Will I need general anesthesia for wisdom tooth extraction?

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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?

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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

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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?

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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?

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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.

Depressed and discouraged about my teeth

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I’m depressed about my teeth. I need advice from someone who cares. At a young age, I started having extreme problems with my teeth because our family was poor and rarely had insurance. My teeth were crooked and bucked. I also had lots of cavities and toothaches.

As a teenager, I had several root canals. Dentists who didn’t care did much of the work. One dentist started a root canal on a front right tooth but didn’t complete it because we lost our insurance and couldn’t afford it. There was a hole in the back of the tooth, and the tooth eventually turned gray and broke in half. I was 19 years old, had no money, and had a broken front tooth. It was devastating for my self-esteem.

I found another dentist within 12 miles of our house, and I rode the bus to the office and cried to him about my teeth. He agreed to help me. My front teeth were crooked, so the dentist did a bridge to replace the broken tooth and make the crookened ones look better.

When I got married at age 25, we finally had insurance. There were so many issues with my teeth that it was challenging to keep up with them. My left front tooth became abscessed, so the dentist did a new bridge that extended from one eye tooth to the other. Then two years later, I needed a bottom ridge. Between that, I still needed root canals and crowns.

Last year, a toothache in a bottom left tooth started to become intense. Another dentist was filling in for my regular dentist, and she said that an abscess was forming on a tooth that had a root canal, and I had a sinus infection. She gave me antibiotics and referred me to an endodontist. The endodontist said that he didn’t see a problem. I returned to my dentist, who agreed that she couldn’t find anything wrong. Sounds suspicious, right?

I still have a toothache in the bottom left tooth. Sometimes the pain is intense but goes away. I didn’t have any pain throughout the winter, and then it came back about three weeks ago. I felt like I had an earache, so I went to my primary care doctor. She examined my ear and said it’s okay. My husband recently lost his job, so we received help from the state and state-sponsored insurance. It’s so difficult to find a dentist who cares.

I finally found a dentist who saw me for less than ten minutes and said I have TMJ. He said that I needed a $400 mouthguard, and other than that, there was nothing he can do. Although I might have TMJ, I have a failed root canal that no dentist can find. I’m convinced that one dentist saw the problem, and the rest either can’t see or don’t want to be bothered.

The pain feels like a horrible earache that extended into my jaw, throat, and chest. Sometimes I feel stabbing pain. I don’t have a fever, and my primary care doctor said that my bloodwork shows ho sign of infection. I’m depressed and worried about what can happen if a dentist isn’t able to find the infection. On top of that, I’m embarrassed to smile. At 35 years old, I have missing, chipped, and cracked teeth that look terrible. And the two bridges look like someone set them in my mouth without trying to make them look halfway natural. I’ve thought about taking the bridges out, but I’m afraid of damaging my teeth and being toothless.

I’ve also thought about dentures, but my husband and friends say that’s a bad idea because it would cause even more problems. I’m sorry for emptying my life’s story on you, but I almost feel hopeless. I was so happy when I found Dr. Brooksher’s website. I’ve looked at most of the pages on it, and it seems like your office cares about people and how they feel about their teeth. Do you think I should get my teeth all pulled out and accept whatever happens? Thanks for your help. Ryleigh from MS

 

Ryleigh,

Like you, many people have teeth that seem to fall apart faster than a dentist can restore them. We know it’s discouraging to you, but it also concerns a dentist who cares. Although some dentists don’t care, many of them do. They are not dentists for the money; they became dentists to help people.

From your description, it seems that you’ve seen dentists who care but are also discouraged by seeing your situation. Some might judge your situation and think that your oral health condition means that you don’t care, so they might not care either. We are confident that you can find and understanding dentist who is willing to help you without extracting all your teeth and giving you dentures. What can you do to improve your oral health and find a dentist to help?

Stop the Cycle of Tooth Decay

Practicing good oral hygiene is one step in preventing tooth decay. But other factors can help.

  • Toothbrushing – Although many people think that toothbrushing is the best way to prevent tooth decay, toothbrushing only cleans the smooth surfaces of teeth. It doesn’t clean cracks, crevices, contact points, and other areas that are vulnerable to decay. Liming what you eat, discussed below, prevents decay more than toothbrushing does.
  • Flossing – Multiple scientific studies show that flossing helps prevent gum disease and interproximal (between the teeth) decay.
  • Saliva – The greatest defense is in your saliva. Saliva contains decay-fighting antibodies and remineralizes small spots of decay in teeth. If you strictly limit the number of times you eat each day, it will maximize your saliva’s effectiveness.

Limit What You Eat

Limit eating to three times a day—three main meals and two snacks. Brush your teeth two to three times a day, and floss between your teeth before bedtime. Limiting how often you eat daily gives saliva time to repair the small spots where decay begins. Most people who reduce the number of times they eat daily also reduce the number of cavities and their growth rate. People who are strict about it can be cavity free eventually.

What’s Next?

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

Sedation dentists are often empathetic toward patients with poor oral health

Don’t give up.  Keep looking for a dentist. Call offices and ask if you can get an office tour or meet the staff and dentist. When you find an office and dentist that makes you feel comfortable and isn’t overwhelmed by your oral situation, start a treatment program with them.

Find a dentist who will try to save—not extract—your teeth. And keep as many teeth as possible. Bone shrinks where teeth are missing. And the only way to prevent shrinkage is by replacing the missing tooth with a dental implant. Keep in mind that dentists who do a lot of sedation dentistry are used to seeing people with “bombed-out mouths” and tend to be more empathetic.

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

Novocain Doesn’t Make Me Numb?

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Hello there,

My teeth are in need of a root canal due to nerve damage and nerve damage. My dentist injected me with Novocain, and it did not work. He injected me again and again, and I still could not get numb. Because of that, he sent me home with some painkillers. I cannot get a root canal done unless my teeth can be numbed. Would a numbing paste work? Is there something I can do? Or is there something wrong with me?

Luther, from Huntington, West Virginia

 

Hi Luther,

It is not a problem with you, with some modifications you can get your teeth to get numb. Your problem is likely related to dental anxiety. The higher your anxiety, the less likely you are to get numb, and the more numbing agent that is needed. If you can lower your anxiety, you will be able to get numb with Novocaine or a numbing paste.

One way to help your dental anxiety will be to go to a sedation dentist. A sedation dentist can write you a script for an anti-anxiety medication to take thirty minutes to an hour prior to your appointment. However, you will need a ride to and from the appointment if you take this medication.

If you do not want to take an anti-anxiety pill, you can find a dentist who uses nitrous oxide. Nitrous oxide wears off quickly after the appointment, and has no ill side effects. It also is more effective at numbing and sedation than novocaine, and is a good alternative for those with dental anxiety who cannot be numbed any other way.

If your current dentist does not offer sedation dentistry, you can seek it elsewhere. If you continue to see your dentist, using techniques to control your anxiety will allow you to finally become numb enough to get your root canal.

This blog post is brought to you by Baton Rouge sedation dentist, Dr. Steven Brooksher, of Dentistry by Brooksher.