Category Archives: Sedation Dentistry

Root Canal Issue Seems Like It Will Never End

I am concerned about a root canal issue that seems will never end. Last November, my dentist filled a small cavity. But the tooth became sensitive to cold on and off. My dentist said I needed a root canal and a crown. He completed treatment, but my dentist had problems getting the bite correct. I was beginning to get jaw pain and earaches. The tooth settled down a bit but was still a little sensitive.

Within the past two weeks, the sensitivity increased. When I visited the dentist last week, he said he might need to repeat the root canal. But I am five months pregnant now and need another X-ray. And I am a little frustrated because it delayed my teeth whitening appointment. How do I know if I need repeat root canal treatment? I don’t know if I can get through the work without sedation. It’s so frustrating. Thanks – Nakia


Although Dr. Lacy would need to examine your tooth and crown, we are concerned about your dentist. It is unusual for a small cavity to end with an infection and root canal treatment. And your dentist has been unable to resolve tooth sensitivity completely.

From Small Cavity to Root Canal Treatment?

When a dentist tells you that they filled a small cavity, but the tooth soon needs root canal treatment, the dentist’s diagnosis is incorrect. The cavity must have been large, or your dentist missed signs of infection.

Tooth Sensitivity After a Filling and Crown

A tooth infection may be causing the sensitivity. But your dentist may have made a mistake while placing the filling or during your root canal treatment.

Dental X-rays During Pregnancy

We understand your concerns about exposing your baby to X-ray radiation or chemicals during pregnancy. But dental X-rays emit low radiation. So, you can review the American Dental Association’s recommendations about dental care during pregnancy. But if you have a tooth infection, it can potentially spread into your bloodstream and become more serious.

If you are skeptical about your dentist’s care, we recommend finding an advanced cosmetic dentist. The dentist will examine your tooth to identify the cause of sensitivity, jaw pain, and earaches. The dentist will also determine if you have a tooth infection and need to repeat root canal treatment. Although the process delays teeth whitening treatment, it is best to resolve it now than have the issue recur or worsen during pregnancy.

Based on your medical history, talk to your obstetrician and dentist about safe sedation options during pregnancy.

Best wishes for a quick resolution.

This post is sponsored by Plano, Texas, female dentist Dr. Miranda Lacy.

Will Dental Insurance Pay for IV Sedation?

I had two consultations with dentists, who agreed I needed two dental implants and three crowns. I am terrified of the dentist and will need sedation for the dental work. One dentist only uses nitrous oxide in the office but would refer me to a specialist for implant surgery. The other dentist uses nitrous oxide and sedation pills. I know more than nitrous oxide is needed regardless of the procedure. I read about IV sedation and that it is stronger than other options. I am willing to switch dentists for more sedation, but I need to schedule consultations after finding dentists who use IV sedation. – Thanks. Paul from Lakeland, FL


Thank you for contacting Dr. Lacy’s office. Many anxious patients require sedation to get dental work. We commend you for caring for your oral health and researching your options.

Will Dental Insurance Pay for IV Sedation?

Whether dental insurance provides coverage for IV sedation depends on the plan level and your needs as a patient. Some insurance companies offer benefits toward IV sedation when it is medically necessary based on several factors, including:

  • Dental procedure type
  • Patient’s physical, intellectual, and medical needs
  • Patients for whom alternatives are ineffective
  • Extraordinarily fearful or anxious patients
  • Patients who have experienced dental trauma and require potent sedation options

We recommend contacting your insurance company to find out how much if any, sedation dentistry procedures they cover. Some insurance companies that provide coverage limit the number of hours of IV sedation dentistry for which they will provide benefits. For example, dental insurance may provide benefits for up to one or two hours of sedation, and you would be responsible for the remaining cost.

Your insurance company may ask you to provide a pre-treatment estimate from your dentist to estimate your out-of-pocket costs.

Plano, Texas, female dentist Dr. Miranda Lacy sponsors this post.

Do I Still Need to See a Dentist If I am Taking Antibiotics?

Do I still need to see a dentist if I am taking antibiotics? I might have a tooth abscess, but I am not sure. I went to urgent care over the weekend. They gave me an antibiotic prescription for a possible infection. They looked at my tooth but said the gum seemed slightly irritated. They gave me discharge papers saying I needed to see a dentist, but I didn’t understand. If the infection goes away, I will be satisfied.

Why pay more to have a dentist look at my tooth and tell me everything looks good? Last year I had an infection, but it wasn’t a tooth infection. Still, the antibiotics knocked it completely out in 2-3 weeks. So I am thinking about giving the tooth the same amount of time, and I should be good. My girlfriend told me I shouldn’t take that kind of chance. I think the antibiotic will work. Is this emergency, and do I still need to see a dentist? I tried to avoid them whenever I could. Sorry. Thanks for your help. Henry

Henry – Your girlfriend is correct. A dentist needs to examine your tooth. Even though you may not have a regular dentist, you can find a dentist who accepts urgent appointments. A dentist will likely ask you to come to the office right away.

If your tooth is infected, it will need a root canal treatment to remove the infection. The dentist will replace the infected tooth pulp with dental filler material. You will most likely need a dental crown to protect the tooth from further decay or damage.

An untreated infection can spread to other teeth, your jawbone, and in the worst case, into your bloodstream. Find an emergency dentist and get the tooth examined and treated right away. Don’t wait two or three weeks to see if the infection clears. You can ask about nitrous oxide or oral conscious sedation to relax you during treatment.

Dr. Miranda Lacy, a Plano, Texas dentist, sponsors this post.

How Long Can a Cracked Crown Last?

My crown cracked this week, and I want to know how long it can last. The crack is on a lower molar tooth, and I can feel it if I glide my tongue along the side of the crown. I can barely see the crack when I look at the crown in the mirror. I haven’t been to the dentist since pre-Covid, and I cannot relax enough to go before my vacation next week. I prefer to wait until I return in February to look for a dentist and let them know that I can only get work done if I get oral sedation first. How much time do I have before the crown breaks? Thanks. Ella from Austin


Dr. Lacy would need to examine your cracked crown to determine the extent of the damage. Although the crack may not be an emergency yet, pressure on your teeth as you bite and chew weakens the crown. It will eventually break.

How Long Can You Delay Fixing a Cracked Dental Crown?

A hairline crack in a dental crown may not be an immediate concern, but how long you can wait depends on the overall condition of the crown. Eventually, you will see the crack and need prompt care.

We recommend scheduling an appointment with a dentist this week to assess the damage. Depending on the condition of the crown, the dentist may recommend a temporary crown to prevent a dental emergency while you are on vacation.

Talk to the dentist about your travel plans and dental anxiety. It is better to get a well-made and bonded temporary crown than a weak one that may fall off and leave the tooth unprotected.

Look for a dentist with cosmetic dentistry training who can provide a temporary crown to match your natural teeth and ensure it is comfortable.

Dr. Miranda Lacy, a Plano, Texas dentist, sponsors this post.

I Think My Dental Implants Are Failing

I think my dental implants are failing. My 2021 full-mouth reconstruction included implants, crowns, and veneers. I think several of the implant teeth are infected, and two crowns have fallen off. My gums are swollen, and it hurts to chew. Unfortunately, the dentist relocated, and I cannot find a current listing for him. I am concerned that another dentist must replace my implants and that I will need a repeat full-mouth reconstruction. I do not know where to begin, and my anxiety level is increasing because I am afraid that I will need implant surgery again and who knows what else. – Thank you. Vadim from IL


We are sorry to hear about your horrible experience. You certainly do not want the dentist doing additional dental work for you.

Infection Around Dental Implants

Infection around dental implants is peri-implantitis, a form of gum disease that can lead to dental implant failure. Signs and symptoms of infection include:

  • Bad breath or a bad taste in your mouth
  • Bleeding around the implants
  • Difficulty chewing
  • Loose implants
  • Pain, aches, or discomfort around the implant
  • Pus around the implants
  • Red or puffy gums
  • Visible implant threads

Treatment for Infection Around Dental Implants

Depending on the extent of the infection around your dental implants, treatment options may include:

  • Antibiotics
  • Antimicrobial therapy
  • Laser therapy for your gums
  • Surgery

Find a Skilled Implant Dentist

Yes, you need to find a new dentist. But look for a dentist with advanced implant training or who partners with an oral surgeon or periodontist to complete implant surgery. A highly trained implant dentist or surgeon will explain your options. You can also discuss your anxiety level and ask about sedation options to keep you relaxed throughout the procedure.

Man on beach portraying sedation dentistry, available form Plano, TX female dentist Dr. Miranda Lacy
Sedation can help you relax throughout dental procedures

It is essential for your new implant dentist or surgeon to perform a 3-D x-ray (CT) for a detailed view of your jawbone and oral anatomy and identify the cause of the problems with your dental implants. Please only trust providers who are willing to perform a CT scan.

Best wishes for a smooth recovery.

This post is sponsored by Plano, Texas, female dentist Dr. Miranda Lacy.

What Kind of Sedation Can I Expect for Wisdom Teeth Removal?

I delayed wisdom teeth removal for years because of dental anxiety. Now, at age 47, two of my wisdom teeth are infected. I have not been to a dentist yet, but my gums around the teeth are swollen. I am sure that a dentist will refer me to an oral surgeon. Will I get local or general anesthesia? Thank you. Tyler from Boulder, CO


Thank you for contacting Dr. Lacy’s office. Most wisdom teeth cases only require local anesthesia. Still, an oral surgeon can give you sedation to relax during the procedure.

IV Sedation for Wisdom Teeth Extraction

Intravenous sedation causes you to drift in an out of consciousness. Your state of relaxation will be deeper than with nitrous oxide (laughing gas), which relaxes you although you are fully awake.

Deep Sedation

Drug-induced sedation prevents you from awakening easily.

Wisdom Teeth Extractions for Adults

Wisdom teeth removal for adults is more challenging because tooth roots and bone fully develop as we age. Nevertheless, oral surgeons are highly skilled at removing wisdom teeth and complete the procedure in 30 to 45 minutes.

Characteristics of adult wisdom teeth:

  • Jawbone – Mature jawbone is dense and firm around tooth roots.
  • Cementum – Calcified bone-like tissue accumulates at tooth roots, making removal more challenging. Still, oral surgeons use tools and techniques for painless, successful tooth removal
  • Position – Teeth can grow sideways in the bone or gum tissue.

Schedule an Appointment for an Exam

A dentist can take x-rays of your wisdom teeth to identify their location and whether they are leaning on other teeth or otherwise affecting your oral health. Your dentist will refer you to an oral surgeon for a consultation. Talk to the oral surgeon about your anxiety, and the surgeon will prescribe sedation based on your anxiety level and the complexity of your surgery. You will have a comfortable, painless procedure.

Dr. Miranda Lacy, a Plano, Texas dentist, sponsors this post.

Crowns on My Front Teeth Are the Wrong Shape

A dentist placed four zirconia crowns on my left central incisor back and the three teeth behind it. I got the crowns from the dentist because his price was $200 cheaper per crown than the other estimates. The crowns do not match the shape of my natural teeth, and they do not look natural at all. I am anxious about dental appointments anyway, and the thought of getting this work redone scares me. Could another dentist reshape these crowns to match my teeth? Thank you. Andra from GA


Thank you for your question. We are sorry to hear about your experience. Getting natural-looking results on crowns for front teeth is challenging, and zirconia crowns are even more difficult.

Challenges with Zirconia Crowns for Front Teeth

Some dentists with advanced cosmetic dentistry training understand how to make zirconia crowns look natural on front teeth. A cosmetic dentist can produce impressive results knowing these principles:

  • Dental labs make zirconia crowns from ceramic blocks – Dental labs mill mono-color zirconia blocks to shape them to fit over damaged natural teeth. The challenges are that a natural tooth varies in shade and translucence and achieving the right tooth shape with crowns takes a skilled dental ceramist.
  • Porcelain layers can make zirconia look natural – A ceramist must bake porcelain onto the surface and manipulate the color to match your natural teeth.

Can a Dentist Reshape Your Crowns?

Unfortunately, you will need new crowns because a dentist cannot reshape the existing ones. Ask your dentist for copies of your dental records and x-rays. Find an advanced cosmetic dentist for a consultation and exam to discuss how to correct your teeth.

Photo of female patient sitting and relaxing in a dental chair, for information on sedation dentistry from Plano female dentist, Dr. Miranda Lacy.
Ask your dentist about sedation options

After taking pictures and a mold of your teeth, a cosmetic dentist can create temporary crowns that match the characteristics of your natural teeth. If you approve the temporary crowns, your dentist will collaborate with a dental ceramist to duplicate them in high-quality ceramic. Speak with the dentist about your anxiety and sedation options to help you relax.

Dr. Miranda Lacy, a Plano, Texas dentist, sponsors this post.

Should I still have intense pain after a tooth extraction?

On April 2, my dentist extracted an upper left root canal tooth that broke. She sectioned the molar into sections to make the extraction easier. Since the extraction pain somehow refers to my lower and spikes in the afternoon through the evening. The side of my face feels numb, and I feel pain in my ear. Why is the pain intense in my jaw when the upper tooth was extracted? And why is it lingering weeks after the extraction? I called my dentist, but she is prescribing pain relievers, which do not help. Should I see another dentist before my anxiety gets worse? Thank you. Alana from NY


Although the pain you describe is not unusual after a tooth extraction, it should not linger more than a week. If you have felt pain for three weeks, something is wrong.

Lingering Pain After Tooth Extraction

Pain after tooth extraction can linger for several reasons, but a dry socket or an infection is most likely. Although Dr. Lacy would need to examine and x-ray your extraction site and the area around it, the source of pain might be near the extraction.

  • Dry socket – This painful condition results when the blood clot at the extraction site dislodges. Without the blood clot, nerves and bone are exposed, causing intense pain.
  • Infection – Bacteria can enter the extraction site and cause inflammation and pain.

Antibiotics for Lingering Pain

If you have an infection, antibiotics will help. Although the extraction was for an upper molar tooth, pain can refer to your lower law. Never pressure can cause you to feel numb.

What to expect – A dentist may begin treatment with a strong antibiotic like clindamycin and follow-up to see if you feel improvement. If you do, you should continue the antibiotic three to four days after all your symptoms are gone. But it would be best to get an examination before treatment.

Get a Second Opinion If Necessary

If you are not comfortable returning to your dentist for an examination, schedule an appointment with an experienced dentist right away. Otherwise, the infection will continue to spread—possibly affecting other teeth and putting them at risk. You can ask about sedation options to help you relax.

Sedation Options

You can ask about sedation options to help you relax. Nitrous oxide or oral sedation are two forms of sedation that may work depending on your anxiety level.

This post is sponsored by Plano, Texas, female dentist Dr. Miranda Lacy.

How Can I Treat Gum Disease at Home?

Although I have not seen a dentist yet, I am sure that I have gum disease. All the signs point to gum disease. I have bleeding and swollen gums and two loose teeth where the gums shrank back a little. I do not have dental insurance right now but am looking for a job that offers it. I also have dental anxiety, so I know they need to give me nitrous or something to calm me down. I’m afraid of not having enough money to meet my home expenses if I must pay for it on my own. Meanwhile, is there anything that I can do at home to slow down the damage to my gums and teeth? Thank you.  Jan from Iowa


The signs and symptoms you described reflect advanced gum disease. When your teeth begin to loosen, you can do nothing at home to save them. And if two teeth are loose, more will probably follow.

What Happens If You Don’t Treat Gum Disease?

Untreated gum disease can threaten your long-term oral and overall health. According to the American Academy of Periodontology, as gum disease gets worse, the following issues result:

  • Chronic inflammation
  • Diseased bone that supports your teeth
  • Deep pockets between your gums and teeth
  • Teeth fall out

Preventing gum disease is not expensive. But the longer you delay, the more costly treatment will become. Your dentist will recommend deep cleanings to remove the buildup of plaque and tartar between your teeth. You may need a specialist to stop the disease from getting worse?

What If You Have Gum Disease But No Dental Insurance?

Photo of female patient sitting and relaxing in a dental chair, for information on sedation dentistry from Plano female dentist, Dr. Miranda Lacy.
Ask a dentist about making gum disease treatment and sedation affordable for you

If you have gum disease but no dental insurance, see a dentist anyway. Even if you need sedation during the treatment you need, it is worth it. Call a few dental offices in your area and ask about payment plans and how the practice can make treatment affordable for you.

Plano Texas dentist Dr. Miranda Lacy sponsors this post.

Can I Trust My Dentist to Get My Crown Color Right This Time?

I fell in August and broke three upper teeth, including one front tooth. And I broke a lower front tooth. I did not like the dentist I had at the time, so I chose another dentist. I was so traumatized that they had to give me sedation even before an exam. The dentist did root canals and crowns on all my broken teeth. The crowns were the wrong color and tooth thick. Then he tried again with only slight improvement.

Now the crowns look light gray instead of almost medium gray. It is still unacceptable. The dentist said he could try again, but he does not sound confident. Also, my anxiety is increasing. Even though he sedates me, I am anxious about being sedated because I do not know how my crowns will look.  Is it worth giving my dentist another chance? Thank you. Cailia from Idaho


Dr. Lacy would need to examine your crowns to identify the issue. Although you have not told us what types of crowns you received, you say they look gray. We guess that you have pure ceramic crowns with metal posts and cores to reinforce the insides of your broken teeth. In that case, the metal is showing through the crowns and making them look gray.

The issue is that your dentist does not know enough about cosmetic dentistry to give you crowns that fit your mouth, are not bulky and match your natural teeth.

How to Prevent Dental Crowns from Looking Gray

A dentist with advanced cosmetic dentistry training understands how to prevent ceramic crowns from looking gray. Three approaches include these steps:

Composite core

  • Perform root canal treatment
  • Insert a fiberglass post in each tooth
  • Add a composite core close to the color of your natural teeth

Metal core

  • Bond composite over the metal to block the color
  • Bond the crown over the opaque layer

Opaque the crown enough

Another alternative is to give the laboratory technician instructions about metal core color and extent and ask the tech to opaque the crown enough to conceal the metal.

Get a Second Opinion

Woman's face with her eyes closed while she receives dental work
You can relax with sedation and dentist you trust

An expert cosmetic dentist understands color manipulation and how to give you crowns that look natural. After two attempts from your dentist, we recommend that you find another dentist to replace your crowns and get them right.

Schedule a consultation first to ensure you are comfortable with the dentist. Although you probably still need sedation during crown replacement, you can have confidence that a cosmetic dentist will resolve the problems with your crowns.

Miranda Lacy, DDS of Plano, Texas, sponsors this post.