There is a lot of anxiety surrounding the dental injection process. Whether it be from the Dentist or Doctor With Needleexpectation of pain from the needle or the anxiety around being numb for an extended period of time, there are a lot of things that can cause distress prior to receiving an injection. So here are some frequently asked questions about what to expect from a dental injection as well as what you should expect to experience afterwards.

  • What are you injection me with?

    The days of novacaine are long gone, now most dentists will use anesthetics such as lidocaine, mepivicaine or prilocaine. These anesthetics are available with or without a small amount of epinephrine.
  • Why do you need to use Epinephrine? Epinephrine is used in local anesthetics to aid in increasing the duration and depth of anesthesia attainable.

  • Can I have an allergic reaction?

    An allergic reaction to modern local anesthetics is very uncommon. In the past some had allergic reactions to some of the components, such as esters, in novacaine. However, the formulations that are marketed in the United States are made with amides as opposed to esters,and are less likely to cause allergic reactions. Some patients may be more sensitive to epinephrine in the anesthetic which can cause some feelings of increased heart rate and a slight tremor to the hands. If this happens let your doctor know.
  • How long will I be numb for?

    Most patients will be numb for about 1-2 hours after the procedure has been completed, with the average procedure length being about 45 minutes. That being each individual is different and recovery time from anesthesia can be different for each individual.
  • What should I tell my Doctor before treatment with local anesthetics?

    Let your doctor know any medications you may be taking as any adverse reactions you may have had with anesthesia in the past. This will help your health care provider choose the appropriate anesthetic for your particular needs.
Injectable local anesthetics; PREPARED BY THE ADA DIVISION OF SCIENCE ON BEHALF OF THE ADA COUNCIL ON SCIENTIFIC AFFAIRS Epinephrine and local anesthesia revisited; Ronald S. Brown, DDS, MS, and NelsonL.Rhodus,DDS,MPH

Occasionally I run into a patient who happens to be newly pregnant. During this time most pregnancypatients have yet to be given the laundry list of do and do not’s  for their day to day lives from their obstetricians and health care providers. So to help anyone who is pregnant, may be pregnant or is planning on being pregnant I’ve compiled a list of what to do for your mouth while you are pregnant.

  • Do tell your dentist or hygienist you are pregnant

    even if it is only a slight possibility or you are in the early days of pregnancy. During pregnancy there are certain restrictions to treatment, such as epinephrine in some of the anesthetics, dental radiographs (unless necessary during an emergency situation)  and nitrous oxide. Let your health care provider know prior to your appointment about your pregnancy so that they can modify treatment accordingly.
  • Do continue to have your exam & cleaning appointments every 6 months

    . During pregnancy we recommend that you continue with hygiene appointments. There are many changes occurring in your body and often times an expectant mother can develop something called pregnancy gingivitis. Your body can become more reactive to plaque and calculus during pregnancy which can cause more inflammation and bleeding between cleanings than you may be used to. By maintaining a good hygiene schedule this can help with inflammation as well as avoid periodontal issues during your pregnancy.
  • Do Not plan on having elective dental work during your pregnancy

    . We recommend that elective dental work should be completed after the pregnancy (with the exception of  dental cleanings). Emergency dental treatment can be completed at any point, and dental treatment that should not wait until after pregnancy is best completed after the first trimester. In each situation it is important to consult your obstetrician prior to having dental treatment.
  • Do Not discontinue topical fluoride use during pregnancy.

      During pregnancy studies show it is safe to use topical fluoride rinses and toothpastes. This will help keep enamel healthy during pregnancy, which is especially useful if you are prone to morning sickness. Studies have shown that using topical fluoride is helpful, however taking a fluoride supplement is not necessary as it does not give any added benefit to mother or fetus.
  • Do Speak to your dentist and obstetrician about nutrition during pregnancy.

      Between morning sickness and pregnancy cravings be sure to speak to your health care providers about nutritious meals as well as what to avoid during pregnancy. From a dental standpoint I recommend that my patients continue using the natural sweetener xylitol. Xylitol is safe and may help with prevention of cavities as well. Also, another tip, if you are prone to morning sickness try rinsing with water and baking soda afterwards to help neutralize the acidity in your mouth prior to brushing your teeth. This will decrease your risk of enamel erosion.
Mäkinen KK. Can the pentitol-hexitol theory explain the clinical observations made with xylitol? Med Hypotheses . 2000;54(4):603-613. Söderling E, Isokangas P, Pienihäkkinen K, Tenovuo J. Influence of maternal xylitol consumption on acquisition of mutans streptococci by infants. J Dent Res . 2000;79(3):882-887. Fluoridation Facts, Published by the American Dental Association, 2005

Choosing a new dentist is not an easy task. Whether you’ve just moved to a new city, your dental insurance has changed or you simply have outgrown your old dentist and need a change. Most people in their lifetime will change their dentist at least two times.The patient admires her smile looking at the mirror And although its pretty common, some just don’t know how to go about doing it. Here are some tips about how to choose a new dentist, and what to look for in your new dental office.

  • What type of life do you lead? Are you on a tight schedule, do you need late or early hours? You’re new dentist should have a schedule that suits your needs. There’s no point to starting in an office that you will never be able to schedule an appointment for!
  • Do you like cutting edge technology or are you happiest with a more traditional office. Many offices have integrated the latest technology into their offices like digital x-rays, CAD/CAM technology and paperless charting. If this is more your speed be sure to ask the office if there’s a website available for you to see what procedures your new dentist is proficient in.
  • Men, Women, Young, Old; you should choose the practitioner that you are most comfortable with. It may sound silly or odd, but dentistry is a very personal experience and you should try and find a dentist who is a good fit with you.
  • Do you need a dentist that takes a particular insurance? Or, can you see someone who is not in your insurances network but will accept your insurance as an out of network  dentist? Depending on your insurance company you may have to see a particular group of dentists, this is something to be aware of before you sign up for a dental insurance. When looking for a dentist ask them prior to your appointment if they accept your insurance or if you are eligible for treatment there.
  • Do you strive for a fast paced dentist? Or a low key, more relaxed environment. When you visit an office for the first time be aware of your surroundings. Besides the decor and cleanliness pay attention to the front desk staff and the dental assistants. You can gain a lot of knowledge about how an office runs by your dentists supporting staff.
  • And finally, never underestimate the power of a good recommendation. Ask, your friends & coworkers, someone who you know will be honest about their dental experience.

You may have noticed that many offices are switching to digital radiography and paperless Tooth signcharting. There are a lot of big changes coming in your dental and medical offices.

  • With the advent of digital technology and advances in imaging many offices are switching to lower radiation digital radiography and some are even pursuing digital impressions.
  • Digital impressions means no more ooey-gooey mold taking for records to send to dental labs. By imaging the mouth with a dental camera, your dental records can be a mouse click away from the dental lab or in office equipment, such as a CEREC machine, and your new restoration.
  • CAD/CAM technology is also becoming more prevalent in dentistry. Using chairside dental imaging, various restorations can be fabricated in the dental office, providing fast, convenient, esthetic, and conservative dental restorations. A popular system that is being seen in more dental offices through out the United States is the CEREC system. CEREC technology allows you take a digital impression of your tooth chair side and fabricate a restoration for you while you wait, which will be inserted that very same day.
  • Another change that you’re sure to notice soon are paperless charts and records. By centralizing all of your information digitally, practitioners can easily access it in their office. And, if necessary can send it effortlessly to you or another dental provider.

During my dental career I have noticed that upon meeting a new patient I am often greeted with the same remark: “This has nothing to do with you… but I hate going to the dentist.”Dental visit I have long since learned that in reality it’s not in fact an offensive remark, but more or less a clearing of the air and really just addressing the elephant in the room. It is common knowledge that the majority of the population dislikes going to the dentist, and the main reasons are not because of the actual dentist and their performance. Read on for the top 5 reasons why people hate the dentist.

  1. Small space with too many people in it.  Dental work is completed in close quarters and commonly your dentist or hygienist is sitting quite close to you. Their face is mere inches from yours and often accompanied by an assistant. Needless to say, some simply cannot feel comfortable with someone in their personal space. Especially someone with pointy instruments! If you find that you feel a little claustrophobic in the dental office let your dentist or hygienist know. The best way to ease anxiety is to be honest about what makes you most uncomfortable, this gives you and your dentist the opportunity to address it and find a solution to make you more comfortable.
  2. Everything smells and tastes weird there.  Well, this category really is self explanatory. The dental office has an odd aseptically clean smell and feel to everything in it. Some people love it, some people hate it, and some people may never have noticed it before. But, when entering a dental office it is a good thing to be greeted with a fresh aseptic smell with clean dressings and fresh instruments.
  3. What if it hurts? The fear of the unexpected, this is one of the top reasons some find dentistry uncomfortable. Even though 99% of their appointments are quick  and pain free, that 1% can set the precedent for future dental experiences spent simply waiting for something to occur. By finding a dentist you trust and feel comfortable with this dental fear can be minimized. Although, most people who have a slight dental anxiety will feel uncomfortable in the dental office, the right dentist can put you at ease. And, if needed offer solutions to ease your anxiety during treatment if necessary.
  4. They’re going to tell me I have a cavity.  For some, the simple possibility of being told you aren’t doing a good enough job with your home care, or that you’ll have some need for more dental work, can cause people to come in with soured expectations. Although this is a tough situation to avoid it is best to keep up with your regular hygiene appointments so that your dentist and hygienist can give you helpful advice in order to avoid more complex and invasive dental treatment. Also, it is much better to have a small cavity filled rather than wait until it becomes a large cavity or something more complicated such as a root canal treatment.
  5. I don’t like being numb.    There really is no confusion as to why this one is on the list. It can be nerve wracking getting an injection and then dealing with the resulting numbness of your lip, tongue and cheek afterwards. But, that being said there is nothing like having pain free dentistry completed!

Are dental amalgams dangerous? Recently, it was brought to my attention that a popular preventativedaytime television show, Dr. Oz, brought up the safety of dental amalgams in the mouth. This is a topic that has been under speculation by the general public for many years and is the source of many questions from our patient family.

Many studies have been done over the years by many sources whether it be the American Dental Association, the American Academy of Pediatrics, the National Multiple Sclerosis Society or the Alzheimer’s Association. Throughout all the research performed, there has been insufficient evidence found to support claims that dental amalgams are dangerous. Dental amalgam restorations are still an option recommended by the American Dental Association. So is there any truth to the speculation? Are dental amalgams dangerous?

  • The best dental restoration is no restoration! By following proper home care and maintaining a good hygiene schedule you may avoid the need for future fillings altogether.
  • If you do have to have a filling place, be aware of your options. There are many choices of dental materials based on the size of the cavity, location of the tooth in the mouth, and the patient’s at home habits. Your dentist will recommend to you the best restorative material for your particular situation.
  • I normally will recommend that a patient replace an amalgam filling only if the filling begins to show signs of breakdown and is no longer properly sealed. Other reasons for replacement are if there is recurrent decay present or it is unable to be cleansed properly, causing inflammation or further decay.
  • Always remember if you have any questions or concerns regarding your dental care it is always best to go directly to the source. Ask your dentist why they recommend a particular type of filling or restoration. Ask what alternatives are and what the risks or benefits of those alternatives are if you are unsure of the treatment presented.

Many of my friends ask me questions such as: When people eat garlic does it make you mad? Or, should I always see the same hygienist or is it okay to switch? These are legitimate Physicianquestions that most people don’t exactly know the answer to. Today’s post is about dental office etiquette, the Do’s and Do Not’s of the dental office.

  • Do show up on time. Most dental offices schedule a time block for one patient and one patient only. If you can’t make it to your appointment or if you are going to be a few minutes late it helps to give the office a heads up as soon as you know. This helps the front desk to adjust the  dentists schedule as best as possible so they can see you and others on time.
  • Do bring old records. If you are a new patient to an office and you have recent x-rays bring them with you. Many people feel very awkward taking their old records when they leave a place to seek a different dentist. Although it is a slightly awkward situation it is not uncommon to see more than one dentist in your lifetime. We know that situations change, people move, change insurances or simply grow out of their relationship with their current dentist. The few minutes of awkwardness asking for your records can save you the trouble of having new ones taken as well as decreasing any unnecessary exposure to radiation.
  • Do try different hygienists, if you feel like it. It is okay and completely acceptable to use different hygienists for your recall appointments. Many people will see different hygienists depending on their schedule or preference, and it is not offensive to switch. Switching between dentists within an office, although not as common, is okay as well. However, if switching dentists it is best to finish any major treatment you may be in the middle of, such as a crown or a root canal before switching.
  • Do Not worry about what you just ate… And finally, if you ate garlic before you came or forgot to brush its not as big a deal as you think! If you do remember it is greatly appreciated, but in general  you are more conscious of the slight garlic breath and food between your teeth than we are!

Bad breath, always the first thing you think about when right before you open your mouth.Silence ‘Does my breath smell bad? I can’t tell, it must smell bad…’ You breathe, you sniff, and still you just can’t tell. That moment of doubt can ruin a social situation by flooding you with insecurity. So what do you do?

  • Although caused by many things, the top reasons your breath may not be as fresh usually is from a few common problems. Such as:  poor oral hygiene, diet and nutrition, or some health problems such as dry mouth, acid reflux or debris from post nasal drip and respiratory tract infections.
  • To keep your bad breath under control try to avoid garlic and onions. These types of foods can stay in your system for up to 72 hours after your consumed them.  Cigarettes, coffee and other odor inducing foods can hang out on the back of your tongue and between your teeth as well. Be sure to brush and floss after you eat and follow with a good mouth rinse. Maintaining a well balanced diet and keeping hydrated as well can help reducing bad breath as well.
  • Be sure you actually have bad breath, check with a friend if you really aren’t sure, or if you are able to, run some floss through your teeth and smell. If your floss is discolored or has a bad odor there is a good chance your breath is smelling the same. Interestingly enough there is a small percentage of the population who believe they have bad breath when they do not and patients who are obsessed with their breath. These people are categorized as being either halitophobic’s or pseudo-halitosis patients.
  • Keep in mind that although gum, breath mints and some mouth rinses are short term quick fixes if you have chronic bad breath or halitosis be sure to see your dentist and evaluate what can be causing it.
Breaking paradigms: a new definition for halitosis in the context of pseudo-halitosis and halitophobia; D. Falcao, C. Vieira, R. Batista de Amorim

In the past we have discussed how to teach your children and yourself child brushing teethto be a great patient, and how to maintain a healthy oral environment. We’ve shared our insights from prenatal to postnatal as well. However, one very important group that seldom is addressed is the Adolescent group. Dentally, this is one of the most important age groups. These budding individuals are past the age where their parents can help them brush, but not mature enough to keep their mouths as clean as they should. A lot of damage can be done in those teen years that can set your child up for a lifetime of dental aggravation. Today’s post is about how to keep your teen’s mouth healthy.

  • Keep the fluoride coming, getting your teen to brush well and brush often is a hard job in itself, asking them to floss and rinse afterwards is even harder. I recommend buying a toothpaste that includes fluoride to help keep their enamel strong and healthy, and if you can try and have them rinse with a fluoride rinse like ACT before bed, even better. You can check out some ACT products here.
  • Try and make sure that your child is brushing at least twice a day. As much as they’ll be annoyed by your hounding them, they’ll be even more annoyed when they have to sit through a filling or two.
  • With the surge in popularity of energy and sports drinks kids are really drawn to these types of beverages.  Limit your teen’s consumption as much as you can. Always stick to sugar free, and be aware of what your teen is consuming. Some sports drinks, although sugar free, are very acidic and are unhealthy for dental enamel.
  • During the teenage years we often see many kids with braces. It is incredibly important to keep your teens mouth clean during this time. There are plenty of tools made to help keep brackets and orthodontic appliances clean. Ask your dentist or orthodontist which tools are best for your teens mouth and have them show your child (and you) how to use them.
  • Candy and carbohydrate laden snack foods are definite cavity causers. If you can’t avoid your child eating these types of foods then at least limit the amount of times during the day that they do. One sitting of eating candy and snacks followed by tooth brushing and flossing can reduce the risk of cavities as opposed to short periods of snacking throughout the day.
  • Teens can be very insecure, with all sorts of new social situations some kids are more concerned than ever about their appearances. Help boost your kids confidence by giving them the tools to keep their smile healthy and beautiful. If they are looking for inspiration, remind them that by not taking care of their mouths there are other risks besides cavities, such as bad breath, broken and discolored teeth.
Overall, to keep your teens mouth healthy make sure your teen is continuing with their regular dental appointments. By instilling in them the value of oral hygiene and good health habits you give your teen the building blocks for a lifetime of great oral and overall health. And finally, the best way to lead is by example!]]>

This time of the year is tough, the holidays are over, flu season is in full effect and tax season is Woman with toothachelooming. This means stress, and one thing that I’ve found in dentistry is that along with stress we often get TMJ and facial pain. How do we discern between run of the mill stressed induced muscle and jaw pain as opposed to sinus pain or even worse tooth or nerve pain? Dental pain can come from a variety of sources and the solution can vary from simple to complex depending on the issue. Whether the pain is from a cavity, exposed root surface, damage to the nerve, sinus pressure, tender jaw muscles or the ligaments surrounding the tooth, can best be diagnosed by a dentist. If you are experiencing any of these kinds of symptoms for more than 2-3 days please call your dental practitioner for advice. Each of these types of dental pain may be confused with each other. But, in a scenario where the pain is not from a cavity or an insult to the dental nerve, why do we feel pain at all?

  • TMJ and facial pain that come from chronic clenching and grinding can be elicited in various ways. It may be pain and tenderness of the muscles that cause our jaw to open and close. The strain of clenching and grinding, whether consciously or subconsciously done, can cause inflammation and irritation of those muscles and may result in pain during day to day functions like eating and talking.
  • Another possibility is tenderness elicited from inflammation of the small ligaments holding the teeth into the bone. With overuse or over-stimulation these small ligaments become inflamed and sore which can cause pain with use or pressure on the tooth.
  • Often times chronic clenching and grinding may be followed by mild recession of the gum tissue exposing a portion of the tooth’s root surface. This surface, which is normally covered by a layer of bone and gum tissue, once exposed is very sensitive to hot, cold, as well as touch. Over time this surface can desensitize however, this process may take up to 2 months.
If you have pain related to clenching and grinding see your dentist for possible treatment solutions. It may be as simple as wearing an oral appliance such as a night guard or using a toothpaste for sensitive teeth. It’s best to have a professional evaluate your situation and diagnose the cause of your pain as well as recommend the best solution to relieve it.]]>