Nicotine Stomatitis

Nicotine Stomatitis is sn uncommon condition caused by smoking tobacco and manifesting as leukoplakia of the hard palate with raised red dots signifying the openings of minor salivary gland ducts; smoking cessation results in improvement of nicotine stomatitis. This condition is caused by smoking pipes, cigars, and cigarettes directed toward the mucosa of the hard palate that produces this lesion.

The clinical features of this condition are unique. The hard palate takes on a gray to white color depending on the amount of smoke directed toward it. Scattered raised areas with red centers complete the clinical picture. The raised areas are clumps of minor salivary glands and the central red dots are the openings of their ducts. It is because ducts are lined with nonkeratinizing epithelium that they appear red.

Cessation of smoking will cure nicotine stomatitis, attempts should be made to eliminate tobacco use. If that is successful, the lesion will subside. If not, incisional biopsies are needed to rule out the presence of dysplasia and anaplasia. As stated earlier, SCC of the hard palate is uncommon; therefore, it is unlikely that the lesion will progress to invasive SCC. It needs to be remembered however that while the palatal effects of smoking may not be serious, the habit may cause mucosal dysplasia or carcinoma-in-situ elsewhere.

TELEHEALTH PROGRAM

The digital era have great influence on the health field, today the growth of telehealth, or telemedicine, continues to expand across the country.

TeleHealth is a unique video conferencing networkconsultations to medical education to staff training, teleHealth provides fulfill a variety of health care, education and business needs.

Today, the comunication is no longer difficult with the technology, especially in the remote area. However, it might be most useful to those residents where it will be most problematic for this technology to reach a– the small rural, distant community.

Access to traditional health service can be limited in these communities because of the cost and difficulty of travel. Yet these same communities also have, potentially, the most difficulty with telecommunication infrastructure.

This is especially true if telehealth technology must be supported with more bandwidth than is currently available in the community. The other problem in public is some of the telehealth equipment has not been easy to use.

It has taken special operating skills, which need to be learned, and these skills continue to change as new hardware and software are introduced. Sufficient training has not been provided before the telehealth application was introduced.

The equipment has not been reliable. An equipment breakdown or a computer glitch occurs and easy and timely service repair is not available. The telecommunications link is slow or unreliable resulting in the view that it is a chore to establish and maintain a current communication link to the consultation service.

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Cleft Course

Padjajaran University Department Oral and Maxillofacial Surgery, Indonesian Oral and Maxillofacial Surgeon (PABMI) and International Oral and Maxillofacial Surgeon Association (IAOMS) announces Workshop on Surgical Techniques in Cleft Lip and Palate.

The Workshop will be held in Bandung, Indonesia August 27-31,2007

Keynote speaker :
Prof. Peter Ward Booth,
Consultant Maxillofacial and Cleft Surgeon
Department of Oral and Maxillofacial Surgery,
Queen Victoria Hospital,
East Grinstead, West Sussex,
UK

This workshop is intended for Oral and Maxillofacial Surgeons, General Surgeons and Plastic Surgeons with an interesst in the management of cleft and facial deformity patients

NO WORKSHOP FEE REQUIRED
Lunch and Coffee break U$ 180

For further information please contact : Asri Arumsari DDS. OMFS
Email: asriarumsari@yahoo.com

Primary Cleft Closure in Indonesia

Cleft lip and palate are the most common congenital anomalies in Indonesia. Nearly one to 600-700 babies born with these anomalies. In Indonesia every year born 5500-6500 new babies with cleft. The treatment we do usually only primary closure for lip and palate.

We do this procedure in the centre of OMFS and charity or public service program in Indonesia, these cases usualy affect the lower level people.

In the centre we start the treatment on 7 days old babies with feeding plate, 3 months old for lip repair, 18-24 months old for palate repair, 11-13 years old for ABGA (Alveolar Bone GraftAugmentation) and 18 years old for Orthognatic Surgery (if necessary). In the charity program we just do the primary closure for lip and palate and the patient usualy come in various ages.

We start this procedure usually 10-12 weeks old babies. We use Tenisson triangular flap technique for Unilateral Cleft closure with modification of Dr. Noordhof technique for nasal reconstruction, this procedure is easy to learn, the point marker are obvious and can be utilized on the several of wide cleft.

Some of the patients are teenager, sometimes we do the surgery under local anesthesia for cooperative patients. For bilateral cleft closure we use Veau III straight-line closure and we do both side on one procedure. We also do management of the muscle to repair the muscle.

For the over protrusive premaxilla, we do reposition by fracturing the premaxilla bone in front of the sutura, reduce the protusive and fix it with small wire on the same procedure with lip repair.

The palate repair start on 18-24 months old. The repair for hard palate and soft palate are done in one procedure. We used push back technique and combine with Z-plasty for lengthening the soft palate.

Osteodistraction

The placement of dental implants needs an adequate alveolar ridge in width and height, therefore restoration of deficiencies of alveolar bone is necessary. Different types of augmentation bone procedures has been described.

The procedures can be classified between those with autogenous and those with alloplastic materials i.e. hydroxylapatite.The sucessfull osseointegration of dental implants is only possible in vital bone material. Beside the amount of bone also the vitality of the bone very important for the successfull incorporation of implants.This is the reason why implants osseointegration in radiated bone is not so easy to achieve. The autogenous bone augmentation procedures can be calssified basically in free bone transplants and in those with microsurgically bone pocedures. Commonly the free bone grafts are successful for implants augmenation procedures.
Depending on the amount of graft is needed the donor site is choosen. In many patients the bone delivered from iliac crest. Mostly the implants are inserted in a second procedure after healing of the bone transplants. This is almost completed after 4 months of bone transplantation. The most important argument against the bone transpaltantion procedure is the donor site morbidity. The procedure takes longer time; the patient has to stay in the hospital and defects in the donor site are possible. Besides the morbidity for the patient the costs of this procedure are quite high. So another procedures for alveolar ridge augmenation were looked for.

A technique using osteotomy with different type of mobilization is the procedure of ostedistraction. This technique was the first described by Iliazarov for lenthening of the lower limb. McCarthy used this technique for lengthening of the mandible in children with hemifacial microsomia. Block et al (1996), described the augmentation of the deficient alveolar ridge with osseodistraction for implant insertion at the animals.

The advantages of this technique are mobilization of a vascularized bone segment and no need for second procedure harvesting bone transplantations, therefore the morbidity can be reduced. Besides this the recontruction of soft tissue is also possible with the lengthening of the bone. Vertical lengthening of the alveolar process is quite easy possible. But the broadening of the alveolar process is not so easy possible and the distractor advices are not so cheap, those are the disanvantage of this procedure.

Communication

“If we could solve the problems inherent in communications, we could indeed solve the most of the problems not only of the organization but the world“

I believe this is absolutelly true, succesfully of management functions of planning,organizing, staffing, directing and controlling as well decissions making by managers, depends on efective communication.

Communication is very essential, when the manager communicate, four things may be accomplished:

1. Information is transmitted

2. Someone is motivated

3. Something is controlled

4. Emotional feelings are expressed

Manager can affect motivation by informing others about rewards based on performance, by providing information that build commitment to HSO/HSs and their objectives and by helping employee understand and full fill their personal need.

Communication can serve the purpose of motivating someone to work harder or perform more efficiently, when employees are praised for their efforts, employees will continue to put forth effort, Consistent and positive communication can affect the morale, Motivation and performance affect level of the work place in general.

A good communication is hallmark to overcome these issues and to keep a healthy work environment. The essence of leaderhip is ability to influence others, that’s why comunication become more important for leader/manager as a tools to distribute fairly and clearly all tasks and authorities among employee also appraise all the accomplishments and give good rewards.

Oral Health in Alaska

Alaska is one of the largest state in the United States of America, about 2.3 times the size of Texas and about one-fifth the size of the Lower 48 states. Alaska has about 640,000 residents occupying 570,374 square miles, or 365,039,104 acres of land. As a young state, Alaska developed so many programs, as well in the Oral Health field, especially because Alaska is so wide with the variety population and spread in the whole Alaska bush, this program become very challenging. Historically a number of studies documented the low decay rates in Alaskan Native population. The traditional diet of natives in almost Alaska was rich in protein and fats and very low in sugars or other fermentable carbohydrates. The change of diets in native population also high rates soda consumption, with limited access to drinking water with fluoridation completing with limited access to dental provider in the rural Alaska are factor contributing to high rates of dental decay in Alaska.

Oral Health

Oral health is fundamental to systemic health, wellbeing and quality of life. Mouth is the first gate through the body, a healthy mouth enables people to eat, speak, breath and socialize without any embarrassment. Poor oral health will impact these abilities and also affecting the systemic health.The prevalence and recurrences of these impacts constitutes silent epidemic. The interaction between oral infection and systemic health was first described in Ancient Egypt and the concept of focal infection dates back more than a hundred years. Knowledge about the link between oral disease and systemic diseases are growing rapidly.
Increasing evidence is available from many investigators to indicate the Oral infection (including periodontitis, caries) as a risk factor for cardiovascular diseases (arthrosclerosis, bacterial endocarditic), diabetes mellitus, low birth weight infants and pulmonary diseases, stroke, rheumatoid arthritis, renal disease and off course oral cancer.
Both epidemiologists and researchers in oral microbiology have contributed significantly to the new paradigm of periodontal disease. Although additional studies are needed to determine the mechanisms by which such associations exist; available research clearly demonstrates that oral diseases and conditions are not only markers for underlying health problems, but also important determinants influencing the development and management of adverse chronic health conditions.

Leadership

Leadership is very important to the overall success of organization. The leadership must be effective within the organization and with external stakeholders. The five components of emotional intelligence are very applicable and important to the leader. These include self awareness, self regulation, motivation, empathy, and social skill.

The essence of leadership is the ability to influence others. To have influence, however, one must have power. Power is the potential to exert influence, the obstacles will need to be overcome with the use of influence and persuasion which will hopefully lead to cooperation. This cooperative relationship will pave the way strengthening organization financial and political situation.

Manager Function

Management is defined as the process, composed of interrelated social and technical functions and activities, occurring in a formal organizational setting for the purpose of accomplishing predetermined objectives through the use of human and other resources.
One of the functions of a manager in this discussion is the “directing function”. This is categorized as a social-behavioral function in that it involves effective leading, motivating and communicating skills.

A manager must be able to lead those s/he is directing to accomplish the objectives of the group. People follow those in whom they respect, trust and by whom they are inspired/motivated. So it follows that a manager will not be effective in leading people to do the work if they cannot inspire trust and motivate effectively. And all of this is contingent on effective communication skills…both internally with those a manager must direct and externally with other department and high level management.
April 23rd, 2007