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Sedation for Wisdom Tooth Extractions

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I have a daughter that just reached her twenties. She has two impacted wisdom teeth. One of them hasn’t erupted at all, which probably means it is still in the bone. Is anesthesia necessary for this? I will be honest, the idea of anesthesia completely terrifies me.

Sylvia

Dear Sylvia,

examples of impacted wisdom teeth

I will preface this by saying I have not seen your daughter’s x-rays. Because of that, I do not have many details about her case. That being said, I cannot imagine her case is complicated enough to warrant general anesthesia. At her age, she should be fine with just oral conscious sedation. This is much safer than general anesthesia. It will give her a pain-free/anxiety-free experience during her procedure without the severe complications that can happen with general anesthesia.

At her age, her bone is still relatively pliable. this is because there is not enough cementum accumulation on the roots of her teeth. It would be a rare case where someone her age would need anything more than oral conscious sedation.

I would visit with a sedation dentist for her extractions. Be aware that while she will only be taking a pill to relax her, it is a STRONG  pill. Though she will be conscious, it will relax her so much that she will likely sleep through the appointment. It is important to note that your daughter will need someone to drive her to and from her appointment as well as stay with her until she is lucid and steady on her feet after the procedure. She will be too groggy.

I hope this puts your mind at ease.

This blog is brought to you by Grosse Pointe Cosmetic Dentist Dr. Patel.

High Resistance to Novacain

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I need some advice. I haven’t been to the dentist in a long time. Almost every experience I have had at the dentists has been excruciating. For some reason, my body just doesn’t use the Novocain well. At this point, I just want to get control of my oral health. I think I need five teeth extracted. I do not know how to go about getting this done without feeling like I would rather be dead so any advice would be helpful.

Paula

Dear Paula,

Woman holding her jaw with TMJ pain

I am sorry you have had so many of these bad experiences. The good news is I have a solution. When patients are struggling to get or stay numb during dental care it is because their body is burning off the medication too quickly. Dentists are now realizing there is a connection between this and dental anxiety. The higher the patient’s anxiety in the dental chair the faster they burn off the numbing medication.

Most people have dental anxiety because of a bad experience at the dentist, often stemming from childhood. Then, compound that with all your bad experiences after that and it is even harder for you to get numb. The solution to this is to find a dentist who offers dental sedation options.

My suggestion is for you is to use oral conscious sedation. Though administered by a pill, it is strong enough for you to need someone to drive you to and from your dental appointment as well as stay with you for a few hours until you are lucid and steady on your feet again. Most patients are so relaxed they sleep completely through their dental appointment.

It has the additional benefit of allowing you to get more work done at each appointment than would otherwise be possible. This will allow you to catch up on your dental work faster.

If it does turn out that you have some teeth that cannot be saved, it will be important that you replace them. My suggestion is you get dental implants for any tooth you extract. This is the closest thing to having a healthy, natural tooth again.

This blog is brought to you by Grosse Pointe Woods Cosmetic Dentist Dr. Theodore Hadgis.

 

Antibiotics for a Tooth Infection

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I have a tooth that is hurting me. It’s possible it is infected. I had a root canal treatment but the whole appointment was so distressing that I didn’t have the stomach to go back for the crown part. That is the tooth that is hurting. Is there an antibiotic I can take this time, instead of having to do the whole root canal thing again?

Bruce

Dear Bruce,

Man grabbing the side of his jaw in obvious pain and in need of a dentist

I am sorry for the experience you had. Those type of traumatic dental procedures are what lead to patients developing a dental anxiety. It sounds like that is where you are right now. The bad news is that taking an antibiotic does not heal a tooth infection. What it can do is keep it from spreading further while you take it. However, once the antibiotic finishes, the infection will begin to spread again.

The only way to properly deal with a tooth infection is to physically remove the infected pulp. This can be done through a root canal treatment or a tooth extraction. There is good news, though!

Your next appointment can be done in a way that is both relaxing and pain-free. What you will need though is a sedation dentist. Specifically, look for someone who offers oral conscious sedation (OCR). This is sometimes called sleep dentistry because patients are often so relaxed that they will sleep through the entire appointment. Be aware, it is strong enough that you will need someone to drive you to and from your dental appointment. You will be way too relaxed to drive.

When a root canal treatment fails, the chances of a successful re-treatment go down with each attempt. Because of that, you may be better off seeing a root canal specialist. They are called endodontists. The exception to that would be if you are talking about a front tooth. Very few endodontists care about the aesthetics and even fewer have invested in any significant cosmetic training. If it is a front tooth, you’ll want to see an AACD accredited dentist. These are the best cosmetic dentists in the country. You want someone who can create a beautiful porcelain crown that will blend in perfectly with your adjacent teeth. That is tricky on a front tooth.

Regardless of what type of dentist you choose, make sure they offer oral conscious sedation so you do not have a repeat of your last appointment.

This blog is brought to you by Grosse Pointe Woods Dentist Dr. Theodore Hadgis.

 

Root Canal on a Canine Tooth

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I have a canine tooth that recently had a root canal treatment. The appointment was awful and reinforced all the reasons I avoid the dentist to begin with. A friend told me I am going to need to go back and get a dental crown put on it or the tooth will fracture. I don’t think I can go back. Is this completely necessary?

Pamela

Dear Pamela,

woman smiling with a dentist behind her

I’m going to address the fear you are experiencing first and then we’ll go into the canine tooth with a root canal treatment. You are not alone in feeling uncomfortable at the dentist. Many people struggle with dental anxiety. So I understand your desire to stay away. However, doing so will make things harder for you. May I suggest something that could change your life and allow you to sit in the dental chair without anxiety?

I am going to suggest you see a dentist who offers sedation options. The option I’d like you to try is oral conscious sedation. it is administered with a simple pill. It is so strong that, if you want to, you can even sleep through your appointment. The only inconvenience is the sedation is so strong you will need someone to drive you to and from your appointment.  On the flip side of that, you can get much more work done in one sitting which will allow you to catch up on needed dental work much sooner.

Root Canals on Canine Teeth

If a back tooth has a root canal treatment, a dental crown is necessary to protect it from fracture because of the biting stress. Front teeth, however, have completely different biting stresses. Because of that, a dental crown will actually weaken the tooth. It can even cause it to break off at the gumline.

The only reason for a crown on a front tooth would be if a significant amount of the tooth was gone because of decay. In that case, a crown would be a necessity even if not ideal.

Another reason some people will put a crown on a front tooth that doesn’t need one is for aesthetic reasons. A tooth with a root canal will turn dark. However, you can avoid a crown if your dentist follows the following procedure.

First, they’ll need to clean out the inside of the entire crown of the tooth. They shouldn’t leave any root canal filling materials or cement. Believe it or not, that material is a large part of the darkening. Then, your dentist will need to place a white fiberglass post deep into the root of the tooth. This will help strengthen the tooth and add resistance against biting stresses. Finally, fill the remainder of the space with a white composite material.

This method prevents darkening for several years. When it does begin turning dark, I’d recommend a porcelain veneer done by a skilled cosmetic dentist.

This blog is brought to you by Grosse Pointe Cosmetic Dentist Dr. Theodore Hadgis.

Dentist Can’t Get Me Numb

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I am terrified of going back to the dentist but know I need to.  I had my first tooth infection. I went in to get the root canal treatment and was a bit nervous already. Then the dentist just couldn’t get me numb. He tried six times. By then, I was a mess of tears. He wrote me a prescription pain killer as well as an antibiotic and told me we’d try again in a week.  It’s almost time again and I’m not sure I can go through with this.  Have you seen this happen before? Is there anything that can help?

Marci

Dear Marci,

Woman asleep in dental chair from dental sedation

I am pretty sure I know what happened here. It is something not many dentists have been educated about so I am not surprised that your dentist wasn’t sure what to do, even though there has been at least one journal article on the topic.  It is interesting to me that you said you were a bit nervous to start.  When you have dental anxiety, it has the unfortunate effect of burning off your numbing medication. It’s a vicious circle because you end up in more afraid after that experience, which in turn makes it harder for you to get numb. Fortunately, there is a way to stop the cycle.

The Solution to Dental Anxiety

Depending on what your dentist has available, you may have to switch dentists for your root canal treatment. You need a dentist who offers dental sedation options. In your case, I am going to recommend oral conscious sedation. This will allow you to sleep through your appointment completely pain-free.  You won’t have to sleep if you do not want to, but you will have no anxiety and will feel no pain. It is quite strong so you will need someone to drive you to and from your appointment.

I am sorry you had this experience.  Using this additional tool will change this to a positive experience for you.

This blog is brought to you by Grosse Pointe Woods Dentist Dr. Theodore Hadgis.

 

Scared to Get My Tooth Pulled

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I had a fall which broke my tooth a bit. It feels fine but looks funny with that chip. My sister told me I could get that repaired. Yet, when I went to see the dentist he wants to pull the tooth and give me a partial denture. I’m opposed to this for a few reasons. First, it’s a front tooth. Second, I’m too young for dentures. Third, and this is just being honest, the idea of getting a tooth pulled terrifies me. I’ve never been comfortable in the dental chair though I try to force myself to go at least once every couple of years. Is this my only option? Money isn’t an issue.

Craig

Dear Craig,

before and after dental bonding

I want you to bear in mind that I haven’t examined your tooth, but am inclined to think you need to see a different dentist. From what I’m getting, your tooth is chipped and that is all, right? If that is the case, the solution would be a dental bonding procedure (pictured above). This is a fairly difficult (for the dentist) cosmetic procedure. It may just boil down to your dentist doesn’t know how to do it. However, there is always the alternative of getting a porcelain crown.

Even if there were some more serious underlying issue, such as the tooth suffering enough trauma for the pulp to die, in that case you’d do a root canal treatment with a dental crown. I don’t understand this rush to extract the tooth. However, let’s say for the sake of argument that there is no way for the tooth to be saved. Why then do a removable partial denture when there are much better options available? Did he mention a dental implant or even a dental bridge? The fact that he is suggesting a cheap denture is a sign to me you are not getting top-quality care. You said money wasn’t an issue, so it is not a matter of him knowing you need the cheapest solution.

What I’d like you to do is get a second opinion from one of the dentists listed on the mynewsmile.com website. They can not only handle all your cosmetic dentistry needs, but additionally, they have the cosmetic skills necessary to give you a gorgeous repair that will blend right in with your tooth.

If the Tooth Needs to Be Extracted

Let’s say the worst-case scenario is true and the tooth needs to be extracted. Don’t be embarrassed for being uncomfortable with that. Many patients aren’t exactly counting down the days with joyous anticipation for their next dental appointment. One thing I suggest to patients in situations such as yous is to have the tooth extracted with a dentist who offers oral conscious sedation. This is sometimes dubbed sleep dentistry because you will be so relaxed you can just sleep through the procedure you want. The only downside is you will need someone to drive you to and from your appointment as well as stay with you until you are lucid and steady on your feet again.

Then, when it is time to get your permanent tooth replacement. I highly recommend you get a dental implant. This is the closest thing to a healthy, natural tooth. It’s also surgically implanted into your jawbone so you will not have to worry about anything removable.

This blog is brought to you by Grosse Pointe Woods Dentist Dr. Theodore Hadgis.

My Tooth is Killing Me

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I’ve had a toothache since the quarantine started. Now it is almost unbearable. I’ve heard you can go to the dentist in situations like this, even during the quarantine, but I will be honest and tell you I am absolutely TERRIFIED of dentists. I feel like I’m going to have to go, but is there any way to do this at a hospital where they can knock me out for any procedures?

Todd G.

Dear Todd,

Man grabbing the side of his jaw in obvious pain and in need of a dentist

You are correct that in cases like yours, where you need urgent care, you are able to see a dentist. A hospital isn’t a good solution for you, though. They will not treat dental issues. At best, they’ll give you a $100 ibuprofen and tell you to see a dentist. However, I do have some good news for you.

First, you should know that you aren’t alone in your struggle with the dental chair. Many patients have a phobia of the dentist. Often, this springs from a traumatic experience as a child. Second, and this is the best bit, there are dentists who understand this, are compassionate, and have a solution.

I’m guessing, based on your question, that you don’t have a regular family dentist. I’d like you to do an internet search using the term sedation dentist. ‘for patients with high dental anxiety, such as yourself, I usually recommend looking for a dentist who offers oral conscious sedation. This is administered by swallowing a pill and will absolutely, completely relax you.

In fact, it is so strong you will need someone to drive you to and from your appointment as well as stay with you for a few hours after the appointment until you are lucid. Most people sleep through their appointments. It will give you a stress-free/pain-free appointment.

I say that now because I want you to understand that a tooth infection is serious and that you can get this treated in a way that you won’t have anxiety. When left untreated, they can spread to your heart, lungs, or even your brain. Those turn life-threatening quickly. It sounds crazy, especially given how treatable they are, but people still die from tooth infections in the 21st century.

Treating a Tooth Infection

Unlike other infections, an antibiotic alone won’t “heal” the infection. This is because the pulp in the tooth dies and the medication can no longer reach the root of the infection. A dentist will have to get in there and physically remove the infected tissue. This is typically done through a root canal treatment. If a tooth isn’t saveable, then you will need to have the tooth extracted. This is another good reason to get this dealt with sooner rather than later.

If you lose the tooth, you will want to replace it. Otherwise, aside from the aesthetic issues on your smile, the other teeth will shift or tip into the empty space. This will throw off your bite and could possibly lead to painful TMJ issues. The best tooth replacement is a dental implant. This will be like having a healthy, natural tooth again.

This blog is brought to you by Grosse Pointe Woods Cosmetic Dentist Dr. Theodore Hadgis.

Novocain Doesn’t Work for Me

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I don’t know what to do. I have some kind of resistance to Novocain. Even after several shots I can feel everything. This has caused quite a few problems as you can imagine. I have a lot of work to catch up on and now I am wondering if the only way to get it handled is with hospitalization under anesthesia. I’ll do that if I have to but the expense will be astronomical. My dentist can’t figure it out. I’m just throwing a Hail Mary here and hoping you’ve encountered it and can give me another option.

Peter

Dear Peter,

Man grabbing the side of his jaw in obvious pain and in need of a dentist

Well, I have good news and great news for you. Yes, I have encountered this. I even have a solution for you. I’m not surprised your dentist didn’t know the solution. Though the cause is starting to become more well-known, there isn’t a ton of literature on it.

Much of the time it is caused by some form of dental anxiety. You may not even have been aware of it the first time. Then, when the medicine didn’t work, it would naturally grow higher. Even the bravest people can have some anxiety in the dental chair. Often that results from a difficult experience with the dentist as a child.

Physiologically, we’ve learned that when a patient is anxious, the metabolism kicks up. This burns off the Novocain the dentist is using to numb you. Hence, the pain during your appointments.

The Solution When You Can’t Get Numb

I want you to find a dentist who offers sedation options. For someone in your situation, I usually recommend oral conscious sedation. This is administered by a pill and completely relaxes you. It is so strong, you will need someone to drive you to and from your appointment as well as stay with you for a few hours when it is completed until you are lucid again.

This is different from anesthesia in a couple of ways. First, it costs significantly less. Second, you aren’t “out”. While most patients are so relaxed they sleep through the procedure, that is up to you. You are able to communicate if you want to. It’s up to you.

There is a side benefit to this type of sedation. It allows your dentist to get more work done in each sitting, enabling you to catch up with your dental work much faster.

This blog is brought to you by Grosse Pointe Dentist Dr. Theodore Hadgis.

Disastrous Sinus Perforation After Extraction

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I’ve had one disaster after another with a tooth extraction. First, they perforated the sinus but didn’t tell me about it until the following day. Then I developed a fever. They called in an antibiotic, but I only got worse. I insisted on coming in. At that appointment, they removed some bone from the area and prescribed me an even stronger antibiotic. I still got worse and went to see an ENT as a result, they said the hole has closed and I should feel fine. Of course I should feel fine. They just blew me off. How they can do that when I still have a fever and I can’t eat, I have no idea. I asked for a copy of my medical records because I’m going to have to go somewhere to get help. I don’t think I can do this much longer. I’m losing a lot of work and pay. Oh, one other thing. When I looked at my informed consent sheet it wasn’t signed. They just have a note that says I couldn’t sign it because I was sedated. Is that when they chose to tell me about the risks to this do you think? I never heard about the possibility of them perforating the sinus cavity.

Penny

Dear Penny,

Man grabbing the side of his jaw in obvious pain and in need of a dentist

I’m going to say first that I am appalled by the care you’ve gotten. First, you had a dentist who blew it on several levels and now you’re dealing with an ENT who seems to not care if you’re in pain. I want you to call your medical doctor. Your dentist has you on the wrong antibiotic. You should not still have a fever at this point. Plus, especially if the ENT is right and the hole is closed, you should be feeling much better. Make sure you tell him or her everything they have you on and how this came about.
I’m glad you are going to see another ENT. Ask your doctor to recommend one to you based on everything you’ve told him.

I’m also going to say you have a good case to get your dentist to pay for the remainder of your treatment as well as any money you’ve lost for work because of the perforation and ensuing poor treatment on his behalf.

Here is a start:

  • He didn’t get informed consent. Even if you’d had signed the document it wouldn’t count. You can’t give consent while you are under dental sedation. Because of that, good sedation dentists go over everything with you before the day of the actual procedure.
  • A bad extraction, resulting in a perforated sinus cavity.
  • Leaving bone fragments in the cavity.
  • Not informing you right away and letting you know what to avoid in the meantime.
  • Not beginning treatment of the perforated sinus until the next day when they finally told you about it.
  • Not giving you the correct antibiotic.

If he gives you a hard time, mention getting a lawyer. That should cause him to call his insurance. Given the circumstances, they’ll tell him to pay for your care. It will cost him a lot less than a lawsuit.

Once you’re healed, you’ll need to look into getting that tooth replaced. I’m going to suggest a dental implant. It is the best tooth replacement available. However, do your research on the dentist who does your procedure. It’s very advanced and requires a great deal of post-doctoral training.

This blog is brought to you by Grosse Pointe Woods Dentist Dr. Theodore Hadgis.

Dentist or Oral Surgeon to Remove Teeth?

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I haven’t been to the dentist in years, which has left me with many broken and decaying teeth. I’m thinking of getting them removed and then getting dentures. Should I go to an oral surgeon or a dentist first for that?

Bruce

Dear Bruce,

Woman asleep in dental chair from dental sedation

If you’re getting dentures, it is always best to go to a dentist who does the extractions and the dentures. This will eliminate any communication issues. Pre-denture surgery isn’t complicated, but you want a dentist who does it normally and not as a special case for you. You can find that out by calling their office and asking them how they normally handle someone who wants full dentures.

You have dental anxiety. That’s not news to you, I’m sure. However, to make this less traumatic for you, I’m going to suggest in addition to what I mentioned above that you also look for a dentist who does sleep dentistry. This way there will be no anxiety and no pain for you.

Consider Sedation Dentistry before Giving Up on Your Teeth

There are consequences to removing all your teeth for complete removable dentures. The most serious is the inevitability of facial collapse. I’m going to recommend, before you settle on dentures, that you first try to save as many teeth as possible. This will be a huge benefit to you in the long run.

cu sil partial dentureOne thing you can do is get this Cu Sil Partial denture. It leaves room for your natural teeth, then if a tooth happens to need extraction at a later date it is fairly easy to pop a new false tooth in there.

The more teeth you save, the better.

You’ll find having dental sedation allows you to get more work done in one sitting. And, like the denture preparation extractions, it will allow you to have it done without anxiety or pain.

Many patients who have suffered from dental anxiety their whole lives, find this changes the way they view the dentist. For the first time, they’re able to get the regular oral health care they need.

This blog is brought to you by Grosse Pointe Woods Dentist Dr. Theodore Hadgis.