Category Archives: Sedation Dentistry

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.

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.