A great number of people simply do not go to the dentist because they are afraid. It may be because they had a bad experience when they where a child and some people have no idea why they are afraid.Whatever the reason, we have seen MANY individuals wait until their teeth were almost killing them because of infections before they would come to the dentist.
In the old days we used to send patients to the hospital and give them general anesthesia to do anything.Now we have the capabilities to give general anesthesia in the luxury of our offices.
When I started getting into more comprehensive type dentistry, we needed to find a way to sedate those individuals who had a fear of dentistry to get them through the procedures, because the procedures they needed done could be perceived as “frightening”, not necessarily painful, but frightening. Sedation provides a solution for eliminating that fear.
Oral Sedation
Oral sedation is very popular in dentistry right now but I use it in a limited manner because it is not as predictable or as safe. You can’t predict how it is going to be absorbed or how it is going to affect one person versus another. and you can’t just keep giving them more medications one after another because it takes 30 minutes to an hour for that medication to be taken up in the stomach and to get in the bloodstream. So you could run the risk of over sedation if pills are given to close together.
IV Sedation
The IV is always much safer because once the patient has receive the medication through the IV, within 60 to 90 seconds you know exactly how it is going to affect that person and then you can titrate it (control concentration) so that you get the proper sedation without over sedation, making this sedation method totally safe.
If someone has been avoiding the dentist because of fear, IV sedation is an option because it allows us to do a lot of dentistry in 1 or 2 appointments. and get them back to good health. Fear of the dentist is based upon many things. One of them is lack of trust – so a patient has to come in and learn how they are going to react with that particular dentist to develop trust. We work with our patients on developing trust, especially those who are fearful because that alleviates a good portion of their fear- if they know they are working with someone who cares about them. You can’t get that kind of care in a clinical situation…where there are many patients waiting for that dental chair. For this reason we provide personalized, private, one-patient-at-a-time dental care.
There are many, many causes for headaches, but the majority of headaches are muscle related. We hear a lot of patients talking about their headaches caused by stress. In many cases, people get headaches because of stress because they are clenching and their bite is not in harmony with their joints. Certainly not in all of them, but that is a big part of it. And when their bite is in harmony with the jaw joints and the muscles are relaxed, they are less prone to get headaches.
Earaches:
Many people complain of earaches when it may be TMJ pain. The physician may tell them that there is nothing wrong with the ear. Often times its an inflammation in or around the jaw joint that is making it feel like an ear ache. A lot of jaw pain is transient. It is exasterbated or brought on by stress and once the stress is gone then a lot of the symptoms will subside. That doesn’t necessarily mean their bite is really great but it does mean they can adapt to it…except during times of stress…and if they get their bite and jaw in harmony then it takes a lot more stress to bring on those symptoms.
What is TMJ?
The Temporal Mandibular Joint is the joint where the jaw meets the skull. Within that joint is a thin disc that sits between the jaw and the skull. And a lot of the problems occur when the ligaments or muscles attached to that disc are damaged or not functioning properly and then the disc starts popping out of place. That’s when people hear the clicks and the pops and the grating noises. Often times our goal is to get the muscles relaxed so they will release their abnormal pressure on the disc so it can go into place and get the inflammation in the ligament space behind the disc and the joint healed. A major goal of our treatment is to get that back in place. In a few cases, it is necessary to do this surgically.
Temporary pain relief:
Something someone can do in the event that they have an acute muscle problem is to use ice packs: 20 minutes on one side and then 20 minutes on the other side…for the first day or two of the acute episode. And then change that over into using more moist heat after that and gently exercising their muscles…stretching, making sure they relax and don’t clench their teeth, get on a soft diet, and take mild anti inflammatory such as Advil.
A healthy TMJ requires finding the right solution:
In a comprehensive approach to dental care, making sure that you have a healthy TMJ has to be the starting point. You cannot restore a bite, restore a smile, or have anything that is going to function well long term for the patient, if the joints aren’t healthy. Fortunately, the majority of jaw pain is muscle pain that is often related to the bite. And if the bite is corrected and in harmony with where the muscles need to function, and the muscles can be calmed down and comforted. And a very small percentage of patients with jaw pain can actually be a problem within the jaw joint itself and many of these can be treated through splint and bite therapy but some of them have to be surgically corrected to get the comfort that’s needed. And all of that needs to be done prior to doing any major restorative work such as crowning teeth, changing bite, and other restorative work. So the foundation has to start with the joints that are healthy and comfortable and in good position. Then the bite can be constructed to be in harmony with that.
How we address TMJ disorder:
The first thing we do is a true assessment with each of our patients to find out if the joints can be loaded without pain, which they should be, similar to the knee or any other joint in the body. We do measurements of range of motion, such as how far can they open and move their jaw from side to side, is it even, do they open without their jaw deviating from one side to another Deviation would indicate a problem within the joint in most cases. We also listen to the joints with a Doppler ultra sound to give us an indication of the health of the joint itself, It all starts with a good assessment. Once we’ve got the assessment its going to give us a good idea in most cases whether the problem is a muscle problem (which it is most of the time) or if it is in the joint. Each are handled/addressed a little differently. In a lot of cases it is wise to utilize a full arch splint where we can recreate an ideal bite that fullfils all the criteria for a good bite in harmony with the joints without doing anything to the teeth until we verify that we can get them comfortable and get the joints in a good place and everything is healthy…And then and only then, should you start on any restorative treatment.
The splints we use are often diagnostic as well as therapeutic. Many of the problems have occurred over long periods of time. While many of them resolve instantaneously, many others take an extended amount of treatment to get them healthy. A joint with abnormal pressure over an extended amount of time may have inflammation or a change within the joint itself that have to change back as you get a proper bite. This is one reason splint therapy sometimes takes some time: the joints themselves will heal and remodel and you want to wait until that remodeling has completed before you start restoring the bite. If you restore the bite where the joint is when it’s not completely healthy that bite is going to change as the joint heals.
A large segment of the population does not seek proper dental care because of fear. Today there are several options that make dentistry much more comfortable. For years nitrous oxide has been available, which is an analgesic gas that raises the pain threshold and alleviates anxiety. This is a good solution for many patients and the gas is out of the system within just a few minutes of breathing oxygen afterwards, so a designated driver is not necessary after treatment.
Some individuals are reluctant to even just have their teeth cleaned because of fear. For these individuals we have oral medication that can be taken 45 minutes to an hour before their appointment that will alleviate their anxiety. The medication is strong enough to really do an effective job so these patients will need a designated driver after treatment.
If we are going to be doing significant dentistry on an individual who is not comfortable sitting for an extended amount of time or has an extreme fear, IV sedation is available. This is a safe method of sedating the patient so that they will not have an unpleasant memory of the treatment. They will not be unconscious, as with general anesthesia, so there are not extreme dangers associated with this sedation. Patients can still respond and inform us if something is bothering them so that we can respond accordingly.
Sedation dentistry allows us to help individuals who have had years of neglect and sometimes get them back to good oral health in just one or two appointments. Once they are healthy, our goal is to keep them in good oral health.
Sometimes there is dead or dying tissue in the canal that holds the roots of the teeth which can cause an abscess, sometimes it is painless but many times it can be a painful experience for the patient. A solution is making an opening into the canal that is in the roots and then removing the diseased tissue from the tooth all the way to the tip of the root and cleaning, shaping, and disinfecting the inside of the canal and then sealing with a plastic material and cement so that bacteria can’t get from the bloodstream back into that space again. In the canal, when it gets infected, the first thing that happens is an increase in blood flow, which causes swelling. The swelling cuts off the blood supply and then the blood can’t fight the bacteria. This causes dead and diseased tissue which becomes a continuous source of food for the bacteria. They grow and then an abscess occurs when the bacteria start getting out to the end of the root and that is when a patient will experience a throbbing pain.
Some symptoms can be sensitivity to hot and cold that lingers afterward, spontaneous throbbing pain, and pain upon chewing. These symptoms do not necessarily mean that the patient needs a root canal. For example, cold sensitivity, if it goes away immediately, may be a sign of an irritated but healthy nerve. However, if you have hot on a tooth and it lingers for a long period of time, most of the time that will be a tooth that needsa root canal.
The most common scenario where it is necessary to do a root canal is if there is infection in the root from decay. Occasionally a root canal is also necessary due to trauma, a cracked tooth, and in rare instances during tooth restoration if the canal is to close to the surface of the tooth.
