I’ve found that many patients don’t really understand what sedation dental care means – what the experience will be like for them. Patients who haven’t explored sedation dental care often assume things that simply aren’t true. Some members of the dental profession even contribute to this confusion by referring to sedation dental care as “sleep dentistry.” That is really a misnomer for the level of sedation dentistry that is normally practiced.

Oral conscious sedation – a level of sedation used to carry out minor to relatively extensive dental procedures – doesn’t put you to sleep (cause you to lose consciousness). When you experience oral conscious sedation, you aren’t subject to the additional risk that comes with increased levels of sedation (such as general anesthesia) that are used for more serious oral surgery purposes. We call those increased levels of sedation deep sedation because they do result in loss of consciousness.

What Does Oral Conscious Sedation Mean?

Oral means that the sedation is provided orally (one or more pills), rather than being given intravenously (with a needle). Secondly, with this form of sedation dental care, you remain conscious, even though you are likely to remember little, if anything, about the treatment experience afterwards. Even those who have experienced it would find it hard to describe the state because of the short-term lack of awareness and time that typically occurs. Many people assume or state that they were asleep because of their lack of recollection. The advantages of remaining conscious are:

• You can still “assist” the dentist – respond to verbal commands (e.g., open your mouth, close your mouth) even though you’re not aware enough to feel like you’re actually participating in the procedure. Your ability to assist can actually shorten the duration of the procedure.
• There is less risk of needing to be resuscitated because of the type of sedation being used.
• This form of sedation is generally less expensive than sedation that renders you unconscious. (The environment, equipment, and staff training requirements all necessarily become more complex to control risk when a patient becomes unconscious. This results in higher costs being passed on to you.)

With oral conscious sedation, you are sedated enough that you will need a caregiver to come to our office and take you home afterward. With many extensive procedures for which we use this method of sedation, patients report that they need less medication to control any post-treatment discomfort compared to when the same treatment is performed without sedation.

Be sure to ask us if you have other questions about sedation dental care and why it might be helpful to you or a family member.

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Dental Health Magazine

If you’re thinking of starting a family, it’s time to be thinking seriously about your dental health. The relationship between your oral health prior to pregnancy and during pregnancy is becoming clearer and clearer with recent research. It’s important that you address dental health issues before pregnancy, because pregnancy may present its own challenges to your oral health.

What does the research show?

First of all, it does not support the old wives’ tale that says you’ll “lose a tooth for every pregnancy,” even though losing teeth can be an outcome of poor dental care during pregnancy due to periodontal disease. (The old wives’ tale was based on the belief that the body would dissolve a tooth to supply additional calcium needed by the developing infant.) Some research findings that support the need for “pre-family dentistry” are as follows:

• More than one study suggests a link between good oral health and fertility. Women seeking fertility treatments were more likely to have bleeding and inflammation of gums than their counterparts who were able to conceive without fertility treatment.
• Somewhere between 60% and 75% of pregnant women will experience gingivitis (often a precursor to more serious periodontal disease).  Hormones associated with pregnancy seem to increase the incidence.
• One study suggests that women with gingivitis or other more serious gum disease are three times as likely to deliver before 37 weeks. Another study suggested that those with severe gum disease were seven times more likely to deliver very early – before 32 weeks.
• Another study suggests that regardless of whether the baby is carried to term or not, it is three times more likely to have a low birth weight (and associated health risks) if the mother has gingivitis during pregnancy.

What are pregnancy tumors?

As many as 10% of pregnant women may develop “pregnancy tumors” – more properly called pyogenic granulomas.  While not cancerous, these growths on the gums can bleed easily and, in some cases, can cause enough discomfort to warrant removal. Even if removed, they may come back. They usually go away on their own after pregnancy.

What can you do before becoming pregnant?

Brush and floss regularly to avoid the plaque build-up that can cause gingivitis. Visit your family dentistry practice for regular dental checkups, and have your teeth cleaned to remove any plaque build-up.  Some information suggests that if plaque does not exist before the pregnancy, the risk of developing pregnancy gingivitis is a fraction of a percent as long as good oral hygiene habits continue during pregnancy.

If you already have inflamed or bleeding gums, see your family dentistry practice to get treatment before you become pregnant if at all possible. If your family dentist isn’t able to provide the needed treatment, he or she will refer you to a periodontist. If you’re having difficulty conceiving, getting your gums in good shape and addressing other health issues may be a less-expensive avenue to try before investing in costly fertility treatments.  Remember, good dental health before and during pregnancy affects not just your own health, but that of your baby.  If you have dental phobia, find a dentist who offers sedation dentistry and get treatment before you become pregnant. Family dentistry practices that offer sedation dentistry may be more “sensitive” and accommodating to your dental anxiety – both before and during your pregnancy.

When are you most susceptible to pregnancy gingivitis?

Risk seems to go up in the second month of pregnancy and peaks around the eighth month. Historically, many women have avoided dental procedures during pregnancy, and that can contribute to risk. This can be a very serious mistake, especially if periodontal disease does develop. One study showed that periodontal therapy reduced the risk of premature birth and low birth weights by 68 percent in women with pregnancy gingivitis. If you’re concerned about risks associated with dental treatment during pregnancy, you may want to make sure to schedule an appointment during your second trimester, or early in your third trimester. No matter what your stage of pregnancy, don’t hesitate to contact your family dentist if you sense that gum disease might be developing.

What is the relationship between gingivitis and premature delivery?

Studies continue to be conducted on this. Pregnancy results in changes to levels of estrogen and progesterone, which may affect the immune system and decrease the woman’s ability to fight off inflammation of the gums. Some studies show that pregnant women with severe periodontitis have elevated levels of prostaglandins. Prostaglandins are substances that have an effect on many different bodily functions, and are believed to have an influence on the opening of the cervix and the onset of labor contractions.

Pre-family dentistry planning is important. Getting needed dental treatment before you become pregnant is one of the best gifts you can offer your soon-to-be-conceived child.

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Before you explore your options for porcelain veneers in Raleigh, you should try to understand the real value of porcelain veneers, in general.

The human body – and the composition of every part of it – is absolutely amazing when you study it. Your tooth enamel – which porcelain veneers essentially replicate but don’t completely replace – are no exception. Many people know that tooth enamel is the outer covering of the tooth, but few have really thought enough about it long enough to understand how amazing tooth enamel truly is. At best, most people know that it is hard and has protective properties for the rest of the tooth.

One of the most interesting and amazing things about tooth enamel is its light refraction properties. If you recall from your science classes, materials fall into three basic categories – transparent (see-through), opaque (can’t see through), and the perhaps more sophisticated and complex category – translucent.

Your tooth enamel is a translucent material – meaning that light passes through it, but it also bounces off it in some rather unusual ways. To some extent it has its own color; to some extent it takes on the color of what is behind it; to some extent it takes on the color of the light hitting it. The best material currently available for “mimicking” your tooth enamel is porcelain.  It is a hard material with translucent properties – meaning that porcelain veneers refract light much the same way that your tooth enamel does. Composite resins, sometimes used for veneers, are semi-transparent, but do not have that translucent property that makes healthy tooth enamel sparkle in a very unique and eye-catching way. There may, in fact, be some real scientific grounding before the idiom “flash a smile.”

One advantage to porcelain veneers is that they are generally stain resistant. Think of fine porcelain china dinnerware – it is very hard and has a shimmering glow. It generally does not stain, but will pick up stains if it is cracked or abraded. But it takes relatively serious abuse to abrade it (and have resultant staining!)  There are some precautions you’ll need to follow if you’re getting porcelain veneers – in Raleigh or anywhere else!  Using your teeth as bottle openers is certainly not advised – nor is it advised for your regular teeth/enamel. Biting down on anything hard is never a good idea because it can cause a fracture in your tooth or its enamel, as well as in a porcelain veneer.  Certain teeth cleaning materials used in some dental offices can also abrade the surface of porcelain veneers and destroy some of their luster.

Similar to fine porcelain china, porcelain veneers are both lovely and durable. With reasonable care and avoidance of strong abrasives, they both can provide a lifetime of enjoyment. (Although you probably won’t be passing your porcelain veneers on to the next generation.) If you’re considering porcelain veneers in Raleigh, let us explain your options and why porcelain veneers may be the best choice in creating the smile you want to achieve!

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For centuries, those about to purchase a horse have taken a look in the horse’s mouth as a means of assessing the wisdom of their investment – outward appearances can be misleading. Primarily, horse buyers have been looking for distinct and quite reliable indicators of the horse’s actual age. In recent decades, there’s growing evidence of the importance of looking in humans’ mouths – not so much to determine age, but to potentially predict problems with not only their oral health, but also their general health.

The connections between oral health and general health are truly amazing. If anxiety about dental treatment is causing you to avoid needed treatment – especially for periodontal disease – then you need to start looking for a Raleigh sedation dentist.

Periodontal disease has been shown to have a strong relationship (causative in many cases) to the following medical situations:

· Cardiovascular issues (heart attacks and strokes) – Studies are ongoing to establish periodontal disease as having a causative effect.

· Premature delivery/low birth weight – Observations and studies show a strong tie to the mother’s gum disease, if it exists.

· Diabetes control – That people with diabetes are prone to gum disease has been known for many, many decades, but newer studies suggest that untreated gum disease can make it hard to control blood sugar levels.

· Respiratory health – In hospitals and nursing homes, evidence suggests that severe gum disease can result in inhalation of bacteria and the development of bacterial pneumonia. Studies are also being used to determine whether gum disease causes flares of respiratory disease in people with COPD.

See a Raleigh Sedation Dentist – For Your Health

A sedation dentist can work with you to overcome your dental anxiety and get the treatment you need. This is particularly important if you are suffering from or beginning to develop gum disease. If you have considered looking for a Raleigh sedation dentist but have been concerned about the safety of using sedation, you can feel more assured than ever. In 2009, the NC Dental board enacted formal guidelines for the administration of sedation by dentists. The dental board now certifies that dentists who have permits to practice sedation dentistry have the necessary training and experience to do it safely. The number of Raleigh sedation dentists is limited, but you owe it to yourself and to your family to find one and get the dental treatment you need to take care of your general health as well as your dental health.

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If you’re considering cosmetic dentistry, you may have heard the terms bonding and veneers. The basic intent of both cosmetic dentistry procedures is the same, but the materials used are quite different.

Bonding uses a tooth-colored composite resin – a putty-like material that we apply over a chip in a tooth or to cover over some other type of deformity. Once the material has “set,” we then contour it to either mimic the original shape or the desired shape. Bonding is not an option in some cases – the extent of the damage to a tooth can be such that neither a composite filling nor bonding is appropriate. In that case, a crown may be needed to restore your tooth and provide good oral health. The same is true for veneers, although there are cases where a veneer will work when bonding is not a viable option.

Veneers are made of porcelain, and can provide a more natural tooth appearance – especially when larger areas of the tooth are being treated.  The natural enamel on your teeth is actually translucent, and the porcelain veneer is also translucent.  That means that light tends to react the same way to both surfaces, and that is why veneers can look more natural than the solid composite resin materials that are used in the bonding process. By now, you may be wondering how veneers can help with severely discolored teeth if they are translucent. That’s where the skill of your dentist really comes into play.

Well-fitted veneers are generally more durable than bonding, although both procedures require that you practice good oral health practices (brushing, flossing) and avoid bad habits like chewing ice or other excessively hard materials.  (That’s not good for your natural teeth, either!) Not sure what you need?  We’re here to provide all your Raleigh cosmetic dentistry needs, in addition to our general dentistry services. We’ll advise you on what treatment is most appropriate for you and answer all the questions you have about the personalized treatment plan we will develop to help you restore or create the smile of your dreams.

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As one of the earliest certified providers of Raleigh sedation dental care (oral conscious sedation), I have patients from time to time who ask me when dentists first started using sedation. Would you believe that the answer to that question is during the 1840’s?  Connecticut dentist Horace Wells introduced the use of nitrous oxide that long ago. And one of his students, William Morton, later demonstrated the use of ether as anesthesia. Many people are surprised to learn that those practicing dentistry were the ones who “brought along” the field of medicine in the use of anesthesia to control pain. Naturally, the dosages and associated risks were not well understood in those days.

Today, we know exponentially more about a whole spectrum of sedation techniques and forms of localized anesthesia. Dentists certified for providing sedation dental care today  have many more options – and an exponentially greater wealth of knowledge of dosages and risk management – than Wells and Morton did in the 1800’s. We know what types of sedation and anesthesia work best in combination for various types of dental procedures. And we know that we’re not only managing pain, but also anxiety. In terms of what the patient experiences, it’s still not well understood just how tightly intertwined the two (pain and anxiety) really are.

Many people assume that anxiety is a purely psychological experience, while pain is the purely physiological experience. Not so! For example, anti-anxiety pharmaceuticals as well as psychological procedures for treating anxiety are often useful in the treatment of pain complaints. And it’s also been scientifically proven that patients who experience high levels of anxiety before undergoing surgical procedures actually have slower healing times. It’s not just about sparing people mental distress, it’s about helping them have a better outcome, too.

That’s another reason that taking advantage of sedation dental care is just good common sense. You don’t NEED to try to figure out whether it’s anxiety or pain management that you need. We know how to manage both effectively and safely. And we’re happy to answer any questions you might have about sedation dental care in Raleigh.

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I think a lot of people who are interested in sedation dental care are being held back because that question lingers at the back of their minds. The relative scarcity of Raleigh sedation dental care (or for matter, across the state of North Carolina) may be part of the reason that people don’t know that much about it. The odd thing, though, is that people are routinely sedated by physicians for procedures that are far less invasive than procedures often done in dentistry without using sedation. And yet, patients don’t usually question being sedated in those lesser circumstances.

Fortunately for residents of North Carolina, the State Board of Dental Examiners recently enacted new guidelines to help patients be assured that sedation dentistry is a safe option for them to use. The Board has put in place a rigorous certification process (July 2009), so that you can be assured that your dentist has the appropriate training. The new guidelines cover various levels of sedation, and ensure that your dentist also has the right type of equipment to monitor you while you’re undergoing sedation dental care. To put your mind fully at ease, you can always ask your dentist to show you his or her formal accreditation to provide sedation dental care, especially since the guidelines are relatively new in our state.

For the type of sedation dental care that lets you have more invasive or lengthy procedures performed comfortably, the level of accreditation is referred to as limited moderate conscious sedation dentistry, or oral conscious sedation dentistry. Some patients also need this level of sedation to be comfortable with lesser procedures, such as teeth cleanings or fillings.

If you still have questions or concerns, you may want to read our more detailed description of the new qualifications put in place by the Dental Board. Of course, Raleigh Comprehensive and Cosmetic Dentistry is happy to personally answer any questions you might have, too, whether you’re an existing patient or not. Learn more about how sedation dental care can free you from the anxiety or pain that might be standing in the way of your own or a family member’s good dental health.

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That’s a question that some of my patients ask, and it’s often based on what they learned about braces one or two decades ago. Some of these people never had braces when they were younger because family finances wouldn’t permit it. Others had braces, but their teeth drifted somewhat out of place after the braces were removed. Some people who have had their teeth whitened feel that the new brightness of their smile draws more attention to misalignments that were not so noticeable before.

The answer is that you’re not too old for braces. A couple of decades ago, adults probably accounted for about 5 percent of the patients wearing braces.  Today, probably a third of the patients getting braces are adults, and the trend could drive that number higher. There are several reasons for that. First, there are new technologies. But more importantly, there are options for braces that are far less noticeable than ever before. You may have friends or colleagues who are wearing them without your even being aware of it. Adults have always been “sensitive” about appearing in public with braces on – maybe because “braces are for children” or maybe because they feel braces could interfere with how they are perceived in the workplace.

One of the most exciting options to be considered for adults is the Invisalign system, which is actually a form of “removable braces.” Not every occurrence of teeth misalignment can be corrected with Invisalign, but people whose misalignment is less severe are usually good candidates. We (Raleigh Comprehensive and Cosmetic Dentistry) are excited to have been named a Preferred Provider of Invisalign in Raleigh, based on our extensive experience with using this system. Even if you’re not a good candidate for Invisalign, we can talk to you about less visible options than the metal braces that were the only option years ago.  See our FAQs About Invisalign to learn more about the system.

If you’ve been thinking about braces or have been wondering if there’s a provider of Invisalign in Raleigh, come talk to us about the options that make sense for your situation. In addition to performing the important dental assessment, our staff can help you understand and plan for the financing, including the possibility of using your healthcare flexible spending account to cover some of the cost.

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Did you know that North Carolina ranks very near the bottom (# 47) in the nation for availability of dental care access? The news is better, however, for those looking for dental care in Raleigh. Wake County is one of eight North Carolina counties with dentist-to-patient ratios that exceed the national average. (Durham and Orange counties are also among the eight.) If you combine June 2009 figures from the North Carolina Dental Board with 2008 census figures for Raleigh, you can extrapolate that for every 1,350 residents, there is one general dentist providing dental care in Raleigh.

The low ranking for the state is a bit surprising, especially since 80% of the students admitted to the UNC School of Dentistry come from North Carolina. The dentistry school is recognized as one of the top in the nation for both education and research. (Unlike medical and law schools, schools of dentistry in the U.S. have no “official” national rankings. But UNC is one the most highly acclaimed schools in the informal rankings that appear from time to time.) It seems like a lot of graduates who were originally residents of NC must be relocating to other states in order for our statewide ranking to be that low.

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There have been many advances in teeth whitening approaches over the last decade. All of them still require the user (yourself or your dentist) to use the products safely. For example, if you use an over-the-counter product for longer than directed because you’re not happy with the speed or degree of whiteness, you’re asking for trouble. Tooth sensitivity or gum irritation can result. That can even happen if you use the products according to directions. Some people are just more sensitive than others, or the products may not work well with the shape of your mouth or teeth because they’re designed for the “average” person.

By the same token, dentists also need to be especially careful with their specialized and more powerful teeth-whitening treatments. One of the best examples is the use of ultraviolet (UV) light in teeth whitening. UV light is sometimes used to activate, accelerate, or enhance bleaching solutions. And it can be used safely. That means directing the UV light only onto the tooth surface – and not onto surrounding gum tissue. Would you even consider going to the beach and holding your lip down to expose your gums to the sun for a couple of hours (aside from the fact that it might look dumb)? I thought not! You’re already aware of the short-term and long-term damage that UV light exacts on your skin – especially when you’re not protected by sunscreen. That’s why it’s very important for your dentist to protect your gums and other mouth tissue from UV light exposure when using it as a component of your teeth-whitening program.

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