Hope Restorative & Cosmetic Dentistry

Allergy or Burning Mouth Syndrome

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I have had two very stressful dental appointments in a row. In one, it felt like I was drowning whenever he used the water. In the most recent, where I had some zirconia crowns placed, he had a lot of trouble getting me numb. Now, the results of this last one have left me with a burning tongue and excessive dry mouth. I went back to my dentist thinking I might be allergic to the zirconia, but he said that no one is allergic to zirconia. My next stop was an ENT, where he has so far eliminated acid reflux or a problem with my mouthwash. Now he is saying it is Burning Mouth Syndrome but that they don’t know the cause of it. Is this just something they said when they can’t figure out what is wrong?

Len

Dear Len,

man holding his jaw in need of an emergency dentist

You have been through the wringer here. I am sorry. Let’s start with your dentist saying that no one is allergic to zirconia. That is a bold claim. Our bodies are very unique and I would be careful of making such a blanket statement. I would say that a zirconia allergy would be very rare, but that does not rule it out completely without any investigation.

Burning Mouth Syndrome is a real thing. While the standard answer is “we don’t know what causes it,” there has been a connection made between traumatic dental experiences and this syndrome. You will need some positive dental experiences. My suggestion is to only go to a sedation dentist.

Given the situation, I would suggest looking into a dentist who not only offers oral conscious sedation, but also I.V. Sedation. You’ll also want them to be DOCS and ACLS certified to make sure you are in the safest hands possible.

In the meantime, you’ll want to address the dry mouth issue. Our saliva is one of the leading warriors in our battle against tooth decay. If your mouth is consistently dry, then you are not able to fight decay as effectively. Call your dentist’s office and see what product they recommend for you. Make sure you are drinking lots and lots of water and are diligent about your brushing and flossing while this is being dealt with.

This blog is brought to you by Tulsa Dentist Dr. Jerome Cha.
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I’m Tired of Being Afraid

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I have spent most of my life afraid of almost everything, including going to the dentist. I want to take control of my life. I also want a mouth that is healthy and I am not ashamed of. I know it is going to be hard to take control of this. Do you have any advice for someone who is afraid of the dentist and likely has a LOT of work they need to be done? Honestly, I still tremble just thinking about it.

Kathy

Dear Kathy,

person cowering behind a chair afraid

First, I want to say how incredibly proud I am of you and I think you are being quite brave. It is no easy thing to deal with your anxiety. The fact that you are trying to take control says so much about your character. Second, is even better. I know exactly how to help you.

I want you to see a dentist who offers dental sedation. For your first visit, make sure they are aware of your anxiety before you go in. You may just want to have them do x-rays and look at your mouth. No real work on your teeth yet. Then, you can sit down with the dentist and evaluate how much work you actually need and create a plan.

When you come in for the bulk of the work, the ideal thing for you to do is to use oral conscious sedation. This is administered with a simple pill. However, that pill is super strong. You will need someone to drive you to and from your dental appointment and will likely sleep through the entire thing. Another benefit of this is you can get a lot more work done in each sitting. This will allow you to get your oral health caught up much faster than you normally would be able to.

Whenever you are not needing any major work, there is a lighter level of sedation that you can use for things such as checkups and cleanings. For this type of work, I’d suggest nitrous oxide. This is sometimes called laughing gas. It doesn’t make you goofy like the nickname suggests. Instead, it gives you a relaxed, floaty feel. This will help you feel comfortable in the dental chair. Its big benefit, aside from relaxing you, is once your appointment is over they will simply switch your gas to oxygen again and you will be good to go on with your day.

I think this will change your life.

This blog is brought to you by Tulsa Cosmetic Dentist Dr. Jerome Cha.

Nervous about Dentist

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My dentist has been closed since the beginning of the quarantine and is opening back up. I know I need a lot of work. I’ve got several cavities and a pimple on one of my gums. I don’t like the dentist in the best of times. The idea of having to go at all gives me the heebie-jeebies. Going more than once…nah. Can I get all of these done at once?

Andy

Dear Andy,

Woma asleep in teh dental chair from sedation

You certainly aren’t alone in your feelings about the dentist. Many people would rather be anywhere else. I have great news for you, though. You can likely get all of this taken care of in just one appointment. Not only that, but you can do it in an anxiety-free way.

I suggest you see a dentist who offers dental sedation. If you get something like oral conscious sedation, you will likely sleep through your entire appointment. Many patients who suffer from dental anxiety find this completely changes their lives. However, you should know it is so strong that you will need someone to drive you to and from your appointment as well as stay with you for a few hours afterward, until you are lucid and steady on your feet.

One thing I am concerned about is the pimple on your gums. This is known as a tooth abscess and is evidence of a dental infection. These are considered dental emergencies. So, even though you don’t fancy going to the dentist, this isn’t something you should put off.

Dental infections have to be physically removed by a dentist either by a root canal treatment or, if the tooth is too far gone, a tooth extraction. If it isn’t treated in one of these two ways, it will continue to spread, even after being treated with an antibiotic. This is a mistake too many people make. If you think about how close your jaw is to your heart, lungs, and brain you can understand why you don’t want to let this spread.

If it does turn out that your tooth cannot be saved and needs to be extracted, you should talk to your dentist about getting it replaced with a dental implant. If I had to replace a tooth, it is the replacement I would want.

This blog is brought to you by Tulsa Dentist Dr. Jerome Cha.

My Tooth Fell Out

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I used to have nightmares about my front teeth falling out. Well today one of my back teeth fell out. I’m not sure what happened. It had been hurting for a while, but then stopped. I’m worried this can happen to the rest of my teeth. The problem is I’m terrified of the dentist. Is there anything I can do from home to help this.

Brandon

Dear Brandon,

hockey player with a knoced out tooth

In general, there are two reasons that will cause your teeth to suddenly fall out. One is trauma. This is what likely happened to the hockey player above. When a tooth gets knocked out, it is imperative you get to the dentists withing 30 minutes. This gives the dentist the best chance of saving your tooth. You’ll want to hold the tooth by the crown and not the root. Be sure to keep it moist, either by keeping it between your cheek and gums or by placing it in a cup of milk. Hopefully, the dentist can reattach it. If not, then the dentist can help you understand your tooth replacement options.

The second reason for losing a tooth suddenly can be more serious and I suspect this may be what you are facing. It is the result of advanced gum disease. This causes bone loss and gum recession, leading to your teeth coming out. This will require interventive treatment to keep more teeth from falling out. Once you’ve got that under control, then you’ll be able to begin replacing the teeth you’ve lost. The best tooth replacement option is dental implants. You won’t be a good candidate for that until you have your gum disease completely under control.

When You Have Dental Anxiety

I know you were hoping for treatment you could do at home and avoid the dentist. Unfortunately, there is no way to treat either of these issues from home. The good news is, I have a way for you to have anxiety-free appointments. I want you to see a dentist who offers dental sedation.

There are varying levels of sedation available. The lightest range is nitrous oxide. This is sometimes called laughing gas. It will help relax you and enable the local anesthetic to work more efficiently. I suspect, because of your level of anxiety, you will require the next level of sedation— Oral conscious sedation. This is administered with a simple pill. However, it is so strong that you’ll need someone to drive you to and from your appointment. You’ll likely even sleep through the whole thing.

This blog is brought to you by Tulsa Dentist Dr. Jerome Cha.

Dentist Can’t Get Me Numb

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I need some help. I’ve been to the dentist three different times for an attempted tooth extraction. Each time, he’s given me up to seven shots of anesthetic and I just can’t seem to go numb. I’m in agony with this infected tooth and I’m worried it will only get worse. Have you encountered this before? My dentist can’t figure out why this is happening as he’s never encountered it.

Paul

Dear Paul,

Woma asleep in teh dental chair from sedation

I think I can help you. Many dentists don’t yet recognize the connection between anxiety and Novocain. It is completely normal to be anxious in the dental chair. For some patients, however, that anxiety severely kicks up their metabolism burning off their numbing medication. Once that happens once, it becomes even harder to get numb the next time because of the previous experience.

Fortunately, there is a solution.

What you need is to see a sedation dentist for this tooth extraction. There are generally three levels of dental sedation. The lightest level is nitrous oxide. This is sometimes called laughing gas. It gives you a relaxed floaty feel. It’s biggest benefit is that once your procedure is done, your dentist will switch the gas from nitrous to oxygen and in just a few moments you are back to normal and able to get on with your day. This is most effective for patients with mild dental anxiety.

The next level of dental sedation is called oral conscious sedation. This is for patients with more severe anxiety. It is a simple pill you will take before your appointment. This will completely relax you. In fact, you will need someone to drive you to and from your appointment, as well as stay with you for several hours afterward until you are lucid. This is he sedation I think you’ll be best served by using.

The third level is I.V. sedation. Very few dentists do this level, though Dr. Cha does.

What Should I Look for in a Sedation Dentist?

While sedation is very safe, you still want to find a dentist who has invested in special training for it. For instance, Dr. Cha is both DOCS and ACLS certified so you know he has invested training in all sedation procedures as well as emergency protocols. That is really what you want to look for.

I’m assuming your tooth is too far gone for a root canal treatment or your dentist would have suggested that, but I always feel it is best to save a tooth if at all possible. Once this tooth is extracted you will need to replace it. Don’t wait too long or your other teeth will shift or tip into its place. Talk to your dentist about all your tooth replacement options, but I’d look strongly at getting a dental implant.

This blog is brought to you by Tulsa Dentist Dr. Jerome Cha.

Oral Surgeon or Dentist for an Extraction

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I have pretty severe dental anxiety. That is what has left me in the quandary I’m in now. I had a cavity I was afraid to get filled. Then, it became infected and the pain was so bad I had to go back in. This dentist did a root canal treatment. That was excruciating for me so I chickened out about coming back for the crown. As a result, the tooth got re-infected. Now the dentist says it needs to be extracted. He told me it would be pretty extensive and there would likely be a need to cut into bone. He gave me the choice between doing it with an oral surgeon using anesthesia or having it cost less using him. I don’t want it to cost more but I also don’t want to have a problem because I didn’t want to spend money. What is the right thing to do?

Marina

Dear Marian,

A woman wearing a nose piece for nitrous oxide

It was unfair of your dentist to put you in that position. He made it sound as if you didn’t go to an oral surgeon, the treatment was risky. It’s not. One thing I wonder is whether or not your dentist feels out of his depth and therefore he’s trying to encourage you to go elsewhere for your procedure.

I would ask him how comfortable he is with the procedure and how much experience he has with this type of extraction. If he’s comfortable with it, there is no reason you can’t do it with your dentist. The anxiety issue can be solved in a way where you can have a pain free appointment.

Sedation Dentistry—the Solution to Dental Anxiety

There are dentists who provide sedation in-office. Most offer two levels of sedation: nitrous oxide and oral conscious sedation.

Nitrous Oxide

This is administered with a nosepiece, as you see in the picture above. You breathe in nitrous oxide right before your procedure. It will relax you and help your numbing medicine become more effective. This is most useful for someone with mild dental anxiety.

A benefit of this type of sedation is once the procedure is over the dentist changes the gas to oxygen and you are lucid again in just a few moments and ready to get on with your day as normal.

Oral Conscious Sedation

If your anxiety is a bit more severe or the procedure is extensive, you may want oral conscious sedation. This is a pill you take before your appointment. It will completely relax you. It’s so strong, most patients sleep through the procedure.

Because of its strength, you will need someone to drive you to and from your appointment as well as stay with you for several hours afterward until you are clear-headed and steady on your feet.

You are likely to find that this helps you with your anxiety and helps you get to the dentist more often. This will help prevent any further dental emergencies as well.

Make sure you replace the extracted tooth. Without a good replacement, like dental implants, the adjacent teeth will drift or tip into the open space. This will lead to TMJ Disorder.

This blog is brought to you by Tulsa dentist Dr. Jerome Cha.

Please Tell Me I Don’t Have to Remove All My Teeth

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I need some advice. I have avoided the dentist for years. It’s a long story, but my fear started when I was a child after a horrible experience. I started having a toothache which was pretty bad and decided I had to go in. It was equally horrible. He told me all my teeth are bad and I need to remove them and get dentures. He tried to insist I do it then saying I’d die if I didn’t. I started to cry and he essentially said I’m being a baby and did this to myself. Then said if I’m not going to do what’s necessary, I need to leave. I left devastated thinking even if I HAD to do this I didn’t want to do it with someone so insensitive. I’d rather give my money to someone else. But, I’m only 32 years old. Are dentures really my only option? I don’t want to look like my grandma. But, I also don’t want to die.
Stacey A.

Dear Stacey,

Dental implant

Dental Implant

I’m sorry you’ve had such a disastrous experience for a second time. I want to assure you that not all dentists are like this. The behaviour of this dentist makes me question his diagnosis. First, most dentists try to save as many teeth as possible. If it’s not possible to save any teeth, the next best option is dental implants. I don’t know any dentists who would suggest full dentures. They’re a last resort kind of option because of all the drawbacks.

What I’d like you to do is get a second opinion. I’m optimistic at least some of your teeth can be saved. You only mentioned the one toothache. I don’t know if you had any symptoms of gum disease. Some ways to recognize that is gum tenderness and even bleeding when brushing your teeth. If it progresses too far, without treatment, it can cause you to lose your teeth.

As far as threatening death, a tooth infection left untreated can spread to the brain or heart, which will lead to death. Only the severely infected tooth would need to be removed, not all of them.

Whatever teeth you do end up losing, you are better suited having replaced with dental implants. That gives you a prosthetic tooth root which will protect you from losing jawbone. That shrunken look your grandmother has is from that loss of jawbone. It’s called facial collapse and is a side effect of dentures. You won’t have to worry about that from dental implants.

I also wanted to address your dental fear. Most patients with dental anxiety developed it in childhood just like you, due to a negative experience. I’ve found that many patients with dental anxiety do much better with dental sedation. The chance to have pain-free dental experiences generally changes their whole outlook on dentistry. Eventually, many don’t even need the dental sedation anymore.

It’s worth looking into, especially if you end up needing more than that one tooth worked on. It can allow you to get a significant amount of more work done than you normally could in one sitting, all without pain or stress.

This blog is brought to you by Dr. Jerome Cha.

Afraid the Dentist Will Kill Me

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I have to find a dentist. Normally, I get my teeth looked after by our local hygiene school. They’re thorough and do a good job. But, if an issue pops up you have to go to a dentist. I’ve never had an issue pop up so never really worried about it. But, that all changed at my last appointment. I need to get a tooth looked after and they said it could be saved with a crown, but I need to be prepared for the fact that it will likely need to be extracted. I’m quite afraid of the dentist. I realize that you probably consider that silly. But, I keep seeing stories like this one where people die from sedation. How can I be sure the dentist won’t kill me?

Stephanie – Boston

Stephanie,

It’s not silly to be afraid of the dentist. In fact, many patients are. Sedation dentistry has done a lot to help with that. But, when you have tragedies, such as the one suffered by that little boy, it can make frightened patients more frightened.

My understanding of that case is the dentist wasn’t certified, though for certain types of sedation that’s not required. However, he also gave a significantly excessive dose of sedative drugs to the child, well above the recommendation. I was appalled when I realized how much medicine he gave that preschooler.

So, how do you prevent such a tragedy from happening to yourself?

When you’re looking for the best dentist in this type of situation, the first thing I’d ask is whether or not the dentist is DOCS certified (The Dental Organization for Conscious Sedation). You’ll also want to be certain your vital signs are monitored at all times. There should be a separate person doing this, not the dentist. He or she will be too busy with the procedure to give your vitals adequate attention.

Additionally, it would be great if the dentist and their staff are ACLS certified (Advanced Cardiac Life Support). In any medical procedure there are risks, whether there’s sedation or not. Every medical professional should be prepared for the worst-case scenarios in order to give their patients the best care possible.

Hopefully, a crown will be available to you. An extraction should always be a last resort.

This blog is brought to you by Dr. Jerome Cha.

 

If I want dentures, do I need a dentist or oral surgeon?

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I haven’t been to the dentist in years. I have an irrational fear of dentists.  As a result, almost all my teeth are disentegrating. Even the ones that aren’t have cavities.  My mouth is quite embarrassing. I think it is time to get dentures, but I’ll have to get my failing teeth removed first.  Will I go to an oral surgeon for that or just a dentist?

Taylor T. – Kentucky

Taylor,

You’ve asked an important question.  You’ll want to go to a dentist that does the surgery and the dentures.  The reason for that is there is coordination that needs to happen between the surgery and the dentures.  If you’re going to two seperate clinics, you’re going to lose some accuracy in translation.  Plus, if you want immediate dentures (so you’ll never have to be in public without teeth) it is much easier to have them done by the same person.

In order to find a dentist that does both, call a dental clinic and ask them what their procedure is for extractions and dentures.  Don’t tell them you want them done by the same person, because they may say they’ll do that (even without the necessary experience) just to get your business. Just ask what they normally do.

I want to address one other thing. Your dental fear is probably not irrational. My guess would be that you had a very negative (and painful) dental appointment in your past. Many patients with dental anxiety actually had a traumatic dental appointment in childhood.  Because of your anxiety, I would also look for a dentist who does oral conscious sedation.  This will give you a pain free appointment, even with all the extractions.

I hope this helps.

This blog is brought to you by Tulsa Cosmetic Dentist Dr. Jerome Cha.

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