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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.

Cavity on a Veneered Tooth

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I have a tooth that is covered with a porcelain veneer but now has a cavity on it. To treat the cavity, my dentist wants remove the porcelain veneer, treat the cavity, and then replace the veneer with a porcelain crown. I’m not too keen on this idea. Is this the standard operating procedure?

Jim

Dear Jim,

A single porcelain veneer being placed on a tooth

 

I wish I had more information about your situation. The first thing I would want to know is how large your cavity is. Truthfully, a cavity would have to be significantly large in order to make a dental crown necessary. Is this the dentist that did your porcelain veneers or a different dentist? It could be that this dentist doesn’t feel comfortable with porcelain veneers and is leaning on his knowledge of crowns.

It is extraordinarily hard to match a single crown to a porcelain veneer. Very few cosmetic dentists can do it well. Because of that, I am going to recommend you get a second opinion on this tooth. It would be best to get your second opinion from someone who does a LOT of cosmetic dental work. Don’t tell him or her what your dentist suggested. You want an unbiased opinion.

If it turns out you do need a dental crown, make sure whoever does the procedure tries in your crown with a temporary try-in paste and allows you to look at it in a variety of lighting. If it doesn’t match perfectly, they need to be willing to send it back until they get it right. If they do not agree to that, find a different dentist to do the procedure.

This blog is brought to you by Grosse Pointe Woods 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.

 

Crowning My Teeth For a Headache?

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I mentioned to my dentist I’d been having pretty bad headaches. He instantly started moving my jaw around and declared that I have TMJ disorder. He wants to crown all my teeth. He says it will solve my headaches but at quite a cost! I’m not sure the $30K is worth it. Is there no other solution? I see that you treat TMJ as well, but seem to have other treatments.

Kimberly

Dear Kimberly,

Illustration of how TMJ is affected by neuromuscular issues

There are many causes and solutions for TMJ Disorder

 

I am glad you wrote. What your dentist is suggesting is known as a full-mouth reconstruction. Not only is it reserved for the most serious of TMJ cases, but it also is an immensely advanced procedure. If you were in need of that, you would not have had to tell him about your headaches. He would have noticed your bite was off. If he didn’t, then he is not the one to do the procedure even if it was necessary.

Before you do anything, I would like you to see a dentist who has significant post-doctoral training in TMJ Disorder. In order to give you some idea of the type of dentist you would need, I would like you to look at Dr. Hadgis’ TMJ Specialist page.  The best dentists will begin with the most conservative treatment. Only if those show no signs of helping would he or she delve into more invasive treatments.  Your dentist is suggesting one of the most invasive treatments from the very beginning.

If it turns out you do need a full-mouth reconstruction, which I highly doubt, I want you to make sure that your dentist not only has the same LVI training that Dr. Hadgis does, but that (also like Dr. Hadgis) he is AACD accredited. These are the top cosmetic dentists in the world. This way, not only will you have the correct bite, but a beautiful smile to go right along with it.

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

Dental Bonding Problems

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I had some dental bonding done a couple of weeks ago. The intent was to have the some chips and wear on the teeth replaced. My dentist is the one who suggested it. I agreed because I have always wanted to have a pretty smile. The dental bonding made the teeth look way more bulky than they were. It almost look like I had halves of white chicklet gum stuck on them. They were obviously fake. They even made it hard for me to talk.  I asked my dentist to take them off. She did, but now the teeth are bumpy and the colors are uneven. When I mentioned that, she told me that my teeth were like that before I just did not recognize them because the bonding made them look even. I know what my teeth looked like. Even though they were ugly, they were THAT ugly. What do you recommend I do?

Elle

Dear Elle,

My guess is you have a family dentist who was trying to learn a new skill. Unfortunately, she did it at your expense. Dental bonding should not ever add to the bulk of the tooth. As you can tell, it can interfere with speech patterns. It can also put the tooth at greater risk for decay because food and other bacteria can get trapped in the nooks created when there is too much structure. All dental bonding should do is replace the lost structure so it looks perfectly natural. Directly below, I have an image of a chipped tooth repaired with dental bonding. There is no difference in the two front teeth. their color and shape are similar. Not carbon copies, which would also look fake. We want similar.

before and after dental bonding

Another mistake she made is the bonding removal. Maybe she told you this would be reversible if you didn’t like it as a selling point. However, as she is sanding or grinding off the composite bonding, how does she know where that ends and your natural tooth enamel begins? It is nearly impossible. I don’t know if she will be willing to give you a refund so you can get this done correctly, but if you have a clear image of what your teeth looked like before her work, that might give you some leverage.

You will want to see an expert cosmetic dentist to get this fixed. While you can go with dental bonding again if you want, my suggestion would be to get porcelain veneers instead. Bonding is good for small repairs. It sounds like your dentist did the entire tooth. If that is the case, porcelain veneers are more durable and will last you a few decades as opposed to the three to five years you’d get out of bonding.  Look for an AACD accredited dentist. They are the top cosmetic dentists in the country.

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

Over Shiny Fake Porcelain Veneers

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I recently had porcelain veneers done. I wanted them white. At first my dentist argued with me saying it would not look natural but I knew what I wanted and suggested. When they were put on, I realized they do look fake. They are overly shiny and bright. They almost look like pieces of chicklet gum. When I talked to my dentist about changing them, he said he told me this would happen and I’d have to pay again. I’m willing to, but I’m also confused because I have seen pictures of porcelain veneers that are really white that look perfectly natural. Why are mine so fake?

Penny

Dear Penny,

beautifully veneers teeth

I’ve got some good news for you, but I am going to tell you the bad news first. While it is your dentist’s fault that they do not look natural, it will be nearly impossible for you to get a refund. You can ask, but he said they wouldn’t look natural. You may luck out and get one, so it is always worth a try.

Let’s go over what went wrong. Look at the image above. Notice they have ridges as well as varying levels of opacity and translucency. It takes an expert cosmetic dentist to do this well. My guess is your porcelain veneers look flat. That adds to their over shiny nature. It’s also why they look fake. Believe it or not, one of the teeth in the images is fake. You can’t tell this because of the skill of the dentist who did the work.

Now for that good news that you are likely desperate for at this point. You can get the beautiful smile you want. You won’t be able to get it done with this dentist, though. Cosmetic dentistry is not a recognized specialty. It is up to the dentist whether and how much training they get. There are dentists who invest in a significant amount of training. The easiest way to find one of them is to get an AACD accredited dentist. These dentists are the top cosmetic dentists in the country.

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

Gums Inflammed After Getting Porcelain Veneers

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I need some advice. I had four porcelain veneers placed not too long ago. Since having them bonded, my gums have been very inflamed. I’ve gone back to get some help from my dentist but they just accused me of babying my teeth and not brushing adequately. I have to admit, I found that insulting. I take care of my teeth and have never had problems with my gums my entire life. Why would I stop taking care of them after investing in improving their appearance? At my last follow-up appointment, the dentist did remove some excess cement that was caught there. My dentist said that is standard. I was hoping that was the cause of my inflammation. While it did help, it didn’t solve the issue. What do I go from here?

Madilyn

Dear Madilyn,

A single porcelain veneer being placed on a tooth

 

I do not blame you for feeling insulted by your dentist’s response to your concerns. Most cosmetic dentists find that patients take better care of their teeth after a smile makeover. They are proud of their new smile and want to keep it in top-notch shape. Like you, I doubt that you are the problem.

Possible Causes of Gum Inflammation

An example of inflammed gums from porcelain veneers.

Above is a picture of two lateral incisors with porcelain veneers that have inflammed gums. If this dentist were trying to become accredited from the American Academy of Cosmetic Dentistry, this case would have kept him from acheiving that goal.  A healthy result for the patient is a minimal expectation.

One of the leading causes of gum irritation and inflammation is not cleaning off all the excess cement. It is informative to me that you still had excess bonding cement at a follow-up appointment. Dentists who do a lot of porcelain veneers have a system to keep this from happening. They will tack on the veneer by curing the cement in the middle. Then they will clean off the excess cement while it is still soft.  Even though the dentist removed some excess cement at your follow up does not mean he was thorough and got all of it.

A second possible cause of inflammed gums is some unevenness where the veneers meet the teeth. This can cause bacteria to get trapped between the veneers and the gums leading to both inflammation and decay.

I am going to suggest you see an expert cosmetic dentist and have them look at your veneers and gums to make an evaluation as to what is going on. If it is necessary that they be replaced, he can help you secure a refund. Then, I suggest you go to that expert to have them redone properly.

So, how will you go about finding an expert cosmetic dentist? My suggestion is you go to aacd.com and use their “Find a Cosmetic Dentist” link. Make sure you put a checkmark indicating you are looking for an AACD accredited dentist. These are the best cosmetic dentists in the country.

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

 

 

Dentist Wants to Do a Full-Mouth Reconstruction to Whiten Her Teeth

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I have two dental veneers and one dental crown. They’re all showing their age and my teeth are not very white, so my dentist suggested we do crowns on all the upper and lower teeth in order to get the whole smile to look the same instead of piecemeal. Is it okay to just do crowns on the teeth that need them or does everything have to be done in order for them all to look white and match?

Amanda

Dear Amanda,

woman with a beautiful smile

It takes a skilled cosmetic dentist to create a beautiful smile.

Please don’t let this dentist anywhere near your mouth. Crowning all your upper and lower teeth is called a full-mouth reconstruction. It is one of the most advanced cases any dentist can do. When not done properly, it can destroy your bite and lead to a lifetime of pain.

This type of procedure is usually done as a last resort for people who have worn down their teeth to nubs or have serious TMJ problems. Even if this was you, I would not suggest this dentist as the one to do it. You would need a dentist who has extensive post-doctoral training in restorative dentistry. I have serious doubts that he has this.

Also, if I understand you correctly, his justification for this is that your teeth need to be whiter and match? This can be done without taking such drastic measures that both grind down your healthy tooth structure and put you at great risk to the health and function of your bite.

How to Get the Smile You Want

I am going to tell you upfront that you are going to need to see a different dentist in order to get a beautiful natural-looking smile. If your dentist needs to cover all your teeth in order to make them match, then he is not a skilled cosmetic dentist. You will be much better served elsewhere.

My suggestion is you find a dentist who is AACD accredited. These are the best cosmetic dentists in the country with proven skill and artistry. Any one of them can give you a stunning smile. I can tell you what they will likely recommend.

First, you will want to whiten your teeth. This will improve the youthful look and color of the teeth that do not need work. Then, the two teeth that have the veneers can be replaced with porcelain veneers. There is no reason to crown those teeth and reduce their structure. The tooth that already has a dental crown will have to be replaced with a crown.

This blog is brought to you by Grosse Pointe Woods 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.

 

Dentists Are Exacerbatting her TMJ Disorder and It’s Serious

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I have had massive problems after seeing two dentists. Each time, rather than helping me they’ve made the situation worse. I am now to the point where I am not sure who to trust and how to fix this. I grind my teeth. They ended up ground down to nubs so my dentist placed a crown on every tooth. That is when things started going downhill. He didn’t do it right and my jaw ended up crooked and slanted, with one side higher than the other. I started having serious pain every day and massive headaches. I went to see another dentist and he told me I’d developed TMJ Disorder. He gave me an orthotic device to wear and ended up opening my bite up too much. He didn’t address the slant in my jaw and now my crowns are ground down the way my teeth were. Is there any hope to getting this fixed?  Someone told me to see a prosthodontist, but I heard they don’t know how to make their crowns pretty. Is it too much to ask to have a pain-free functioning smile that also looks great?

Penelope

Dear Penelope,

Woman holding her jaw with TMJ pain

You certainly haven’t had the best dentists in this situation. You’d think they would at least not make it worse. As you can tell, not all dentists invest in the post-doctoral training necessary to handle advanced classes such as yours. When all your teeth are ground down to nubs, the solution is to crown them, a procedure known as a full-mouth reconstruction. While he knew what procedure to do, he obviously didn’t have the expertise to do it.

You are now dealing with serious TMJ Disorder and will need a dentist who knows how to reconstruct your bite to its proper position. While there isn’t a recognized specialty in TMJ, there are some post-doctoral institutions who have great training programs in learning to skillfully diagnose and treat this problem.

I would look for a dentist who has invested in training with one or more of the following:

  • The Dawson Academy
  • The Spear Institute
  • The Las Vegas Institute for Advanced Dental Studies
  • The Kois Center

Dr. Hadgis not only has training from the Las Vegas Institute for Advanced Dental Studies, but he is also now a Fellow, which requires extra training and skill. This is the type of advanced TMJ dentist you need to help you with your full mouth reconstruction.

Getting a Functional AND Beautiful Smile

You don’t need to choose between form and function. Though a tall order, it is possible to find a dentist with TMJ and cosmetic dentistry training. My suggestion would be to look for an AACD accredited dentist then look to see what their training is in reconstructive dentistry.

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