Tag Archives: sleep dentistry

Porcelain Veneers

Will Peroxide Help My Porcelain Veneers

I had a set of porcelain veneers done overseas. They look okay, but my gums have been red and swollen from the beginning. The dentist told me that was normal and would go down in a few days. It hasn’t. In fact, it’s been well over a month and my gums are miserable. Do you know if I did a peroxide rinse if it would help with the swelling and tenderness? If so, will it damage the veneers?

Greg

Dear Greg,

An image of a porcelain veneer being held up to a tooth.

While peroxide will not damage your porcelain veneers, it will not solve your problem. In this case, the problem is the veneers themselves. I know you likely went out of the country in order to save money on your smile makeover. This is often called dental tourism. It works sometimes, but not as often as is safe for people to risk.

Your dentist lied to you. The redness and swelling is not normal. Because your underlying problem is the veneers, the first order of business is to find the underlying cause of the problem. If you don’t fix that, not only will you have the irritation, but it will lead to gum disease. Here are a few possibilities:

  • The margin between your porcelain veneers and your teeth are supposed to be completely seamless as well as smooth. Without that, there will be an overhang. It will catch food debris. This will become a breeding ground for bacteria and infection.
  • The veneer can be overcontoured at the gumline. That means there is an extra bulge in the veneers at the gumline, that also traps food debris and bacteria.
  • Your dentist could have left hardened cement that hasn’t been cleaned off the tooth. This will leave a very rough surface there, which will cause irritation. This one would be the easiest to solve.

This blog is brought to you by Gilbert Dentist Dr. Matt Roper.
Click here to learn about sleep dentistry.

Sedation Dentistry

Is Dental Sedation Safe?

I keep reading about how dental sedation can help someone with like me with severe dental anxiety. I was about to schedule an appointment, but then I read about a case where someone died because of sedation and the dentist was blamed. Is dental sedation really safe?

Emma

Dear Emma,

woman asleep in the dental chair from dental sedation

I think I know of the case you are talking about. In fact, if it is the case I’m thinking about (and it’s the only one I’ve heard of in years) a colleague of mine was actually called as an expert witness in this case. Before I go over the case for those who are unaware of what happened, I want to assure you that dental sedation is completely safe.

The Wrongful Death Case

The patient was a 270-pound female with extreme dental anxiety. I do not mention her weight as a means of being cruel. It is actually quite relevant to the case. She was given 1.0 mg of Triazolam. This medication is commonly used for dental oral conscious sedation. This is a pill, which the patient is instructed to take at a certain time before their appointment and will be taking affect by the time the patient arrives. When this patient arrived, she showed no signs of there being any issue. She entered without needing assistance and was able to communicate well.

However, once she was given the local anesthetic, something every dental patient is given during a procedure even if they don’t use sedation, things changed. She quickly became unresponsive. She was taken to a hospital where she later died.

The Iowa dental board asserted that the dentist gave the patient double the recommended dose of the sedation medication. The typical recommendation is 0.5 mg and she was given 1.0 mg. They accused the dentist of overdosing the patient. Here is why that is absolutely ridiculous and I’m dumbfounded as to why the board would even suggest it.

In order to establish the safety of a medication, the recommended does isn’t the standard for evaluation. This is because some drugs have a very narrow safety margin and even giving a tiny amount over the recommendation is dangerous, but for other drugs (like
triazolam) there is a HUGE safety margin.

I won’t get too technical, but if you want all the technical details please write again and I will give you all the data. The maximum safe dose of a drug is the LD-50, which is when 50% of the animals in the clinical trial died. Tested on mice, which are extremely small compared to even a normal sized human, the recommended does is no greater than 1,000 mg/kg. When you are talking about a woman who is 270 pounds, which is a little over 120 kg. That would mean she was safe to have up to 120,000 mg of the medication.

Obviously, the dentist didn’t give her anywhere near that. There was no overdose from the dentist. The coroner didn’t give an official cause of death, which is odd. The patient did have a history of drug use, so (and please understand I’m just wondering about this next statement, I have no documentation) I wonder if she’d taken something else along with the medicine her dentist gave her or if given her physical condition combined with the stress it was just too much for her.

Bottom line, dental sedation is very safe. In fact, patients with dental anxiety find that it completely changes their life for the better and they are finally able to get the dental care they need.

This blog is brought to you by Gilbert Dentist Dr. Matt Roper.
Click here to learn how he tries to keep dental care affordable.

Emergency Dentist

A Tooth Infection is Dangerous

I had a molar break about a month and a half ago. I did not have money to deal with it. Recently, I’ve been having pains in my cheeks, sinuses and temple on the side of the mouth with the broken tooth. This morning I woke up with pain in my neck, also on the side of the tooth. Do you think this is related? My sister thinks it is an infection. Is this dangerous? I tend to avoid dentists both because of the cost and the fact that I have never had a pleasant experience at the dentist. So, if there is an antibiotic I can use, I’d rather go that route.

Analisa

Dear Analisa,

Woman holding her jaw from a toothache

I am sorry this is happening to you. Before I talk about your tooth infection, I want to let you know ahead of time that I do have a solution for your negative experiences at the dentist. I want you aware of that so you do not panic.

Yes, you do have a tooth infection and it is spreading. It is dangerous. Yours has already spread up to your temple and your neck. Here are some things that can happen if it is not treated, all of which are life-threatening. It can spread to your brain. Your neck can swell up closing your breathing passage. It can continue past your neck and spread to your heart. I know it sounds crazy, but people die every year from an untreated tooth infection.

Unfortunately, an antibiotic won’t help. The most it can do is temporarily stave off the infection. It will not cure it. This is because it can only reach the part of the infection that has spilled out of your tooth. The only way to treat this is either with a root canal treatment or a tooth extraction.

Both of those probably sound very scary to you. I am going to recommend, especially because of your history, that you see a sedation dentist. They can provide you with a pill that will completely relax you during your treatment. In fact, many people call it sleep dentistry because you can sleep through your treatment if you want to.

Please don’t put off getting this tooth treated. It is a dental emergency and I do not want you turning into another statistic.

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

Sedation Dentistry

I Want to Get ALL My Dental Work Done

I have avoided the dentist for years, but my mouth has been hurting so much that I went in. I need a LOT of work done. A LOT. I know it is my own fault, but I’ve never had a pleasant dental appointment in my entire life. I’ve decided it is time to man up. I want to get as much of this done at once as possible. So, give it to me straight. How much can I get done in one day?

Troy

Dear Troy,

woman asleep in the dental chair from dental sedation

You are not alone in your dental anxiety. Many of those anxieties start because they had a horrible experience at the dentist when they were children. This often happens because parents don’t think very young children need a dentist and wait until there is a problem before they bring them to the pediatric dentist. Then, their first experience in the dental chair is a painful and frightening one. That’s enough to keep anyone away!

I have a couple of pieces of good news for you. One, there is a way for you to have an anxiety-free/pain-free dental appointment. Two, there is a way for you to get more work done than would normally be possible in one appointment. Even better, they both have the same solution.

The best thing for you to do is to see a sedation dentist. They can prescribe you a medication that will completely relax you. I recommend that you find a dentist who offers oral conscious sedation. With this medication you will be able to sleep through your appointment if that is what you choose to do. It is so strong. The only real downside is that it’s strength means you will need someone to drive you to and from your appointment, as well as stay with you for a few hours after your appointment.

Dentists who offer sedation are more compassionate with their patients who have dental anxiety than most other dentists. Plus, because you are so relaxed, or even asleep, you are able to tolerate more work done in each sitting. Though, you need to know up front that dentists vary in the amount of work they are willing to do in each appointment.

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

Dental Emergency

Should I Wait to Extract an Impacted Wisdom Tooth If It Isn’t Bothering Me?

I have four wisdom teeth. Two are impacted. The one on the top right is bothering me. The one on the bottom left does not. I’m having the one on the top right extracted. My dentist asked if I wanted to extract the other impacted tooth, but warned me the root went past the nerve. He said we could leave the root and that way there’d be less chance of a problem. I can’t decide what to do. That bottom tooth does not bother me so I wonder if I am borrowing trouble by removing it. Is there a standard for this situation?

Miles

Dear Miles,

An illustration with four examples of impacted wisdom teeth.

The most important rule of thumb is to take an impacted wisdom tooth out when you are young. When you are in your late teens to twenties, everything is relatively pliable. The older you get, the greater the risk of complications. By the time you are thirty years old, your risk of complications doubles. Then it doubles again every few years after that.

An impacted tooth almost always becomes a problem at some point. What you don’t want is to wait until there is a dental emergency to have to deal with it. You will have far less control over the circumstances at that point. Leaving the tooth root is not a bad idea. However, I am not in favor of leaving the entire root. I would suggest you just have him leave the root tip that is near the nerve. You’ll reduce the chances of having trouble with it if the root tip is small.

For dental procedures such as yours, where the patient can feel very anxious, I recommend using oral conscious sedation. This will allow you to get the needed work done in an anxiety free/pain free way. In fact, you will be so relaxed that you could sleep through the entire procedure if you wanted to.

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

Sedation Dentistry

Dentist or Oral Surgeon for Denture Surgery

I have always had a fear of the dentist. This really kept me from getting my teeth taken care of. I generally only ended up going in when there was a dental emergency. I know that wasn’t the best way to handle things, but what is done is done. I am now to the point that I need dentures. Most of my teeth are either missing, broken, or decayed. In that case, should I go to an oral surgeon or a dentist to have the remainder of my teeth extracted?

Bruce

Dear Bruce,

Image of dentures

I would go to a dentist who can do both the tooth extractions and the dentures. Most general dentists do pre-denture surgery. It is not a difficult thing to do. I would call to several offices and ask them what the dentist’s normal procedure is. Do not hint to them what you are looking for, just ask about their denture procedure.

Because you struggle with dental anxiety, I am going to suggest that you see a dentist who offers oral conscious sedation. This is sometimes called sleep dentistry because most patients are so relaxed they just sleep through the entire procedure. This will ensure you do not have to have any fear or pain during your procedure.

The reason for using a dentist instead of oral surgeon is to get the best fit possible for your denture. An oral surgeon won’t be as familiar with designing and fitting dentures, as a result they don’t know the things that can be done during the extractions to make this work better.

You should be aware that even the best fitting dentures will reduce your chewing capacity by 50%. There are also long-term consequences, including shrinking of the jawbone. Dental implants can help with both of these issues and I recommend discussing this with your dentist before making any final decisions on your treatment plan.

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

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.

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.

Sedation Dentistry

Can a Diabetic Use Dental Sedation?

I have type-2 diabetes and am about to have my wisdom teeth out. I understand that there is dental sedation available for this procedure. Will my being diabetic be a problem? I have a glucose monitor and my levels have been staying in a healthy range. One of the things I worry about is the ability to eat before a procedure because that affects my levels significantly. Am I a candidate for dental sedation or will I have to tough this thing out the hard way?

Karen

Dear Karen,

woman asleep in the dental chair from dental sedation

I am glad you wrote. Diabetes sure does make life more complicated, doesn’t it? The good news is this should not keep you from having dental sedation. Your levels are staying steady and it sounds like you keep up with your care. My suggestion is you ask for oral conscious sedation. This is administered by a pill but is quite strong. Not only will you be able to eat before your procedure, it will be important for you to do so. Also, don’t skip your insulin dose, though I doubt you would. If you didn’t have a monitor, we’d ask you to bring a glucometer, but your meter will make monitoring your levels during the procedure simple.

With oral conscious sedation, you will need a driver to get you to and from your appointment as well as to stay with you for a few hours afterward until you are lucid and steady on your feet. You may want to pick that person well in advance and make sure to train them in your diabetic care so they are prepared for any eventualities.

Other than that, you will want to keep a close eye on your healing and surgical site. It is harder for diabetics to heal, so stay on top of all your post-operative care.

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

Dental Implants

I Can Smell My Husband’s Dental Implants

My husband just received six dental implants for his implant overdenture. He is currently wearing a temporary acrylic denture while we have the porcelain ones made. The big problem is that I can literally smell his dental implants and it is making me gag. It almost smells like vomit. I’ve even had to start sleeping on the couch. I would like him to trade out the metal implants he has for the metal-free zirconia implants, but his dentist says there is no way what I am smelling is his implants. I think this dentist just does not want to admit the metal implants are outdated because he does not offer the zirconia ones and we’d have to go elsewhere to get them replaced. What can I tell my husband that will help him understand how far superior the newer ones are so he will be willing to replace them?

Jade

Dear Jade,

metal and zircomia dental implants

I can sense you are frustrated. The truth is, while there is something causing that smell, I don’t believe it is his dental implants. Titanium is inert, so it will not have a smell. I bet if you asked his dentist to allow you to smell one that he has in his office, he would let you. My guess is the smell is coming from something not getting completely cleaned out of his acrylic dentures. He’s probably got some food or bacteria trapped in there. There are a couple of options for dealing with this. He can get something like a Waterpik that will help him get more of the food out. He can also rinse with peroxide, which kills bacteria and debris. I do not recommend using the peroxide more than that or he could get a yeast infection. The peroxide will not distinguish between good and bad bacteria.

I also don’t think you want him to replace your husband’s dental implants unnecessarily. Here’s why. The implants will have to be surgically removed. When they are removed, they will take some bone structure with them. In order to replace them with new implants, he’ll need to first get new bone grafted into that area with a bone grafting procedure. Then, after that heals, he will need another surgery to have new implants placed. Then, another waiting period for the osseointegration to take place and finally his dentures.

That is a lot of unnecessary extra surgeries for your husband. Plus, you take a huge risk of the second group of implants not being successful. These are working. Get to the real cause of the smell and don’t go through all those unnecessary procedures.

This blog is brought to you by Gilbert Dentist Dr. Matt Roper.
Click here to read about sleep dentistry.