Hope Restorative & Cosmetic Dentistry

Twelve Shots of Novocaine to Get Numb

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I had a tooth extracted and it’s been nothing but a disaster. First, it took the dentist twelve shots of Novocain to get me numb enough for the procedure. That was fun. Then, a few days later a bone spur appeared. This took the dentist over 30 minutes to remove. Now, a week after everything, this ridge has appeared with something sharp sticking out. I sort of don’t know how good my dentist is at this point and am just wondering if this is a normal part of the healing process or should I be concerned?

Jack H.

Dear Jack,

man in a blue clothes posing on white holding his jaw in pain

Let’s start with the problem of getting numb. There are two possibilities for why it took so many shots of Novocaine to get you numb. The first is that your dentist missed many times, possible but unlikely. The second is that you had some dental anxiety. Many dentists still haven’t recognized the connection between dental anxiety and the ability for the anesthetic to work. The higher your anxiety, the more it burns off the medication. If you had trouble getting numb at first, that would only increase the anxiety, making it even harder to numb you.

I am going to suggest for your next appointment that requires anything other than a cleaning and checkup that you ask him or her to use dental sedation. If they don’t offer that this will not be the best dentist for you. In that case, do an internet search for a sedation dentist and go there. You will need some pain free experiences under your belt again before you will be able to get numbed quickly.

As for the sharp ridge that has appeared. This is actually quite normal. When your tooth is removed, those sharp edges are already there. You don’t notice it then because your gums are swollen and covering it. As the swelling goes down and the gums recede from the extraction it becomes more obvious. Your dentist can easily smooth it over or clip it. Again, though, I’d ask for some form of sedation.

One other thing. When a tooth is removed, it really does need to be replaced. If you don’t, the other teeth can shift or tip into the spot, which will throw off your bite. A misaligned bite is one of the causes of TMJ disorder and that is not something you will want to mess around with. The best tooth replacement is a dental implant, so I’d look at that first.

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.

Antibiotic for a Tooth Infection

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I have a toothache. I’ll be honest and tell you that I am not fond of the dentist even in the best of circumstances. I was kind of relieved when the government shut down dental clinics. It stopped hurting for a bit, but now it’s starting to hurt worse. Which antibiotic is best for this? My doctor will write me a prescription.

Luke

Dear Luke,

man holding his jaw in need of an emergency dentist

You are definitely going to need to see a dentist. Antibiotics will not work for this. They are only a temporary stop measure for dental infections. In your situation, it sounds like the tooth has already died, so it will be even more temporary for you. The tooth feeling better is probably when the infected pulp died, but that doesn’t remove the infection itself, just the pain. Now it has spread past the tooth.

This is considered urgent dental care and therefore, your dentist will be able to treat you. This has been a consistent exception to the COVID-19 quarantine because it is medically necessary. Dental infections have to be physically removed. That is typically done in one of two ways. If the tooth can be saved, a dentist will do a root canal treatment. If the tooth can’t be saved, then an extraction becomes necessary. If that happens, you will want to replace your tooth.

Dealing with Dental Anxiety

I know you are not the most comfortable going to the dentist and hearing the procedure doesn’t have to be postponed because of the quarantine probably increased your anxiety. The good news is, there is a fantastic solution, which could change the way you view dentistry in the future.

I’d like you to see a dentist who offers dental sedation options. Most dentists offer two levels of sedation. Nitrous oxide, which is a gas administered to people with mild anxiety, and oral conscious sedation. This is administered by a pill and is strong enough where you’ll need someone to drive you to and from your appointment.

Dr. Cha offers a third level — I.V. Sedation. This is for patients with such high anxiety that they want to be out. Very few dentists offer this option and it requires special training.

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.

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