Category Archives: Sedation Dentistry

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.

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


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


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


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


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


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.