Monthly Archive June 2015


Psoriasis Causes, Symptoms Treatment and Oral Manifestations

What is Psoriasis?

Psoriasis is a noncontagious skin disorder that most commonly appears as inflamed, edematous skin lesions covered with a silvery white scale. The most common type of psoriasis is plaque psoriasis and is characterized by patches on the scalp, trunk and limbs. The nails may be pitted and/or thickened. In rare instances it has been reported to manifest oral mucous membrane lesions. Psoriasis can be seen in people of any age, from babies to senior, most commonly patients are first diagnosed in their early adult years. Psoriasis is uncommon in children, and seldom does a primary attack occur after the age of 45 years. Psoriasis is slightly more common in women

What are the Causes of Psoriasis?

The causes of psoriasis are not fully understood. It is not purely a skin disorder and can have a negative impact on many organ systems.

  • Psoriasis is generally considered a genetic disease, though to be triggered or influenced by environmental factors
  • Life style:-worsening of the disease includes chronic infection, stress and changes in season and climate. Other factors include hot water, scratching psoriasis skin lesions, skin dryness, excessive alcohol, smoking and obesity
  • HIV:-people with advanced HIV often exhibit psoriasis. Psoriasis tend to be more severe in people infected with HIV
  • Medication:-drug induced psoriasis may occur with beta blockers, lithium, antimicrobial medication, ca channel blockers, captopril, interleukins, lipid lowering drugs
  • Withdrawal of corticosteroids can aggravate psoriasis due to the rebound effect of corticosteroids
  • Psoriasis has been associated with an increased risk of certain cancers, cardiovascular diseases and other immune mediated disorders such as crohn’s disease and ulcerative colitis.

What are the Symptoms of Psoriasis?

  • Although psoriasis plaques can be limited to only a few small areas, the condition can involve wide spread areas of skin anywhere on the body.
  • Psoriasis of the skin is characterized by the occurrence of small, sharply delineated, dry papules, each covered by a delicate silvery scale which has been described as resembling a thin layer of mica.
  • If the deep scales are removed, one or more tiny bleeding poins are disclosed, a characteristic features termed Auspitz’s sign. After removal of the scale the surface of the skin is red and dusky in appearance
  • The skin lesions which are painful and seldom pruritic, may be few in number or extensive in distribution. Large plaques of irregular outline formed by the union of smaller lesions. They are roughly symmetrical and are most freqjuently grouped on the elbows and knees, the scalp, back and chest, face and abdomen.
  • New lesions slowly arise over a period of weeks, months or even years. The disease may remain static for a long time, progress slowly to involve more and more skin area, or exhibit acute generalized exaserbations.
  • The disease is more severe in the winter and less severe in the summer as a result of increased exposure to ultraviolet light; patients who move to a warm sunny climate usually undergo improvement in their condition.
  • Arthritis:-Arthritis is a complication in about 12 percent of persons with psoriasis.
  • Nail psoriasis:-

psoriasis-skin-diseaseWhat are the oral Symptoms of Psoriasis?

Psoriatic involvement of oral mucosa is extremely rare. Psoriatic lesions have been reported on the lips, buccal mucosa, palate, gingiva and floor of the mouth. Clinically they are described as gray or yellowish-white plaque; as salivary white, scaly lesions with an erythematous base; as multiple popular eruptions which may be ulcerated with a scaly surface.

What is the Treatment for Psoriasis?

Since psoriasis mainly affects the skin, topical treatments are very useful because they are relatively safe, quite effective and can be applied directly to the disease. Treatments for more general or advanced psoriasis include UV-A light, retinoid, cyclosporine, methotrexate particularly for arthritis. UV light exposure can treat large areas of skin with few side effects. Laser therapy is quite effective for small plaques of psoriasis.

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folic-acid rich foods

Folic acid Foods – Benefits & Deficiency Symptoms

Folate and folic acid are forms of a water soluble B vitamin. Folate occurs naturally in food and folic acid is the synthetic form of this vitamin. Folic acid also referred to as vitamin B9 or vitamin M. Folic acid or folacin word came from the Latin word folium means leaf. Folic acid is abundantly found in green leafy vegetables. It is important for one carbon metabolism and is required for the synthesis of certain amino acids, purines and the pyrimidine-thymine. The active form of folic acid is tetrahydrofolate.

What are the Functions of folic acid?

  • Folic acid is needed for the proper development of the human body. It involved in producing the genetic material called DNA and in numerous other bodily functions
  • Tetrahydrofolate, the coenzyme of folic acid is actively involved in the one carbon metabolism
  • Folic acid helps in the production of the healthy red blood cells
  • Folic acid helps in rapid cell division and cell growth
  • Enhances brain health
  • Folic acid is necessary for fertility in both men and women. It contributes in spermatogenesis

Why folic acid is important in pregnancy?

folic-acid rich foodsFolic acid helps protect against a number of congenital malformations, including neural tube defects. Neural tube defects are severe abnormalities of the central nervous system that develop in embryos during the first few weeks of pregnancy resulting in malformations of the spine, skull and brain. Most common neural tube defects are spina bifida and ancephaly. Folic acid reduce the risk of congenital heart defects, cleft lip, limb defects and urinary tract anomalies. Folic acid deficiency increase the risk of preterm delivery, infant low birth weight and fetal growth retardation.

Why doctors prescribe folic acid supplements during pregnancy?

Folic acid reduces the pregnancy complications such as placental abruption and pre-eclamplasia. Folic acid supplements may also protect the fetus against disease when the mother is battling a disease or taking medication or smoking during pregnancy.

What is the recommended dietary allowance for folic acid?

  • Birth to 6 months                                       65 mcg
  • 7-12 months                                               80 mcg
  • 1-3 years                                                     150 mcg
  • 4-8 years                                                     200 mcg
  • 9-13 years                                                   300 mcg
  • 14-18 years                                                 400 mcg
  • 19+ years                                                    400 mcg
  • Pregnant women                                         600 mcg
  • Lactating women                                         500 mcg

What are the Food sources of Folic acid?

Dark green vegetables are good sources of folic acid. Folic acid content decreases due to over cooking.

  • Spinach, turnip greens, mustard greens
  • Asparagus
  • Beans, peas, lentils
  • Liver, kidney
  • Citrus fruits: papaya, oranges, strawberries, raspberries
  • Avocado
  • Sunflower seeds, peanuts, flaxseeds, almonds
  • Cauliflower, beets, corn, celery, carrots
  • Cabbage, potato
  • Egg yolk
  • Milk is a rather poor source of folic acid
  • Whole wheat bread usually fortified

What is the Symptoms of Folic acid Deficiency?

Folic acid deficiency is probably the most common vitamin deficiency, observed primarily in the pregnant women, in both developed and developing countries.

  • The macrocytic anemia associated with megaloblastic changes in bone marrow is a characteristic feature of folate deficiency. Symptoms of anemia are pale skin, lethargy, persistent fatigue, tender tongue, irritability, diarrhea
  • Fatigue, tiredness
  • Grey hair
  • Mouth sores
  • Tongue swelling
  • Growth problems
  • Forgetfulness
  • Loss of appetite
  • Weight loss
  • Being irritable

What are the Causes of folic acid Deficiency?

  • Taking diet low in folic acid
  • Over cooking of foods
  • Crohn’s disease and celiac disease can affect the absorption of the folic acid
  • Certain medications can cause folic acid deficiency such as phenytoin, sulfasalazine
  • Excessive alcohol intake. Alcohol interfere with folic acid absorption and also increases folate excretion through the urine

What is the treatment for folic acid deficiency?

To treat folic acid deficiency anemia, your doctor will usually prescribe daily folic acid tablets to build up your folate levels. The doctor may also give you dietary advice so you can increase your folate intake. Folic acid is frequently combined with other B vitamins in supplements. Alcohol intake should be decreased and completely eliminated for pregnant women. People who take medications known to cause folic acid deficiency should take supplements as well on doctors advice.

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Functions Sources and Deficiency Symptoms of Vitamin B12

Vitamin B12 also called as Cobalamin. It is a water soluble vitamin. Vitamin B12 plays a key role in the normal functioning of the brain and nervous system and for the formation of the blood. It is a unique vitamin, synthesized by only microorganisms and not by animals and plants. The two coenzyme forms of vitamin B12 are Methylcobalamin and 5’-Deoxyadenosyl Cobalamin. The vitamin B12 is present in the diet in a bound form to proteins.

What are the Functions of Vitamin B12?

  • Vitamin B12 normally involved in the metabolism of every cell of the human body especially affecting DNA synthesis and regulation , fatty acid metabolism and amino acid metabolism
  • Vitamin B12 acts as a cofactor for methionine synthase and L-methyl malonyl-coenzyme A mutase
  • Vitamin B12 is vital for the formation of red blood cells
  • Vitamin B12 plays important role in the normal functioning of the brain and nervous system
  • Vitamin B12 is necessary for the synthesis of metrhionine from homocysteine

What is the RDA for vitamin B12?

Recommended dietary allowance (RDA):-average daily level of intake sufficient to meet the nutrient requirements of nearly all healthy individuals.

  • 0-6 months                               0.4 mcg
  • 7-12 months                             0.5 mcg
  • 1-3 years                                     0.9 mcg
  • 4-8 years                                     1.2 mcg
  • 9-13 years                                   1.8 mcg
  • 14-18 years                                 2.4 mcg
  • 19+years                                     2.4 mcg
  • Pregnancy                                   2.6 mcg
  • Lactating women                       2.8 mcg

What are the sources of Vitamin B12?

Vitamin B12 is found naturally in a wide variety of animal foods. Foods of animal origin are the only sources for vitamin B12. Curd is a better source than milk, due to the synthesis of B12 by Lactobacillus. Vitamin B12 is synthesized only by micro-organisms. Plant foods have no vitamin B12 unless they are fortified. The best way to meet your body’s vitamin B12 needs is to eat a wide variety of animal products.

  • Organ meats (beef liver)
  • Shellfish
  • Meat, poultry, eggs and milk
  • Fortified soy products
  • Fortified cereals
  • Red meat
  • Swiss cheese

What are the Deficiency Symptoms of Vitamin B12?

The most important disease associated with vitamin B12 deficiency is pernicious anemia. It is characterized by low hemoglobin levels, decreased number of erythrocytes and neurological manifestations.

  • B 12 deficiency anemia:-in B12 deficiency the body produces larger than normal blood cells.
  • Weakness, tiredness or light headedness
  • Rapid heartbeat and breathing
  • Pale skin
  • Easy bruising or bleeding, bleeding gums, mouth ulcers
  • Stomach upset and weight loss
  • Diarrhea and constipation
  • Yellowing of the skin
  • Sore, red tongue
  • Mouth ulcers
  • Mood changes, irritability, depression or psychosis
  • Tinnitus (ringing in the ears)

vitamin b12What are the causes of Vitamin B12 Deficiency?

In healthy adults, vitamin B12 deficiency is uncommon. Deficiency is more common mainly because of impaired intestinal absorption that can result in marginal to severe vitamin B12 deficiency in this population.

  • The most common cause of vitamin B12 deficiency is Pernicious anemia, an autoimmune condition caused by a lack of a protein called intrinsic factor that’s needed to absorb vitamin B12 from food into the body from the gastrointestinal tract.
  • Intestinal malabsorption:-absorption of vitamin B12 from food requires normal function of the stomach, pancreas and small intestine.
  • Atrophic gastritis:-this condition is frequently associated with the presence of autoantibodies directed towards stomach cells. Diminished gastric function in individuals with a atrophic gastritis can result in bacterial over growth in the small intestine and cause food bound B12 malabsorption
  • Vitamin B12 levels in serum, plasma and gastric fluids are significantly decreased in individuals with Hpylori infection
  • Surgical resection of the stomach or portion of the small intestine where receptors for the IF-B12 complex are located
  • Chronic alcoholism:- reduced in absorption of vitamin B12
  • Digestive conditions such as Crohn’s disease, Coeliac disease
  • Medication including proton pump inhibitors for indigestion

What is the Treatment for Vitamin B12 Deficiency?

Vitamin B12 deficiency treatment depends on the cause. If pernicious anemia or a problem with absorption is the cause, you will need to replace B12 usually by injection or by prescription. For most people treatment resolves the problem. But any nerve damage that happened due to the deficiency could be permanent. A combined therapy of vitamin B12 and folic acid is generally employed to treat the patients with megaloblastic anemia.

How to Prevent Vitamin B12 Deficiency?

  • Vitamin B12 deficiency can be prevent by eating enough meat, sea food, dairy products and eggs
  • Vegetarians can get vitamin B12 by taking cereal fortified with vitamin B12
  • Consult your doctor for the B12 supplements.
  • For people who cannot absorb B12, the condition cannot be presented. However, once it is diagnosed, regular injection of vitamin B12 will prevent symptoms from returning

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Migraine Causes

Migraine Causes, Symptoms and Treatment

Most of the people experience the migraine headache. Migraine is a term applied to certain headaches with a vascular quality. Migraine often begins in childhood, adolescence or early adulthood. Migraine is characterized by varying degree of recurrent vascular headache, visual disturbances, sleep disruption and depression.

What are the Causes of Migraine?

Migraine cause isn’t understood, genetics and environmental factors appear to p[lay a role. Migraine may be caused by changes in the brainstem and its interactions with the trigeminal nerve, a major pain pathway. Imbalance in brain chemicals may also cause migraine.

What are the Trigger Factors for Migraine?

Some factors may cause migraine attack. These factors are called as trigger factors.

  • Hormonal changes in women
  • Foods such as aged cheese, salty foods and processed food
  • Drinks such as alcohol especially wine
  • Stress
  • Changes in wake sleep pattern
  • Food additives such as sweeteners, preservatives
  • Medication such as oral contraceptives
  • Environment changes
  • Physical factors such as intense physical exertion

What are the Risk factors for Migraine?

  • Family history:-up to 90% of people with migraines have a family history of migraine attacks. If one or both your parents have migraine, then you have a good chance of having migraines too
  • Age:-it can begin at any age. Migraine usually begins during the second decade of life and is especially common in professional persons
  • Sex:-migraine headaches are reported to affect women more than men. Women are 3 times more likely to have migraines
  • Hormonal changes:-hormonal changes are seen in menstrual cycle, pregnancy, and menopause. Migraine may begin at any stage of hormonal change. Generally migraine improve after menopause

What are the Symptoms of Migraine?

Migraine may progress through 4 stages

  1. Prodromal stage
  2. Aura
  3. Headache
  4. Postdromal stage

Symptoms of Prodromal stage:

A prodromal stage or preheadache stage is noted by some patients, consisting of lethargy and dejection several hours before the headache.

  • Constipation
  • Depression
  • Confusion
  • Unilateral Paraesthesia
  • Food cravings
  • Hyperactivity
  • Irritability
  • Neck stiffness
  • Uncontrollable yawning


Most people experience migraine headaches without aura. Usually begins gradually, buids up over several minutes and then commonly lasts for 20 to 60 minutes

  • Usually visual disturbances such as flashes of light
  • Sensory, movement and speech disturbances


When untreated, a migraine lasts from 4 to 72 hours, but the frequency with which headaches occur varies from person to person. At the time of headache the pati9ent may appear extremely ill. The face is usually pale, sallow, and sweaty.

  • Pain on one side or both sides of your head
  • Pain that has a pulsating, throbbing quality
  • Sensitivity to light, sounds and sometimes smells
  • Nausea and vomiting
  • Impaired memory and concentration
  • Blurred vision
  • Prolonged and painful contraction of head and neck muscles is found in some patients
  • Lightheadedness sometimes followed by fainting


It occurs after a migraine attack. Some people report feeling, mildly euphoric

Migraine CausesWhat is the Treatment for Migraine?

Doctor consultation in the early stage of migraine is necessary. The treatment of migraine includes a wide variety of drugs ranging from acetylsalicylic acid and codeine to ergotamine, and norepinephrine. The prognosis of disease is good, since the condition is not dangerous and may undergo complete and permanent remission

Natural Tips to reduce migraine headache

While there are a number of other drugs that treat and prevent migraines, there are also a number of natural options to ease the pain.

  • Turn off the lights:-migraines often increase sensitive to light and sound. Relax in dark, quiet room, sleep if you can
  • Massage painful areas:-apply gentle pressure to your scalp and temples
  • Drink a caffeinated beverage:- in small amounts caffeine alone can relieve migraine pain in the early stages
  • Don’t skip meals and establish regular sleep hours
  • Avoid foods that trigger migraines such as ages cheese, chocolates and alcohol
  • Feverfew:-the herb feverfew has been used for centuries as a folk remedy for migraine, arthritis, pain and fever in Europe. Feverfew contains compounds called parthenolides, which appear to help control expansion and contraction of blood vessels in the head
  • Butterbur:-butterbur is a shrub like plant that grows in northern Asia, Europe and parts of North America. Extracts made from the herb have been used to treat migraines, stomach cramps, cough, allergies and asthma
  • Magnesium:-Mg reduces the severity and frequency of migraine. People with migraine and cluster headaches are often deficient in magnesium. Mg supplements may also help to reduce headache
  • Riboflavin:-this B vitamin found naturally in foods like milk, meat, nuts and green veggies. Riboflavin was linked to prevent migraine
  • Flax seeds, salmon fish and fish oil supplements may also help to reduce migraine
  • Sniff peppermint:-certain smells can trigger the pain but peppermint in particular seems to have pain reducing effect. It may not work for everyone
  • Ginger:-ginger can ease migraine related nausea and it may decrease pain
  • Simple head rub and whole body massage can help to reduce the migraine
  • Meditation:-meditation practice can relieve stress. Stress relief can reduce the migraine attacks
  • Drink more water:-plenty of headaches are triggered by dehydration. Patients who will quickly drink a few glasses of water when they feel a migraine coming on, and actually stop it in its tracks
  • Acupuncture:-it is time consuming and expensive
  • Regular exercises:-regular exercise relaxes you, it releases endorphins.

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lip sucking

Causes and Effect of Lip Sucking Habit in Children

Normal lip structure and function is important for speaking, eating and maintaining the balanced occlusion. The lip habit may involve either of the lips, higher chances towards the lower lip. It is a habit that involves manipulation of lips and perioral structures. Prolonged thumb sucking, lip licking, lip biting, cheek chewing, mouth breathing affect both the oral and perioral tissues. Lip sucking in childhood is not rare, but probably under diagnosed

Classification of Lip habit:-

  1. Lip licking/wetting of lips by the tongue
  2. Lip sucking habit-pulling the lips into the mouth between the teeth

What are the Causes of lip habit?

  • Malocclusion-some children have a problem with occlusion such as an overjet. Because of this overjet, placing the lower lip tissue in the space between the upper and lower jaws becomes much easier to accomplish
  • Emotional stress
  • Lip sucking occurs in children when mental attention and concentration are required in situations such as a new environment or a new task being learned that causes stress for the child

Clinical manifestations of lip habit:-

  • Proclination of upper front teeth
  • Retrusion of lower front teeth
  • Muscular imbalance
  • Lower incisor collapse with lingual crowding
  • Reddened ad chopped lip
  • Mento-labial sulcus becomes accentuated

lip suckingWhat is the treatment for lip sucking/licking?

Lip habit is not self- correcting and may become more deleterious with age because of the muscular force interacting child’s growth. Treatment of lip sucking habit should be directed initially towards the cause followed by appliance therapy like lip protector, oral screen and lip bumper. If the child is older, explain the esthetic importance to discontinue the habit. In some cases, psychological support may be needed depending upon the severity of the problem.

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enlarge tongue causes

Enlarged Tongue Causes, Symptoms and Treatment

Enlarged tongue also called as Macroglossia or tongue hypertrophy or prolapses of the tongue. Macroglossia, meaning large tongue, has been a documented anatomical anomaly for several centuries. Severe enlargement of the tongue can cause cosmetic and functional difficulties including in speaking, eating, swallowing and sleeping. Macroglossia is uncommon and usually occurs in children. The exact incidence of Macroglossia is unknown because the causes are too numerous to quantify. In Beckwith-Weidman syndrome, 97.5% of patients have macroglossia. Macroglossia has an extensive list of possible causes. Its treatment has been largely surgical in the modern era

What are the Symptoms of Macroglossia?

  • Dyspnea-difficult noisy breathing, obstructive sleep apnea (airway obstruction)
  • Dysphagia-difficulty in swallowing and eating
  • Dysphonia-disrupted speech, possibly manifest as lisping
  • Sores ate the corners of the mouth
  • Marks or indentations on the lateral border of the tongue caused by pressure from the teeth
  • Open bite, orthodontic abnormalities including diastema and tooth spacing
  • mandibular prognathism
  • Mouth breathing
  • A tongue that constantly protrudes from the mouth is vulnerable to drying out, ulceration, infection or even necrosis.

What are the Causes of Macroglossia?

Two types of Macroglossia are present

1.      True Macroglossia:-

True macroglossia is associated with definitive histopathological findings. True macroglossia may be primary—characterized by hypertrophy or hyperplasia of the tongue muscles and it may be secondary-the result of infiltration of normal tissue with anomalous elements.

Causes of true macroglossia include congenital and acquired causes

Congenital causes:-

  • Idiopathic muscle hypertrophy
  • Lymphangioma
  • Hemangioma
  • Down syndrome
  • Trisomy 22
  • Laband syndrome
  • Chromosomal abnormalities including Beckwith-Weidmann syndrome
  • Lingual thyroid
  • Autosomal dominant inheritance
  • Transient neonatal diabetes
  • Tollner syndrome

Acquired causes:-

  • Metabolic\endocrine-hypothyroidism, cretinism, diabetes
  • Inflammatory/infectious-syphilis, amebic dysentery, Ludwig angina, pneumonia, typhoid, scurvy, pellagra, candidiasis, tuberculosis, rheumatic fever, smallpox
  • Systemic medical conditions-uremi9a, myxedema, hypertrophy, acromegaly, neurofibromatosis
  • Traumatic-surgery, hemorrhage, direct trauma, radiation therapy, intubation injury
  • Neop[lastic-lingual thyroid, lymphangioma, Hemangioma, carcinoma,plasmacytoma
  • Infiltrative-amyloidosis, sarcoidosis

2.      Pseudo Macroglossia:-

In Pseudomacroglossia, an individual has a normal sized tongue that, as a result of oral or skeletal abnormalities. It includes any of the following conditions, which force the tongue to sit in an abnormal position

  • Habitual posturing of the tongue
  • Enlarged tonsils and or adenoids displacing tongue
  • Low palate and decreased oral cavity volume displacing the tongue
  • Severe mandibular deficiency
  • Neoplasms displacing the tongue
  • Hypotonia of the tongue

enlarge tongue causesWhat is the Treatment for Macroglossia/Enlarged Tongue?

Treatment of Macroglossia depends upon its cause and also upon the severity of the enlargement and symptoms it is causing. No treatment may be required for mild cases or cases with minimal symptoms. Surgery is indicated for the severe cases. The goal of the surgery is to reduce tongue size and thereby improve function. Those main functions include chewing, swallowing, protection of the airway, and gustation. Treatment may also involve correction of orthodontic abnormalities that may have been caused by enlarged tongue. Treatment o0f any underlying systemic disease may be required.

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