Herpetic GingivoStomatitis……Fever blisters

Image of secondary infection, Source: Wikipedia

Herpetic gingivostomatitis is a very common infection in children. Often it is very stressful for parents because of children catching high fever and also the way child’s mouth looks. Gingivostomatitis is caused by herpes simplex virus, type 1. This is the same virus that causes cold sores on lips in adults. It is the primary infection that has systemic symptoms. After the primary infection, the virus stays dormant in the body and recurrence is usually seen as cold sores on lips or other parts of the mouth, when body goes through stress. It is contagious; children usually catch it from contact with family members or by playing with other kids. Within a few weeks, the mouth becomes painful and gums are intensely inflamed. Lips, tongue, buccal mucosa, palate, pharynx and tonsils may also be involved. Then yellowish fluid filled vesicles develop, which rupture to form painful ulcers.


  • Blisters on lips, tongue, cheeks, lips and gums
  • Child refuses to eat due to pain
  • Drooling
  • High fever
  • Pain in mouth
  • Swollen and bleeding gums
  • Bad breath
  • Headache
  • Pain upon swallowing


Herpetic stomatitis usually clears in 2-3 weeks. Since it is viral infection, antibiotics are not prescribed unless recommended by your doctor. Controlling the fever and keeping the child hydrated is most important. Give them lots of fluids to drink. Soft, cold and non spicy food may be easier to swallow. Topical anesthetics also help ease pain.




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Silver verses White fillings

Often parents have a hard time deciding whether to have white or silver fillings done on their children’s teeth. All parents want to do what is best for their children, no matter what it takes. Silver fillings have been used for ages and are very economical compared to white fillings. Whether the dentist is trying to sell an expensive upgrade or do the right thing, is a question on everyone’s mind. I want to list the pros and cons of both fillings, so parents with the help of dentist can decide what is best for their child.

Amalgam (silver) fillings have been used by dentists for more than a hundred years. It is an alloy made by combining mercury, silver, tin and copper. It may contain traces of some other metals. Dental amalgam is the most widely used restorative material; however, there are concerns about mercury present in it. There are concerns about how much mercury is released once the filling is completed. Research has shown that the amount of mercury released is very low. The major U.S. and international scientific health bodies, including WHO and FDA, are satisfied that amalgam is a safe, reliable and effective restorative material. Some individuals may be allergic or sensitive to mercury or other metals in amalgam, though it is very rare. They should inform the dentist and not get amalgam fillings.

Composite (white) fillings are a mixture of glass or quartz in a resin media. They are not as strong as amalgam but over the years they have greatly improved the strength of the material.

Pros and cons: Amalgam Fillings

  • Amalgam is a strong filling and can better withstand forces of mastication.
  • Recommended on teeth if it cannot be kept dry during filling, for example fillings under the gum.
  • They are more economical.
  • Well tolerated and biocompatible.
  • Tooth can be sensitive to hot and cold for few weeks after filling is done.
  • Shows when you smile or talk especially when done on front teeth.
  • Can cause discoloration of tooth.
  • Requires dentist to remove more tooth structure to create retention.

Pros and cons: Composite Fillings

  • White fillings are not as strong as amalgam.
  • Less tooth structure needs to be removed since it bonds to the tooth.
  • They are tooth colored, so more aesthetic.
  • Requires cavity preparation that is dry and clean during filling.
  • More expensive than amalgam.
  • Has no mercury
  • White filling can shrink and that can cause recurrent decay and discoloration of tooth.

FDA does not recommend that you have your amalgam filling replaced if they are sound and have no decay underneath. It results in unnecessary loss of healthy tooth structure and exposes you to mercury vapor while having filling removed.

Next time you visit a dentist, make an informed decision.




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My Grandfather

It has been a year since you have been gone; there hasn’t been a day when I did not think about you. You left a hole in my heart, one that will never heal. I feel you around me, every time I smile I can see you smile, every time I cry, I miss your shoulder and wonder what you would have said to me. Although I believe that you are in a better place, what wouldn’t I give up to have you by my side? I loved you from the day I was born, and will love you till my heart beats. May Allah grant you the highest place in Paradise.


When I was young, I was often asked to write essays for homework. I was never enthusiastic about it, since homework was not one of my favorite things to do. Some of the topics I was told to write about were: “If I were an Apple or a Tree,” “My Best Friend,” “Morning Walk,” and so on. For the first time in my life, I feel like writing one, as if this is the most important essay of my life; one about my grandfather, Totha, a man I will always love with my heart and soul. He was the man who played an instrumental role in my upbringing.

He was a great man. What I liked most about him was his generosity; he had such a big heart. I remember when someone asked him for help, he would help them regardless. When it came to doing things for family and friends he did everything he could to make their life easier and happier without expecting anything in return.

I tend to fall short of words when I describe the love he has given me. It can be hard for me to recall a day of my childhood without him, for he was involved in a huge part of my life. Every morning he would walk with me to the bus stop, and in the afternoon he would be waiting there for me to take me home. I would wait for him to tell me stories. Among them my favorites were Kashmiri folk tales, such as “Gule Bakawali,” and “Princess who loved salt.” I would love hearing them over and over again. At night, when I was sleepy and didn’t want to eat, I remember he would sneak fruits into bed and trick me into eating them. He would have me sit on his shoulders, and would take me along everywhere he went, such as the market, park, lakes, or mosque. You name it. The ride on the motor boat between Hazratbal mosque and Char Chinari was my favorite. I would  hold on to his Dusa (shawl) or  sleeve of his Pheran and  follow him around. He never seemed to get tired. Countless times in a day I would mess around with his personal belongings, but he would never get upset. Every year, he would plant a new fruit tree, exclusively for me and my sister. By law, we had to be the first ones to eat the fruits every year. As we grew older, so did the fruit trees.

1989, I had my matriculation exam. I was very nervous. Everyday he came with me to the examination center, and would wait outside until I was done. On the day of my English test, there was a bomb blast in Kashmir, probably the first one. Kashmir had never seen anything like this before.  Chaos was in the air, and I began to cry.  I had no idea how I would get to the examination center. Back then, things like this were not common. There was no way to communicate with other people, and cell phones did not exist. He came to me and said that if the test was not postponed he would take me to the examination center no matter what it took. We walked, hitch hiked, and ran just to get there. I may have been late, but we made it. That one day would have otherwise cost me an extra year of schooling.

I left Kashmir soon after I graduated tenth grade. My education was on top of my grandfather’s priority list. He would visit me three times a year, and would bring loads of fruits from the trees he had planted for me. Kashmiri was the only language he could speak, yet he managed to travel from one end of country to another just to see me and my sister.

My friends fell in love with him, and many of them did not know a single word of Kashmiri. They looked forward to seeing him and all the goodies he would get for us. All my friends would call him “Thoats”. They would often tell him that he was blindly in love with me and my sister. Once, he lost a part of his finger at the train station when he was travelling to Madras to see me, but never mentioned it. It just wasn’t important to him. My sister and I were the queens of his heart, and he would happily give his life for us.

As I got older, my life began to get busy, and simultaneously, age began to show on him. My sister and I got married and moved thousands of miles away from him. I still remember how happy he was on our wedding. The distance and age slowly got to him. I believe it was more about the separation than the age. He had not done anything other than care for us. The saddest part was that when he needed me the most I was never there for him, and I regret it. The guilt and regret will always remain in my heart.

Grandparents are the best things that happen to a child; their unconditional love, forgiving heart, and soft touch to me are like natural fertilizers. Today, my grandfather is not with us and I sit in my shame and guilt. One of the most beautiful chapters of my life has  come to an end. I couldn’t do much for him but I pray that may Allah grant him paradise and make me as good of a grandparent as he was for me.  Ameen


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Nursing Bottle Syndrome

Picture of  a 17 month old  baby who went through full mouth restoration, four extractions, seven baby root canals and seven crowns.

Picture of a 5 year old boy

Nursing bottle Syndrome (NBS) also known as baby bottle syndrome affects children less than 5 years of age. NBS causes extensive decay of baby teeth, as a result children as young as two year old end up needing fillings, crowns or extraction.

It is hard for me to comprehend the pain patients suffering with Nursing Bottle Syndrome (NBS) must be dealing with. For last ten years, I have seen these children suffer and their parents cry when I was treating them.  Most of my patients are children who are less than five years old.  Over the years, I have noticed how under addressed the issue of Nursing Bottle Syndrome is.  As serious as it is, NBS can be prevented very easily, with just basic education of parents. Some diseases just happen, nobody knows the cause or the cure and then there are others we know the cause and the preventive measures. The first kind, till the mystery is solved is out of our hands, but if the second one happens then we as doctors have failed. In this day and age nobody should be uninformed. Patient education should be the most important part of medical field and it should be facilitated by the media.

Some things in life leave a definite impression on our mind and motivate you to do things that we never thought of doing. Nursing Bottle Syndrome made me write the book, it gave me the drive to write for Greater Kashmir.

 Picture of  a 5 year old child . No child should have to go through such extensive dental treatment.

NBS is caused by contact of liquids containing sugars, such as milk, formula or juice for an extended period of time. At night, when the child falls asleep while having the bottle or breast feeding, the child does not swallow the milk, and it remains in their mouth all night long. Bacteria which are present in the mouth will break down the sugar into acid, which will eventually lead to tooth decay. Some mothers also use a bottle filled with milk or juice as a pacifier. As a result, the liquid is left in contact with the teeth for an extended period of time, giving bacteria lots of time to cause cavities. NBS can also be caused by frequent snacking with sticky food.

  • Wean children from the bottle as early as 12 – 14 months.
  • Always follow feeding from the bottle with water, to rinse out any residue left from the milk or juice. If your baby wakes up at night to drink milk keep another bottle filled with water by your bedside .When you are done feeding the baby give him or her few sips of water to wash the milk away. Same is true for breast feeding.
  • Bottle should only be used for feeding purpose not as a habit to make baby sleep. Never let your child walk around with bottle filled with milk for more than 20 minutes.
  • Begin brushing your child’s teeth as soon as teeth appear in the mouth, or clean them using a wet cloth.
  • Dental examination should begin at 12 months, or earlier if a problem is noted.
  • Juices and sodas cause erosion of teeth they should be avoided in children. Water and fresh fruits are excellent alternatives. 4 oz is the maximum amount of juice a child should consume in a day.
  • Children should be fed every 2-3 hours breakfast at 8.00 AM, snack at 10.30AM, lunch at 1.00 PM and so forth. This will also increase their appetite.


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All of us get frost bites in winter and try remedies that our elders tell us, either to prevent them or heal them. I remember when I was young, my grandmother would tell everyone to boil radish and soak feet in that water. Some argued that soaking in Lipton chai got the job done. I would get frostbites once in a while but for my sister winter was a nightmare. No matter what we did, we always lost the battle. She would get them on her feet, hands and ears too.

What is frostbite?

It is a localized damage to skin due to extreme cold. It usually affects the extremities that are farthest from heart and with exposed areas like fingers, toes, nose and ears. It used to be a military problem but everyone is susceptible to it especially people who spend lot of time outdoors, alcoholics, medically comprised patients and elderly people without adequate food, shelter and water.


When body is exposed to extreme cold it responds to keep your vital organs functional. It sends signals to arms and legs to constrict its blood vessels. This slows the blood flow to the skin especially in the extremities and at the same time increases the blood flow to vital organs and maintains body temperature. It is your body working to keep you alive.

As the process continues body goes through cycle of constriction and dilation to preserve maximum function in extremities. But if your brain senses the danger of body temperature lower that 98.6 F, it completely constricts the blood vessels in order to prevent cold blood returning to vital organs and this initiates a frost bite.

The damage caused by frostbite depends on the degree of frost bite.

In first degree frostbite, there is itching and pain. There is no permanent damage since only superficial layer of skin is involved. If the freezing continues, the skin gets harder and then forms a blister. This is the second degree frostbite, but deep tissues are not affected. It usually heals in a month. If the area freezes further, deeper tissues get involved. This is when the muscles, tendons, nerves and blood vessels freeze. If at this stage care is delayed, it can lead to permanent loss of function and amputation of parts involved.


Keep the affected area warm. See a doctor, especially if you are diabetic. Excessive movement of involved tissue can form ice crystals to cause more damage. Splinting or wrapping of frostbitten area can help. For the same reason rubbing and messaging the frostbitten area may not be a good idea. Never apply ice to the affected area to help ease pain and itching. There was a girl inKashmirwho lost a part of her foot because she kept rubbing ice on it.

I guess it was the warm Lipton chai or the warm turnip water that got the job done. Winter is here, keep yourself warm and wear socks and gloves whenever you step out.


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Your Baby’s Teeth

From a Mother to a Mother

 Children don’t come with a manual. Your first child is always a learning experience. I wanted to give a first time mother a list of few things that will help take care of her child’s teeth.

The first tooth in babies will erupt between 4-8 months of age and kids usually get all their baby teeth by age two and half to three. Teething process is different for every baby. Some children have a difficult time during teething, while others sprout teeth effortlessly.

Some things to note about teething:

  • Teething may cause increased drooling.
  • Babies may refuse to eat due to pain in their gums. They often get restless and fussy.
  • Pain due to teething may cause them to sleep less or wake up often.
  • Referred pain from back teeth erupting may cause them to rub their cheeks.
  • They will put their hands in their mouth and bite on everything they can get hold of.
  • Excessive drooling around their mouth can causes rashes due to skin irritation.
  • Some babies may get a low grade fever or mild diarrhea but it is very important that you get him or her checked by a doctor to make sure that they are not getting the flu, ear infection or diarrhea due to infection. (Children usually do not get high fever with teething).

Things to do at home to reduce pain:

  • Massage the gums with a finger or wet gauge. Keep the area clean.
  • Use teething rings as they are very helpful.
  • Chilled teethers are very helpful. Do not freeze the teether. Cold carrots are good teethers if the baby can chew on solid food.
  • To prevent skin rash from excessive drooling use a cloth to dry baby’s chin.
  • If baby is extremely uncomfortable, see a dentist. He/she may prescribe a medicine to ease the pain.

Important tips to remember:

Start cleaning your child’s teeth as soon as the teeth erupt. Use a wet gauge to clean them when they are partially erupted; once the front tooth erupts completely, use a soft tooth brush. Make sure you are cleaning the gums too. Use no fluoride training toothpaste, which is safe to swallow until your child learns to spit out the toothpaste. Brush two times a day and floss once. Stop the bottle  after first birthday. Babies should not be fed in the middle of the night after they are 14-15 months old unless suggested by a doctor. Feed them a good dinner before you put them to bed. Avoid juice; water and fresh fruits are the best alternatives.

Time does go by fast and one day your child will come and tell you that his or her tooth is loose. First baby tooth usually falls out at an age of six or seven, although some kids may start losing them a year early or later. Loose teeth can cause pain and kids sometimes will avoid brushing around loose teeth so it is important that parents help them keep those areas clean. Baby teeth usually fall out on their own, however, in some kids they can be stubborn and may stick around even after permanent teeth have erupted. In that case they may need to be taken out by a dentist.

Other important thing to watch out for is the first permanent molar also called six year molar. This is a very important tooth and it erupts behind baby teeth; kids are not used to having a tooth so far back and can easily skip brushing them. Also it is a big tooth and can cause considerable amount of pain and sometimes infection too due to food collecting around it. Salt water gargle, brushing and massaging that area will help ease the pain. As soon as the molar erupts it needs to be sealed. Sealant is like a nail polish coat that goes on top surface of the molar. It prevents food from collecting in groves and helps reduce the incidence of cavities.

Keeping all these things in mind will help your children develop healthy teeth and a beautiful smile. Books to educate children and get them to maintain a good oral hygiene. They are free and can be downloaded on Android and Apple phones and tablets.

Parents with Android phones and tablets.

“Sam and the Sugar Bug,” will teach them the importance of good oral hygiene.

Leila and the Tooth Fairy,” will help them make healthy choices.

“Leila’s first visit to the Dentist,” will make their  visit to Dentist easy.

“Sam and the Sugar Bug,” on Apple

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Steve Jobs……The Man in Black Turtleneck

Steve Jobs was an entrepreneur, a visionary, a creative genius and a great businessman. Truly an Edison or Einstein of our time. What amazes me is that he wasn’t even an engineer. He just had a beautiful mind. The world has lost someone very important; someone who touched everyone’s life in one way or the other. Things we take for granted would not have been possible without him. He made advanced technology easy enough for a two year old to use. Steve Jobs gave ordinary man gadgets that only big companies or corporations used to enjoy.

He co-founded Apple in 1970. Apple did not do as good as predicted. He was forced to leave the company in 1985. Microsoft took over the market for personal computers. He formed a new company called Next, a computer platform development company specializing in higher education and business market. He acquired Pixar Studios in 1986 and made some very successful movies. In 1996, Apple bought Next and that brought Steve Jobs back to Apple. That marked a new beginning for the ailing company.

It all started with iMac followed by iPod, iphone, ipad and many more small innovations that made our lives easy, especially for technologically challenged people like me. Every time his products hit the market, people lined at the store doors at midnight to buy them. It was like a sequel of a good movie that you had to watch and without fail the sequel was better. He kept his promise every time. It reminds me of my all time favorite animation movies Toy Story 1, 2 and 3. To my surprise he was the executive producer of the movies. Steve Job was a perfectionist. When he designed a gadget he thought of every small detail, from function to esthetic. His users had nothing to complain; the product was always complete leaving one wondering what was left to upgrade.

Steve Jobs came from a humble background. As soon as he was born, his mother put him for adoption. He was a college drop out. Later in his life he was fired from the very company he started. When he left Apple, everyone thought that was the end of his career but for him it was a new beginning. Steve Jobs said that being fired from Apple was the best thing that happened to him. His success had been replaced by being a beginner again. That had given him the freedom to enter one of the most creative periods of his life. When he returned to Apple he completely reshaped it. Apple went from being on the brink of bankruptcy to the biggest technology company of our times.  He probably left Bill Gates speechless. Steve Jobs may no longer be with us but his amazing gadgets are part of the daily lives of millions of people. He continues to live through his magical inventions. He is not only an inspiration for businessmen whose career has taken a turn for worse but also for all of us

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