Tag Archives: sedation dentistry

Dental care for a person in recovery from addiction

Four months ago I started treatment for an addiction to opiates. I am on methadone maintenance, and it seems to be working well. The issue is that I need dental work, and a lot of it. I went to my old family dentist last week, and he refused to give me any pain medication when I was honest with him about the methadone. I didn’t last ten minutes in that chair before I had to call a halt. I tried to persuade him, but he would not even call the clinic, even after I gave him the number. He said I need at least five root canal treatments, maybe more, and treatment for gum disease.

So I need to find a new dentist. I know I have to tell them about the methadone because of the way it might react with the pain meds, but I don’t know how in the world to find someone who will work with me. The dentist I just saw has known me for more than 20 years, and he would not help. I guess that makes me feel like no one will.

Do you have any suggestions for finding someone?

Thanks,

Edward in Tampa Bay

Dear Edward,

Congratulations to you on your efforts to recover from addiction.

The first step in finding a dentist who might work with you is to look for a dentist who is a sedation dentist (sometimes called “sleep dentists” by lay people, though that term is inaccurate).  Sedation dentists tend to be more compassionate to pain issues than dentists who have not pursued the extra training in pain management.  Be very up front, and ask if he or she can help you.

A second avenue of information might be the doctor you work with at the clinic. They are very likely to have the names and contact information of dentists and doctors that are compassionate and educated in issues faced by people who are in addiction recovery.

The very best of luck to you in your endeavors.

Detroit cosmetic dentist Dr. Hadgis’s office sponsored this blog post.

Does an oral surgeon have to do this kind of extraction for me?

I’ve had problems with one of my molars for quite some time. It has had a filling in it since I was a kid, and a few years ago the filling fell out, and the tooth broke. I finally got it treated when it was just too painful to stand. The dentist did a root canal treatment, but I’m not sure it worked. I never did go back to get a cap put on the tooth, and now the temporary tooth has fallen out and the tooth is infected again.

It sounds like I don’t care about my dental health, but I do. I am just really, really scared of going to the dentist. Every time I go it hurts like crazy, and the pain meds they give me never seem to work for me the way they do for everyone else. No matter how much Novocaine they give me, I can always feel what they are doing! I mention this because my dentist has told me that this tooth needs to come out, and I don’t think I am going to be able to handle it.

My question is, should I get an oral surgeon to do the extraction, because can’t they knock me all the way out? I don’t want to be awake at all while this tooth is being pulled.

Carson in Omaha

Dear Carson,

Dental anxiety so often results in situations like yours, and that is a real shame.

You need to locate a dentist who does sedation dentistry. This is a dentist who is trained and licensed to administer different levels of sedation. Depending on the level of your anxiety, a dentist can treat with nitrous oxide (also called laughing gas) or what is called conscious sedation. When a patient is under conscious sedation, they are not unconscious, but so deeply relaxed that most patients do not remember anything at all about their treatment. The key for you is to locate a sedation dentist so they can help you figure out what level of sedation will be necessary for you to get this work done.

You would do best to locate a dentist that can do both sedation dentistry and dental implants. When the extraction is complete, the best solution to replace the missing tooth is probably a dental implant.

This blog brought to you courtesy of Grosse Pointe Woods cosmetic dentistDr. Hadgis.

Can I get all this work done in just one appointment?

I’ve been putting off going to the dentist for many years, and just recently got dental coverage as part of my new job. Wow, am I going to pay a price for not keeping up on my dental care! I need six root canals, at least. I have three cavities that need to be drilled and filled, one tooth that needs to be ground down because it is messing up my bite, and all of my teeth need to be whitened, badly.

One of the reasons I put all this off for so long is that I hate going to the dentist. Is there any way all of this could be done in one appointment? I’d like to just get it over with! What is the limit for the number of hours treatment can take?

Stephanie in Baltimore, MD

Dear Stephanie,

You’ll really have to talk to your dentist about how much of the work they feel they can accomplish in one visit. The limiting factor will really be your tolerance for being in the chair that long, especially if you are an anxious dental patient. Most people who do not have dental anxiety can endure about four hours of treatment. If you are anxious at all, and I strongly advise you to be honest and up-front about that with your dentist right from the beginning, then your ability to tolerate treatment will be much less.

Something to consider is going to a sedation dentist, or asking your current dentist if he does sedation dentistry. You may have heard it referred to as “sleep dentistry“, which is a bit of a misleading term used by lay people. With sedation dentistry, you are not technically asleep, though you are in such a relaxed state that most patients report no memory of the treatment at all. If you are an anxious patient, this might be one way for you to get all that work done in a minimal number of visits.

Beyond your tolerance, the amount of time/number of appointments the treatments will take also depends on the locations of the teeth that need root canal treatment. If they are in the front of your mouth, they can likely be done in one appointment. If they are molars, you may want to consider going to an endodontist, which is a dentist who specializes in root canal treatments. For molars, it is important for you to get the treatments done in as few visits as possible, and with so many to do, you’ll need the speed and expertise of a specialist to get them all accomplished in a reasonable amount of time.

Best of luck to you. We’re glad you’re regaining your dental health!

My daughter’s teeth have severe decay

I’ve been trying to gather information about dental care for very young children, and your blog seems to be well informed. My daughter is four years old, and to date has not really had a true dental appointment. I’ve taken her to several different dentists, but she refuses to open her mouth for any of them. My first question is whether you think a pediatric dentist would have better luck than a general dentist, or if I will have to think about letting them sedate her, as the last dentist suggested. I hate the idea of sedation, but things are getting critical.

She lets me look in her mouth occasionally. I can see four teeth on the top that have cavities, and two of them look really deep. I don’t see anything really worrisome on the bottom teeth yet, but have not had a really good look at those in a while. The two teeth on top that are really bad have started to chip away, and that brings me to my second question–can anything be done to salvage those teeth? From the reading I have done, I know that if those teeth are pulled, it could mess up the alignment of her teeth permanently, even though they are baby teeth. I’ve been reading about porcelain crowns and white fillings, and both of those sound like good options, if they will work with really damaged teeth. I don’t want her to feel self conscious if we have to do some kind of metal filling or crown.

I know you can’t make a definitive diagnosis just from my descriptions, but any information you can offer would be great.

Thanks,

Doreen in Tallahassee

Dear Doreen,

We recommend locating a pediatric dentist that has experience with sedation dentistry. That way, if your daughter can’t be persuaded to open her mouth, you can have a “Plan B” in place to get her the dental care she needs.

You are absolutely right that the best course of action would be to salvage those decayed teeth. If they cannot be saved, she will need some kind of space maintainers so her permanent molars do not drift forward, which would be expensive to fix down the road. Because these are baby teeth, your dentist will recommend a temporary fix kind of solution, such as a stainless steel crown. This will not look nice, as you point out, but if you are willing to pay for a porcelain crown that will only last a few years, your dentist will certainly place it. If the decay is not too widespread, your dentist might also be able to use white fillings or direct dental bonding to protect the remaining tooth structure. The best advice I can give you in this matter is to listen carefully to what the dentist recommends, and make your decision from the options presented. It is usually a bad idea to push a dentist into doing a treatment that they don’t feel comfortable with.

Another matter that must be addressed is how your daughter’s teeth wound up with this level of decay. The kind of decay you describe has to be fed continuously, all day, every day. Unless you want to face this situation again and again, you’ll need to change the way your daughter eats. She should only eat every three or four hours, and she should be brushing or at least rinsing with water every single time she eats.