Dental Anxiety and Phobia

Some people don't look forward to dental appointments but no more than they look forward to visits to other health care providers such as their physician. Most dental procedures when done right are reasonably comfortable. However, just being examined can make some people feel stressed. Most can live with having some anxiety about going to the dentist but for those with dental phobia, the thought of a dental visit is terrifying. They may be so frightened, in fact, that they'll do just about anything to avoid a dental appointment. 

People often use the words "anxiety" and "phobia" to mean the same thing, but they are different. A phobia is an intense, unreasonable fear of a specific activity, object or situation. Phobic patients will have exaggerated or unfounded worries or fears. Dental phobia is definitely a more serious condition than dental anxiety. People with dental phobia often put off routine care for years or even decades. To avoid it, they'll put up with gum infections, pain, or even broken and unsightly teeth.

Dental anxiety and phobia are extremely common. It has been estimated that 9% to 15% of Americans avoid seeing the dentist because of anxiety and fear. That's about 30 million to 40 million people. In a survey 36% of those who didn't see a dentist regularly said that fear was the main reason.

People develop dental anxieties and phobias for many different reasons. When researchers interview patients, however, a few common themes emerge:
Pain and/or discomfort — In a survey of people who had not seen a dentist for 12 months, 6% reported fear of pain as the main reason. This may be because their early dental visits happened before many of the advances in "pain-free" dentistry.
Helplessness and loss of control — Many people develop phobias about situations — such as flying in an airplane — in which they feel they have no control. When they're in the dental chair, they have to stay still. They may feel they can't see what's going on or predict what's going to hurt. It's common for people to feel helpless and out of control, which may trigger anxiety.
Embarrassment — The mouth is an intimate part of the body. People may feel ashamed or embarrassed to have a stranger looking inside. This may be a particular problem if they're self-conscious about how their teeth look. Dental treatments also require physical closeness. During a treatment, the hygienist or dentist's face may be just a few inches away. This can make people anxious and uncomfortable.
Negative past experiences — Anyone who has had pain or discomfort during previous dental procedures is likely to be more anxious the next time around.


There are several relaxation techniques and tools that you can utilize to help you maintain your comfort during dental visits. Many patients prefer a distraction during their visit such as listening to an ipod filled with their favorite music. Relaxation breathing or progressive muscle relaxation are techniques you may wish to try prior to beginning.
Your dentist should always explain the procedure to you in detail and make sure that you fully understand the procedures being preformed. An educated patient will always make a better patient. 
A signaling system is always useful if you feel you need a break. For most patients, being able to raise their hand and asking the dentist to stop is comforting and allows them to feel more in control of the situation.
Ultimately the most important part of overcoming dental fear is trust. Finding the right dentist who you are comfortable with and feel that you can trust will make the most difference in helping you relax during your visit.

Halloween & Healthy Teeth

Undoubtedly, candy will come home in classroom party goody bags and fall festival take-home treats. Add plain old trick-or-treating, and it’s no wonder a child’s excessive exposure to sugar can be a common result. It’s definitely a problem every parent faces and finding that balance between children being healthy and at the same time having fun and enjoying Halloween is a tough balancing act.

The process by which sugary snacks can cause cavities is as follows. Bacteria that live in a child's mouth feed on sugars and produce acids. These acids will demineralize or break down the tooth structure, resulting in decay. Generally speaking the longer the exposure to sugary materials, the more extensive the decay. The frequency of sugar consumption is much more critical than the amount.

Prevention starts with that well-known word that is easy to say but more difficult to implement: moderation. However moderation can be difficult to enforce when a full Halloween bag lurks on top of the refrigerator. But protecting your children’s teeth from the onslaught of sugar is another important consideration for parents. 
In the days following Halloween, it is recommended to ensure that your child eats a full plate of balanced and healthy foods before adding a sugary treat. Don’t buy Halloween candy too far in advance to avoid the temptation for children (and adults) to get a head start on the splurge. Try to ensure children eat a good, hearty meal before trick-or-treating so there will be less temptation to gorge on candy. Encourage kids to eat a set amount of candy in one sitting immediately followed by a thorough tooth-brushing, or at least a glass of water. Promote good oral health care habits year-round to your children by encouraging twice daily brushing with fluoridated toothpaste, flossing and getting regular dental checkups.

Gagging

Gagging is a protective, natural reflex that stops entry of unwanted objects into the mouth and throat area. This reflex varies in intensity from one person to the next. Pronounced gag reflexes can compromise various aspects of dentistry, from diagnostic procedures of clinical examination and radiography to any form of treatment. In severe cases it could even lead to a patient avoiding care. There are many techniques in overcoming this condition and different strategies may be necessary in delivering dental treatment.


There are two basic classifications. One is called somatogenic which is induced by actual physical stimuli. The second is psychogenic in which psychological factors are thought to induce gagging without any physical stimulants.


Strategies for patient management fall under four categories. 
First is psychological management via relaxation. This is accomplished through providing a comfortable and relaxing environment and/or breathing exercises like controlled rhythmic breathing and relaxed abdominal breathing. 
Distraction techniques are also effective and thought to work by diverting attention away from the gagging problem long enough to carry out a procedure. Patients are asked to concentrate on a task or thought that will completely absorb their mind and prevent them from focusing on their gagging which increase their anxiety level. 
Another technique is systematic desensitization and consists of incremental exposure to the feared stimulus which over a period of time will allow patients to become more used to certain stimuli. 
Lastly there is the pharmacological option. A number of agents have been identified as effective against the gag reflex. Some topical anesthetics in forms of sprays or gels applied to the soft palate can be useful. Also some centrally acting drugs such as antihistamines and sedatives are helpful. 

The attitude of the dentist toward the patient and his/her problem is ultimately very important. constant reassurance that the patient is alright will reduce embarrassment and anxiety.       

Oral health & overall health

In the past decade or so many researchers have come to realize that good oral health has very significant effects on the overall health of our bodies. It is extremely important to understand the intimate connection between oral health and overall health and what you can do to protect yourself. 
Your mouth is normally teeming with bacteria — most of them harmless. The body's natural defenses and good oral health care, such as daily brushing and flossing, can keep these bacteria under control. However, harmful bacteria can sometimes grow out of control and cause oral infections, such as tooth decay and gum disease. 
In addition, medical procedures, medications, or treatments that reduce saliva flow, disrupt the normal balance of bacteria in your mouth or breach the mouth's normal protective barriers may make it easier for bacteria to enter your bloodstream. 

Your oral health may affect, be affected by or contribute to various diseases and conditions, including:

• Endocarditis. Gum disease and dental procedures that cut your gums may allow bacteria to enter your bloodstream. If you have a weak immune system or a damaged heart valve, this can cause infection in other parts of the body — such as an infection of the inner lining of the heart.
• Cardiovascular disease. Some research suggests that heart disease, clogged arteries and stroke may be linked to oral bacteria, possibly due to chronic inflammation from periodontitis — a severe form of gum disease.
• Pregnancy and birth. Gum disease has been linked to premature birth and low birth weight.
• Diabetes. Diabetes reduces the body's resistance to infection — putting the gums at risk. In addition, people who have inadequate blood sugar control may develop more-frequent and severe infections of the gums and the bone that holds teeth in place, and they may lose more teeth than do people who have good blood sugar control.
• HIV/AIDS. Oral problems, such as painful mucosal lesions, are common in people who have HIV/AIDS.
• Osteoporosis. Osteoporosis — which causes bones to become weak and brittle — may be associated with periodontal bone loss and tooth loss.
• Alzheimer's disease. Tooth loss before age 35 may be a risk factor for Alzheimer's disease.
• Other conditions. Other conditions that may be linked to oral health include Sjogren's syndrome — an immune system disorder — and eating disorders.

Be sure to tell your dentist if you're taking any medications or have had any changes in your overall health — especially if you've had any recent illnesses or you have a chronic condition.

Dental Sports Injuries

According to recent research, dental injuries make up around 40% of the total number of sporting injuries that occur each year. It just goes to show how vulnerable our teeth can be, especially the front teeth. The added problem is that our vulnerable front teeth are also our most visible: so a lost tooth here can not only be painful, it can also be really damaging to our self-confidence and self-esteem.
The fact is that our teeth do not grow back and the risk of irreversible damage is real. So when you lose or damage a tooth due to a sporting injury, it is not quite the same as other injuries which heal over a period of time. While a damaged tooth may only feel like a minor injury, it is not and can in fact negatively affect other aspects of your oral and overall health. It can also mean that, in the longer term, you feel self-conscious about smiling, talking and eating in social situations.
It is important to realize that the aesthetics are not the only aspect of the damage that a missing tooth can cause. A missing tooth puts extra, unusual pressure on the remaining teeth and on your jaw, which can lead to a whole variety of aches and ailments, from grinding your teeth at night to having aches in the neck, shoulders, back and also damaging the remaining dentition.
Of course different severities of trauma and the specific circumstances will require different and yet appropriate treatments. The key is to contact your dental professional as soon as possible to have a clinical and radiographic examination and come up with a treatment plan. 
Always use proper safety equipment, including a sports mouth guard when indicated as necessary.                         

Dental X-rays.

Dental X-ray examinations provide valuable information that helps your dentist evaluate your oral health. With the help of radiographs a dentist can look at what is happening beneath the surface of teeth and gums. 
As X-rays from an X-ray machine pass through your mouth they are mostly absorbed by teeth and bone because these tissues, which are called hard tissues, are denser than cheeks and gums, which are called soft tissues. When X-rays strike the film or a digital sensor, an image called a radiograph is created. Radiographs allow your dentist to see hidden abnormalities, like tooth decay, infections and signs of gum disease.
As far as frequency goes, we recommend a six-film series once a year and a full mouth series(18 films) once every five years. These guidelines provides optimal diagnostics over a patients life time and are considered very safe. In my practice we utilize digital X-ray systems that require even less radiation than conventional radiographs.
Finding and treating dental problems at an early stage can save time, money and unnecessary discomfort. Radiographs can help us detect problems in your mouth that otherwise would not be seen and are absolutely necessary.

Guide to different types of dental restoration

Different types of dental restorations are designed to do specific jobs. Often the type of restoration recommended is directly dependent on how much healthy tooth structure is remaining after excavation of the pathology. Here is a breakdown of the most common restorations:

1. Sealants- White filling materials in a "flowable" form. Used to fill the decay-susceptible grooves of the back teeth. Usually utilized in children between 6-18 years as a preventative measure.
2. Fillings- Composite or white fillings. Placed directly into the prepared tooth. Used where the existing fillings or areas of decay are small enough that the remaining tooth structure has not been overly compromised.
3. Porcelain Inlays- Used in similar situations as fillings except a pre-made piece of ceramic material is bonded into the tooth. This results in superior physical properties, possibly providing a lifespan of 2 to 3 times longer than a composite filling. Inlays are a top-quality alternative to the composite filling.
4. Porcelain Onlays- Used in situations where the tooth is fractured or has been severely decayed, the onlay is similar to the inlay described above except that the ceramic covers the entire or most of the biting surface. An onlay is more conservative in preparation than a crown, it does not cover the entire visible tooth structure, so there is no need to grind away all sides of the tooth unless there is a specific reason.
5. Crowns(caps)- A crown, the largest single tooth restoration, sometimes cannot be avoided. It covers all sides of the tooth as well as the end. It is used when there is limited tooth structure left, when an existing crown must be replaced, or when the tooth is an "anchor" tooth for a fixed bridge.
6. Veneers- Thin porcelain facings that cover the front side of teeth. Used cosmetically to change the length, color and shape of teeth. Can be preformed with minimal tooth preparation and an excellent choice for a cosmetic make-over.
7. Bridges- Used to replace missing teeth when sufficient "anchor" teeth are available on each side of the gap. Numerous systems are available, including fiber-reinforced ceramics, Zirconium-based ceramics and porcelain fused to metal bridges.
8. Implants-Titanium posts surgically placed into the jawbone. After placement the bone grows around the implant through a process called osseointegration (usually three-six months after placement) and later the restorative phase can begin. Implants are used to support various dental prosthesis ranging from single crowns to a full denture. Given the choice between a bridge and an implant, an implant is considered the superior choice since it doesn't require preparation of adjacent teeth and there for more conservative.
9. Removable Partial Dentures- Used to replace missing teeth when insufficient teeth remain to support fixed bridges or a patient is not a good candidate for dental implants. Partial dentures can be metal or acrylic-based.
10. Removable Complete Denture- Utilized when no teeth remain and implants are not an option due to case specifics. By today's standards this is basically a last resort.

Mouth Ulcers

Mouth ulcers, sometimes called canker sores, are a common affliction. Often they are simply caused by trauma and heal quickly on their own. The recurrent, bothersome form is known as recurrent aphthous stomatitis or simply aphthous ulcers. Certain triggers for these are stress, acidic foods, specific foods for the individual, trauma, chemical sensitivities, and can play a role in setting off an attack.
The cause of these ulcers is unknown, though it is believed to be some sort of immune mediated condition. At this time it seems aphthous stomatitis is not caused by any infectious agent (viruses or bacteria) and these ulcers are not contagious. Aphthae can also be manifestations of various systemic diseases such as Bechet's syndrome, HIV, autoimmune disorders, Crohn's disease, and the like.

There is no cure for aphthous stomatitis and lesions are basically treated palliatively. A  dentist applied treatment, Debacterol, gives almost immediate relief and speeds healing. It is an acidic agent which chemically cauterizes the ulcer surface, sterilizing it, and covering the painful nerve endings. Only available as an in office treatment,  Debacterol is 90 percent effective in giving immediate and lasting pain relief. Avoiding known triggers is helpful. A healthy diet with vitamin supplementation is recommended. Excellent oral hygiene, including use of antibacterial rinses (Rx chlorhexidine or OTC Listerine), has been shown to reduce frequency of attacks. Reducing stress is important as well. In severe cases a short course of systemic steroid (prednisone, etc.) may be needed. A new drug Apthasol is on the market and has been shown to have some beneficial effects as well.

Oral Hygiene

Brushing and flossing your teeth are only parts of an optimal oral hygiene program. Most people know that good oral hygiene is important in maintaining the health of the teeth and gums, but it is also important to maintain the health of the entire mouth including other tissues in the oral cavity. In addition to brushing the teeth at least twice a day with fluoride toothpaste and flossing on a regular basis, it is also important to clean other areas of the mouth, particularly the tongue.
The tongue's rough and porous surface can harbor plaque-causing bacteria. Plaque is a bacterial film that forms when food particles collect on teeth, promoting tooth decay and gum disease. If the tongue isn't cleaned regularly and continues to harbor these bacteria, it can serve as a reservoir and re-seed the teeth and gums with bacteria.
Not only do the bacteria coating the tongue contribute to plaque formation, they also can cause odor, resulting in halitosis or bad breath.
The solution to these problems is brushing your tongue with a soft-bristled toothbrush in good condition at least a couple of times a week. An antiseptic mouthwash such as Listerine will also cut down on bacteria that dwell in the mouth.
An alternative to brushing the tongue is the use of a tongue scraper, which is a hand-held device, usually with serrated edges, designed to remove bacteria from the tongue by drawing them across its surface. Tongue scrapers are OK, but they're really no better than a good toothbrush. It's really up to the individual as to how they clean their tongue. The important thing is that they do it on a regular basis.

Food Allergies

Food allergy occurs when the immune system mistakenly attacks a food protein as if it were a pathogen. Ingestion of the offending food may trigger the sudden release of chemicals, including histamine, resulting in symptoms of an allergic reaction. Scientists estimate that approximately 12 million Americans suffer from food allergies.
Food allergies can be diagnosed using a skin prick test or a blood test. A skin prick test is usually less expensive and can be done in the doctor’s office. A Positive skin prick tests or immunoassay test results will show that IgE antibody is present in the body, but cannot alone predict that a reaction will occur if the patient were to eat a suspected allergy-causing food. The results of the tests are combined with other information, such as a history of symptoms and the result of a food challenge to determine whether a food allergy exists.

Strict avoidance of the allergy-causing food is the only way to avoid a reaction. Reading ingredient labels for all foods is the key to avoiding a reaction. If a product doesn’t have a label, individuals with a food allergy should not eat that food. If you have any doubt whether a food is safe, call the manufacturer for more information. There is no cure for food allergies. Studies are inconclusive about whether food allergies can be prevented.
Symptoms may include one or more of the following: a tingling sensation in the mouth, swelling of the tongue and the throat, difficulty breathing, hives, vomiting, abdominal cramps, diarrhea, drop in blood pressure, loss of consciousness, and even death. Symptoms typically appear within minutes to two hours after the person has eaten the food to which he or she is allergic.
Studies are inconclusive about whether food allergies can be prevented. Parents should become familiar with the early signs of allergic disease such as eczema, hives, repeated diarrhea and/or vomiting in reaction to formulas, wheezing, and talk to a doctor about those symptoms.
At this time, no medication can be taken to prevent food allergies. Strict avoidance of the allergy-causing food is the only way to prevent a reaction. Epinephrine, also called adrenaline, is the medication of choice for controlling a severe reaction. It is available by prescription as a self-injectable device (EpiPen® or Twinject®).

Nutrition Tips for Healthier Teeth and Gums.

The types of foods you eat can affect your smile as much as brushing or flossing. Every time you eat sugary or starchy foods, the bacteria in plaque get another chance to form decay-causing acid. But choosing foods that naturally fight bacteria, remove plaque, strengthen enamel, and freshen breath is a good way to preserve your teeth.
1. Celery
Celery protects your teeth in two ways. The extra chewing it requires produces plenty of saliva, which neutralizes the bacteria Streptococcus Mutans that causes cavities. Additionally, chomping on naturally abrasive foods massages gums and cleans between teeth.
2. Cheese
Studies from the last decade show that cheese, with its low carbohydrate and high calcium and phosphate content, provides several benefits for your teeth. It helps balance your mouth's pH (an acidic pH encourages the growth of cavity-causing bacteria). Cheese also preserves and rebuilds tooth enamel and produces saliva, which kills the bacteria that cause cavities and gum disease.
3. Green Tea
Green tea contains substances called Catechins that kill the bacteria in your mouth that turn sugar into plaque. Catechins also wipe out the bacteria that cause bad breath.
4. Kiwis
For their size, kiwis pack more vitamin C than any other fruit. In fact, one large kiwi supplies more than 100 percent of your recommended daily amount. If you don't get enough vitamin C, research shows that the collagen network in your gums can break down, making your gums tender and more susceptible to the bacteria that cause periodontal disease.
5. Onions
Onions contain powerful antibacterial sulfur compounds. In a 1997 test tube study, onions killed various types of bacteria, including S. Mutans. Research indicates that they are most powerful when eaten freshly peeled and raw. Of course, raw onions can do a number on your breath, so be sure to have some fresh parsley on hand.
6. Parsley
Chewing parsley or mint leaves after a pungent meal will help you maintain sweet-smelling breath. These herbs contain Monoterpenes, volatile substances that travel quickly from your bloodstream to your lungs, where their odor is released via your breath.
7. Sesame Seeds
According to fossils, our Paleolithic ancestors had great teeth. Anthropologists suggest that this is partly due to the cleansing action of primitive foods like seeds, which slough off plaque and help build tooth enamel. Sesame seeds, for example, are also high in calcium, which helps preserve the bone around your teeth and gums.
8. Shiitake Mushrooms
A 2000 study in Caries Research showed that lentinan, a sugar found in shiitake mushrooms, prevents mouth bacteria from creating plaque.
9. Wasabi
Otherwise known as Japanese horse-radish, this condiment not only provides zing to sushi, it also protects your teeth. A 2000 study in Biofactors revealed that the substances that make wasabi taste hot, called Isothiocyanates, also inhibit the growth of cavity-causing bacteria.
10. water
Drinking water keeps your gums hydrated and is the best way to stimulate saliva--your body's greatest defense against the bacteria that cause plaque and cavities. Rinsing your mouth with water also helps wash away trapped food particles that decompose in the mouth and cause bad breath.

Bad Oral Habits

While it is obvious that our teeth's main purpose is the initial processing of foods before swallowing, it is sometimes not so clear what other functions should be expected! As capable as our teeth are in biting and chewing food, there exists many limitations outside of this realm. 
In all my years of  clinical experience, I've come across lots of pathologies that are self-inflicted through misuse of teeth. As a general rule, I always tell my patients that when in doubt don't do it. It is easy to forget sometimes that our teeth can be quite fragile under certain circumstances and misuse could cause chips and fractures, resulting in unnecessary dental work. Here is a short list of some common things to avoid; Chewing ice, chewing non-food objects such as finger nails and pens, chewing some hard nuts either with or without shells, cutting strings and aggressive use of toothpicks, just to name a few.
We also recommend night guards to those who have a tendency to clench and/or grind their teeth. They are a small investment to make that can go a long way in preventing reversible or irreversible damage.
Lastly, please remember that it is not that we do not want to see you in the dental office. We just do not want to have to treat you in preventable situations! Please try to avoid using your teeth as a multi-purpose tool, unless of course it is for processing food!

Good Nutrition

Good nutrition and healthy eating habits are essential to maintaining optimal oral and overall health. The food and beverage choices you make have a direct effect on the health of your entire body. Each time a sugary snack or beverage is consumed, the sugar, along with the bacteria in your mouth, bathe your teeth in harmful acids that attack your teeth for at least twenty minutes. Each bite or sip brings on another acid attack. After repeat attacks, teeth are susceptible to tooth decay.
While it’s important to eat a variety of nutritious foods from the five major food groups grains, dairy, fruits, vegetables and meat/poultry/fish, it’s not necessary to throw out everything in your pantry that contains sugar. Almost all foods, including milk and vegetables, contain some form of sugar, and many offer key nutrients that are part of a well-balanced diet. Instead of cutting out sugar from your diet altogether, one should read the labels on foods and beverages and set a goal to reduce those that contain added sugars, such as soft drinks, candy and cookies. Soda, whether regular soda containing sugar or diet sugar-free soda, is high in acid content and contributes to the erosion of enamel. The enamel layer which covers the outer surface of teeth is the hardest substance in the body and normally protects the inside of the tooth by acting as a barricade.
Also we should be limiting snacking between meals. Foods eaten as part of a meal cause less harm to your teeth because more saliva is released during mealtime. Saliva naturally protects our teeth and helps to wash food particles from your mouth, lessening the acid build up that leads to tooth decay.
When you need a snack, make nutritious choices, such as fruit, raw vegetables, cheese, plain yogurt or other snacks that are low in sugar. Instead of soda, choose healthy beverages, such as water or milk.
Brush twice a day with fluoride toothpaste. Floss daily to help remove plaque, the sticky film of bacteria, which gets stuck between your teeth and gums.
Schedule regular checkups with your dentist at least every six months to help prevent problems from occurring and detect possible problems in their early stages.