Bad Breath Reasons and Causes You Never Knew !

It's not your fault if you are searching for the reasons of chronic bad breath in your food or you smoking habit. 

If you have not read any research papers or if you are not a professional then it's normal to blame something which is not truly responsible for your persistent bad breath. 

What I have seen is that most of the people search for causes of bad breath in there eating habits, which is responsible for transient bad breath which easily goes once you brush your teeth.

It have been seen that people don't seek professional help for bad breath and they don't realizes that pathologic etiology may be the cause of there persistent bad breath. 

Bad breath is also called as halitosis or oral malodor 

Recommended reading : How to get rid of Bad breath or Halitosis

Reasons for your persistent Bad Breath 

There are certain chemicals collectively called as Volatile sulfur compounds- Hydrogen sulfide, Methylmercaptan, Dimethyl sulfide these are the chemical reasons for bad breath.

Other chemicals like Putrescine, Cadaverine, indol, skatole, butyric or propionic acid are also responsible for halitosis or bad breath.

These chemicals are generated by bacteria through the process of putrefaction of peptides which are present in the saliva, shed epithelium, gingival crevicular fluid, interdental plaque, food debris, post nasal drip and blood. Gram negative anaerobic bacteria have ability to do this kind of activity.

Causes of Bad Breath

Intraoral Causes (which are present in the mouth)

Dentition- Irregularly placed teeth increases the chance of debris accumulation, Deep cavities causes food lodgment and its decaying causes bad smell, Interdental spacing causes food accumulation and difficulty in cleaning.

Periodontal infection- Patients suffering from periodontitis (inflammation and deep infection of gums )or gingivitis (inflammation or superficial infection of gums) show increased level of oral malodor,

Dry mouth- It is also called as Xerostomia,Increased microbial activity and release of volatile sulfur compound becomes the reasons for bad breath.

Tongue and Tongue Coating- Tongue have large number of papillae which have central crater and lifted
border this makes tongue a rough surface tongue have tendency to accumulate debris and coating, those who forget to clean there tongue or those who don’t clean there tongue will suffer from bad breath. There are some conditions like fissurated tongue, scrotal tongue and hairy tongue increases the debris retention and problem.

Extraoral Causes (these originates at places other than mouth).

Ear, Nose, Throat- Acute Pharyngitis, purulent sinusitis, post nasal drip, regurgitation esophagitis, Ozena, Chronic tonsillitis.

Bronchi and Lung- Some conditions like chronic bronchitis, bronchiectasis, bronchial carcinoma causes halitosis.

Liver- Patients suffering from liver insufficiency (like cirrhosis, will result in increased ammonium content in their blood which is exhaled in breathed air resulting in one of the causes of halitosis.

Kidney- Conditions like Chronic glomerulonephritis which result in kidney insufficiency will lead to increased uric acid level which will be exhaled in breathed air and cause bad breath.

Types of Halitosis/ Bad Breath

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To get rid of bad breath person or dentist must first distinguish between the Genuine halitosis and Pseudo
halitosis.

Genuine halitosis is when bad breath is real and it can be conformed by Organoleptic or Physic- Chemical means.

Pseudo halitosis is a condition in which patient thinks he has halitosis.

When patient continue to feel that they have halitosis even after successful treatment the are called suffering from Halitophobia.

Genuine Halitosis is subdivided in Physiologic halitosis and Pathologic halitosis.

Physiologic halitosis is transient and usually doesn't require any kind of treatment, most of the time it originate from tongue surface, it is also called as morning breath.

Pathologic halitosis is persistent, doesn't resolve by regular oral hygiene and prevents patient from caring normal lifestyle.

Further Reading: How to get rid of Bad breath or Halitosis

Gum Infection Symptoms that indicates- You need a Treatment

Gum infection is one of the commonest problem in humans and in 90% of the cases it occurs due to bad oral hygiene, but there are many factors like medical conditions, food habit, medicine we use; which are also responsible for it.

In medical terminology Gum infection is called as Gingivitis or Periodontitis depending upon the severity of condition.

So today we will learn to recognize gum infection symptoms because 40% of people can’t recognize they have gum infections until it gets very bad.

You may like to have a mirror with you while reading this, to check the symptoms one by one.

11 Gum Infection Symptoms you must know about

1.Bleeding gums- This is the first symptom of gum infection, people first see this kind of symptom while
brushing their teeth, person suffering from gum infection will see blood in tooth paste foam when they spit in sink or while eating hard food. Bleeding occurs from the junction of the gum and tooth, even a slight irritation of gums will induce bleeding.

2.Redness of gums-Normal color of gum is pink but in gum infection cases redness of gums can be seen, at first the redness is around the margins of the gum but it may become diffused later on, in acute conditions you will see marked redness combined with gum bleeding. This redness may be seen around single tooth or it can be seen generalized in all the gums. This redness is sign of inflammation and goes after treatment.

3.Bluish or purple gums- In some cases when the infection becomes chronic; the color of gum changes from red to bluish purple this is sign of venous engorgement of the blood vessels in gums whenever you seen such kind of coloration of gums it’s time to go to your doctor.






4.Bad breath- This is second most common sign of gum infection after bleeding gums, those people who
have bad breath are prone to have gum infection, bad breath signifies high level of bacterial grown in your mouth and hence a compromised oral health. Best way to test bad breath- lick your wrist and wait for some time then smell that area f your experience fowl smell then you are suffering from halitosis.

Want to know How to get rid of bad breath or Halitosis

5.Swollen and spongy gums- This is the point when patients really start to notice the problem. Gums become swollen and puffy, its surface loses stippling and becomes smooth, when swelling enlarges then ulceration may develop over them, ulceration are due to mechanical trauma while eating. Swelling may be over one tooth or it may be generalized.

6.Recession of gums- This symptom indicates that gum infection is in the advanced state of its development, in this symptom the gums leave it natural position and move down toward bone this may expose the roots and may form gaps between the teeth. This occurs due to loss of underlying supporting bone. Some time it may be associated with single tooth and some time it is generalized.


7.Bad taste in mouth- advanced gum infection causes pocket formation at the junction of the tooth and gum, these deep pockets harbor bacteria and debris these pockets may result in exudates formation and these exudates result in bad taste.

8.Sensitivity- This gum infection symptom indicates serious problem. Gum recession will results in exposure of root surface which intern results in sensitivity, tooth will look longer then it usually are and patient may feel sharp pain like feeling while having cold stuffs.

9.Tenderness & pain- In advanced stage of gum infection pain can be experienced by the patient this pain can be from gums and some time the tooth associated with the infected gums will become symptomatic and it will become painful.

10.Ulcerated gums- If ulcers can be seen on the gums that means acute form of gum infection. If gum ulceration is generalized then it indicates some serious oral disease, get it checked.

11.Hyper salivation or pasty saliva- As your gum infection get established for long time it may result in increased salivary flow this is a usual sign of infection in mouth, in chronic cases saliva becomes pasty.

Conclusion: A Research by National Institute of Dental Research, National Institutes of Health, Bethesda, Maryland says that there is lack of awareness of Gum infection symptoms in patients and there is lack of interest in assessment of the problem by the general dentist. This problem can only be prevented and cured with the help of individual and professional effort.

How to Get Rid of Bad Breath or Halitosis Permnentaly

If you have a question, what can i do to get rid of bad breath then you have landed on correct page which gives every answer to your problem.

For most of the people bad breath is a temporary problem and it vanishes after they begin their day, but some times it becomes Chronic bad breath and it doesn't go, no matter what you do it comes back.

Then begins experiments, some try to cure bad breath naturally and some try to find ways to cure bad breath in chewing gums and sprays.

At last a question comes in mind How to get rid of bad breath ?

I suggest you to read with patience because this article is little bit lengthy and I’m giving you the information which is not given at school or home or even at your physicians office.

If you really want to cure bad breath permanently then understand this fact that people suffer from bad breath due to different reasons and these reasons for bad breath should be diagnosed and removed to cure it permanently.

Bad Breath can be defined as The subjective perception after smelling someone’s breath. It can be unpleasant or even disturbing, it is also called as Oral malodor and Halitosis

How bad breath affects social and personal life. 

There are some striking survey data from America alone, Bad breath causes social problem among 50% of the people in developed countries. This shows the fear and social effect of bad breath in our contemporary society.

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 Americans alone spend 1 billion dollar per year on deodorant like mouth rinses, OTC products and home remedies for bad breath in attempt to mask it or cure it.

After surveying dental clinics, it is indicated that most of the people suffer from bad breath for several years before seeking professional treatment and they seek professional treatment when forced by there spouse, family or friends.This situation is called as "bad breath paradox" because the person suffering from bad breath is unaware of it.

There is no gender predominance and patients are from age groups 5 to 80 yr. Patients are not only from the poor socioeconomic strata but from good social class too.

This problem have serious socio psychological effect on the person who is suffering from it, lack of confidence in social and personal relationship is seen in these subjects.

Two major behavioral changes are- They avoid talking in a social group and they avoid close contacts in personal relationships.

This problem can also define how others behave with these people; some people may avoid talking with person who is suffering from bad breath and spouse may even avoid kissing.

Types of Halitosis

To get rid of bad breath person or dentist must first distinguish between the Genuine halitosis and Pseudo halitosis.

Genuine halitosis is when bad breath is real and it can be conformed by Organoleptic or Physic- Chemical means.

Pseudo halitosis is a condition in which patient thinks he has halitosis.

When patient continue to feel that they have halitosis even after successful treatment the are called suffering from Halitophobia.

Genuine Halitosis is subdivided in Physiologic halitosis and Pathologic halitosis.

Physiologic halitosis is transient and usually doesn't require any kind of treatment, most of the time it originate from tongue surface, it is also called as morning breath.

Pathologic halitosis is persistent, doesn't resolve by regular oral hygiene and prevents patient from caring normal lifestyle.

How to get rid of bad breath or halitosis

First step - Mechanical reduction of intraoral debris and microorganisms by correct oral hygiene methods.

Keep patience for 30 days to see consistent results. If bad breath is gone then continue to maintain your oral hygiene, you probably had physiologic halitosis which is now resolved.

Methods to keep good oral hygiene

Proper tooth brushing technique- Person how is suffering from halitosis should start from baby steps ie. learn about proper tooth brushing technique and start brushing your tooth twice a day for at least two minutes. This habit will reduce the amount of plaque and debris to significant levels hence reducing the number of bad breath producing bacteria.

Electronic tooth brush Vs Manual Tooth brush
Even after repeated attempts if you are not able to maintain a proper tooth brushing technique and you can still see plaque and debris on your tooth then don't get frustrated, may be due to crowding or irregularly placed teeth it is getting difficult for you.

In other cases some people lack manual dexterity or patience to perform proper brushing technique.

If you feel that you are not able to perform a proper brushing technique and find it difficult then you must try electronic tooth brush.

Electronic tooth brush have a benefit that they don't require any specific brushing technique and can be mastered easily.They are fast in action and efficient in cleaning. If you are tired of your bad brushing habit and you are rushing to complete your brushing every morning then go for an electronic tooth brush.

Three good electronic tooth brush are:
Philips Sonicare Rechargeable Electric Toothbrush
Oral-B Professional Healthy Clean Precision 1000 Rechargeable Electric Toothbrush 
Oral-B Professional Healthy Clean + Floss Action Rechargeable Electric Toothbrush 

Proper tongue cleaning- A tooth brush can be used to clean the surface of the tongue but a tongue scraper is better option for this work. Daily tongue cleaning has marked effect on the halitosis reduction treatment. it have added benefit of improving taste sensation.

Proper interdental cleaning - Most of the people forget about interdental cleaning, but it may affect the treatment results drastically if done properly. Patient is educated to use floss to clean tight interdental areas and interdental brush is used to clean areas which have gaps.

If bad breath persists then go to second step

Second step- Proper diagnosis and professional treatment, If your halitosis is not resolving by implementing
step one for 30 days then there is a chance that you may be suffering from pathologic halitosis.

Schedule an appointment with your dentist and discuss your problem with him, tell him that how you tried to maintain good oral hygiene for last one month but your bad breath is not going.

He will do detailed examination and if your halitosis is due to intraoral cause then he will suggest a treatment plan for it, If your halitosis is due to extra oral cause then he may send you to physician or any other specialist for further diagnosis and treatment.

Most common intraoral causes of pathologic halitosis.

Gingivitis and Periodontitis are the major causes of bad breath or pathologic halitosis, professional periodontal therapy is needed to control the growth and multiplication of microorganisms.

If your are suffering from Gingivitis then dentist may suggest oral prophylaxis, which is combination of scaling and polishing of your tooth.

If you are suffering from Periodontitis then dentist may suggest you to go for scaling + curettage + Root plaining, complete process depending on your periodontal pocket depth. (Not your financial pocket depth. LOL)

Combined with scaling and root planing (where needed) the application of chlorhexidine will reduce the bad breath upto 90%. Your dentist may also prescribe some antibiotics in combination with treatment.

Seek a professional advice from your dentist.

Third step- (Use of pharmacological agents in conjugation with above steps to reduce halitosis producing bacteria), objective behind using chemical reduction technique is to reduce the microbial load in oral cavity but the drawback of this technique is that its effect is limited, This is why it is advice to practice this technique in conjugation with above told steps.

I’m telling you few agents which can be used

Chlorhexidine – Antiplaque and antigingivitis agent. Chlorhexidine mouthwash provide superior and significant reduction in volatile sulfur producing compounds, .

Chlorine dioxide- It’s an oxidizing agent which can eliminate bad breath by oxidizing hydrogen sulfide, methylmercaptan, cystein.

Triclosan- Broad spectrum antimicrobial agent of superior quality then above mentioned agents,

Hydrogen Peroxide- 3% hydrogen peroxide produced impressive reduction 90% in sulfur gas that persisted for 8 hrs.

Home remedy for bad breath in emergency situations

How to get rid of bad breath when you are in a party or just before a date. I’ll give you an effective home remedy for this situation-

 Increase water intake and put a chewing gum in your mouth chew on it for 5 minutes and spit, gargle with fresh water and then have a glass of lemon juice or orange juice.

(chewing gum will do the mechanical and chemical cleansing of your oral cavity then water will flush and clean the debris and then orange juice will alter the ph which will control your bad breath for some time)

Note: This is not a cure of bad breath, and it may not work if you are having pathologic halitosis, this may only work for physiologic halitosis or transient halitosis. 

Conclusion

For best results readers are suggested to understand the multi factorial  reasons of bad breath and take professional care.

The most common cause of malodor are gingivitis, periodontitis and tongue coating which can be managed by professional care combined with use of proper oral hygiene methods.

You have to maintain good oral hygiene and eat healthy food to get rid of bad breath and stay away from it.

How to tell or help someone have have bad breath ?- Email this article to them using share button.

How to Improve your Practical Hand or Dexterity In Dentistry.The Secret of that Perfect Hand.

This article have been written for dental students but beginner dentists can also find it helpful.

Being a Dentist we are bit different from other health professionals.We treat our patients by working actively
inside there mouth and we have to develop superior manual dexterity to achieve best results.Consider average mouth opening of a person,it is not more then four fingers wide and what about the visibility and accessibility of our operating field? It’s weird!!! We work in a field in which people struggle to put a ‘Burger’ and we are expected to do miracle and yes we are doing miracles. We perform detailed, meticulous procedures on a minute scale and margin of errors are in micro fractions, our instruments are sharp and invasive, loss of concentration will result in damage to vital tissue which is unacceptable.

Hmmm... I think its enough of self praising!!

So what is this so called Good practical hand ?

It is called as Clinical dexterity in proper terms and it is skill in performing task especially with hands.

Clinical dexterity or abilities to perform task with hands develop over time,starting with primitive gestures such as grabbing at objects to more precise activities that involve precise eye–hand coordination.Improving your clinical dexterity involves practice of same procedure multiple time in controlled way, In this way small muscles of your hand will be conditioned for the procedure. This is called as developing Fine motor skills and these are the skills that involve a refined use of the small muscles which control the hand, fingers, and thumb. The development of these skills allows one to be able to complete tasks such as writing, drawing, buttoning and finally doing dental procedures.

How motor skills are developed?

You must know that there are two types of motor skill,

Gross motor skills include lifting one's head,turning,moving head etc.Generally large muscles develop before smaller ones, thus, gross motor development is the foundation for developing skills.

Fine motor skills include the ability to manipulate small objects,and various eye–hand coordination tasks. Some examples of fine motor skills are using the pincer grasp (thumb and forefinger) to pick up small objects,like holding endodontic files.

Two Essential Things that affects your motor skill:

1.Hand-eye coordination:

One more important factor for a dentist is good hand-eye coordination. Hand–eye coordination is the coordinated control of eye movement with hand movement, and the processing of visual input to guide reaching and grasping along with the use of proprioception of the hands to guide the eyes.

2.Correct Positioning : 

Positioning is very important for engagement in fine motor tasks. A dentists seat should allow him to sit comfortably with his feet placed firmly on the floor. His hips, knees, and ankles should be at 90 degree angles, with his torso slightly forward. His operating field should be approximately at the level of his elbows when his arms are at rest at his side.Keep in mind that trunk stability is necessary for good mobility of the arms, hands, and fingers.

Interesting Fact: Ambidexterity is a specialized skill in which right and left both hands are equally dexterous and dentist can use any one of his hands as dominant one while working.

How can you build your skill by the time you proceed in your dental school :

 1.Start with simple manipulation of dental materials: how to hold spatula and bowl. What is the correct technique of mixing? Don’t dare to underestimate it. it will build foundation of your dexterity as well as your confidence and in bonus you will learn about properties of dental materials. If a dentist cant manipulate plaster or alginate it’s hopeless.

2.Wax block carving: Enjoy your carvings. Carve the anatomy of ALL teeth not for completing quota but for fun. Never ask anybody to carve for you. Dedicate as much time as you can in understanding and reproducing the anatomy of tooth. Not only teeth but you can do your imaginary carvings .Get an idea from your surroundings try to carve it on wax block and if you make something good don’t keep it to yourself Show it to your classmates, teachers and seniors get appreciated, this is the secret of building positive attitude, every time you get appreciated your confidence is improved your hand is improved.

3.Making miniature models/ sculptures: out of dental materials like plaster and modeling wax is one of the favorite things I did in my college time. I used to make something out of any dental material which can be manipulated. Fortunately I got Best crafts award in   “Colors 2009” annual function. Try doing!! its real fun. Beside it will improve your dexterity and confidence.

4.Preclinical Work: Take your preclinical very seriously. This is the step before handling real patients. This is to prepare and train you for your clinical work. If you try to skip it or take it lightly. You are going to do blunders in your patient’s mouth. Become through with the basic theories try to do work as ideal as possible. Complete your quotas and work hard to do so.

5.Clinical Work: A sound practical knowledge is necessary for doing clinical work it’s the humans on which we are working on. we have to read lots of literature to understand and build good practical knowledge. It’s important to note that I am not asking you to mug-up the theories, I am asking you to understand it, analyses it and be able to Execute it when needed.While working on patients be calm and controlled try to execute the ideal work style ( I know it not 100% possible but try to be close to it) if you know you will have particular patient in particular days ex- extractions in  oral surgery posting  then do your preparations. Find books on local anesthesia read the technique for blocks arrange a skull and mandible find some one good in that to demonstrate you the landmarks and technique. Try making mental map and imagine it in patients. Believe me if you are prepared you will be less anxious and more confident. Try to apply this in every department, if you know you have to treat patients be prepared for it. Never go empty head you will not get anything accept your frustration and scolding from your teachers.

Pattern of learning for Dentists- [ The Read, See and Do] formula

READ- your text before any Demonstration, don’t go blank for any demonstration.

SEE – Observe carefully with full concentration what your Teacher or Guide is demonstrating. Humans have amazing photographic memory use it.

DO- Try to execute it as soon as possible our memory is very volatile try not to rely on it. Doing soon means you retain most of the part of demonstration.

So now we know how it works and how it can be developed. First and foremost thing is your interest in dentistry. The person aspiring to become dentist should be self motivated and ready to accept this challenging field. This field require long period of Training, Patience, Hard work, Endurance and Dedications. (It’s important to note I have not written the word intelligence because I don’t think it’s need in starting because you will develop it by time if you have above mentioned qualities).

Its not important where you start its important where you end.

Conclusion

This article is not for those who want to achieve there goals by hook and crook or just want a degree.I am writing this article for those who want self improvement and want to achieve there goals by there work and prove themselves.This field is for tough people and hard workers don’t opt it if u don’t think you are one of them otherwise you will end up in frustration and failure and if you are dedicated then don’t worry because one day you will develop these qualities and achieve success.

photo credit: Symic via photopin cc

6 Steps and Tips to Improve Your Tooth Carving.

Some people want tooth carving be removed from syllabus and they have there own point of view but I admire it's value.
One of my colleague asked me,

Sir! do we have to carve tooth in our clinics 
I said No!, 

Does salary of a dentist depends on it, 
I said No! 

Then why the heck am I carving a tooth?

Some times it becomes so frustrating that finding scholarships for dental students seems easier then mastering the tooth carving.

For a dental students tooth carving is one of the first difficult task which he/she encounters in dental school.

I faced same problems when I was a dental student but I loved tooth carving because I knew about the fact that tooth carving is basic step in building the dexterity required to become a successful dentist.

Today I'm writing down all my tips and learning in point wise and summary fashion. You may not find this in any dental books online or offline in this way. But most important thing is that- 
it requires attitude and commitment to learn this art.

STEP 1. Read and understand the tooth anatomy

1.Before your guide gives you the demonstration- first thing you must do is read the anatomy of that tooth. If you will go empty mind its difficult to absorb anything from demo.

2.While reading the anatomy make point wise notes of the each surface of tooth. Facial, lingual, Mesial etc.

3.My favorite book for dental anatomy is Wheeler's Dental Anatomy, Physiology and Occlusion use it. it's a must and best standard text book.

4.Don't rely on memory keep this notes and Wheeler's book beside you while you are carving the tooth.

STEP 2. Get proper instruments        

1.Get a good quality Lecron carver for yourself. While buying the carver check for the sharpness of carver, don't take blunt carvers.

2.A Metal scale ruler is best for measuring dimensions, vernier caliper can also be used for perfection.

3.Take good quality of carving wax it should neither be too soft or too hard. too soft will be distorted and too hard will be difficult to carve.

STEP 3. Keep an ideally carved tooth in front of you

Ask some one like your teacher or fellow classmate or senior who are good at carving to do an ideal tooth carving for you, 

This have two benefits- 
1. You have an Ideal carving to look and learn,
2.You get a extra demo when you see your friend or senior carving the tooth. If no body is there to carve for you then get an Extracted tooth. 

Step 4. Start Carving

1.At the time when you start carving you should have good understanding of the anatomy of the tooth.

2.Start with gross carving of different surfaces - starting with facial then lingual, then mesial and distal, occlusal being the last.

3.While doing the gross carving keep measurements 1mm greater then what is needed this 1mm will be used in fine carving and finishing. 

4.After doing the gross carving, go for the fine carving for producing the details

5.Wipe the finished tooth with a piece of gauze. be careful not to apply pressure.

Step 5. Remove Distraction & Concentrate 

1.Find a comfortable place where there is least distraction.Carving needs lots of concentration,observation and learning don't take it casually.

Step 6. Do Imaginary carving

1.Just take a wax block and carve what ever comes in your mind, keep a model in front of you or just imagine and carve a sculpture.

2.This need not to be perfect or amazing, 

3.I'm asking you to do this because it have following benefits.-
You don't have to be perfect or follow any measurement so you carve with more relaxed mood. 

It will keep up the interest of carving.

You start to learn the properties of wax- how much pressure to apply and how to remove and cut wax. what to do what not to do. its a basic process of learning.

Bonus Tip no 7: Practice, Practice, Practice

Keep on trying and practicing to carve, It can not be mastered in one day,

More you carve better you get.

When you practiced enough with certain tooth, help your friends if they ask for it, Don't carve to complete their quota but give them demo and share your learning. 

"Hand of Hope!" A Medical miracle

On Aug. 19, 1999, photographer Michael Clancy shot the "Fetal Hand Grasp" — his picture of a 21-week-old fetus grasping a doctor's finger during innovative surgery to correct spina bifida. Nearly four months later, on Dec. 2, Samuel Armas was "born famous."

The photo, which first appeared in USA Today on Sept. 7, 1999, quickly spread across the globe as proof of development in the womb and was later cited during congressional debates on the Partial-Birth Abortion Ban Act, which passed in 2000.

No wonder they say the world still holds wonderful miracles ...

A picture began circulating in November. It should be "The Picture of the Year," ...or perhaps, "Picture of the Decade." It won't be. In fact, unless you obtained a copy of the U.S. paper which published it, you probably would never have seen it.The picture is that of a 21-week-old unborn baby named Samuel Alexander Armas, who is being operated on by surgeon named Joseph Bruner. The baby was diagnosed with spina bifida and would not survive if removed from his mother's womb.


Little Samuel's mother, Julie Armas, is an obstetrics nurse in Atlanta.She knew of Dr. Bruner's remarkable surgical procedure. Practicing at Vanderbilt University Medical Center in Nashville, he performs these
special operations while the baby is still in the womb. Duringthe procedure, the doctor removes the uterus via C-section and makes a small incision to operate on the baby. As Dr. Bruner completed the surgery on Samuel, the little guy reached his tiny, but fully developed hand through the incision and firmly grasped the surgeon's finger. Dr.Bruner was reported as saying that when his finger was grasped, it was the most emotional moment of his life, and that for an instant during the procedure he was just frozen, totally immobile.

The photograph captures this amazing event with perfect clarity. The editors titled the picture, "Hand of Hope." The text explaining the picture begins, "The tiny hand of 21-week-old fetus Samuel Alexander Armas emerges from the mother's uterus to grasp the finger of Dr. Joseph Bruner as if thanking the doctor for the gift of life."

Little Samuel's mother said they "wept for days" when they saw the picture. She said, "The photo reminds us pregnancy isn't about disability or an illness, it's about a little person" Samuel was born in perfect health,
the operation 100 percent successful. Now see the actual picture, and it is awesome...incredible....and hey, pass it on! The world needs to see this one !

After reading this touchy Article it came in my mind that where is this Little Samuel nowadays.So i researched little bit and found some recent pictures of him and some more facts about the story behind the picture.& some one even made a (facebook page of hand of hope) Here is more to satisfy your curiosity.

Story of the "Fetal Hand Grasp" Photograph
As a veteran photojournalist in Nashville, Tennessee, I was hired by USA Today newspaper to photograph a spina bifida corrective surgical procedure. It was to be performed on a twenty-one week old fetus in utero at Vanderbilt University Medical Center. At that time, in 1999, twenty-one weeks in utero was the earliest that the surgical team would consider for surgery. The worst possible outcome would be that the surgery would cause premature delivery, and no child born earlier than twenty-three weeks had survived.
The tension could be felt in the operating room as the surgery began. A typical C-section incision was made to access the uterus, which was then lifted out and laid at the junction of the mother's thighs. The entire procedure would take place within the uterus, and no part of the child was to breach the surgical opening. During the procedure, the position of the fetus was adjusted by gently manipulating the outside of the uterus. The entire surgical procedure on the child was completed in 1 hour and thirteen minutes. When it was over, the surgical team breathed a sigh of relief, as did I.
As a doctor asked me what speed of film I was using, out of the corner of my eye I saw the uterus shake, but no one's hands were near it. It was shaking from within. Suddenly, an entire arm thrust out of the opening, then pulled back until just a little hand was showing. The doctor reached over and lifted the hand, which reacted and squeezed the doctor's finger. As if testing for strength, the doctor shook the tiny fist. Samuel held firm. I took the picture! Wow! It happened so fast that the nurse standing next to me asked, "What happened?" "The child reached out," I said. "Oh. They do that all the time," she responded.
The surgical opening to the uterus was closed and the uterus was then put back into the mother and the C-section opening was closed.
It was ten days before I knew if the picture was even in focus. To ensure no digital manipulation of images before they see them, USA Today requires that film be submitted unprocessed. When the photo editor finally phoned me he said, "It's the most incredible picture I've ever seen."
- Michael Clancy (photographer of the hand of hope)
check his website

Picture of Samuel Armas 

[Image:Michael Clancy ]

10 Free Apple iPad iPhone Applications for Dentists and Dental patients.

So my dear friends ! Apple iPad is here and being a dentist we all are thinking how to use it to improve our practice.iPad can be used in all aspect of dentistry it can simplify filling of patients forms and record keeping,It enables you to educate your patients through various pictures and video applications and it can also help technicians refer to digital images and create perfect prosthesis.if you 

Here are Top iPad application hand picked by me, Hope you find it useful. Note-Most of the applications can also be used on iPhone

1.Dental Expert- By Cosmetic Innovations,Inc

This application is an excellent patient guide it nicely explains all the aspects and procedures of dentistry,and it have proof read by Dr.MarcLazore of NYC Dentist.Its the best thing.Its Free! Check here for details & download

2.Dentistry ProConsult- By Georgia Health science University

This is a must have application for every dental students.It includes procedures for all kind of dental treatment in quick and easy way.Its one of the authentic manuals you can use.And guess what?? Its Free! Check here for details and download

3.Dental Manager- By Team Mozzi 

This application is for Dentists It can be used for treatment plan construction,for calculating dental costs,For patient consultation and sending results,customer management through photos, emails,SMS etc. to create patient database on your mobile.And the best thing is that its Free!.Check here for details & download 

4.Dental Aid Lite -By Digibunny Tech

This application tells about main procedures of common dental treatments,This application provides plenty of figures.The content is divided in categories.Overall best for patients.It will cost you Free! Check here for details & download

5.Dental Plan- By Brayant Clark

This is very useful as For patients They can learn and apply for various dental plans by this application, It also support medical plan,Its Free! of cost.Check here for details & download

6.Dental tree- By Twigger LLC

Its an interactive communication device which covers whole range of dental treatment options.It is very nice educational tool.Its Free! of cost.Check here for details and download

7.Dentalappointments.com- By Dentisoft Technologies

This application makes managing your practice easy.You can research dental tearms,establish online relation with current dentist.set appointments,billing records and much more,and all this is Free! Check here for details & download.

8.Dental Removable Partial Denture Design- By Renata Janson

 

This application can be used to design RPD on the pictures of the patient cast.I personally don't know the effectiveness,you can download and try, trial is free.You have to buy if you want full features but for now it's Free! Check here for details and download

9.Pediatric Dental Expert- By Cosmetic Innovations,Inc

This application is a parents guide to understand all aspects of your childes dental care & it have been proof read by Dr Marc Lazare of NYC Dentist.its Free! to download so go for it if your care for our child.Check here for details & download

10.DentalXChange Activity Snapshot- By DetnalXChange

If you use DentalXChange for maintaining your bills this application will be very handy for you.It maintains your -Claim connect,Bill connect,Payconnect And its Free! Check here for details & download.