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

Posted on by .

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

Posted on by .

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?

Posted on by .

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?

Posted on by .

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.

I Had a Panic Attack at the Dentist and Walked Out

Posted on by .

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.

Will I need general anesthesia for wisdom tooth extraction?

Posted on by .

I am 44 years old and have three impacted wisdom teeth. One tooth is under the bone. I am wondering if general anesthesia is necessary or if sedation is enough. I’ve never had general anesthesia, and I prefer not to get it. Thanks. Wade from AR

 

Wade,

Thank you for your inquiry. Although we do not have your case details, most wisdom tooth extractions do not require general anesthesia. Other levels of sedation work well with extractions without making you unconscious, like general anesthesia.

Moderate Sedation for Wisdom Teeth Extraction

Four diagrams of impacted wisdom teeth that require sedation dentistryIntravenous, moderate sedation is known as twilight sedation. Your state will be between awake and asleep. And you will drift in and out of consciousness. Most patients do not remember anything about the procedure except feeling sleepy and relaxed. Moderate sedation offers deeper relaxation than sedation with nitrous oxide, which gives you a sense of well-being while you are fully awake.

Deep Sedation for Wisdom Teeth Extraction

Deep sedation is drug-induced, depresses consciousness, and prevents you from awakening easily.

General Anesthesia for Wisdom Teeth Extraction

General anesthesia makes you completely unconscious. Risks increase with general anesthesia, too.

What Makes Some Wisdom Teeth Extractions More Difficult?

As we age, several factors can make wisdom teeth extractions more difficult. And your dentist will recommend sedation based on your sensitivity and condition of your teeth.

  • Bone – The older the bone is, the less pliable it becomes.
  • Cementum – Calcified bone-like tissue at the tooth roots accumulates. Although cementum and can make extractions more challenging, an oral surgeon or a dentist with experience in wisdom teeth extractions will be successful.
  • Position – Impacted wisdom teeth may grow sideways or lean against other teeth. A skilled dentist or oral surgeon can remove them without harming nearby teeth.

Sedation Second Opinion

If you need a tooth extraction, but your dentist or oral surgeon recommends general anesthesia, ask why. Underlying factors might be influencing the recommendation. If not, you can get a second opinion from another sedation dentist or oral surgeon to discuss your options.

 

Dr. Steven Brooksher of Baton Rouge, LA, sponsors this post.

When will jaw numbness after wisdom tooth extraction go away?

Posted on by .

A week after getting all my wisdom teeth extracted, the lower left side of my jaw still felt numb. Three days ago, the oral surgeon did sensation tests. I will return in two weeks for a follow-up appointment.

The numbness is causing problems when I eat and brush my teeth. Did the IV sedation affect my jaw nerve? Is there anything else I can do to improve the situation? Is this common, or should I be more concerned than the oral surgeon seems to be? – Thank you. Tiffany P. from Athens, GA

Tiffany,

Thank you for your inquiry. Your description sounds like your lower-left jaw nerve is damaged. The extent of the damage determines how much the nerve will recover.

Nerve Damage with Wisdom Tooth Removal

Nerve damage can occur with wisdom teeth removal because the nerve for your lower teeth and lip is close to your wisdom tooth roots. During wisdom tooth removal, the nerve can be damaged. But the damage is not related to receiving sedation to help you relax before the procedure. Before surgery, an oral surgeon should do the following:

  • X-ray your teeth and jawbone to see the location of the nerve
  • Notify you of the risk of damaging the nerve during wisdom teeth removal

Many surgeons overestimate the risk of nerve damage to protect themselves from possible lawsuits.

Categories of Nerve Injury During Wisdom Tooth Removal

The three categories of nerve injury during wisdom tooth removal have different results:

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

Sedation relaxes you during tooth extraction but does not cause lingering jaw numbness

  • Bruised – You will feel numbness for about a month, after which the feeling will return.
  • Crushed – Symptoms last about a year as new nerve fibers grow.
  • Severed – Permanent injury prevents nerve fibers from regrowing, and you will continue to experience symptoms.

What to Expect

  • Depending on the extent of damage to the nerve in your jaw, you may not see improvement when you return to your oral surgeon for a checkup.
  • It may take a month or up to a year for improvement. If the nerve can recover, you will begin to feel tingling in your lip as it heals.
  • Some patients say that their body adjusts to the numbness and symptoms become less intense even with a severed nerve.

Although there isn’t anything you can do to repair the nerve, try to be patient as you wait for signs of improvement. Your oral surgeon can advise you on how much progress you might expect to feel over the next few months.

 

 

Steven Brooksher, DDS, of Baton Rouge, sponsors this post.

My zirconia crowns don’t match after a second try

Posted on by .

In September, my dentist placed four new zirconia crowns on my upper front teeth. The crowns don’t match the shape of my natural teeth. They look like they would not match the shape of anyone’s natural teeth. My mistake was to ask my dentist to do the work. He said he could do it for $600 – $800 less than other dentists because I am an existing patient.  Thank you, Ada

Ada,

My dentist agrees that my teeth do not look natural, so he referred me to a prosthodontist to correct the issue. Now the shape of my teeth is okay, but the color is off. I made the mistake of asking for sedation before I saw the crowns. The prosthodontist cemented the crowns without me getting a non-sedated look at them. I am angry and frustrated. He said he will change the color if I pay for it. Why should I pay for teeth that look gray? Isn’t a prosthodontist a specialist?

It’s unfortunate to know you’ve had two bad experiences with dentists who can’t give you natural-looking results with crowns.

Your dentist should take responsibility to correct your smile in the best way possible instead of referring you to a prosthodontist. Although prosthodontists have two to three years of training in restoring teeth, few are artists in cosmetic dentistry. They can get the technical details and function correctly, but the aesthetics are often lacking. But an excellent cosmetic dentist is concerned about the details that make your smile look natural. And they don’t bond the work to your teeth unless you love the way it looks.

Zirconia crowns for front teeth

Although a dentist can give you zirconia crowns on your front teeth, it takes advanced cosmetic dentistry training to make the crowns look natural.

  • Zirconia crowns are made from a block – A dental lab tech makes zirconia crowns from blocks and mills them into shape to fit over your tooth. But a zirconia block has one color throughout it. Your natural teeth have variations in color and translucence.
  • Porcelain layers can make zirconia look natural – A zirconia crown cannot recreate the look of your tooth unless a ceramist bakes porcelain onto the surface and manipulates the color.

Sedation for dental crowns

Face of a woman relaxed during dental treatment for information on sedation dentistry from Dr. Brooksher of Baton Rouge

Try on temporary crowns before receiving sedation dentistry

If you need sedation when your crowns are cemented, your dentist can create temporary crowns first. If you like the temporary crowns, a dental ceramist can duplicate them when making your permanent restorations. Before you are sedated for the final crowns, at least you know you approved them.

What’s Next?

Our recommendations are below:

  • Discontinue treatment – Don’t let the prosthodontist do any more work on your teeth. He isn’t interested in giving you crowns that you love.
  • Ask for a refund – Depending on the extent of color mismatch in your crowns, you may only receive a partial refund.
  • Look for an advanced cosmetic dentist – Don’t rely on a referral. Look for a dentist with credentials (accreditation, at least) from the American Academy of Cosmetic Dentistry or the American Academy of Dental Aesthetics.

 

Steven Brooksher, DDS, is a cosmetic and implant dentist in Baton Rouge, LA. Read about his credentials and visit his smile gallery.

Do zirconia crowns cause a dry tongue?

Posted on by .

I think I need to switch to a holistic dentist. After I received three new zirconia crowns in July, my tongue is dry, my throat burns, and my voice is hoarse. I think I am allergic to the crowns, but my dentist says that zirconia crowns don’t cause a reaction. He advised me to see an ENT because of the issue with my throat, but the ENT said that he doesn’t see anything that’s causing the burning sensation. My sinuses are okay. I also went to a gastro doctor who ruled out reflux. I guess that I will get allergy testing next.

My other concern is about my options after removing the zirconia crowns. I feel safer with a new dentist, and as I mentioned, a holistic dentist. Besides, when my dentist installed the crowns, he used so much water that I felt like I was drowning. I threw up some of the water. I read online about a few other people whose dentist used so much water that it was overwhelming. What are my options other than zirconia crowns? Thank you, Isaiah from Maryland

Isaiah,

Your experience with getting zirconia crowns sounds stressful. We disagree with telling a patient that they can’t be allergic to a specific dental material. Each person has unique circumstances, and immune systems can be unpredictable, even if you have no known allergies.

You visited multiple specialists to identify the cause of your burning throat and dry tongue but still don’t have a diagnosis. We are considering another possibility—burning mouth syndrome.

What Is Burning Mouth Syndrome?

Burning mouth syndrome is a condition characterized by a burning sensation in your mouth or on your lips or tongue. It can also cause your tongue or mouth to feel dry. Symptoms can linger for days or months. Women are five times more likely than men to experience the symptoms.

What Causes Burning Mouth Syndrome?

Damage to pain and taste nerves is the suspected cause of burning mouth syndrome. Other possible causes include:

  • Allergic reaction
  • Nutritional deficiencies
  • Certain medications
  • Medical conditions, including reflux, endocrine disorders, and fungal infections
  • Anxiety, depression, or stress

Allergy Testing

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 change your view about dental visits

A dentist who offers holistic—or biological—treatment can help you find resources for Clifford Materials Reactivity Testing. The testing will reveal if you have an allergy or sensitivity to any dental materials, including zirconia.

But if your allergy tests are negative, consider the possibility that your stressful dental experience triggered burning mouth syndrome.

Your new dentist can explain your treatment options for metal-free crowns and how sedation can help you relax during your appointment and help you get the treatment you need. If you don’t have allergies or sensitivities, your anxiety and discomfort may improve as you develop trust and confidence in a new dentist.

 

Steven Brooksher, DDS, of Baton Rouge, sponsors this post.

 

Why do some of my veneers fall off every week?

Posted on by .

I started going to my dentist in 2015, and last October, I decided that I trusted her enough to get porcelain veneers. That was a huge mistake because my veneers regularly fall off. I asked for veneers because one of my front teeth was shorter than the others, a few teeth were chipped, and I wanted a brighter smile. My dentist explained that I needed veneers to protect my teeth and limit the cracks I have in them from grinding. My dentist made a custom nightguard to protect my veneers from grinding.

Before I agreed to veneers, my dentist explained that she would need to prepare my teeth first, but she ground my front upper teeth down to stumps. When I saw my teeth, I almost cried, but she reassured me that the veneers would look and feel so beautiful that I wouldn’t remember the preparation. She placed temporary veneers, and I wore them for two weeks. I did love the look and thought that my dentist was right about how much I would love my smile.

Everything was going well with my porcelain veneers the first week, but in the middle of the second week, a veneer popped off. I called my dentist’s office, and they were quite accommodating. I went to the office in the afternoon, and my dentist bonded the veneer on my tooth. But every week at least one veneer falls. I’ve noticed that the veneers that pop off the most have a ledge on the backside of them. Also, my breath smells terribly just before a veneer pops off. Over the winter holidays, we had family visiting, and I had three veneers missing. I tried not to smile so that no one would notice my tiny ground-down teeth. I keep glue in my purse just in case a veneer comes off.

This is an ongoing issue. Last week, I received a call from my dentist’s office to come in for my dentist to try something different. I’m beginning to think that I’m my dentist’s first porcelain veneers patient. I’m stressed out about this daily. How are my veneers going to last 20 years as my dentist promised? I know this can’t be normal because porcelain veneers are too popular. People wouldn’t get them knowing they would fall off regularly.

Can my teeth be fixed? Am I going to need dentures? Our family will be moving at the end of summer, and I’m afraid that a dentist in our new location won’t want to try to fix the mess my dentist made. Is there anything I can do?

Also, I want to ask about the combination of Ativan and nitrous oxide. My dentist gave me Ativan. I take one pill the night before my appointment and another about an hour before going to the office. While she works on my veneers, I breathe in nitrous oxide. I’m out of it for the rest of the day and sleep through the next morning. I am only slightly anxious about my appointments, and I’ve only had anxiety since I received these botched veneers, but is this sedation too heavy? – Andreja from Mississippi

Andreja,

We are sorry to hear about the trauma your dentist is causing and the horror story with your porcelain veneers. Porcelain veneers are meant to improve your smile and quality of life, not make you dread smiling.

No, the things you are experiencing are not typical. You have had an awful time with what should have been an enjoyable experience. Your dentist did several things wrong. And what has happened to you might be classified as malpractice.

Your dentist prepared your teeth for crowns

Your dentist prepared your teeth for porcelain crowns—not veneers. As the photos below show, a dentist only reduces about a half-millimeter of enamel from the front of a tooth to prepare it for a veneer. But when you’re receiving a crown, a tooth is tapered all around. And you describe it as a stump. Your experience says that your dentist doesn’t know how to do porcelain veneers and isn’t familiar with bonding technology. Your options for correcting the situation are limited.

Side-by-side photos of upper front teeth with porcelain veneer preparation and porcelain crown preparation

The crowns don’t have proper retention form

If a dentist prepares a tooth correctly, conventional dental cement will keep a crown in place. Bonding technology isn’t required. But your dentist hasn’t been able to do that. Although Dr. Brooksher would need to examine your teeth, we guess that they are shorter than the teeth shown in the photograph. Your dentist so aggressively prepared your teeth that crowns won’t stay on. She grossly violated the standard of care, and she’s liable. Your crowns are getting loose in function. Saliva and bacteria are getting under the crown, which causes an awful smell and taste.

Your sedation

You described having mild anxiety about dental visits. We can’t explain why your dentist gives you Ativan because it lingers in your bloodstream. The term, serum half-life, represents how long half the dose of a medication is still in your bloodstream. After 24 hours, half the Ativan dose is still in your bloodstream, and it can take a couple of days to go away completely. Most dentists use triazolam, which lasts about three hours after a dental appointment. That’s plenty of time.

How can you resolve it?

We think that your dentist is legally liable for damaging your teeth. She should pay for another cosmetic dentist to correct your teeth and restore your oral health. But she should also compensate you for over-treatment that could affect you throughout life. Before you relocate, start searching for a competent dentist in your new location who can correct your teeth. The new dentist can confront the dentist who damaged your teeth. Her malpractice insurance should cover the cost of restoring your teeth, and your case shouldn’t need to go to court. But if you take your case to court, we think you would receive a substantial award.

Accredited cosmetic dentist, Steven Brooksher, DDS of Baton Rouge sponsors this post.