Category: Trismus

Know about the causes of trismus, ways to prevent trismus, and rehabilitation methods for improvement of restricted mouth opening

YD Shukla – Oral Cancer and Skin Induration, Postoperative Rehabilitation

 
Mr. YD Shukla of Kanpur was diagnosed with cancer of the buccal mucosa with skin induration and was operated on by Dr. Pawan Gupta at MAX Vaishali on March 1st, 2022. He had extensive surgery with free flap reconstruction. A good rehabilitation with speech and swallowing therapy along with mouth-opening exercises was given. TrisCaRe the mouth-opening device was given in the early stages of post-surgery. Now at 8 months, he is psychologically, functionally, and cosmetically doing well.
 

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This Diwali greatest Gift for Tobacco Chewer – TrisCaRe

CAN NOT ENJOY FOOD DUE TO TRISMUS Caused by PAAN MASALA

This Diwali greatest Gift for Tobacco Chewer – TRISCaRe

Mr. Anil Joshi a regular tobacco user for 12 years when he visited MAX-ICanCaRe Oral Care and Tobacco Cessation Centre at MAX Vaishali, 3 months back he was all fears that he must have developed cancer in the oral cavity. His mouth opening was just 1.5 fingers around 2 cm and has been decreasing over a period of time.

At the center he was examined thoroughly, certain procedures were conducted, and were declared that he does not have cancer! His oral cavity was cleaned, tobacco stains removed and for his mouth opening, he was given a special instrument TRISCaRe and training to use it regularly.

Dr. Harshita Pandey, Certified Tobacco Cessation Specialist and in charge of the center says all those who take tobacco is not necessary will have cancer, however they develop specific changes in the oral cavity that needs to be taken care of. One of the commonest problems tobacco users have is decreased mouth opening. We examine and treat them and give them TRISCaRe, the innovative mouth-opening device.

Mr. Anil has a mouth opening of 3.2 cm and says he is happy that he would be able to enjoy eating golgappas, laddoos, and rasagollas this Diwali thanks to the doctors at MAX-ICanCaRe Oral Care and Tobacco Cessation center. Now I am completely tobacco-free and glad I have no cancer. This is the greatest Diwali gift I got!

Dr. Pawan Gupta M.Ch., Director, Cancer Surgery, at MAX Institute of Cancer Care, who designed and patented TrisCaRe says this simple instrument is the greatest gift for tobacco chewers. Lots of brainstorming was done to make TrisCaRe although the design and prelim model was introduced in 2010, that would fail the test of pressure required to open the mouth – either teeth would break or the instrument would break. The present material used has now stood the test on thousands of patients and is working wonders. TrisCaRe is, the Innovative Mouth Opening Device is ergonomically designed, Screw type, Broad Dental Plate, Measurement Scale for trismus measurement, and POLYOXYMETHYLENE material with good fatigue resistance.

He is happy for patients like Anil who have benefitted from his instrument TrisCaRe and Oral CaRe program.

ICanCaRe with its innovative tobacco cessation and oral care program has been benefitting thousands of tobacco users across India. Program is available virtual and also physical at ICanCaRe direct or trained Specialist centers.

CALL 011-43077695 to fix your appointment or download the ICanCaRe APP http://app.icancare.in

TrisCaRe is available on www.icancare.org/triscare or Flipkart and Amazon

 

Areca Nut (Betel Nut, Guwaha, Supari) – Agents of Oral Cancers

Introduction:

The use of betel nut in various forms is rampant in India. It is being glamorized by the industry and sold in various forms. Rich and poor, male or female, all age groups are consuming it, almost 30% of the population in both rural and urban India consume it freely across all ages and socio-economic sections of the community. That’s why Oral cancer is very prevalent in India and stands at 30% of all cancer cases reported. Betel nut is one of the significant contributors to this. The market size of areca nut is around 100 billion rupees and it is being sold in India in various forms and advertised as mouth fresheners under various names Rajshree, gutkha, mukhwash, tulsi, rajnigandha, etc. Unfortunately, the young generation is being lured into using this harmful product. It is time we create awareness about the dangers of supari.

Areca (Betel) nut is a seed of the fruit of Areca Palm.  It is a stimulant drug.

The betel nut is used in various ways – fresh, dried, boiled, baked, roasted, or cured.

Betel nut consumption is rampant in the northern and eastern zones of the country. A common way of consuming betel nut is by using it as paan betel quids i.e. betel leaf, slaked lime, and betel nut with any other additives like cloves, elaichi, etc. Nowadays it is available in varieties in the market as part of paan masalas.

In many parts of India and Southeast Asia, it is part of social practice/customs, religious practices, and cultural rituals.

Effects of betel nuts:

It is carcinogenic and used with tobacco it causes cancer of the oral cavity, oropharynx, and esophagus. Betel nut affects almost all organs of the body including the brain, heart, lungs, gastrointestinal tract and reproductive organs, and also the endocrine system.

It is a stimulant drug. Like all drugs, there is no safe limit and one needs to be careful. The effect of the drug may vary according to size, weight, and health of the individual and also on the amount consumed. The variety of betel nut also matters.

As a stimulant the person may experience the following:

  • Mild euphoria and feeling of wellbeing
  • Alertness
  • Increased heart rate
  • Increased blood pressure
  • Sweating
  • Redness on the face and feeling warm
  • Tremors
  • Dizziness
  • Upset stomach, diarrhoea, vomiting
  • Psychosis

Long term effects:

  • Oral cavity and dental –
    • Discoloration of teeth and gums
    • Oral ulcers and gum diseases
    • Submucous fibrosis
    • Oral Cancers
  • Heart diseases – myocardial infarction, cardiac arrhythmias
  • Pulmonary – asthma
  • Gastrointestinal system – Stomach ulcers, hepatotoxicity
  • Reproductive system – infertility, harmful effect on the fetus when being used during pregnancy.
  • Endocrine system – diabetes, hyperlipidemia, hypothyroidism, prostate hyperplasia, central obesity
  • Aggravate immune system- suppressed T-cell activity
  • Cancers – oral cavity, oropharynx, esophagus, liver, biliary tract, and uterus.
  • dependency

Pathology and metabolism

Betel nuts contain 4 main alkaloids – Arecholine, arecaidine, guvacoline, and guvacine

The main alkaloid Arecholine has a systemic effect as well as it is a carcinogen. A number of nitrosamines are formed in the oral cavity mainly methylnitrosaminoproprionitrile which is most carcinogenic in the oral cavity causing cancers and submucous fibrosis.

The betel nut is being glamorized by the industry as mouth fresheners sold as Paan Masalas and fresheners. It is a harmful substance and needs to be banned.

The patient is referred to the Tobacco Cessation Intervention specialist to treat the patient for the smoking and chewing tobacco including betel nut, paan masala, gutkha, khaini, etc. One can Call 011-43077695 or visit www.icancare.in/quittobacco for assistance.

(The Author – Dr. Pawan Gupta M.Ch. is Director of Surgical Oncology at Max Super Speciality Hospital, Vaishali. Patparganj and Noida. He is the author of the book – Win Over Tobacco Made Easy, Be Smart Do Not Start and is highly recognized for his work on Oral Cancer and Tobacco Cessation. He is the convenor for Certified Course in Tobacco Cessation under the Gujarat University)

References:

Garg A, Chaturvedi P, Gupta PC. A review of the systemic adverse effects of areca nut or betel nut. Indian J Med Paediatr Oncol. 2014;35(1):3-9. doi:10.4103/0971-5851.133702