NIGHT TIME BEDWETTING

By Kleovoulos Chandanos, Paediatrician

The anatomic and physiologic relation between the brain and the urinary bladder develops and completely matures within the first five or six years of life. From the age of two to two and a half years, the child can check the contractile muscles for the bladder and intestine, while from two and a half to three years, most children can urinate in a receptacle or a toilet without any help. Wetting, like constipation, is seldom due to the negligence of parents in helping the child to develop the quality of controlling the contractile muscles.

As a rule, they are due to overzealousness.

Wetting is the involuntary urination by a child that has reached the age at which the control of the bladder is expected to be complete, and that's age five for girls and six for boys. Involuntary urination is distinguished in night-time, day-time and day-long. It is further separated into primary, if the bladder control has never been possible, and secondary, if there was an interval of at least six months during which the child remained dry. 

The night-time one is more frequent and more difficult to combat. It appears in 10 percent of the five-year olds, in five percent of the 10-year olds, and in one percent of the over-15 age group. The analogy in boys versus girls is 2:1. A small percentage of this is due to an underlying problem, like a urinary infection, renal insufficiency, diabetes, or chronic constipation. In the majority of cases it happens to healthy children, where in 70 percent there is a positive familial background. The explanation in these cases is unknown as there is no organic origin. The underlying disturbance in the above mentioned cases is thought to be the delayed maturation of the part of the nervous system that controls the bladder.  

Combatting the Problem

Firstly, the parents should know that the child is not responsible for this situation. It must therefore be faced with understanding and not with mockery or punishment. Working together with your child and encouraging the effort to overcome it, is of primary importance. A good practice can be that of establishing a timetable where the dry nights are noted and a reward is given when the child achieves the objective; for example, three dry nights, five nights, two weeks etc.

Also, during the daytime, there can be exercises like postponement of urination (so that the child can learn to hold it), interrupted urination (the child interrupts urinating at will, learning to control the contractile muscles). Also, decreasing the afternoon and evening consumption of liquids is recommended, as well as enforcing obligatory urination before the child goes to sleep.

In certain persistent cases, and only after consulting with a specialist, some types of medication can be used, like desmopressin, which is a synthetic anti-diuretic hormone.

 
REGARDING DENTAL IMPLANTS

By Nikolaos Koubanakis, Dental Surgeon

The development of dental implants constitutes the most important accomplishment of modern dentistry. Its systematic use benefits in many ways the functional and aesthetic restoration of the mouth. However, above all it has improved the psychology of patients.

Frequent questions from patients ask: what are the positive and negative indications to use implants?

The truth is that special attention must be given to choosing the candidates who will receive the implants.

Positive indications:  missing teeth; large gaps between two or more teeth with dental supports; insufficient number and positions of support-teeth; inability to tolerate partial or full movable denture.

Negative indications: pregnancy; non-controllable metabolic illnesses like diabetes; radiotherapy in the region that must be restored; patients lacking sufficient oral hygiene; patients undergoing chemotherapy; unrealistic expectations from patient.

Initially, the patient undergoes a detailed clinical examination, during which several factors are analyzed, like the missing-tooth region, bone mass, soft tissue mass and condition of natural teeth in forming the bite.

At the same time, more data is compiled regarding more general dental aesthetics, particularly if the missing-tooth region is in the front.

Naturally, the clinical examination is limited to optical, which only gives an initial picture, but is very limited and insufficient for the final diagnosis.

Advantages and disadvantages of implants: the pros include: easy painless placement; no drilling teeth as with a bridge.

The cons include: a long wait for the acceptance of the implants; higher cost; increased oral hygiene.