their dreams. While deep sleep is necessary for physical health, REM sleep is needed for mental health. Dreaming serves a necessary function of clearing out mental clutter to better facilitate memory and learning.

Night Time is for sleeping

Feeling sleepy and being wide awake is regulated by an internal biological clock, known as the circadian rhythm. This brain mechanism is influenced by various external factors, namely light and time cues, which explains why we feel alert during daytime and tiredness sets in when it gets dark.

Even so, sleep habits vary in different people. “There are 2 types of sleepers; morning larks and night owls. A morning lark tends to wake up early and go to bed early. A night owl on the other hand, tends to sleep late and wake up later in the morning,” explained Amy Ho, a registered polysomnographic sleep technologist, and Senior Sleep Technologist at the ASEAN Sleep Research and Complete Centre (an initiative of University Malaya Specialist Centre).

Whichever type of sleeper one may be, the typical adult still needs seven to eight hours of sleep each night for optimal health and proper functioning during the day. Moreover, it is unlikely for sleep needs to change as one gets older. “What will change is the sleep architecture, which may contribute to sleep problems among the elderly,” said Dr Izuan Ismail, Consultant Respiratory Physician and Senior Lecturer at the Faculty of Medicine, Universiti Teknologi MARA.

Shedding light on the common misconception, he explained why people sleep less with age, “Although the amount of sleep needed often remains constant, older people spend more time in the lighter stages of sleep than in deep sleep. They are also prone to advance phase sleep disorder, where they tend to fall asleep early around 8 to 9pm, and wake up at night.”

Nevertheless, the best way to ensure uninterrupted sleep is to practice good sleep hygiene. Your sleep hygiene refers to cultivating practices, rituals and behaviours before bedtime, and also the design of your sleep environment. Good sleep hygiene means cultivating habits that signals to the mind and body to relax and prepare for sleep, in a comfortable environment that is conducive to sleep.

The key to maintaining good sleep hygiene, Ho said, is consistency. “Set a regular sleep and wake time every day, including weekends and public holidays. This practice will anchor the biological clock at the desired time.”

She also offered a simple suggestion for good sleep hygiene; remove electronics such as a computer, TV or mobile phones from the bedroom, as these items emit lights that can delay sleep onset by a few hours. Furthermore, one may be stirred by the sound from their gadgets during REM sleep. “We have to associate bedroom with sleep and sex only, so no watching TV, working on the computer, eating or texting in bed. Your last meal should be three to four hours before bedtime. If you get hungry at night, a light snack is recommended,” said Ho.

Never too busy to sleep

Often times, the common excuse for not getting enough sleep is being too busy and having too much to do. This may be a legitimate concern for those whose job requires frequent travelling and odd hour client meetings. In such cases, one could benefit from taking naps.

“A study at the National Aeronautics and Space Administration (NASA), US, on sleepy military pilots and astronauts found that a nap improved performance by 34% and alertness by 100%,”said Dr Izuan. However, napping has to be done correctly, with an understanding of the sleep architecture, for it to be beneficial.

According to Dr. Izuan, the key to effective snoozing is to avoid going into arriving at the deep sleep stage and waking up feeling more tired than before, “A nap should be about 20-30 minutes and not longer. Napping should not be too late in the day either, as it will affect night time sleep patterns. The best time is probably around lunch time, in the afternoon.”

Although it is ideal to maintain a sleep schedule during the same time frame each day, with as little variation to the routine as possible, it may not be feasible for certain individuals due to work-life demands, such as having to work night shift. If you need to go against the natural sleep-wake rhythm, Ho recommended a few quick fixes:

Spend time outside in the afternoon or early evening. “This will help in staying up later and be more alert because the body is exposed to bright light.”
Exercise in the evening. “A walk or going to the gym will promote alertness.”
Taking caffeine. “Drinking coffee, energy drinks or chocolate, 20-30 minutes before work may help to boost alertness.”

While these short -term remedies may be helpful, they should be utilised sparingly as continuous sleep deprivation and living out of sync with the day is bound to take its toll. “Short-term consequences are feeling tired, lethargic, drowsy, irritable, unable to concentrate, decreased work productivity and increased risk of accidents. Long-term consequences include developing hypertension, diabetes, increase risk of heart attack and stroke, obesity, depression and impotence,” Ho cautioned.

References:

ASEAN Sleep Research and Complete Center (ASRCC). Available at

www.aseansleep.org

Epstein, L., & Mardon, S. (2007). The Harvard Medical School guide to a good night’s sleep. New York: McGraw-Hill.

Sleep Disorder Society Malaysia (SDSM). Available at www.sleepsocietymalaysia.org

If you like this article, do subscribe here.

Treat, Not Tolerate

May 2, 2022 Return

Dr Jose Antonio San Juan Consultant Orthopedic Surgeon, Chong Hua Hospital, Phillipines

When Adam underwent a hernia surgery sometime ago, he expected a certain amount of pain post-surgery. After all, pain after surgery is normal. However when the pain persisted for several months, he suspected something amiss and consulted his doctor. What he thought was a typical after-effect of surgery was actually persistent post-operative pain.

Which is which?

Like Adam, many people have initially chalked up their persistent post-operative pain to something unimportant and tried tolerating it as long as possible. This only increased their suffering and decreased their quality of life. So, it begets the question: Where is the fine line separating normal post-operative pain from persistent post-operative pain?

Dr Jose Antonio San Juan explains, “Persistent post-operative pain is pain which persists beyond the patient’s expected recovery period and is most common in thoracic, abdominal and orthopaedic surgeries. It mustn’t be confused with acute post-operative pain which occurs immediately post-surgery. It typically lingers for days to weeks which is an expected outcome of surgery.”

Elaborating further, he says, “Common causes of persistent post-operative pain include inefficient acute post-operative pain control, inadequate post-surgery analgesia, soft-tissue injury (possibly due to poor surgical technique) and patient-related factors which have been inadequately addressed pre-surgery (eg, anxiety, depression or chronic pain disorders).”

Ignorance isn’t bliss

“Patients respond differently to persistent post-operative pain for various reasons which may include their own expectations of the surgery and cultural beliefs. There are some who tend to brush it off because they expect pain post-surgery but what they don’t realize is this pain can become persistent and is actually treatable.”

Prevention is key

When asked if persistent post-operative pain is preventable, Dr Jose says, “Yes, it’s possible if risk factors are properly addressed peri-operatively (before, during and after surgery). Patient education is crucial pre-surgery. Also, the surgeon must employ methods of preventive or preemptive analgesia. The patient should be given medication that’s tailored for their needs. Doses should be adjusted according to the patient’s pain score.”

When treating persistent post-operative pain, a multimodal approach is used – meaning treatments are combined to offer maximum relief. “Various types of medication are used like NSAIDS, opioids and anticonvulsants. Anticonvulsants can effectively control post-surgery pain. For instance, in total knee replacement surgeries where the neuropathic pain incidence is as high as 12%, the incidence was reduced to 0 when anticonvulsants were used peri-operatively.”

Dr Jose concludes, “While the condition can’t be cured, it can be controlled and kept to a minimum. If you suspect you’ve a problem, get yourself checked. Treatment can improve your quality of life significantly.”

If you like this article, do subscribe here.