Posts for: October, 2018
The best way to prevent dental visit anxiety in your children is start those visits around their first birthday, and continue with them through childhood. Age One visits are the best way to ensure they're comfortable with the dentist now and that they'll continue the habit into adulthood.
But in spite of your best efforts and those of your dental provider, there's no guarantee your child won't experience dental visit anxiety at some point. If that happens, we recommend conscious sedation.
Conscious sedation is the use of certain medications to help a patient relax. It's not the same as anesthesia, which eliminates pain by numbing tissues (local anesthesia) or inducing unconsciousness (general anesthesia). During conscious sedation a patient remains awake or at the most in a dream-like state, can still respond to touch or verbal commands, and although monitored doesn't require assistance in heart or lung function.
We can induce this relaxed state in a number of ways: orally, with medication given by mouth a short time before the visit; intravenously, the medication delivered through a drip directly into the bloodstream; or by inhalation, usually nitrous oxide gas mixed with oxygen and delivered by mask.
Oral sedation is the most common. On the day of the procedure, we'll give your child one or more sedative drugs, usually in syrup form. For best results we advise they eat a low-fat dinner the night before and not eat or drink any food or liquid afterward. We typically use Midazolam and Hydroxyzine, both of which are proven safe and fast acting.
During the procedure, we'll also assign a team member to monitor their vital signs while they're under the influence of the drugs. We may also employ special positioning or immobilization equipment to keep movement to a minimum.
After the procedure, we'll continue to monitor vitals until they return to pre-sedation levels. The child should remain home the rest of the day to rest and return to school the next day.
Conscious sedation is regulated by states: providers must be trained and licensed to administer sedation drugs with continuing education requirements. Even so, the use of sedation for children is becoming more widespread and helps to safely ensure they're getting the dental care they need.
If you would like more information on comfortable dentistry for children, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Sedation Dentistry for Kids.”
Along with the gums, your teeth’s roots help stabilize them. Without them your teeth couldn’t handle the normal biting forces you encounter every day. That’s why a rare condition called root resorption must be treated promptly: this gradual breakdown and dissolving of root structure could eventually cause you to lose your tooth.
Resorption is normal in primary (“baby”) teeth giving way for permanent teeth or sometimes during orthodontic treatment. But the form of resorption we’re referring to in permanent teeth isn’t normal, and is highly destructive.
The condition begins in most cases outside the tooth and works its way in, usually at the gum line around the cervical or “neck-like” region of the tooth (hence the term external cervical resorption or ECR). ECR produces pink spots on the teeth in its early stages: these are spots of weakened enamel filled with pink-colored cells that cause the actual damage. The cells create cavity-like areas that can continue to enlarge.
We don’t fully understand what causes ECR, but there seems to be links with excessive force during orthodontics, tooth trauma (especially to the gum ligaments), tooth grinding habits or internal bleaching procedures. However, most people with these problems don’t develop ECR, so the exact mechanism remains a bit of a mystery.
The good news, though, is that we can treat ECR effectively, provided we discover it before it inflicts too much damage. That’s why regular dental visits are important, coupled with your own observation of anything out of the ordinary and immediate dental follow-up.
If the affected area is relatively small, we may be able to remove the cells causing the damage and repair the area with a tooth-colored filling. If it appears the pulp (the tooth’s innermost layer) is involved, we may need to perform a root canal treatment to remove infected tissue and fill the empty space with a special filling. You may also need other procedures to reduce the chances of gum recession around the affected tooth.
Proactive dental care is your best insurance against losing a tooth to root resorption. So keep an eye on your teeth and see your dentist regularly to keep your teeth and gums healthy.
If you would like more information on the signs and treatments for root resorption, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Root Resorption: An Unusual Phenomenon.”
If you have chronic jaw pain, you know how difficult eating, speaking or even smiling can be. Many sufferers will do anything to gain relief, even surgery. But before you go down that road, consider the traditional conservative approach to temporomandibular disorders (TMD) management first—it could provide the most relief with the least risk of side effects.
The temporomandibular joints connect the lower jaw to the skull on either side of the head. These ball and socket joints also contain a cushioning disk to facilitate movement. This disk is believed to be the primary focus for jaw pain problems known collectively as TMD.
Doctors now believe injury, stress, metabolic issues, jaw anatomy defects or similar factors trigger the chain reaction of muscle spasms, pain and soreness that can erupt during a TMD episode. A TMD patient may experience pain within the jaw muscles or joints themselves, clicking sensations, or an inability to open the jaw to its full range.
TMD therapy has traditionally followed an orthopedic path—treating jaw joints like any other joint. In recent years, though, a more aggressive treatment model has emerged that promotes more invasive techniques like orthodontics, dental work or jaw surgery to relieve discomfort. But the track record for this model, especially concerning jaw surgery, remains hazy at best and offers no guarantee of relief. These techniques are also irreversible and have even made symptoms worse in some patients.
It’s usually prudent, then, to try conservative treatments first. This can include pain and muscle relaxant medication, jaw exercises, stretching and massage, and dietary changes to reduce chewing force. Patients with teeth grinding habits may also benefit from a bite guard worn at night to reduce the biting force during sleep and help the joints relax.
By finding the right mix of treatments, you may be able to find significant relief from TMD symptoms with the conservative approach. If not, you might then discuss more invasive options with your dentist. But even if your dentist recommends such a procedure, you would be wise to seek a second opinion.
TMD can definitely interfere with your quality of life and peace of mind. But there are ways to reduce its effects and make for a happier life.
If you would like more information on managing chronic jaw pain, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Seeking Relief from TMD.”