Family & Cosmetic Care in a Comfortable, Relaxed Environment.

Serving Las Vegas and Henderson, Nevada since 1999.

Dental Anxiety - Abnormal fear or dread of visiting the dentist for preventive care or follow up treatment and extreme anxiety over dental procedures.

Let’s face it, not many people truly enjoy going to the dentist. There are plenty who do, but most do not. We know it is good for our dental and overall health, so we go for that reason. For some, an irrational fear takes over, leaving them paralyzed with fear, and without the dental care they need to enjoy their lives fully.  According to a 2009 study by the U.S. Centers for Disease Control and Prevention (CDC) almost 50% of adults skip dental visits due to dental anxiety.

Psychology of Dental Anxiety

Many dental related fears are developed when you are young and impressionable. Sometimes the dental fear is transferred from parents to their children. When a parent is highly anxious, they oftentimes elaborate on pain, needles, drilling, and tooth removal, causing the child to believe that this will happen to them also. For some, a bad dental experience can traumatize them for the future. Feeling pain, gagging, losing control, not knowing what is going on, or having unexpected procedure you were not prepared for can be very difficult to get over. Prior to modern dentistry, dentists and their instruments were given a bad reputation in real life, movies and TV shows . The instruments and techniques used to mask discomfort were less than ideal. In modern dentistry, the dentist is more in tune to patients dental anxiety and dental fears. These dental anxieties can be overcome with a concerted effort by the patient, loved ones, and dentist.

How to Overcome Dental Anxiety

Overcoming dental anxiety can take as little as one visit, or it can take months to years. It all depends on the level of anxiety or phobia a patient might have. The following are some tips to help overcome dental anxiety:

1) Find the “right” dentist. Not all dentists have the same educational training, techniques, or patience when it comes to patients with dental anxiety. Do your research, use the Internet or ask friends and loved ones for recommendations. A good dentist is one, who is able to communicate effectively with you, and put you at ease. Most patients feel better when they know whats going on and how its going to happen. Understanding what will happen in the appointment, and having a signal to stop whenever you need to, gives back control to the patient and takes the surprise out of the situation. You and your dentist will figure out what specific things elevate your dental anxiety, and find ways to work around them. Ask your dentist their policy on emergencies after hours. Many dentists do not return calls after hours while others personally answer calls after hours and even open the office if the situation is necessary.

2) Distraction. Oftentimes, redirecting your mind can set you at ease. Meditation can be taught to you by your dentist. Music can help if the noises of dentistry affect you, bring your ipod or mp3 player with your favorite music and listen during the treatment to distract your mind and relieve your dental anxiety. A soft “squeezy ball” can help, and give that comforting feeling of squeezing someones hand.

3) Take Breaks when Needed. This goes back to communication. Take the time out during procedures to compose yourself as needed. Have a predetermined hand signal to stop the procedure as often as needed. Some patients with dental anxiety feel claustrophobic after awhile and may need to walk around a bit, catch their breath, ask a question, etc. before finishing the dental procedure.

4) Be Open and Honest. Tell your dentist what bothers you most about the dental experience, or past problems that have increased your dental anxiety. For some, the loud pitched noises may be very difficult, for others it might be the smells of the dental office, and for others it might be a past painful experience. These issues can be addressed in order to make your experience more acceptable. In dentistry today, there are many techniques to deliver a more comfortable and comforting experience.

5) Consider Medication. For some of us with more extreme dental anxiety, a mild form of sedation may be necessary to get you through. Taking a medication such as Valium prior to your appointment can help you sleep the night before, and allow for you to actually get to your appointment. Generally, such medications relax your entire body, decreasing the sweats, heart racing, and panic attacks that might otherwise disable you. This is a wonderful way to acclimate yourself to your new dentist, and the dental experience. Over time, the dosage can be reduced as you gain confidence in your dentist and your own coping abilities.  Plenty of patients, with time, can learn the techniques necessary to have dental treatment without medication.

Dental Anxiety Conclusion

Dental anxiety can be truly crippling. What we have to remember is, that if we want good health, dental treatment is necessary.  Recent studies have shown definite links between our dental health and our general health. This means it makes our dental health doubly important for us to lead healthy, happy lives. Dental anxiety CAN be overcome and defeated with a concerted effort by dentist and patient. If you are suffering from dental anxiety, take that first step, and make an appointment to meet with a dentist well versed in treating dental anxiety and dental phobia.

 

Dry socket (also called alveolar osteitis) is an extremely painful dental condition that can occur after removal (extraction) of a permanent adult tooth.

Having a tooth removed is generally not something anyone looks forward to. Most people understand there will be some level of discomfort following the procedure.  Many are given a prescription for pain medication before leaving their dentist. Most people in fact do not even need to get the prescription filled. However, when a patient experiences what is called a dry socket the pain can become quite intense and linger for days.

Very few people are affected by dry socket. The development of Dry socket after a tooth extraction occurs in only about 2-3% of patients. For those who experience dry socket it can be a very scary experience. Fortunately dry socket is treatable.

A dry socket occurs when the blood clot at the site of the tooth extraction has never fully formed, has broken free, or has dissolved before the wound has had a chance to fully heal. The blood clot is the protective layer for the underlying bone and nerves, it begins the process of healing so that gum tissue and bone can refill the area. When the clot is gone the bone and nerves are now exposed to the outside air, food, fluid, and anything else that enters the mouth. This can lead to a dry socket with sharp, aching pain that can last for 5-6 days, and in the case of a patient taking fosamax type drugs the pain can last for weeks.

A dry socket is considered the most common complication following tooth extractions. It happens more frequently with extraction of impacted wisdom teeth, in patients with poor blood flow to the socket, (smokers, patients taking fosamax), delayed healing (diabetics ).  The pain begins to build and develop about 2-4 days following the procedure.

Signs and Symptoms of Dry Socket

Signs and symptoms of dry socket may include:

-Sharp, aching pain within 2-4 days after a tooth removal.

explanation of dry socket

Graphic explanation of dry socket…image courtesy of Dental Care Matters

-Partial or total loss of the blood clot at the tooth extraction site. You would be able to visually notice a deep hole or space where tooth used to be, that weeps fluid when pressed vs a blood clot overlaying the site.

-Bone that is visible upon visual examination in the socket

-Pain that radiates from the socket to your ear, eye, temple or neck on the same side of your face as the extraction

-Abnormally bad breath or a foul odor emanating from your mouth. This will coincide with having a bad taste in your mouth as well.

-If you have swollen lymph nodes around your jaw or neck, this is a sign of infection and you need to be seen by your dentist immediately.

Over the counter medications by themselves will not control the symptoms. Your dentist or oral surgeon will need to begin treatments to lessen pain and allow for healing to take place.

Treatment of Dry Socket

Taking a nonsteroidal anti inflammatory drug (NSAID – aspirin or ibuprofen) can help to ease the pain but probably will not be enough to take it away completely. When the pain persists you should call your dentist immediately. The dentist may prescribe you a stronger pain medication to allow the pain to subside for you or give you anesthesia in the office to relieve some of the symptoms for a little while anyway.

paste for dry socket

Paste for Dry Socket

What will your dentist need to do for the dry socket? Your dentist will need to numb and clean the tooth socket. This will allow for  removal of any debris from the space where the tooth once was, and allow for rebleeding into the site. The dentist may then fill the socket with a medicated dressing or a special paste to promote healing and soothe the symptoms. Patients with dry socket dressings generally need to come back to be seen by the dentist every day until the pain subsides. The dressing needs to be changed daily. Warm cloth on the outside of the face also helps promote blood flow.

An antibiotic may also be prescribed at this point to prevent an infection from forming. At home care will include rinsing with salt water and being careful what you eat and how you eat it, ( avoiding the side where the dry socket is ).

The site will usually heal completely following treatment in 1-2 weeks.

Who is most likely to get a Dry Socket?

Some patients will be more likely than others to get a dry socket after a tooth extraction. These include the following:

-Smokers. Patients who smoke have twice the chance of developing dry socket over those who do not. Smoking also is believed to slow the healing process.

-Poor Oral Hygiene. Those with poor oral hygiene will have an increased risk due to the amount of bacteria in the mouth. Will be difficult to maintain a sterile field when removing tooth.

-Having wisdom teeth (3rd molars) extracted. Increased trauma to area during procedure is one of the indicators for increasing the possibility for the development of dry socket. 3rd molars tend to be more difficult to remove especially if they are fully or partially impacted.

-Previous history of dry socket. If you have had dry socket previously, you are more likely to develop it after another extraction.

-Use of birth control pills. Contraceptives which contain estrogen effect the blood clotting system of the body. So we see an increased incidence in dry socket in patients on oral contraceptives.

Rinsing and spitting a lot or smoking after having a tooth extracted also can increase your risk of getting dry socket. These activities will increase chances of the blood clot becoming dislodged.

Following the removal of a tooth it is very important to follow all instructions given to you by your dentist. If you are unsure of anything you must ask or call back. At first sign of pain or discomfort call your dentist to be sure it is not something more serious. As always, maintain a regular schedule visiting your dentist, as well as keeping an open communication with your dentist. This will make you feel comfortable asking questions and knowing you are getting the proper information to care for your oral health.

We don’t often give much regard to the importance of the bone our teeth sit in until there is a problem. The bone not only serves as the foundation for our teeth but it also plays a big part in our visual aesthetic appearance. Bone can be lost by tooth removal or periodontal disease. If a tooth is missing or removed, the bone may collapse into the empty socket and cause a sunken appearance to our cheeks or jawbone. A bone graft can restore these problems caused by dental disease or those that result from an accident. One of the main reasons for bone grafts in modern dentistry is to form a good foundation for dental implants.

What is a Bone Graft?

A bone graft is the replacement or augmentation of the bone around the teeth. Bone grafting is a term used to describe a variety of procedures used to add or build bone so that dental implants can be placed.
Dental Bone Grafting
A bone graft typically involves adding bone or bone like materials to the jaw. The bone graft can be your own bone (also called Autologous  bone), synthetic bone, be processed bone obtained from a cadaver (also called Allograft), or can even come from bovine/cow sources (these types are also called Xenografts). After grafting, you generally have to wait several months for the grafted material to fuse or become one with the existing bone structure.  Processed bone grafted materials either cause surrounding bone to grow into the graft or cause cells around the graft to change into bone. Autologous bone transplants bone cells or a block of bone that fuses to the jaw.

Implant Dentistry

It is often used to augment bone to allow for a more successful implant placement. A few reasons for bone grafting in implant dentistry include:
1) Augmenting bone in the sinus area to allow for implant placement.
2) Augmenting bone to enhance the fit and comfort of removable prostheses (dentures)
3) To enhance aesthetics of a missing tooth site in the smile or aesthetic zone. This zone is generally defined as the visible area seen upon full smile, including the teeth, gingiva, and lips.
For a dental implants to be a success, the patient must have sufficient bone in the jaw to place the implant into.
Assumptions were once made that if a patient did not have sufficient quality or quantity of bone in their jaw they would not be suitable candidates for dental implants. Today, thanks to the exponential advances in dental techniques, materials, and technology, patients with insufficient bone in their jaws can have the bone rebuilt using bone grafting.

Bone Grafting Procedure

The actual bone grafting procedure is quite straightforward. A dentist will assess the quantity and quality of your bone during the treatment planning stages. It will be at this time that he/she will determine if there is a need for bone grafting. Then your dentist will review the different types of bone grafts with you and decide which will be the most suitable for your individual case.

Once this has been decided the bone graft procedure can be performed. The actual procedure requires the dentist to place bone under the gum tissue at the site where the bone graft is needed. The dentist will then be able to place the bone to be grafted onto the site and then cover it with a membrane for protection. Membranes are often used to help stabilize the bone graft as well as keep the gum tissue from invading the healing bone graft. The gum tissue will grow at a much faster rate than bone, therefore, membranes are used to prevent gum tissue from growing in and displacing the bone graft before it fully matures.This membrane is also used to protect the boneDental Bone Grafting from any germs found in the oral cavity and ensure that the area is perfectly clean to allow the healing process to take place. Finally, the area is closed and the tissue is stitched into place. Bone graft healing time is usually right around 4-6 months. But this can vary from patient to patient. Patients are given a prescription for antibiotics to take following their bone graft. Antibiotic mouthwashes can also be prescribed to preserve the health of the gum covering the bone graft.

On follow up visits the dentist will check on the success of the bone graft by taking x-rays to determine the height and width of the new bone. Once this has been verified as satisfactory, and the site of the bone graft is completely healed, the next stage of the dental implant process can begin.

Dental bone grafts for the purpose of dental implants has a very high success rate. But there is always a possibility that the bone graft will not work as planned, even if your own bone was used. Bone grafts are not rejected by the body like organ transplants. There is still some mystery as to why some bone grafts fail. We do know that certain people (for example, smokers, diabetics, patients with poor dental hygiene) have higher risks of graft failure.

A failed graft will need to be removed. Once healed properly, you and your dentist may choose to place a second graft.

A bone graft gives the implant dentist and patient one more tool to achieve a successful outcome to just about any implant treatment.

Dental Bone Graft