Category Archives: Sedation Dentistry

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

Caila,

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.

Acid reflux is making my teeth sensitive

Man holding his face with tooth pain - for sedation dentistry info from Miranda Lacy, DDS of Plano, TX

I’ve had acid reflux for years. Although I have used proton pump inhibitors for more than ten years, my new gastro specialist asked me to stop. We are exploring alternatives. Meanwhile, I am following a strict low acidic diet which seems to help. But my teeth are in horrible condition from years of stomach acid and vomit eating away at them. It hurts to chew a banana. I cannot image the pain of getting my teeth cleaned or treated for the sensitivity and pain. Will I need crowns on my teeth? Jamie

Jamie

Thank you for contacting our office. Dr. Lacy would need to examine your teeth, but we hope your acid reflux is controlled soon.

As you mentioned, vomit is acidic—so acidic that it dissolves too enamel. Your teeth become sensitive and prone to decay. Acid reflux, or Gastroesophageal reflux disease (GERD), has the same effect on teeth as bulimia.

What Is the Best Treatment for Acid Reflux Damaged Teeth?

Prevention—controlling reflux disease—is the best treatment to protect your teeth. After doctor has the disease under control, your dentist can discuss treatment options.

  • Fluoride – Fluoride may strengthen your teeth with fluoride treatments. Fluoride will decrease tooth sensitivity.
  • Dental crowns – Your dentist can use ceramic crowns to cover and protect your teeth. But the acid can potentially get beneath the crown, attack the tooth, and loosen the crowns eventually.
  • Self-care – Meanwhile, rinse your mouth immediately after every snack or meal to neutralize the acid. Although rinsing your mouth is not a long-term solution. It will reduce the potency of stomach acid and vomit and limit the damage to your teeth. Limit brushing your teeth to twice daily. Too much brushing can further weaken your teeth.

Regardless of the treatment your dentist recommends, local anesthetic will prevent you from feeling pain. And sedation will calm your anxiety.

Best wishes for a swift resolution to your medical and dental health.

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

Oral Surgeon Refuses to Remove Both My Wisdom Teeth

Last May, I got two root canals, one repeat root canal, and three crowns. I am trying to catch up on dental work for my neglected teeth. I have two wisdom teeth left – both lower – one hurts and is impacted. The oral surgeon says the impacted wisdom tooth is causing neck and ear pain. She says that after she removed it, I will feel relief. For some reason, she does not want to remove both wisdom teeth while I am sedated. I told her that I do not want either of them removed if she does not take both teeth out. Neither of us is budging. Why wouldn’t she remove both teeth? Thank you. Jonah from TN

Jonah,

Dr. Lacy would need to examine your teeth or refer you to an oral surgeon for a second opinion. Without an exam, we cannot give you an accurate diagnosis. If your oral surgeon does not want to remove both wisdom teeth while you are sedated, she must have a good reason for it. Maybe there are no issues with the tooth.

But if you do not understand why the oral surgeon will not remove the tooth, it is best to speak with her. Ask for an explanation.

What Happens If You Do Not Remove and Impacted Wisdom Teeth

Woman's face with her eyes closed while she receives dental work
Get a second opinion on wisdom teeth removal

If you do not remove an impacted wisdom tooth, a tooth infection can spread. If you already have an earache and neck pain, they are symptoms that your body is trying to fight the infection. Lingering tooth infections can flare-up. In rare cases, they can even be life-threatening.

You and your oral surgeon disagree. So, you can schedule a second opinion with another oral surgeon. Have copies of your x-ray sent before your second-opinion appointment.

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

My dentist pre-ordered a crown, but my Repeat root canal may fail

My dentist took the crown off an abscessed molar and did a second root canal on the tooth. I had my first root canal in 2013. After the root canal, I had an ongoing infection for six weeks. My dentist referred me to an endodontist who got rid of the infection, but he told me not to wear a crown for a few months. I decided that if the tooth gave me any more problems, I would have sedation and an extraction. My dentist ordered a new crown, which I paid for half in advance. I asked for a refund because the specialist told me not to get a crown for a while, and I want to see if the tooth will last. But my dentist’s office will not refund me. Am I unreasonable? – Lola from SC

Lola,

Your request is polite and reasonable. It is not wise to crown a root canal tooth until you know treatment is successful. And the specialist recommended that you wait, too. Some root canal treatments fail the first time. But this is the second treatment for your tooth. So, the risk of failure increases. And your next appointment may be for sedation and extraction.

Getting a Refund for a Pre-Ordered Crown You May Not Need

Woman's face with her eyes closed while she receives dental work

Your dentist did not necessarily do anything wrong with your root canal procedure. But it is fair for him to be responsible for ordering a crown without knowing the treatment results. Your dentist should be aware of the risks of repeat root canal treatment and be willing to refund you for the crown and all fees.

You can contact your dental office again and ask to speak with your dentist. If that doesn’t work, you can schedule an appointment with your dentist to examine the tooth and use the time to talk about your concerns. Other options are to report the issue to your insurance company or the state dental board or file a case in small claims court. Or a call from an attorney’s office might work, too.

Miranda Lacy, DDS, a Plano, TX female dentist, sponsors this post.

New cavities after pregnancy and my fillings hurt

I am writing about an increase in cavities and pain after new fillings. My third child was born in December 2020. And within a few months, I began feeling severe pain whenever I ate anything sweet. When I went to the dentist, she found two cavities. My dentist placed composite fillings. In March, after my dental appointment, my dentist found four more cavities. Two fillings are fine, but I still have pain when chewing with the other two.  My teeth ache sometimes. My dentist checked by bite, which she says is fine. She offered to replace the fillings. And she mentioned that the teeth might be cracked. Why would formerly healthy teeth be cracked? I had no issues before delivering my baby in December, and now I have multiple cavities that seem to be increasing. I brush my teeth at least twice daily and at least once daily. Why is this happening? Do I need to find a dentist who specializes in fillings? But aren’t fillings basic treatment? My anxiety is increasing with so many dental appointments. Thanks in advance for your suggestions. Kashvi from GA

Kashvi,

Although filling teeth is not a specialty, your dentist’s technique with composite fillings might be faulty. Dr. Lacy would need to examine your teeth and fillings, but we can offer some insight.

Pregnancy and Cavities

Pregnant women can experience tooth decay and cavities for several reasons:

  • Hormonal changes – As your hormones fluctuate, it can increase the risk of gum disease. And gum infection can promote tooth decay and lead to more cavities.
  • Increased eating – Some women eat more during pregnancy. Frequent eating or snacking increases bacteria on teeth and promotes decay. Rinse your mouth well after eating and brush your teeth more frequently—but not excessively.
  • Morning sickness – Stomach acid from vomiting can erode tooth enamel. Rinse your mouth well and drink plenty of water.

Pain When Chewing on a New Filling

If you have pain when chewing—not biting—on a new filling, it is usually a problem with how the dentist bonded the filling. Your pain will probably resolve if a dentist removes the fillings and bonds them properly. But take care of it promptly. Pain when biting on a new filling would have a different cause.

Pain with Multiple Tooth Fillings

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

When multiple tooth fillings are painful, your dentist does not understand how to place or bond the filling completely. Amalgam fillings are easier to place than white fillings and require less skill. But composite fillings require advanced training to place and bond so they will last without causing discomfort.

Many dental schools still teach students to place amalgam fillings on back teeth. After dental school, a dentist must pursue continuing education to understand composite bonding and do it well. But some dentists try to use the techniques they learned for amalgam fillings when placing composite fillings. And it just does not work.

Schedule a Second Opinion

Look for a cosmetic dentist with advanced cosmetic dentistry training. Check a few dentists’ websites for their credentials. After a consultation and examination, a cosmetic dentist will explain your options for replacing or re-bonding your fillings and relieving your pain. If your anxiety level remains high, speak with the dentist about your options for sedation.

Miranda Lacy, DDS, a Plano, TX female dentist, sponsors this post.

How much does sedation dentistry cost?

Can you tell me how much sedation dentistry costs? I have put off dental work for some time, knowing that I have severe decay. I have delayed going to the dentist because I did not have dental insurance for years. And although I got dental insurance in September of last year, I did not make a dental appointment due to anxiety. I’ve had three dentists over my lifetime, and two of them had poor patient care and were unnecessarily rough. I always left appointments in pain regardless of the procedure. Last weekend I fell and cracked a tooth. The crack doesn’t look that bad, but my tooth hurts. The pain throbs on and off. I think that I can make a dental appointment if I get sedated, but I would like to know how much it costs. If sedation is expensive, I can save money from each paycheck over the next two months. Thank you. Amit

Amit,

Thank you for submitting your inquiry to our office. Your throbbing tooth pain is a symptom of internal tooth damage. See a dentist promptly for an examination.

Although sedation dentistry fees vary and you must speak with your provider for exacts costs, we can provide estimates.

How Much Does Sedation Dentistry Cost?

The cost of sedation dentistry depends on several factors, including the type of sedation you receive, the length of your dental appointment, and where you live in the U.S. because dental fees vary by location throughout the country.

Types of Sedation

Although dental offices vary with the sedation services offered, the types of sedation available include nitrous oxide, oral conscious sedation, and IV sedation. Many dental offices do not offer sedation at all, but others provide at least one option. The costs below are estimates. Call your dentist’s office to ask what type of sedation is available and how much it costs.

Sedation Dentistry with Nitrous Oxide

Nitrous oxide, also known as laughing gas, is the lowest level of sedation.  You breathe in nitrous oxide through a small nose mask during your dental procedure. After the procedure, your dentist will give you pure oxygen to breathe in and quickly reverse the effects.

How much does nitrous oxide cost?

The average cost of sedation dentistry with nitrous oxide in the U.S. is $80 to $150 for the first hour. Your dentist may charge an additional fee if you require nitrous oxide longer than an hour.

Oral Conscious Sedation

Oral conscious sedation is in pill form. Many dentists use the medication Halcion (Triazolam), while others may offer diazepam or lorazepam for sedation. You will take the medication before your dental appointment so that you can arrive relaxed.

How much does oral conscious sedation cost?

The average cost of oral conscious sedation in the U.S. is $250 to $500 per hour. If you need to remain sedated beyond an hour, you may incur an additional fee.

IV Sedation

Intravenous sedation works faster than nitrous oxide and sedation dentistry. The amount of sedation your dentist gives you can vary from making you drowsy to putting you in a deep sleep.

How much does IV sedation cost?

Although the depth of sedation affects the cost, on average, in the U.S., IV sedation costs $500 to $1000 per hour with an additional fee beyond an hour.

Will Insurance Cover the Cost of Sedation?

Woman's face with her eyes closed while she receives dental work
Ask your dentist’s office about sedation dentistry fees and contact your insurance provider about benefits

Each insurance plan differs. Contact your insurance provider and ask if they provide benefits for sedation dentistry. Most insurance plans that offer sedation benefits have restrictions on the length of time coverage is provided for a procedure. For example, an insurance plan may provide benefits toward the first hour of sedation only.

Your dentist’s office will explain sedation dentistry fees and how long you will need sedation during your dental procedure.

Plano, TX dentist Dr. Miranda Lacy sponsors this post.

Is it too late to save my fractured tooth?

I split my left incisor tooth, and after seeing three dentists, none of them want to save it. They all recommend extraction, but I want a dentist who will try to save it first. How can I find a dentist without schedule one consultation after another? I sweat when I think about what it will take to repair the tooth, but I can’t worry about the pain. I want to save it. – Thank you. Clarke

Clarke,

You have two challenges in finding a dentist who will try to save your fractured tooth.

Timing – It is essential to get treatment within a day or two. Although you didn’t mention when your tooth split, more than two days may have passed if you have seen three dentists.

Technique – Few dentists try to save a fractured tooth. But some have found success with this method:

  • Fit the tooth pieces perfectly back together
  • Hold the pieces with a dental crown
  • Follow-up on the tooth for the life of the patient

Documentation on this technique is limited, and there is insufficient research to declare it an acceptable method.

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

If a dentist is willing to save your tooth, perhaps an endodontist (root canal specialist) might be willing to do it. Visit the American Association of Endodontists website for information about traumatic tooth injuries, the risks associated with them, and where an endodontist can save a tooth or need to extract it. Regardless of which treatment you receive, an endodontist will numb the tooth. If you are anxious, you can request sedation.

But you must get an appointment right away. Look for a board-certified endodontist and schedule an appointment for an exam. You do not have any more time to schedule a consultation. The longer you wait, the higher the risk of requiring tooth extraction and a dental implant.

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

Is the screw post in my tooth causing this weird sensation?

My dentist did a root canal on my left front tooth, but the tooth broke at the gumline. I returned to my dentist, and she used a metal screw to attach the temporary crown.  After getting the screw, I feel a weird pressure-like sensation in my nose, but it is not painful. Is this screw going to cause more problems? I am afraid that I will lose the tooth and need a bridge. I’ve needed nitrous oxide for minor dental appointments and stronger sedation for anything more serious. I am concerned about how much this will cost because I lost my full-time job and insurance in April. I have two part-time jobs and no dental insurance. Ezra from FL

Ezra,

You probably would have more success with the tooth if your dentist inserted the metal post right after root canal treatment. The tooth might not have broken if your dentist had stabilized it. But we will focus on the post and possible treatment options. Keep in mind that Dr. Lacy would need to examine and x-ray your tooth for an accurate diagnosis.

What Is a Dental Post for a Crown?

A dental post for a crown is a small metal shaft or screw. A dentist places the metal post inside the tooth after root canal treatment. A post helps support a crown if you do not have enough healthy tooth structure left. A dental lab makes a custom crown that your dentist will cement to the post.

What Are the Risks of a Post?

Although screw posts are generally stable and stay in the tooth, they can exert pressure on the tooth root. The root can split with the stress and cause sensitivity or pain. A dentist needs to examine your tooth and post to determine if the post is causing your symptoms.

Treatment for Front Tooth Broken at the Gumline

When a front tooth breaks at the gumline, many dentists agree that it cannot be saved. Rotational forces on front teeth can cause a crown or post to loosen. You can accept your dentist’s recommendation for the crown and post or get a second option.

Alternative treatment if you lose the tooth

Diagram of a dental bridge
Dental bridge

If you lose your tooth, the most effective way to replace it is with a dental implant. But you explained your employment situation and lack of dental insurance. And implants are the most expensive treatment for replacing missing teeth. A dental bridge or a dental flipper is a more affordable option.

  • Dental bridgeThree crowns are connected at the sides to replace a missing tooth. Your dentist must taper the tooth on either side of the missing one because the crown on each end of the bridge must fit over those teeth to anchor the bridge.
  • Flipper partial – A replacement tooth is embedded in an acrylic base. A clasp on each end of the appliance hooks around a tooth to keep the partial in place.
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

Depending on which treatment you use, you might need stronger sedation than nitrous oxide to help you relax. Talk to your dentist about your anxiety. Also, speak with her about financing or a payment plan to help you pay for care over time.

Miranda Lacy, DDS, a female dentist in Plano, TX, sponsors this post.

How Often Do Porcelain Veneers Fall Off?

For the past two years, I’ve been talking with my dentist about the possibility of getting porcelain veneers. I finally decided to move forward with my plans, so I had a long discussion with my dentist last week. One of my questions was about how long veneers last and if they ever need to be replaced. My dentist said that I could plan on returning to the office every three to four months because veneers fall off, and she will bond them back on. She said if I am careful about not eating crunchy foods, my veneers should last longer. I researched online over the weekend and didn’t see anything about veneers consistently popping off unless the dentist did something wrong.

My dentist’s estimate of how long veneers last is making me nervous. I already have a little dental anxiety. Sometimes I need nitrous oxide, but if I return to her office every few months because veneers pop off, I’ll end up a nitrous junkie. How frequently do veneers pop off? Thanks, Audriana

Audriana,

Shame on your dentist for telling you to expect your new veneers to pop off every few months.

It seems that your dentist is speaking from experience, which can mean several things:

  • Your dentist uses cheap veneers
  • She prepares teeth so aggressively that veneers won’t stay on
  • Bonding techniques are not in your dentist’s skill set

The dental profession has a principle—the standard of care. Although cosmetic dentistry isn’t a recognized specialty, porcelain veneers must stay on—even if they look bad.

How Often Do Porcelain Veneers Fall Off?

Photo of a single porcelain veneers, from affordable Plano TX dentist Dr. Miranda Lacy.
True cosmetic dentists prepare teeth conservatively and bond porcelain veneers so well they don’t come off

Veneers should never fall off, and they should last at least ten years. Your dentist’s prediction about porcelain veneers’ longevity is a warning to find a cosmetic dentist who is skilled with veneers.

And you can eat whatever you want with veneers. But don’t use your veneers—or even your natural teeth—to bite pins, bottle caps, or other hard objects.

We encourage you to search online for cosmetic dentists, look at their patient reviews or smile gallery, and choose two dentists for a consultation. Ask about each dentist’s processes and how long you can expect your veneers to last. Get ready to switch to a new dentist for veneers. And you won’t have to worry about repeat appointments and needing sedation to get through them.

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

Effects of Tooth Roots Left Behind After Extraction

I have tooth roots left from previous extractions that a dentist did years ago. Now a need surgery around the area where the root was left. The tooth that will be extracted is above a root. Is this a risky surgery? My current dentist says it should be no problem, but his answer does not give me confidence. I sent an x-ray of the tooth and the root beneath it. I’m already anxious about another extraction, and the thought of nerve damage is really scary. – Danni from NM

Danni

Your lower premolar is near the mental foramen, an opening in your front lower jaw that transmits the mental nerve and artery. A skilled surgeon can extract your tooth without damaging the nerve. But your dentist doesn’t sound confident about extracting the tooth without damage.

Your x-ray shows that the dentist who completed your extractions left a large amount of root behind. The bone didn’t heal correctly and left a defect that can damage neighboring teeth. We also see a fragment on the right side that doesn’t appear to be threatening.

Photo of female patient sitting and relaxing in a dental chair, for information on sedation dentistry from Plano female dentist, Dr. Miranda Lacy.
Ask about sedation options to help you relax during tooth extraction

We’re sorry that your former dentist did sloppy extractions. If your current dentist isn’t confident about removing your tooth without damaging a nerve, please get a second opinion or ask your dentist to refer you to an oral surgeon.

During your second opinion or consultation with a surgeon or another dentist, ask about sedation options to calm your anxiety before and during treatment.

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