Who Discovered Bechet’s Syndrome?

Hulusi Bechet was born in Istanbul in 1889, the same year that Heinrich Dreser, a German scientist, wrote about the medicinal value of Aspirin. His father, Ahmet Behçet, was a well known businessman and was amongst the friends of Mustafa Kemal Atatürk, the founder of Turkish Republic. He lost his mother when he was a child and he was raised by his grandmother. His childhood was difficult for him and this gloomy state of mind had a detrimental influence on his whole life, leading him to become very introverted. He got his primary education in Damascus because of his father’s business affairs there. At this time, because there was no civil medical faculty, Dr. Behçet pursued his education at Gülhane Military Medical Academy. He was 16 years old when he had started at the Academy, graduating at the age of 21 in 1910.

After he had become a medical doctor, he specialized in dermatology and venereal diseases at Gülhane Military Medical Academy and he completed his specialization in 1914. The First World War started at this time and the Ottoman Empire participated as ally of Germany.

He served at the Edirne Military Hospital during 1914-1918 as a specialist in dermatology and venereal diseases and an assistant to the head of the hospital. After the war between 1918-1919, first went to Budapest and then to Berlin’s Charite Hospital to improve his medical knowledge. He had the opportunity to meet some famous colleagues at that time.

He never thought of living in Europe, however, and after his return to Turkey he worked as a free medical doctor. Then in 1923 he was appointed as the head medical doctor at the Hasköy Venereal Diseases Hospital. Six months later, he moved to Guraba Hospital, which is now part of the Istanbul Medical College, as a dermatologist. As well as his position as a professor at the university, he worked in a private consulting office.

In 1923, the year of the establishment of the Turkish Republic, he married Refika Davaz, who was sister of one his patients. His wife was the daughter of a famous diplomat, which led him to accept many patients from high society of Istanbul. He had a daughter, Güler, from this marriage and she now live in England working as a decorator.

After the establishment of the Turkish Republic, many social reforms were enacted. In 1933, the old-fashioned medical college (Darul-funun), which did not approve of scientific progress and insisted on religious principles, was abolished and the University of Istanbul was established. During this period of reform, the scientific vision and knowledge of academic staff was reevaluated and some were dismissed. Dr. Behçet stayed and he set up the department of dermatology and venereal diseases which remains the base of dermatology. At that time, the dermatology department, which had been at Vakýf Guraba Hospital, moved to a place on campus which had once been a tobacco depot. It still houses the Department of Dermatology.

Dr. Behçet was the first Turk who received the title of professor, in Turkish academic life. His curiosity for investigation, writing and discussion were his intellectual characteristics. Starting from the early years in his profession, his participation in national and international congresses with original articles was very apparent, publishing many articles in his own country and abroad. The famous German pathologist Prof. Schwartz called him a scientist who was well known everywhere except in his country, adding that you could never find him in Turkey because he was always abroad presenting his findings.

He translated many articles into Turkish to help educate new generations and he published original case reports in international reviews in order to make contact with such countries as Korea.

He had been interested in syphilis since 1922 and he had published many international articles on its diagnosis, treatment, hereditary properties, serology and social aspects.

Leishmaniosis (Oriental Sore) was another disease which Dr. Behçet worked on, beginning in 1923. He wrote about it in many articles and succeeded in its treatment with diathermic.

He first described “the nail sign” appearing by the removal of the crust of an Oriental Sore.

A part of his published work was concerned with parasitosis. In 1923, he described the etiologic agents of “gale cereal” in Turkey. He had dealt with superficial and deep mycoses and their treatments. Due to his observations, he described the dermatitis of fig (dermatitis figus carica) in 1933.

In 1935, at the Dermatology Congress in Budapest, he was honored for his studies on mycosis. He was also in the publishing vanguard to improve Turkish medicine and he was responsible for the first dermato-venerology journal of Turkey called “Turkish Archives of Dermatology and Syphilology” in 1924.

In 1939, he was elected as a correspondent member to the German journals “Dermatologiche Wohenschrift” and “Medizinsche Wohenschrift”. The most important work that Dr. Behçet brought to Turkish medicine was the monograph published in 1940 called “Clinical and Practical Syphilis, Diagnosis and Related Dermatoses”. Every page of this book contains an aspect of syphilis and the footnotes, provides a wealth of detailed information about the differential diagnosis of other skin diseases. As a result, scientists had the chance to learn about syphilis and dermatology at the same time.

This book, despite its out dated style, still retains its value and spirit in medicine as being the only example in its field. Dr. Behçet continued as the Head of the Department of Dermatology and Venereal Diseases until 1947. In 1939, he received the degree of “ordinarius”.

His first observations on Behçet’s disease started with a patient he met between 1924-1925. This patient had been consulted for 40 years in Istanbul and Vienna several times. According to his symptoms, the illness had been diagnosed as “aphte recidivante chronique”, “erythema nodosum”, “sarcoide de Boeck” or “erythema exudativum multiformis”. From the etiology, syphilis and tuberculosis were suspected.

Austrian doctors had called an unknown protozoal disease. Ophthalmologists had described the ocular symptomes as “iritis recividante a l’hypopion”. Iritis might be the result of syphilis, tuberculosis or streptococcal or staphylococcal infections. After several iridectomies, the patient had completely lost his vision. Dr. Behçet continued to follow up the patient for many years.

In 1930, a woman suffering from irritation in her eye and with lesions in her mouth and genital regions was referred to Dr. Behçet’s clinic and told him that these symptoms had been recurring for several years.

Dr. Behçet consulted the woman until 1932 and tried to diagnose the etiological agent for tuberculosis, syphilis or mycosis etc. by biopsy and other laboratory analysis, but he could not find anything. The prominent opthalmologists Murat Rahmi and Iggescheimer had evaluated the ocular symptoms as “episclerite” and “conjunctivitis”.

Following those two patients, in 1936 a male patient from a dental clinic with oral pemphigus like wounds, acneiform signs on the back, scrotal ulcer, eye irritation, evening fever, and abdominal pain was sent to the clinic. After the consultation, nothing except a dental cyst was found. Dr. Behçet thought the recurrent symptoms might be due to a virus. He referred the patient to Prof. Braun who did a viral investigation and found some corpuscular structures.

Dr. Behçet, with the symptoms of these three patients whom he had followed for years, then decided that they were the symptoms of a new disease and in 1936, he described the situation in a meeting and this was published in the “Archives of Dermatology and Venereal Disease”.

In 1937, he wrote his ideas in “Dermatologische Wohenschrift” Journal and in the same year he presented it at the meeting of the Dermatology Association of Paris. At this meeting, he declared that a dental infection might cause the etiology of the disease.

In 1938, he published his ideas about the subject in “Dermatologische Wohenschrift” Journal in a more detailed form. In the same year, Dr. Niyazi Gözcü and Prof. Frank reported two new cases with the same symptoms. In 1938, Belgian scientists Weekers and Reginster, and the Italian Frachescetti reported some patients with similar symptoms. Therefore European doctors had accepted the appearance of a new disease. Ophtalmologists had begun to accept “Behçet’s Disease” but dermatologists kept denying the new disease, insisting they could be symptoms of pemphigus, ulcus vulvae acutum, dermatomyozitis, aphtosis of Neumann, erythema exudativum multiforme, etc. While that debate was taking place, some new cases were reported from Belgium, Austria, the U.S., Japan, Denmark, Switzerland and Israel. When they had been published, the whole world finally came to accept that they had confronted with a new disease. In 1947, at the suggestion of Prof. Mischner of the Zurich Medical Faculty during the International Medical Congress of Geneva, this finding of Dr. Behçet’s was named “Morbus Behçet”. Though it was evaluated in the early days as “Behçet’s Syndrome”, “Trisymptom Behçet”, and “Morbus Behçet”, today the disease is universally called Behçet’s Disease in medical literature.

In order to give the disease its place in medical literature, credit should go to Niyazi Gözcü, Iggescheimer, Murad Rahmi, Ýrfan Baþar, Naci Bengisu, Marchionini, Braun and Obendorfer from Turkey, Weekers, Reginster from Belgium, Franchescetti from Italy, Jensen Tage from Denmark, Sulzberger & Wise from U.S. who all supported and participated in the work.

Hulusi Behçet interested deeply in the arts, particularly literature. Generally he was nervous and suffered from insomnia, colitis and angina pectoris, but sometimes he was joyful and good humored among friends.

He was divorced from his wife seven years before his death from a sudden heart attack on March 8, 1948.
Among his colleagues and close friends were Prof. Dr. Fahrettin Kerim Gökay, Ord. Prof. Dr. Murad Rahmi, Prof. Dr. Muzaffer Þevki, Prof. Dr. Gougerot and Prof. Dr. Cartoud.

In 1975, many years after his death, he was honored with the TUBITAK Scientific Award. Several classes, laboratories and libraries had been named in his honor; and masks and statues have been made in his likeness. A new generation of scientists continue to carry on the excellent work he began, working with foundations and units that bear his name. In national and international congresses, events like “Korea-Turkey Behçet Days” are taking place. The results of this studies are published every year in various journals.

Hulusi Behçet published 126 national and international articles between 1921-1940. Fifty-three of those appeared in prestigious European scientific journals.

In 1980, on the initiative of one of his students, Dr. Ali Arban, a stamp was published in his commemoration, about which an article was published in “The Journal of the American Dental Association”. His biographies were published in the “Journal of Philatelic Society” and in the “Medical Bulletin of the United States Army, Europe and Seventh Army’s Medical Bulletin”.

In 1982, he was awarded with the Medical Award of the Turkish Republic by Eczacýbaþý Foundation of Scientific Investigation. In October 1996, the Turkish mint released commemoration coins for Dr. Behçet during the National Dermatology Congress. This silver coin designed by Sculptor Suat Özyönüm, was presented in Portugal. The coin is still presented by the Cerrahpaþa Medical Faculty, Dermatology Department and by the Turkish Dermatology Association.

The life story of Hulusi Behçet, his curiosity for investigation, his delicate observation ability and his patience resulted in a gift to medicine, a mysterious new disease which is focus of wide research and interest to this day.

Much of this article is adapted from ‘Life Story of Dr. Hulusi Behçet’ by Türkan Saylan TÜRKÇE
Yonsei Medical Journal 1997; 38(6): 327-332.

Occlusion and Long Term Health

Occlusion is how teeth bite and fit together as they function. Most of the time when patients think of occlusion, they think of crooked teeth in need of braces for cosmetic reasons. The teeth in the back of the mouth usually go unnoticed because they aren’t seen. While this is a very common concern, occlusion goes much further into the health of not only each tooth, but the entire mouth.

When new restorations or dental prosthesis are used, such as a crown, bridge or denture, the occlusion is carefully adjusted and styled so that the appliance fits in perfect form with other existing teeth. Even so much as 1 millimeter of a discrepancy can cause discomfort or other side effects. Having a tooth that is high, wide, etc. can lead to it or the opposing teeth to wear at an abnormally fast rate. Excess wear ages the function of the tooth, causing it to become short and not as functional.

Our teeth are made for chewing, biting and grinding. Large or older restorations are not meant to withstand the forces that are needed for normal use. Sometimes this means that as your dentist detects an aging filling, it may need to be replaced long before you ever have any symptoms of it wearing out. Not replacing it soon enough could lead to one single bite causing the enamel around the filling to fracture and break off of the tooth. Unfortunately, correcting problems like that are usually more advanced and costly than replacing the filling in the first place.

Malocclusion (misalignment of how the teeth bite together) may negatively influence conditions like TMJ disorder, which causes pain and headaches. If teeth do not occlude together correctly, malocclusion can lead to strain in the TMJ area during normal use. For patients that have habits of grinding or clenching, a bite guard or night guard can help prevent excess wear and muscular fatigue.

Surprisingly, your tooth alignment can also influence your cardiovascular health and other systemic health conditions. Teeth that are crowded or misaligned are at an increased risk to have gingivitis and periodontal disease. Plaque is difficult to remove from these areas, due to the position of the teeth. Studies show that misaligned teeth develop periodontal disease much quicker. (1) Further studies show that the severity of periodontal disease correlates directly with coronary and systemic health conditions (2). Heart disease, stroke, diabetes, obesity, premature birth and low birth weights are all linked with gum disease.

So there you have it. Occlusion isn’t something that just means straight, pretty teeth. It’s much more than that. A proper occlusion effects normal everyday activity, and long term health!

References:
1. Harrel SK, Nunn ME (April 2001). The effect of occlusal discrepancies on periodontitis. II. Relationship of occlusal treatment to the progression of periodontal disease. J Periodontology,72, 4, 495–505.

2. Amabile N., Susini G., Bonello L., Gil J, Arques S., Bonfil J.J., Paganelli F. (2008). Severity of periodontal disease correlates to inflammatory systemic status and independently predicts the presence and angiographic extent of stable coronary artery disease. Journal of Internal Medicine, 263, 6, 644-652.

Dental Tips For Tea Drinkers

Mornings can be tough and caffeine is typically the way Americans muddle through that portion of the day. Not all caffeinated drinks are created equally as some are naturally better health choices than others. One of the healthiest options of all is opting for green tea over coffee, as the elixir is well known for having high levels of antioxidants, which are essential for your general physiology and your dental health.

Previous research on green tea has shown that consuming the unsweetened beverage Journal of Periodontology has shown the benefits do not stop there. In the Japanese study, research gauged the oral health of 940 men based on the three main conditions associated with periodontal disease clinical attachment loss of gum tissue, periodontal pocket depth and bleeding upon probing of the gum tissue. Their findings have indicated that for every cup of green tea consumed, a marked decrease in all the symptoms was noted.

The research team was unable to determine what component of green tea sparked the symbiotic relationship, but their theory revolves around the antioxidants naturally present in green tea have the power to reduce the body’s natural, inflammatory response to periodontal bacteria.

Not everyone enjoys a cup of green tea as some like their leaves black. Black tea is the most consumed beverage in the world and new research has indicated that the naturally occurring fluoride levels in the beverage are significantly higher than originally anticipated.

New information released by the Medical College of Georgia have indicated that heavy, black tea drinkers are at risk for developing bone problem caused by consuming too much fluoride over long periods of time. It would take ingesting about 20 milligrams a day over 10 or more years before bone problems would develop, however the risk is real. On average, people consume a safe level of two to three milligrams of fluoride on a daily basis courtesy of their toothpaste, drinking water on food.

Previous research had indicated that black tea had one to five milligrams of fluoride per serving. However, the new research presented by Dr. Gary Whitford, Regents Professor of oral biology in the School of Dentistry at the International Association of Dental Research Conference in Barcelona, Spain, has intimated that the beverage may actually deliver 9 milligrams of anion F− per serving.

Type 2 Diabetes – Screening for Diabetes in the Dental Chair

Periodontitis, a disease of the gums and tissues underlying the teeth, is the most common cause of tooth loss and can be a complication of Type 2 diabetes… it is more common when uncontrolled blood sugar is present. High blood sugar causes inflammation, leading to infection by bacteria in the mouth. Bacteria can release dangerous toxins into the bloodstream and even cause death if not treated promptly.

It is estimated about 8 million people in the United States alone are walking around with undiagnosed Type 2 diabetes. Diabetes can be life-threatening and lead to many serious complications if not diagnosed early. Periodontitis is present in about a quarter of people diagnosed with this form of diabetes.

Researchers at Boise University in Twin Falls, Idaho, United States, looked at the possibility of having Type 2 diabetes diagnosed by dental hygienists when clients are treated for periodontitis. Their study, reported on in the International Journal of Dental Hygiene in March 2015, included 50 participants with periodontitis and at least one other risk factor for developing Type 2 diabetes…

  • 16 dental patients were found to have prediabetes, and
  • 17 were diagnosed with full-blown Type 2 diabetes.

Diagnosis and discussion of diabetes with each dental patient took 14 minutes on average, and cost $US9.00. The dental clients diagnosed with Type 2 diabetes were advised to see their family doctor within 2 weeks… 9 were seen by their primary care provider within that time frame.

From these findings it was concluded diabetes screening by dental hygienists was an effective and convenient method for Type 2 diabetics to be diagnosed. Test kits for chairside or home use are available, and require only a simple prick of the finger.

Once Type 2 diabetes is diagnosed and the primary care practitioner notified, early treatment can help to prevent further advances in periodontitis as well as other complications related to this form of diabetes. Because blood carries sugar throughout the entire body, most organs can be affected. If weight can be brought down to normal, many times complete remission or dramatic improvement is possible.

A normal HbA1c level is 5 percent. Bringing it down to below 7 percent is the goal most doctors set. This is accomplished with…

  • weight loss,
  • a healthful diet primarily made up of vegetables, and
  • exercise.

If you are overweight or obese, have a family history of Type 2 diabetes, have delivered a baby that weighed over 8 pounds, or are over 50, screening for diabetes when you have and teeth cleaning is something to consider. If you have periodontitis plus another risk factor, it is definitely a good idea.

Getting the Most Out Of Cosmetic Dentistry

Today, dentistry is no longer merely a case of extracting and filling teeth like it was for many years. Nowadays lots of people are turning to aesthetic dentistry as a technique of enhancing their facial appearance, very much as they would make use normal cosmetic surgery. Frequently used dental procedures include bonding, crowns, bleaching, veneers and contouring and teeth reshaping.

Which is the Best Procedure for You?

Your dentist will be able to answer any questions which you could be having about available techniques to perk up your smile. If you are interested in further reading, the International Journal of Esthetic Dentistry could also guide you on what is the best procedure for you as it contains comprehensive notes on cosmetic dentistry.

If you are contemplating a dental treatment, there are several questions you could ask your dentist prior to deciding if a specific procedure is suitable for you. Some of the questions could be:

– How will the changes on me look like?
– What should I be expecting throughout the treatment course?
– How long will the treatment take?
– What kind of maintenance will be needed?
– What are the costs involved?

How Can I know one is a Good Cosmetic Dentist?

To confirm that your dentist is skilled in aesthetic dentistry, the Australian Society of Implant Dentistry (ASID) advocates that before agreeing to undergo treatment, you ask him or her for the following items:

– Ask to be shown several before and after photos. These types of photos allow you to opportunity of examining the results of the other patients who have been treated by the same dentist to ensure that his or her work fits well with your dental needs.

– Let him or her show you some references which will allow you to have a sense of the quality of care that is being provided.

– Seek evidence of continuing education. Dentistry is a dynamic and growing branch of health care. Ascertain that your dentist has been taking continuing education courses and trainings to remain up-to-dated with the most recent techniques in clinical aesthetic dentistry. For example, a dentist who is an active member of the Australasian Academy of Dento-Facial Aesthetics (AADFA) is likely to be very up-to-date because the AADFA is known for offering regular training courses for dento-facial surgeons.

Depending on your particular dental needs, the following methods are available:

Bleaching or Teeth Whitening

Tooth whitening or bleaching happens when your discoloured teeth get bleached with a safe whitening agent.

Dental Fillings and Teeth Bonding

Dentists are now using porcelain materials and composite resins to replace teeth. These materials naturally ape the feel, look and function of your natural teeth. Through advanced bonding techniques, your natural tooth enamel and artificial dentin get fused to produce a strong dental structure which reacts and looks much just like the original tooth.

Dental Implants, Crowns and Veneers

A dental implant replaces your missing tooth and helps in maintaining the bone support of your adjacent teeth. Crowns or dental caps cover your tooth to restore its appearance and normal shape. Veneers, which are thin pieces of plastic or porcelain, are placed over your front teeth to modify the shape or colour of your teeth.

Dental Braces

Also known as orthodontics, they are performed by orthodontists to bring your teeth back to their original position in case they might have shifted or had some injuries which made them move. For the latest regarding Orthodontics, the Australian Dental Association (ADA) website would be a good resource for you to visit.