Category Archives: Sedation Dentistry

My Dental Crown Won’t Stay On

My crown isn’t staying on. It has popped off three times now, and after each trip back to the dentist, I get the same answer: another procedure. This time, it is cutting away gum tissue to expose more of the tooth for the crown to hold onto. Sounds intense, right? There’s another thing that freaks me out—the base of my tooth, where the crown is black now. I could swear it wasn’t like that before the last repair. I have the crown in my hand. What should I do next? I’m exhausted. I had never hated dental visits before this drama. I can’t unwind. Thanks. Cherie


I understand your frustration with your crown falling off three times, and the proposed crown lengthening solution raises some concerns. While the procedure can be necessary in certain situations, your dentist’s approach, in this case, doesn’t sit quite right.

Our concerns:

  • Repeated failures: A crown shouldn’t fall off repeatedly. This suggests issues with either the initial preparation or the material used.
  • Reactive approach: Why wasn’t crown lengthening discussed upfront? Addressing potential limitations before starting seems like the responsible course of action.
  • Blackening on the tooth: This new development warrants investigation.

Gather information from one or two second-opinion appointments with dentists experienced in crown retentive techniques. Ask questions to understand your treatment options. Also, explain your anxiety and possible need for sedation to keep you relaxed.

If your dentist didn’t discuss potential limitations and the need for additional procedures upfront, ask for a refund or help paying for a new crown.

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

Will I Need Crowns on All My Teeth After Bulimia Recovery?

I’m recovering from bulimia and trying to save my teeth. Will I need crowns on all teeth to save them? I’ve seen four cosmetic dentists with good reputations in the state to see which one is the best dentist for a smile makeover. Two of the four dentists recommended porcelain crowns for a smile makeover because several of my teeth are severely decayed. They basically said that the crowns could correct my bite and give me a good-looking smile.

The decay is severe in 11 of my teeth; 3 more have limited decay, and my remaining teeth don’t need major work. Their recommendation surprised me, and I wonder if I should let them grind down all my teeth when most don’t need aggressive action. I’m beginning to regret seeing so many dentists because it was the last two dentists who recommended crowns. Or maybe I shouldn’t have told each dentist what the other one said. I’m confused.

I also get nervous at the dentist, so I chose dentists who were willing to do sedation. Are the first two dentists I saw too conservative, or are the last two dentists too aggressive? Should I start all over and schedule consultations with dentists, maybe in another state? Thanks, Sole from GA


It’s good to know you’re recovering from bulimia nervosa and concerned about your smile. Although one of our dentists would need to see you in person to examine your teeth and review your x-rays and dental history, the recommendations you received from the last two dentists concern us.

Conservative treatment is a priority for advanced, ethical cosmetic dentists. They want to preserve as much healthy tooth structure as possible. If you’re uncomfortable with aggressive treatment, a cosmetic dentist concerned about you as a patient certainly wouldn’t recommend it.

Do You Need Crowns On All Your Teeth After Bulimia Recovery?

Whether a dentist needs to place crowns on all your teeth to preserve them or limit dental problems as you recover from bulimia depends on the condition of your teeth. If you sense that the last two dentists are more interested in selling you crowns than giving you a smile makeover that helps you feel good about recovering from bulimia, choose another dentist. A conservative cosmetic dentist will recommend treatment that increases your confidence about your smile—not options that increase worry about your teeth.

A full-mouth reconstruction with crowns on all teeth is sometimes required, though. Common reasons include:

  • Many missing teeth and jawbone resorption that make your face sag
  • Severe, painful issues with your bite
  • Most of your teeth are severely decayed or broken

How to Decide on Treatment

We recommend you return to either of the first two cosmetic dentists offering conservative treatment. Without telling them about the recommendations from the last two dentists, ask about the pros and cons of dental crowns for all your teeth. Each of the first two cosmetic dentists will explain their recommendation and the disadvantages of crowns on all your teeth.

Depending on the extent of damage to your teeth from bulimia, the recommendation for your smile makeover might include a combination of treatments: orthodontic treatment, porcelain veneers, dental implants, cosmetic bonding, or dental crowns.

It is good that you recognize your sedation needs. Even patients without dental anxiety have better dental experiences with sedation when they need extensive dental work.

You stated that seeing four dentists might have confused your decision. If you want to return to each of the first two dentists you saw, hearing them confirm treatment recommendations might give you more confidence.

We wish you continued success in your recovery from bulimia and a smile makeover that will further improve your quality of life.

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

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.