John F. Carpenter DMD, MAGD Family, Cosmetic & Imp

Understanding Sedation in Dentistry

Sedation Dentistry

 

 

Dentists use sedation to help relax our patients and reduce fear and pain.  Sedation can easily be administered orally or through inhalation.

What Types of Medication are Used?

The most common is nitrous oxide (a gas which is delivered through a nose piece).  This is actually a mixture of Nitrous Oxide and Oxygen.  The percentage is titrated until the patient feels relaxed.  (“Like you had a few cocktails”).  Patients are awake and respond to verbal commands.  When the visit is completed, the oxygen portion of the mixture is turned up and the Nitrous turned off.  Within 2 minutes, you are back to normal and will be able to drive home.

The second most commonly used sedation method is Oral Sedation.  One hour before you arrive for treatment, you will take a small pill.   This will begin the relaxing process.  Upon arrival, an assessment will be made and additional oral medication and Nitrous Oxide may be provided.  A designated driver is necessary when having Oral Sedation.  Upon completion of your dental care (which you often will not remember), you will be tired and need to rest for the remainder of the day.

Benefits Include:

  • Limited memory of the procedures
  • No fear
  • Hours seem like minutes
  • Multiple treatment completed in one visit
  • Decreased gag reflex
  • Regaining dental health
  • The fabulous smile you always wanted!

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Is an Implant Better Than a Tooth?

When should a tooth be extracted and an implant placed?

My answer to the question is:  IT DEPENDS.

I have placed and restored hundred of implants during the past 35 years.  At the same time, I have restored thousands of natural teeth.  Both treatments are successful if properly executed.

Each patient’s dental situation is unique and individual.  There are  many treatment options but there is only one accurate diagnosis.  The first step is to obtain records that include radiographs,  clinical exam, a dental history (decay rate and periodontal status) as well as a medical history.

A careful assessment of the tooth in question must be completed.  Is the tooth restorable or is the damage so severe that the tooth is non-restorable and an implant is a better choice?   A CBCT (Cone Beam CT) gives a 3D view of the bone and damaged tooth and is often extremely helpful.

After a complete diagnosis is made, a discussion with the patient must take place.  Do they feel strongly about maintaining their existing tooth or is an implant an acceptable option?  The advantages and disadvantages of each treatment option are discussed.  Alternative treatments and the risk of no treatment will also be reviewed.

Often it is possible to restore a natural tooth, but only if heroic and costly efforts are made.  The long-term prognosis might still be questionable.  Other times, an existing tooth with less damage can be repaired/restored, and maintained with excellent prognosis.

IT DEPENDS . . . .

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Why do Dentists Use Prescription Toothpastes?

fluoride toothpastePreviDent 5000 Plus, Sodium Fluoride 5000 Plus

 

 

 

 

 

How does Fluoride toothpaste protect teeth?

All toothpastes help remove plaque (a film of bacteria that forms on teeth and gums every day).  Plaque causes tooth decay and gum disease.  Plaque left on the surface of your teeth produces acid that causes the breakdown of enamel (demineralize).  This creates a weak spot in the tooth (cavity).  It is the fluoride in the toothpaste that helps rebuild (remineralize) weakened tooth enamel.  New enamel crystals form that are harder and more resistant to acid.

Who will benefit from a high fluoride prescription toothpaste?

Patients that have . . .

  • a history of multiple cavities
  • exposed root surfaces
  • a dry mouth
  • a large number of existing fillings and/or crowns
  • sensitivity
  • poor oral hygiene

Prescription fluoride toothpaste contains a higher concentration of fluoride (5,000 parts per million) than over-the-counter (OTC) toothpaste (1,000 parts per million).  OTC toothpaste reduces cavities by approximately 23%.  A 5,000 ppm prescription toothpaste reduces the cavity risk even more, estimated to be a 42% reduction.

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Dental Erosion – Silent and Costly

 

The loss of tooth enamel due to acid erosion is a growing epidemic.  A 2012 study found that 22 percent of US adults have acid erosion, which can cause tooth sensitivity, transparency, discoloration and decay.

As tough as tooth enamel is, it can be worn down.  Acids from foods and drinks can dissolve the enamel and expose the inside of teeth.

dental erosion

Causes of dental erosion

Most people are aware that soft drinks and fruit juices are contributors to tooth decay because of the significant amount of sugar they can contain – a 600ml bottle of soft drink can contain up to 13 teaspoons of sugar.  What is not so well known is that even sugar-free soft drinks, along with fruit juices, sports drinks, and so-called “energy” drinks have high acid levels, which play a major role in the development of tooth erosion.

Acid erosion can also occur as a result of your teeth’s exposure to stomach acids due to some medical conditions, including gastroesophageal reflux disease (GERD) and bulimia.

Dry mouth (xerostomia) can accelerate the damage of erosion.  Saliva plays a protective role washing away food particles, neutralizing damaging acid and re-mineralizing teeth.

What can I do to prevent dental acid erosion?

 Cut down on the consumption of carbonated soft drinks, sports and energy drinks, and pure fruit juice.

  • Drink water throughout the day.
  • Avoid sugary snacks
  • Restrict acidic beverages to main meals. Do not sip over long periods.
  • Chew sugar-free gum to help produce more saliva and help re-mineralize your teeth.
  • Maintain excellent oral hygiene
  • Utilize prescription fluoride toothpaste (Prevident 5000)

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All-on-Four Implants

Terminal failing dentition

Pre-op condition

zirconium porcelain implant bridge

Post-op zirconium implant bridge

For patients who have lost all their teeth or their remaining teeth are hopeless, several options are available.  One of the most advanced and beautiful option is a fixed implant solution.

This solution is known by several names:   All-On-4, Fixed Hybrid, Teeth in a Day, Teeth Tomorrow, Malo Bridge, Prettau Bridge and Hybridge, to name a few.

Usually 4 to 6 implants are placed, which replace the root part of missing teeth.  Then, zirconium porcelain teeth are screwed in to the titanium implant roots.   This has become widely popular worldwide.  If the idea of having to wear a denture for the rest of your life makes you uncomfortable, call us.  Your 1st visit will include an exam, consultation and a 3D CAT scan so we can properly review your options.

Don’t hesitate to contact us.  Remember – – creative financial options are available.

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Can Gum Disease Spread to Other Parts of the Body?

80% of Americans have some form of gum disease.

Bacteria forms on the teeth and grows down into the space between the teeth and gums (a periodontal pocket).  These pockets become breeding grounds for bacteria and cause inflammation, tenderness, bleeding and infection.

If not addressed properly, this bacteria will spread to other parts of the body through the bloodstream. (Think of “Toe bone is connected to the foot bone.  Foot bone connected to the ankle bone . . . “)

Scientific studies have substantiated links to heart disease, diabetes, colorectal cancer and even Alzheimer’s disease.

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Change your Smile

Like it or not, we live in beauty-conscious society.  This is particularly true in the entertainment industry.  Not all “beautiful people” were born that way.

Many have taken advantage of Cosmetic Dentistry.  Remember Cher’s early smile?  Fortunately, self-improvement is not exclusive to the Rich and Famous.

Visit Before and After photos.

 

What’s New in Dental Implantology?

dental implants“Immediate implants” and “teeth” are the latest buzz words in dentistry.  Do they work?  Yes, but it depends on the unique situation a patient presents with.  It’s great to be able to remove bad teeth and place implants the same day when it is indicated.  After the implants (the foundation)  are placed, a second decision must be made regarding which type of temporary will be placed on top of the implant.

In the anterior esthetic zone, ideally I like to place  a fixed, immediate replacement.  However, if the implant isn’t stable enough at placement and requires time to heal, removable teeth can be placed.  Utilizing either a fixed or removable temporary, patients leave with teeth and a great smile.

New Windsor Dentist Sedates Anxious Patients

Many patients tell me they had a traumatic dental experience as a child, the dentist had trouble getting them numb or they easily gag.

You are not alone.  Dr. Carpenter’s office has been offering conscious sedation for the past 15 years to help you.

Conscious sedation utilizes oral medications and nitrous oxide.  It is completely safe because you are conscious and always breathing on your own with all your protective reflexes intact.  Afterwards, most patients tell us they remember nothing or very little of the appointment.

What to Expect:

You will need a responsible adult to drive you to and from the office.  The appointment is usually 2-3 hours long and allows for the correction of years of neglect.  When the appointment is finished, you will go straight home and usually sleep the remainder of the day.

Dental anxiety

Dental anxiety

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Sedation Dentistry, a Bad Case of Gum Disease and a Happy Family

bad breath, halitosisA 42 year old male patient, let’s call him “Bob”, presented to the office last month.  Bob’s main complaint was he was afraid to kiss his wife because of his bad breath.  “Our sex life is suffering because of it and my kids have been avoiding me.”

After spending time getting to know Bob, he disclosed that he hadn’t been to a dentist since he was a teenager.  “I had gone for bleeding gums, was traumatized and hadn’t been back since”.  Bob allowed us to examine him and take basic X-rays.  Heavy calculus (tartar) and bleeding gums were visible.  All the signs and symptoms of gum disease were present.

We let Bob know that he was a perfect candidate for dental sedation.  All his gum treatments, the extraction of 2 hopeless teeth and a few fillings could all be done in one visit with sedation.  He was scheduled for his sedation visit the next week and in over 3 hours, all his treatment was completed.

But the best part was when Bob returned for a 2 week follow-up.  Happy and smiling in the welcome area, he called out to me “My mouth hasn’t felt this good in years and my family loves what you did for me.”

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