I Hate Shots. I Wish That You Would Have Something Else!
Many years ago, just the opposite was stated. Dental anesthesia simply didn’t exist! There was really nothing to numb or deaden a tooth so it could be treated. The first local anesthetic used was actually cocaine. It worked but of course, it was addictive and toxic. It wasn’t until the beginning of the last century that our famous Novocaine came on the scene. In fact, it was so popular that many people today use the word to mean a local anesthetic.
Pain-free dentistry is now a reality!
We really don’t use Novocaine anymore in dentistry as it has been replaced by better anesthetics with fewer side issues. These newer products give better numbing, which we call “anesthesia” and work quicker. It would be an understatement to say that local anesthetic has revolutionized dental care. We can now perform a variety of procedures, whether simple or sophisticated with the patient being totally pain-free.
Before local anesthetic, the only treatment available was the removal of a troublesome tooth and of course was not a pleasant experience for any one. The ability to numb a tooth has led to more people keeping teeth for their entire lives, rather than being toothless in their twenties. So that’s great! We can do a dental procedure in a pain-free environment using a local anesthetic. The problem with this from the patient perspective is how we have to administer it. Of course, I am referring to the dreaded shot.
What is dental anesthetics?
Let’s talk a little about this. The method of action of a local anesthetic is to bathe the nerves that transmit sensation from the tooth to the brain in this numbing liquid. When the nerves come in contact with the solution they shut down and no longer do their job of sending a pain signal. This closed for lunch sign is effective until the anesthetic leaves the area of the nerve and sensation comes back to the tooth.
Different locations of the mouth have different requirements for giving the anesthetic. For the upper teeth, it is given one way. For the lower teeth, it is given another way. The upper jaw is much more porous than the lower jaw. Therefore, simply placing the anesthetic under the gum next to an upper tooth will cause the tooth to numb. The lower jaw is much denser and if you put anesthetic next to a tooth it will not penetrate the jaw and reach the nerves of the tooth. To numb a lower tooth, you have to find the nerve that supplies the entire side of the mouth and numb that. That is why we numb the back of the mouth when we work on lower teeth even though we may be working more towards the front of the mouth.
Did you know? There is now a nasal spray dental anesthetic!
The human body is a marvel of complication, sophistication, and crossovers when it comes to its various parts. Because of this, we now can actually numb many upper teeth without a shot. Yes, that is not a typo! We DO NOT need a shot for a number of upper teeth. Just last year the FDA approved a product called Kovanaze for use in dentistry for upper teeth. The product is a nasal spray that is given prior to performing dental work. It can numb the upper front teeth without the side effect of numbing the lips and cheeks. It is not for all teeth, but one of the most sensitive injections is in the front of the mouth. With this nasal spray anesthetic, those days are history.
Topical dental anesthetic for pain-free cleanings
Many people are sensitive to having their teeth cleaned. Because of this, they skip their very important dental cleanings and checkups and only come when it is too late. I use another product which can be squirted around a tooth without the use of a needle to numb the area. This can make your cleaning totally pain free.
Unlike the nasal spray, I can use this any place in the mouth. It doesn’t make a difference if it is an upper tooth with its porous jaw or a lower tooth with a dense jaw. This product simply works without having to use a shot. This product is called Oraqix (pronounced Ora-Kicks) and I have used it for a number of years to make routine procedures more comfortable and easier. When you are at ease, our work goes faster and is done much better. It is a win-win for all involved.
Today, Dental Anesthesia does not have to mean shots
So although needles have not left medicine, and dentistry, in particular, there are a number of innovations that work towards my goal in interacting with my patients. That goal is providing the best care with the most comfort. Needle free anesthesia is an example of that approach and desire. If these or other dental topics are intriguing and you want to learn more about new techniques and products, please call me. I can be reached at 440.951.7856 and look forward to hearing from you.
When one’s tooth is in need of repair it’s interesting to see how as doctor & patient, we each have different concerns when faced with a cracked/chipped tooth restoration procedure.
I’m Leaving Town Next Week. What Can You Do For My Broken Front Tooth?
This was asked to me by a patient that I have been privileged to serve for 38 years. Yes, we know each other very well and I am proud to say that she has all of her teeth. This is the result of she and I working together to maintain her oral health.
Her particular dilemma last week was that she was going away for a few weeks and her front tooth had fractured. She thought that time was the biggest issue in this case. “How will you get this done in time?” I had some other concerns. Let’s talk about her anxiety and later on my thoughts and worries on the matter.
Dental treatment and Tooth Restoration repair times
At times, certain types of dental treatment can take a long time to accomplish. If I can fix something in the office, then I am usually done in one visit. Problems of time develop when I need to collaborate with one of my dental treatment partners. Most notably, this is the dental laboratory One of the biggest things that slow us down can be laboratory time to make a dental replacement. Tooth restoration could involve crafting a crown, a denture or a variety of other dental devices that are custom made for your mouth. They could require a multitude of visits, impressions, phone calls and emails to the lab. This just slows everything down.
However, new digital technology can speed up a number of procedures and make long waits not relevant to many cases. They are not for everyone and every situation but when we can use them, they are fantastic. This was actually the case with my patient. We were able to use a special type of metal-free material and in just a few days get our final beautiful result.
A temporary and permanent solution
In the office, I tended to her needs and immediately began to fix her broken front tooth. With new in-office materials, I was able to obtain an acceptable temporary result before she left. The final, long lasting and highly aesthetic result needed my dental laboratory’s involvement. We chose a type of very cosmetic crown which can be made in a day. It turns out, that time, which she thought was a major issue, was really not a concern at all. Her new front tooth came back from the lab in plenty of time for her to catch her flight.
What I as a cosmetic dentist worries about when repairing a front tooth
I began this column with the comment that I had other concerns besides the time factor. My biggest worry was due to the fact that we were dealing with one of her smile teeth. Let me rephrase that. We were dealing with her very front teeth.
Matching a front tooth to its ‘twin’
One of the hardest things to do in dentistry from a cosmetic standpoint is matching a front tooth to its paired tooth. What do I mean by a “paired tooth”? Let’s draw an imaginary line right through the center of our nose in a vertical direction. Half of our teeth are on the right side of this line and half of the teeth are on the right side of this line. We call this line, the “midline”. All of our front teeth have a pair or a twin. One of these teeth is on the left side of the midline and one is on the right side of the midline. These two sides meet smack dab in the center. Our large front teeth, which we call central incisors are right next to each other.
When we need to fix one of them, the slightest difference between them in color or shape will be very noticeable. This is because this tooth’s partner or twin is right next to it. We spend a lot of time brushing our front teeth and see this pair of teeth the most. Matching them can be a real challenge. Sometimes, we are forced to treat both teeth in an effort to create a stunning result.
Both our concerns resolved to our mutual satisfaction
When I finally tried in her new front tooth, she said that I had a twinkle in my eye and a smile on my face. She knew that I had successfully dealt with my concern. I had created a natural look that both she and I were proud of.
The longer that I practice and see new innovations in the field, the happier I am for my patients. Dentistry can offer so many solutions to problems of the past.
If you have a cosmetic or tooth restoration concern, don’t hesitate to educate yourself. Call your dentist or call me, and let’s talk about your issues. I can be reached at 440.951.7856 and look forward to speaking to you.
There was a folk song that was popular many years ago that was entitled “If I Had A Hammer”. The lyrics began with “If I had a hammer, I’d hammer in the morning, I’d hammer in the evening, All over this land….” I thought of this song as I saw an ad in the paper for the use of mini-implants. The ad seemed to imply that instead of using conventional (whatever that may mean) implants, anyone can use mini-implants and get all the same results. The commercial said that these mini-implants were easier to place, took less time, involved faster healing, and were half the cost. It would seem anyone is a good candidate for mini-implants.
Sounds great right? Unfortunately, mini-implants are not the magic bullet some make them out to be. Let’s take a few minutes to learn together about this subject and why not just anyone is a good candidate for mini-implants.
What are Mini-Implants?
Mini-Implants are pretty self-descriptive. They are miniature versions of their big brother – traditional dental implants.
We all like small. We like items to be petite. Our phones have become miniature computers. There is even a brand of car that is becoming more popular call the Mini Cooper. In an era of super-sizing, being smaller and more compact is still a very positive attribute to have.
So it sounds like smaller, miniature implants are the new and improved implant. We have moved forward to this compact era. I can use a mini-implant wherever I previously used a conventional implant. Just like the song says: I would hammer in the morning…….” I would use my hammer everywhere and all the time.
Size – The Biggest Advantage and Disadvantage of Mini-Implants
The ad went on to say that healing is faster and the teeth can go in faster and the results are immediate. We all want this. Right? As with many things in life, if something was really true then everyone would be doing that thing. We need to talk about this. The biggest advantage to mini-implants is their size. The biggest disadvantage to mini-implants is their size! That’s right, the best thing about them is actually the worst thing about them.
Implants serve as a foundation for teeth in the mouth
Many years ago a wise oral surgeon told me that he always over-engineered his implant cases. He used the biggest and most implants wherever he possibly could. The reason was very simple. Implants serve as a foundation for teeth in the mouth.
When we build a house, for example, do you ever hear that the contractor uses mini-supports? Where we need to use studs every sixteen inches, do we put them every three feet? Of course not. We need to construct a structure that is solid and will endure the weight and other forces that may be put on it.
So I will ask you: Why do we think that we can skimp on support for teeth? We chew meat….we chew bread…we chew nuts. These and many other foods put many heavy forces on our teeth. We need support. We have at least twenty-eight teeth. Why do we need so many? Let us develop a few big teeth on some small roots and that’s it. These mini roots would make it easier to brush and floss. Our dental cleanings would go faster as there are fewer and smaller roots to develop tartar to clean.
The answer is obvious. It wouldn’t work. From a structural standpoint, it is faulty. We need enough teeth and large enough roots to handle all the forces of chewing. People with a full compliment of teeth and a healthy supporting gums and bone can exert the greatest biting forces. These forces are needed to properly eat our food and allow us to be nutritionally fit.
Where the greater force is exerted, the greater the support needed
Where we have the greatest forces, we need the biggest implants to support these tremendous forces. Back teeth is NOT an area where we use mini-implants. The biting and chewing forces of our large molars will overload a miniature implant. You can’t put a top-heavy crown on a little tiny implant and expect the support to last. This will overload the situation and cause the implant to fail. I have written extensively on how detrimental to natural teeth excessive biting and grinding can be. In the case of an undersized implant, even normal biting is too much!
Where mini-implants are best used
So, after all, is said and done, where would I use a mini-implant? Who is a good candidate for mini-implants? I have used them for years, but the need to pick and choose the right candidate for mini-implants is important. I would not “use my hammer to hammer all over the land”.
Mini-Implants are best used to support a denture that already has a reduced biting force. It should bite against another denture, not against natural teeth. This will produce excessive forces for the mini-implant. Because they are smaller in diameter, one needs more of them to support a denture. Where I could use 2 normal size implants, with mini-implants, I need at least double that.
You still need to evaluate the patient and the remaining bone to place these properly. I have seen too many inexperienced dentists place mini-implants in the wrong area or missed the bone because they used shortcuts in their techniques. When I teach my students, I emphasize proper preparation before ever beginning any treatment.
So yes, mini-implants are a valuable adjunct to all the other tools and techniques that I have. Proper preparation and planning are crucial as with all things in life. If you ever wondered if you are a good candidate for mini-implants or any other type of implant, please call me at 440.951.7856. I will be more than happy to talk to you and advise you to the best of my ability. I look forward to hearing from you.
The Crown Holding My Partial Fell Out. Can You Please Make A New One?
Crown replacement is another common request that I hear in my office. It can be necessary when one of the anchor teeth that helps hold a partial or removable bridge (as it is often called) falls out. Either a tooth cracks or a crown that has been there for years has come off and no longer fits. This tooth or crown allows the partial to fit over it with a complex array of metal or non-metal arms. These arms, which we call ‘clasps’, allow the removable teeth to be stable in the mouth. It and a few of its friends that look similar create a steady base that allows functional movements and speech. These functional movements we shall call chewing. Without the tooth or crown, and the clasps on top and around it, the removable bridge would flop all over the mouth.
Once Upon A Time, Reverse Engineering Teeth to Fit Inside Crowns Was Nearly Impossible.
Unfortunately, crown replacement is not always that simple. I would like to illustrate it with a story from my years in dental school. When in school everything moves along at a snail’s pace. That’s okay, as the students are learning new skills and practicing to create a perfect result. Let me tell you about what happened in my second year, to one of my classmates. We were in our dental lab working on plastic teeth in a model of the mouth. We were making crowns and bridges as a full term project. We worked on this for weeks and months. Long hours both during and after school were invested by all of us. After all, this single project accounted for 70% of our grade. The night before the project was due, many of us were working in the lab and putting the final touches on our work. I noticed one fellow in particular who was not very happy. He was in his work area, laboring diligently with a notable frown on his face. I went over to him to find out what was wrong. He promptly showed me his finished work. It looked great. I congratulated him and asked him as to why he appeared to be upset. He proceeded to tell me that he although he has his project, he could not find the plastic model of the teeth upon which he made the project. It was lost! He has to work backward! He was attempting to shape the teeth to fit inside the crowns. The key to our grading was the fit of the project on the plastic teeth.
Modern Dental Technology & Techniques to the Rescue
Under normal circumstances, we take an impression of a natural tooth or a crown and then make the partial denture over the tooth. When the patient walks in the door with a partial and the supporting tooth underneath is compromised through breaking or falling off, we, just like my dental student friend, have to work backward. This is beyond difficult as we need to make the underneath tooth fit inside the partial denture. In truth, in the past, there were a variety of techniques to accomplish this but they were really hit or miss. Finally, after years of struggling, computers, scanners and advancements in dental technologies have come to the rescue. I can now take an impression of the original tooth and use this to create a scan which can be superimposed to create an exact copy of what was there. This exact duplication of the way the tooth was allows me to make a replacement crown that will fit into and under the partial that is already there. I can not tell you what a cost and time saver this is for everyone involved. The patient does need to have their removable bridge replaced and can return to normal life in just a couple of appointments.
This is just another way where modern dental techniques have turned a nightmare of the past into a very predictable and affordable procedure in the present. Do you have an issue with a tooth or teeth, which you think that there is no solution? Please call me and run the predicament by me. You never know what simple solution that I may have to suggest. I can be reached at 440-951-7856 and I look forward to hearing from you.