Need Sedation Dentistry for Routine Care. Nitrous Isn’t Enough

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I need sedation for routine dental care, and now my new dentist says I need a root canal and four fillings. They gave me nitrous oxide for this past visit, but that’s all the dentist offers, and I will need more potent medication for a root canal and fillings. During Covid, my anxiety over other things increased my dental phobia. Last week I had my first dental appointment since 2019. Unfortunately, I was so concerned about seeing a dentist that I didn’t ask about the kinds of sedation the dentist offers. I can’t get through a root canal on nitrous alone. Should I ask the dentist for something stronger or switch to another dentist? Thank you. Wesley

Wesley,

Thank you for contacting Dentistry by Brooksher in Baton Rouge with your sedation dentistry question. Millions of patients have dental anxiety or phobia and want sedation for routine dental care.

Can You Ask Your Dentist to Increase the Sedation Level?

If you want to increase your sedation level for non-routine dental procedures, you can ask a dentist what levels of sedation they provide. Dentists who only offer nitrous oxide must have moderate-sedation training before administering oral conscious sedation.

According to the American Dental Association (ADA), a dentist must complete the following training to provide patients with moderate sedation:

  • A comprehensive moderate sedation training program that meets the ADA Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students, or
  • An advanced education program accredited by the Commission on Dental Accreditation that includes comprehensive and appropriate training to administer and manage moderate sedation according to ADA guidelines, and
  • Current Basic Life Support for Healthcare Providers certification, and
  • Current Advanced Cardiac Life Support (ACLS or equivalent) certification, or
  • An appropriate dental sedation/anesthesia emergency management course that matches the ACLS recertification requirements cycle

Schedule a Sedation Dentistry Consultation

Unfortunately, if a dentist only offers nitrous oxide and that is not enough for your anxiety level, you must find another dentist with training in moderate sedation. We recommend scheduling consultations with at least two dentists before you select a provider. The benefits of consultations include:

  • Getting acquainted with the dentist
  • Experiencing the office environment
  • Explaining your dental anxiety and triggers
  • Confirming that the dentist can meet your sedation requirements
  • Reviewing your dental history and discussing your treatment options

Best wishes, Wesley, for successful consultations and sedation care that allows you to relax and restore your oral health.

Baton Rouge dentist Dr. Steven Brooksher sponsors this post. Read about his education and training, and learn what he does to provide some of the best dental care in Baton Rouge.

I Have a Hole in My Tooth and It Smells

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I have a hole up an upper molar tooth. I looked at a tooth chart online, and it is tooth #13, a second premolar. The tooth smells worse than it hurts, but I wonder if I can fill it or pull it. I have a lot of anxiety about medical and dental appointments. Even though I can expect some pain, it’s easier for me to do it myself than have someone else invading my mouth. Is the hole a cavity I can fill with something from the drugstore, or will I need to pull it? Thank you. Marv

Marv,

Thank you for contacting Dr. Brooksher’s office. He would need to examine and x-ray your tooth to determine the cause of the hole and recommend treatment.

Can You Fill a Hole in Your Tooth?

You should not attempt to fill a hole in your tooth. Your efforts will be temporary and may make the tooth worse. Also, if the tooth has a foul odor, it may be infected even if you do not feel pain.

Drugstore-bought fillings are temporary. Even if you try to fill your tooth with filling material sold in drugstores, it will temporarily fix your tooth.

Tooth decay may be the reason for a hole in your tooth. Without removing the infection, it can spread to other teeth or your bone.

Filling a savable tooth is better than removing it. Although filling your tooth won’t work, pulling creates more concerns. You may damage other teeth while pulling the one with a hole. Removing the tooth will cause nearby teeth to shift. Misalignment issues affect your smile and digestion. In the future, you may need braces to correct the misalignment.

How Can You Save a Tooth with a Hole in It?

A dentist can use root canal treatment to save a tooth with a hole. A gentle dentist can explain sedation options to help you relax during the procedure. You will not feel anything throughout treatment, including the numbing injections.

What happens during root canal treatment?

A hammock on the beach for information on relaxing with dental sedation when you have a hole in your tooth

Sedation relaxes you through dental procedures

A dentist will remove the decay and any infection and sanitize it. Afterward, the dentist will fill the tooth with a dental filler material. You may need a dental crown or a composite filling to protect the tooth.

We recommend looking for a gentle dentist who offers sedation. The dentist will explain what to expect from your treatment options. You can start with an exam, which will be comfortable and painless.

 

Dr. Steven Brooksher, a Baton Rouge accredited cosmetic dentist, sponsors this post. Request a consultation with Dr. Brooksher today.

 

How Many Bite Adjustments Before Dental Crowns Crack?

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Mature man sitting on a couch with chin resting on his folded hands, portraying dental crown bite adjustment problemsHow many times can my dentist try to fix my bite before the crowns crack? I got six zirconia crowns in August, and my bite is still off. My dentist sent two crowns back, shaved the others, and still can’t get it right. Why is my bite still off? The situation is so stressful that I have begun chewing my tongue, which I have never done in my life. I cannot imagine needing new crowns. I don’t think I can take it emotionally. What is my dentist doing wrong? Thanks. Brad from Arlington, TX

Brad,

Thank you for contacting Dr. Brooksher’s office. We understand your frustration about your new dental crowns and an uncomfortable bite. Dr. Brooksher would need to examine your crowns to determine why your bite is off, but we will address your concerns.

Why Can’t Your Dentist Adjust Your Bite?

If a dentist cannot adjust your bite with new crowns, it could be due to a lack of training in occlusion and bite. A dentist must get post-graduate training to understand how to achieve harmony with your bite. Otherwise, the disruption can cause symptoms associated with TMJ disorder, including jaw pain or stiffness, neck pain, earaches, and headaches.

We recommend getting a second opinion because we are concerned that your dentist does not know how to correct your bite. Look for a dentist with advanced occlusion and bite training from a post-graduate institute, such as these:

  • The L.D. Pankey Institute in Florida
  • The Dawson Academy in Florida
  • Spear Education in Arizona

You can do a Google search for dentists in your city with occlusal and bite training or use the name of one of the institutes listed above when you search. It is not surprising that your situation is causing you to develop the habit of chewing your tongue.

Sedation for New Dental Crowns

A dentist will offer sedation based on your level of anxiety if you need new dental crowns. Explain how the concerns with the crowns have affected you, and your new cosmetic dentist will recommend sedation options to help you relax during treatment.

Dr. Steven Brooksher, a Baton Rouge accredited cosmetic dentist and founding member of the L.D. Pankey Alumni Study Club sponsors this post.

Should a Dentist Repair a Gold Onlay with Silver Filling?

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I’ve had a gold onlay for one of my molars for about 20 years. It is wearing out. My dentist wants to save as much gold as possible and fill the damaged portion with a silver filling. I don’t like amalgam. White fillings look better, and I’m into holistic care anyway. Why would he even suggest silver? I am already anxious, but this treatment recommendation is making things worse. Thanks. F. Turner  – San Jose

Dear F. Turner,

Thank you for your question. Dr. Brooksher would need to examine your tooth and onlay to determine the best way to preserve your tooth.

What Is a Gold Onlay?

A gold onlay is a custom tooth restoration that covers one or more cusps or points of a tooth. Unlike a dental crown, it does not cover the entire tooth. Did your dentist explain why he does not want to use composite in the tooth?

Should a Dentist Repair a Gold Onlay with Silver Filling?

Photo of woman sitting back in a dental chair with her eyes closed; for information on Baton Rouge sedation dentistry during tooth extraction.

Sedation can help you relax and get the dental care you need

Repairing the tooth with white composite filling is preferable to amalgam (often referred to as “silver”). If your dentist uses amalgam, two dissimilar metals would be in the same tooth, creating a slight electric current that could cause the amalgam to corrode faster than usual. Also, the gold will absorb some of the mercury from the amalgam.

A dentist who recommends amalgam might be uncomfortable placing composite fillings. Insisting on having composite fillings from the dentist may give you an undesirable result that needs to be replaced.

If you want composite fillings, find a cosmetic dentist who regularly uses them on back teeth. Call the office and ask if the dentist does many silver fillings. If the office representative says that the dentist does very few of them or does not use them, it is likely that the dentist is comfortable placing composite fillings on back teeth.

If your dentist is not answering your questions to your satisfaction, look for a skilled cosmetic dentist and request an exam. Tell the dentist about your anxiety and ask about sedation options.

 

Dr. Steven Brooksher, an accredited cosmetic dentist in Baton Rouge, sponsors this post.

Still Looking for a Dentist to Respect My Allergies and Reactions

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I have a lot of autoimmune issues going on, in addition to allergies. Joint pain is a big concern for me, and I notice that it worsens when I am exposed to certain chemicals. I went to a different state to get some thorough testing done and found out everything I am allergic to or have a chemical sensitivity to. I have cleaned my house from top to bottom and removed everything I reasonably could that is a trigger for my symptoms.

Now I am trying to address environmental issues and anything else that could affect me. Last night I looked at my schedule and saw that my 6-month dental checkup is due in late October. My dentist isn’t into the natural thing, so I am wondering about any dental treatment, the materials used in my mouth, and what kind of reaction it might be causing. I am not really interested in trying my dentist out again to figure out how I react and what I am reacting to. I am just going to start fresh and find a dentist who maybe is more up on treating patients with chemical sensitivities or allergies. I am not sure what I am looking for, but I did notice your site and the page for holistic dentistry. Is this a common specialty so that I could find a holistic dentist, maybe within 20 miles or so of my home? I have started searching already and didn’t get good results. I am becoming anxious about getting the care I need and wonder how if I can ever relax again at a dental appointment. Thanks. Reagan from NJ

Photo of a young woman relaxing in a hammock that is tied to palm trees on the beach; for information on Baton Rouge sedation dentistry from Dentistry by Brooksher.

Sedation dentistry creates relaxing experiences

Reagan – Holistic dentistry is not an official specialty that is recognized by the American Dental Association. There are dentists who avoid metal materials or who use biocompatible dental materials.

Do an Internet search for “holistic dentist” or “biological dentist” to find one in your area who will look for ways to give you dental treatment to which you are least sensitive. Some dentists recommend allergy testing to help identify your sensitivities.

Please do not be discouraged if you cannot find a holistic dentist within 20 miles of your residence. You may find a nearby dentist who is willing to work with you and, as much as possible, avoid materials that cause a reaction. Be patient with your search. You can also consider scheduling consultations with a few dentists who seem agreeable to treating you. Find out what each dentist will do to ensure your requests are respected to the extent possible. If your anxiety level escalates, ask the dentist about sedation options.

 Dr. Steven Brooksher, an accredited cosmetic dentist in Baton Rouge, sponsors this post.

I Had a Panic Attack at the Dentist and Walked Out

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I am always nervous about the dentist, but last Wednesday was worse than ever. When I pulled into the parking lot, I started feeling nauseous. I thought about calling the office and telling them that I was in the parking lot but sick. For some reason, I decided to go in anyway. I felt woozy and sat down quickly. When the dental assistant called my name, I jumped up and walked out of the office.

I was supposed to talk to my dentist about implants for two missing upper molar teeth. But I had a panic attack in the waiting area and had to leave without seeing her. I called to apologize but did not reschedule. I don’t know what to do next. I am terrified that this is something that I won’t be able to cope with enough to get dental implants. I am embarrassed but do not want to start over with another dentist. Thanks. Malachi from TX

Malachi – Thank you for contacting Dr. Brooksher’s office. Millions of people have dental anxiety and skip appointments because of it.

You may need to start by addressing the reason for your anxiety. Past dental experiences that were emotionally or physically painful can cause anxiety. Also, consider whether your current dentist understands and sympathizes with your anxiety.

Dentists who welcome anxious patients will listen to your concerns and fears and address them. Frequent, clear communication may be enough to calm your fears. Some patients require sedation for dental appointments, and you may be one of them.

A beach hammock between palm trees portraying the relaxation of sedation dentistry

Sedation dentistry relaxes you during denal visits


We suggest that you start by speaking with your current dentist. If she does not understand your anxiety, look for another implant dentist. Schedule a consultation, explain your concerns, and ask what the dentist can do to help you relax. Ask friends for recommendations for dentists or search online for dentists who cater to anxious patients. We are confident that you will find a dentist to meet your needs.

Dr. Steven Brooker, a Baton Rouge Fellow of implant dentistry, sponsors this post. Dr. Brooksher is accredited by the International Congress of Oral Implantologists.

My Dental Crown Feels Weird When I Chew

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My dentist placed a crown on an upper left molar three weeks ago. The tooth touches the opposite bottom molar tooth when I chew, but it feels off. I think the crown needs deeper grooves so the other tooth will match it when I chew. If I ask my dentist to drill down some of the crown’s surface, will it damage it? Although I will need laughing gas or another sedation to cope with my anxiety and get through this, I want it resolved. I already told my dentist about the discomfort, and she said that I need time to get used to my bite. How long will that take? Thanks. Randall from Memphis

Randall,

Your dentist’s request to give your concerns more time means that she does not know what to do. Brooksher would need to examine your tooth and crown to determine what is causing the disharmony when you chew. But the situation could be challenging to correct, or your dentist’s lack of knowledge might be the problem.

Your bite should be perfectly comfortable when you receive a new crown or onlay. But the motions involved in chewing make the occlusion—how the upper and lower teeth fit together—complex. And many dentists lack the training and skill to resolve the issue.

Post-graduate institutes, including the Las Vegas Institute for Advanced Dental Studies, the Texas Center for Occlusal Studies, the Dawson Academy, the Pankey Institute, and others, train dentists in the science of occlusion. Many cosmetic dentists attend the institutes or receive courses from other organizations that teach the same principles. Still, many other dentists feel that basic dental school education is enough, and they do not need occlusion training. Although dentists who bypass additional training might complete single crowns or onlays, they may not be qualified to complete a full-mouth reconstruction with a balanced bite. So, as a patient, a dentist may tell you that it takes time to get used to your bite.

What Is Malocclusion and What Problems Can It Cause?

Malocclusion is the term for disharmony in how your upper and lower teeth line up. The shape, size, or position of your jaw or teeth may cause malocclusion, or misaligned teeth. The shape and size of a dental crown can affect your bite. Although you might adjust to how your bite feels, it does not mean it is aligned correctly. And malocclusion can lead to other issues.

  • Unusual stress on teeth – The stress can lead to bone loss around the affected teeth.
  • TMJ disorder – You might experience symptoms or signs related to TMJ, including jaw, facial, or neck pain, and headaches or earaches.

Face of a woman relaxed during dental treatment for information on sedation dentistry from Dr. Brooksher of Baton RougeMany dentists adjust a new crown or onlay by asking you to bite on bite registration paper. The paper leaves marks where the crown or onlay makes contact prematurely. The dentist will grind down the crown in those places. Your dentist has completed that essential step, and your crown is not high.

The issue with your bite is more subtle. But a dentist—perhaps not your dentist—can adjust the crown to make it comfortable without damaging it. If your dentist does not know how to correct it, you can wait a few months to see if the tooth begins to feel better with your bite. Or you can get a second opinion from an advanced cosmetic dentist. Look on a few dentists’ websites for information about post-graduate training in occlusion from one of the institutes mentioned on this page. You can talk to the dentist about your anxiety and discuss sedation options during your consultation.

Baton Rouge dentist Dr. Steven Brooksher sponsors this post.

How Does Lupus Affect Your Teeth?

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Young African American woman portraying concern over lupus and oral healthI was diagnosed with lupus two months ago. I have a friend who was diagnosed over 20 years ago. She says that lupus can affect your teeth. I haven’t been one to be regular at any dentist because of my anxiety. But I know I need to rethink it all. What kind of changes should I look for in my teeth now that I have lupus? – Krista

Krista- Thank you for your question.

According to a 2019 article in the dental journal, Oral Diseases, studies show that people with systematic lupus have a greater risk of “compromised oral and dental health exhibiting increased risk of periodontal diseases and temporomandibular joint disorders.” So, how does lupus affect your teeth?

How Does Lupus Affect Your Teeth?

Lupus can affect your teeth and jawbone health, salivary glands, and increase tooth decay. We will explain:

  • Jaw joint health – Lupus often affects joints in the body. The temporomandibular joint, which connects the jawbone to the skull, can be affected. Temporomandibular joint disorder (TMJ) can result from chronic inflammation of the joints that lupus can cause.
  • Salivary glands – Auto-immune conditions, including lupus, can attack the body’s moisture-producing glands, including salivary glands. A reduction in saliva flow in the mouth increases acid.
  • Tooth decay – Tooth decay increases when acid attacks your teeth. In severe cases of decay, a cosmetic dentist can protect and restore your teeth.
  • Mouth sores – Additionally, many medications prescribed to treat lupus can cause mouth sores.

Maintaining Your Oral Health with Lupus

It is an excellent time to start seeing a dentist for regular exams and cleanings. Let your dentist know that you have lupus. They will monitor your teeth and gums for signs of dryness. If you experience dry mouth, your dentist can recommend at-home care or prescription remedies to assist with saliva production.

Please do not let your anxiety keep you away from the dentist. Schedule a consultation with an experienced dentist to discuss your options for treatment along with sedation to help you relax.

Baton Rouge dentist Dr. Steven Brooksher sponsors this post.

Why Is My Palateless Denture Loose?

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Last August, I found a dentist who does palateless dentures. He took some x-rays, reviewed my medical records, and said I could get the denture. I was excited because I have worn dentures for 20 years. I was very nervous because I had never had any oral surgery before last September when the dentist did four implants. I was under IV sedation, so the surgery went better than expected. Everything seemed to go okay until mid-January, when I felt something shift in my mouth. I returned to the dentist before my next scheduled appointment. He said that the denture might be loose, and he will check the implants next week. I am terrified of what the dentist might find and that I might lose all the implants. I don’t know if my anxiety will let me start all over again. Now, my trust level is down. What are some reasons that my palateless denture might be loose? – Thanks so much. Giada from Florida

Giada,

Thank you for your question. Dr. Brooksher would need to examine your denture and take a 3-D cone beam CT scan to identify the problem. But will explain some possible causes of your loose palateless dentures. But first, we will explain how a palateless denture works for any of our readers who are not familiar with it.

What Is a Palateless Denture?

Palateless upper denture prepared for dental implantsA palateless is shaped like an arch and has no upper plate that touches the roof of your mouth. A palateless implant denture snaps or screws onto dental implants. Dental implants are tiny screws that an implant dentist places in your jawbone. Two to six implants can keep your denture in place. After about four months of healing, your dentist will attach the final denture to the implants.

Palateless implant denture vs. traditional implant denture

  • Traditional denture – A traditional denture has a palate that touches the roof of your mouth. Suction from the top of your mouth keeps the denture in place. Many denture wearers find it uncomfortable. Some also say that it distorts the taste of food.
  • Palateless implant denture – Dental implants embedded in your jawbone can support a palateless denture. You will have a more comfortable experience wearing dentures that do not cup the roof of your mouth.

Why Is Your Palateless Denture Loose?

If your palateless implant denture is loose, perhaps the denture is not secured to the implants. Or, your implants and jawbone may not have fused. An examination and 3-D CT scan will provide the answer.

  • Denture not secured to the implants – If your palateless denture is loose, your dentist must determine the cause. Perhaps the denture base is misaligned with the implants. Or, maybe the connection between your denture and implants is unstable.
  • Jawbone and dental implant did not fuse – When your jawbone and implant do not fuse, the cause could be the location of the implants, inflammation around the implants, poor-quality implants, or other factors.

Get a Second Opinion Right Away

We recommend getting a second opinion right away. The American Society of Implant and Reconstructive dentistry cautions that if the implant connection is loose, it can have these effects:

  • Alter your bite (the way your upper and lower teeth meet when you close your mouth)
  • Damage the implants
  • Cause bone loss

You mentioned that your dentist took some x-rays, but you did not say a 3-D cone beam CT scan. Did your implant dentist complete that scan? Search for an implant dentist with credentials (not membership only) from the International Congress of Oral Implantologists or the American Dental Implant Association. Schedule an appointment for a second opinion. You will need a comprehensive exam and a 3-D CT scan at some point.

Your anxiety is understandable, but an implant dentist will recommend sedation options to keep you relaxed while getting the care you need. We wish you a healthy resolution for your loose palateless denture.

 

Dr. Steven Brooksher of Baton Rouge, Louisiana, sponsors this post. Dr. Brooker is a Fellow of the International Congress of Oral Implantologists.

Never Had Issues Like This Until I Got a Dental Implant

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I lost my right second molar at age 17 and never replaced it. As an adult, I decided to do something about it. I wore a partial denture for many years, and now at age 47, I have decided to get an implant.  But I regret it because I never had dental issues like this until I got the implant.

After implant surgery, my dentist told me that he placed the implant, although my bone level was shallow. He said that if it didn’t work out, he could do a bridge instead. I was furious, and after four months, my dentist said the implant was not healing well. I had a lot of anxiety about getting an implant, and it is increasing because someone must remove the implant. But I refuse to get a bridge. I would rather leave the space empty. I’m writing out of frustration but unsure of what question to ask. – Thank you. Marcus from KY

Marcus,

Thank you for contacting our office. We understand that you must be frustrated.

Do You Have Enough Bone Volume for a Dental Implant?

Whether you have enough bone level for a dental implant is something that any responsible implant dentist determines before surgery. Implant dentists take a 3-D digital CT scan before recommending implants. The scan helps your dentist identify:

  • Bone level
  • Oral anatomy
  • Best implant location

We are also concerned because if you have had a missing tooth for 30 years, your dentist knows that you have experienced significant bone shrinkage.

How Much Does Bone Shrink When a Tooth Is Missing?

When a tooth is missing, bone shrinkage progresses rapidly. If your dentist takes a 3-D CT scan before placing an implant, they will notice the shrinkage and determine if you need bone grafting. An article published by the American Academy of Implant Dentistry on how missing teeth affect your bone notes that when you have a missing tooth, bone shrinkage occurs at these rates:

  • 25 percent in three months
  • Up to 50 percent in six months

How to Deal with Poor Implant Dentistry

When you are a victim of poor implant dentistry, your dentist owes you a refund. You paid your dentist for a service you did not receive—a healthy, functioning dental implant. Also, our dentist failed to meet the standard of care by not taking adequate x-rays to measure your bone volume. So, your dentist owes you for the implant process and negligence.

What Are Your Options After Dental Implant Failure?

If you have experienced dental implant failure, get a second opinion from a skilled implant dentist. Look for credentials from one of these organizations:

  • International Congress of Oral Implantologists
  • International Dental Implant Association
  • American Academy of Implant Dentistry
Dental implant components, including root form, abutment, and crown

Discuss your sedation options with an accredited implant dentist

Schedule an appointment for an examination. The dentist will explain your options for sedation and a comfortable procedure and recovery. And expect a skilled implant dentist to take a 3-D CT scan before recommending treatment options. Also, talk to your new dentist about your anxiety and what triggers it.

 

Dr. Steven Brooker, a Baton Rouge Fellow of implant dentistry, sponsors this post. Dr. Brooksher is accredited by the International Congress of Oral Implantologists.