Sedation Dentistry

Oral Sedation and Dentistry

Oral conscious sedation has been an extremely positive experience for many of our patients.  I would like to share a recent example.

A middle-aged woman “Kathy” (fictitious name) presented to our office with a dental history of poor experiences.  Her care was mostly just emergency-based and “nothing” was ever “finished”.  Her immediate concerns were several broken teeth and bleeding gums.   Most of these broken teeth had root canals but she had never returned for crowns since the pain was gone.

Kathy informed us she was subject to panic attacks and appeared to  have a hard time sitting in the chair.  A complete oral exam, including medical history review, full Xrays and photos was completed.  It was determined that several teeth were hopeless and required extraction.  Several other teeth could be saved with crowns and the missing teeth could be replaced with implants.  Her periodontal situation required 4 quadrants of root planning and scaling.

The risks and benefits of different treatments were discussed with Kathy and a customized treatment plan was formulated.  She really wanted all the treatment done in as few visits as possible.  With the help of sedation a treatment that normally would take 10 visits would be performed over 2 3-hour visits.

Kathy’s treatment went extremely well and at follow-up, she brought us all little gifts and let us know that everything exceeded her expectations.  “I don’t remember much of the visits and I’m so happy everything got fixed over so few visits.”

Destruction associated with Bruxism

     The grinding of one’s teeth is called bruxism and happens as we sleep.  You might have symptoms such as jaw pain and headaches, or no symptoms at all.   This patient had no pain but was unhappy with how his teeth looked.  He was convinced he never ground his teeth.  Well, teeth don’t lie and this is an example of severe wear/bruxism.  Happening over a period of years, he was left with worn, chipped teeth and a distorted smile.

      The first step toward his new smile was to fit him with a mouthguard to protect his teeth while he slept.  I did not want to fabricate porcelain crowns and watch them fracture also.  After approximately one month of wearing the mouthguard, a compliance check was performed.   The patient told me “you know, I might grind my teeth at night”.  When we checked, we could see lines on the plastic mouthguard.  I reminded him that after we fixed his teeth, he would have to be faithful and wear his mouthguard every night.  This would prevent breakage of his new porcelain crowns.  Porcelain is actually a glass and is prone to breakage, just like teeth.

Two porcelain crowns and contouring

By fabricating two porcelain crowns and contouring his lower anterior teeth, this patient was given the smile he wanted.  His old worn teeth were given new life.

Let’s face it – - all injections are painful!  Studies have shown that approximately 40 million Americans avoid the dentist because of fear.

Now there is a new invention that has been helping us give more comfortable injections.  Called the “DentalVibe”, it works by sending soothing vibrations into the oral tissue as the injection is given.  The vibrations overload the brain with more stimulus than it can handle, thus overshadowing the injection.  Our patients who have experienced the DentalVibe have really appreciated it.

Don’t forget a topical anesthetic is still applied first and given time to penetrate.  The topical anesthetic we use is specially formulated for us and consists of 3 different anesthetics.  I find this formulated topical significantly more effective than the standard commercially available benzocaine.

There are two major costs of dental implant treatment.  The first is the implant itself and the second is the restoration (tooth or teeth).  If your dentist is going to replace a missing tooth utilizing a dental implant, they will usually refer you to an oral surgeon or a periodontist to have the implant placed.  The placement of the implant is one fee and you return to your dentist to have the restoration, which is a second fee.   True dental implantologists, who provide both parts of the process to our patients, can charge much less for the same procedure.

Does insurance cover implants?  This depends on your insurance plan.  Some will pay for dental implants and others will not.  Sometimes they will not pay for the implant placement but pay for the crown or bridge restoration that is attached.

While dental implants may be costly, they are often the most reliable and economic long-term solution.  The single tooth replacement fee is approximately $3,000.  For complicated cases, several solutions often exist with different costs, advantages and disadvantages.  Each situation is unique and requires careful evaluation and discussion.  After this evaluation, different options and their associated fees need to be discussed.  We do our best to give a fixed, all-inclusive fee.

Are payment plans available to help pay for dental implants?  YES!  Our office provides assistance to make implant procedures more affordable and fit most budgets.  We work with CARE CREDIT which offers NO INTEREST financing options if paid within 12 months.

Please contact us for complete solutions at one location.

Xerostomia is defined as dry mouth due to reduced saliva flow.  Xerostomia is not a disease, but a symptom.  I estimate  20% of my dental practice patients have a decrease in salivary gland function.

Difficulty in speech, eating and swallowing can be caused by xerostomia.  It also leads to halitosis and a dramatic rise in the number of cavities as the protective effect of saliva’s remineralizing ability is decreased.

The major cause of Xerostomia in my patients is related to the many medications they are using.  Medications that list dry mouth as a side effect include:  antihypertensives, antidepressants, analgesics, tranquilizers, diuretics and antihistamines.

Treatment involves identifying correctable causes and removing them if possible.  Elimination of irritating alcoholic mouthwashes and minimizing the use of antihistamines are such examples.  In most cases, however, it is not possible to fully eliminate Xerostomia, and treatment involves relieving the symptoms and preventing tooth decay (caries).

Xerostomia Dental Decay

Basic palliative treatment options include sipping water and using over-the-counter dry mouth products.  Click here to view my “Xerostomia Recommendations“.

Over the last 10 years, I have seen a significant increase in patients with Xerostomia.  The rapid progression of dental caries caused by dry mouth can be devastating and  create a dental cripple.

Vigilant home oral hygiene, extremely low sugar intake and avoidance of sticky, carbohydrate-rich foods are necessary to minimize caries risk.  Patients should be seen by the dental hygienist at least 3 times per year to minimize hard and soft tissue damage.

A longtime patient asked if there was anything that could be done for her “crooked teeth”.    “My parents could never afford braces for me when I was a kid.”  She’s been wanting to have something done for the past 20 years and finally got the courage to ask.

A complete examination was done including photos which we reviewed on the computer together.  I find this very helpful for the patients.  A discussion ensued concerning treatment options, including full braces, clear aligners (Invisalign/Clear Correct), bonding and porcelain veneers/crowns.  Digital photo imaging and a chairside composite removable “mock-up” helped her visualize the proposed smile makeover.  She selected a restorative solution using porcelain veneers and crowns.

After Smile Makeover

“I’m so happy and everyone says I look great.  My mother, who is 80 years old, was thrilled:  ‘you finally got your teeth straightened’.”

Interested in fixing your smile?  We’d love to help!  Visit our Smile Analysis Handout and our Patient Smile Gallery for ideas.

Conscious Sedation is a safe and common technique to quell patients’ fears.  The night before your dental appointment, a pill is taken to help you relax and sleep.  One hour before your dental appointment, a second pill is taken.  Additional medication will be provided at the office to create the ultimate in relaxation.  Often nitrous oxide (laughing gas) is used in conjunction with these oral medications.  A responsible caregiver will be needed to drive you to and from the office.

The benefits are numerous and include:

• No fear or anxiety.
• Hours seem like minutes.
• No recollection of smells or noises.
• No memory of undergoing dentistry.
• Multiple treatments will be completed in just 1 visit.
• No gag reflex interfering with treatment.
• Turn back time.
• Regain your health and have the fabulous smile you always wanted.
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  Sedation Dentistry

  Visit “A Patient’s Guide to Sedation Dentistry“