Sunday, November 22, 2009

What are implant dentures?

'Dentures aren't a replacement for teeth. They're a replacement for no teeth'. This is a common phrase in the dental world to describe the limitations of traditional dentures. At their best traditional dentures can be a beautiful replica of a full set of pearly whites, fooling even close friends and loved ones with their natural look. Even a great looking set of dentures, however, usually leaves something to be desired when eating a meal with foods like steak, salad, and crunchy vegetables. Most denture wearers experience the shifting, sliding, and falling out that can be a very frustrating part of the denture experience. Besides making eating difficult, it can give a person a lot of anxiety about their denture coming out during social or romantic situations. Many people can get by with an upper denture because there is usually a lot more bone for the denture to rest on and more suction provided by the roof of the mouth. Unless advanced bone loss is present, a little adhesive can generally make an upper denture tolerable. But a lower denture is a completely different story. Making a traditional lower denture that satisfies all of a person's expectations for fit, comfort, and chewing ability is without a doubt one of the hardest things to do consistently as a dentist. Try as we might, the lack of bone combined with the strong action of the chin muscles and the floor of the mouth pulling upwards and outwards often makes trying to keep a lower denture in place during chewing like trying to keep a tight squeeze on a bar of soap with wet hands. This is where dental implants can make a huge difference in a person's quality of life, by giving support to a lower denture to keep it in place while eating and speaking. Just two titanium implants can reduce a lower denture's movement and improve all of its features. Depending on how much movement a denture wearer is willing to put up with, more implants can be added (often with a bar connecting them) to reduce the movement even further. If enough implants are used(often 5-6 in the lower jaw) a prosthesis with no movement at all can be made, with the additional benefit that the teeth can stay in all the time. This can be done gradually, adding a couple implants every few years until enough are in place to go with this option. Because bone loss starts the moment teeth are removed, it's best to make implants a part of the plan with lower dentures right from the start. As bone loss takes place, the window of opportunity for having implants slowly closes, so that by the time a person is really having problems with denture movement, extensive bone grafting may be needed, adding time and expense to one's treatment. With dental implants, dentures CAN be a great substitute for teeth, and can be very rewarding for both patients and their dentists, who get to hear about their improved chewing, self-esteem, and confidence compared to what they experienced with traditional dentures. Feel free to ask any questions you have about implant dentures, and I'll be happy to try to answer them for you.

Sunday, November 1, 2009

Sedation Options in Dentistry

Sedation dentistry most often involves the use of anti-anxiety medication to do just that--reduce your anxiety surrounding dental treatment. Depending on your level of fear and the procedure that you need to have done (taking into account things like how long it will take), your dentist can discuss different options to improve your dental experience. It's important to remember that something like having a dental implant placed or undergoing root canal treatment causes different levels of anxiety in different people, and the goal is to match the level of sedation with your particular needs. In order of the lightest to the heaviest levels of sedation, here are the options you'll usually have:

In a general dental setting (and often in the movies) the most common option (due to its high level of safety) is nitrous oxide, known affectionately as 'laughing gas'. When mixed with oxygen and inhaled through a small rubber mask that fits over your nose, nitrous oxide produces a feeling that most people find very pleasant. The phrase I like to use (because it seems to be accurate) is that once the gas kicks in, being at the dentist sounds like a much better idea than it did on the way to the office. By reducing your anxiety, the gas also elevates your pain threshold (which is great because even though you'll still receive numbing medication, for some people things like opening wide and having your lips and tongue tugged on can be bothersome too). It also can make the appointment seem shorter. If for any reason you don't like how the gas makes you feel, it can be turned off and its effects wear off very quickly. Perhaps the best benefit of this option is that after a few minutes of breathing regular oxygen as the procedure is finishing up, you're back to feeling like your old self and can drive yourself home with no after-effects (though to be completely honest, you sometimes feel a little drained--this is thought to come more from the adrenaline surge you get building up anxiety before the procedure than from the gas itself). If I haven't convinced you yet, it's also wonderful for all procedures performed on children, allowing us to build positive experiences for them from the start. In many offices there is no charge for the gas so you may want to consider it even for minor work like fillings and other small procedures.

The next step up would be oral sedation, usually given as a single dose in pill-form before your appointment. For a small fee (the cost of the pill at the pharmacy) you'll reach a slightly more sedated level than with nitrous oxide, but will still be awake and breathing on your own. If you appear to be strongly affected your doctor will likely attach a monitor to you to keep a constant watch on your blood pressure and breathing habits to keep you safe. You'll probably talk during the procedure but will have little recollection of it. This type of sedation means that you need to arrive at the office with an escort who will stay there until your appointment is over, can go over post-operative instructions with us, and will drive you home afterward. This is a common option if you'd prefer not to remember too much about the visit, but requires a little more planning because you'll probably be drowsy for several hours after your appointment so you'll have to make arrangements for work, etc. Another great use for this type of sedation is take a small dose to help you get a restful night's sleep before the appointment. Because medications affect everyone differently, you might be a little more or less sedated than you planned on but over a couple of visits your dentist can figure out a dosage that works best for you.

The safe way to reach a deeper level of sedation (though still called 'conscious sedation' because you're still breathing on your own) involves the use of intravenous (IV) medication. When you take a pill your level of sedation cannot be adjusted because taking more pills while in the chair is not a safe option. With IV sedation, however, your doctor can predictably raise your level of sedation if you are uncomfortable or lower it if you appear to be approaching levels deeper than conscious sedation. You'll be in a state where you can be woken up if needed, but you'll probably spend much of the appointment with your eyes closed and will have less memory of the procedure than you would with oral sedation. Like oral sedation you're required to bring an escort. There's an additional requirement of not having anything to eat after midnight the night before your appointment. Due to the additional training, equipment, and medications needed to offer this option, IV sedation almost always carries a moderate fee.

Less common, the deepest levels of sedation are often reserved for treatment in an oral surgeon's office or in the most serious cases of dental anxiety. As you'd expect for a surgery like having your appendix removed, you are unconscious and breathing is controlled for you via machine until the procedure is over. Though this option has a long track record of safety, it can sometimes result in more drowsiness and nausea. Since it requires the most equipment and training it often carries the highest cost but in some instances it is the only option.

Hopefully this gives you some idea of what options are out there. Your dentist can discuss whether you are a candidate for one of these types of sedation. For some people these techniques can mean the difference between being able to receive dental care or not, while others may choose to use them only from time-to-time for a particularly involved or anxiety-producing procedure. As always, the choice is up to you, but know that you can probably benefit from at least one of the many types of sedation in dentistry. If you have any questions, please feel free to contact us here or at!

Discussing Fear and Anxiety with Your Dentist

It's no secret that going to the dentist is consistently ranked as one of the things most feared by people, sometimes listed higher than public speaking or even death. I've heard many different stories from our patients over the years about dental experiences that caused them a great deal of pain or left them feeling traumatized for life. Often these were procedures they had done as children, and the memories still conjure up anxiety, in many cases so much so that certain parts of the dental experience trigger an overwhelming sense of terror or a 'fight or flight' type of response. This could include arriving at the office, getting in the chair, or seeing the instruments on the table. It often results in a vicious cycle of avoiding the dentist until something is seriously wrong and extensive work is needed, leading to even more anxiety and causing the person to think 'This is why I hate going to the dentist in the first place!'

Regardless of your level of anxiety about receiving dental care, you can be sure that a caring dentist will be happy to discuss the things that are unpleasant for you, and would prefer to know about them so they can do their best to minimize their impact on you. Many people feel embarrassed or guilty and feel the need to apologize for what are often uncontrollable responses that come from their fear and anxiety. The first thing to realize is that your fears, whatever they may be, are completely normal and are probably shared by many others just like you. Your dentist has almost certainly heard a story similar to yours at least once and is there to help you have better experiences moving forward. We really do want to make you as comfortable as possible, and our profession as a whole has more tools than ever before at our disposal to do this. We know that these triggers are different for everyone, and something that really frightens one person may just annoy someone else but isn't even noticed by another. Some people are more comfortable being able to ask many questions about a procedure (this is always allowed and highly recommended if you are interested) while others would prefer to know as little as possible about the details. Knowing as much about your past experiences allows us as dentists to try to tailor your dental experience to your individual triggers and emotions. This type of open discussion can do wonders for improving how you feel about the dentist! But beyond discussion dentistry has many other tools we can offer to make your experience a better one; these are often grouped together into what is called 'sedation dentistry'... (more on this in the next post)