12
singapore he alth
NOV⁄ DEC 2011
News
Wait till morning A toothache might hurt badly, but it’s not considered an emergency unless there is an infection and swelling About 80 per cent of all dental cases seen at the A&E of Singapore General Hospital (SGH) are toothaches. While traumatising, they do not warrant a trip to the A&E and can wait till the morning. The real emergencies Dr Lai Juen Bin, Associate Consultant, Department of Oral & Maxillofacial Surgery, National Dental Centre (NDC) of
Singapore explained that the A&E is only equipped to handle urgent dental cases such as road accident victims who have a fractured upper or lower jaw, mid-face, or teeth. Facial fractures need immediate attention because if left untreated, the bones will set unevenly, leading to a misaligned jaw and subsequent difficulty in eating. Emergency cases – usually injuries from accidents or trauma – need immedi-
ate attention. They include uncontrolled bleeding (from the gums), facial swelling due to dental infections, loosened or dislodged teeth, broken teeth, mid-face fractures, and severe cuts to the gums, lips or cheek. Others are severe tooth infections which have spread to the face, causing facial swelling or neck swelling. These must be treated immediately. If left untreated, the swelling can eventually cut off the air supply.
dental X-ray. Because of this, patients with toothache who seek A&E treatment may be reluctant to undergo a procedure as permanent as tooth removal – especially when it’s uncertain exactly which tooth is causing the trouble. But no one is turned away. “Patients who come in will be treated. However, it is advisable that they seek dental treatment afterwards, at NDC or any other dental clinic*.” Pain relief at home Dr Lai said toothaches can be alleviated at home with over-the-counter painkillers most of the time. For simple toothaches, painkillers such as paracetamol or aspirin, or anti-inflammatory drugs are prescribed. These can be taken at home. In the A&E, walk-in patients are registered, triaged by a nurse, examined by a medical officer, then, depending on the severity of the problem, seen by a dental officer or an oral maxillofacial surgeon. What may also be given for temporary relief is a local anaesthetic injection and medicated dental fillings to soothe the tooth. Patients who get these fillings must return to a dentist to have the temporary fillings replaced with proper ones. NDC operates from Mondays to Fridays, 8am to 5.30pm. Consultation is by appointment only. For more information on toothaches, dental trauma and emergencies, visit the Conditions and Treatment Glossary at NDC’s website – www.ndc.com.sg.
Patients who come in will be treated. However, it is advisable that they seek dental treatment afterwards, at NDC or any other dental clinic. Dr Lai Juen Bin, Associate Consultant, Department of Oral & Ma xillofacial Surgery, National Dental Centre of Singapore
Patients can manage the pain of toothaches at home with painkillers rather than visiting the accident and emergency department.
Non-emergency cases In contrast, common dental problems such as extractions, root canal treatments, scaling, dentures, crowns, bridges and implants are considered non-emergencies. Dr Lai said the A&E is not fitted with the necessary equipment for these common dental problems. For example, there’s no
*Corporate Dental Clinic at 38 Haig Road (after-hours hotline 9670-7300) is an emergency dental clinic.
Getting to grips with the problem An elderly cancer patient’s handgrip can predict how long he can live, and may be useful in determining treatment
In the last decade, studies have linked the strength of a person’s handgrip to his body strength and lifespan. Now, National Cancer Centre Singapore (NCCS) researchers have tested how it relates to survival in elderly cancer patients. The results of their study – on 249 newly diagnosed patients aged 70 years and above – were presented at the American Society of Clinical Oncology’s Annual Meeting in Chicago this year. Dr Ravidran Kanesvaran, Associate Consultant, Department of Oncology, NCCS, and principal investigator of the study said: “Our study concluded that low handgrip strength consistently related to higher chances of early death in elderly cancer patients.” He said that there are numerous handgrip studies related to survival but the NCCS study is in a niche area focusing
on patients in this age group. The results will pave the way for more research to be done to help doctors decide how aggressively (or not) to treat the cancer in their elderly patients. Currently, some may be under-treated if their family or doctor has doubts about their ability to tolerate treatment. Stronger grip, better survival While the study is still in its infancy, interim results strongly indicate a positive relationship between handgrip
A dynanometer, like the one shown here, is used in handgrip testing of elderly patients. PHOTO: NCCS
BY Ruth Loh
strength and overall survival. “We hope the information will enable us to better stratify the elderly into appropriate risk groups for physicians to make informed choices regarding their treatment.” He added: “Patients in the study who were of the same age, weight, height, performance status, nutritional status, gender and stage of disease were found, for each pound of excess force shown in the handgrip test, to have a three per cent increased likelihood of survival.” In other words: Stronger grip equals better survival. Dr Ravidran said, at present, the preliminary study results will not change the way oncology is practiced, but it provides an impetus for researchers to explore the role of handgrip tests further, and may in future impact the lives of patients.
How is handgrip testing done? Patient remains in a standing position
With hand slack against the thigh, the patient clutches the handle of the handgrip dynanometer
The patient is asked to squeeze as hard as he can
As he begins squeezing, he is asked to extend his arm upwards till his fist is at shoulder height
The test is done twice with both hands and the best score is recorded