Posts for: September, 2019
Most dental procedures today only require local anesthesia to numb just the affected area. It's a safer approach than general anesthesia: the unconscious state created by putting someone "to sleep" can lead to some unpleasant complications.
But patient comfort involves more than preventing physical pain during a procedure. There's also the emotional factor—many people experience nervousness, anxiety or fear during dental visits. It's especially problematic for an estimated 15% of the population whose dental visit anxiety is so great they often try to avoid dental care altogether.
One option is to use general anesthesia for patients with acute anxiety rather than local anesthesia. This removes them consciously from their anxiety, but they must then be monitored closely for complications.
But there's a safer way to relax patients with high anxiety called intravenous or IV sedation. The method delivers a sedative medication directly into a patient's bloodstream through a small needle or catheter inserted into a vein. The sedative places the patient in a relaxed "semi-awake" state, taking the edge off their anxiety while still enabling them to respond to verbal commands.
Coupled with local anesthesia, they won't experience any pain and very little if any discomfort. And many of the sedatives used also have an amnesiac effect so that the patient won't remember the procedures being performed.
IV sedation does require monitoring of vital signs, but the patient won't need help maintaining their breathing or heart function. And although the medication can be adjusted to reduce any lingering after-effects, a patient will still need someone to accompany them to and from their visit.
For lesser anxiety or nervousness, dentists sometimes prescribe an oral sedative to take just before a visit. This can help take the edge off your nerves and help you relax. With either method, though, sedation can help you overcome fear and anxiety and have a more pleasant treatment experience.
If you would like more information on IV sedation, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “IV Sedation in Dentistry.”
Bite problems aren't limited to teeth simply out of position. The problem could be some teeth aren't there—visibly, that is. They still exist below the gums and bone, but they've been crowded out and blocked from erupting. We call this condition impaction.
Any tooth can become impacted and affect the bite, but a person's smile suffers more if it involves visible front teeth. This is especially so if the teeth in question are upper canines or "eye teeth"—the smile doesn't look normal without these pointed teeth on either side of the central and lateral incisors.
Impacted teeth can also contribute to more than a cosmetic problem: they're more susceptible to abscesses (pockets of infection) or root damage both to themselves or neighboring teeth. To minimize these potential health issues, we'll often remove impacted teeth surgically (as is often done with wisdom teeth).
But because of their important role in not only appearance but also bite function, we may first try to assist impacted canines to fully erupt before considering extraction. It takes a bit of orthodontic "magic," but it can be done.
Before we can make that decision, though, we want to precisely locate the impacted teeth's positions and how it may affect other teeth. This initial evaluation, often with advanced diagnostics like CT scanning or digital x-rays, helps us determine if the impacted teeth are in a workable position to save. If they're not, we may then need to consider removing them and ultimately replacing them with a dental implant or similar restoration.
But if their position is workable and there are no other impediments, we can proceed with helping them erupt. To do this we'll have to first expose them by creating a small opening in the gums through minor surgery. We then bond a small bracket to the tooth, to which we'll attach a small chain that we then attach to orthodontic braces. This enables us to exert continuous pressure on the tooth.
Over time, the pressure coaxes the tooth to erupt. We may still need to apply other forms of orthodontics and cosmetic procedures, but using this procedure to rescue impacted canines can produce a healthier and more attractive smile.
If you would like more information on treating complex bite problems, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Exposing Impacted Canines.”
Millions of microorganisms call your mouth home—and while most are friendly, some are not. An invasive procedure like implant surgery can disrupt the mouth's soft tissues and allow disease-causing bacteria to enter the bloodstream.
This isn't necessarily a major concern if your immune system is sound—your body will move quickly to quash any developing infection. But if your body's defense is weak or compromised by other health conditions, an ensuing infection could cause you problems. In the case of a dental implant, a localized infection around it could lead to its failure.
The bone normally grows and adheres to the surface of an implant soon after it's placed, giving it the added strength and durability for which implants are best known. A bacterial infection, though, could impede bone integration and weaken the implant's hold within the jaw.
One way to avoid this is by treating patients at high risk for infection with an antibiotic before the procedure. In one recent study, researchers concluded that patients receiving a 2-gram dose of amoxicillin an hour before implant surgery helped reduce the risk of future implant failure.
But before taking this route, the dentist must first decide whether antibiotic pre-treatment might be more detrimental than beneficial to an individual patient. Antibiotics can cause side effects in certain people ranging from diarrhea to allergic reactions. Healthcare providers must also be prudent with administering antibiotics for the good of society in general—overuse can potentially give rise to antibiotic-resistant bacteria.
A number of healthcare associations highly recommend antibiotic pre-treatment for any dental patient with prosthetic heart valves, a history of infective endocarditis, a heart transplant and similar heart conditions. They also recognize patients with conditions like prosthetic joints, weakened immune systems, diabetics or other serious health problems could also benefit from antibiotic pre-treatment, but leave it to the physician's discretion on whether or not it's appropriate for an individual patient.
If you're planning to undergo implant surgery or a similar procedure and are concerned about infection, speak with your dentist about whether you would qualify and benefit from antibiotic pre-treatment. If appropriate, taking an antibiotic beforehand could minimize your infection risk.
If you would like more information on pre-surgical antibiotic treatment, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Implants & Antibiotics: Lowering Risk of Implant Failure.”