Dental visit anxiety is a serious problem: Half of all Americans admit to some level of dental fear, while 15% avoid dental care altogether due to acute anxiety. The harm this can cause to dental health is incalculable.
But dentists have a number of sedation techniques that can relax anxious patients and allow them to receive the care they need. Although often used together, sedation is slightly different from anesthesia, which aims to deaden pain sensation. The aim of sedation is to calm the emotions and state of mind.
Sedation isn't a new approach: Physicians have used substances like root herbs or alcohol to relieve anxiety since ancient times. Modern dentistry also has a long history with sedation, dating from the early 1800s with the first use of nitrous oxide gas.
Modern dental sedation has expanded into an array of drugs and techniques to match varying levels of anxiety intensity. At the milder end of the scale are oral sedatives, taken an hour or so before a dental appointment to produce a calmer state. This may be enough for some patients, or it can be used in conjunction with nitrous oxide.
For those with more intense anxiety, dentists can turn to intravenous (IV) sedation. In this case, the sedative is delivered directly into the bloodstream through a small needle or catheter inserted in a vein. This causes a quicker and deeper reaction than oral sedatives.
Although similar to general anesthesia, IV sedation does differ in significant ways. Rather than unconsciousness, IV sedation places a patient in a “semi-awake” state that may still allow them respond to verbal commands. And although the patient's vital signs (heart rate, breathing, blood pressure, etc.) must be monitored, the patient doesn't need breathing assistance as with anesthesia.
There's one other benefit: The drugs used often have an amnesic effect, meaning the patient won't remember the treatment experience after recovery. This can be helpful in creating more pleasant memories of their dental experience, which could have its own sedative effect in the future.
Whether oral, gas or IV, sedatives are a safe and effective way to calm dental fears during treatment. That could help someone with anxiety maintain their oral health.
If you would like more information on reducing dental anxiety, 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.”
Some moviegoers have been known to crunch popcorn, bite their fingers or grab their neighbor’s hands during the intense scenes of a thriller. But for one fan, the on-screen action in the new superhero film Black Panther led to a different reaction.
Sophia Robb, an 18-year-old Californian, had to make an emergency visit to the orthodontic office because she snapped the steel wire on her retainer while watching a battle scene featuring her Hollywood crush, Michael B. Jordan. Her jaw-clenching mishap went viral and even prompted an unexpected reply from the actor himself!
Meanwhile, Sophia got her retainer fixed pronto—which was exactly the right thing to do. The retention phase is a very important part of orthodontic treatment: If you don’t wear a retainer, the beautiful new smile you’re enjoying could become crooked again. That’s because if the teeth are not held in their new positions, they will naturally begin to drift back into their former locations—and you may have to start treatment all over again…
While it’s much more common to lose a removable retainer than to damage one, it is possible for even sturdy retainers to wear out or break. This includes traditional plastic-and-wire types (also called Hawley retainers), clear plastic retainers that are molded to fit your teeth (sometimes called Essix retainers), and bonded retainers: the kind that consists of a wire that’s permanently attached to the back side of your teeth. So whichever kind you use, do what Sophia did if you feel that anything is amiss—have it looked at right away!
When Black Panther co-star Michael B. Jordan heard about the retainer mishap, he sent a message to the teen: “Since I feel partly responsible for breaking your retainers let me know if I can replace them.” His young fan was grateful for the offer—but even more thrilled to have a celebrity twitter follower.
If you have questions about orthodontic retainers, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “The Importance of Orthodontic Retainers” and “Bonded Retainers.”
If you know anything about dental disease, then you know bacteria ranks high on the Usual Suspects list. Tooth decay gets its start from acid produced by bacteria; periodontal (gum) disease is often triggered by bacteria that infect the gums.
But the particular strains of bacteria that can cause dental disease are a small percentage of the 10,000-plus species inhabiting your mouth. The rest, numbering in the millions, are fairly benign—and some, as recent research is now showing, play a sizeable role in protecting your teeth and gums against other malicious bacteria, fungi and viruses.
Dr. Aaron Weinberg, a dental researcher at Case Western Reserve University, has been investigating these protective bacteria for many years. His research began with a scientific conundrum: although the mouth has one of the highest densities of bacterial populations, wounds in the mouth tend to heal quickly.
The answer, he believes, originates with human beta defensins (hBDs), substances produced by cells in the lining of the mouth that are natural antibiotics against disease. He has found that certain bacteria actually help stimulate their production.
This isn't just an interesting fact about the body's defenses and immune system. During his research, Dr. Weinberg was able to identify the agent within the bacteria that triggered hBD production. This has opened up a new line of research: The possibility that harnessing this agent might help assist in our treatment of infection by boosting the body's defensive capabilities.
For example, researchers have proposed including a form of the agent in toothpaste. Over time, this might stimulate hBD production and guard the mouth against the development of dental diseases like gum disease.
These possibilities all come from our increasing knowledge and understanding of the microscopic world around us, especially in our mouths. Bacteria are much more complex than we may have realized—not all are our enemies, and some are definitely our friends. Learning more may open up new ways to keep our teeth and gums healthy.
What makes a beautiful smile? Beautiful teeth, for sure. But there's also another component that can make or break your smile, regardless of your teeth's condition: your gums. Although their primary function is to protect and stabilize the teeth, your gums also enhance them aesthetically by providing an attractive frame.
But just as a painting displayed in an oversized frame can lose some of its appeal, so can your smile if the size of your gums appears out of proportion with your teeth. Normally, a smile that displays more than four millimeters of gum tissue is considered “gummy.”
There are some things we can do to improve your gum to teeth ratios. What we do will depend on which of the following is the actual cause for your gummy smile.
Excess gum tissue. We'll start with the obvious: you have excess gum tissue that obscures some of the visible tooth crown. We can often correct this with a surgical procedure called “crown lengthening,” which removes some of the excess tissue and then reshapes the gums and bone to expose more teeth length.
Teeth that appear too short. The problem may not be your gums — it could be your teeth appear too short. This can happen if the teeth didn't erupt fully, or if they've worn down due to aging or a grinding habit. One option here is to “lengthen” the tooth cosmetically with veneers, crowns or other bonding techniques.
Higher lip movement. Rather than your teeth and gums being out of size proportion, your upper lip may be rising too high when you smile, a condition known as hypermobility. One temporary fix is through Botox injections that paralyze the lip muscles and prevent their movement from overextending. We could also use periodontal surgery to perform a lip stabilization procedure that permanently corrects the upper lip movement.
Overextended jaw. Your gums may seem more prominent if your upper jaw extends too far down and forward. In this case, orthognathic (jaw straightening) surgery might be used to reposition the jaw relative to its connection with the skull. Setting the jaw up and back in this way would reduce the prominence of the gums when you smile.
As you can see, treatments range from cosmetic techniques to moderate surgical procedures. A full dental exam will help determine which if any of these measures could reduce gumminess and improve your smile.
If you would like more information on correcting gummy smiles, 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 “Gummy Smiles.”
One of the best restorative options for slightly deformed, misaligned or stained teeth is a porcelain veneer. Composed of thin, laminated layers of dental material, the veneer is bonded to the outside of the tooth to transform both its shape and color to blend with other natural teeth.
Veneers are more than a technical process — they’re works of art produced by skilled artisans known as dental lab technicians. They use their skills to shape veneers into forms so life-like they can’t be distinguished from other teeth.
How technicians produce veneers depends on the material used. The mainstay for many years was feldspathic porcelain, a powdered material mixed with water to form a paste, which technicians use to build up layers on top of each other. After curing or “firing” in an oven, the finished veneer can mimic both the color variations and translucency of natural teeth.
Although still in use today, feldspathic porcelain does have limitations. It has a tendency to shrink during firing, and because it’s built up in layers it’s not as strong and shatter-resistant as a single composed piece. To address these weaknesses, a different type of veneer material reinforced with leucite came into use in the 1990s. Adding this mineral to the ceramic base, the core of the veneer could be formed into one piece by pressing the heated material into a mold. But while increasing its strength, early leucite veneers were thicker than traditional porcelain and only worked where extra space allowed for them.
This has led to the newest and most advanced form that uses a stronger type of glass ceramic called lithium disilicate. These easily fabricated veneers can be pressed down to a thickness of three tenths of a millimeter, much thinner than leucite veneers with twice the strength.Â And like leucite, lithium disilicate can be milled to increase the accuracy of the fit. It’s also possible to add a layer of feldspathic porcelain to enhance their appearance.
The science — and artistry — of porcelain veneers has come a long way over the last three decades. With more durable, pliable materials, you can have veneers that with proper care could continue to provide you an attractive smile for decades to come.
If you would like more information on dental veneers, please contact us to schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Porcelain Veneers.”
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