Tag Archives: Nitrous Oxide

Need Advice about a Tooth Extraction

Years ago I had an infected tooth. I avoided the dentist because I have never had a good experience with one. When I could not take the pain anymore, I schedule an appointment. He said the tooth was infected and performed a root canal treatment. I was supposed to schedule a follow-up appointment for the cap, but never did. I probably should have because it seems like the tooth got reinfected. It hurt again and pieces started falling off. I went to another dentist who confirmed the infection. I received quite a lecture about the state of my teeth and not getting regular care. He told me it would be a tough extraction. The best he could offer me was nitrous oxide. If I didn’t think I was able to handle the procedure, he could refer me to an oral surgeon. I was thinking I would go with the oral surgeon. However, it turns out they are a LOT more expensive. Would I be able to get this done with a dentist and it not be an absolute nightmare or do I need to take out a loan and see the oral surgeon?

Imogen

Dear Imogen,

Woman resting in dental chair from dental sedation

I am going to say right off the bat that this dentist you saw will not be the best dentist for you. What you need is compassion and a solution, not a lecture. That does not lend toward helping patients feel comfortable going to the dentist.

You should not have to take out a loan and go to an oral surgeon for this extraction. The right dentist can do this extraction for you. What I think you need is a dentist who offers other, stronger, dental sedations options, such as oral conscious sedation.

They are generally more compassionate with anxious patients than the dentist you just experienced. Let them look at the tooth and tell you whether or not they can do the extraction. My guess is you will find someone. It sounds more like this dentist was out of his comfort level and was trying to push  the blame off on you.

With oral conscious sedation, you are not knocked out, but will be so completely relaxed that you will be able to sleep completely through the procedure if you want to.  Most patients who use dental sedation find it completely changes their life and they are able to get the dental care they have always wanted.

The only downside is, because of its strength, you will need someone to drive you to and from your appointment, as well as stay with you for a few hours after the procedure. They will want to make certain you are lucid and steady on your feet.

This blog is brought to you by Lafayette, LA Dentists Drs. Foreman and Thimmesch.

Should I Take My Son to a Sedation Dentist

I’m sort of kicking of myself for how my son’s last dental appointment went. He’s been going to my dentist for all his check ups. This last appointment didn’t go so well. He’s six year old and normally does so well. This time, however, he was a bit fidgety. Our dentist said he had a cavity and mentioned that he could take care of it right then. My son melted down and slid out of the chair and started crying. He didn’t let anyone touch him. Now I’m wondering if I should have not tried to bring him to a sedation dentist. Now I am afraid he’ll never cooperate at the dentist again. Did I ruin his view of the dentist by not planning ahead?

Callie Anne

Dear Callie Anne,

Children in a line smiling

I’m glad you wrote. I don’t think you’ve completely ruined your son. Hindsight is always 20/20 so don’t judge yourself too harshly. You obviously care about your son and have been careful to take care of his oral health. It is equally obvious that your dentist is not used to working with children. Had he been familiar with children, he would not have just sprung a new procedure on your son like that. Children need a little bit of preparation for the unfamiliar.

My suggestion to you is similar to what you’ve already figured out. It would help him adjust back to the dentist by having sedation for this filling. I don’t think he would need anything strong, such as oral conscious sedation. Just some nitrous oxide would be enough to relax him enough to be calm and allow the dentist to do the work.

However, I am also going to suggest you look for another dentist for your son. It does not have to be a pediatric dentist. Instead, you could see a general dentist who is good with children. One way to know if they enjoy children is to ask what age they are first willing to see them. If they first see children around two years old, you can know that they enjoy working with children. If they want to wait until they are around five years old, then I would look for someone else.

This blog is brought to you by Lafayette, LA Dentists Drs. Foreman and Thimmesch.

Dentist Is Growing Frustrated with Me

I have problems in the dental chair. I don’t know what it is but every time the dentist or hygienist comes at me with something sharp looking, I can’t help but wiggle and sometimes even have trouble breathing. I thought my dentist was understanding. We’d had a couple of appointments where he waited for me to calm down. However, at my third appointment, he said, “You’re an adult and should be able to handle this by now.” I was so embarrassed. I know I’m an adult. I know I should be able to handle this by now. But, I don’t know any solutions. Have you had patients who’ve struggled as I do?

MaryAnne

Dear MaryAnne,

Woman resting from dental sedation

I am going to tell you right off the bat that your current dentist is not going to be the best dentist for you. To be frank, he was rude and insensitive to your very real anxiety in the dental chair. Adult or not, many patients are uncomfortable in the dental chair, some so much that they can’t even go and end up only going in for dental emergencies.

I don’t know where you live, but what I would like you to look for someone who considers themself a sedation dentist. Not only will they be compassionate, instead of rude and judgmental, but they also have the tools to give you an anxiety-free/pain-free dental appointment.

What Type of Sedation is Best?

My recommendation is to start with the lowest level of sedation that is useful to you. The lowest level is nitrous oxide, which people used to call laughing gas for the floaty, happy feeling it can give you. This will relax you in the dental chair. A benefit to nitrous is that you can get right back on with your day once your appointment is completed.

For invasive procedures, I recommend oral conscious sedation. This is administered by pill. However, it is so strong that you will need someone to drive you to and from your dental appointment as well as stay with you for a few hours after your procedure until you are lucid and steady on your feet. Most people find they completely sleep through their procedure, leading some to dub it sleep dentistry.

Look for a dentist who offers these options and I think you will find your life changed.
This blog is brought to you by Lafayette, LA Dentist Drs. Foreman and Thimessch.

Dentist Cut Me and I Want a Refund?

My last dental appointment was a disaster. I needed a crown on one tooth and a dental filling on another tooth. It was a two-hour procedure that went from bad to worse, he splashed some type of chemical that got in my eye and burned like mad. Then, he cut my lip with a dental tool. As if that was not enough, he then slipped with the dental drill and cut my tongue. In all this, not only did he not once apologize, but he tried to blame me. He said that none of it would have happened if I would have stayed still like I was supposed to. Is there a way to get a refund from this jerk?

Sunny W.

Dear Sunny,

Woman resting from dental sedation

Unfortunately, though he seems to have very poor skills, I don’t think you’ll be able to get a refund…or an apology. A lawsuit would not really be worth your time or money because I don’t think you could demonstrate there has been enough damage to even cover the cost of the suit. The only thing you can do is write a review warning other potential patients about his lack of abilities and consideration. That will make a dent in his business.

As for the wiggling. Even if you were wiggling, he could have stopped and figured out why you were so uncomfortable so the procedure could have continued safely. My suggestion is for your next dentist you look for someone who is a sedation dentist. They can offer you medication that will completely relax you for the duration of your procedure.

Some options are mild, such as nitrous oxide which allows you to get on with your day as soon as the procedure is completed. If you want something stronger, I’d recommend oral conscious sedation. Though it is administered with a pill, it is so strong that you will need someone to drive you to and from your appointment as well as stay with you for several hours after the procedure. You will be loopy and unsteady on your feet.

This blog is brought to you by Lafayette, LA Dentist Drs. Foreman and Thimmesch.

Twelve Shots to Get Numb?

I recently had a lower second molar extracted. The appointment was a nightmare. First, it took twelve shots for him to get me numb. How he could miss the area that many times is beyond me. Then, I had a bone spur in the area that took the dentist over thirty minutes to get. Now, I seem to have a sharp edge on the extraction site. I’ve sort of lost confidence in this dentist. Can you tell me if this is normal or if I need to have another procedure done to deal with this?

Cassidy

Dear Cassidy,

Woman holding her jaw in pain

I would find it hard to think any dentist would actually miss the spot that many times. The more likely scenario is that you had some dental anxiety going in and, as a result, your body was fighting the local anesthetic.

Unfortunately, not enough dentists currently understand the connection between dental anxiety and the inability to get numb. I am going to recommend for your next appointment where you need any work done you see a sedation dentist. Even just some nitrous oxide will help relax you, which in turn enables the anesthetic to do its work.

For those with a more severe level of anxiety, I recommend oral conscious sedation. While it is administered by a pill, it is so strong that you will need someone to drive you to and from your dental appointment as well as stay with you for a few hours afterward until you are lucid and steady on your feet again. Most people who use oral conscious sedation sleep through their appointment.

As for the bony ridge. sharp edges do show up during the healing process. You don’t notice them at first because your gums are swollen. As the swelling goes down the ridges appear. If it stays a problem, your dentist can clip it.

One thing I want to make sure your dentist addressed is the need to replace that second molar. If you leave the space open, your other teeth can drift or tip into the space, which will throw off your bite. That can lead to painful TMJ Disorder.

If you want the best tooth replacement, I’d look into a dental implant. However, you do have other options.

This blog is brought to you by Lafayette, LA Dentists Drs. Foreman and Thimmesch.

Numbing Medicine Doesn’t Work On My Daughter

My seven-year-old daughter developed a cavity on a back tooth, which is weird because they have sealings. I took her in for them to do the filling and they could not get the numbing medicine to work. She is in agony and ended up thrashing about. He did seven shots to no avail. He finally just sent her home without the tooth dealt with. Where do I go from here?

Maggie

Dear Maggie,

Little girl smiling in a dental chair

I am sorry you and your daughter had to go through this. It is agony watching our children suffer. The good news is I have a solution. It appears that your current pediatric dentist is not aware of the connection between anxiety and numbing medication.

If a patient is very anxious, it has the effect of metabolizing the numbing medication very quickly. Sometimes so quickly that the patient gets no benefit out of it. I feel this was what happened to your daughter. Traumatic experiences like this are what keep people away from the dentist in adulthood.

Our goals right now for her are two-fold. First, get the cavity dealt with before it blows up into something more substantial or even a dental emergency. Two, give her a positive experience at the dentist so she can feel good about her oral health care.

I want you to find a dentist who is good with children that also offers dental sedation. It doesn’t have to be a pediatric dentist. There are many general dentists who enjoy treating children and are qualified.

Under normal conditions, she would only need some nitrous oxide to relax her. However, after her recent experience, I am concerned that will not be enough. Look for someone who offers oral conscious sedation. It is so strong that she will sleep through her whole procedure. In fact, some people call it sleep dentistry for that reason. She is still conscious. This is not anesthesia. It just completely relaxes her which will allow that numbing medication to do its job.

Be aware that she will still be woozy for a few hours after that procedure. You might want to set her up a little castle on the couch and let her binge watch something like “A Series of Unfortunate Events,” which will entertain her while simultaneously realizing her life isn’t so bad.

As for her sealants. Sometimes those will come off. Make sure you have the dentist check that the others are still intact.

This blog is brought to you by Lafayette, LA Dentists Dr. Foreman and Thimmesch.

Daughter Broke Her Front Tooth

My daughter fell and broke a chunk off her front tooth. I immediately called our pediatric dentist and he said the soonest he could see her is six months from now. I told him we are pretty anxious to get it fixed and asked him to recommend somewhere. His response was that everyone will tell us that the nerves need time to calm down and then they can see us. For some reason that felt like an excuse to me. If not, why not say that upfront instead of originally saying he’s booked for six weeks? Is there really a necessary time to wait?

Belinda

Dear Belinda,

Your instincts are good. There isn’t really a reason you should have to wait. I’m guessing your pediatric dentist just didn’t want to lose any business. This can be treated right away.

If you have the piece that broke off, a good cosmetic dentist can reattach it. If not, the solution would be to have dental bonding done. This will also need to be done by a good cosmetic dentist. It doesn’t necessarily need to also be a pediatric dentist. There are general dentists who work well with children.

As she ages, the pulp of her tooth will get smaller. At that point, it may be necessary to do a dental crown. Until then, bonding or reattachement are your best options for her.

If she gets nervous at the dentist, look for someone who offers dental sedation. They can give her something to relax her. It doesn’t have to be very strong, even just nitrous oxide will be enough.

This blog is brought to you by Lafayette, LA Dentist Drs. Foreman and Thimmesch.

Are CEREC Crowns Better for Anxious Patients?

I have never been crazy about going to the dentist. I had a toothache and decided to go in because it means something is wrong. It turns out I have a large cavity. Now I have to have a dental crown. I’m really nervous about this. What can I expect?

Belinda

Dear Belinda,

A tooth receiving a CEREC crown

It’s good that you went in. The fact that you did despite your dental anxiety means you are courageous. If you’d allowed your fear to get the better of you, you would have ended up with a dental infection. That would have meant an additional procedure of a root canal treatment. Or, possibly your tooth would not be able to be saved and you’d need to have it extracted and replaced. To get a great replacement, like a dental implant, requires surgery. Obviously, you made the right decision.

What to expect depends on the type of dental crown you’re getting. Did your dentist mention whether you’re getting a traditional crown or a CEREC crown?

What to Expect with a Traditional Crown

If you’re getting a traditional crown, it takes two visits. First, your dentist will have to remove any decay as well as grind down enough tooth structure to make room for the dental crown. You can see how small your natural tooth has to be in the image above. After that, your dentist will make an impression of your teeth and fit you with a temporary crown. The impression will be sent to the lab to make your permanent crown.

It takes a couple of weeks for the permanent crown to be made and sent to your dental office. Then your dentist will call you, fit you with the permanent crown and bond it on.

What to Expect with a CEREC Crown

Given your anxiety, this will be a better option for you. First, they can be done in just one appointment. That minimizes how often you have to come in. Second, many patients hate having to do impressions. The goo is messy and bad tasting. With CEREC crowns, you just have a digital image made and a computer designs the crown. Not only is this less nerve-racking, but it’s also faster and more accurate.

While you’re at the office, the computer will mill the crown immediately and your dentist can then bond it on before you leave.

This is a must simpler procedure. Plus, if you’re still nervous, it’s very compatible with a sedation such as nitrous oxide which can relax you.

A Front Tooth Requires an Expert Cosmetic Dentist

You didn’t mention which tooth is being crowned. If it’s a front tooth, there’s an additional consideration. It’s very challenging to match a single crown to a front tooth. You will need to find a dentist with both technical expertise and artistry.

In your place, I’d look for a dentist who has reached accreditation with the American Academy of Cosmetic Dentistry. Simply go to aacd.com and look for an AACD accredited dentist in your area. They can give you a beautiful crown that blends in perfectly with your other front tooth.

This blog is brought to you by Louisiana Cosmetic Dentist Dr. Mike Malone.

Pediatric Dentist Strapped My Child Down

I am absolutely appalled. I took my daughter to the pediatric dentist for the first time. I got a little nervous when they didn’t let me back with her, but I didn’t want to make her worry so I pretended it was no big deal and she’d have a lot of fun. You can imagine how heartbroken I was when she told me that she got scared so they strapped her down. When they brought her out I could tell she’d been crying. I called, thinking I must have misunderstood her or she didn’t know how to explain what actually happened. They told me it’s standard procedure in dealing with an uncooperative child. Please tell me that’s not correct. She doesn’t ever want to go back.

Amy L.

Dear Amy,

Boy smiling and holding a toothbrush
Dental Care for Children Should be All Smiles

I’m heartbroken with you for the trauma your little girl experienced. I believe what you’re referring to is a papoose board. It wraps the child which essentially keeps them from moving during their appointment. It used to be a regular practice in many pediatric offices but has come under fire in recent years. Even the American Academy of Pediatric Dentistry has warned of its drawbacks and said parents have the right to terminate its use at any time.

While some children do better alone, many feel comforted knowing the mother is there to look out for them during their appointment. The goal of pediatric dental care is to give children a positive experience and get them excited about taking care of their teeth. I’d say your pediatric dentist totally failed at that.

Finding a Good Pediatric Dentist

You’ll obviously want to switch to a different practice. You can take your daughter to a pediatric specialist or a general dentist who enjoys treating children. One way to know how good a general dentist is with children is the age they’re willing to first see them. If they say around two years of age, you can feel pretty sure they’re comfortable with the wee set. If they say 8-10, then I’d look elsewhere.

Given your daughter’s experience, you’ll want a dentist who will let you go back with her. She’ll need to feel safe. You may also want to give her some nitrous oxide. It’s commonly called laughing gas and will help relax her. Wherever you end up, be sure to check their reviews ahead of time as well.

Please tell the new dentist what your daughter went through so they’ll be prepared to handle her understandable fear. We want to get her on the right track having positive experiences.

Most adults who end up with dental emergencies do so because they had a traumatic experience as a child and now avoid the dentist until their services become unavoidable.

For those patients, we recommend oral conscious sedation. It’s stronger than nitrous and will allow them to sleep through the appointment. That would be the last resort with a child, though. Let’s see if we can’t get her relaxed and happy without it.

This blog is brought to you by Dr. Mike Malone.

What if Novocain doesn’t work for me?

I have a problem. The numbing medications used by dentists simply do not work on me like they do on other people. Added to that, I have put off some pretty extensive dental work that needs to be done, and now the thought of having to go through that without adequate pain medication is literally keeping me up at night. Between my aching teeth and the idea of what I am going to have to go through to get them fixed, I am missing a lot of sleep.

I really think the only way I am going to be able to get this done is if I am out cold. Are there dentists out there that will knock you out to get extensive treatments done? I know oral surgeons can put you out for wisdom teeth removal and things like that, but I have never looked into what can be done if pain meds simply don’t work.

Lula in San Francisco

Dear Lula,

Yes, there definitely dentists out there that can help you. They are called sedation dentists, although you will sometimes hear them referred to as “sleep dentists” or their practices called “sleep dentistry”. This is not a technically correct term, as their patients are not actually sleeping.

Most of these dentists use what is called “conscious sedation”. This means that you are not fully unconscious for the procedure, though most people don’t remember anything about the treatment. Conscious sedation medication is usually administered through an oral pill, taken before the appointment. For this reason, if you are undergoing a procedure that involved oral sedation, you must have someone available to drive you to and from your appointment, and you probably will not be able to return to work that day.

We should mention, too, that sometimes the Novocain or other numbing medication is not as effective in patients who have a high level of anxiety. Many dentists have great success using nitrous oxide (also called NO or “laughing gas”) to help their patients relax, and then administering the numbing medication. The really great thing about that is that you don’t have to have someone drive you to and from the appointment. The effects of nitrous oxide wear off very quickly, and have no lingering effects that preclude driving or returning to work.

If you and your dentist talk through all the options and you are still not comfortable, then some dentists are trained to administer general anesthetic. Only you and your dentist can decide what level of intervention is necessary for you to get the treatment you need.

Good luck to you.

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