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When Novacain Doesn’t Work

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I am at a loss. No one else I know goes through this the way I do. My dentist will give me a shot of Novocain and I will start to go numb. But, by the time he starts the procedure, it wears off. My dental care is excruciating. Have you encountered this? Is there a solution?

Mike

Dear Mike,

A woman receiving nitrous oxide

Dental trauma and anxiety can kill the effectiveness of Novocain.

Yes, I’m aware of this phenomenon. It usually occurs when someone has dental anxiety due to dental trauma in the past. What happens is your body’s metabolism kicks in and burns off the medication making it almost impossible to get numb. My guess is, at some point, you had a difficult dental appointment which has caused your body to go into overdrive.

There is a good solution. I’d like you to see a dentist who offers dental sedation. Most of them offer two different levels of sedation. I’d start with the lowest level to see if that is all you need. If that doesn’t help, the second level will.

Levels of Dental Sedation

Nitrous Oxide

This is the lowest level and the most convenient for you. It’s most effective for patients with a low level of anxiety.

Your dentist will provide nitrous oxide gas for you to breathe through a nose piece. The gas will give you a relaxed floaty feeling. Sometimes, this is all a patient needs to relax them enough to get the numbing medication to work.

One of the biggest benefits of this is when your procedure is done, the dentist simply switches your gas to oxygen and after a few moments, you’re able to go right on with your day. There are no lingering effects from the gas.

Oral Conscious Sedation

Other patients have a higher level of anxiety so nitrous won’t work for them. If that is the case, there is still help.

Oral conscious sedation is highly effective but does require some pre-planning. Your dentist will provide you with a pill to take before your procedure. This pill is strong and will completely relax you. I mean completely. You will need to find a ride to and from your appointment as well as someone to stay with you at home until you are lucid.

You will find yourself completely relaxed and anxiety-free throughout your appointment. It will change your life with the dentist. You’ll also find if you have a lot of neglected dental work which needs to be caught up with, this enables you to catch up faster. Your dentist can get much more work done during each appointment, lowering the number of appointments you need.

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

Why Can’t My Dentist Get Me Numb?

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My dentist put a paste on my gums and ended up giving six injections, yet none of that helped. He gave me pain meds and sent me home and said we’d try again. We did this three times and he can’t get me numb. He’s never had this happen before. I’m in tremendous pain and still in need of my root canal treatment. Do you have any idea why he can’t get me numb?

Martin

Dear Martin,

person hiding behind chair in fear
Dental Anxiety Affects Your Numbing Medication

I know precisely what is going on and how to prevent it as well. This has happened to other patients, including dentists when they were patients. One thing many people don’t realize, including some dentists, is that anxiety affects the numbing medication.

It’s almost as if the anxiety causes your metabolism to burn it up too quickly. The stronger the anxiety, the less effective the medication. Fortunately, there is a solution.

Sedation Dentistry Changes Lives

The easiest way to counter this is with dental sedation. Most dentists offer two levels:

  • Nitrous Oxide

This is sometimes nicknamed laughing gas. It is best used for patients with mild anxiety. Your dentist will put a nosepiece on you which provides the gas you’ll inhale. It will relax you and let you feel floaty. This helps take the edge off of the axiety and makes the numbing medication more effective.

  • Oral Conscious Sedation

This is a higher level of sedation and works for patients who have more severe anxiety. It’s likely what you are facing. The good news is this is also a simple procedure. You’ll take a pill before your appointment. It will completely relax you. And I mean completely.

You will need someone to drive you to and from your appointment as well as stay with you until you are lucid again. It’s highly effective and will allow you to get your root canal treatment with no problem whatsoever.

While nitrous is fairly easy to work with, when it comes to oral conscious sedation you’ll want a dentist who is DOCS certified. This shows they have the right training ensuring your safety.

I hope this puts your mind at ease. You will be able to get the treatment you need.

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

Craigslist for Dental Sedation

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I’m having a procedure for which my dentist strongly recommended dental sedation. He wants to use something called oral conscious sedation. Apparently, I have to have someone drive me to and from the appointment and the doctor wants to meet them and talk about post-op. The problem is I usually take an Uber to my medical appointments. . I’m not married and all my friends work. I can’t really ask them to take a day off for this. With Uber, you don’t really know who you’re getting so it’s not like I can depend on one of them walking in with me and talking to the dentist. Then coming back for me later. I was thinking a good option would be Craigslist. I could advertise the need for a driver that day plus time at the dental office. If I interviewed them ahead of time, I’d get a feel for them. Have you ever had a patient use this method before?

Liv

Dear Liv,

Woman asleep in the dental chair from dental sedation

Sedation dentistry is a great way to get through difficult procedures, especially oral conscious sedation. You will be absolutely relaxed throughout. In fact, most patients completely sleep through their procedures.

This effect doesn’t just end once the procedure ends. You will be groggy and unsteady on your feet for several hours afterward. You need to really think about your suggestion of hiring someone to drive you.

First, they won’t just be driving you to and from your appointment. They will also have to stay with you during your recovery time. You’ll be unsteady on your feet and a tad loopy.

Even if you interviewed them ahead of time, are you certain you would trust them with your home and body? This could be very dangerous for you.

Assistance with Dental Sedation

If you truly have no one who can assist you, there are still options. Check with your insurance for a home health option. Also, if you’re a member of a faith group, see if someone in your congregation can help. I’m sure your pastor, priest, or rabbi could even recommend someone.

Even if you’re not a member of a faith group, there are many churches who’d be willing to help someone in your situation. You’ll just have to let them know of your need.

If you’re uncomfortable with faith groups, you could try some community groups. There are always options. Let your dentist know your struggle as well. He may have faced this with other patients and already has great ideas about it.

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

Dental Sedation for Fear

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I keep hearing that dental sedation is a good solution for patients who have a lot of fear. However, when I look into it, there seem to be several different types. Is there much difference between them? If so, how do I know which one is best for me? Can you use it for anything dental or just for “big” procedures?

Lucy

Dear Lucy,

A woman receiving nitrous oxide

You’re absolutely correct about dental sedation helping people with dental fear. In fact, for many, it has transformed their lives. You’re also right that there are several different types of sedation. They are used for different levels of anxiety and purposes.

Sedation Level One: Nitrous Oxide

This is used for mild anxiety and used to be dubbed laughing gas. Using a nosepiece, similar to the one pictured above, you’ll be given a nitrous solution which will relax you and put you at ease. It has three major benefits.

First, because you’re more at ease, it makes your appointments more pleasant for you. Second, lowering your level of anxiety makes your local anesthetic more effective (if you need one). Many people don’t realize that anxiety causes your metabolism to burn off the anesthetic more quickly. Third, it’s only effective while receiving the solution.

When your procedure is done, they switch the solution to more oxygen and you’re perfectly capable of getting on with your day as normal. No missed days at work or delay of other important responsibilities. If you’re just needing a cleaning, this would be what I’d start with to see if it’s enough.

However, if your anxiety is extremely high or you are going in for a more invasive procedure, you may want to consider the next level of sedation.

Sedation Level Two: Oral Conscious Sedation

This is just a pill you will take before your appointment. However, it’s so strong you’ll need someone to drive you to and from your appointment, as well as stay with you at home until you’re lucid. The biggest benefit of this is its strength.

You’ll be conscious and can communicate but you’ll be absolutely and completely relaxed, giving you a pain-free appointment. Truthfully, most people just sleep through the appointment entirely.

It does require a prior consultation with the dentist to go over any medications you are taking, as well as any medical conditions you have. This is for your protection so the dentist doesn’t give you anything which will interfere with your current health regimen.

What Do You Need in a Sedation Dentist?

Compassion
You don’t want an impatient dentist who uses sedation to not have to deal with patients. You want someone who desires to help fearful patients. These dentists are gentle and patient; always willing to take the time to answer any questions you have and pause when you are overwhelmed.

DOCS Certified

DOCS is the Dental Organization for Conscious Sedation. Dentists who’ve been certified have the training to keep you perfectly safe during your appointment and know the emergency protocols if something unexpected were to happen. Make sure your dentist is DOCS certified before scheduling your appointment.

Benefits of Sedation

You’ll be able to have anxiety-free appointments which allow you to get your dental care caught up and back on track. If you need a lot of work, using Oral Conscious Sedation allows you to get more work done at each appointment. In turn, having healthy teeth and gums gives you far more choices for your smile. Now, if you desired, you could get your teeth whitened or even a smile makeover! That’s never required, of course, but it’s great to have more options available.

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

Can a Dentist Do Additional Work While Under Sedation?

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I had decided to take control of my dental health. I’d allowed anxiety to keep me away for too long. A friend told me about dental sedation and it sounded like the perfect solution for me. Now I’m wondering if I made a huge mistake. We’d set up this carefully laid out plan that worked within my financial limitations. We were doing everything on a specific schedule to phase out the treatments giving me time to save up for the next group. They had me sign everything ahead of time because they said I couldn’t agree to anything while under sedation so had to sign now. I liked that I could trust that they wouldn’t do anything without my consent…or so I thought. The day of the service went well enough. My husband took me. I seemed to have slept through everything. He took me home and then I slept through the majority of the rest of the day. I was in heaven thinking I’d finally be able to get my mouth in order again. But, two days later, they called to “check up on me” and announce that the dentist was able to do more work than he originally thought and would I please submit the additional payment. I was shocked. I reminded her that we scheduled everything according to what I could afford. She said, “Well, it’s done now and the dentist should get paid for his work. I’ll have 30 days before they “have to” turn it over to collections. Really? Can they do that?

Joyce B.

Dear Joyce,

The closed eye of someone asleep

Choosing Your Sedation Dentist

First, let me say how impressed I am that, despite your dental anxiety, you’re taking the initiative to improve your situation. That is fantastic! Second, I’m horrified at what you experienced. In fact, they can’t do work while you’re under sedation that you haven’t pre-approved. Signing a scheduled treatment agreement doesn’t count. You agreed to have that work done at another time.

The first thing I’d suggest is you bypass the front desk. Tell them you need to speak directly to the dentist. Remind him of your agreement and that you don’t have that money at the moment. If he gives you trouble, tell him he’s leaving you no option but to go to the dental board. That should give him a moment’s pause to think about the consequences of his unethical actions

I’m also going to suggest you not return to this dental practice. They obviously can’t be trusted.

Finding a Trustworthy Sedation Dentist

Obviously, the first step is just to do an internet search for sedation dentists in your area. Though, you didn’t need me to tell you that. The next two steps are vitally important. Make sure the dentist is DOCS certified. That is the Dental Organization for Conscious Sedation. This will give you an extra level of security that your dentist knows what they’re doing and can handle any emergencies that crop up.

After that, you want to do a tiny bit of research. Check their reviews. Sites like Yelp! and Google Reviews are great at giving you insight into the type of dentist you’d be seeing. Are they professional? Do they seem to care about their patients? People are pretty blunt in their reviews.

Above all else, don’t let this one bad apple discourage you from continuing with your determination to get your oral health back on track. There are fantastic, caring, dentists out there. Ones who will bend over backwards for their patients.

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

Am I Sexist for Wanting a Female Sedation Dentist?

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My dentist is wonderful but doesn’t believe in sedation dentistry. I have a procedure that pretty much requires it. I’m getting a wisdom tooth extracted. She wrote me the names of three oral surgeons but they’re all men. I’ve always felt more comfortable with female practitioners. Because of that, I called my dental insurance and asked for a female oral surgeon. The person on the phone said I was being sexist. Am I? I don’t dislike men but have just always wanted someone with a more maternal nature. Either way, I did some research and can’t seem to find a female oral surgeon in my area. Do they exist?

Louisa

Dear Louisa,

The closed eye of someone asleep

Choosing Your Sedation Dentist

Everyone is different in the type of caregiver they’re comfortable with. Some men are only comfortable with male practitioners. Some females are only comfortable with a female practitioner. What matters is that the patient feels comfortable and cared for. Therefore, my personal opinion is that is not a sexist attitude.

The fact that you can’t find a female oral surgeon may be more of why the person on the phone tried to cast dispersion on you. Believe it or not, hardly any women go into that particular field, but no one seems to know why.

There are sedation dentists who will extract your wisdom tooth. You could do a search for a sedation dentist and list all the female dentists. Please be sure to check their reviews as well as their sedation qualifications. For instance, Dr. Rothwell is certified with DOCS (Dental Organization for Conscious Sedation). This will ensure they’re fully trained and know how to handle any emergencies that arise.

What If You Can’t Find a Female Sedation Dentist

If for some reason you can’t find a female sedation dentist, you have choices. First, you can look for a male sedation dentist with the right qualifications and ask to have a female hygienist present. Dentists should always have someone else present while you’re using sedation anyway because they’re focused on the procedure and need others focused on your vitals, etc.

If you prefer an oral surgeon, however, you can do something similar. My suggestion is you find an oral surgeon on your list who gets great reviews from patients. Then, have a consultation with him to see how you feel. I’d also discuss with him that you prefer having a female present. Most surgeons have females on their surgical team so that shouldn’t be a problem.

This blog is brought to you by Dr. Bonnie Rothwell.

Is It Normal to Not Get Numb at the Dentist’s?

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I think there’s something wrong with me. My poor dentist felt so bad about what happened that he didn’t even charge me for the last two appointments where he’s tried to get me numb. He really tried too. After ten shots. TEN. I still wasn’t numb and the pain was excruciating. I was crying. He even teared up because he didn’t like seeing me suffer. He said in all his years he’s never had that happen. I don’t know what to do and neither does he. Do you have any idea?

MaryAnne W.

Dear MaryAnne,

A woman giving a thumb's up in the dental chair

First, let me say how sorry I am you went through such a disastrous experience. However, I absolutely love the empathy your dentist showed. It warms my heart to hear about members of the dental community showing they care what a patient is experiencing. Please tell your dentist he has my respect. My respect doesn’t take care of your problem though, does it?

To put your mind at ease, I believe I know exactly what was going on. I suspect, though you may not realize it, that you have some pretty substantial dental anxiety. For some patients, like you, they may have the anxiety but are used to doing things that frighten them and just put on their big girl clothes and do what needs to be done. Others, though, are so frightened they can’t even get through the door.

Even though you are extraordinarily brave and move forward when frightened, it doesn’t stop your body’s response to fear. Your metabolism jumps through the roof. When that happens it burns off the numbing medication before it can take effect. Your dentist could have given you shots all day long and it wouldn’t have worked.

Dental Sedation Helps Patients Who Can’t Get Numb

What you need is something which will help you relax enough to allow your local anesthetic to work. Dental sedation is likely the perfect solution for you. There are several levels of sedation available. The first is nitrous oxide. It’s also known as laughing gas. It relaxes you a bit and could be all you need. You wil be right back to normal by the end of the appointment and able to leave on your own.

If that’s not enough, you could get oral conscious sedation. This is quite strong and will make you groggy. You’ll still be awake, if you want to be, but will be so completely relaxed you could sleep through the entire procedure if you wanted to. However, you will need someone to drive you home and stay with you throughout the day until the medicine wears off.

You’ll also find you can get more work done at each appointment than you normally would too. I don’t want you to have to put off your necessary work and then it blow up into a dental emergency.

This blog is brought to you by Dr. Bonnie Rothwell.

How Do I Find a Good Dentist for Anxiety Ridden Patients?

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I had the best dentist on the planet. He was patient, gentle, fun. You really knew he cared about you. He retired a couple of years ago and I haven’t been too crazy about his replacement. I’ve tried a few dentists since then but none of them seem a good fit. I freeze up when I get frightened and they grow impatient with me. When I do internet searches for dentists are there some special dental clue words I can use to help me find a dentist who is patient with those who struggle with dental anxiety?

Melissa I.

Dear Melissa,

Hilton Head Sedation Dentistry

That’s a great question to ask. I also want you to know you’re not alone in your dental anxiety. Many people are so uncomfortable with dentists they avoid them altogether. It’s commendable you’re not giving up. That says a lot about how seriously you take your oral care.

The good news is there are some key words you can use to find a dentist. When you do your search, try one of these terms:

Generally, these dentists are much more patient and kind. They understand patients with dental anxiety and often cater to them. Before you pick one to visit, I’d suggest two other things to consider.

1. What types of services are you looking for?

If all you’re looking for is a good family dentist, then the terms I gave above combined with item #2 should be all you’d really need. However, if you’re interested in more specialized cosmetic services such as porcelain veneers, then you’ll want an expert cosmetic dentist, in addition. Ideally, you’d want a dentist who’s reached accreditation level with the American Academy of Cosmetic Dentistry (AACD). They can create the most beautiful smile. In fact, many of them even have a beautiful smile guarantee.

2. Be sure to check their reviews.

Sometimes what dentists say they are and what they actually accomplish are two different things. That’s why it’s helpful to get an opinion from someone who’s actually visited their office before. Check what patients have to say on sites like Google Reviews and Yelp! That will help you know ahead of time what kind of chairside manner they have and if they do quality work.

Best of Luck!
This blog is brought to you by Dr. Bonnie Rothwell.

Can I Take an Uber Home From a Dental Sedation Appointment?

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I’ve moved to a new city. I don’t know anyone yet and don’t start work for two more months. I’ve come early to get settled. There’s a tooth I’ve needed to be crowned for a while because of teeth grinding, but I keep putting it off. Now an upper tooth has a toothache. I’m going to find a dentist, but I want to get all this work done before I start at my new job. I always use dental sedation for these type of appointments and I know the drill; you need a driver. Because I just moved here, I don’t know anyone. Will they let me take an Uber home, seeing as I’ll have no one to drive me?

Rebecca M.

Dear Rebecca,

You’re in a tough situation. I can see why you’d want to get the work done before starting your job. Plus, with a toothache, you don’t want to put things off and end up with a dental emergency. Those can be life-threatening.

Not knowing someone to take you is the stickler. While an Uber driver could bring you home, your dentist is going to want to know there is someone to stay with you throughout the day. The reason for that, as I’m sure you’ve noticed in the past is you won’t be too steady on your feet for a while. You’re at risk for a fall. The preference is you spend the day resting either in bed or on your sofa.

But, let’s say you find a dentist that’s fine with Uber. You’re not going to be too coherent. Are you willing to trust an Uber driver to help you into your home? Will they even be willing to escort someone who’s medically handicapped? Those are things to consider.

I don’t know if you hold to any particular religious faith, but I’ve often found that if you call a bishop, priest, or rabbi from your area and explain your situation, they’re usually very good at helping you meet people and getting you some assistance in an emergency. This could be considered an emergency situation.

This blog is brought to you by Dr. Bonnie Rothwell.

Can Sedation Dentistry Really Make You Think the World Is Ending?

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My dad likes to play pranks. I’m a little worried about that because I’m scheduled for dental sedation in just a few days. I saw this YouTube video where these brothers seriously pranked their sister into thinking there was a zombie apocalypse. I can’t imagine she would have fallen for that if she’d not had sedation. Is my dad going to be able to make me think it’s the end of the world?

Franny A. – Abilene, TX

Franny,

I saw that video. It was kind of funny. She had a serious survival instinct. But, I’d like to put your mind at ease. Dental sedation did NOT make her think there was a zombie apocalypse. The sedation will relax you, but it will not change your cognition. She was likely slightly gullible before the sedation. It will make you a little less likely to resist your natural impulses. It will also make you woozy.

What you will need is someone to drive you to and from your appointment. You’ll also need that person (or someone else) to stay with you throughout the day. You won’t be too steady on your feet, so you’ll need someone to watch after you. Maybe you should get someone other than your dad to do that.

When you’re having a medical or dental procedure, you need time to recover. That recovery goes much faster if you’re relaxed. Maybe you could talk to your mom and let her know what you’re worried about. You need to be able to relax.

I don’t want you worrying about the sedation. It’s perfectly safe. In fact, it’s like you just get a day to completely relax. In a way, it’s a free day. So, stock up on your favorite movies. Get your comfy jammies and have a day just for you.

This blog is brought to you by Dr. Bonnie Rothwell.

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