“Doc, can I have more Novocaine? I don’t feel very numb.” Of course, it is nice to feel numb before dental surgeries! Have you ever been in a situation in which you had difficulty getting numb?
Local anesthetic is effective in most situations, however approximately 15% of dental patients experience a partial or total lack of numbness after receiving anesthesia injections. This phenomenon usually occurs in the lower jaw, when mandibular bone is too dense for infiltrated anesthetic injections to take, unlike the upper jaw which can receive the anesthetic solution easily. The dental nerve within the lower jaw is essentially buried within the dense bone itself, so it requires a mandibular block injection for proper numbing (numbing which includes the teeth, tongue and lips in the same quadrant).
Variations in the anatomy of the “entry window location” (where the mandibular injection deposits its solution) makes it difficult for some people to receive proper numbing, even when the dentist follows the usual landmarks – don’t blame the dentist right away if your anesthesia doesn’t work! The physiology of each individual varies besides the anatomy, which will lead to different thresholds or reactions to various dental injections. Different dental injection solutions also gives different numbing effects – your dental professional should choose what is most applicable to your situation, usually epinephrine (the blood vessel constrictor) is added to give a better local numbing effect.
Speedy injections or anxious patients can cause a racy heart beat, which could be very uncomfortable. If you’ve had too many cups of coffee or if your blood sugar is low from having not eaten, you may feel uncomfortable after receive the dental injection. The wine from last night can also alter the effectiveness of the numbing. This all makes anesthesia a very delicate science. The technique of the operator (the dental professional) can occasionally be at fault for improper anesthesia, but more likely than not it is a complication with a patient variable. It is important for you to communicate with your dental professionals if you’ve had a history of difficulty with dental anesthetics.
Special oral local anesthetic techniques, such as intraosseous anesthesia, which can enhance deep pulpal anesthesia, may help to increase the numbing sensation. This process injects novocaine directly into the bone marrow – because the needle penetrates the hard cortex of the bone, it penetrates to the jaw’s deepest level and can adequately numb the site. It is important to remember that every mouth can be anesthetized, however because intraosseous anesthesia is considered a specialized procedure, it is important to find a dental professional who is experienced with such techniques.
” May I have some laughing gas please?” is a popular request among the “high anxiety” or “wants to get away” group.
A patient is anesthetized with nitrous oxide.
Nitrous oxide gas (nitrous oxide and oxygen (N20-02)) is affectionately known as “laughing gas” due to its euphoric qualities when inhaled. Discovered in 1772 by Humphrey Davy, he had this to say about its effects: “On the day when the inflammation was the most troublesome, I breathed three large doses of nitrous oxide. The pain always diminished after the first four or five inspirations; the thrilling came on as usual, and uneasiness was for a few minutes swallowed up in pleasure.” When the gas is inhaled (at an approximately 50% nitrous oxide + 50% oxygen dilution), after several minutes nearly all pain dissipates from the body and a euphoric warmth spreads throughout the body. This pleasant feeling is not only pain-reducing, but can calm anxious nerves and relax all but the most fearsome patients. The calming, relaxing and euphoric qualities of nitrous oxide make it a prime candidate for anesthetizing patients who have irrational fears about dental procedures who are unable to get comfortable in the chair. Because laughing gas can be highly effective in treating moderate dental anxieties, nitrous oxide gas can also benefit the dental physician working on a patient – calm environments benefit everyone! Patients with high blood pressure, or who have had heart attacks in the past and are at risk from traditional IV anesthesia are prime candidates for nitrous oxide sedation.
The level of sedation and warmth felt in the body after inhaling nitrous oxide gas depends on the concentration of the dosage, and how long the gas is administered. Because the gas is administered into the lungs, it is saturated into the blood stream very quickly and once the procedure is finished, there are no lingering “hangover” effects, meaning it is safe to drive home without an escort. Local anesthesia is still necessary for the treatment site, but needle-phobia will disappear with laughing gas. If you suffer from dental anxieties and have tried different techniques, seen different dentist and you still can not face dental work with ease, it is worth while for you to try nitrous oxide during your next dental procedure. Have a discussion with your dental professional.
Mark came in with a severe tooth ache, and after an examination, I could see the tooth was severely broken down. The basic options were to either save the tooth – going through root canal therapy and finishing with a post and crown restoration, or to remove the tooth and restore with a dental implant and crown. “Should I save my tooth, or should I pull it!” This is the eternal question!
Root canal therapy (also known as endodontic therapy) is a procedure of treatment for the pulp of a tooth once it has become infected – the inner pulpal material must be removed, in order to protect and decontaminate the tooth from future microbial invasion to the jaw bone. Once a root canal procedure is performed, however, the lack of nutritional supply in the tooth (once the organic tissue is removed from the tooth during the procedure) will render the tooth brittle, the weakened tooth should be reinforced and restored properly, with a post and crown.
Root canal treatment does have a bad reputation due to the pain and the stigma associated with the procedure. Often times, a patient will have a root canal performed and think the procedure was a success, only to have pain and infection return several years down the line. The complexity of the anatomic root variation could be an obstacle and techniques can often be tedious, which is why specialized service is usually performed by a highly trained dentist or endodontist. Special tools like microscopes are also often necessary for a successful procedure. Advanced instrumentation and technique will ensure long-term success.
Regular dental checkups are vital to properly maintain your dental health. If the unhealthy dental condition requires a root canal treatment or an extraction, have your dental professional explain the pros and cons of each option, then make an educated decision. If there is a mystery pain, a 3-D image (Morita Survey of CT scan) would be invaluable for proper diagnosis. Regular dental x-rays are not capable of capturing images of a cracked tooth nor accessory root canals (which are small and difficult to see). These tiny cracks or canal issues can lead to prolonged discomfort, which you may have thought was a figment of your imagination! If the prognosis was poor, or a tooth has broken down so much that it has become unrestorable, extraction and a dental implant might be a more sustainable investment to you dental health. Prevention is always the best treatment! Brush and floss your teeth twice daily and after meals. If you have any dental pain, schedule an appointment with your dentist sooner rather than later.
When you smile, the corners of the mouth upturn, eyes begin twinkling and positive emotion radiates. A person’s smile is a pleasant, agreeable part of their appearance and facial characteristics; a person’s smile is the window to their heart!
Dental components like teeth and gum do play an important role in a smile. In today’s society, if a person’s dental components are not healthy or if they do not look right, most will feel far less confident to smile. As cosmetic dentistry has come into a heavier demand in recent years, smile design has become a term used for various clinical treatment plans and for aesthetic improvement. This means smile design: projecting an enhanced smile through alteration of dental components as a practice of cosmetic dentistry. This is a type of comprehensive oral care that combines art and science to greatly improve the aesthetic appearance of the smile, as well as its health and function.
Proper smile design starts with a facial analysis, when the line between the pupils and the horizontal line from the connecting edges of your upper teeth (smile line) are [hopefully] in parallel harmony; the smile line should also harmonize with the upper curvature of the lower lip. Then we evaluate the color, size and alignment of the dental compound, whether it is somewhat in the right places and proportional in relation with the face.
Some of the most common cosmetic procedures include tooth bleaching (or whitening) which enhances the color appearance of your teeth, bonding and veneers or porcelain crowns(which can enhance the outward appearance of a tooth’s color or shape), and gum work (like a gingival plasty, gum contouring or crown lengthening) to harmonize with teeth. Straightening of teeth through adult orthodontics are also a part of cosmetic smile design – not only for improvement of the smile, but to set up a healthier foundation for other cosmetic procedures (or simply to make the mouth easier to clean and maintain).
Laser dentistry is very complimentary to cosmetic dentistry. Laser smile design not only makes common procedures like teeth whitening and gum contouring quick and painless, but because of the laser’s highly focused energy path, very little tissue around the site is disturbed. Procedures are very non-invasive.
Ultimately, cosmetic dentistry and laser smile design could be a great investment if you are not comfortable with your smile or the condition of your teeth (especially if they are worn or broken down, requiring rehablitation or reconstruction). Once you present a confident and happy smile, people will smile back at you and many windows and opportunity will open! Give thought to whether it’s time to have a smile analysis and smile design performed by your dental professional. If you need to find out more about cosmetic dentistry, www.aacd.com can be a referral source.
Have you ever felt sick, taken some Pepto Bismol and then a while later, had a black tongue? You may be thinking you’ve eaten something strange, or that you are having an allergic reaction! This is actually not a rare side effect of Pepto Bismol however – read on to find out why your tongue is black!
Black Tongue is harmless.
Numerous brands of nausea medication, including Pepto Bismol, have an active ingredient called Bismuth subsalicylate, a multi compound drug useful in treating nausea, heartburn, indigestion, diarrhea, and other temporary discomforts of the stomach and gastrointestinal tract. In a tablet form, Bismuth subsalicylate is meant to be swallowed with water – however, when exposed to the surface of your tongue (from chewing), the drug will often turn the tongue black after several hours, and can last several days. A black tongue and black stools in some users of the drug is not harmful, but the color is produced as a side effect of the drug interacting with saliva and the gastrointestinal tract.
The good news is this discoloration has no adverse affect on your health; there is nothing to worry about if your tongue has gone black or if it is staining your teeth with black strips after taking Pepto Bismol. The stain can be removed easily by thorough brushing or seek help from your dental professional. If a thorough brushing was followed after taking the Pepto Bismo, the staining issue would be eliminated. You must be aware of your body if you have a upset stomach in the first place; getting a good assessment and managing the root of the problem rather than just masking the symptoms should be the overall, long-term goal. Maintain a healthy diet, full of fruit, vegetables and lean proteins to control the PH of your body (which should be neutral or mild alkaline). Getting 7-8 hours of sleep every night will ease and equip your body to deal with the stress. If you do have an upset stomach, have a cup of peppermint or chamomile tea with honey on me, which will help with your upset stomach. We can all work on respecting our body and mind to take better care of ourselves.
Got an itchy nose when you are in the dental chair? Have you felt itchy and red on your cheeks when you last visited your dental professional? You might be hypersensitive or have latex allergies. The reactions are most likely from powdered latex gloves. In recent years, latex allergies have become much more predominant in health care provider offices, meaning people must be aware and knowledgeable about how their bodies react to such materials.
Latex is derived from the Rubber Tree.
Natural rubber latex products (like powdered latex gloves) come from rubber trees located throughout South America and elsewhere. This naturally occurring product contains proteins which are the primary source of allergens. There are different types of adverse reactions that occur with latex gloves: the most common is irritant contact dermatitis, which is not an actual allergy, but a skin reaction to the detergent, additives or powders that cover most latex gloves (usually your skin will appear red, dry and cracked). If it is allergic contact dermatitis, you can get a skin rash after a few hours and up to 48 hours after contact. The non-contact exposure to airborne particles when removing the gloves can cause signs and symptoms similar to those of hay fever or asthma. An actual latex allergy is a systemic allergic reaction which is caused by IgE antibodies in the blood to the proteins in natural latex. The response is immediate, such as itching, redness, swelling, sneezing and wheezing; the most serious reactions can be a life threatening and result in anaphylactic shock .
If you do have a latex allergy , be sure to communicate with your health provider, because there are alternatives. Because health care providers are repeatedly exposed to latex quite frequently, they are at a higher risk factor of developing latex allergies – as many as 17% of all health care providers are estimated to have latex allergies. Also, the allergy-causing proteins in latex are found in foods (such as avocado, banana, chestnut, kiwi and passion fruit) – so you might be allergic both latex and some related food.
There is no cure for a latex allergy, although medications are available to reduce the symptoms of latex allergies like antihistamines. If a severe reaction occurs, you will need an emergency injection of adrenaline (epinephrine). For those prone to anaphylaxis, an epi-pen should be carried at all times. The best treatment is prevention, avoid all products that contain latex and ask for advise from your doctor who might be able to suggest ways you can avoid latex in your daily life. Keep identification on you that clearly alerts others of any allergies you have, choose alternative products, and inform your health care professional of any developments.
“Dr. Sun, can you check why I taste metal in my mouth? I have no metal fillings; I checked on line, and I’m afraid I might have a cavity or gum infection!” So, I checked, and the oral department was cleared.
” Your mouth is healthy, tell me what has changed in your life?”
” I lost my job, I’ve been taking anti depressants and Ambien for sleep, but I had a physical exam that was fine.”
“Have you been good to yourself, healthy diet, taking supplements, exercising and proactive on job hunting?”
“Ha! Funny, Dr. Sun, I was going to ask you for a job! I exercise, but not eating well and maybe drinking more.”
“Well, keep yourself in the best condition. The metallic taste has lot to do with the medications you are taking; poor diet and alcohol intake don’t help either. My advise to you is be positive, count your blessings, treat yourself right, maintain a healthy diet, cut down on alcohol and keep up your good oral hygiene. You may rinse your mouth with warm salt water or rinse with warm water with added baking soda (1/4 teaspoon to 8 oz warm water) to neutralize the taste. Also talk to your physician about this, see whether GERD or other gastrointestinal issues play a role.”
It is common to get the funny taste in your mouth (dysgeusia), it might taste metallic, acidic or bitter, it usually goes away on its own, but if is lasts more than two weeks, consult with your health care professional.
Dysgeusia is related to a multitude of adverse health conditions. It is a sign of imbalanced body chemistry, associated with changes of your physical, mental or oral condition: medication and diet also are contributing factors. Starting with the mouth, make sure there is no caries, infection or poor oral hygiene. Think about whether you are taking prescription medications to treat hypertension and anxiety, (like lithium) antibiotics, antidepressant or others which may cause the metallic taste. The last would be possible physical illness likes cancer, a peptic ulcer, food allergies, or excessive metal elements (iron, copper, iodine, mercury, selenium, lead) in your body. Effects of radiation therapy may also cause dysgeusia.
Get a good assessment of the condition, then improve your health and feel better. Apart from consulting with your health care professional, do your part of eating right. Keep up good and clean habits, including oral hygiene, balanced stress level and a positive life outlook. You can also try brushing / scraping the tongue, rinsing with herbal mouth wash (like Tooth & Gum tonic), or swishing with warm salt water or baking soda rinse to neutralize the metallic taste.
There is no way around it: smoking and drinking have a detrimental effect on your dental health, in addition to the rest of your body’s health. There could be arguments about the benefits of a glass of red wine or the medical use of marijuana, but as your health provider, my message is to encourage a clean , healthy drug-free way of living! When you smoke tobacco or drink alcohol, the harmful substances introduced to your body have adverse effects on your organs, and are both addictive and linked to cancers. As far as to your dental health, they can lead to tooth staining and discoloration, tooth decay, gum inflammation and disease, bone loss even tooth loss, as well as an increased risk of developing oral cancer.
Smoking and drinking directly passes foreign material through the oral cavity, generating adverse effects on your oral cavity. Alcohol is a desiccant (drying things up); heavy drinking dramatically decreases moisture needed to maintain a healthy oral cavity. A dry mouth increases one’s likelihood of developing tooth decay, gum disease, bad breath, fungal infection, burning sensations or soreness of the mouth. Alcohol’s acidic nature can also erode the enamel coating on a drinker’s teeth, leading to an increased chance of sensitivity and decay. Long-term contact with alcohol in the oral cavity has also been found to be possibly carcinogenic. Frequent drinking will dramatically increase the ability of cancer-causing substances present in alcoholic beverages to penetrate the lining of your mouth, such as Acetaldehyde – which forms in a person’s mouth after using alcoholic mouthwash (suspected to be carcinogenic).
Smoking is equally detrimental to your oral health. Bad breath (halitosis), sinusitis and tooth discoloration will be the first signs of oral stress of a smoker, as nicotine and tar present in cigarette smoke stains the teeth. Smoking can also result in gum disease, leading to bone loss and tooth loss from decreases in blood flow and oxygen level, and increased plaque and tartar build-up. Smoking also raises the temperature of your mouth to 140-160º F, causing constant irritation and inflammation. An increased risk of developing oral cancer is also a consequence which should not to be over looked – there are 4000 different chemicals in tobacco smoke and 50 are known carcinogens. Nearly 90% of all oral cancer patients are smokers!
In all, smoking and drinking equally wreak havoc on your teeth, gums and oral environment. Avoid smoking and drinking at all costs, and keep your oral hygiene in tip-top condition by brushing , flossing , fluoridation, proper nutrition, and increasing the intake of supplements of vitamin Bs and C. Antioxidants are essential as well.
When you stay up way too late you might find pimples on your face and canker sores in your mouth – never fun to get! This painfully annoying little mouth sore – also known as an aphthous ulcer, can be quite bothersome to your eating and speaking actions for days. Thankfully, you can still kiss your loved ones with a canker sore, which are not contagious, different from viral cold sores (also known as a fever blister) caused by the herpes virus. Both are ulcerative sores in the mouth, but canker sores occur on the soft tissue inside the mouth. Cold sores tend to be on the outside of the mouth, around the lips.
Canker sores can arise for many reasons; the most common are stress factors, like a lack of sleep. Stress can wear down your body’s immune system, making your oral environment more susceptible to ulceration. Food allergies or sensitivities (to acidic fruits or toothpaste containing sodium lauryl sulfate for example) can trigger canker sore formation. The environment you are in can also stress your body and cause canker sores, like being in extreme heat or cold. Deficiencies in iron, folic acid, zinc or vitamin B12 will lead to a nutritional imbalance in your body, making you more susceptible to canker sores. Bacterial infection, hormonal imbalances and hereditary issues can all be causative factors. Finally, dental appliances or procedures which place pressure in specific parts of your mouth (like braces) can cause canker sores. Some physicians have theorized that canker sores are actually hereditary, but extensive research on this topic has not yet taken place.
So what do you do if you have a canker sore? Improve your lifestyle! If you are able to extend your sleep cycle to between 7 and 8.5 hours of sleep nightly, maintain a balanced diet and master “stress management” at work, school and at home, your canker sore frequency will decrease. Canker sores are your body’s way of telling you to slow down and re-evaluate! Luckily, most canker sores will heal within 14 days (albeit painfully), unless your immune system was compromised. If you have a canker sore, avoid contact with it. Any unnecessary stimulation to the site can cause you to say ouch! Avoid spicy or acidic foods as this will further irritate the site. Make sure you are eating a well balanced diet, take supplements like vitamin B and C, and reduce your acidic fruit intake.
There are topical agents which can relieve canker sore symptoms, such as Milk of Magnesia, kenalog in orabase, tetracycline, suspension or low-level-laser-therapy (LLLT). Non-alcoholic mouthwash can also reduce the frequency of canker sores. If you do suffer from severe, frequent or lingering canker sores, speak with your dental professional or your primary health care physician. Remember, the best path to a healthy, ulcer-free mouth is proper oral hygiene, a healthy lifestyle (including quality sleep) and a healthy, balanced diet – if you take care of your body, you can enjoy your quality of life even more.
Have you ever woken up feeling tired? Have you ever fallen asleep while driving? Even if you went to sleep early last night? Do you snore? Sleep apnea could be playing a role. There are countless undiagnosed and untreated cases of sleep apnea in our society (which have been linked to car accidents and machinery accidents from sufferers of sleep apnea, causing operator error).
The most common type of sleep apnea is obstructive sleep apnea. It is a disorder in which a person periodically pauses breathing during sleep (usually an average of 10 seconds). This is usually associated with a reduction in blood oxygen saturation, which can lead to drowsy and excessive sleepiness during the day. Obstructive sleep apnea can also endanger your cardiovascular system.
The airway can become obstructed at several sites. The upper airway can be obstructed by excess tissue in the airway, large tonsils, a large tongue and/or a retruded lower jaw. Usually, the airway muscles are relaxing and collapsing during sleep in this case. Nasal congestion or blockages (as a deviated septum), large turbinate and collapsed nostrils can cause your throat and tongue muscles to contract at night. Ask your partner to observe you sleep if you are in doubt, and keep a sleep diary every night, recording when you fall asleep, when you wake up, if you recall any trouble breathing during the night and how refreshed you feel when you wake. Speak with a sleep specialist to have a sleep test.
If you do have sleep apnea, what does it mean? Depending on the type and severity of your sleep apnea, it could spell some very dangerous health effects, and could even be life-threatening. The main effects of sleep apnea are daytime drowsiness (sleep deprivation) and oxygen deprivation. Depriving your brain of oxygen while sleeping is particularly dangerous and can result in heart disease, high blood pressure, sexual dysfunction, and learning/memory problems. Some sufferers of sleep apnea report short term memory loss, as a result of oxygen deprivation during sleep.
Mild sleep apnea is usually treated by some behavioral changes. Losing weight and sleeping on your side is often recommended. There are several oral or dental devices that can help keep the airway open – most are for bringing your lower jaw forward, or elevating your soft palete to retrain the tongue from falling back, blocking the airway. Moderate to severe sleep apnea is usually treated with a CPAP system (continuous positive airway pressure) which straps around your head and ventilates oxygen into your respiratory system, ensuring a clear breathing pathway during sleep. There are surgical innovations, such as LAUP (laser assisted uvulo-plasty) as well as radio-frequency somnoplasties and radio-frequency volumetric reductions of the palate or tongue to help alleviate severe sleep apnea.
Behavioral modifications can also be advised from your dental professional to treat obstructive sleep apnea, after it has been diagnosed. Besides losing weight and sleeping on your side and controlling your allergies, a properly designed dental appliance can help you get healthier sleep. Your bed partner might get more peaceful sleep as well!
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is effective in most situations, however approximately 15% of dental patients experience a partial or total lack of numbness after receiving anesthesia 
