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Discouraged By Teeth

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I need some advice. I did not get to go to the dentist growing up. My parents were quite poor. Don’t get me wrong, they did their best and made sure we had food, clothing, and an education. Dentistry was just one thing they couldn’t do. When I finished college and got a job, it had dental insurance. I was so excited. However, since then, it has been non-stop work on my teeth. Whenever one gets fixed another one falls apart. I assure you I brush twice a day and use floss once a day. I even go to the dentist every six months even though every appointment terrifies me and feels like torture. None of it seems to help. Now my dentist says it is pointless. He’s suggesting that I just extract all of my teeth and get dentures. I’m only 27! I really don’t want to look like a grandma. I’ve been crying since my appointment. I’m discouraged by my teeth, but I’m not ready to give them up completely. Is there any other option for me?

Stacey

Dear Stacey,

Woman with a hand covering her mouth

I would not give up on your teeth yet. Dentists have different tolerances levels off the efforts they will put in to save teeth. Some dentists will pull out all the stops to save your teeth. Others prefer to just pull the teeth out. Then, you have the dentists who assume if your teeth have a lot of problems it means you don’t care about them and don’t take care of them. I think those dentists do their patients a huge disservice. Here’s why.

Brushing and going to the dentist are not the only factors in healthy teeth. While, yes, there is a genetics issue as well, I have found that most patients (and too many dentists) do not realize that snacking is a huge factor in tooth decay. One of the biggest allies you have in the battle against decay is your saliva, which has minerals specifically designed to fight bacteria. If you are a frequent snacker, that means there is not enough time for your saliva to do it’s job effectively because it is spending too much time dealing with the snacks.

While you are doing great with your oral hygiene, see if cutting back on your between meal snacks will help. I’m also going to suggest you find a different dentist. Any dentist who suggests to a 27 year old that they should get removable dentures is not the best dentist in my book. Within ten our so years, facial collapse will kick in and you’ll no longer have enough jawbone left to even retain your dentures.

I suggest you first get a second opinion on these teeth. Chances are very good they can be saved, especially as diligent as you have been. If on the off chance they cannot, don’t panic, but don’t get removable dentures. Instead, I would get implant supported dentures. These are the closest to having healthy, natural teeth in your mouth. They’re completely secure and you will not have to worry about facial collapse. If you get them done by an expert cosmetic dentist, they will also be beautiful.

One other thing. There is no reason in the world you should be suffering through dental appointments. As I think you need a different dentist anyway, I would like to suggest you see a sedation dentist. They can provide you with a medication that will give you a pain-free/anxiety-free appointment.

This blog is brought to you by Hilton Head Cosmetic Dentist Dr. Bonnie Rothwell.

Dental Sedation for a Recovery Addict

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I am desperately trying to get my life back together. I’d been living on the streets as an addict. One day, the little kid came by and asked if I was hurt. When I said, “No,” he asked then why was I laying on the sidewalk. For some reason the shame that overcame me at that very moment was just the kick in the rear I needed. I contacted my sister who took me in and has been helping me get cleaned up. I’ve got a job and am on a methadone treatment program to make it easier for me to work while weaning off the methadone. My employer hired me but did tell me privately that if I wanted to get promoted, I would have to get my teeth tended to. He wasn’t being rude, my teeth are a wreck. I was actually surprised he hired me given my background and appearance. He gave me a job in the back, but if I want to interact with customers, I will need to improve my appearance. The problem I am having is the massive amount of painful work I need. I’d like to get it done, but not only is no one willing to give me sedation, they’re not even willing to give me post-operative pain medication. I have been up front with every one of them and told them about my recovery. I gave him the name and number of my clinic and written permission to speak to the clinic’s doctor and my counselor. I have pretty bad dental anxiety and whenever I have done treatment without sedation it was a horror story. Is there any way to get the treatment I need?

Kevin

Dear Kevin,

A partial image of someone asleep from dental sedation

First, I want to say that you are to be congratulated for all the progress you have made and the steps you are continuing to take. You have much to be proud of. I am sorry for the trouble you have encountered in trying to get the treatment you need. I don’t think all of them are just judgmental. Especially recently, both dentists and medical doctors have lived in fear of the DEA (Drug Enforcement Administration). Every little activity is scrutinized and no one wants to do anything that could draw their attention. I know of two dentists that suffered greatly just because they were compassionate. It’s happening more and more. Unfortunatley, it is the patients in legitimate difficulties that suffer.

If you are persistent in your search, I am sure you will find a dentist whose compassion overrules their fear of the DEA. Start by calling dentists who advertise as sedation dentists. They tend to understand fearful patients more than most. Be upfront with them, as you have been thus far, and ask if they can help you with both sedaton and post-operative pain control. I think you will find someone who can help you.

This blog is brought to you by Hilton Head Cosmetic Dentist Dr. Bonnie Rothwell.

Dental Sedation for Wisdom Tooth Extraction

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My 21 year old daughter needs a wisdom tooth extracted. I don’t know if dental sedation will be enough to make this a tolerable situation for her or if we need to have this done with anesthesia. I will be honest that anesthesia terrifies me but I don’t want my daughter in agony. What is the best course of action for her?

Caroline

Dear Caroline,

Woman resting in a dental chair from dental sedation

 

Though I obviously do not know all the circumstances of your daughter’s particular case, unless there is a highly unusual situation with her wisdom tooth, there should be no reason why she could not just use dental sedation. I recommend oral conscious sedation for her. She will be completely relaxed and is very likely to just sleep through the appointment altogether.

Especially at your daughter’s age, wisdom tooth removal is much easier. The bone is still relatively pliable because there has not been much cementum accumulation on the roots. She should have not problems with this procedure.

It is understandable that you want to avoid anesthesia. There are always additional risks with that. However, I get the feeling you are concerned that your decision not to do anesthesia means that you are putting her through more pain. I want to assure you that is not the case.

In fact, most patients who have gone through oral conscious sedation do not even remember the procedure. Even after the extraction is completed, she will need you to stick around with her. She’ll be loopy and will need someone with her until she is lucid and steady on her feet again.

I can tell you will not mind doing that at all. I just wanted to give yu the heads up so you could plan your day accordingly. You can just plop her on the couch and let her binge watch her favorite shows or just nap away.

This blog is brought to you by Hilton Head Cosmetic Dentist Dr. Bonnie Rothwell.

Veneers Keep Popping off and I Don’t Remember My Appointments

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I need some advice. I’ve been a tooth grinder and my dentist said the only way to fix it was porcelain veneers. That was so expensive! To protect them, I also now wear a nightguard. The problem I am having is they keep popping off. I don’t know what to do. My dentist is good enough to glue them back in every time, but that is more time off work. Plus, I’m constantly terrified of them coming off because the tooth underneath the veneers is a tiny little nub. The last time, they came off at career day at my son’s school. It was humiliating both for me and my son. My dentist now says he wants to try something else, but what worries me about this is for every appointment thus far they have said sedation is necessary. I don’t remember anything from my appointments and I am out for a complete day. What do you recommend I do?

Carolyn

Dear Carolyn,

What a disaster! I am sorry this happened to you. It appears that not only do you have an incompetent dentist, but an unethical one as well. You keep saying porcelain veneers, but what your dentist gave you were porcelain crowns. Here is how I know this.

Side by Side tooth prep comparison

If you were getting porcelain veneers, the tooth prep would be more like what you see on the right. What you described is more like the photo on the left, with the little nubs. Some dentists who cannot do porcelain veneers will suggest porcelain crowns as an alternative. It appears that yours just straight out lies and says he’s giving you veneers when he is not.

Worse than that, your dentist does not even seem to be able to do your porcelain crowns correctly. This is mystifying to me because dental crowns are one of the first things we are taught in dental school. Most dentists go their entire careers without one crown falling out, let alone the number you are dealing with. Quite frankly, I am not sure how he even graduated.

Another thing that bothers me is the dental sedation. If you were getting porcelain veneers, all you would need is a local. However, you received porcelain crowns. Now, some people with severe dental anxiety might benefit from sedation in these types of cases, but you never even mentioned dental anxiety. It was your dentist who said this was necessary.

I think your dentist should pay to have this fixed by another dentist. Unfortunately, because you were given dental crowns, you are now stuck with dental crowns. That tooth structure he ground down will not come back. But, you can get a beautiful, functional smile that will stay put. In your place, I would go to a dentist that is AACD accredited. These are the best cosmetic dentists in the country. Again, your dentist should cover this expense. If not, you can go to the dental board and even file a lawsuit. That should sober your dentist up.

This blog is brought to you by Hilton Head Cosmetic Dentist Dr. Bonnie Rothwell.

Dentist or Oral Surgeon for Dentures

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I am 68 years old and always had a terrible fear of the dentist because of a traumatic experience in my teen years. Because of that, my teeth are an absolute mess and need to come out. I’m not sure I know how to approach this. If you need dentures, do you go to a dentist or an oral surgeon to remove the remaining teeth?

Fred

Dear Fred,

Hilton Head Affordable Dentures

I would look for a dentist who can do both the surgical removal of your teeth as well as the dentures. This will give you the best outcome. I’m going to also suggest, though it is completely up to you, that you look into snap-on dentures. This gives you two dental implants that can anchor your dentures a little bit to your jaw. This way you won’t have to worry about them slipping around. Obviously, the more dental implants the better and more secure they are, but two is enough to keep them in.

Because of the dental anxiety you mentioned, I think when you look for the dentist to do this, you find one who offers oral conscious sedation. This is will give you a pain-free and anxiety-free procedure. It is administered by a pill but is quite strong. In fact, some people have dubbed it sleep dentistry because you can sleep through the entire procedure. I honestly wish someone had told you about sedation dentistry earlier because it could have helped you with your fear of the dentist and saved your teeth. Either way, at least you can go to the dentist this time knowing it will not be the horrible traumatic experience you had in the past.

One last thing to check before committing. You are still young and I want you to have a smile you are proud of. Ask to see some of their “after” pictures of dentures they’ve done. You want a dentist who can create a beautiful smile for you. These days, dentures can look natural and beautiful so don’t settle for someone who is going to make you fake looking teeth.

This blog is brought to you by Hilton Head Cosmetic Dr. Bonnie Rothwell.

Getting a Pretty Smile with Dental Anxiety

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I am so tired of being ashamed of my smile. At the same time, I am terrified of the dentist. Absolutely terrified. I get a panic attack every time I’ve tried to go. Have you encountered someone who struggles as much as I do? What would it take to get my smile pretty? My teeth are yellow, two of them are chipped, and the front two are crooked. I’m sure there are cavities too, but I don’t see any.

Kallie

Dear Kallie,

person hiding behind chair in fear

How would you like to never fear the dentist again?

You are not alone in your dental anxiety. Many Americans struggle with going to the dentist. Often, this stems from a traumatic experience during childhood with their pediatric dentist. While we can’t do anything about the past, we can help you with your future. There are dentists who are particularly good at working with fearful patients. In your place, I would look for a dentist who advertises as a sedation dentist. They are great with fearful patients. To make things even easier for you, they can provide medication that will completely relax you. Given your level of anxiety, I am going to recommend you see someone who offers oral conscious sedation. It’s administered by a pill. This pill is so strong, though, that 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 until you are lucid and steady on your feet again. Most people sleep through their entire appointment.

Another benefit to dental sedation is it enables you and the dentist to get more work done at each sitting. That will help you get the smile you want even faster. One you can be proud to share. As to the work you need, you have several choices. Before those, your first order of business is to make sure you don’t have any decay and if you do, deal with that first. Once that is established, the first thing I recommend is teeth whitening. Not only will that make a dramatic difference in your smile, but it is a precursor to most other work. The easiest and most dramatic fix will be porcelain veneers. You have other options as well, but this is the top-of-the-line smile makeover and what gives celebrities that Hollywood smile.

One important thing to be aware of. While you can go to any sedation dentist to get your oral health on track, cosmetic dentistry is different. It requires extensive post-doctoral training. Don’t be fooled into thinking dental school is enough. In your place, I would look for a dentist who has reached accreditation with the American Academy of Cosmetic Dentistry. AACD accredited dentists are the top cosmetic dentists in the country. Your smile will be stunning.

This blog is brought to you by Hilton Head Cosmetic Dentist Dr. Bonnie Rothwell.

She Needs a Second Opinion

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I had a toothache for about a week. I know I should have gone sooner, but just to be honest, the dentist makes me quite nervous. When I arrived, he did an x-ray and discovered a tooth that already had a filling had become re-infected. He said only 10% of the tooth is viable and wants to extract it and replace it with a dental implant. I have to admit this idea terrifies me. Is there no way to just do another filling?

Kellie

Dear Kellie,

person hiding behind chair in fear

How would you like to never fear the dentist again?

There are a couple of things going on here that concern me. To answer your question, if your tooth were really that far gone, then an extraction would be the only avenue left to you. Replacing a lost tooth with a dental implant is the best option in that case. However, and this is a big however, I don’t think that is your case. If your tooth were truly that far degraded, he would not have needed an x-ray to determine it. Such a substantial amount of decay would have been visible with the naked eye. In addition to that, the filling you currently had would have fallen out and there would be a gaping hole there. In all honesty, I think you need a second opinion before moving forward.

Let’s say that by some crazy set of circumstances your dentist ends up being right. I doubt it, but let’s just roll with it. Then, you would need the tooth extracted. Leaving it in, turn a dental emergency into a life-threatening one as the infection spread throughout your body.

Dealing wiht Dental Anxiety

It distresses me to see patients in your situation. You want dental care, yet that anxiety keeps you from getting it. The good news is there is a solution, which will enable you to get past that anxiety, caught up on your dental care, and even look forward to going to the dentist.

When you get that second opinion, look for a sedation dentist. This isn’t a specialty, but rather a dentist who offers at least two levels of dental sedation. For a check-up and cleaning, using nitrous oxide is usually enough to relax you. If you need a more extensive treatment, such as a root canal treatment or tooth extraction, you can request oral conscious sedation. This is so powerful, you will need someone to drive you to and from your dental appointment. You will be so completely relaxed that you could sleep through your appointment if you wanted to.

This blog is brought to you by Hilton Head Dentist Dr. Bonnie Rothwell.

High Tolerance for Novocain

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I need some help. I’ve had horrible experiences at the dentist. I’ve always had a high tolerance for Novocain which is what makes my appointments a nightmare. As a young woman, I avoided the dentist like the plague. Now, I’m paying for that. I’d really love to take control of my oral health and appearance. With that in mind, I need some advice. First, is there a way to make the necessary work as painless os possible? I guess I’m hoping there have been advancements and there’s an alternative to Novocain. Second, once the health of my teeth are in shape, I’d like to improve their appearance. How do you find a good cosmetic dentist?

Paula

Dear Paula,

A woman receiving nitrous oxide

Our chemical make-up is amazing, along with how differently each body responds. Take thyroid medication for example. Two patients can take the exact same dose and the way their body’s respond is so different as to think they’re taking different medications altogether.

Another reason you may have a high tolerance to Novocain could be dental anxiety. Most people are a tad uncomfortable in the dental chair. If you compound that with the many bad experiences you’ve had the misfortune to go through at the dentist, your anxiety would be compounded. Anxiety causes the topical anesthetic to metabolize more quickly. `This would lead to your high tolerance.

Dealing with Dental Anxiety

I’m going to suggest you see a sedation dentist as you embark on getting your oral health under control. There are two typical levels available to patients, though some sedation dentists offer a third.

The mildest form is nitrous oxide (pictured above). You inhale a gas through a nose piece. It may be enough to relax you and allow the Novocain to do its job. The second is oral conscious sedation. It is done with a pill, but is significantly stronger. If fact, it is so strong, you will need someone to drive you to and from your appointment as well as stay with you afterward until you are lucid again.

Using sedation has an additional benefit. Your dentist will be able to get more work done in each sitting. This will enable you to catch up with your needed dental work much sooner than would otherwise be possible.

Finding a Cosmetic Dentist

As to your second question, this is both easy and difficult. The best cosmetic dentists have reached accreditation with the American Academy of Cosmetic Dentists. AACD accredited dentists are in the top 1% of cosmetic dentists in the country. They can provide you with a stunning smile. The top of the line procedure for that will be to use porcelain veneers.

Based on the condition of your teeth you may need a combination of porcelain veneers and porcelain crowns. That’s the easy part. the hard part is not many dentists have reached accreditation. You may have to travel to get a stunning smile. If you do, believe me, it will be worth it.

This blog is brought to you by Hilton Head Cosmetic Dentist Dr. Bonnie Rothwell.

Dentist or Oral Surgeon for a Tooth Extraction

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I had a dental filling which fell out. I was foolish and didn’t go back to the dentist because my last appointment was a bad experience. I know I should have because eventually the tooth developed an infection and I was in tremendous pain. In fact, it was so unbearable I went to see another dentist. This dentist did a root canal treatment, but we never scheduled a follow-up appointment. Because of that it eventually developed more decay. Now, I’ve got a dentist telling me it needs to be extracted. He suggested the extraction would be complicated enough that I might consider an oral surgeon. I did some number crunching and the oral surgeon would be a lot more expensive. Am I putting myself in danger by going with the less expensive option?

Amanda

Dear Amanda,

Woman asleep in the dental chair from detntal sedation

I feel it was unfair of your dentist to phrase it this way. It makes you feel like going the affordable route is dangerous. It’s possible he feels this procedure is above his current skill level and that is why he’s recommending an oral surgeon. If that is the case, I definitely wouldn’t have your dentist do it. He could get into a situation during the procedure where he doesn’t know what to do.

Before making a decision, I’d ask some more questions. Has he done this type of extraction before? What is his comfort level in performing the procedure himself? Does he offer dental sedation?

If it turns out he’s experienced and comfortable with the extraction and he offers sedation options, you’re fine to go ahead having the extraction done at his office. Based on how he framed it, however, I don’t think that is going to end up being the case. You will either need to see an oral surgeon or use a different dentist who had more experience in this particular procedure.

How Using Dental Sedation Can Change Your Life

When you have dental anxiety, it often has a negative impact on your oral health. You’ve already experienced this so you understand, I’m just saying it for the benefit of others. However, knowing that doesn’t take away your anxiety. I do have something that actually could help, though.

Going to a dentist who offers sedation doesn’t have to be reserved for the most difficult of cases. It can be done for any procedure you’d like. Though, if you’re just getting a cleaning, I wouldn’t go for the “big guns”, like oral conscious sedation or I.V. Sedation. You’ll be fine with just nitrous for that.

If you’re having specific work done, such as dental fillings or a dental crown, you could then upgrade to something like oral conscious sedation. You’ll also find you can get more work done during each appointment, allowing you to catch up much more quickly on the work you’ve been needing. Before you know it, you’re all caught up and no longer even need sedation.

This blog is brought to you by Hilton Head Dentist Dr. Bonnie Rothwell.

Twelve Shots to Get Numb & then More Problems

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I’ve had a nightmare of a tooth extraction. First, it took twelve shots to get me numb. Then, I developed a bone spur after the extraction. I went back to have that removed and now I’m still in pain. There’s also what seems like a bony ridge by the site. What’s going on?

Lucy

Dear Lucy,

Woman asleep in the dental chair from dental sedation

It’s fairly common for sharp edges to surface during the healing process. When your tooth is removed, the socket will have a sharp edge to it. It’s not as noticeable in the beginning because your gum tissue is over it. As it heals, the gum can shrink down and the sharp edge will then be on the surface. If it’s causing pain, your dentist can smooth it over.

I’m a little concerned about the twelve shots of Novocain that were required for you to be fully numb. This can happen for one of two reasons. First, the dentist could have a problem missing the proper injection site. Second, and the more likely scenario, is you have underlying dental anxiety.

Some dentists don’t yet realize how anxiety affects a patient’s ability to get and stay numb. This isn’t your fault and is likely caused by a traumatic experience you had at the dentist in your past. When you get in the dental chair for a procedure, your anxiety kicks in. This, in turn, ratchets up your metabolism enough to burn off your numbing medication. This can make it almost impossible to get numb.

Fortunately, there is a solution.

The Solution to Dental Anxiety

I’m going to recommend you ask your dentist if he or she will provide you with dental sedation. There are usually two levels of sedation available. The first is nitrous oxide. This is a gas you breathe in with a nose piece. It is fairly mild but enough to relax you. For some patients, this is enough to enable the medication to work for you. Once the procedure is over, your dentist will simply switch the gas from nitrous to oxygen and you’ll be up and ready to go in just a few moments. You can carry on with your day as normal.

Other patients, with more extreme anxiety, require a sedation a bit stronger. That is where oral conscious sedation comes in. This is a pill you will take before your appointment. This is very strong. Because of that, you will need someone to drive you to and from your dental appointment. It should be someone you trust because they’ll need to stay with you after your appointment for a few hours, until you are lucid again.

This blog is brought to you by Hilton Head Cosmetic Dentist Dr. Bonnie Rothwell.

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