QI am 65 years of age and one of my last teeth on both lower and upper jaws is shaking and not properly secure. There is no cavity in the teeth but the gums have badly receded.

I consulted a dentist who told me that it is due to old age (wear and tear) and there is no remedy except to take these teeth out since I feel some pain while drinking/eating hot/cold things and there is pain in the jaws. What should I do? Is there any remedy to secure them, if so please advise me.

AIt is difficult to asses the condition without an examination, however, with the limited available information, the best advice is to get those teeth extracted since these teeth will cause further damage to other standing teeth.

As the gum is already bleeding, this indicates a poor oral health condition of the mouth. The loosening reflects this condition, which needs the removal of these teeth. And it will also save the remaining teeth from further loosening. As the loosing of the tooth can be caused by many reasons, for example poor oral hygiene, poor periodontal health and many other metabolic conditions like diabetes. The best option is to get the patient examined.

It is difficult to say if the teeth are infected and how much is the loss. Assuming that the last tooth being the last molar tooth and all the teeth in front of these are present, with this age and mobility and a poor oral health status of the mouth as indicated with the bleeding gums, it is better to extract these teeth so as to prevent food lodgement, which will lead to mobility of other remaining teeth.

Moreover, I will also recommend that you must take measures to improve your oral health conditions to prevent the other teeth from damage.

Dr Touqeer ul Islam
Liaquat National Hospital

QMy nephew died suddenly last year of a massive heart attack. We have no history of heart disease in our family. He was 38 years old. What I want to know is that when he was 15 he had Hodgkin's disease, of which he was cured. Did the subsequent treatment, chemo and radiation, which he had, gradually hardened his arteries? We are in the dark because we just don't know what happened? Could you please explain?

AUnfortunately positive family history of heart disease is not the only risk factor for heart disease. There are other factors like smoking, high cholesterol, diabetes mellitus, hypertension, sedentary lifestyle and poor dietary habits. Your nephew might have some of these problems. It is also possible to get heart disease in the absence of any of these factors.

As he had radiotherapy of Hodgkin's disease, he was more at risk of heart disease. Therapeutic irradiation of the chest results in the inadvertent inclusion of the heart within the irradiation field. Over the next 10 to 20 years, some of these people may experience pathological changes of the heart valves that could predispose them to endocarditis (infection of heart valve), accelerated atherosclerosis (hardening) of the coronary artery that heightens their risk of experiencing angina or fatal myocardial infarction (heart attack) or both. Radiation damage may also affect the pericardium (heart covering) and myocardium (heart muscle) causing pericarditis and arrhythmias (irregular heart beat).

Patients with Hodgkin's disease tend to be young and live long enough to manifest these late heart complications. Chest irradiation for Hodgkin's disease increases the risk of subsequent death from heart disease. Risk increases with high radiation doses, minimal protective cardiac blocking, young age at radiation and increasing duration of follow-up. It is mandatory to carefully plan the management (low dose, involved field irradiation) of newly diagnosed patients as well as their cardiologic follow-up.

I hope I have answered your question.

Dr. Saleem Mujtaba
Liaquat National Hospital

Identities of the questioners are being withheld on request.
All questions may be sent to the Sunday Magazine by post or at magazine@dawn.com