FAQ's

1. Is Root Canal Therapy Safe?

2. Are Dental Implants Safe?

3. Adult Orthodontics A&B

4. Are Dental X-Rays Safe?

5. To remove a tooth or not to remove a tooth…, that is the question.

Endodontics (Root Canal Therapy)

“Is it safe to have a root canal done by a dentist and to keep a dead tooth in your mouth?”

Answer:

I am often asked if it is safe to have a root canal done by a dentist and to keep a dead tooth in your mouth. Just hearing a dentist saying the words, ”you need a root canal”, is enough to send most patients into a fear frenzy. This article will hopefully answer some of your questions, dispel any incorrect information and make your visits for this procedure more comfortable both physically and emotionally.

Endodontics (root canal therapy) is the treatment in which the pulp (vital organ of the tooth within the internal canals of the roots) containing nerves, blood vessels and lymph vessels is damaged by decay through the hard tooth layers (enamel and dentin) into the pulp or by trauma to or fracture of the tooth. The tissue may become irritated, inflamed, infected and possibly abscessed.

Symptoms may range from sensitivity to hot, cold and chewing to severe pain and swelling. Irritation and inflammation may be reversed by more conservative treatment such as a bite adjustment or a filling.

Infection and abscess of the pulp always require endodontics to relieve the symptoms. The basic goal of Root Canal Therapy is the removal of decaying material, maintenance of dryness, cleanliness and sterility within the root canals and filling and sealing the root canals.

The procedure is usually performed in the following manner.

1. Tooth is anaesthetized.
2. For safety and in order to keep the tooth clean and sterile, a latex rubber dam with a small hole is placed into the mouth exposing only the one tooth.
3. The dentist gains access to the pulp with a hand piece (drill).
4. The exact length of the tooth is established using an x-ray, (preferably digitally taken) and/or a piece of equipment called an apex finder, which measures the value (frequency or amplitude) of electrical conductivity at the narrowest point of the root canal (apical constriction) to locate the apex (end of root).
5. Thin and flexible, files, broaches and reamers, either steel or now the mostly used, more flexible Nickel-Titanium (Ni-TI) either by hand or on a hand-piece (rotary instrumentation) will remove the decayed matter, blood vessels and nerve tissue to the apex, then widen or enlarge the canal.
6. Sterile water or Hydrogen Peroxide or Sodium Hypochlorite is used to flush and clean out the debris, necrotic (dead) tissue and bacteria.
7. The canal is dried, then a cotton pellet with/without a medicament (preferably a non-toxic one) is placed in the opening disinfect or sterilize the canal the opening is closed with temporary cement between visits.
8. When the tooth is ready, the canals are permanently sealed by filling or packing with materials discussed later in this article.

This procedure takes one to three visits depending upon the number of canals, position of the tooth, and how damaged the pulp was.

The hard tooth structure of the root remains anchored in the bone. The hard tooth structure that is visible in the mouth is later restored with a filling or a post and crown dependent upon the amount of tooth that remains.

Historically, the safety of endodontics has always been debated. Some research has resulted in the focal infection theory, which states that it’s not possible to sterilize or seal all large and accessory canals. Anaerobic bacteria that remain create a toxic environment in and around the tooth.

The body’s response to the toxins and the ingredients in the root canal materials can be local or systemic, appearing as inflammation, infection, abscess, bone damage, or allergic or immune reactions.

There may be some health-compromised patients who may benefit from the removal of some endodontically treated teeth and there is a small percent of root canals that fail. However, removal of all non-vital teeth is not and should not be a dental or legal standard of treatment.

All root canal materials used have some chemical ingredients that may be harmful to some patients. In order to disinfect or attempt to sterilize the canal, medicaments such as eugenol (oil of clove) and formocresol (formaldehyde-creosote) are used. The latter is more toxic. Often none are necessary. Sterile water, hydrogen peroxide or sodium hypochlorite may be used to flush out canal debris. The former is the least toxic and frequently used , although the latter,used by most dentists is reported to have antimicrobial effects.

The most common materials used to obturate (seal and pack ) the canal are a zinc oxide/eugenol cement (seal) and gutta percha (pack). Gutta percha is the refined, milky exudate of certain trees. When mixed with substances including zinc oxide, it becomes a pliable rubber. When heated in the thermoplastic obturation technique or in contact with oils such as eugenol, eucalyptol or chloroform, it becomes a moldable plastic or liquid which is packed or injected into the canal and will fill the space left in the canal.

More recently, Bioceramic materials, which include a combination of glasses, composites and silicates, and have been considered by some to be more biocompatible and effective, have been successfully used as a sealer along with Bioceramic coated gutta percha cones.

The least toxic material, calcium hydroxide paste, which is reported to have some antimicrobial effects, is used by some dentists to further sterilize and even to obturate the canal. Biocalex is a product that combines calcium oxide, zinc oxide and an ethyl/glycol/water liquid. Proponents claim that it is the most biocompatible material and that due to its volumetric expansion will most effectively seal the canals. Difficulty in controlling the delivery and placement of the material and the lack of appearance on an x-ray discourage extensive usage of calcium hydroxide products except in deciduous in deciduous ( baby) teeth.

In some of the products, there are stronger antibiotics such as tetracycline and chemicals like formaldehyde, which may cause a more severe physiological reaction. These products should not be used. Chlorhexidine, also reported to have some antimicrobial effects, can be used either alone or in mixture with Calcium Hydroxide, and may have some toxicity. Prior to proceeding with endodontics, it is very important that you discuss the treatment with your dentist or endodontist and that you are clear about the materials that will be used.

Despite some research about the problems of allowing a non-vital tooth to remain, most dentists, including myself, choose to do the root canal procedure rather than to remove the tooth for the following reason. When you remove a tooth, a space may be left which needs to be restored using an implant or a non-removable bridge. In the second case, adjacent teeth on either side of the space may have to be included in any bridge that is constructed. Therefore, it is possible that further dental and medical problems will occur from the treatment and the the materials that have to be used.

Other than for orthodontic purposes or in situations where wisdom teeth need to be removed, there may be circumstances when a tooth is beyond repair and has to be removed. But, I believe that these situations occur in a small percent of cases and should only happen after careful diagnosis, treatment planning and consultation with your dentist. Back to top

Dental Implants

“I had to have some teeth pulled recently. My dentist has recommended either a removable partial denture or implants and a permanent bridge. How safe are implants? Are dentures an acceptable replacement for your teeth?”

Answer:

When someone loses several teeth and a non-removable bridge is contraindicated, a dentist may recommend either a removable partial denture or implants and a permanent bridge. Many patients still question the efficacy and the safety of implants.

As a holistic dentist who is very cognizant of the biocompatibility aspect of dental materials, I often question the use of certain materials, especially metals, in the oral cavity. Having said that, when I weigh the potential biologic and allergic risk of dental implants with the benefits I have seen, and the personal experience with my own family, I have to support their continued usage.

Of course, in order to properly diagnose a particular situation and offer a treatment plan, x-rays must be taken and a thorough clinical examination must be conducted.

There are many circumstances for which either procedure could be done. Very often, finances may determine the choice. Implant dentistry requires a surgical procedure and is far more costly than removable dentures. However, for some patients, its many advantages may override the expense and surgical treatment involved.

Removable partial dentures are made of a metal alloy cast frame with a tissue-color plastic base and closely shaded plastic teeth. When most of the natural posterior (back) teeth are missing, they are a safe, functional, and esthetic replacement.

Some patients object to the metal clasps, which can damage the gingiva (gum) and wear or loosen abutment (anchor) teeth. Crowning the abutment teeth will allow the clasps to be hidden in the crowns to create a more natural and stable result. Some patients may react to the alloy or the acrylic plastic material, in which case alternative materials can be tried.

Slight movement of the base of the denture may cause irritation and soreness. Adjustments to the base can relieve the sore spots. If the tissue facing the base (ridge tissue) resorbs (shrinks) too much, a larger space may be created, which can allow too much movement and cause damage. Fortunately, your dentist can reline the base of the denture (with the same plastic material used to make the denture) so that it fits more closely and becomes more stable. Periodic replacement of this type of denture is necessary due to changes in oral health and denture wear or breakage.

The clinical success of implant dentistry has made it one of the fastest growing areas in the dental profession. Today, most implants are usually done in 2 phases. a one-step surgical procedure, followed by a restoration (crown, bridge and partial or removable denture).

Many implant specialists prefer the one-step surgical procedure. An incision is made into the gingiva (gum) to reveal the bone beneath. A small hole is drilled into the bone to a shallow depth. A smooth or serrated titanium metal implant, (previously treated for increased bonding to the bone), is then tapped or screwed into the bone.

A healing cap, the head of which shows slightly through the ridge of the gum, is then placed into the implant and the area is sutured and allowed to heal for three to six months, during which time the implant integrates (becomes part of) the bone. In some circumstances, some surgeons may perform a technique that does not require an incision.

Sometimes, dependent upon factors like occlusion (bite), length and width of implant and bone bonding ability, an implant may even be immediately loaded with a finished temporary crown during the healing process.

During the restorative phase, a titanium abutment (a further extension out of the gum) is screwed into the implant, an impression is taken and then a crown or a bridge (multiple crowns) will later be cemented or screwed on. Removable partial and full dentures may also be made more stable by attaching or snapping onto the implant abutments. This is especially true in the mandible (lower jaw) for a patient who is edentulous (has no teeth).

Even though there are still some concerns that have been lessened by time and success, there are health issues that still exist and failures that do occur.

Often times a patient may choose, or their dentist may recommend, that they use a sedative IV pre-medication during surgery. Some patients are hesitant to be put to sleep for this procedure, and a small percentage of complications may occur.

Although some dentists may recommend medication, including pre- and post-operative antibiotics and post-operative analgesics (pain pills), some patients may be reluctant to take the medication and therefore they may not opt to do implants.

Even though concerns about implants have been lessened by time and success, health issues still exist, and failures do occur. Surgical placement of the implant can damage bone, nerves, or blood vessels. Post-operative pain, swelling, infection, and abscess are possible. The implant is a foreign metal object that may cause the autoimmune system of the body to reject the material.

Some studies report that there is may be a potential for electrical current causing problems with “electromagnetic and biophotonic information” in the oral cavity or the potential for micro-bacterial invasion or peri-implantitis. All of the above must be considered before a patient decides whether or not to have an implant.

Even though there are pitfalls in using titanium implants, they are a proven means of restoring lost teeth, especially in circumstances where no other restoration will fix the problem, when there are non-restored teeth on either side of implant area or when they might help to stabilize a partial or full denture.

Although there are fewer instances of reactions, some patients are either intolerable of metal or do not want to use metal. For them, there is the possibility that research and clinical success will favor the use of what may be more biocompatible materials. Zirconium is a ceramic material that is used in spaceships because of its high resistance to fracture and heat. Proponents report some advantages:

A) Ziconium is metal free and is believed to be more holistic and biocompatible.

B) Ziconium is more aesthetic. Because of its white (more tooth-like color), Zirconium is suited for the anterior (front) teeth where the metallic color of Titanium (dark line around the gum) can be eliminated.

C) Ziconium is more hygienic. Zirconium retains less plaque and calculus than titanium, therefore promotes healthier gums.

D) Zirconium is a good material for a single stage implant is perfect to avoid bone loss (no micro gap, no movement).

There are also some disadvantages of Zirconium implants reported.

A) There is a potential for micro-fractures when prepping for crowns or when masticatory (chewing) pressures are too great.

B) Osseointegration (connection of implant to bone) may be less than that of titanium.

In my opinion, as of today, although these Zirconium implants have been successfully used in Europe for nearly a decade, and in North America for several years, they have not yet been thoroughly time-tested enough to recommend its use over that of titanium. I feel confident that this situation may soon change.

Three other factors can increase the potential for success. Finding the most skillful surgical and restorative dentists, having an implant only in the proper situations, and providing proper aftercare of the area once the implant is in place will greatly enhance the longevity of the procedure and the comfort of the patient. Back to top

Adult Orthodontics

Question 3A

“Are braces “natural”? Two of my front teeth have grown in a crooked manner over the last five to ten years and I am now in a position to consider getting braces for them. Is there any alternative or any other advice to consider?”

Question #3b)

“I am twenty-five years old and I have an overbite of my upper jaw. I think that the procedure of going to the orthodontist and being fit for braces–and then wearing them–could be harmful. What do you think?”

Answer:

Both of these questions deal with a very basic quandary for those who want to live a natural or holistic lifestyle. If we define the word “natural” as it appears in Webster’s New World Dictionary as “produced or existing in nature; not artificial”, then, orthodontic treatment (braces) is not natural.

However, the fact that orthodontics can correct non-alignment (crooked) and malocclusions (bad bite) of the teeth and dysfunctions of the jaws caused by a multitude of occlusal (bite) abnormalities, growth and hereditary disorders and trauma provides positive reasons to compromise on this philosophy.

This orthodontic treatment can dramatically improve the esthetics (appearance) and the quality of a patient’s life morphologically (form), physiologically (function) and psychologically with very few possible side effects, especially in the conscientious patient. A healthy adult with orthodontic needs must always weigh the benefits compared to the possible negative effects of wearing either fixed or removable orthodontic appliances (braces).

Significant factors that determine the necessity and rationale for orthodontic treatment are as follows:

1. severity of occlusion (bite) and esthetic (appearance) problems
2. possible need for extracting (removing) one or more teeth to create space
3. irritation, pressure and pain caused by having foreign materials in your mouth that are moving your teeth
4. decreased ability to maintain cleanliness around appliances which may lead to tooth decay and periodontal (gum and bone) disease
5. age of the patient
6. length of the treatment and…
7. cost

Even though question #1a appears on the surface to be the less severe condition, there could be more is going on than just two crooked teeth. Necessary X-rays coupled with a thorough examination, diagnosis and treatment plan are needed to determine the full scope of the orthodontic condition. Assuming that there are no other underlying factors, a couple of crooked teeth pose mainly an esthetic and maintenance problem.

It is not considered a severe malocclusion (bite problem) because it does not affect the ability or the efficiency of mastication (chewing). Nowadays, a problem such as yours can be treated conservatively by slightly filing the two teeth and bonding (adhering) composites, glass ionomers or veneers (thin porcelain facings).

If necessary, removable plastic retainers and appliances can be used to treat this problem. In order to create the small amount of space necessary to move the two teeth into position, it might be necessary to slightly file and narrow the proximal teeth on either side. Although the movement of the appliance might rub and irritate the surrounding tissue, the fact that it can be taken out of the mouth and that the teeth and the appliance can be more easily cleaned will reduce the potential for damage. Up to six months or more (two years) will be necessary to move and anchor those two teeth into proper position.

The use of more conservative, though not necessarily less costly, “short-term” approaches offered by treatment such as Invisalign, are very common and successful. Invisalign treatment consists of a series of removable, thin clear plastic aligners that fit over your teeth (similar to a mouthguard) that you switch out about every two weeks. Each aligner is custom-made for your teeth and is individually manufactured with exact calculations to gradually shift your teeth into place.

If the problem is more severe, traditional bonded fixed metal or plastic bands and brackets and adjustable wires and rubber bands may have to be used. It may also be necessary to extract some teeth in order to create the room necessary to align the teeth properly.

In question # 3b, an “overbite” of the upper jaw is definitely a more serious malocclusion. In addition to an obvious esthetic and mastication problem, the malposition (wrong position) of the jaws can cause stress on the masticatory (chewing) muscles and damage to the TMJ (temperomandibular (jaw) joint) resulting in more discomfort and an increased possibility of complications.

Some severe orthodontic cases might need adjunctive additional treatment such as TMJ therapy, tooth extraction (removal), periodontal (gum and bone) surgery, operative dentistry (fillings) and crown and bridge treatment.

It should be noted that an adult offers further complications because the teeth are fully erupted and the completely formed jaw bones are more dense than that of an adolescent. Most cases like this will require the use of some combination of fixed and removable appliances (braces) and can take up to two years or longer to complete the case.

I cannot over-emphasize the importance of excellent home care during and after treatment. The patient can use a combination of toothbrushes, dental floss, floss threaders (thin flexible plastic needles to help get the floss under the non-removable bands and brackets), water pics and any other dental hygiene aids that are recommended. Dentists and orthodontists always advocate the decrease or elimination of sticky, hard or sugary food to lessen the possibility of tooth decay or breakage of the braces.

The appliances are bulky plaque, calculus, food and bacteria traps that can irritate and damage the gingiva (gum). Home care and regularly scheduled dental exams, prophylaxis and scaling ( professional cleanings) of the teeth and gingiva (gum) will also lessen the possibility of swelling, bleeding and discomfort of the gingiva (gum). Your dentist and orthodontist are able to inform and educate you about the pros and cons of treatment. Finally, although orthodontics might be difficult, costly and take a long time, adults are routinely and successfully treated with minimal negative effects on the oral cavity. Back to top

Are Dental X-Rays Safe?

“I hesitate to go to a dentist. I am concerned about receiving too many X-Rays. Are they dangerous? Are they necessary? How often should I get them? When should they be avoided?”

Answer:

The fear of the dangers of exposure to radiation permeates our consciousness. Yet in the medical environment, patients are often exposed to great amounts of radiation in diagnosing as well as treating diseases. The side effects of radiation are well documented and should be avoided unless absolutely necessary.

The amount of exposure from one, or even several, dental radiographs (X-Rays) is minimal when compared to the diagnostic information that they provide your dentist.

Dental X-Rays are not always necessary on children and adults who have very healthy mouths upon a thorough visual clinical examination. For my reassurance, I still may recommend some pictures, because visual clinical examination does not reveal all of the possible dental problems.

Unfortunately, by the time most people come to the dental office, they have developed problems and have backed themselves into a compromising situation. At that point, dental radiographs are necessary if successful reconstruction is going to be accomplished. Dental X-Rays help the dentist in the following ways:

1) to see roots, nerves, (including the pulp (nerve of the tooth), ligaments, and surrounding bone of teeth;

2) to determine bone level and depth of decay and fillings;

3) to see impacted teeth, broken root tips, abscesses, tumors, fractures, growths abnormalities within bone;

4) to assess the extent of bone level or damage;

5) to evaluate the presence and position of adult teeth beneath deciduous (baby) teeth;

6) to assess the periodontal (gum and bone) condition;

7) to assess the orthodontic condition;

to better visualize the extent and the depth of decay and fillings;

9) to efficiently render most dental treatment including, but not limited to, endodontics (root canal therapy), emergency treatment, periodontal (gum and bone) treatment, oral surgery, dental implants and orthodontics;

10) to see the TMJ (Temperomandibular Joint);

11) In most procedures, it is necessary to obtain X-Rays for legal protection of the dentist and the patient. Many people have insurance or Medicaid, which require pre-treatment X-Rays in order to okay the treatment.

There are several types of dental radiographs.

1) The most common is the periapical X-Ray. Each one shows the tooth structures and surrounding bone of three to four teeth. It helps diagnose cavities and many dental problems. Bitewing X-Rays show decay and bone level of back teeth. A full mouth series of up to 14 periapicals and two bitewings is recommended as needed in five- to ten-year intervals.

2) A panorex is one single X-Ray of the oral cavity showing all the teeth and surrounding bone structures. A Panorex is mainly used to look at the structures of the maxilla (upper jaw)and mandible lower jaw), neck, and head. It is a screening tool that is used to make sure that there are no abnormalities. It is often used by orthodontists to diagnose and treat abnormal bites, by oral surgeons to determine position of impacted teeth, abscesses, tumors, and fractures, and to see the TMJ (Temperomandibular Joint) in order to diagnose muscular or TMJ pain. Panorex X-Rays use less radiation than a full mouth series. They are, however, not a substitute for the full mouth series, which provides more accurate detail for most general family dentistry.

3) Tomogram and Transcranial X-Rays are used to see the position of the mandible (lower jaw bone) in relationship to the maxilla (upper jaw bone) and the skull bone. These X-Rays are used to show the space where the top of the mandible (condyle) and underside of the maxilla (upper jaw) meet. This is called the glenoid fossa. This space is actually a fibrocartilage disc that acts as protective cushion between the head of the condyle and the maxilla. If the space or the disc becomes too thin or dislocates, TMJ pain can result.

4) Head/Skull X-Rays can also be used to show the position of the maxilla, the mandible, the skull and neck bones. These help to determine where any imbalance may exist. Computerized renditions of these X-Rays may help to determine the causes of pain and may help to plan future treatment.

5) Computer technology has allowed a dramatic decrease in the amount of potential exposure to radiation. Direct digital filmless radiography may reduce radiation by as much as 90% over conventional techniques. This approach is equal in diagnostic quality to conventional X-Rays. Some patients report discomfort from the sensor pressing on soft tissue. However, since this approach decreases both the radiation and environmental impact of conventional X-Rays, and since it offers an increased ability to enhance the image—to enlarge small areas for closer inspection, and though the cost of a machine to the dentist is sometimes prohibitive in many practices, I believe that it offers very a important option for dentists and their patients.

I have recently had experience with an oral surgeon who is doing an implant for my son. He took a cat scan of his maxilla (upper jaw) and mandible (lower jaw) with the Icat Cone Beam 3-D Dental Imaging for dental applications. It produces an accurate photopolymer replica of a patient’s mandible or maxilla based on CT scan data. He was able to save the scans and burn them on a CD and mail it to me. I then downloaded software to open the CD. It was remarkable. X-Rays of various sections and angles showed the existing implants in the bone. It is used by the oral surgeon to help to properly plan for future treatment. This technology is fast becoming a necessity in the rapidly growing field of dental implantology.

There are many precautions that your dentist may take to reduce the amount of radiation that a patient receives:

1) taking the minimum number of X-Rays for the age, physical condition, and dental needs of the patient;

2) usage of lead-lined walls and lead aprons to cover vital organs;

3) using fast-speed films;

4) using proper equipment and machine settings;

5) periodic required testing and inspection of the equipment.

Again, please note that children and adults with healthy dentition generally need fewer X-Rays. Pregnant women, particularly those in the first trimester, should avoid radiographs, except in an emergency. Women who are of child-bearing age or are lactating, and patients who are undergoing radiation therapy should limit their exposure.

Keep in mind that you do not necessarily need to have X-Rays taken by every dental professional you see. If you have had X-Rays taken within the last five years by a previous dentist, periodontist, or orthodontist, obtaining them may eliminate or reduce the need for additional X-Rays.

At present, the use of dental X-Rays is an unfortunate necessity in order to render proper dental care. The dental profession is doing its best to protect the patient and allay the public’s apprehension about radiation exposure. By becoming knowledgeable about this issue, and expressing your concerns, you should be able to create a cooperative partnership with your dentist. In most cases, without the information that an X-Ray affords the dentist, he/she cannot render treatment as effectively. Back to top

Remove a Tooth?

“I have been very uncomfortable in my mouth and am afraid to go to the dentist. I have had many of my teeth removed already and really can’t afford to spend more money. Is is okay to remove the teeth that bother me and have a dentist make me a partial denture or or even remove them all and get a full denture?”

Whenever a patient, particularly one who is afraid of dentists or dental treatment, is in severe discomfort with his/her teeth and/or gums, the first thought that comes to their minds is to remove the tooth. I often hear from women that their “tooth discomfort is worse than childbirth.” They say , “at least there is a beginning and an end to that discomfort.” That strategy may indeed give the patient immediate relief and therefore can be a short term  solution.

Even if they have dental insurance, they also complain about the high cost of dental treatment.  They believe that removing some or  all  of  their teeth and replacing them with a partial or a full denture is the answer to their financial strain and oral cavity problems, and that the result can be as functional and look as good as their natural teeth.

To remove some or all of your teeth and replacing with a partial or full denture is not a good long-term solution. Although I empathize with their situation, especially the high cost of proper dental care, the common fears of dental treatment and the potential discomfort during and after treatment, I definitely would ask them to explore other solutions with their dentists.

In situations where nothing can be done to save the teeth, extraction and the fitting of full dentures is an option. However, these full dentures can never be as attractive or as functional as natural teeth.

I would like to address these concerns so that patients may have the information necessary to make an informed decision on their future dental health.

Even with previously planned orthodontic or wisdom tooth extraction, the decision to remove teeth should never be taken lightly. The loss of a single tooth can potentially affect the entire mouth. Almost immediately, the adjacent and opposing teeth will drift into the space created, allowing food to get caught. This can damage the gums and, eventually, the bone. The change in the way that the teeth bite may cause muscle and jaw pain.

The cost of proper dental treatment can be a deterrent for some patients. Many dentists will accept your dental insurance as partial or full payment, or be willing to work out an affordable monthly payment plan. Because of the importance of maintaining your teeth, it would be advantageous for you and your dentist to work this out together.

Although dentures do not usually cost as much as dental treatment to save your teeth, they can result in problems. These can be costly, and can compromise your health. Following is a list of problems associated with wearing full dentures.

1. Food cannot be chewed as efficiently, which can lead to digestive problems. Certain foods, such as corn and apples, may not be able to be eaten at all. Even well made dentures fall short of looking or acting like natural tissue and teeth.

2. Dentures are made of plastic that can wear or break, and need to be repaired or replaced periodically.

3. The plastic will absorb mouth fluids, causing discoloration and odor.

4. The tissue beneath the denture can shrink, causing rubbing and sore spots. This also may cause the denture to loosen, necessitating the use of messy denture adhesive creams, or relining, to tighten the fit.

5. A full denture is an artificial device that needs to be removed for a period of time each day.

6. Implants may be used to stabilize a full denture. However, even then, it cannot equal the form and function of natural teeth.

Getting full dentures may be less costly and, in some cases, a less painful procedure for a patient, but when saving your own teeth is possible, it is unquestionably the best option.

Odontophobia is defined as the “fear of all things dental”. A mild dread is called dental anxiety; a severe case is termed dental phobia.

Avoiding dentists and proper dental treatment is a problem, given that ongoing neglect can lead to tooth decay, periodontal (gum and bone) disease, tooth abscesses, and moderate to severe pain. This can spiral until the only visits are for dental emergencies.

It can also affect one socially. Many patients will be too embarrassed  to smile. Some men may even grow mustaches or beards in order to hide their poor oral condition.

Studies show fear of dentists can often be traced to a personal bad childhood experiences or dental horror stories that they hear from family and friends or even movies that they have seen that depict dentistry in a negative context.

During the course of my career, I have listened to many patients expressing their fear of dentists and dental treatment. Some the reasons given are:

1) not being fully numb during treatment

2) being held down or restrained in a papoose

3) being yelled at by the dentist.

4) fear of needles

5) fear of pain during and after treatment

6) fear of not being in control

7) gagging during X-Rays.

excessive cost of dental treatment

9) worry that they’ll be derided and made to feel bad by the dentist for the condition of their mouth.

Any of the above may deter many patients from seeking proper dental care in the future. The profession is very sensitive to this issue. There are many methods that can be used to reduce discomfort and also reduce a patient’s fears about dental treatment.

When looking for  a dentist who is sensitive to these issues, I always recommend word of mouth from family and friends as the first and best referral. There are dentist locater services like 1800dentist or local dental associations that one can contact. However, note that these services cannot guarantee the quality of care or the possibility that the dentist will be  sensitive to your individual needs. And just because he/she advertises that they specialize in treating fearful patients, remember that anyone can make that claim.

In this age of computers, you can also check out their website. Then, call the office. Speak to the receptionist to get an initial feel of the practice. You can even ask to speak to the dentist. If he/she takes the time out of a busy schedule and is willing to answer your questions, it should give you an even better feel if it’s the right place for you.

Then, schedule a no-treatment, consultation-only appointment. This is an an excellent opportunity for you to interview the office. Don’t be afraid to ask any questions and be sure you get the answers you need. Don’t be intimidated. Be sure that you understand the explanations and that the dentist breaks it down to language that you understand. Notice key words that are used. A dentist who is sensitive to fearful patients will use words like discomfort instead of pain, or numb/freeze instead of needle or injection. Approach the visit with the idea that you are hiring them to take care of you and your special needs. It must be an environment that you trust and that makes you as comfortable as possible. Knowledge can help to diminish fear of the unknown.

Besides the simple agreement between the dentist and the patient to put the patient in control to use a hand signal to stop treatment, the following is a list of techniques that dentists may use to reduce or eliminate pain and fear :

1) EFT (Emotional Freedom Technique) is a form of energy psychology. It is a simple technique of tapping on specific acupuncture points while thinking about the issue. The results can be a dramatic decrease in the emotional charge surrounding previous dental experiences or traumas.  EFT  can help dentists and patients reduce or eliminate the emotional stresses related to dental treatment and the dental offices and staff to reduce the stress inherent in the dental environment.

2) Some dental offices can teach you some other simple relaxation methods and/or deep diaphragmatic breathing and/or yoga techniques and/or behavior modification therapy and/or desensitization. These can help to lessen the fear response to being in the dental office.

3) Hypnosis can be used by trained practitioners to reduce a patient’s anxieties about dentistry.

4) Acupressure or acupuncture can be used by trained practitioners to reduce dental anxieties and discomfort.

5) By clipping an electrode to a patient’s ear lobes, through a technique called painless cranial electro-stimulation, the patient can control the amount of stimulation to relax them.

6) Television, audiotapes, videotapes and the use of a virtual reality-like set of goggles are forms of distraction. By placing the patient in a more pleasant visual and/or auditory setting, focus on the dental treatment can be reduced.

7) Inhalation anesthetics such as Nitrous Oxide analgesia (laughing gas) is breathed in through a mask placed over your nose during treatment. It will create conscious sedation and will reduce anxiety and discomfort for the patient.

Topical anesthetics (numbing gels or patches) are placed onto the tissue site minutes prior to the injection in order to reduce the feeling of the tip of the needle entering tissue.

9) Local anesthetics, such as Novocaine (used little in dentistry today), Lidocaine or Carbocaine (the latter does not contain epinephrine, which can raise blood pressure). In all cases, warming the cartridge, injecting slowly, using a topical anesthetic and shaking the lip will decrease the discomfort of the injection.

10) Other than the commonly known syringe and needle that delivers a local anesthetic to numb a tooth or a section of the mouth, there are other methods, including computer-assisted injection systems such as “The Wand”, that can be used in many circumstances that can cause the patient less pain than the conventional syringe.

11) Pain, anti-anxiety and sedation medication can be taken orally before treatment to produce oral conscious sedation and parenterally (IV or injection, infusion and implantation) prior to during or after treatment to reduce anxiety and pain. IV sedation involves being conscious but having no memory of the procedure and is only offered by specially trained practitioners.

12) General anesthesia (being totally asleep) has the greatest risks and is usually reserved for extreme cases. It can be used with patients who are very apprehensive and extremely phobic. Because the patient is rendered unconscious, this procedure should only be done by a dentist who is properly trained, and in circumstances where either the severity of treatment or the patient’s fear of the treatment precludes any other possibility.

13) To decrease the heat and vibration ( the main source of physical pain during dental treatment),  and the whining sound (the main source of the auditory and emotional pain) that accompanies a Hi-Speed Air-Driven Turbine Handpiece (Dental Drill). Today, there are three systems can be used as alternatives to the dental handpiece in certain situations. Each has its uses and its limitations. All of these procedures can virtually eliminate the need for local anesthetic in some cases.

A)The Kinetic Cavity Preparation system (KCP-”Drill-less” Air abrasion) can be used for small cavities and early tooth decay. The process uses a special handpiece to spray or propel a stream of clean dry air mixed with tiny abrasive particles of alpha alumina  (a substance used in toothpaste) onto the surface of the tooth and remove the tooth decay. It is most effectively used for placing fissure sealants, removal of small discoloration and stains, and repair or replacement of small fillings. It can be used to expose early tooth decay (hidden cavities), which can then be removed and restored with a filling material.

B) In addition to soft tissue (gum) procedures, root canal therapy,  and bonding of tooth colored materials and tooth bleaching, some Dental Laser Systems use a combination of laser energy and water (hydro-kinetic energy) to precisely remove tooth decay and hard tooth structure. It is then restored with a filling material.

C) Ozone Therapy is a more controversial procedure, whose efficacy for dental procedures is not yet accepted by the ADA at this time. It is my belief, that although more research is necessary, the concept of Ozone Therapy, either alone as explained below or in conjunction with conventional procedure will someday be used to replace the conventional air-driven turbine hand-piece in some cases.

1) Ozone is a gas; that fresh, clean smell that you find at high altitudes and after thunderstorms is ozone. It is our natural protection against harmful sunlight above us high in the atmosphere, and present all around us in the air we breathe.

2) Ozone kills bacteria, viruses and fungi within about 5 seconds. It is used in hospitals and public places to control infections and smells. It is used to purify water you drink. Ozone works by breaking up the cell walls of bacteria, viruses and fungi, and breaking up sulphur compounds (bad breath) into non-smelling compounds.

3) In the procedure a small laser, the Diagnodent, is used to look inside the surface of your teeth. It detects areas of bacteria that cause decay, and gives us an idea of how much decay is present. A special hand piece is then used to put Ozone onto the decayed area. It is simple, and painless. There is no drilling, fillings, injections or damage to your tooth in most cases.

4)  Ozone kills the bacteria that cause decay and gum disease. Decay is caused by acid producing bacteria that grow out of control. Once these bacteria have been eliminated, a special liquid mineral is placed onto the cleaned area of decay. This starts the healing part of the tooth’s treatment. You are also given a special tooth paste and mouth rinse. These contain all the essential minerals that your body needs to repair the decayed area. Regular use of this home kit is recommended to ensure the success of your Ozone treatment. Three months later you are asked to return to check diagnodent laser readings.

The research they report shows that in over 90% of cases, the decay has stopped or reversed. A second ozone treatment is done at this appointment as an added benefit. The whole process of the laser readings, the application of ozone to your tooth, and the mineral wash are all painless. In most cases, it does not involve any damage to your tooth or gum tissue.

Some combination of the above methods will make most patients comfortable. It should be noted that many procedures can be done on some individuals without using any of the above methods.

The treatment rendered and the pain threshold of the patient will determine discomfort after treatment. Patients should not eat until the numb feeling is completely gone. If they do, it is possible that because they don’t have feeling, they may chew on their tongue or lip causing damage. It  is particularly important for parents to watch their children. Freshly squeezed vegetable and fruit juices, soft food such as yogurt, blended salads, cooked grains are a good nutritional source of food if the patient is having a difficult time eating more solid foods.

A short fast also may help in the healing process and limit stress on the sore area. Even though it is not ideal to suppress symptoms, if the pain more than the patient can tolerate, consult with the dentist who did the procedure about options for pain reduction.

Despite your best efforts, if you’re not making progress in alleviating your fear and it’s severe enough to keep you from getting care, you may need to seek professional assistance or find a self-help group.Back to top