A Nephrologist Answers Your Questions About Organ Transplant

WORDS DR MUHAMMAD IQBAL ABDUL HAFIDZ

FEATURED EXPERT
DR MUHAMMAD IQBAL ABDUL HAFIDZ
Head of the Nephrology Unit and Kidney Transplant Programme
Universiti Teknologi MARA (UiTM)
QUESTION 1
Considering the advances made in dialysis technology, why is kidney transplant still considered a necessity for people with end stage kidney disease?

Kidney transplantation is generally regarded as the optimal treatment endpoint for individuals with end stage kidney disease.

This is because it offers superior long-term outcomes, improved quality of life, and reduced health risks.

Patients can lead a life like the one before they underwent dialysis.

However, it’s essential to consider individual eligibility and specific medical circumstances when determining whether the individual is suitable to receive a kidney transplant.

QUESTION 2
What are the likely reasons that make many Malaysians hesitate to donate their organs?

Such hesitancy could be due to cultural and religious beliefs, lack of awareness about the benefits and importance of organ donation, concerns about the healthcare system’s transparency, and potential family influences on their decision-making.

QUESTION 3
What are some of the common misconceptions that Malaysians harbour about organ donation?

Common misconceptions include:

  • Fears about the impact on the body after death.
  • Concerns about the fairness of organ allocation.
  • Lack of trust in the healthcare system.
  • Misunderstandings about the compatibility of organ donation with cultural or religious beliefs.

Education is crucial to dispel these myths.

QUESTION 4
What are the criteria for one to be eligible to be an organ donor?

Eligibility criteria for organ donation include:

  • Being in good general health.
  • Typically, under the age of 70.
  • Have no active infections or severe medical conditions.
  • Donor meets specific organ-specific criteria.

It’s essential for potential donors to discuss their intentions with their immediate family and register as donors to ensure their wishes are known and considered.

QUESTION 5
How do we register as an organ donor?

You can register as an organ donor through the MySejahtera app.

It is very simple to do. All you need to do is ensure that the next of kin is informed, which is part of the registration itself.

Once you complete the registration, the donor card will appear on the MySejahtera app.

If you change your mind later about being an organ pledger, you can make the necessary changes via the app at any time after you have registered.

An Expert Discusses What Happened to the Generational Endgame Bill of Malaysia

WORDS MUHAMMAD ZAID ZAINUDDIN

FEATURED EXPERT
MUHAMMAD ZAID ZAINUDDIN
Lecturer (Anatomy)
Centre of Preclinical Science Studies
Faculty of Dentistry
Universiti Teknologi MARA (UiTM)
IN RECENT NEWS

In November 2023, the Dewan Rakyat passed the Control of Smoking Products and Public Health Bill.

The Bill aims to regulate the sale and purchase of tobacco products, smoking materials, tobacco substitute products, and smoking devices, which includes smoking products such as electronic cigarettes or vape.

Though the passing of the bill is a positive step for the country’s public healthcare system and future generations, it has left members of the parliament and public health experts outraged.

WHY THE OUTRAGE?

The passed Control of Smoking Products and Public Health Bill is a watered-down version of the ambitious proposal initiated by our former Minister of Health, Khairy Jamaluddin.

The previous bill, dubbed the “Generational Endgame Bill”, proposed to prohibit persons born on or after 1 January 2007 from purchasing and smoking tobacco products, substitute tobacco products and smoking substances which includes e-cigarettes and vapes.

The bill passed in November 2023 removed this bold clause that would give rise to a smoke-free Malaysian generation in the future.

WHAT WOULD HAPPEN IF THE GENERATIONAL ENDGAME BILL WAS PASSED IN ITS ORIGINAL PROPOSED FORM?

In terms of impact on healthcare, the proposed Generational Endgame policy would ban smoking and vaping for those born in 2007 and onwards for the rest of their lives.

Ideally, this will create a smoke-free generation in the coming decades and save north of RM6 billion ringgit per year in terms of healthcare expenditure in the years to come.

This is stipulated by 2020 data, whereby the country had spent RM6.2 billion to treat three major diseases caused by smoking; lung cancer, heart disease, and chronic obstructive pulmonary disease. This cost was estimated to increase to RM8.8 billion by 2030 and will increase further if smoking had not been curbed.

THEN, WHY WAS THE GENERATIONAL ENDGAME CLAUSE DROPPED?

The Generational Endgame clause was dropped after considering the views from the Attorney-General’s Chambers, who claimed potential constitutional arguments.

The clause is unconstitutional.

In brief, the passing of the bill would create unequal treatment under the law between persons born before 1 January 2007, and individuals born after.

This is contradictory to Article 8 (1) of the Federal Constitution, which states that every person shall be equal under the law and have equal protection of the law.

The proposed bill would be unconstitutional as it would create two sets of laws for two different groups of citizens based on age.

Socio-economic impact on Malaysians.

An assessment of Malaysia’s Generational Endgame Policy by Oxford Economics, published in September 2023, states that the policy would be unlikely to deliver a reduction in healthcare costs. This is because future smokers would switch to illicit products.

This is on the basis that Malaysia has one of the largest illicit tobacco problems globally, with an estimated 57% of all cigarette sales in 2022 occurring through illicit channels.

An argument against the bill claims that a total ban of tobacco products would just expand the illicit tobacco market.

Impact on the economy.

The report also estimates that the legal tobacco industry in Malaysia currently supports a RM983 million contribution to the country’s GDP, RM3.3 billion in tax receipts, and 7,940 jobs.

A total ban of tobacco products would decrease these economic benefits on top of having to sustain an expensive expenditure on policy implementation, public communication, and enforcement programmes in addition to efforts needed to control the expanding of illicit markets.

IS THIS THE END OF THE GENERATIONAL ENDGAME POLICY?

Absolutely not!

The passing of the current bill is a small step forward toward achieving the Generational Endgame policy.

Though not banning the selling of tobacco products in its entirety, the Control of Smoking Products and Public Health Bill protects the younger generation from modern smoking devices, a rampant disease amongst our teenage youths.

The bill prohibits the sale and purchase of tobacco products, smoking materials, or substitute tobacco products as well as the provision of any services for smoking to under 18-year-olds, ultimately curbing the increase of smoking and vaping habit amongst children and teenagers.

IN CONCLUSION

Though our healthcare workers and policy makers are working hard to curb the rise of smoking and vaping, it is of the highest importance to maintain public awareness of the dangers of smoking and vaping. Such public awareness should be promoted and reiterated from generation to generation.

References:

  1. Bernama. (2023, December 7). Experts: Anti-smoking bill first step towards a smoke-free generation. NST Online. https://www.nst.com.my/news/government-public-policy/2023/12/987431/experts-anti-smoking-bill-first-step-towards-smoke-free
  2. Choy, N.Y. (2023, November 23). Health minister pledges to table Generational Endgame bill on tobacco before the end of Parliament sitting. The Edge Malaysia. https://theedgemalaysia.com/node/690959
  3. Harun, H. N. (2023, November 28). GEG dropped due to constitutional arguments – Dr Zaliha. NST Online. https://www.nst.com.my/news/government-public-policy/2023/11/984010/geg-dropped-due-constitutional-arguments-dr-zaliha
  4. Cabello, K. (2023, October 6). An assessment of Malaysia’s ‘Generational Endgame Policy’. Oxford Economics. https://www.oxfordeconomics.com/resource/gegmalaysia/

A Prosthodontist Answers All Your Questions About the Right Way to Brush Your Teeth

WORDS DR ZETHY HANUM MOHAMED KASSIM

FEATURED EXPERT
DR ZETHY HANUM MOHAMED KASSIM
Senior Lecturer and Prosthodontist
Faculty of Dentistry
Universiti Teknologi MARA (UiTM)

The health of your teeth and their supporting structures can be compromised by decay.

Indeed, tooth decay affects an estimated 2 billion adults and 514 million children worldwide, while gum disease affects 19% of the world population.

The following are answers to some common questions commonly received by dentists, related to the maintenance of healthy teeth and gums.

WHAT ARE THE CAUSES OF DENTAL DISEASES?

The main culprit is plaque.

Plaque is a sticky white substance found on the surface of a tooth. It contains bacteria, proteins, bacterial by-products, and food debris.

Tooth decay

Bacteria in plaque ferment sugar into lactic acid, the latter can cause the tooth to lose important protective minerals via a process called demineralization. Over time, this process will lead to tooth decay.

Gum disease

The presence of bacterial products can also trigger an overt response from your immune system. This could result in gum disease that, if left untreated, will eventually cause the destruction of the ligaments and bony socket that keep the affected tooth in place.

Tooth loss

Over time, when left untreated, both gum disease and tooth decay can lead to the loss of teeth.

WHY IS TOOTHBRUSHING IMPORTANT?

The act of brushing your teeth can disrupt plaque that is present on the surfaces of your teeth.

This will thus help to prevent tooth decay and gum disease.

HOW OFTEN SHOULD I BRUSH MY TEETH?

Currently, evidence suggests that how often you brush your teeth does not greatly affect your chances of developing tooth decay.

However, it is commonly accepted that you should brush your teeth at least twice a day—after meals and before going to bed.

SHOULD I USE A MANUAL TOOTHBRUSH OR A POWERED TOOTHBRUSH?

Both can be used, but research found that powered toothbrush—also known as electric toothbrush—is more effective in removing plaque (65% compared to 41% using a manual toothbrush).

HOW LONG SHOULD I BRUSH MY TEETH?

2 minutes is the recommended duration for effective plaque removal.

HOW SHOULD I BRUSH MY TEETH?

Use the modified Bass technique. Click on the image below for a larger, clearer version.

  1. Angle your toothbrush at 45° to your gum margin.
  2. Brush gently using a short circular scrubbing motion.
  3. Sweep your toothbrush toward the occlusion surface of the teeth.
  4. Do steps 2 and 3 for the top, outer, and inner surfaces of all your teeth.
  5. Clean your tongue as well in the same short circular scrubbing motion.

Compared to the horizontal scrub method—you drag the toothbrush across your teeth in a horizontal right and left manner—this is a preferred method for effective plaque removal while reducing the incidence of gum recession.

HOW DO I CHOOSE MY TOOTHBRUSH?

Evidence points to toothbrushes with angled bristle tufts being more effective when compared to flat-trimmed or multi-level bristles.

The stiffness of the toothbrush bristles can affect the effectiveness of plaque removal. However, stiffer bristles may lead to more gum recession overtime. Therefore, most dentists would recommend the use of toothbrushes with soft bristles.

SHOULD I PRACTICE INTERDENTAL CLEANING?

Interdental cleaning refers to the cleaning of the areas between the teeth to remove food particles and plaque that are ‘caught’ in those areas.

Toothbrushing alone cannot reach those areas, hence interdental cleaning aids have been introduced for such a purpose.

Interdental cleaning aids

Evidence suggests that the use of interdental toothbrushes and flosses leads to more consistent plaque removal and a reduction in gum inflammation, compared to the use of oral irrigators and wooden or rubber sticks.

When it comes to gaps between teeth, the use of interdental toothbrushes, which are available in various sizes, would be more effective compared to floss.

HOW DO I CHOOSE MY TOOTHPASTE?

Toothpaste must contain fluoride with a minimum of 1,000 parts per million (PPM).

Fluoride helps to mineralize teeth, which is important to help prevent tooth decay.

This substance is usually present in toothpastes in the form of sodium fluoride and sodium monoflourophosphate, so if you are unsure, you can check the package of the toothpaste for the presence of these active ingredients.

OTHER BENEFICIAL ACTIVE INGREDIENTS TO LOOK OUT FOR IN A TOOTHPASTE
  • Stannous fluoride, effective for the reduction of gum disease.
  • Nano-hydroxyapatite and arginine to help reduce dentine hypersensitivity.
  • Hydrogen peroxide and blue covarin colorant produce the best tooth whitening with continued use.
  • Abrasives such as silica, alumina, and calcium carbonate to remove stains. Those with a value below a unit of 250 radioactive dentine abrasion (RDA) are considered safe to prevent progressive tooth surface abrasion.
HOW MUCH TOOTHPASTE SHOULD I USE?

When using regular strength fluoride toothpaste (1,350 to 1,500 PPM), a pea-sized amount is recommended for all individuals and children aged 2 years and above.

A smear is recommended for children under the age of 2, as these children are more likely to swallow their toothpaste—something that can increase their risk of developing mottled teeth or fluorosis.

Fluorosis is caused by ingestion of large amounts of fluoride by children before eruption of their permanent teeth. A common sign of fluorosis is tooth discolouration.
SHOULD I USE MOUTH RINSES?

Mouth rinses may be useful to increase the availability of fluoride for individuals 8 years and older who experience difficulties in brushing their teeth. For example, children that wear braces.

Mouth rinses with active ingredients such as chlorhexidine, acetyl pyridinium chloride, and essential oils may be useful to prevent gum disease.

To improve their effectiveness, mouth rinses should be used at different times from toothbrushing.

Experts Explain Why Thumb Sucking Can Be a Damaging Habit for Children Over 5

WORDS DR NIK MUKHRIZ NIK MUSTAPHA & DR MOHD AMIR MUKHSIN ZURIN ADNAN

FEATURED EXPERTS

DR NIK MUKHRIZ NIK MUSTAPHA
Lecturer and Specialist Orthodontist
Centre of Paediatric Dentistry and Orthodontic Studies Faculty of Dentistry
Universiti Teknologi MARA (UiTM)
DR MOHD AMIR MUKHSIN ZURIN ADNAN
Lecturer and Specialist Orthodontist
Centre of Paediatric Dentistry and Orthodontic Studies Faculty of Dentistry
Universiti Teknologi MARA (UiTM)
5 QUICK FACTS ABOUT THUMB SUCKING
  1. Thumb-sucking—a repetitive behaviour of sucking the thumb—is one of the behaviours referred collectively as non-nutritive sucking habits (NNSH).
  2. This behaviour has the potential to adversely affect the dentition, occlusion, and facial structures.
  3. It is prevalent among young children, particularly girls, and its occurrence tends to decrease with age. Approximately 70% to 80% of children exhibited this habit before the age of 5, with the incidence reducing to 12.1% and 1.9% beyond the age of 7 and 12, respectively.
  4. Interestingly, a higher percentage of mothers with thumb-sucking children had received some college education in comparison to mothers of children that don’t have this habit.
  5. It was also reported that the prevalence of thumb-sucking was least common among children that had favourable breastfeeding opportunities.
THUMB-SUCKING COMFORTS & SOOTHES INFANTS

The thumb-sucking reflex is one of the first sophisticated patterns of behaviour in infants, appearing around the 29th week of age.

Such reflex is considered normal, harmless, and comforting.

It helps infants to fall asleep easier as well as provide a sense of comfort, happiness, and security when they feel distressed.

COMMON FACTORS, EMOTIONS & SITUATIONS ASSOCIATED WITH A BABY’S THUMB-SUCKING HABIT
  • Fatigue.
  • Boredom.
  • Hunger.
  • Anger.
  • Fear.
  • Excitement.
  • Tooth eruption.
  • Insufficient sense of satisfaction.
  • Physical and emotional stress.
WHAT STARTED OUT AS AN EMOTIONAL COPING MECHANISM CAN BECOME A HABIT WHEN THE CHILD IS OLDER

Because thumb-sucking is a comforting coping mechanism, a child may eventually develop a strong attachment to this habit that persists at an older age.

This is the point at which problems begin to arise.

There is a direct link between the destructive effects of thumb-sucking habit and the intensity, frequency, and duration of the habit.

Having the habit for a short period will not leave much of an impact on the child.

However, continuous thumb sucking more than 6 hours daily often lead to the development of significant destructive outcomes.

Abnormal Pattern of Teeth Formation

The constant pressure and sucking motion exerted by the thumb on the teeth may interfere with a child’s normal path of tooth eruption and cause teeth to shift unnaturally. The position of the thumb within the oral cavity determines the pattern of the deformity.

A study has indicated that the incidence of tooth misalignment (malocclusion) is 3 times higher among children that exhibit thumb-sucking behaviour and other unhealthy oral habits, compared to those who do not have any such habits.

Asymmetrical Open Bite

The child’s front upper and bottom teeth do not come in contact when biting. This is usually worse on the side that the digit is sucked.

In turn, this may interfere in biting, speech, and to some extent, prevent closing of the lips.

Asymmetrical Facial Appearance

The narrowing of the palate associated with strong buccal musculature contraction and low position of the tongue can lead to the development of a posterior crossbite.

This can potentially impede the establishment of a proper bite and cause the jawbone to shift to one side, resulting in an asymmetrical facial appearance.

Increased Overjet

The tongue may push the upper front teeth forward, resulting in a ‘sticking out’ appearance while the lower front teeth is backward. The combination of these movements will result in an increased horizontal gap between the upper front and lower front teeth, a condition referred to as increased overjet.

Children with an increased overjet usually are at a greater risk of dental trauma due to the prominence of the teeth.

Speech Difficulties

Pronouncing certain words using tip of the tongue may be difficult, often with the child developing a lisp.

Skin Problems

Prolonged thumb sucking can cause skin irritation, cracked skin, and callus formation along the thumb.

Fingernail infection and eczema of the thumb may also develop.

WHEN SHOULD PARENTS BE CONCERNED ABOUT THEIR CHILD’S THUMB SUCKING?

The American Dental Association recommends intervening before a child turns 4 or, at the latest, by the time the permanent front teeth are about to erupt at the age of 5.

If the habit continues into the mixed dentition stage, past the age of 6, problems with the position of teeth might occur.

These problems can still self-correct and the child experience normal tooth growth if the habit is stopped by the age of 7.

After this age, the positions of the child’s teeth become more established and self-correction is less likely to occur. Complex orthodontic treatment is needed at this stage.

Hence, parents should aim to help their child stop the habit as early as possible, such as during preschool.

HOW TO WEAN YOUR CHILD OFF THUMB SUCKING
Psychological or Behavioural Approaches

Identify triggers. Determine the situations or times that would most likely drive your child to suck their thumb. By identifying these triggers, you can redirect their attention or provide them with alternative forms of comfort.

Positive reinforcement. Celebrate your child’s thumb-free moments. Consider setting up a reward system like a sticker chart that allows your child to visualize their progress and earn treats for sustained periods without thumb-sucking.

Communicate. Engage your child in age-appropriate discussions about thumb-sucking. Help them understand why they need to stop, while at the same time addressing any of their anxieties that lead them to suck their thumb.

Use visual reminders such as a band-aid on their thumb or a colourful bracelet on their wrist as a visual cue to remind them not to suck their thumb.

Distraction and substitution. Help your child find alternative ways to comfort themselves or keep their hands busy. Offer items like a soft toy, a soothing blanket, or even a stress ball. Keeping their hands occupied can divert attention away from thumb-sucking.

Seek professional help. If your child’s the thumb-sucking habit persists despite your efforts, consider consulting a child psychologist or counsellor. They can help identify any underlying emotional or psychological issues contributing to the habit and provide appropriate guidance.

Non-orthodontic Strategies

Thumb guards are devices that fit over the thumb and make thumb-sucking less enjoyable.

Other forms of physical barriers that can be used include bandages and gloves, but parents will have to monitor the child as these barriers can be easily removed by the child.

Taste-based deterrents. Apply bitter-tasting products to the child’s thumb as an immediate and often effective deterrent.

Orthodontic Strategies

Palatal crib is a dental appliance attached to the upper teeth. It prevents the thumb from comfortably resting against the roof of the mouth. Dentists often recommend the use of this appliance if the child’s thumb-sucking habit is causing dental issues.

Bluegrass appliance is designed to redirect thumb-sucking behaviour. It includes a roller or bead that the child can play with using their tongue, instead of sucking their thumb. Over time, this can help break the habit.

Quad-helix with crib attachment is recommended for more severe dental complications arising from prolonged thumb-sucking. This device corrects dental misalignments while curbing the thumb-sucking habit.