This document reviews the etiology and management of gagging. It begins by distinguishing between gagging and retching, describing gagging as a protective reflex. It then discusses common triggers of gagging during dental procedures and classifies gagging as either somatic or psychogenic. The review covers contributing local, anatomical, psychological, and iatrogenic factors. It provides an overview of behavioral and pharmacological management techniques including relaxation, distraction, desensitization, and palateless dentures. The goal of management is to reduce anxiety and uncondition the gag reflex through modification of triggers and learning.
phonetics play an important role in planning and preparing complete denture for the complete edentulous patients.design of the prosthetic denture affects speech in a number of ways.
Neutral Zone
In dentistry, the neutral zone refers to that space in the oral cavity where the forces exerted by the musculature.of.the tongue are equal and balanced with the.forces exerted by the buccinators.muscle of the cheek.laterally and the orbicularis.oris muscle anteriorly
this presentation has all the techniques in impression making in the fabrication of an RPD.
The presentation is available on request. Mail me at apurvathampi@gmail.com
phonetics play an important role in planning and preparing complete denture for the complete edentulous patients.design of the prosthetic denture affects speech in a number of ways.
Neutral Zone
In dentistry, the neutral zone refers to that space in the oral cavity where the forces exerted by the musculature.of.the tongue are equal and balanced with the.forces exerted by the buccinators.muscle of the cheek.laterally and the orbicularis.oris muscle anteriorly
this presentation has all the techniques in impression making in the fabrication of an RPD.
The presentation is available on request. Mail me at apurvathampi@gmail.com
Tongue thrust and mouth breathing habits in childrenDr. Harsh Shah
Overview on mouth breathing and tongue thrusting in children leading to ill effects
Presented by : Pratiksha Ahire
Guided by : Dr. Rehan Khan
Dept. of Pediatric Dentistry
SDDCH PArbhani
1.THE EPILEPTIC Patient And How To Manage Them In Dentistry.pptxSamkeloKhumalo2
Epilepsy is a chronic neurological disorder characterized by recurrent seizures. Epilepsy generally begins in childhood, potentially impeding education, employment, social relationships, and the development of a sense of self-worth. The number of decayed and missing teeth, the degree of abrasion, and periodontal indices are significantly worse in patients with epilepsy. Epileptic patients require special care during dental treatment.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
common oral baits like tongue thrusting,nail biting,thumb sucking, lip biting, mouth breathing have been described in detail with their clinical features,oral manifestations and treatment and prevention part. removable and fixed appliances have been described in brief for various habits.
Similar to The etiology and management of gagging (20)
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
1. THE ETIOLOGY AND
MANAGEMENT OF
GAGGING:A REVIEW
OF THE LITERATURE
J Pros Dent.-G.S Bassi,G.M. Humphris,L.P. Longman(May
2004)
2. Gagging or Retching ?
Retching - An ejectory contraction of the muscles of the gastro-intestinal tract and oropharynx
Gagging - A normal protective reflex designed to protect the airway and prevent material entering the
oropharynx and the upper gastro-intestinal tract
3. INTRODUCTION
• Gagging commonly occurs during dental procedures,such as making a
maxillary impression.
• Severe gagging can be elicited by the dentist’s fingers or instruments
contacting the oral mucosa or even by nontactile stimuli.
4. • These patients tends not to seek a dental treatment or may request
treatment under general anaesthesia.
• Commonly results in exodontia.
• Final outcome- Edentulousness....
5. THE GAG REFLEX
It is a normal defense mechanism that prevents foreign
bodies from entering the trachea,pharynx,or larynx.
Unwanted ,irritating, or toxic material is ejected from the
upper respiratory tract by the contraction of
oropharyngeal muscles.
6. Retching :peristalsis becomes spasmodic, uncoordinated and the direction
is reversed.
Air is forced over the closed glottis producing a characteristic
retching sound.
Reactions by patient: simple contraction of palatal or circumoral
musculature to spasm of pharyngeal structures, accompanied by
vomiting.
7. Gagging is accompanied by excessive
salivation,lacrimation,sweating,fainting or a panic attack.
8. Stimulation occurs intraorally
afferent fibers of vagus, glossopharyngeal , trigeminal pass to medulla
oblongata.
efferent impulses give rise to spasmodic and uncoordinated muscle
movement.
9. Five intraoral areas known to be “Trigger Zones”:
1. Palatoglossal and palatopharyngeal folds
2. Base of tongue
11. • It may also be elicited by non-tactile sensations such as
visual,auditory,or olfactory stimuli.
• Sight of dentist or dental equipment.
• Sound of dental handpiece or person retching.
• Certain smells like cigarette smoke, or perfume.
• Certain thoughts.
12. Classification by Aetiology
Somatic:
Induced by touching a ‘trigger’ area
Psychogenic:
Induced without direct contact
13. CONTRIBUTORY FACTORS OF
GAGGING
1. Local and Systemic Factors
2. Anatomic Factors
3. Psychological Factors
4. Iatrogenic factors
14. Local factors
Nasal obstruction,postnasal drip,catarrh,sinusitis,nasal polyps,mucosal
congestion of the upper respiratory tract,a dry mouth, and
medications.
Chronic gastrointestinal disease,notably chronic gastritis,peptic
ulceration,and carcinoma of the stomach .
Hiatus hernia and uncontrolled diabetes.
15. Anatomic Factors
Anatomic abnormalities and oropharyngeal abnormalities.
Palate anatomy
Long uvula
Tongue shape
Tongue position
Other ‘irregularities
16. Psychological Factors
Systemic conditions like:TMJ dysfunction syndrome, atypical facial
pain, denture intolerance, burning mouth syndrome, the gag reflex.
There are two mechanisms of learning known as:
1. Classical conditioning
2. Operant conditioning
17. Classical conditioning
-It occurs when an originally neural stimuli is paired with a specific
behavioral response.
-Inoffensive stimuli such as sight of an impression tray,smell of dental
surgery,sound of dental handpiece.
-Overloaded impression tray or the accumulation of large quantities of
water from the handpiece.
18. Operant conditioning
-It is a training process whereby the consequence of a response changes
the likelihood that the individual will produce that response again.
-some behaviour pattern are reinforced because they secure attention and
sympathy(positive reinforcement), avoid a stressful situation (negative
reinforcement) , or achieve some other desirable result.
19. Iatrogenic factors
Poor cliical technique.
Overextended borders of a prosthesis.
Increased vertical dimension of
occlusion.
A smooth,highly polished surface which
is coated with saliva may produce a
slimy sensation,therefore, a matte finish
is advocated.
Inadequate posterior palatal seal
20. • Restricted tongue space
• Loss of normal palatal contour
• Poor retention
• Incorrect occlusal plane
21. Implications for the Patient
Emotional
Fear, anger & embarrassment
Avoidance behaviour
Physical
Acceptance of dental care
Oral hygiene practices
Ability to wear prostheses
22. Implications for the Dentist
Emotional
Fear, anger & embarrassment
Avoidance behaviour
Physical
Compromises ability to examine, diagnose and treat
Influences treatment decisions
23. MANAGEMENT
1.ASSESSMENT OF THE PATIENT
Identify
initiating
event
• Choking associated with swallowing of impression material.
• Panic attack by difficulty in removing new prosthesis.
• Non dental events such as suffocation.
• Sexual abuse involving oro genital penetration.
Ascertain triggers
• Tactile(examination,radiographs,impressions,wearing dentures.
• Gustatory for eg:smell of impression material.
• Olfactory for eg:smell of surgery.
• Visual for eg:white coats,dental chairs.
• Auditory for eg:sound of handpiece.
• Cognitions for eg:memories of past events.
24. Detailed dental history
and expectations
• How has previous treatment been performed?
• Has preventive treatment been employed?
• Is patient willing or suitable for restoration?
• What are patient’s motivation?
• Is attitude to treatment helpful?
• Are expectations realistic?
Associated clinical
features
• Are panic attacks,fainting,mood changes or other features associated with gagging?
25. BEHAVIORAL TECHNIQUES
1.BEHAVIOR MODIFICATION
• It has been recommendedthat all disruptive gagging should be
viewed and presented to the patient as a behavioral response and
, therefore, amenable to behavioral modification.
• An exaggerated or extended period of gagging in the absence of a
normal stimulus is usually a learned response.
• GENERALLY THE OBJECTIVES ARE TO REDUCE THE ANXIETY AND
TO UNLEARN THE BEHAVIOURS THAT PROVOKE GAGGING.
28. 3. Distraction Techniques
Concentration on a task, place, object or event to temporarily
divert the patient’s attention away from the gagging
a. Short dental procedure
b. Leg raising (Krol)
c. Breathing exercises
d. Talking (Faigenblum)
e. Salt on tongue
f. Describing the procedure
29. 4.Systemic desensitization
Aims to progressively reduce the gagging threshold
• Tongue/palate stimulation
• Marbles/discs (Singer)
• Progressive appliance wear & training bases
• Dentures with acrylic beads & mat surfaces
Hard palate is gently brushed with a toothbrush without inducing gag reflex.
5.Training bases
5mins-once a day
5mins-twice a day
10mins 3times a day
15mins till 1hr...
30. 6.Errorless learning
For patients who have dentures but do not wear them because dentures
evoke gagging.
Patients are advised to look at the dentures or hold it till the symptoms of
retching develops.
7.Cognitive behavioral therapy
8.Sensory flooding
31. Teaching patients to swallow with their mouth open
Gaggers swallow with their teeth clenched,using the teeth,lips and cheeks
as buttress for tongue to push against.
Teach the patient to swallow with teeth apart,tip of tongue placed
anteriorly on hard palate, orbicularis muscle relaxed.
32. PHARMACOLOGICAL TECHNIQUES
1.Local anaesthesia
Mucosal surface is desensitized ,the patient is less likely to gag.
Sprays ,gels,lozenges are used.
Topical anaesthetics are used in few but in others it may induce nausea
and vomiting.
Deposition in posterior palatal foramen in few in those patients who gag
when it is touched.
But it is criticized by many authors.
33. 2.Conscious sedation
Nitrous oxide alters the perception of external stimuli and it is suggested
that this altered perception depresses the gag reflex.
Patients tolerance to keep intraoral objects is increased.
34. 3.General anaesthesia
Patients who do not respond to any of the treatment modalities have to
be given general anaesthesia as the last resort.
35. PALATELESS DENTURES
:help for gagging patients
TECHNIQUE
Impression procedures
-Preliminary impression of edentulous maxillary arch is made in a stock Rim-Lock edentulous tray and
modeling compound.
-Impression tray can be removed and modeling compound refined by repeatedly warming or by placing
additional modeling compound until the desired preliminary border molding and impression are
completed.
36. -The tray is readily removed between gagging episodes.
-An acrylic custom tray is fabricated on the resultant cast.
-The tray is constructed 2mm short of the reflections and adjusted intraorally.
-Border molding with modeling compound is accomplished to obtain a physiological
seal.
-The border molding encompasses the entire maxillary region as well as the labial and
buccal vestibules.
37. Cast Preparation
-the labial and buccal extensions for border seal is established in final impression.
-the lingual palatal border is established by placing a bead line prepared with a No.4
round bur and refined with a spoon excavator.
-the bead line should be approximately 0.5 to 1mm in depth and width.
.
38. -The palatal borders should be located at the junction of horizontal and vertical
slopes of the palate and be as symmetric as possible.
-Anteriorly,the beaded border should cross the mid palatal suture line at right
angles and placed in rugae valleys when possible.
-Posteriorly ,the bead line extends to and blends with the pterygomaxillary
notches bilaterally.
39. Denture base construction
-A cast metal denture base of aluminium or chrome nickel alloy is
recommended.
-The primary advantage is the achievement of intimate contact between the
denture base and the underlying tissue,which markedly increases the
retention of the prosthesis.
-The metal base also provides rigidity to resist breakage and arpage,uniform
thickness material,a beaded metal finish line on the palatal surface,and a
stable substructure for recording jaw relations.
40. -The metal base extends from the palatal bead line to cover the crest of the ridge.
-No 14 retention beads are placed for attachment of the acrylic resin to the metal base.
-The labial and buccal borders of the denture are processed in acrylic resin.
-An external palatal finish line is placed on the anterior lingual and palatal slopes to
within 5mm of the denture border to provide for acrylic resin palatal contours and
avoid a resin-metal junction that might interfere with speech or irritate the tongue.
41. Occlusal considerations.
A bilateral balanced occlusion is achieved with a modified anatomic or
cuspless tooth form.
42. MAKING AN IMPRESSION OF A
MAXILLARY EDENTULOUS
BY PRESSING CAVES PATIENT
-The gag reflex is stimulated and controlled by nerve endings situated in soft
palate,pharynx,and pharyngeal part of the tongue.
Some suggested to anaesthetize the soft palate or injecting local anaesthetic into
posterior palatal foramen.
-Ansari advocated a secondary impression with injection type polyvinyl siloxane in a
custom tray.
-Friedman suggested to extend their tongue and place salt on the tip of the tongue.
-Ren Xianyun suggested to press two chinese caves,or accupuncture caves.
43.
44. PROCEDURE
1.Apply light pressure and increase to a heavy pressure until the patient feels soreness
and distension to both the left and right concave area at medial aspect by the
forearm and concave area between the first and second metacarpal bones with the
tumb for 5to 20 minutes.
-The patient should feel the soreness and distension immediately.
-The impression tray should be inserted into the mouth witout gagging at thistime.
2.Pressure can be applied by the patient,dental assistant or dentist.
45.
46. MANAGEMENT OF GAG REFLEX IN
PATIENTS
MAKING AN IRREVERSIBLE HYDROCOLLOID IMPRESSION
-A local anaesthetic was incorporated into irreversible hydrocolloid
material for reducing the gag reflex.
-ADVANTAGES:- 1.Controls the flow of anaesthetic agent to sensitize gag
and vomit-reflex areas.
2.Minimizes the risk of hazard and toxicity.
3.It allays apprehension by not introducing secondary items to the
patient’s mouth.
4.It dampens the sensitivity of the entire arch during the impression
making.
5.Technique is simple.
47. Procedure
1.Prepare the patient by stimulating positive attitude towards dental care,allaying
anxiety,and instilling confidence.inform the patient that this hydrocolloid is
specially prepared to eleminate gagging.
2.Instruct the patient in basic breathing and muscle relaxation exercises.
3.Dispense 1 capsule of local anaesthetic solution(1.8ml of 2% lidocaine with 1 part in
1,00,000 epinephrine)to the plastic measuring cylinder and then add water to the
correct volume.
4.Pour the water/anaesthetic mixture into the bowl,then add the measured powder
and mix thoroughly.insert the loaded tray gently in the patient’s mouth and press
until set.
48. SUMMARY OF MANAGEMENT OF
GAGGING PATIENT
Individual assessment
Assess patient’s attitude willingness to
And motivation to tt. -Try tt. And invest time in tt.
-Commit to homework
-accept that the tt. May be prolonged
techniques common to all patients
1. Sympathetic approach
2. Positive attitude
3. Thorough history
4. Reassure patient gagging is a normal response.Many
patients hv very sensitive gag reflex.
The majority of patients can learn to
control gagging but it takes time.
Gagging is nothing to be embarressed
about.Build patient’s self confidence.
49. Explain and demonstrate
stop signal [for ex-raising allow the patient to feel
Hand ] some control
Careful intraoral examination obtain patient’s feedback and
continually re negotiate consent.
Avoid trigger zones
praise patient.
Specific treatment modalities
behavioral relaxation techniques
distraction
suggestion/ hypnosis
systematic desensitization
cognitive behavioural therapy
50. Pharmacological oral
inhalation
intravenous
Combined several techniques may be used together or
in successsion
Simple measures for all don’t overload imp. Tray
patients use quick setting impression materials
ensure efficient aspiration
Miscellaneous akinosi closed mouth technique for
local analgesia of inferior dental nerve.
Treat patient in an upright psition
frequent cessation of the treatment.
51. Prosthodontic
Unable to tolerate impressions distraction technique
relaxation
systemic desensitization
hypnosis
sedation
Unable to wear denture satisfactory dentures
available-’errorless learning’
no satisfactory dentures-systemic
desensitization ,for
eg,training basis and errorless
learning.
acrylic discs may be helpful prior
to provision of training bases.
52. Restorative
Unable to tolrate no short term treatment requirements:
instrumentation,For eg, -hypnosis
examination,scaling, -systemic desensitization for oral
tooth preparation hygiene measure,scaling ,polishing
-encourage regular reviews
-sedation
in urgent need of treatment:
-hypnosis
-sedation