Dear Dr. Khan,
I got great results after using the inter-dental brush you suggested. Now there is no pocket formation or foul smell. According to your advice, I am also cleaning (scaling) every six months. By the way, a dentist told me that I need two root canal treatments. But I want to have it done by you during my winter vacation. Can I wait another three months?
Thanking you.
Anis
USA

Dear Mr. Anis,
I am doing fine. It is a pleasure to hear that you have noticed significant improvement. However, if your dentist suggested root canal treatment, then I will strongly recommend you not to wait another three months. Do it now!

Dear Dr. Khan,
I have one question regarding the root canal treatment on diabetic patients. Is it safe to do root canal and capping for diabetics? Are there any special measures you need to take during root canal or putting a cap?
Both my parents are diabetic and our dentist advised us about the limitation of dental treatment for them. I came to know that BIRDEM has a dental out patient department. Please let me know about the limitations or special measures.

Yes, it is safe to do orodental procedures on a well-controlled diabetic patient. We usually take extra care for aseptic (germ free environment) conditions during dental procedure of a diabetic patient and prescribe antibiotics. This is just to prevent secondary infection. But there are some limitations during the surgical procedures (dental extraction, minor oral surgery, etc.) of diabetic patient. Some time we need to take special measures.
Yes we have modern dental out door facilities at BIRDEM (4th floor).

Dear Dr. Khan,
Hi! I am 30 years old. I have dental cavity but there is no pain. Do I need root canal?
Mahtab

Dear Mr Mahtab,
A dental X-Ray can reveal whether you need root canal or simple filling. But usually if the cavity is shallow and there is no history of pain, you may not need root canal.

Dear Dr. Khan,
I have a bleeding gum. I am a diabetic and 49 years old. I also have hypertension. Can I do scaling? Can my high blood sugar level cause problems with scaling? Will appreciate your responses
Tuhin

Dear Mr. Tuhin,
Yes, you can go for dental scaling with preoperative antibiotics coverage. There is no contraindication for doing dental scaling for patients who have high blood pressure.

For those who have high blood sugar level, even we can do dental scaling with/without antibiotics, depending on other systemic condition.

Dear Dr. Khan,
I am 45 years old, non-diabetic but I am suffering from severe gum disease. You mentioned that the incidence of gum disease is high for diabetic patient.

I have visited a dental hospital and they advised me for total extraction. I am confused. Please help me by sending some tips on how to keep my gum healthy.

It seems you have generalised gum disease, which causes loosening of your valuable teeth. Without seeing your actual oral condition and X-ray, I can not comment. For dental health tips and to avoid repetition, please see Dental Wise column of 7 Aug, 2007 edition of Star Lifestyle.

Dear Dr. Khan
I am 39 years old. I have bad breath but no caries or gum infection. I brush my teeth every after meals. Why is it still persisting? Can there be any other cause?
-Nusrat

Dear Ms Nusrat,
There are several causes for bad breath. Among them more than 60% are from oral and dental origin and rest from other systemic causes such as liver disease, intestinal problems, sinusitis, pharyngitis etc. Can you visit your dental surgeon to exclude any oral and dental problems?

Dear Dr. Mahfuj,
I am Rubana, 33 years old. I have a carious front tooth. It has become black, but there is no pain. What will be the probable treatment. Actually I visited a dentist who suggested root canal treatment and porcelain cap. But I am in confused why I need root canal as I do not have any pain. Can you explain me what to do?
- Fatema

Dear Ms Fatema,
For your carious front tooth, root canal with porcelain cap will be the permanent solution. But as you mentioned that you don't have any pain, in that case you can try with a special type of tooth colour filling (composite/bonding).

Dear Dr. Mahfuj,
I wrote to you four years back and am very happy to see that you are still continuing with the effort. Actually, now I am residing abroad and doing scaling even seems very expensive. You suggest to do scaling every six months, but is it okay if I do it every two years? I will appreciate your valuable advise. Thanking you.
-Mostofa

Dear Mostofa
Yes I am doing fine. Thanks for your appreciation. I will recommend you to do dental scaling in every 6 months to 1 year.

Bad breath can cause embarrassment, create social and psychological barriers and even affect relationships. In recent years, there has been a growing awareness that bad breath is a problem that the dental profession should recognise and treat.

Remedies for bad breath have been around for thousands of years and are even recorded in ancient Greek and Roman literature. Some of the old folk remedies to freshen breath are still in use today including the use of parsley, cloves and guava peels.

Under A Different Sky

Walking thoughts

By Iffat Nawaz

I walk because I can; it's most convenient, most independent. So I walk all streets that fall on my way- after I stand up, before I sit down, I walk.

Humid, summer evenings, sky full of sunlight, and I walk. And so does everyone else around me. I don't notice cars that drive by. I notice people. And people in cars somehow seem less human than the humans walking around me. As if a part of their identity has been taken away when they stepped into their cars, they are no longer people but square things with wheels.

In my own bubble I walk, watching, feeling…contemplating…questioning and answering. My own bubble makes me feel precious, I become the most important person alive, the most amazing, even if a much greater marvel is walking across the street, even if all my splendours are fading away while I walk. Even if there are 1000 Me's walking around the world thinking we are unique, we haven't met each other, and even if we did, we wouldn't recognise.

While we walk, we think. Think about the past and the future but never about the present. How much money I have spent, how many days I have wasted, how many places I have visited, how many kilos have I lost or gained. And the future, less and less broad as I grow older, less and less dramatic, but with equal uncertainty as the past, so I walk to be certain.

And I look at the store windows with big bold “Sale” signs. Middle of July and the summer collection is already too old. Emptying out spaces for sweaters already, they think ahead, more ahead than I want to.

So I walk through stores, to learn about the future. Fall collection in the middle of summer, ruffles and cowl necks, painted buttons and three-quarter sleeves. For the first time I buy one, a sweater in the middle of the summer, to feel progressive, futuristic. It remains wrapped up waiting to be worn, waiting to be walked, someday.

While I walk our bubbles collide, we look, blatantly, we don't react. Maybe inside just a little thought provokes, and then it changes into another realm. I see children with their parents, children in laps, children in strollers. Young hopeful parents, older accomplished parents. Parents who got bored, parents who wanted more, and they chose to have a child, the hard-easy choice. And I see some of them have stopped walking for themselves and now they only walk for their child, the greater being, new life, new steps. And I wonder if I can ever walk for someone else.

When I was young in Dhaka , one of our househelps after finishing her chores would always call me to lock the door behind her. When I said bye to her she would say “Jodi baicha thaki taile kaal dekha hoibo,” "in case I am alive I will see you tomorrow". Everyday, she said the same thing, every single day. And I saw her every single day. She walked to our house in the mornings, and walked back to her home late afternoon, thinking about tomorrow, and if she will be alive, and it annoyed me, I thought it was overdramatic. It's been a long time since I last saw her, she is dead now, like she was suppose to be, like I am suppose to be one day. But I don't like thinking every walk could be my last, I am more cautious than pretend to be.

My toe nails are always half painted, my legs are always tired, but I still walk, because it's convenient, because it's independent and I am too scared to run and too bored to stand and walking never gets old, only I do.