Thursday, March 5, 2015

Give Up 'Ghutka' ? - Truely Dental Diary

Mr Virani owns a small industrial unit in our city. He manufactures metal furniture. He has a number of people working for him and I often receive calls from him requesting favour of ‘instant treatment - without appointment’ for his workers. He seems to be a nice man no doubt, but this request is not an indication of his concern towards the well being of his employees. It is because he does not want them to avoid work giving the reason of a tooth ache. Anyway, I am not here to analyse Mr Virani’s attitude towards his employees. My job is to treat the patients and I try to do my best. And the employees get the benefit of getting Mr Virani’s vehicle for the trip to my clinic and the visit is considered ‘on duty’.

Yesterday I received a call from him and within half an hour one of his workers was in the clinic.  Mr Virani firmly believes that if a tooth is causing pain, the best thing to do is to pull it out. No medications, temporary fillings, RCTs and such other nonsense for him. Go to the dentist, wait for an hour if necessary, get the tooth out and get back to work. That is what he wants for himself as well as his employees. “Doctor saab daat dard kar raha hai. Abhi aataa hoon. Nikaal dena.” And “Doctor saab unko phirse mat bulao. Abhi daat nikaalke bhejo” (Doctor, tooth is paining. I am coming now. Please remove it” And “Doctor, don’t call him again and again. Pull out his tooth right now and send him back"). What is good for him must be good for his employees too. It is not always possible to oblige Mr Virani and help him maintain his production schedule. I go by my assessment of the case and not by Mr Virani’s insistence. But sometimes I can oblige him. This seemed to be one such. The fellow who was in the clinic, said that one of his teeth was shaking and was very painful.

I put him on the chair and examined him. The tooth was mobile and tender ( Patients complaint - in our language). The best thing would be to remove it then and there and he would not even need a pain killer. Two minutes flat. Thirty seconds for the injection, one minute for the injection to take effect. Thirty seconds to pull the tooth out.  Over.  All are happy. Patient, because the pain is gone like magic. Virani, because his worker is back to work in fifteen minutes flat. And me, because my appointment schedule is not at all affected and I get a bit of extra money without any effort. But it was not like that. There was something disturbing here. Take a look at the picture.

The fellow is little over twenty years in age and already has a shaky tooth. Not good. I am sure you can guess which is the tooth I am talking about. Yes, the third grinder from the back. You can see something black below the tooth. That is the root of the tooth, which, in normal case should not be exposed. And it is black. The result of the tooth being in constant contact with tobacco. A wad of ‘Ghutka’ to be precise. Ghutka has not just destroyed his gums, it has affected the inside ‘skin’ of his cheek. What we call as the 'buccal mucous membrane'. It is not difficult to notice a sort of elevated or thickened, off white or yellowish patch next to the tooth, easily differentiated from the pink mucous membrane around. That patch is a ‘precancerous lesion’. Meaning something that has the potential to turn into full blown oral cancer. At an age little over twenty.

I see many ‘Ghutka’ chewers in my clinic, who mostly visit me to have their tobacco stained teeth cleaned. I hate that job but cannot evade it. More than my hatred towards this cleaning job is my hatred towards these tobacco chewers in general. Every nerve end in my body burns with irritation when I see these people spitting tobacco juice everywhere - once every minute - without any concern, as if they own the world. I can’t do anything and I just allow my stomach lining to get burnt. But when they are in the chair it is a different situation. I treat them alright but I also deliver a sermon which lasts through the session. And sometimes it will be quite a fiery one. I also try to put all sorts of fears, real of course - though a bit exaggerated, in their mind to make them give up ‘Ghutka’. I know it is not of much use but I try.

As I injected, I started my sermon for the benefit of the fellow who was in the chair. I told him that his case was much more serious than the ones that I usually see and if he persists with the addiction he may end up with cancer. I gave him five years, ten at the most. I finished the extraction asking him what prevents him from giving up this dirty habit? I put a pack in his mouth and sent him off. He went out sheepishly.

 After I finished the next case he entered again and stood silently in a corner. I asked him what was the matter

“You see Doctor saab” he said (in hindi) “I don’t like to chew this stuff all the time but I need it to carry me through the day. I work for nearly ten hours at a stretch with a break of half an hour and it is an exacting job. To do this work for ten hours, I need to eat a lot. But the salary I get is barely enough for two meals and if I don’t work I do not get even that. I am always hungry. A cup of tea costs five rupees and it is almost water. If I put one packet of Ghutka in my mouth it kills my hunger and I can easily carry on for two to three hours.Three packets of Ghutka costing six rupees see me through the day. You say that I will not live more than ten years if I keep eating Ghutka. If I don't, I will die of hunger, much earlier. How am I going to manage if I stop chewing Ghutka?”

I did not know what to say. Look at the fellow, observe his cloths and you can appreciate his words better. Now what am I going to do? Ask his employer to raise his salary? Provide him other employment which is more paying? Suggest that he find an easier job? Suggest him any other remedy?  Write to the labour department?           

I do not have an answer. If you have, please let me know. 

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