A Dentist Sets the Record Straight on How Kids Can Have Healthy Teeth

WORDS LIM TECK CHOON

Tip 1
START EARLY—CLEAN YOUR BABY’S GUMS AT LEAST TWICE A DAY

“It is easy to overlook oral care in babies – after all, they won’t have teeth till months later!” says Dr Yogeswari Sivapragasam,

  • Get a clean, damp washcloth.
  • Use the washcloth to gently wipe clean your baby’s gums.
  • Also gently clean the front of your baby’s tongue.

You should do this after every breastfeeding.

“Besides that, parents should also get advice from healthcare practitioners, such as a nurse advisor at community clinics or paediatricians, on how to care for their child’s oral health from birth, which includes what to do when their teeth first appear,” Dr Yogeswari further advises.

Tip 2
DELAY ADDING SALT & SUGAR INTO YOUR KID’S DIET

Dr Yogeswari advises us to hold back the introduction of added salt and sugar into their child’s diet.

This is because getting your child hooked early on sweet or salty foods can increase their risk of dental problems as well as chronic health conditions (obesity, type 2 diabetes, etc) later in life.

Instead, let your child develop a liking for naturally unsweetened and unsalted foods.

Tip 3
TAKE YOUR KID TO THE DENTIST REGULARLY & MAKE THESE VISITS AS FUN AS POSSIBLE

Children should receive their first dental check-up when they are 1 year old.

“Remember this: first birthday, first dental check-up!” says Dr Yogeswari.

After the first dental visit, you are advised to bring your kid to the dentist every 6 months.

“While it is unlikely that they will have any dental problems at this young age, this will help young children have a positive experience rather than associate dental visits with pain and fear,” Dr Yogeswari further adds. “Regular visits will help to normalize the experience of visiting a dentist and will go a long way towards preventive care.”

Of course, regular visits to the dentist will also help to detect early any potential problems with your kid’s oral health and tooth development, and allow the dentist to address these problems without further delay.

Tip 4
KEEP AN EYE OUT FOR UNUSUAL CHANGES IN BEHAVIOUR

Your child sometimes refuses certain foods or refuses to brush their teeth. “While this may be easily explained as the child being fussy or picky, there could be another reason behind it,” says Dr Yogeswari.

For example, your child may have developed cavities or gum disease, and the constant pain and discomfort may cause them to refuse foods that need to be chewed.

“This may inadvertently lead them to avoid whole foods such as apples and chicken,” Dr Yogeswari elaborates, “and choose softer foods instead, many of which are processed and contain higher levels of salt, sugar and fat. Over time, this may lead to nutritional deficiencies or chronic conditions that can affect a child’s health into adulthood.”

The constant pain can also cause irritability and affect their ability to concentrate during lessons in school.

“In addition, poor oral health can also affect a child’s self-esteem if they are teased due to the appearance of their stained or rotten teeth. This may cause them to avoid social activities or become withdrawn,” Dr Yogeswari adds.

As such, be alert and check for possible dental problems if your child suddenly appears to be unwilling to chew or becomes irritable without any apparent cause.

5 Popular Dengue Myths Debunked by a Family Medicine Specialist

WORDS LIM TECK CHOON

Myth 1
YOU ONLY CATCH DENGUE ONCE IN YOUR LIFETIME 

Unfortunately, no.

“There are 4 dengue serotypes,” says Associate Professor Dr Verna Lee Kar Mun.

Serotype is a word used to describe a strain of microorganism, which means that there are 4 different types of the dengue virus that can infect us.

This means that each of us can get infected up to 4 times, once with each serotype, and achieve total immunity to dengue only after being infected with all 4 serotypes!

“However, before you start thinking it’s a good idea to get infected four times, bear in mind that subsequent infections are likely to be more serious than the first,” warns Assoc Prof Dr Verna, “and each infection only increases your chances of getting severe dengue.”

Myth 2
YOU’RE GETTING BETTER WHEN YOUR FEVER GOES AWAY

Well, things are not so simple.

You see, according to Assoc Prof Dr Verna, there are 3 different stages of dengue fever.

  • Febrile phase: 1 to 2 days of high fever that begins suddenly. During this time, we’re likely to have experience aches, headache with pain behind the eyes, flushed faces, and sometimes blotchy skin or rashes.
  • Critical phase: the fever subsides, and we may feel that we are getting better. However, these 1 to 2 days are also a period when our blood capillaries may leak plasma, leading to a sudden drop in blood pressure and sending us into shock.
  • The next phase will depend on the outcome of the critical phase. We may get better after receiving proper medical treatment and proceed to the recovery phase, or we may get worse and experience severe dengue instead.

“Many viral illnesses such as dengue are self-limiting, which means they will naturally subside,” Assoc Prof Dr Verna shares. “In most cases, patients only need self-care at home, and the most important thing to remember is to take plenty of fluids to prevent the dehydration that comes with plasma leakage.”

“Anyone who gets dengue fever should aim to drink at least 3 litres of water daily for the first 3 days,” she adds.

Myth 3
DENGUE IS ONLY A SMALL CONCERN; AFTER ALL, YOU CAN GET BETTER FROM PRACTICING SELF CARE AT HOME

Not necessarily true.

“An estimated 1% of patients will experience severe dengue, also known as haemorrhagic dengue, which will require hospitalization,” says Assoc Prof Dr Verna.

She goes on to explain that one may begin to experience bleeding during the febrile phase, usually in the skin or gums. If the bleeding weren’t managed well, the dengue will worsen during the critical phase, forcing us to be admitted into the hospital.

“Those with a healthy immune system usually recover in 2 days, but if there is inflammation affecting the organs such as the heart, liver or brain, it can take up to a week, longer if there are other complications,” she goes on to say.

Myth 4
YOU SHOULD ONLY TEST FOR DENGUE AFTER 3 DAYS 

“It is true that the initial symptoms are vague, as a fever can be a sign of many different illnesses,” says Assoc Prof Dr Verna.

However, with dengue, the high fever usually comes suddenly.

“The S1 dengue rapid antigen test can detect dengue from the first day, so don’t delay seeking medical advice if you suddenly develop a high fever,” she advises.

Delay in getting tested may lead to severe consequences, as we will enter the critical phase 1 to 2 days after catching dengue—a time when our condition can suddenly take a turn for the worse!

Myth 5
ONCE YOUR NEIGHBOURHOOD HAS BEEN FOGGED, THERE IS NO NEED TO DO ANYTHING ELSE TO PREVENT DENGUE

Not true.

Assoc Prof Dr Verna reveals that while fogging helps to kill adult mosquitoes and getting rid of stagnant water in public drains and other places helps to prevent breeding sites, this method are only partially effective.

To illustrate, millions are spent on fogging efforts every year—an estimated RM777 million was spent on fogging efforts in the 2009 to 2010 period—but dengue remains prevalent to this day. There is even evidence that mosquitoes have grown resistant to the common insecticides used in fogging!

“On a personal level, all of us can do something at home to help prevent mosquito bites and breeding sites. We need to make a bigger effort to protect ourselves and our loved ones by making sure our home environment is clear of any breeding sites, covering up exposed skin and using mosquito repellents, especially during sunrise and sundown,” she advises.

Rise of the Superbugs

WORDS LIM TECK CHOON

PROFESSOR CHIN BEEK YOKE
Associate Dean
School of Health Sciences
International Medical University

Superbug is a term coined to describe multi-drug resistant bacteria.

Medications that are usually effective on them, such as antibiotics, just don’t work as effectively anymore. “These are bacteria that circumvent the effects of antibiotics and proliferate or multiply uncontrollably in the host,” explains Professor Chin Beek Yoke.

EVERY BACTERIAL SPECIES CAN BE A SUPERBUG

Any species of bacteria can develop a resistance to antibiotics and become a superbug.

“Bacteria are very smart. They will mutate to overcome antibiotics. Once bacteria has the resistance gene in them, they can duplicate and combine with different species of bacteria. That’s how bacteria propagate their multi-drug resistance in nature,” Prof Chin shares.

WE HAVE A ROLE IN CREATING SUPERBUGS

According to Prof Chin, a key reason why superbugs are prevalent is the unnecessary and over-prescription of antibiotics.

GOOD HABITS TO ADOPT
  • Take antibiotics only when necessary. Diseases that are not caused by bacteria do not require antibiotics!
  • Complete your full course of antibiotics—finish all the antibiotics your doctor gave you. Don’t stop just because you think you are feeling better.
  • Avoid using unapproved or black market antibiotics that are not at full strength and do not work as effectively as genuine ones
IMPROPER DISPOSAL OF ANTIBIOTICS MAY ALSO PLAY A ROLE

People tend to dispose of antibiotics incorrectly, and this can be a problem.

“We pour it down the drain, or throw it into the trash. The excess antibiotics then get into our ecosystem, in the soil, or may end up in rivers and water bodies,” says Prof Chin.

GOOD HABIT TO ADOPT
The correct way to dispose of the extra antibiotics is to bring them to your nearest pharmacy. Many pharmacies are equipped to dispose of extra medicines in the appropriate manner.
THEN THERE’S THE ISSUE OF ANTIBIOTICS IN ANIMAL AND FISH FEED…

Another cause is the use of antibiotics in feed for domestic animals or fish. When humans consume the meat from these animals and fish, they also consume the residual antibiotics present in these products.

This unintended consumption of antibiotics may modify the bacterial environment in our bodies and render us susceptible to future bacterial infections.

GOOD HABIT TO ADOPT
Purchase foods that are obtained from sources that are free of antibiotics.
HOW TO MINIMIZE POSSIBLE CONTACT WITH SUPERBUGS

Multidrug resistant bacteria are everywhere, but we can do a few things to reduce coming in contact with them.

PRACTICE GOOD HYGIENE
  • Wipe surfaces and clean items that come into our household
  • Wash all fruits and vegetables after purchase, before storage, and before cooking. This will prevent the bacteria from propagating
  • If you wish to try fruits from stalls and supermarkets in order to ‘test before buying’, wipe them first with a wet wipe
  • Wear shoes and socks when travelling in areas where contaminated soil or water is prevalent
DON’T PANIC TOO MUCH ABOUT COMING IN CONTACT WITH SUPERBUGS, HOWEVER!

Prof Chin explains that having them on your skin alone doesn’t mean that you will become infected and suffer.

“Your skin is a very good protective organ,” she says. “Bacteria or pathogens can only enter when there is a cut. So, if you don’t have a cut or laceration, you will be fine. Just make sure to wash your hands and feet or any exposed areas.”

The same goes for the times when you ingest bacteria. “You will usually have enough stomach acid to kill these superbugs, and most of the time you have enough innate immune cells in your body to fight them off,” she explains.

However, people with health conditions that weaken their immune system should take precautions to reduce their odds of contracting bacterial infections; they should consult their doctor on the best ways to do this.

Let’s Talk about Monkeypox

WORDS LIM TECK CHOON

PROFESSOR DR JAMES KOH KWEE CHOY
Head of Division of Medicine
School of Medicine
International Medical University
FACT 1
MONKEYPOX IS CAUSED BY, YES, THE MONKEYPOX VIRUS
This virus belongs to the same family (Poxviridae) as the smallpox virus.

“The monkeypox virus was first isolated from a colony of monkeys in the 1950s, hence the name. Although it is called ‘monkeypox’, monkeys and humans are incidental hosts,” explains Professor James Koh Kwee Choy, an infectious disease consultant. “The actual reservoir is unknown, but is likely to be certain rodents.”

What we know it that the virus can be transmitted from animals, such as primates and rats, to humans. From thereon, the virus can be spread by humans to other humans and even other animals.

FACT 2
MONKEYPOX IS NOT A NEW DISEASE, AND IN FACT USED TO BE PRETTY RARE… UNTIL 2022, THAT IS
Monkeypox was first identified as a cause of disease in humans in the 1970s, when it was detected among certain populations in the Democratic Republic of Congo (at that time, the country was called Zaire).

Because outbreaks were rare and the spread was limited outside of the African continent, in the years after researchers assumed that the virus spread to humans in an ‘inefficient’ way.

Well, that assumption was definitely challenged in the May 2022 monkeypox outbreak!

“This outbreak is unusual because, in the past, the number of cases were small,” shares Prof James. “This time around, there is a wider and faster spread, and the symptoms or presentations are also different.”

In light of the outbreak, the WHO has since declared monkeypox an ‘evolving threat of moderate public health concern’.

YOU MAY HAVE MONKEYPOX IF YOU…
  • Develop a rash at or near your genitals or anus; other possible locations for the rash include your hands, feet, chest, face, and mouth
  • The rash may look like pimples or blisters, but will go through several stages (including scabbing) before healing
  • The rash can be painful or itchy
  • Some people may also have symptoms such as fever, swollen lymph nodes, aches in their muscles and back, headaches, coughing, sore throat, etc
  • Symptoms can vary from person to person; some may develop a rash first before other symptoms, while others develop the symptoms first and rash later, or they only develop a rash with no other symptoms
FACT 3
MONKEYPOX ISN’T ALWAYS FATAL, BUT THAT DOESN’T MEAN WE SHOULD TAKE IT LIGHTLY

Monkeypox has a recorded fatality rate of 1% to 10%.

Without any treatment given, the disease can usually resolve on its own between 2 and 4 weeks.

However, some people with monkeypox may develop severe complications, especially if they have existing health conditions or are undergoing treatments that weaken their immune system. These people will need hospitalization and close medical care.

FACT 4
MONKEYPOX CAN BE SPREAD THROUGH CLOSE & PROLONGED SKIN-TO-SKIN CONTACT

Prof James emphasizes that it is important to remember that transmission requires prolonged exposure to the infected person.

Brushing against someone in a crowded place, for example, or quickly kissing someone are unlikely to cause transmission.

So, what are the more likely means of transmission that we should be aware of?

  1. Direct contact with the rash or body fluids of someone with monkeypox—note that this includes not just oral or penetrative sex but also touching, kissing and other face-to-face contact, hugging, massaging, and other intimate acts with the infected person
  2. Prolonged contact with items that are or have been used by someone with monkeypox, such as clothing, bedding, towels, etc.
  3. Prolonged exposure to the person’s respiratory secretions, which are produced when they talk, sneeze, cough, etc
  4. An infected pregnant woman may spread the virus to the child she is carrying
  5. It is also possible that one may contract monkeypox from eating poorly-cooked meat of infected animals, or from scratches and bites of infected animals

Someone with monkeypox can spread the virus from the time they develop their symptoms until the rash is fully healed.

FACT 5
MONKEYPOX IS NOT A ‘GAY PERSON’S DISEASE’—IT CAN AFFECT ANYONE AND EVERYONE

While it is certainly true that monkeypox currently affects a large population of men who have sex with men (MSM), it will be a mistake to assume that it is a disease that affects only these men.

As we have seen, the virus can spread through other means other than sex, so people that don’t engage in acts of intimacy with members of their own sex shouldn’t be complacent and assume that they are safe from it!

FACT 6
YES, THE SMALLPOX VACCINE MAY HELP, BUT THINGS ARE NOT SO STRAIGHTFORWARD

While smallpox and monkeypox are two different diseases, Prof James notes that the smallpox vaccine can help reduce the risk of catching the monkeypox by up to five times.

“Most Malaysians born before 1980 are vaccinated against smallpox as part of the National Immunisation Programme of that time,” Prof James notes.

Unfortunately, smallpox vaccines are not readily available. Therefore preventive strategies are important.

Click on the image to see the large version.

References:

  1. Ladnyj, I. D., Ziegler, P., & Kima, E. (1972). A human infection caused by monkeypox virus in Basankusu Territory, Democratic Republic of the Congo. Bulletin of the World Health Organization, 46(5), 593–597. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2480792/
  2. Thornhill, J. P., Barkati, S., Walmsley, S., Rockstroh, J., Antinori, A., Harrison, L. B., Palich, R., Nori, A., Reeves, I., Habibi, M. S., Apea, V., Boesecke, C., Vandekerckhove, L., Yakubovsky, M., Sendagorta, E., Blanco, J. L., Florence, E., Moschese, D., Maltez, F. M., Goorhuis, A., … SHARE-net Clinical Group (2022). Monkeypox virus infection in humans across 16 countries – April-June 2022. The New England journal of medicine, 10.1056/NEJMoa2207323. Advance online publication. https://doi.org/10.1056/NEJMoa2207323

Please Take This Short Survey about COVID-19 Vaccination and Your Child

WORDS ASSOCIATE PROFESSOR DR ERWIN KHOO JIAYUAN

The survey is now closed. All parties involved would like to express their gratitude to everyone that participated in the study.
ASSOCIATE PROFESSOR DR ERWIN KHOO JIAYUAN
Consultant Paediatrician
Department of Paediatrics
School of Medicine
International Medical University (IMU)
IT CAN BE CHALLENGING FOR A PARENT TO DETERMINE FACTS FROM FICTION WHEN IT COMES TO NEWS ON SOCIAL MEDIA

Netizens who are vaccine hesitant have an alarming footprint on social media. In a vicious cycle, their hesitance is likely to be fueled by health (mis)information obtained from a variety of sources, including news media such as the Internet and social media platforms.

As access to technology has improved, social media has attained global penetration. In contrast to traditional media, social media allow individuals to rapidly create and share content globally without editorial oversight. Users may self-select content streams, contributing to ideological isolation. As such, there are considerable public health concerns.

These worries may be magnified in the face of the ongoing COVID-19 pandemic. As the development and subsequent deployment of more vaccines are expected to play a critical role in downstream emerging pandemic control efforts, social media will remain a powerful tool. Most concerning is how (mis)information and (un)substantiated reports on its platforms will threaten to erode public confidence even well before the release of any scientific evidence.

It is not readily evident why social media is so disproportionately successful in promoting vaccine hesitancy as opposed to uptake. Social media users may represent a skewed population sample with baseline misperceptions regarding the benefits and side effects of vaccination whilst simultaneously lacking familiarity with the consequences of vaccine-preventable disease. Moreover, when evaluating the risks and benefits of vaccination in general, the risks may be overestimated and may seem more immediate, and tangible as compared to the more abstract potential benefits of disease prevention.

IF YOU ARE A PARENT WITH A CHILD UNDER 18, PLEASE SPEND 15 MINUTES TO HELP US BETTER UNDERSTAND THE SITUATION

SOcial MEdia on HesitAncy in Vaccine E-survey or in short, SOMEHAVE, is a multinational collaborative study between International Medical University (IMU), the Singapore’s National University Health System (NUHS), National University of Malaysia (UKM) and Universiti Malaya (UM)

The study uses unidentified e-survey for parents with the aim of seeking the impact of social media on vaccine hesitancy.

For the English survey form, please click here (link opens in a new tab).

For the Bahasa Malaysia version, please click here (link also opens in a new tab).

[IRB Ref No: IMU R 279/2021, UKM PPI/111/8/JEP-2021-824, NHG DSRB (Singapore) Ref: 2021/00900]