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.