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Sedation Dentistry

High tolerance for Novocain

I have always had a high tolerance for Novocain, which has made all of my dental appointments a living nightmare. I’ve been avoiding the dentist for quite a few years as a result. I am in a position now where I cannot put it off any longer. I feel certain at least two of my teeth will need to be extracted. I just need to grab the bull by the horns. Do you have any recommendations for how to do this with the least amount of pain possible? Also, I’ve been reading up on tooth replacement options. Are dental implants as good as they are advertised to be?

Carla

Dear Carla,

woman smiling in the dental chair with her dentist standing nearby

I can actually help you on both counts here. Your dentist may not have been aware that when a person has a high resistance to Novocain, it is usually a sign that they have dental anxiety. The higher the anxiety, the greater the resistance to the numbing medication. This is because your metabolism kicks in and burns the medication off.

What you need for the numbing medication to actually work is a way to deal with the anxiety. Most people can’t just turn it on and off at will. Instead, you need a dentist who offers dental sedation options. I recommend oral conscious sedation for you. It is sometimes called sleep dentistry because it is so strong that you can sleep through the procedure. You will need someone to drive you to and from your appointment as well as stay with you for a few hours after your appontment until you are lucid and steady on your feet. You will have an anxiety-free/pain-free dental appointment.

As for dental implants, yes, they are the top tooth replacement available. Once completed, it will be like having healthy, natural teeth in your mouth again. Just make sure you see an experienced implant dentist. It is an advanced procedure. Ask them how many dental implant procedures they have done as well as what their success rate is. Don’t settle for anyting under 95%.

This blog is brought to you by Gilbert Dentist Dr. Matt Roper.

Porcelain Veneers

One Discolored Porcelain Veneer

My daughter had porcelain veneers placed a few months ago. All of them are doing fine except one, which seems to be turning dark, sort of a bluish color. We tried to get an emergency appointment at our dentists, but he said this wasn’t considered a dental emergency. She is terrified that this veneer will fall off while she is at university. What should we do?

Becky

Dear Becky,

Porcelain veneer being added to a tooth

While not technically a dental emergency, it could be considered an aesthetic emergency. I don’t know what is going on with this veneer because I have not examined her or seen any images of her porcelain veneers. However, based on the description of the darkening and bluish color, I am leaning toward thinking she has a leaky veneer. This is when the bond is breaking between the tooth and the veneer, allowing food and other bacteria to get in between the two. This is causing the darker color.

The bad news is that eventually this veneer will fall off as the bond breaks down. When it does fall off, it is fairly easy to bond it back on. Depending on where she is going to school, I am sure you can find a decent cosmetic dentist who will get her in and bond it back on.

If it remains but becomes so unsightly that it embarrasses her, then she can have the veneer removed and replaced. The dentist who originally did her porcelain veneers is ethically obligated to share all his notes and diagnostics with the whichever dentist she ends up going to see to have this repaired.

This blog is brought to you by Gilbert Dentist Dr. Matt Roper.

Teeth Whitening

Lemons for Teeth Whitening

Is it possible to use lemons to whiten your teeth? I read something on a website about this method. Before I tried it, I thought it would be best if I checked with a dentist before I did something I might regret.

Angie

Dear Angie,

Lemons

You were wise to write and ask. It is the citrus acid that is the problem here. A while back I looked into an at-home teeth whitening kit that someone asked me about. It contained a citrus acid rinse that the patient would start with. This would give the tooth a frothy appearance because the acid etches the teeth. Then, they would use a white pigment that they would attach to the teeth. For a short period the teeth would look much whiter. Unfortunately, because the citric acid etches the teeth, they will begin picking up stains fairly quickly and you will end up with teeth that look darker than when you started.

The second problem you will have as a result of using lemons is the damage that the citric acid will do to your enamel. Prolonged usage will thin out your enamel. Not only will this add to tooth sensitivity but will make you more susceptible to tooth decay.

My suggestion is to have your teeth whitening done safely, with a dentist. The materials they used are proven both safe and effictive. Additionally, they use a special tray custom fit to your bite. This will make sure the teeth whitening gel stays on your teeth while simultaneously protecting your gums.

This blog is brought to you by Gilbert Dentist Dr. Matt Roper.

Pediatric Dentistry

Discolored Baby Teeth

My five year old son has two front teeth that have become discolored. Is there something I can do? They used to be so white and beautiful. Will teeth whitening work?

Donna

Dear Donna,

Happy girl in pediatric dental chair

I don’t know of a dentist that would do teeth whitening on a child that young. In fact, he would probably resist it anyway because the whitening gel doesn’t exactly taste like a peppermint candy. Plus, he would have to keep the whitening trays on for a minimum of fifteen minutes. Good luck with that unless you want to sit by him the entire time. Additionally, messing with his teeth like that could cause them to fall out prematurely.

There is good news, though. Your son is five years old. It will only be a year or two before those front teeth fall out. Then, he will have nice shiny white adult teeth in there.

If it is surface stains and your regular toothpaste isn’t working, you could try Supersmile Toothpaste. This does a fantatic job in removing surface stains in a safe way. Do not use over-the-counter whitening toothpaste. These contain abrasives that actually damage tooth enamel, leading to more stains.

Other than that, make sure he is brushing after each meal and flossing his teeth before bed. It sounds like you really care about your son’s oral health, so you are probably already doing all of this.

Children at his age rarely pay attention to the appearance of their peer’s teeth. while kids like to make fun of each other, they are more likely to find something else to tease him about than some tooth discoloration.

If after his adult teeth come in there are still stains, then I would speak with his pediatric dentist to get to the root cause of the problem. With baby teeth, they’ll just let nature take its course.

This blog is brought to you by Gilbert Dentist Dr. Matt Roper.

Sedation Dentistry

What is the Fastest Way to Get Caught Up On My Son’s Dental Care?

My son has never been to the dentist even though he is nine years old. We’ve been broke for so many years. Now my husband has been offered a great job and it even has dental insurance. I am certain my son will need a TON of dental work (as will my husband and myself). What is the easiest and fastest way to catch him up on his needed care without traumatizing him. I remember hating the dentist as a child.

Patricia

Dear Patricia,

Happy girl in pediatric dental chair

I am glad you wrote and I can tell you care about your son! It’s always hard when their first experience with the pediatric dentist is to deal with decay, etc.. Ideally, their first visit is in their toddler years before there is a time for any problems to develop. That way they associate the dentist with fun. However, we realize the ideal is not always possible. You were in that situation, but are still trying to do the best you can for your son.

The good news is he may not need as much work as you think. If his genetics are working in his favor and he’s done a good job keeping up with his oral health care at home, you may just get lucky. I once had a woman who wasn’t ever able to go to the dentist growing up. Her first dental visit was when she married. She came in at twenty five years of age very nervous about what she’d find. Would you believe that woman didn’t have even one cavity! The entire office was amazed. It was a combination of superior oral care at home along with fantastic genetics when it came to her teeth.

The first thing I would recommend, because you do not know what type of shape your son’s teeth are in, is that you go to a pediatric dentist that also offers dental sedation. For his first appointment, you may want to have them use nitrous oxide so that he is relaxed. This is very mild sedation. He can be awake the whole time. Let’s say, however, that at your son’s first check up, they find a bunch of things that need to be worked on. Don’t panic. There is a way to do that without him feeling any pain whatsoever.

There is another type of sedation you can use for his treatment appointments called oral conscious sedation. This will make him very sleepy. In fact, he’ll sleep through the entire appointment which will allow dentists to get more work done during each appointment. This is the fastest way to get him caught up.

I hope this helps you.
This blog is brought to you by Gilbert Dentist Dr. Matt Roper.

Emergency Dentist

When a Dental Crown Feels Off

I had a root canal and dental crown put on a tooth a couple of years ago, but it has really been bugging me lately. It’s not pain, it just awkward. I know that makes absolutely no sense, but it is distracting. My dentist said he can replace it. I let him, but it did not really make a difference. I am not sure what to do. I feel like I’m going crazy. Have you encountered anything like this?

Andrew

Dear Andrew,

Man in pain, grabbing his cheek in need of emergency dental care.

When a dental crown is done correctly and nothing else is wrong that has been missed, you won’t notice the crown at all. It will just fit in with the rest of your teeth. That is not happening for you, so obviously, there is something amiss. You are not going crazy.

Believe it or not, I know a colleague, an advanced and experienced dentist himself, that went through something similar. He too was not being listened to by his dentist, so he switched. When he went in for his first appointment, he asked the hygienist to take a periapical x-ray in hopes of getting some more information. Boy did he!

It turned out that the tooth under his crown was halfway eaten from decay from the inside. He didn’t feel pain because that tooth had a root canal treatment done on it, just as yours did. It was a good thing he kept following up on this because that decay could have spread and caused a massive dental emergency with little warning.

The solution in his case was to have the tooth extracted and replaced with a dental implant. In your place, I would suggest that you go back to your dentist and ask for this same type of X-ray. Follow your gut and until you are comfortable, don’t back down. If he won’t follow up, find a different dentist.

This blog is brought to you by Gilbert Dentist Dr. Matt Roper.

Dental Bonding

Will Dental Bonding Fix My Peg Lateral?

I have one peg lateral tooth and it really bothers me. I hate the way it makes my smile look so I never smile in pictures. Someone mentioned to me that I might be able to get this fixed with dental bonding and I wanted to know if that was accurate before I get my hopes up too much.

Carly

Dear Carly,

What Are Peg Laterals?

I am going to answer your question, but not many readers will know what a peg lateral is, so I will start with that. Peg laterals are a genetic malformation of the developing tooth, which essentially means the tooth does not fully develop. As a result, the teeth look smaller than the other teeth and sometimes can even be pointy.

Can Dental Bonding Work?

Before and after dental bonding

For those who may not know what dental bonding is I have a picture directly above of one of its most common uses. Dental bonding uses a composite resin in order to replace missing tooth structures. It is used to fix chipped teeth, gapped teeth, divots, and much more.

In answer to your question, yes, dental bonding can fix the peg lateral. Your dentist will fill the area with the composite material that is shaded to match your tooth, then it will be appropriately shaped, adjusted, polished, and smoothed. If done correctly, it will match your bite perfectly.

You Have Options

Another solution for peg laterals is to have dental crowns placed over them. Often there is so much structure missing that you don’t even need a lot of tooth preparation. Because the crowns are made from porcelain, they are more stain resistant than the composite bonding. I’d advise the crown as your first option, but if you are opposed to them, then getting bonding done is a great second choice.

Make sure the dentist you go to have this procedure done is experienced in dental bonding and can show you before and after images of cases he’s done, similar to the photo I posted above. Dental bonding is a tricky procedure that has to be done free hand. There is no try in for the results the way you would get with dental crowns.

This blog is brought to you by Gilbert Dentist Dr. Matt Roper.

Pediatric Dentistry

Should My Special Needs Foster Teen Go to a General or Pediatric Dentist?

I’ve recently become a foster parent. I choose to work with special needs children. They give us training, but of course, there is no way to teach us about every single issue that comes up. What I am up against now is that he needs to see a dentist. He is sixteen years old and is pretty much a child in a man’s body because of his special needs. Of course, he doesn’t want to be treated like a child. I am trying to decide whether to take him to a pediatric dentist or a general dentist. My concern is he will be hurt or offended about the idea of a pediatric dentist but that his social skills and compliance issues, which aren’t bad except when his anxiety jumps through the roof, will be an issue with the general dentist. Do you have any recommendations for me?

Pricilla

Dear Pricilla,

Happy girl in pediatric dental chair

First, let me say right off that bat that I admire you for taking on foster children, and especially those with special needs. You are amazing. The first thing I would do is look up some websites of pediatric dentists that are in your insurance network. Show your foster son the pictures they have on the site and see what he thinks. If he gets excited about it, go to a pediatric dentist. If he complains that it is for little kids, you still have a good option.

There are general dentists who like to treat children. However, some are better at working with children than others. If a general dentist recommends bringing in children as young as two years old, then you can know they are good at working with kiddos and really enjoy them. If they want you to wait until the child is about five or six years old, then I would look for someone else.

Whichever you end up with, I have two additional recommendations. First, is that you let the office know ahead of time about his special needs. The second is that you set up a time for him to “tour” the dental office and meet the staff. That way it won’t be a totally new experience for him when he goes in for his dental care.

This blog is brought to you by Gilbert Dentist Dr. Matt Roper.

Teeth Whitening

Crest 3D Advanced White Toothpaste Gunk

I don’t quite know how to explain this but will do my best. I’ve been wanting to whiten my teeth but thought I would just try the whitening toothpaste first to see what type of results I can get. It’s leaving this weird white gunk on the inside of my lips about ten minutes after I use it that makes it look like my skin is ready to peel off. Is this common and part of the process?

Kelly

Dear Kelly,

teeth whitening trays
Professional teeth whitening trays

Most whitening toothpaste that you purchase over the counter does not whiten your teeth the way that professional teeth whitening does. Your dentist would provide you with a gel that will penetrate the tooth and oxidize it from the inside out. Whitening toothpaste uses abrasives that scratch the surface of your teeth and scrub the surface stains off. While this can remove the stains temporarily it does damage your enamel which will cause it to pick up more stains at a faster rate.

I think the reason for the peeling skin you are experiencing is sodium lauryl sulfate, an ingredient found in this toothpaste. It has been known to produce side effects such as inflammation, skin irritation, and sloughing of oral tissues. I would stop using this because you are obviously having a reaction to it.

If you want to try a whitening toothpaste, I recommend you use Supersmile Toothpaste. This uses a protein pellicle to remove surface stains and will not damage your teeth. Bear in mind, that it will only remove surface stains, which is all that a toothpaste can do.

If you have years of stains on your teeth, you are better off with professional teeth whitening. Though it costs a little more, the results are massively better than anything else you’d get with an over the counter product, including something like whitestrips. If cost is the main issue, talk to your dentist and he or she may be willing to work with you on payment options.

This blog is brought to you by Gilbert Dentist Dr. Matt Roper.

Sedation Dentistry

Sedation Dentistry and Type-2 Diabetes

If I have type-2 diabetes can I still use sedation dentistry? I have to get my wisdom teeth out and I’m a huge baby when it comes to the dentist. He told me not to worry because I can be sedated. It wasn’t until a few minutes ago that I realized my diabetes might be a problem. I haven’t found anything online, but did come across your blog. I have a glucose monitor that keeps my blood sugar steady, but I do need to eat regularly. I just read the pamphlet that said not to eat the morning of the procedure. That will be a problem for me. Will any of this mess up my sedation?

Cassie

Dear Cassie,

woman asleep in the dental chair from dental sedation

I am so sorry you are having to deal with this. Diabetes brings so many worries into a person’s life. The good news is having sedation dentistry done, will not have to be one of them.

It sounds like your diabetes is being well controlled with your glucose monitor and you stay on top of things. That is wonderful and will be very important because of the impact diabetes has on your ability to heal.

My recommendation for you will be oral conscious sedation. This is sometimes called sleep dentistry because you are so relaxed you sleep through your appointment. Unlike general anesthesia, you will be okay to eat before the procedure with this type of sedation. It is administered by a pill. You will need someone to drive you to and from your appointment, as well as to stay with you for several hours after your procedure. Whoever you choose as your caregiver will need to make sure you are completely lucid and steady on your feet before leaving you on your own.

When you arrive at the office, all of your vitals will be recorded. Make sure to let them know your most recent HbA1c levels.

You probably already know this but diabetes can be hard on teeth and gums, so make sure you keep up with your regular check ups and appointments. You mentioned being a baby about the dentist. Don’t feel too bad about that. Dental anxiety is quite common. You could ask for some nitrous oxide for your regular, simple appointments. This is a gas that will relax you and take the edge of the appointment. It’s not as demanding as oral conscious sedation and you will be fine to drive yourself home afterward.

This blog is brought to you by Gilbert Dentist Dr. Matt Roper.