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April is Oral Cancer Awareness Month.

What should we be aware of and why is it important?

The bad news:

Oral cancer is defined as cancer of the lip, mouth or tongue. It can be a devastating disease. In India it is one of the most common forms of cancer, accounting for between 30% and 40% of all malignancies (higher than in other parts of the world). Although the prognosis can be good if spotted early, the majority of those with the disease are diagnosed too late. This type of cancer is very malignant, meaning that it can spread quickly if not treated early.

People are dying because of lack of awareness.

The good news:

Many types of mouth cancer are preventable by avoiding the known risk factors. It is also possible to spot signs of early signs of mouth cancer or conditions that can lead to cancer by regular, thorough mouth examinations. If people are aware of the possible signs and symptoms they can be alerted to see a dentist or doctor as soon as they spot these. The earlier a lesion is diagnosed and treated the better the outcome.

Risk factors and prevention

 
Tobacco use has been shown to be the biggest risk factor for developing mouth cancer. Tobacco contains carcinogens (substances directly involved in causing cancer) and causes approximately 85% of all cancers of the head and neck. Tobacco is a risk factor whether it it smoked or chewed. One of the reasons for the higher incidence of mouth cancer in South Asia is the widespread use of tobacco in paan, gutkha or betel quid. These are typically kept in the cheek and chewed or sucked for some time.
Other risk factors include:
  • Heavy alcohol consumption (particulary when combined with tobacco use)
  • UV radiation from sun exposure can cause lip cancer (as well as skin cancer)
  • Infection with Human Papilloma Virus (HPV)
  • Chronic trauma from a sharp tooth or ill-fitting dentures
  • Poor diet, lacking in fruit and vegetables
  • Genetic factors

 

Early detection

 
Oral cancer can start in the floor of the mouth, gums, lips, inside the cheek or on the tongue or palate. Some cancers may start as “pre-malignant lesions” – these are areas which have a risk of developing into cancer and so need to be monitored.
The most common early signs are:

  • An ulcer with no obvious cause which does not heal after 2 weeks
  • A white, red or speckled patch which cannot be rubbed off                                                                                                                                                 These are usually not painful in the early stages.
                (Photographs courtesy of http://www.oralcancerawareness.org)
Other signs and symptoms to look out for:
  • Unexplained pain or numbness in the mouth or ear area
  • Lump in the neck
  • Difficulty swallowing or opening the mouth
If you have any of these, it doesn’t necessarily mean you have cancer. It just means that you should get checked by your dentist or doctor. They will either be able to reassure you, or arrange for further tests if necessary.
Regular check-ups with your dentist will enable them to examine your whole mouth (not just your teeth). No one wishes or expects to get cancer but if early signs are seen, treatment can be far easier and more successful than if cancer is diagnosed at a later stage.

 

Are you worried or anxious about visiting the dentist?

You are not alone.

Dental anxiety is common.It is reported that approximately 20% of people put of visiting the dentist due to anxiety.


A smaller percentage (maybe less than 5%) have severe dental phobia and will live with extreme pain from their teeth rather than go to the dentist.



In this blog we are going to discuss the causes of dental anxiety and phobia as well as ways to overcome these.

What is Dental Anxiety?

Anxiety is fear of the unknown. Most people experience some degree of dental anxiety. This is natural if you are about to have something done which you have never experienced before.

Fear is reaction to a known danger. This can be due to past bad experiences and lead to avoidance of similar circumstances. Fear can also result from hearing or reading scare-stories from other people, including parents or from media portrayal.

Phobia is an extreme, persistent or irrational fear. This leads people with a dental phobia to avoid dentists or anything related to dentistry.

Research has shown that men and women are equally affected by dental anxiety and phobia. Men may find it more difficult to talk about their fear and therefore to get help in overcoming it. Children can pick up fears from their parents even before they ever have any experience of dentistry.

Dental phobia can have a major impact on daily life due to the pain and embarrassment caused by untreated dental problems. This can lead to loss of self esteem or depression.

Some of the most common factors involved in dental anxiety or phobia:

  • Feeling of loss of control
  • Fear of the unknown
  • Past bad experiences
  • Specific fears such as injections, the drill or pain
  • Fear of embarrassment or humiliation
  • Stories from others
  • History of child abuse can also cause dental anxiety

If you recognise any of these issues or feelings, there is hope.At Smile Station in Bangalore, we specialise in helping patients who are fearful or anxious.Here is a testimonial from one of our patients at Smile Station who was is overcoming her fears:

Hi This is Monami  from Bangalore and I was paranoid about dental treatment and had to go through general anesthesia for even fillings and tooth extraction. Many dentists tried to work with me but I ran away every time as I was over sensitive to the instruments. Then luckily I met Dr. Gurudev who not only talked me through the procedure but also is trying to work with me to get this trauma out of my mind for good. I really thank Dr. Gurudev for being so patient with me and acting more like a psychologist than a doctor. Thanks a million Dr. Gurudev.

In the following 3 sections we will discuss the following ways of overcoming fear and anxiety about visiting the dentist:

Part 2  -  How to find a good dentist you can trust and communicate well with.

Part 3  – Specific issues which may cause anxiety and techniques for overcoming them.

Part 4  –  More ways to overcome anxiety, including relaxation techniques and good pain control.Check back soon for the following parts, or follow by email using the link on the right.

In the first part of this blog we looked at some of the causes and effects of dental anxiety and phobia.

In this section we will discuss how to find a good dentist who can work with you to overcome your fears.

As in any profession, there are good and bad dentists. Most dentists want to relieve pain and keep their patients happy. However, not all dentists have the personality, time or interest to work with those who are fearful and need extra care and attention.

Unfortunately, if you have had bad experiences in the past with one or more dentists this may lead you to believe that all dentists are uncaring or “bad”.


Media portrayal of dentists usually does not help. While movies may make other doctors the hero in their plots they usually portray the dentist as the villain!


If you had a schoolteacher who was cruel and ridiculed you, this does not mean that all teachers are the same.

There are many gentle, caring dentists who are  good with nervous people. 

The key is finding the right dentist for you. 

Qualities of a good dentist

Of course, a dentist needs to be well qualified, knowledgeable and skillful at their job.The following qualities are also important, especially if you are anxious or have dental phobia:

  • Someone you can develop a good rapport with.
  • Makes you feel at ease and works to gain your trust.
  • Treats all people with respect.
  • Interested in whole person – does not just see people as a mouth or set of teeth!
  • Understands anxiety and is gentle and caring.
  • Willing to spend extra time when needed and listen to your concerns.
  • Explains the diagnosis and treatment options in a way that you can understand.
  • Involves you in decision making and gives preventive advice so that you become a partner in your dental care.
  • If sedation is used, it should only be in conjunction with, and not as a replacement for, good communication and psychological support.
  • Dental office environment should be clean and as welcoming and comfortable as possible.

So how do you find a dentist the right dentist for you?

The best way is by word of mouth. Ask your friends and family, if they have a dentist they can recommend. If a friend or family member is also anxious or an ex-dental phobic but has found a dentist who they get along well with, this is a good sign. You can also check a dentist’s reviews on various websites, but a personal recommendation is better.

There is no one dentist who is a perfect fit for every patient. Depending on past experience and personal preference, you may be happier with a male or female dentist, or someone with a different personality type than your friend.

Taking the first step

Once you have some recommendations you could telephone the practices to ask about the dentist and get some more information. If you are very anxious, you could ask someone to do this for you. Try to call into the practice, with a friend, if needed, to get get a feel for the place before making an appointment. You could explain to the receptionist that you are anxious and ask how the dentist deals with anxious patients.

Unless you have severe pain or infection, you do not need to rush into dental treatment. You will probably have been putting off seeing a dentist for some time, so a few more weeks are not going to make a huge difference. It is important to find a dentist who will help you overcome your fears, rather than reinforce them.

It may be less scary to ask to just have a chat with the dentist away from the dental chair for the first visit. It is best to be open about your fears, anxieties and past bad experiences, as this can enable the dentist to find the best way to help you. If you feel unable to talk about some of your fears, you could put them in writing.

If you feel positive about the dentist you can then make an appointment for a check-up. Trust your instincts, if you don’t feel comfortable with the dentist then make your excuses and leave. You can keep looking until you find the right dentist for you.

If you have a dental phobia, just making the first appointment can be the hardest part. An understanding dentist will let you take one step at a time in order to build up your confidence. Once you have managed a check-up and x-ray, you will probably find that your level of anxiety is reduced. It is best to start with a simpler procedure, such as cleaning, before moving onto to more complex treatment.Congratulate yourself for each new step you take.

As the following testimonial from a Smile Station patient shows, it is possible to overcome your fears once you find the right dentist:

“When I was referred by my colleague to go to Smile Station, I thought it is going to be yet another place and have to bear the grueling pains which normally arises due to dental treatments. After the first consultation with Dr Gurudev I changed my opinion completely. Within few sittings all my problems along with fear has gone and our entire family is now under the care of Smile Station. Both Dr Pramila and Dr Gurudev are excellent in their approach and services to the patients!! Cheers and Good wishes to the entire Team !!!”

Look out for the next section in which we will look at specific anxieties and some techniques for overcoming them.

As we discussed in the first part of this blog, dental anxiety is common. However, individuals may face different issues depending on their personalities and past experiences.
In the following 2 sections we will cover some specific fears and anxieties and look at ways of overcoming them.

Loss of Control

A big issue for many people is the feeling of loss of control when visiting the dentist. You may feel like you do not know what is going on in your mouth or that you are not able to have a say in what the dentist does.
You may have had bad experiences in the past with a dentist who did not explain what they were doing or why. This may have given you the feeling that dentistry is something that “is done to you” rather than you being a partner in your dental care.  As discussed in theprevious post – finding a good dentist who you can communicate well with is vital in overcoming anxiety. A good dentist will explain treatment options, along with risks and benefits in a way that you can understand. You may need to take some time to consider your options before agreeing to treatment.
Dentists are required to obtain “informed consent” before treatment. Sometimes you may be asked to sign a consent form. Only sign this if you feel you have enough information to agree to treatment – if not then ask questions. A good question to ask your dentist is what would they choose if it were their tooth or mouth. You should also know the likely consequences if you choose to have no treatment. Remember, you should be in control and always have a choice in your treatment.Similarly, a good dentist will explain what is involved in your treatment from your point of view, what sensations you are likely to feel and how to let them know if you want them to stop or take a break. Some dentists may ask you to raise your hand if you have any discomfort or need a break. This enables you to give a stop signal to your dentist when you are not able to talk easily without suddenly moving your head. Another option is to agree to take a break after an agreed number of minutes, this can be useful if you are afraid to interrupt the dentist while they are working. However, if you have any significant discomfort, don’t be afraid to raise your hand to let the dentist know. If you have a good relationship with a dentist you can trust they will stop and try to make you comfortable.

Often, it is helpful if your dentist not only explains the procedure but also demonstrates any tools or materials before using them. This technique, called tell-show-do, is often used for children but can also be very beneficial for adults who are anxious. For example, you can feel the dental instrument on the back of your hand or your finger nail before it is used in your mouth so that you know what it feels like.

As we discussed in the previous section of this blog, it is best to overcome anxieties one step at a time. You should become comfortable with having a check-up, or cleaning before moving onto longer or more complex procedures. Relaxation is important in this process. In the next section, we will also discuss some relaxation techniques.

The Dental Chair

For some people with a dental phobia just the thought of lying in the dental chair can be terrifying. Lying down can make you feel exposed or vulnerable. It is often possible to do a check up with the dental chair upright, or even in a normal chair. For treatment, you can ask your dentist if is possible to leave the chair in a more upright or semi-reclined position. For some procedures, especially if working on the back or top teeth, the dentist will need the chair to be more reclined but you can ask for this to be done gradually, so that you can get used to it. If you don’t like the feeling of being tipped back then you can ask for the chair to be put into the correct position before you sit or lie back.

Fear of “the diagnosis” or embarrassment


If you have a dental phobia you will probably have put off visiting the dentist even when you have pain or know that they need urgent treatment. This can lead to embarrassment and the feeling that you have the worst teeth the dentist has ever seen. You may also fear being “told off” or receiving a lecture from the dentist. You may also fear that you need a lot of extensive treatment.
Dentists will have seen a wide variety of people and their mouths so it is unlikely that anything in your mouth shock them. These days, most dentists realise that scolding or lecturing their patients is counter-productive. A sympathetic dentist will understand how difficult it has been for you to visit a dentist after a long time and will want to work with you to overcome your fears and improve your oral health.Also, dentists should maintain confidentiality and not discuss your diagnosis or treatment in front of other patients or members of the public. You can ask to discuss your treatment in a private setting and have the door closed during treatment if this is an issue for you.

Here is the experience of one patient, Garima, from Smile Station, Bangalore who has been able to overcome her dental phobia:

“I had dentist phobia and there was so much of work to be done on my teeth, but I was always afraid of visiting dentist, in fact I had never visited one. I randomly walked into Smile station for a check up, and Dr Guru did not make me nervous. He would be so patient throughout the treatment which is commendable, given the fact that he is always busy. But what I experienced was he would never ignore or take any patient lightly. Another very good thing is he will exactly tell what needs to be done, gives various options and explains pros and cons of each treatment, so that a person is involved and knows what is going on. I feel that every service / treatment at Smile Station has a personal touch in it. I have now shifted to London, but make sure that on my way back India, I see Dr. Guru as well as get the check up done. I just feel that I / my teeth :-) are in safe hands.”

 

In the next section we will look at more factors which can cause anxiety and techniques which can help.You can subscribe to the blog by email by using the link on the right.

In this concluding section we will look at some more issues, in particular the importance of good pain control and techniques for relaxation.

 

Fear of being awake for treatment

One major difference between dentistry and other medical specialties is that, most of the time, patients remain awake for treatment. Many patients with a dental phobia say that they would like to be “knocked out” (have a general anaesthetic) for treatment but there are reasons why a general anaesthetic (GA) is not used routinely, but only as a last resort, in dentistry. There are risks associated with having a GA and it is required that general anaesthetics are only carried out in a fully equipped hospital. Weighing the risks against the benefits, GA is generally only justified for complex oral surgery or for urgent treatment when other methods, eg. psychological techniques and sedation, have been tried unsuccessfully. In addition, having treatment while asleep will not help a person with dental phobia overcome their fears and it will not be possible to keep having treatment under GA in the future. It is much better to find a good, sympathetic dentist who will work with you as we have discussed in part 2 of this blog.

Fear of “the drill”

For many people, even the sound of the dental handpiece (or drill) can make them very anxious. This may be due to a previous bad experience where the tooth was not sufficiently numb and/or the dentist did not stop treatment when they felt pain.When a tooth is properly numb, the only sensations that should be felt are vibration and slight pressure (see more about this in under subheading “fear of pain”). However, for some, the vibration itself can be uncomfortable. If this is the case, using an electric tooth brush at home may be help you get used to the vibration sensation.Many people do not like the sound of “the drill”. Music can be helpful to blend out unpleasant sounds. Some dentists have music in the treatment room, or you could bring your own mobile device with your favourite songs or music for relaxation on. Of course, you would need to turn the music off when you need to speak to the dentist.Other distractions, such as watching a video, either on a screen above the dental chair or by wearing virtual reality goggles, may also help. Sometimes it is helpful if your dentist tells you that they will need to use the handpiece for 5 or 10 seconds at time and even counts this out loud. Don’t forget, you can let your dentist know that you need to take a break by raising your hand. This is called the “stop signal” which we discussed in part 3 of this blog

Fear of Pain

If you have had a past experience of painful treatment at the dentist this will have most likely have led to fear and anxiety.
The reason for pain could have been:
  • Not having local anaesthetic (LA) to numb the tooth when it was required.
  • The dentist starting treatment without allowing sufficient time for the local anaesthetic to work – this can take between 5 and 15 minutes, depending on the tooth and procedure.
  • Infection in the tooth or surrounding area may prevent the LA working properly. This can sometimes be a problem during root canal treatment and antibiotics or a sedative dressing placed in the tooth between visits may be required.
  • Painful injection (see next paragraph).
  • The dentist not stopping when you felt pain to make you comfortable or give more local anaesthetic.
All of these problems can be overcome with a combination of good communication and using the right techniques. Don’t be afraid to tell your dentist if you experience pain so that they can do something about it.

Fear of injections

Maybe when local anaesthetic injections were mentioned in the last paragraph, you thought “but that is my biggest fear!” This is quite common, to the extent that some people would rather suffer pain during treatment that have the numbing injection. Generally, the thought of having an injection is much worse than the reality and there are ways that your dentist can help you:
  • A good relationship with a dentist you can trust goes a long way in relieving anxiety.
  • A topical gel or spray can be used to numb the gum first, this takes a couple of minutes to work.
  • Injection should be slow and gentle – fast injection can cause pain.
  • Distraction – your dentist may talk to you or you may listen to music or watch a video.
  • Relaxation techniques (discussed below).
  • Try to think about the benefits of your tooth being numb so that you will not have pain during treatment.

Fear of choking or gagging

Some people have a strong gag reflex or have a fear of choking while at the dentist. There is a physical aspect to this but anxiety will also cause these problems to be worse. The following solutions may help:

  • Discuss the problem with your dentist so that they can find ways to help you.
  • Slow breathing through your nose. For those who have a problem with this, a nasal spray used beforehand may help.
  • Your dentist could use a numbing throat spray to make the area less sensitive. Some people also find rinsing with salty water or putting salt on the tip of their tongue has a similar effect.
  • Desensitization – you could ask your dentist if you can borrow a mouth mirror to practice placing it in your mouth at home.
  • Distraction or humming to yourself.
  • Relaxation techniques (discussed below).
  • Inhalation sedation using nitrous oxide mixed with oxygen (discussed below) is also known to reduce the gag reflex as well as anxiety.

Relaxation Techniques

Relaxation is the opposite of anxiety and it is impossible to be relaxed and anxious at the same time. There are various relaxation techniques that you can try to see which works best for you. All of these need to be practiced regularly at home. They will not work if you start while in the dental chair.
Click on each for a link with more details:

Sedation

So what if you have tried the techniques suggested and you still can’t cope with dental treatment?
This is where conscious sedation comes in. Sedation is used to reduce anxiety and aid relaxation, making dental visits more comfortable. You will still be awake but less anxious. You can discuss the options with your dentist. If they do not offer the type of sedation which is right for you, they may be able to refer you to someone who does.
There 3 types of sedation commonly used in dentistry:

  • Inhalation sedation - a mixture of nitrous oxide (laughing gas) and oxygen is inhaled through a rubber cup which fits comfortably over the nose throughout treatment. The sedation reduces anxiety so that you feel happy and relaxed. This is the safest and gentlest form of sedation with few side effects and fast recovery time. It can be used for children and adults. Inhalation sedation is available at Smile Station in Bangalore. You can contact the practice for more details.
  • Oral sedation -  a medication (usually a benzodiazepine) prescribed to be taken in the hours before a dental appointment, or sometimes the night before, which has sedative and anti-anxiety effects. These should only be taken on the advice of your physician and/or dentist as they have side effects and may interact with other medication. You should not drive or operate machinery after taking oral sedation.
  • Intravenous (IV) sedation - a sedative drug is administered into the bloodstream through a vein. This induces a deeper state of relaxation but you will still be awake. It may give either partial or full memory loss during the time of sedation. IV sedation is only recommended for adults and impairs ability to drive or operate machinery.
Remember, sedation is never a substitute for a good, caring dentist who will work with you to overcome your fears.Finally, here is a testimonial from Chelsea – a patient at Smile Station who has been able to overcome her anxiety:“Smile Station, a place I never thought would actually be pleasant to go to. Simply because it was a dentist’s clinic. but my experience here made me change my entire opinion and made me feel extremely comfortable. A root canal from what I had heard was supposed to be the most painful thing, but Dr. Gurudev being so experienced made it feel like a cake walk. He was extremely gentle and helped me get over my fear of the dentist. The facilities are extremely good too! I am so happy I chose to come to Smile Station and I would recommend this clinic to anyone!”If you have any comments on this blog, or would like to see any other topics covered, please post a message below.

www.smilestation.in

Take a moment and listen to Kiran, Debbie and others about their dental experience at Smile Station, Indiranagar, Bangalore. Their dental visits turned out to be dental experiences of their lifetime.

Smile Station is a premier ISO 9001:2008 certified one stop dental care center located close to the metro station in Indiranagar, Bangalore, India.

We provide you the highest quality of personalized dental care in a calm and relaxed environment to keep your visits stress-free and relaxed.

We specialize in dental implants, teeth whitening, smile design & makeovers, invisible braces, laser dentistry, pediatric dentistry and nitrous oxide dentistry. Our other areas of expertise include single visit root canal treatments, all-ceramic crowns and bridges, dental jewelry, correction of gummy smile, dental braces, plastic surgery of gums and preserving smiles through dental stem cells banking

The smiles on the faces of over 5000 odd patrons both locally and internationally – expats, health travelers and tourists, serve as testament of our work. Also, the constant inflow of patrons from many developed countries like Germany, Switzerland, the USA and the UK is a reflection of the standard of care that we provide.

If you want to visit our facility or if you are looking for a specialist who will understand and care for your dental needs, then we are just a click away at www.smiestation.in

For a beautiful and healthy smile, just dial ……. +91 80 4125 6715.

Looking forward to meeting you,

Creating smiles everyday,

Dr. Gurudev and Team

SPECIALITY – ORTHODONTICS & DENTOFACIAL ORTHOPEDICS

Dr. Venkatesh Garla is a vastly experienced Orthodontist and consults at Smile Station, the premier ISO certified dental center in Indiranagar Bangalore.

He obtained his Masters in Orthodontics & Dento-Facial Orthopedics from Rajiv Gandhi University of Health Sciences in 2006 and M.Orth from the Royal College of Surgeons, Edinburgh,U.K. in 2007. He is also a certified Invisalign (Invisible braces) practitioner and is actively involved in academics.

He is a Professor and has trained multiple post graduates in Orthodontics. He is in the board of Rajiv Gandhi University of Health Sciences.

SPECIALITY – RESTORATIVE DENTISTRY & ENDODONTICS

 

Dr. Sai Ramesh Shetty is the endodontist at Smile Station, the premier ISO Certified dental centre in Indiranagar Bangalore.

He obtained his Masters in Restorative Dentistry & Endodontics from Rajiv Gandhi University of Health Sciences.

He is a faculty at the University and actively involved in academics.

 

SPECIALITY – ORTHODONTICS & DENTO-FACIAL ORTHOPEDICS

Dr. Lakshmikanth is a vastly experienced Orthodontist and consults at Smile Station, the premier ISO certified dental center in Indiranagar Bangalore.

He obtained his Masters in Orthodontics & Dento-Facial Orthopedics from Manipal University in 1997 and is actively involved in academics.

He is a Professor and has trained multiple post graduates in Orthodontics. He is in the board of Rajiv Gandhi University of Health Sciences.

He is a consultant at St. John’s Hospital, Bangalore.

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Living with a crooked, faded and an unattractive smile can be a source great disappointment and self-confidence. The chances are that you may have considered braces or extensive cosmetic dental treatment many times, but never could imagine seeing yourself with braces or having the courage to get your teeth worked upon extensively.

But with the arrival of the Inman Aligner, all that has changed.

The Inman Aligner is a specially designed customized, removable orthodontic appliance using 3-D technology that works on your front teeth and corrects your smile unbelievably in just a few 4 – 16 weeks and combined with teeth whitening and a little bonding/ contouring, you could be flashing your bright new beautiful smile that you always longed for. Thus making it also one of the best choices for smile correction and enhancement in line up for those special moments in your life, like your wedding day or your graduation from college.

Are you ready for a new smile?

Now is the opportunity to straighten your teeth and get more confident in your professional life or rekindle your dwindling social life with a bright smile.

We at Smile Station believe in making straighter, whiter teeth affordable to all. For further details do get in touch with us. The Inman Aligner system has its own evaluation criteria and only Inman aligner trained and certified dentists can provide them. Dr. Gurudev is one of the few trained & certified Inman Aligner provider in the country.

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