Dear Dr. Khan,
My elder sister is 41 years old and mentally handicapped. Her oral and dental hygiene is very poor, as she does not like toothpaste and brush. I have heard about electric toothbrush. Is prolonged use of electric toothbrush safe?
Thanking you,
Troubled

Yes she can use an electric toothbrush. She can use the brush unless the bristle is straight. I think she can operate by herself, but that will depend on the severity of her illness. Someone can also help her. Periodically you may visit a dental surgeon for professional cleaning (Dental scaling).

Dear Dr. Khan,
Thanks for the information regarding diabetic patient's dental management. Please tell me the correct approach to brushing teeth. The method, timing and frequency make it all very confusing. Will appreciate your help.
Thanks,
Mahin

DO:
·Brush twice daily, with a soft-bristled toothbrush
·Use a toothpaste containing fluoride
·Brush inner, outer and chewing surfaces with a back-and-forth motion
·Hold brush at 45o angle to the gums to clean gum line
·With the 'toe' of the toothbrush, clean the inner surface of the front teeth using an up-and-down stroke
·Brush the tongue gently
·Replace tooth brush every three months

DON'T:
·Brush too vigorously
·Brush too frequently
·Use a toothbrush too large to easily clean all surfaces

Dear Dr. Khan,
I want to know about bridge (fixed replacement of missing teeth). Please let me know the merits and demerits of a bridge. Can a diabetic use a bridge?
Regards,
Alamgir Kabir

Dear Mr. Kabir
There is no absolute contraindication to do any kind of prosthesis on a diabetic patient but careful pre-assessment about his/her oral health condition would be an important step before doing any fixed prosthesis.

When there is a missing tooth in between two, a bridge is the ideal way to replace the missing teeth. Replacement teeth can be attached to two crowns constructed for the two teeth on either side of the open space. This is called a bridge because it bridges the open space.

Once a tooth is lost, five or more adjacent teeth may drift so it is essential to place a replacement tooth as quickly as possible. The space left from a missing tooth may cause several problems. Teeth may drift into the space changing your bite, this changed 'bite' may result in sore jaws, gum disease, or decay (due to more difficult hygiene).

Bridges are not removable by the patient. As with other types of crowns (caps), a bridge can be made of metal or porcelain, or a combination of these two.

First of all the area needs to be examined to see if you had any skin disease. If not, then probably you had a condition known as Alopecia areatta. If no treatment works and the skin in that area is fine then a hair transplant can be done to cover that area.

Dear Doctor,
I have a strange problem. I am 43 years old and exercise regularly. I am not exactly overweight, but my upper abdomen is bulging and it makes me look bad when I wear a sari. What can I do?

Well first we have to see if it is excess fat that you have because the coastal area is one of the areas where fat accumulates. If it is fat we can reduce it by liposuction but if it is intra-abdominal fat then you have to really do some more exercise and go on a diet, which will help you reduce it. The fat, which accumulates inside our abdomen, cannot be reduced by any surgery, so exercise and dieting is the only answer.

Dear Doctor,
I am a 23 years old female. I had an accident 6 years back and the side of my nose was injured very badly. In fact, part of the opening of my nose has become smaller. I wear a veil to cover my nose, as I cannot go out publicly as people stare and I feel very self-conscious. In fact, I have almost stopped going to college because I get stared at whenever I take off my veil. Can you help?

A deformity like that does make oneself feel very conscious, but I hope you continue with your education as that is very important for your future. As for your nose, a reconstructive surgery can definitely be done but first of course you need to be examined by a doctor to decide what you need. Please contact a doctor who is used to doing rhinoplasty and I am sure you can be helped.