Much remains unknown about the Zika virus and the consequences of infection. Following the concept that prevention is better than cure, dental professionals should be prepared to manage the risks, recognize the signs and symptoms of illness, collect and analyze thorough medical and potential exposure histories, assess the possibility for transmission, and provide timely referrals for evaluation and treatment. Consistent adherence to standard precautions is crucial for every team member. The effectiveness of infection control programs should be continually evaluated to help ensure that policies, procedures and practices are effective in preventing transmission.

Because typical clinical manifestations of the symptomatic Zika virus are nonspecific, its differential diagnosis is broad. Health care providers are encouraged to report suspected cases to their state or local health departments to facilitate diagnosis and reduce the possibility of local transmission. In New York, for example, laboratory diagnostic testing is available at the Department of Health’s Wadsworth Laboratories, one of only a few state public health laboratories that can test for Zika virus outside of the CDC.

Dental teams must also be able to dispel misinformation about the Zika virus and the illnesses it can cause by providing up-to-date, evidence-based information to patients. Clinicians and patients appear to be adequately protected by the use of established infection prevention protocols. Oral health professionals should keep abreast of any emerging epidemic or pandemic, including Zika. Some experts warn that climate changes, urbanization, population growth and international travel may place increasing numbers at risk of diseases such as Zika. Thus, health care providers must remain aware of emergent diseases and be ready to limit the spread of infection.

The CDC website (cdc.gov/zika/index.html) is an excellent resource for current information about the Zika epidemic. In addition, the Organization for Safety, Asepsis, and Prevention provides helpful information about infection control practices at osap.org/?page=Issues_ZikaVirUS.

Colour Changes on Tongue to Orange, Black, Red, White, Yellow – Causes

Changes in the color of tongue is something you get to see often when you eat colored food substances but if the change is long lasting and not just temporary which washes away, you need to see if it is related to any medication or underlying medical condition. Eating colored food like, candy, popsicle or ice cream, chinese food or any food  substance which contains food coloring can lead to temporary change in color of tongue.

You need to start worrying about the change in color of your tongue if you have not eaten any colored food and the color lasts for more than 24 hours. So let us look at the most common changes in color of the tongue and their causes:


Orange Color Tongue:

The dorsal or top surface of the tongue which is pink or red in color looks Orange in color, there can be many reasons for it and let us look at each of them in detail.


Poor Oral Hygiene: It is important to keep your tongue clean while you brush your teeth as the surface of the tongue is exposed to all the food substances which we eat. Using a Tongue cleaner regularly is a must. Food Substances which consist of Beta Carotene are the most likely cause of Orange discoloration of tongue surface. Carrot, Beetroot, mangoes, papaya, pumpkins, using Tobacco, Pan or Ghutka, drinking coffee, tea etc are some of the most common food substance which might lead to orange colored tongue.


Dry Mouth or Xerostomia

Oral Thrush or Candidiasis: It is a Fungal infection which usually appears White in color, but it also appears Yellow or Orange due to pigmentation of the lesions. Medicines causing Orange Tongue: There are certain medicines which lead to orange discoloration of the tongue while the medicine is used. The most common medicine which leads to orange tongue is Rifampin (Rifampicin) used to treat Tuberculosis. The other less common medications used are amiodarone, bleomycin, chloroquine, chlorpromazine, doxorubicin, hydroxychloroquine, minocycline, quinacrine, quinidine etc. The color from medicines is usually because of the substance used to cover the medicine surface, so the discoloration can be avoided by swishing or gargling water after taking the tablet.



Yellow Colored Tongue:

Most of the causes of Orange tongue can be the causes of Yellow tongue when the color intensity diminishes it appears yellow. Other common reasons or causes of Yellow tongue are Jaundice (due to increase in bilirubin).


Black Colored Tongue:

One of the most common causes of Black tongue is due to Hairy Leukoplakia or Hairy tongue. The other reason for Black tongue is due to medicines which contain Bismuth as a



White Colored Tongue:

Most common cause is Oral Thrush or Candidiasis which appear as patches on the surface of the tongue which are scrapable and leave a red colored lesion. Poor Oral Hygiene is

also a reason for Whitish discoloration of the surface of tongue. Leukoplakia lesions also turn the dorsal surface of the tongue white. The surface of the tongue turns white when you suffer from Fever. Other diseases which lead to white tongue are dehydration, syphilis etc.



Bright Red Colored Tongue:

Most common cause of Red Tongue is Glossitis or inflammation of the tongue which can be due to multiple reasons. Red Tongue is sometimes called as Strawberry Tongue which is

seen in Scarlet fever or Kawasaki disease (commonly sen in children). Treatment of discoloration of tongue is to treat the underlying condition which is the most common reason

How epilepsy can affect oral health?

When we hear about epilepsy the first thing that comes in our mind is seizures. However, this brain disorder can have a severe impact on oral health as well. Epilepsy, when combined with poor oral health, can make the visit to the doctor or Dentist, CT, a real challenge.

People with epilepsy must schedule their visit to a dentist on a regular basis. There are a lot of conditions that can affect the health of an epileptic person. Some of the most common issues that an epileptic patient can face are:

Gnashing teeth leading to tongue and cheeks bite.

Displacement of the tooth from the socket.

Fracture in the jaw.

Need for the root canal, making the situation more difficult for the patients. This treatment is relatively painful and especially in a situation where a patient is suffering from epilepsy, it can further degrade the situation and make it worse.

Tooth dislocation is a possible outcome

Epileptic patients are more likely to have more missing tooth as compared to others. Apart from these common issues, there are several problems that can be the outcome of treatment required in epilepsy, also the seizures cause various issues like bleeding gums, overgrown gums etc.

Epilepsy also creates B 12 deficiency in patients that can cause ulcers. The medications used for the treatment can also have an adverse effect on the absorption strength of the body with respect to vitamin D. Therefore, along with B 12 deficiency, patients can also go through severe vitamin D deficiency, leading to further downfall in oral health.

Though it takes some time to overcome epilepsy and its adverse effects on health, however issues related to oral health can easily be combated by making regular visits to dental care clinic center for a regular oral health check-up.

How to make dental visits easier:

We all know that visit to the doctor during this health condition can be really exhausting, however small precautions and tips can make these visits relatively easier. Make sure to schedule your appointments, also ensure that your dentist is well aware of your situation. Before you start any medication, talk to your dentist and tell him about all the previous medicines that you are taking. This is to ensure that no two medicines have an adverse effect. If you have a missing tooth consult both your dentist and physician before getting it replaced. Tooth replacement must be done in accordance with the frequency of seizures and other epilepsy consultations.

Dural Venous Sinus Thrombosis due to maxillary sinus infection

Dural venous sinus thrombosis ( DVST ) is a sporadic disease with an unreliable prognosis. Diverse aetiologies play major role in the development of dural sinus thrombosis like infections from paranasal sinusitis, intracranial abscess, otitis, mastoiditis and meningitis have also been reported. DVST is a rare complication of maxillary sinus infection. Maxillary sinusitis infection may spread directly to orbit via lamina papyracea and it is expedited by the presence veins of breschet.

The trabeculated cavernous sinus acts as sieves, fltering bacteria, thrombi from the maxillary sinus, medial third of face and teeth. Due to lack of one-way valves infected thrombi or blood clot from deep facial vein or inferior ophthalmic vein communicate to cavernous sinus via pterygoid plexus.

Clinical presentations are various in DVST and headache is themost common presenting symptom. Sensory defcits, dysphagia, seizures occurs in 75% of cases. Magnetic Resonance Imaging (MRI) combined with Magnetic Resonance Venography (MRV) remains gold standard imaging technique in diagnosing DVST.

The corner stone of DVST treatment is administration of anticoagulants such as low molecular weight heparin and warfarin. Dentist often accidently diagnose maxillary sinusitis during routine radiographic examination like intraoral periapical radiograph and panoramic tomogram.

Most of maxillary sinusitis patient present with pain originating from orofacial region. Severe headache, papilloedema with signs like kernig’s sign tends to preponderate in most cases of DVST. Early aggressive treatment of infection involving maxillary sinus can prevent the development of DVST

Herpes-associated erythema multiforme (HAEM)

Erythema multiforme is an acute and self-limiting mucocutaneous hypersensitivity reaction

triggered by certain infections and medications. One of the most common predisposing factors for erythema multiforme is infection with herpes simplex virus (HSV). HAEM is an acute exudative dermatic and mucosal disease caused by the infecting HSV. It has a recurrence and idiorestriction, characterised by increasing of CD4+ T leucomonocytes.


Drugs, including dioclofenac sodium, sulfonamides and penicillins, also predispose to thedevelopment of erythema multiforme. Alpinia galanga is a known Siddha drug used by thattraditional medicinal system for treating numerous acute and chronic inflammatory disorder. The anti-inflammatory action of Alpinia galanga is due to active phytochemical components such as 10-acetoxychavicol acetate (ACA) and trans-p-hydroxycinnamaldehyde present in it.


             The most common trigger for the development of EM is the HSV (HSV-1 and HSV-2). The pathogenesis of HAEM is consistent with a delayed hypersensitivity reaction. The disease begins with the transport of HSV DNA fragments by circulating peripheral blood mononuclear CD34+ cells (Langerhans cell precursors) to keratinocytes, which leads to the recruitment of HSV-specific CD4+ Th1 cells. The inflammatory cascade is initiated by interferon γ (IFN-γ), which is released from the CD4+ cells in response to viral antigens, and immunomediated epidermal damage subsequently begins.

Treatment of erythema multiforme depends on the severity of the clinical features. Mild forms usually heal in 2–6 weeks; local wound care, topical analgesics or anaesthetics for pain control,

and a liquid diet, are often indicated in these situations. For more severe cases, intensive management with intravenous fluid therapy may be necessary. Oral antihistamines and topical steroids may also be necessary to provide symptom relief. Systemic corticosteroids have been used successfully in some patients, but evidence to support their use for erythema multiforme is limited.

     In case of HAEM, it is effectively managed with acyclovir (200 mg, 5 times a day for 5 days), but only if the therapeutic scheme is started in the first few days. If erythema multiforme keeps recurring, a continuous low dose of oral acyclovir is necessary. Oral acyclovir has been shown to be effective at preventing recurrent HAEM and the protocols may include 200–800 mg/day for 26 weeks.

Before treatment

Before treatment

After treatment

After treatment

Is Paracetamol safest analgesic?

Paracetamol (Acetaminophen) is a commonly used analgesic and antipyretic agent. It acts by preferentially inhibiting Cox-3 receptors. Angioedema to paracetamol is rare and likely to occur in children. Angioedema is a localized self-limiting swelling in the dermis, lip mucosa and tongue. It occurs due to release of plasma and vasoactive mediators.

 Angioedema is generally subdivided into idiopathic angioedema, extrinsic factor induced angioedema and angioedema with C1-INH defciency. The extrinsic factor induced angioedema includes angioedema associated with Non Steroidal Anti Inflammatory Drug (NSAID) such as aspirin, paracetamol.

Generally NSAID-induced angioedema considered as a non-allergic reaction. The pathogenesis of NSAID induced angioedema is by inhibition of Cyclooxygenase (Cox) which results in signifcant
changes in arachidonic acid metabolism such as cysteinyl leukotriene excessive production. Recent research suggests that bradykinin play a vital role in the pathogenesis of most forms of nonallergic angioedema.

 Patient with oropharyngeal angioedema may present with acute upper airway obstruction and this should be monitored for airway. Since, oedema from the site typically progresses rapidly and may end up in life-threatening complications

The important step in treatment of angioedema is to terminate the drug that suspected to trigger angioedema. Antihistamines and glucocorticoids often act as mainstay drugs in treatment of drug induced angioedema

All healthcare professionals should be aware of such a possibility of allergy due to paracetamol . Furthermore, such an event should be recognized early and treated accordingly.