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The history of dental hygiene is actually an interesting story. At the onset of the 20th century, dental hygiene was virtually non-existent. A green stick was used to scrape only the most obvious of plaque and toothpaste was scoffed. Toothpaste recipes that included burnt bread, pulverized brick and chalk were used as abrasives. But it wasn't until the brilliant Dr. Washington Sheffield of Connecticut discovered that if you put mint into the toothpaste, people actually enjoyed using it (what a concept, right?)

Bone edema is the term used by doctors (radiologists) to describe swelling within bone. Bone swelling is typically identified on MRI and is the result of either a direct injury to bone or load bearing that is greater than what can be sustained by the bone (stress injuries). Bone edema can also be found secondary to an inflammatory injury of bone. Inflammatory injuries include various forms of infection or arthritis.

This week was my week to see cases of psoriasis. Psoriasis is an autoimmune disorder that is manifested by the rapid turn over of skin cells resulting in disruption of normal skin production. There are 5 different classifications of psoriasis based on their appearance. The two most common that we see in foot care are plaque and pustular psoriasis.

I'm on call this week for our hospital's Critical Limb Care program. First thing Monday morning I had a call from a cardiologist who wanted to know whether to proceed or cancel an angioplasty (PCA). The case was an ablation of the right atrium. The problem was that the patient presented with a mid shin wound that had been present for 3 weeks. The question at hand was whether the wound was infected and would contaminate the procedure. 'What should I do? Cancel the case?'

Methotrexate is an antimetabolite that works by inhibiting dihydrofolic reductase. This enzyme is important in the production of DNA. Methotrexate targets rapidly growing cells such as inflammatory cells in rheumatoid arthritis or psoriasis. Methotrexate was originally used as a cancer drug for malignancies including acute lymphoblastic leukemia and lymphomas.