Tag Archives: Nitrous Oxide

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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