Pharmacotherapy

Safe and effective medications remain the cornerstone of treatment for most allergic conditions. Non-sedating antihistamines, topical (inhaled, intranasal, or cutaneous) corticosteroid preparations, bronchodilators (asthma rescue inhalers), and various other medical therapies can be safely and effectively used to control most allergy and asthma symptoms.

Early, appropriate and regular use of appropriate controller or anti-inflammatory medications for asthma, allergic rhinitis, and atopic dermatitis have been shown to dramatically reduce symptoms, improve quality of life, and decrease long-term complications from these common and often life-long conditions

Your Snö allergy team shares your goal: the least amount of medication required to adequately and appropriately control your condition. It is important to understand that as much as we would all love to eliminate your need for treatment, there is no “cure” for most allergic conditions, and it is possible you or your child will require medication for a long time. Your allergist will work with you to ensure a safe and effective treatment plan, which will be continually reassessed and adjusted over time

Immunotherapy

Also known as Allergen “immunotherapy” (IT) is the oldest treatment for allergic conditions, first described more than 100 years ago.

There are 3”, primary forms of allergen immunotherapy, subcutaneous (injection) IT, sublingual (under the tongue) IT, and oral (swallowed) IT.

Subcutaneous (injection) immunotherapy, also known as SCIT or “allergy shots”,s the oldest and most familiar approach. SCIT is often used for environmental allergies such as tree, grass or weed pollen, dust mites, or furred animals. SCIT is the only appropriate treatment to prevent stinging insect or venomallergies, and can be considered a life-saving treatment for this very serious condition.

SCIT involves injecting small and gradually increases amounts of the allergen into the fatty tissue in the upper arm, usually every week until eventually achieving a target monthly “maintenance” dose, which has been proven to result in protection against the allergic exposure and long-term benefit in decreasing the allergic response. SCIT has the potential to “cure” an allergy in some cases, with 3-5 years of treatment usually resulting in long-term immunologic benefit

SCIT has a long record of safety and efficacy, however this treatment does carry a risk of anaphylaxis, with as many as 1/6 patients receiving high-dose IT suffering a systemic reaction along the way. Your Snö allergy team has extensive training and experience in determining your need for SCIT, and in the safe administration of such therapy.

Sublingual immunotherapy (SLIT) is a newer approach, common in Europe for the past 20 years, with either drops or dissolvable tablets of allergen placed under the tongue on a daily basis. This has been most commonly used for environmental allergies, including tree, grass & weed pollen, dust mites, and furred animals, and there are currently approved SLIT tablets for grasspollen, ragweed pollen, and dust mites, with even more on the way. SLIT offers the convenience of home dosing, with a very low risk of reaction, and may also have similar long-term immunologic benefits like SCIT.

Oral immunotherapy (OIT) is a newer and evolving approach to food allergies. Studies have shown that OIT can be very effective for children with milk, egg, and peanut allergies, and may be able to “cure” a food allergy over time, allowing the child to enjoy a normal diet. While a promising approach for some children, OIT carries a risk for anaphylaxis, and your allergist will help determine if this is an appropriate option for your child.

Education and avoidance

Your Snö allergy team places a premium on patient education, and will spend a great deal of time explaining your diagnosis, management plan, therapeutic options, and prognosis.We will always take the time to answer your questions and make sure that you are comfortable with your treatment plan.

Whenever possible, your allergy team will help you determine strategies to avoid your allergic triggers. Although it is usually fairly easy to avoid allergenic foodsor medications, it may be a lot harder to effectively avoid environmental allergens. Your allergist will work with you to determine if changes to your environment will be worthwhile.

Asthma

Asthma is a chronic lung condition characterized by inflammation and narrowing of the airways. Asthma results in symptoms of cough, wheezing, tightness in the chest and shortness of breath.

Asthma symptoms vary from person to person. Common triggers that lead to asthma symptoms include environmental allergens such as pollens, dust mites, moulds and animal danders, irritants such as cigarette smoke, exercise, emotional stress, and respiratory infections.

Asthma affects people of all ages, but it most often starts during childhood. Its cause is unknown but researchers think some genetic and environmental factors interact to cause asthma. Treating asthma early may prevent long-term lung damage and helps keep the condition from worsening over time.

Biological therapies

There have been tremendous advances in targeted biological therapies for asthma and allergies over the past 20 years, and your Snö team has experience and expertise in determining if any of these may be appropriate for you or your child.

Anti-IgE therapy (omalizumab)

Omalizumab is a monoclonal antibody therapy proven effective for moderate-to-severe asthma in patients > 6 years of age, or for patients with chronic urticaria (hives) > 12 years of age. It has also shown promising results in patients undergoing OIT for food allergies. This biological agent has been in wide use for nearly 20 years, and your allergist will be able to determine if this is a good option for you.

Anti-IL5 therapies (mepolizumab, reslizumab, benralizumab)

These newer biological anti-IL5 or anti-eosinophil agents have been shown to be particularly effective in severe difficult-to-control allergic or eosinophilic asthma. They each have their own potential advantages, and your allergist will be able to help decide if one of these agents is right for you.

Anti-IL4 therapy (dupilumab)

Dupilumab is a novel anti-IL4 antibody which has been proven effective for severe persistent atopic dermatitis (eczema), and has also shown promising results for severe asthma, both allergic/eosinophilic and not. The Snö Asthma & Allergy team will help determine if you are a candidate for this newer treatment option.

Elimination diet

An elimination diet involves removing specific food from the patient’s diet that could potentially cause an allergic reaction, and are later reintroduced, one at a time while testing for symptoms.

It generally lasts for two to four weeks.

Some UAE dentists caught out for grossly over-treating patients

By: Nick Webster | May 12, 2018 | The National

Dubai Health Authority handed out 25 fines for fraud, waste and abuse cases.

 

 

From left, Dr Per Rehnberg, chief executive of Snö Dental Clinics, and dentist Dr Nasser Fouda, say dentists can often view their practice as a business rather than as providing healthcare. Pawan Singh / The National

Expensive and pointless dental treatments offered to patients to boost profits have been exposed in a mystery shopping exercise at practices in Abu Dhabi and Dubai.

Fifteen clinics were checked by dentists posing as patients to assess how common over-treatment is in the industry.

One patient was offered unnecessary root canal treatment, crowns and fillings at a total cost of Dh26,200, when all that was required was two fillings and a visit to a hygienist.

The case was just one example highlighted by Scandinavian dentists in Abu Dhabi.

Regulators said they were stepping up inspections, and would only recommend providers based on a positive history of care.

 

Dr Per Rehnberg, chief executive of Snö Dental Clinics, who has been working in Sweden, Norway and Denmark before running a dentist practice in Abu Dhabi, was shocked at the high level of treatments being offered to patients, with insurers often picking up the costs.

“Root canal treatment is often suggested and is very common here.” he said.

“After my experience, I sent staff out to several other clinics and they found the same thing.

“There was a lack of documentation. Clinics take x-rays but it is very important for patients to get a proper status so they know what is being included in an exam.”

One clinic suggested a patient had a root canal, 3 crowns fitted and 4 fillings amongst other minor treatments costing Dh26,200.Caries – decaying teeth – were removed by another dentist to avoid the need for fillings, root canal work or crown fittings, at a cost of just Dh3,000.

“It is a competitive business, we know that, but none of the mystery shoppers were given any documents and the majority of clinics recommended over treatment,” Dr Rehnberg said.

“The science has gone so far forward. We know there are many alternatives that are cheaper and less invasive than a root canal.

“We earn less money as dentists, as insurance companies do not always pay for these kind of alternative treatments, but they are usually better for the patient.”

Dentists said nine out of ten patients in pain did not need a root canal treatment, yet the procedure was still offered.

“The Hollywood smile is big business; it looks good but many patients I see for follow up work it is clear it has been done in a hurry,” Dr Rehnberg said.

“Cosmetics are very popular, but many dentists are not describing the pros and cons to patients. “There is always risk.”

Veneers at a cost of between Dh2,000 to Dh4,000 per tooth were commonly prescribed, instead of a cheaper option of bleaching.

To achieve the perfect smile, patients can expect to pay anything from Dh12,000 to Dh40,000 for veneers, whereas bleaching can cost just Dh2,000.

Dentists have said proper record keeping is crucial to maintain a transparent industry.

 

 

Dr Nasser Fouda has been in the UAE since 1996 and said a common trend is dentists viewing their practice as more of a business than providing healthcare.

“Many dentists call people clients, rather than patients and want to make money – they are more like teeth mechanics, and are happy to drill, screw or carry out a root canal,” he said.

“Patients may go in for a simple filling, and end up with a crown – that’s not always the best option.

“Dentistry teams often want to do everything themselves, rather than call in specialists to maximise their profits. This is not always the best option.

 

“It’s preferable to preserve natural teeth for as long as possible, as the structure is much better and artificial products will never be as good as enamel and dentine.”

There are clear rules and regulations for dentistry to follow, and clinics must adhere to a strict operating policy imposed by regulators – either the Dubai Health Authority or Department of Health.

DHA has said its regulators inspected 59 clinics in Dubai in 2017, issuing seven warnings and handing out 25 fines for misdemeanors around fraud, waste and abuse.

“At the Health Funding Department we do not directly regulate provider service pricing at this time,” said Ali Lutfi, Head of Insurance Permit at Health Funding at the DHA.

“However, we do conduct inspections across all medical providers in the Emirate from a financial aspect – including hospitals, medical centers, dental clinics and pharmacies. Our inspections mainly look for fraud, waste and abuse (FWA).

“Part of our licensing requirements for insurance companies and third party administrators is for them to provide us with quarterly FWA reports, highlighting any providers with suspected FWA.

“We select providers to inspect based on these reports and feedback from members via our various complaints channels.”

The Department of Health did not respond to a comment request in time for publication.

 

 

By Nick Webster

May 12, 2018

 

Article Link: https://www.thenational.ae/uae/some-uae-dentists-caught-out-for-grossly-over-treating-patients-1.729646

Most root canal treatments not needed, warn UAE dentists

By: Jasmine Al Kuttab/ Abu Dhabi | May 7, 2018 | Khaleej Times

Dental experts say root canal is the last treatment to be considered and 9 out of 10 patients do not need a root filling. Much less invasive and cheaper options can be carried out in most cases.

Dentists must inform their patients that only 10 per cent of the cases need a root canal.

Almost nine out of 10 patients never required root canal treatment but most were unnecessarily lured into the invasive treatment, an Abu Dhabi doctor has said.

 

 

As Root Canal Awareness Week gets under way across the globe, Dr Per Rehnberg, CEO of Snö Dental, is warning against the over-use of the treatment. He urged patients to obtain all the facts before proceeding with it. “Root canal is the absolute last thing you should consider for your teeth; everything should be done to ensure natural teeth are kept vital.”

He stressed that patients who often complain about tooth ache, which can be caused by a cavity, can usually have a much less invasive and cheaper option done than the root canal treatment.

“The problem is that around 10 per cent of the band aid cases (traditional filling) will need a root filling, that is why many dentists are often quick to suggest a root canal. But nine out of 10 patients do not actually need a root filling.”

He pointed out that dentists must inform their patients that only 10 per cent of the cases  need a root canal and share with them the other available options.

Moreover, Dr Rehnberg exp-lained that health insurance companies pay much more for a root canal treatment than the traditional filling, which could be why many dental clinics lure patients into getting the costly treatment.

He added that the band aid treatment costs around Dh500, whereas a root canal treatment is usually around Dh3,000, and will also require extra procedures, including placing a crown on top of the tooth, which costs another Dh2,000.

“What we have seen is that the root canal treatment has become a common option, or even a first-time option when the pat-ient only has slight tooth ache.”

In fact, Dr Rehnberg and his team conducted a mystery shopping survey around the UAE to identify the clinics that provide thorough information to the patients, and those that recommend invasive, costly and unnecessary treatments. “We wanted to look at the diagnoses and suggestions for treatment, and we found that it is very common to suggest the root canal treatment before they even knew what to do.

“We took 15 people from our company and sent them out for the mystery shopping in Abu Dhabi and Dubai and found that most dentists showed a lack of proper documentation. Many patients were also suggested the root can-als, which we later treated with simpler and more affordable treatments.”

He said that it is important for patients to trust their dentists; however, it is also important to receive transparent information about the alternatives.

Dr Rehnberg added that people are more prone to having dental cavities in the UAE, for various reasons that are often related to their lifestyle choices, including smoking and eating sugary and processed foods.

However, having cavities does not necessarily mean patients have to turn to the invasive treatment.  “I’ve seen people who had low risk and still had root canals. This is a sign of possible over-treatment.”

He also noted that official documentation is necessary for the pat-ient in order to be able to receive second opinions.

“If a dentist is reluctant to allow the patients to keep their documents, then this is a concern, because it’s a matter of trust.”

 Dr Gun Norell of Snö Dental, who has worked in dentistry in various parts of the world for over 30 years, said raising awareness on the matter is key.

“We urge people to seek a second opinion before having invasive treatments carried out, and advise that they think about root canal as the last option rather than the first.”

 

Free second opinions for patients

To help support patients with their decision, Snö Dental is offering free second opinions on root canal treatments for all residents of Abu Dhabi, during Root Canal Awareness Week from May 6-12.

“We always evaluate the teeth and if we can avoid over treatment by providing a less invasive option for the tooth to recover, we will do that,” said Dr Per Rehnberg, CEO of Snö Dental.

 

Jasmine Al Kuttab/ Abu Dhabi

May 7, 2018

 

Article Link: https://www.khaleejtimes.com/news/uae-health/most-root-canal-treatments-not-needed-warn-uae-dentists

 

 

Other Sources:

Al Ittihad: http://www.alittihad.ae/details.php?id=33871&y=2018&article=full

Everything you need to know about finding a dentist

By: Camille Hogg | December 20, 2017 | Abu Dhabi World Online

From cavities to consultations, we find out about the main dental issues in Abu Dhabi and how to pick a good dentist.

 

Your smile says a lot about you, and that’s especially true when it comes to your teeth.

With cavities and gum disease on the rise, we consult the experts on maintaining good hygiene, dealing with dental emergencies and knowing what to look for in a clinician.

The root of the problem

“The two biggest diseases in dentistry are caries – or cavities – and periodontitis,” explains Dr Per Rehnberg, CEO at Snö Clinics.

Caused by factors including poor oral hygiene and diet, cavities are common in children and adults, and occur when your tooth enamel begins to erode due to acids caused by bacteria.

With a particularly high prevalence of decay in the region among children, Dr Per is keen to emphasise that more awareness is needed of the detrimental effects our sugary habits have on our teeth.

“In this region, the caries in kids are so much worse. Kids drink a lot of juice and soda, and the low pH means that the soda is acidic as well as sugary, so we see a lot of eroded teeth,” says Dr Per.

Dr Heba Aboushady, general dentist at the Boston Dental Center, agrees.

“Adults misunderstand the right diet for the teeth and switch from milk to fruit juices; these are actually very high in sugar and acids,” she emphasises. “We need more education on healthy diets and how to follow basic oral hygiene instructions.”

But with pain, sensitivity to cold and, in severe cases, visible holes as key symptoms of caries in children and adults, the solution isn’t always drilling.

“Small caries can be healed without drilling,” Dr Per clarifies. “If you do flossing and fluoride treatments, we can check in three to six months and you may not need a filling, so [the tooth] will have much better longevity.”

Even with larger cavities, there are still options before you need to undergo a root canal, where the infected pulp from inside the tooth is removed and the tooth sealed.

“The root has a function, so once you replace it with a root filling, it shortens the lifespan of the tooth,” Dr Per explains.

“When [the cavity] is middle-big and gets closer to the nerve, you can still do a filling in that case without a root canal treatment.

“If you have a cavity that is close to the pulp, one way of treating it is to have a special kind of dressing and calming filling on top of that in order to save the root,” he adds.

Periodontitis is another common disease in the region, but unlike cavities, pain is not a common symptom until more advanced stages.

“Many people in this region are under-diagnosed with periodontitis,” says Dr Per. “It’s not usually painful for the first ten to 15 years, but then it’s often too late to save the teeth.

“It generally starts with bleeding gums. Bad breath could also be a factor. When you eat, food gets stuck between your teeth and causes inflammation as it rots; this causes tooth loss. We also associate calculus (plaque that has hardened and cannot be removed by brushing) with the disease, which can be removed at the hygienist.”

One key way to slow the disease down is flossing, and Dr Per recommends a once-a-day regimen.

However, whatever your problem, acting early is key, as regular check-ups can prevent problems from escalating.

Things you should look out for include pain or sensation when you consume something cold, as well as bridges, crowns or problematic wisdom teeth – and any jaw joint issues should be dealt with by your dentist, too.

Dental emergencies

With many of us harbouring a deep fear of the dentist, we often ignore our problems before it becomes an emergency – and that’s not a good idea.

“There’s often a difference in opinion between the dentist and their patient as to what constitutes an emergency,” Dr Heba chuckles wryly.

“When there’s a cosmetic problem, like a tooth has fallen out or a filling has broken, I find that patients come in quite quickly, but with pain or infection, it’s not always the case.

“As a dentist, things like swelling on one side of your face, fever and difficulty swallowing can indicate a life-threatening infection,” Dr Heba states.

“Things like accidents involving knocked-out teeth also need quick intervention, and constant pain might be an abscess or deep cavity. One thing people don’t know too much about is that if you have red patches or ulcers in the mouth, you need to take instant action.”

Dr Per agrees, noting the location of the pain or problem: “Go quickly to the dentist, especially if the infection is in the lower jaw.”

 

Which dentist?

With so many options on the market, it can be hard to know what to look for when picking your dentist.

“That’s the hard thing about being the patient,” agrees Dr Per. “You just don’t know. We have a transitory community here and people don’t tend to get that long bond with their dentist that they might get in their home country.

“One way is to make sure you can audit what the clinic has done,” he adds. “You need to ask to see the documentation, diagnosis, x-rays, printouts and treatment plans so that if needed, you can get a second opinion.”

While many dentists may offer deals for free consultations, Dr Per recommends knowing what you’re getting from the experience.

“It’s very important to have a proper exam,” Dr Per advises. “If you don’t have all the data on the patient’s specific conditions, it’s very hard to suggest the right treatment – it’s like building a house without having a foundation.

 

 

“Many dentists might offer a free exam, but these may not be full exams – a proper one would usually take at least 45 minutes and will detail the status today, risk calculation and a prevention plan.

“Patients also need to be informed about problems that might happen,” Dr Per adds. “Many dentists are reactive; they might only treat symptoms like tooth pain, but a good dentist would look at underlying causes.”

For Dr Heba, communication is a huge factor.

“A good dentist will explain everything to the patient, including treatment options, the procedures involved, the expected outcome and, of course, involve the patient in any decision making,” she says.

“Going to the dentist can be scary – I was that child and I had a bad experience,” she laughs. “These days, it’s very different: there are new techniques, technologies and types of anaesthetic.

“We don’t want you to have more pain; we want you to be rid of it, and a good dentist will explain what they’re doing.”

At the end of the day, make sure you feel confident before you put your money where your mouth is, says Dr Per.

“Establishing trust with your dentist is very important, and if you don’t like the clinic or clinician, then close your mouth and get a second opinion.”

 

 

Word of mouth

Good oral hygiene takes some effort, so here are our experts’ top tips.

Have regular check-ups: Scheduling a check-up depends on your oral health, says Dr Per. If you have ongoing conditions such as periodontitis or you’re at increased risk of cavities, you’ll need them more frequently, but between six months and one year is common in the UAE.

Get a fresh brush: “You need to change your brush every three months – and use a soft one,” Dr Heba says.

Don’t forget to floss: “Use floss or interdental brushes if you have a brace, crowns or bridges. They have tighter contact than air flossers,” Dr Heba says.

Supplement with fluoride: “Water here has no fluoride,” says Dr Heba. “Fluoride application for children can help reverse early signs of decay.”

 

 

By Camille Hogg

December 20, 2017

Article Link: http://www.adwonline.ae/everything-need-know-finding-dentist/

Do not neglect dental hygiene when fasting

By: Samihah Zaman | May 23, 2018 | Gulf News

Common issue like bad breath can be easily prevented with proper care, dentists say

Abu Dhabi: Overindulging in sweets coupled with lack of hydration during Ramadan leaves many residents with bad breath, or worsens dental problems, dentists warned.

“Many people believe that bad breath cannot be avoided while fasting. They also put off dental treatment during Ramadan, but this can make existing tooth cavities bigger,” Dr Nasser Fouda, gum specialist at Sno Dental Clinic in Abu Dhabi, said. “Simple steps like rinsing the mouth frequently and brushing and flossing properly will ensure dental hygiene, even while fasting

According to Dr Fouda, bad breath, or halitosis, is often the result of a dry mouth. The lack of saliva causes bacteria in the mouth to act upon food remnants between the teeth and on the coating of the tongue, releasing unpleasant gases.

“It doesn’t help either that people eat a lot more sugary food and meat, then go to bed without brushing their teeth,” added Dr Sujay Mohan Rai, specialist prosthodontics at NMC Specialty Hospital.

“Dental prostheses like dentures, bridges and retainers should not be ignored, and should be cleaned frequently while fasting, as they too can harbour food particles,” he added.

In addition, it is a good idea to rinse frequently with mouthwash or just water.

“We also advise residents not to put off dental treatment till after Ramadan. Even if you are worried that the treatments will affect the fast, most dental clinics are open till very late to accommodate patients after iftar. So if you were getting treatment for gum disease or cavities before Ramadan, make sure you continue to visit the dentist,” Dr Fouda said.

Dr Rai also cautioned against ignoring dental problems.

“If you are facing bleeding gums or pain, do see a dentist immediately. Not doing so can cause the problem to worsen, and make the eventual treatment lengthy and painful,” he said.

Although awareness about dental health is improving, the doctors added that they still see a significant increase in the number of patients after Ramadan, with many of them requiring major dental work.

 

Dentists say…

■ Rinse frequently while fasting to prevent bad breath.

■ Drink enough water after iftar.

■ Brush as well as floss before going to bed.

■ Use a tongue scraper as bacteria multiplies on the tongue coating.

■ Clean dentures, bridges and retainers through the day.

■ Avoid too much sugary and fatty food.

■ Do not put off dental treatment till after Ramadan.

 

 

Samihah Zaman

May 23, 2018

 

Article link: https://gulfnews.com/guides/life/ramadan/news/do-not-neglect-dental-hygiene-when-fasting-1.2225956

Other Sources.

Gulf Today: http://gulftoday.ae/portal/28efd0a4-b7e5-48d9-ad72-d995ff7e7cf0.aspx