Posts for: July, 2018
Did you know 50% of people admit to some form of anxiety visiting the dentist, with roughly 1 in 6 avoiding dental care altogether because of it? To ease anxiety dentistry has developed sedation methods that help patients relax during dental treatment.
Many can achieve relaxation with an oral sedative taken about an hour before a visit. Some with acute anxiety, though, may need deeper sedation through an intravenous (IV) injection of medication. Unlike general anesthesia which achieves complete unconsciousness to block pain, IV sedation reduces consciousness to a controllable level. Patients aren’t so much “asleep” as in a “semi-awake” state that’s safe and effective for reducing anxiety.
While there are a variety of IV medications, the most popular for dental offices are the benzodiazepines, most often Midazolam (Versed). Benzodiazepines act quickly and wear off faster than similar drugs, and have a good amnesic effect (you won’t recall details while under its influence). While relatively safe, they shouldn’t be used with individuals with poor liver function because of their adverse interaction with liver enzymes.
Other drugs or substances are often used in conjunction with IV sedation. Nitrous oxide (“laughing gas”) may be introduced initially to help with anxiety over the IV needle stick. Sometimes pain-reducing drugs like Fentanyl may be added to the IV solution to boost the sedative effect and to reduce the amount of the main drug.
If we recommend IV sedation for your dental treatment, there are some things you should do to help the procedure go smoothly and safely. Because the after effects of sedation may impair your driving ability, be sure you have someone with you to take you home. Don’t eat or drink anything after midnight the day before your appointment, and consult with both your physician and dentist about taking any prescription medication beforehand. Wear loose, comfortable clothing and don’t wear contact lenses, oral appliances like dentures or retainers, watches or other jewelry.
Our top priority is safety — we follow strict standards and protocols regarding IV sedation and you’ll be carefully monitored before, during and after your procedure. Performed with the utmost care, IV sedation could make your next dental procedure pleasant and uneventful, and impact your oral health for the better.
A few days before the Oscars, Vanity Fair magazine asked Academy Awards host Neil Patrick Harris to name his most treasured possession. Was it his Tony award statuette for best leading actor in a musical? His star on the Hollywood Walk of Fame? The stethoscope he wore while playing teenaged doctor Doogie Howser on TV? No, as it turns out, the 41-year-old actor’s most treasured possession is… his wisdom teeth. Yes, you read that correctly. “Oddly, I still have my four wisdom teeth,” Harris said. “I refuse to let them go or I’ll lose my wise parts.”
How odd is it for a 41-year-old to have wisdom teeth? Actually, not that odd at all. While it is true that wisdom teeth are often removed, there’s no one-size-fits-all approach to this. It all depends on whether they are causing problems now, or are likely to cause problems in the future.
The trouble wisdom teeth cause is related to the fact that they are the last molars to come in, and that molars are large in size. By the time wisdom teeth appear between the ages of 17 and 21, there often is not enough room for them in the jaw. Sometimes it’s because you may have inherited a jaw size that’s too small for your tooth size; and generally speaking, the size of the human jaw has evolved to become smaller over time.
If room is lacking, the adjacent molar (that came in earlier) can interfere with the path of eruption — causing the wisdom tooth to come in at an odd angle. The wisdom tooth can hit up against that other tooth, possibly causing pain or damaging the adjacent tooth. This is known as “impaction.” Sometimes the wisdom tooth breaks only partway through the gum tissue, leaving a space beneath the gum line that’s almost impossible to clean, causing infection. A serious oral infection can jeopardize the survival of teeth, and even spread to other parts of the body.
If a wisdom tooth is impacted, will you know it? Not necessarily. A tooth can be impacted without causing pain. But we can see the position of your wisdom teeth on a dental x-ray and help you make an informed decision as to whether they should stay or go. If removal is the best course of action, rest assured that this procedure is completely routine and that your comfort and safety is our highest priority. If there is no great risk to keeping them, as Neil Patrick Harris has done, we can simply continue to monitor their condition at your regular dental checkups. It will be particularly important to make sure you are reaching those teeth with your brush and floss, and that you keep to your schedule of regular professional cleanings at the dental office. All healthy teeth are indeed worth treasuring.
If you would like more information about wisdom teeth, please contact us or schedule an appointment for a consultation. You can learn more by reading the Dear Doctor magazine articles “Wisdom Teeth” and “Removing Wisdom Teeth.”
When your braces finally come off, you’ll hopefully be astounded by what you see –once-crooked teeth replaced by a more attractive smile. But you might also see something you didn’t expect: noticeable white spots on some of your teeth.
These spots called white spot lesions (WSLs) appear lighter than the surrounding tooth enamel due to mineral loss just beneath the surface. This happens because bacterial or food acids have contacted the enamel surface for too long and dissolved the underlying calcium and other minerals. This results in a small discolored and chalky-like area in the enamel.
WSLs are common during orthodontics because wires and brackets create hard to reach places for brushing and flossing, which can accumulate bacterial plaque. The bacteria produce acid, which weakens the enamel at these places. The tiny white spots that result are more than just unattractive—they can become entry points into the tooth for decay. That’s why they should be dealt with as soon as possible—and preferably before they’re created.
To that end, you’ll need to do as thorough a job as possible brushing and flossing while undergoing orthodontic treatment. To improve your thoroughness try using an interproximal toothbrush that can maneuver more closely around braces hardware than a regular brush. You can also improve your flossing with a floss threader or a water flosser, a device that sprays pressurized water to loosen and flush away plaque.
If you do develop WSLs, there are some things we can do to treat them. We can attempt to re-mineralize the affected enamel with the help of topical fluoride (either pastes or gels for home use or with an office application) or a re-mineralizing agent. We can also use techniques like microabrasion, which restores damaged areas beneath the surface, or inject a liquid, tooth-colored resin beneath the WSL’s surface to improve appearance and protect against decay.
If while wearing braces you do notice any white spots or other tooth discoloration let your dentist or orthodontist know right away. The sooner your dental providers can begin dealing with potential WSLs the better your chances for a healthy and beautiful outcome after braces.
If you would like more information on oral hygiene while wearing braces, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “White Spots on Teeth During Orthodontic Treatment.”