Medical Weblog

What are they?

There are many problems connected with wearing dentures, many of which are related to the fact that they are not nearly as stable as natural teeth. Advertisements suggest that denture fixatives are the answer and they certainly do work, but even the best false teeth are clumsy and cannot match up to natural teeth. Surveys have found that between 15 and 45 per cent of denture wearers are unhappy with them, and that 20 million people wear dentures in the US alone. This amounts to a very large number of individuals worldwide. One study found that about 30 per cent of denture wearers thought they needed refitting, or that they needed new dentures.

What causes them?

Some problems with dentures are inevitable because they are not fixed structures like natural teeth. They are only as good as the bony ridge or foundation on which they sit. In a fair percentage of denture wearers the bony ridge shrinks away. As this happens the dentures fit less and less well. This bone loss can be prevented.

Prevention

• Take more calcium. One study of people with denture problems found that those with good underlying bone were consuming about 900 mg calcium a day and that those who had jawbone problems were getting only about 500 mg calcium. Another trial looked at dummy tablets versus vitamin D (which helps with calcium absorption and better bone formation) for jawbone loss. After a year those taking the supplemental calcium had lost 34 per cent less bone from their upper jaws and 39 per cent less from their lower jaws than had the un-supplemented group. This study also found that the ratio of calcium to phosphorus the person consumed was important too. As levels of phosphorus rose jawbone resorption speeded up. The ideal ratio of calcium to phosphorus is 1:1. In red meat, though, there is twenty times too much phosphorus and in refined cereal products six times too much. They found that meat, bread and potato eaters experienced more of this bone loss than did other people. Also, soft drinks contain lots of phosphorus. Even teenage girls have been found to have started losing bone abnormally as a result of their soft-drink intake. This study recommended taking Dolomite, a phosphorus-free calcium and magnesium supplement. It can be bought at health-food shops and chemists. All of this is interesting even to those of us who still have our teeth, because the breakdown of tooth support is seen in gum disease. A study of people with bleeding, inflamed gums found that taking l g of supplemental calcium for six months produced considerable improvement. X-rays of the jawbones showed that bone loss reversed in 70 per cent of the cases.

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Trials and influential factors

In order to determine the safety and value of substances that are to be used to create a change in human or anima conditions, various trials are necessary. Even cosmetic preparations can come into this category because they can influence the physiology of the body by being absorbed through the skin and hair. Trials usually begin with animals and progress to studies using human patients, once safety and reasonable chances of efficacy have been established.

There is little to criticize in the actual trials themselves, provided that they are carried out with the true aim of the trial in mind. This means that these trials should not just be thought of as routine procedures: they must take account of any special application that the substance under trial may have. They must also take into account both the specific nature of the substance and the specific purpose for which it is being used. This all sounds so obvious, but unfortunately trials are not always carried out this way. This can, of course, mean that a potentially valuable substance can be missed or given a false evaluation because of incompetence in trial application.

The interpretation of results

Perhaps the main faults in trial work come in the interpretation of results. In most scientific trials or survey work, once the structure of the trial system has been suitably established, the trial procedures are fairly simple and can be conducted by non-specialist staff. Where expertise and specialist training come in is the interpretation of the results produced by the trial. Unfortunately, even in some of the highly-rated establishments, errors in judgment and mismanagement creep in.

It might be argued that this is, after all, the kind of human error that occurs in all spheres of life. Agreed; but in these cases such errors can result in something of great value in the treatment of disease being incorrectly assessed and perhaps lost, to the detriment of thousands of afflicted people. There are also problems of corruption and bias, particularly when governmental and commercial interests are involved. Having pointed out, perhaps rather dramatically, the way in which trial results are so dependent on the character and ability of those who organize and interpret them, it might be as well to suggest a possible remedy for this disorder in the testing system.

Basically, there is no guaranteed remedy because there will always be corruption. If we ignore this aspect and concentrate on the more practical one of ability, then there are possibilities. Normally, the rating of a person or an establishment is based on ability, though not always. It is suggested that future assessment of potential, new, therapeutic substances will need to be done by assessors who have ability as well as knowledge. This means that they are able to apply their knowledge beyond the narrow confines of books of regulations. This will be a necessity in the future as we progress into the greater utilization of the earth’s resources for survival. This sort of comment is not so dramatic as it may sound. Just think for a moment of the world-wide change in energy and fuel policy over the last few years! The same may happen in medicine and nutrition, though perhaps to a lesser degree.

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Complications of general anesthesia

As has already been mentioned, there is always a small risk associated with the use of a general anesthetic. However, you are far more likely to be run over while crossing the road than you are to suffer any serious complication caused by a general anesthetic.

Very rarely, the supply of oxygen to the brain can be interrupted during anesthesia, and brain damage, possibly with paralysis, or death can occur. Although this risk has to be borne in mind, it should be kept in perspective.

Other minor complications are a sore throat, coughs and chest infections. Muscle pain which may develop as a result of the muscle relaxants used usually lasts for no more than 48 hours.

If a complication arises

If you are at all concerned about anything that occurs after your operation, contact your doctor, the consultant or the hospital ward for advice. Although serious complications are not common, it is better to err on the safe side, and most doctors will be happy to discuss your worries with you.

Recurrence

One of the worst complications to follow surgery for cancer is to have a recurrence of the disease. The risk of cancer recurring in the scar of the operation or in the lymphatic in the armpit should be less than 5 per cent. The surgeon will take all possible steps to be sure that local control of the cancer is achieved. Recurrence outside the area of the breast and its immediate lymphatic drainage is less easy to predict and to treat.

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The hormonal treatments currently available in Australia for the treatment of endometriosis are Danazol, Duphaston, Provera, Depo-Provera, Primolut N and the oral contraceptive pill.

GnRH agonists and Gestrinone are two newly developed forms of hormonal treatment used in some overseas countries which are currently only available in Australia on a trial basis.

Danazol is the drug which is most commonly used for the treatment of endometriosis. First developed in the early 1960s, it has been used for the treatment of endometriosis in Australia since the late 1970s; it is also used for the treatment of menorrhagia (heavy bleeding).

Danazol is a weakened form of the male hormone testosterone. Testosterone is one of a group of male hormones known as androgens which are produced by the male testes. They are responsible for the functioning of the male reproductive system and the development of the male characteristics such as facial hair and a deep voice. Women also produce very small amounts of androgens in their ovaries.

Danazol is distributed by Winthrop in the form of 100 and 200 milligram white gelatin capsules. In Australia, Danazol is also known by its trade name of Danocrine. In die United States, the United Kingdom and Canada it is marketed under the trade names of Danocrine, Danol and Cyclomen respectively.

In Australia, Danazol can only be supplied under the Pharmaceutical Benefits Scheme for the treatment of endometriosis if your endometriosis has been definitely diagnosed during a laparoscopy or a laparotomy and if your doctor fills in a special prescription form known as an ‘Authority’. If this is done a script of Danazol will only cost you the maximum cost of a prescription under the Pharmaceutical Benefits Scheme as opposed to its full cost.

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Treatment of bulimia has a different focus. For one thing, anorexics need to do more of something – eating – while bulimics need to do less of something – bingeing and purging.

Rodney Dangerfield, the comedian, tells about the time he went to his doctor with a sore shoulder. Raising his arm, he said, “It hurts when I go like that.” The doctor replied, “Don’t go like that.”

Unfortunately, breaking the binge-purge cycle is rarely that easy. Instead of just telling the patient, “Don’t go like that,” one must reduce the forces behind the urge to binge and purge. These forces include the physical effects that are caused by an irregular pattern of eating or trying to maintain a weight that is too low.

Another goal of treatment is to change the patient’s characteristic cognitive distortions and disturbed emotional responses. For example, learning how to be more assertive can be a key element in recovery. A binge is frequently triggered by anger that the patient feels powerless to express. One woman told me her boss demanded that she work on a Saturday when she had made other plans. She suppressed her fury, telling herself that “I’m lucky to have this job, no one else would hire such a worthless person.” She worked that Saturday, then went home and pigged out for two hours. After assertiveness training, such patients find it easier to “just say no” without feeling guilt or self-hatred.

Finally, improving family relationships can be very helpful, especially for patients living at home. But because bulimic families can vary widely in their dynamics, therapy must address the particular family pattern involved.

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In 1997, when David Zimmerman arrived home after a year of active duty overseas in the U.S. Marine Corps, he got the surprise of his life. His wife, Hope, was there to greet him—121 pounds lighter.

He didn’t recognize her. He’d never seen her so svelte.

“It was a big motivator for me, to try to shock him,” Hope says. And shock him she did. “He didn’t know who I was at first,” recalls the 31-year-old Leavittsburg, Ohio, resident. “After he hugged me, he stepped back to look at me and said, ‘Oh my gosh, how did you get smaller than me?’ That whole day, he kept touching me now and then, saying, ‘I just don’t understand where it all went!’

Hope had set out on her secret weight-loss mission after watching her obese grandmother struggle after breaking a rib. “She was so overweight that it took two people to move her out of bed,”

Hope recalls. “And she was so independent. I could see what it was § doing to her pride. I didn’t want that to be me one day.” So at 6 feet and 306 pounds, and with her husband far away, © s Hope joined TOPS—Take Off Pounds Sensibly Through the program’s sound diet-and-exercise program, she whittled her way to 185 pounds in just over 11 months.

Months later, still jazzed by her weight-loss success, Hope bought herself a sexy velvet dress. Her husband was on the phone with a relative when she walked downstairs to model it. He paused to lavish her with compliments, then described to the caller how fabulous his wife looked. “The reply was, ‘She’s not as thin as your brother’s girlfriend,’ Hope recalls. “I was devastated.”

Hurt and angry, she headed to the kitchen for some solace. But she stopped in her tracks, then went outside for a walk instead. Thirty minutes later, she returned home, calm and enlightened. “I let go of those hurtful words by focusing on the kindness that I received from others who supported me,” she says.

Eventually, Hope began strength training to shape and tone her body. Now a Zena-esque size 10 and 195 pounds, she no longer turns to food to heal those emotional blows. If she feels down, she bypasses the kitchen and heads out for a walk.

WINNING ACTION

Realize that you have weight-loss friends and foes.

When hurtful words hit you, consider the source. Understand that there will always be negative people in your life, but don’t accept their perception of you. Remember the title of the book written by Saturday Night Live character Stuart Smalley: I’m Good Enough, I’m Smart Enough, and Doggone It, People Like Me!

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