Understanding Dental Anxiety and Fear

The overwhelming fear of dental appointments can be a common cause of anxiety.  Many people visualize a drill-wielding man in a white coat just waiting to cause pain and remove teeth.  The reality, however, is very different.  The comfort, relaxation, and happiness of the patient are the primary focus of any good dental practice.  The staff at the practice will do whatever they can to reduce anxiety, allay fears, and provide painless, quick treatments.

Recent technological advancements have meant that in many cases, dentists are able to replace noisy drills with painless laser beams.  There are also a wide variety of safe anesthetics available to eliminate pain and reduce anxiety during routine appointments.

Here is a List of Some of the Most Common Dental Fears:

How Can You Overcome Dental Anxiety?

Dental anxiety and fear can become completely overwhelming.  It is estimated that as many as 35 million people do not visit the dental office at all because they are too afraid.  Receiving regular dental check-ups and cleanings is incredibly important.  Having regular routine check-ups is the easiest way to maintain excellent oral hygiene and reduce the need for more complex treatments.

Here are Some Tips to Help Reduce Dental Fear and Anxiety:

Talk to us – Though it can be hard to talk about irrational fears with a stranger, we can take extra precautions during visits if fears and anxiety are communicated.

Bring a portable music player – Music acts as a relaxant and also drowns out any fear-producing noises.  Listening to calming music throughout the appointment will help to reduce anxiety.

Agree on a signal – Many people are afraid that the dentist will not know they are in significant pain during the appointment and will continue with the procedure regardless.  The best way to solve this problem is to agree on a “stop” hand signal.  Both parties can easily understand signals like raising the hand or tapping on the chair.

Spray the throat – Throat sprays (for example, Vicks® Chloraseptic® Throat Spray) can actually control the gag reflex.  Two or three sprays will usually keep the reflex under control for about an hour.

Take a mirror – Not being able to see what is happening can increase anxiety and make the imagination run wild. Watching the procedure can help keep reality at the forefront of the mind.

Sedation – If there is no other way to cope, sedation offers an excellent option for many people.  There are several types of sedation, but the general premise behind them is the same: the patient regains their faculties after treatment is complete.

Ask about alternatives – Advances in technology mean that dental microsurgery is now an option. Lasers can be used to prepare teeth for fillings, whiten teeth, and remove staining.  Discuss all the options with us and decide on one that is effective and produces minimal anxiety.

If you struggle with dental anxiety or fear, we can help. Richland Smiles is dedicated to helping patients get the care they need, while working with any concerns you have. We’ll work together to create a plan that works for you. Call our Richland, WA / Tri-Cities dental office today for an appointment.

The field of orthodontics is most commonly associated with treatment for pre-teens and teenagers, but an increasing amount of adults are choosing to correct jaw irregularities (malocclusions) and misaligned teeth with orthodontics. It is now estimated that approximately one third of all orthodontic patients are adults. The major advantage of treating irregularities at a young age is that orthodontic appliances are widely accepted in youth and ideal alignment can be achieved before adulthood. Most orthodontists agree, however, that it is never too late to get braces.

Aside from the pleasing aesthetic of a beautifully straight smile, correcting malocclusion and teeth misalignment with braces is beneficial for a number of other reasons:

Reduced Tooth Decay – Misaligned teeth can make maintaining adequate oral hygiene incredibly difficult. Hard-to-reach spaces can become breeding grounds for the oral bacteria that cause tooth decay.

Reduced Wear and Tear – Chewing capability is impacted by malocclusion. Improper alignment means that as food is chewed, force is not evenly distributed. This can lead to flattened teeth and lopsided wear and tear on dental enamel.

Relief of Jaw Pain – Not only does a comfortable bite distribute pressure evenly across teeth, it can also create smooth, pain-free dental function. Patients with malocclusion experience jaw joint disorders (TMJ dysfunction) that create clicking, popping, and discomfort when opening and closing the mouth.

What Types of Misalignment Require Braces?

An oral health professional can successfully treat jaw irregularities and teeth alignment issues with orthodontic braces. Here is a brief overview of the most common types of issues and alignment irregularities that require braces:

Overbite – An overbite occurs when the maxilla (upper jaw) protrudes further than the mandible (lower jaw). This condition can give the chin a sunken appearance and make the smile look toothier than normal.

Underbite – An underbite occurs when the mandible protrudes further than the maxilla. This condition may be the result of growth irregularities and can make the chin look overly large.

Overcrowding – Overcrowding occurs when there is insufficient room for the adult teeth to erupt and align. In some cases, a tooth or several teeth may need to be extracted to provide room on the arch for proper alignment.

What Kind Of Braces Will I Need?

Dental braces tend to fall into two major categories: fixed and removable. Before recommending a specific course of treatment, your dental professional will visually examine your mouth, take x-rays and form bite impressions. Once a firm diagnosis has been made, a discussion regarding treatment options can take place to determine the quickest and best procedure.

Here is a brief overview of some common types of braces:

Fixed Dental Braces – These dental braces have two major components: brackets and an archwire. A metal, clear or ceramic bracket is glued to each tooth and an archwire is used to link them. During adjustment appointments, the orthodontist will gently tighten or replace wires to train the teeth into the desired position.

Lingual Braces – These braces are fixed yet invisible because they are fitted behind the teeth. Lingual braces are effective for straightening teeth, but on occasion cause minor speech problems and tongue discomforts due to their positioning.

Invisalign® – This system of removable aligners is favored by many adults because of its natural appearance. A series of plastic trays are used to gradually move teeth into proper alignment.

Retainers – When realignment is complete, measures need to be taken to ensure that the teeth do not shift back into the old alignment. Retainers hold teeth in the desired position, allowing bone to form around teeth’s new position.

A composite, or tooth colored filling is used to repair a tooth that is affected by decay, cracks, fractures, etc.  The decayed or affected portion of the tooth will be removed and then filled with a composite filling.

There are many types of filling materials available, each with their own advantages and disadvantages.  You and your dentist can discuss the best options for restoring your teeth.  Composite fillings, along with silver amalgam fillings, are the most widely used today.  Because composite fillings are tooth colored, they can be closely matched to the color of existing teeth, and are more aesthetically suited for use in front teeth or more visible areas of the mouth.

As with most dental restorations, fillings are not permanent and may someday have to be replaced.  They are very durable and will last many years, giving you a long lasting, beautiful smile.

Reasons for Composite Fillings:

How Are Composite Fillings Placed?

Composite fillings are usually placed in one appointment.  While the tooth is numb, your dentist will remove decay as needed.  The space will then be thoroughly cleaned and carefully prepared before the new filling is placed.  If the decay was near the nerve of the tooth, a special medication will be applied for added protection.  The composite filling will then be precisely placed, shaped, and polished, restoring your tooth to its original shape and function.

It is normal to experience sensitivity to hot and cold when composite fillings are first placed, however this will subside shortly after your tooth acclimates to the new filling.

You will be given care instructions at the conclusion of your treatment.  Good oral hygiene practices, eating habits, and regular dental visits will aid in the life of your new fillings.

Straighter teeth perform chewing, biting and speaking functions more effectively than crooked teeth.  In addition, a straight smile boosts confidence, is aesthetically pleasing to look at, and can help stave off a wide variety of dental ailments.

There are several types of malocclusion including overbite, underbite, crossbite, and overcrowding.  Each of these alignment problems negatively impacts the functionality and cosmetic appearance of the teeth.

Here is a brief overview of some of the main disorders associated with crooked teeth:

Periodontitis – Periodontitis or gum disease begins with a bacterial infection.  The bacterial infection is caused by inadequate oral hygiene.  Crooked teeth are hard to clean effectively, which means that debris, plaque and bacteria can build up in hard-to-reach areas.  Straight teeth are much easier to clean and are at less risk of contracting gum disease.

Temporomandibular Disorder (TMJ) – Crooked teeth can lead to improper jaw alignment, which in turn causes a painful condition known as TMJ.  Severe headaches, jaw pain, lockjaw and the grinding of teeth characterize this debilitating disorder.

Tooth injury – Straight teeth creates a strong wall, which means injuries are less likely to occur.  Crooked teeth are weaker and often protrude, making them far more vulnerable to external injury.

Uneven wear – Crooked teeth cause some of the teeth to work harder than others when biting and chewing.  Straight teeth share the workload evenly, meaning less risk of injury and better aesthetics.

Teeth can be straightened using either orthodontic braces or customized aligning trays.  Orthodontic braces are usually affixed to the teeth for a set duration.  The brackets and archwires are tightened regularly by the orthodontist and removed when treatment is complete.  Fixed braces can be placed on the front side or back side of the teeth and are effective for most types of malocclusion.

Aligning trays are fully removable and are used where the malocclusion is less severe, and the teeth need to move a shorter distance.  These trays are replaced every few weeks for the duration of the treatment, and have proven to be equally effective for straightening teeth.

Oral Cancer Exams

According to research conducted by the American Cancer Society, more than 30,000 cases of oral cancer are diagnosed each year.  More than 7,000 of these cases result in the death of the patient.  The good news is that oral cancer can easily be diagnosed with an annual oral cancer exam, and effectively treated when caught in its earliest stages.

Oral cancer is a pathologic process which begins with an asymptomatic stage during which the usual cancer signs may not be readily noticeable.  This makes the oral cancer examinations performed by the dentist critically important.  Oral cancers can be of varied histologic types such as teratoma, adenocarcinoma and melanoma.  The most common type of oral cancer is the malignant squamous cell carcinoma.  This oral cancer type usually originates in lip and mouth tissues.

There are many different places in the oral cavity and maxillofacial region in which oral cancers commonly occur, including:

Reasons for Oral Cancer Exams

It is important to note that around 75 percent of oral cancers are linked with modifiable behaviors such as smoking, tobacco use and excessive alcohol consumption.  Your dentist can provide literature and education on making lifestyle changes and smoking cessation.

When oral cancer is diagnosed in its earliest stages, treatment is generally very effective.  Any noticeable abnormalities in the tongue, gums, mouth or surrounding area should be evaluated by a health professional as quickly as possible.  During the oral cancer exam, the dentist and dental hygienist will be scrutinizing the maxillofacial and oral regions carefully for signs of pathologic changes.

During An Oral Cancer Exam, We’ll Look For The Following Symptoms:

Oral Cancer Exams, Diagnosis and Treatment

The oral cancer examination is a completely painless process.  During the visual part of the examination, the dentist will look for abnormality and feel the face, glands and neck for unusual bumps.  Lasers which can highlight pathologic changes are also a wonderful tool for oral cancer checks.  The laser can “look” below the surface for abnormal signs and lesions which would be invisible to the naked eye.

If abnormalities, lesions, leukoplakia or lumps are apparent, the dentist will implement a diagnostic impression and treatment plan.  In the event that the initial treatment plan is ineffective, a biopsy of the area will be performed.  The biopsy includes a clinical evaluation which will identify the precise stage and grade of the oral lesion.

Oral cancer is deemed to be present when the basement membrane of the epithelium has been broken.  Malignant types of cancer can readily spread to other places in the oral and maxillofacial regions, posing additional secondary threats.  Treatment methods vary according to the precise diagnosis, but may include excision, radiation therapy and chemotherapy.

During bi-annual check-ups, the dentist and hygienist will thoroughly look for changes and lesions in the mouth, but a dedicated comprehensive oral cancer screening should be performed at least once each year.

Schedule An Appointment

Are you showing any symptoms, or have concerns over oral cancer? Call our office today to set up an appointment for a screening.

While most dental surgery is performed on an out-patient basis, it remains an involved procedure that requires specific preparation and aftercare.  In an effort to provide safe, comfortable care, we encourage you to review our pre- and post-operative instructions, which are intended to facilitate a smooth operation and safer recovery.

If you have any questions or concerns about your surgery, please contact our practice today.

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There are a number of reasons that your dentist might recommend a tooth extraction. Some dental patients suffer from tooth decay; others need to remove teeth hindering orthodontic treatment, whereas various patients simply need wisdom teeth removal. While a tooth extraction can be a serious dental procedure, aftercare is just as critical as the procedure itself. As the dental patient, it is important to understand that pain and the risk of infection can be lessened with proper care.

Care immediately following surgery:

After your tooth has been extracted, healing will take some time. Within 3 to 14 days, your sutures should fall out or dissolve. For sutures that are non-resorbable, your doctor will schedule a follow-up appointment to remove the stitches for you. Your tooth’s empty socket will gradually fill in with bone over time and smooth over with adjacent tissues.

Possible complications after a tooth extraction

Bleeding – Bleeding after a tooth extraction is entirely normal. A pinkish tinted saliva and subtle oozing is fairly common during the first 36 hours. If bleeding gets excessive, control it by using dampened gauze pads and biting down to keep pressure on the area. As an alternative to gauze pads, a moistened tea bag can be used, as the tannic acid helps blood vessels contract. Apply pressure to the gauze or tea bag by gently biting down for 30 minutes. Please remember that raised tempers, sitting upright, and exercise can all increase blood flow to the head, which can cause excess bleeding. Try to avoid these as much as possible. If your bleeding does not reduce after 48 hours, please call the practice.

Bone sequestra (dead tooth fragments) – Some patients have small sharp tooth fragments that were unable to be completely removed during surgery. During the recovery period, these dead bone fragments, or bone sequestra, slowly work themselves through the gums as a natural healing process. This can be a little painful until the sequestra are removed so please call our practice immediately if you notice any sharp fragments poking through the surgery site.

Dry socket – In the days that follow your tooth extraction, pain should gradually subside. Rarely, patients report that pain increases to a throbbing unbearable pain that shoots up towards the ear. Often this is a case of dry socket. Dry socket occurs when the blood clot becomes irritated and ousted before healing is complete. Food and debris can then get into the socket causing irritation. Tobacco users and women taking oral contraceptives are at a higher risk of getting dry socket. Dry socket is not an infection but does require a visit to our office. If you think you may be suffering from dry socket, please contact the practice immediately.

Lightheadedness – Because you may have been fasting prior to surgery, your blood sugar levels may be lower than normal. Until your body has had the chance to catch up and process some sugars, you should remember to stand up slowly when getting up from a relaxed position. For somewhat immediate relief, try eating something soft and sugary, stay in a relaxed position, and reduce the elevation of your head.

Numbness – Many patients report still feeling numb hours after their tooth extraction procedure. An extended lack of feeling around the mouth is normal and can last 10-12 hours after surgery.

Swelling – Swelling should subside almost entirely within 10 days after surgery. Immediately following your tooth extraction, apply an ice pack to the facial areas near the extraction. Continue using the ice in 15 minute intervals for the first 36 hours. After 36 hours, ice will no longer be beneficial in reducing swelling and moist heat should be used instead. To decrease swelling, apply a warm damp cloth to the sides of your face.

Trismus (difficulty opening and closing mouth) – If you experience a sore jaw and difficulty chewing or swallowing, do not be alarmed. Occasionally patients’ chewing muscles and jaw joints remain sore 3-5 days after surgery. This soreness can also make it difficult to open and close your mouth. Soreness should eventually subside.

Home Care Instructions for After Dental Implant Surgery

Following dental implant surgery, patients must take detailed care of the area surrounding their new implant.  For the first month the dental implant is still integrating with the bone and tissues so the patient’s care routine will be slightly more involved during this initial period.  Above all, do not disturb the wound in the initial days that follow surgery.  Avoid rinsing, spitting, and touching the mouth for 24 hours after surgery to avoid contaminating or irritating the surgical site.  After dental implant surgery it’s important to follow these care instructions:

What Dental Implant Recovery Involve?

While each patient’s case is different, recovery after dental implant surgery happens in a series of phases. With your new dental implants, maintaining proper oral hygiene should be your primary focus. In order for the implant to properly fuse with the jawbone, it must remain clean. Also keep in mind that when properly cared for, a dental implant can serve its owner for life.

When maintaining proper hygiene, oral discomfort should gradually lessen. Swelling, bruising, and minor bleeding may still occur. If any pain does continue, feel free to continue using the pain medications.

Healing time differs depending on whether a patient receives immediate crown placement, or waits for the implant to fuse with the jawbone. Your recovery timeframe will depend on your individual case and treatment plan; follow-up appointments will be scheduled accordingly.

A gum graft (also known as a gingival graft or periodontal plastic surgery), is a collective name for surgical periodontal procedures that aim to cover an exposed tooth root surface with grafted oral tissue.

Exposed tooth roots are usually the result of gingival recession due to periodontal disease.  There are other common causes, including overly aggressive brushing and trauma.

Here are Some of the Most Common Types of Gum Grafting:

Free gingival graft 

This procedure is often used to thicken gum tissue.  A layer of tissue is removed from the palate and relocated to the area affected by gum recession.  Both sites will quickly heal without permanent damage.

Subepithelial connective tissue graft

This procedure is commonly used to cover exposed roots.  Tissue is removed fairly painlessly from the outer layer of the palate and relocated to the site of gum recession.

 Acellular dermal matrix allograft

This procedure uses medically processed, donated human tissue as a tissue source for the graft.  The advantage of this is procedure is that there is no need for a donor site from the patient’s palate (and thus, less pain).

Reasons for Gum Grafting

Gum grafting is a common periodontal procedure.  Though the name might sound frightening, the procedure is commonly performed with excellent results.

Here are some of the major benefits associated with gum grafting:

 Reduced sensitivity

When the tooth root becomes exposed, eating or drinking hot or cold foods can cause extreme sensitivity to the teeth.  Gum grafting surgery permanently covers the exposed root, helps reduce discomfort, and restores the good health of the gums.

 Improved appearance 

Periodontal disease is characterized by gum recession and inflammation.  Gum recession and root exposure can make the teeth look longer than normal and the smile to appear “toothy.”  Gum grafting can make the teeth look shorter, more symmetrical and generally more pleasing to look at.  In addition, adjacent tissue can be enhanced and augmented during the procedure for aesthetic purposes.

Improved gum health 

Periodontal disease can progress and destroy gum tissue very rapidly.  If left untreated, a large amount of gum tissue can be lost in a short period of time.  Gum grafting can help halt tissue and bone loss; preventing further problems and protecting exposed roots from further decay.

What Does Gum Grafting Treatment Involve?

Once the need for gum grafting surgery has been determined, there are several treatments the dentist will want perform before gum grafting takes place.  First, the teeth must be thoroughly cleaned supra and subgingivally to remove calculus (tartar) and bacteria.  The dentist can also provide literature, advice and educational tools to increase the effectiveness of homecare and help reduce the susceptibility of periodontal disease in the future.

The gum grafting procedure is usually performed under local anesthetic.  The exact procedure will depend much on whether tissue is coming from the patient’s palate or a tissue bank.

Initially, small incisions will be made at the recipient site to create a small pocket to accommodate the graft.  Then a split thickness incision is made and the connective tissue graft is inserted into the space between the two sections of tissue. The graft is usually slightly larger than the recession area, so some excess will be apparent.

Sutures are often placed to further stabilize the graft and to prevent any shifting from the designated site.  Surgical material is used to protect the surgical area during the first week of healing.  Uniformity and healing of the gums will be achieved in approximately six weeks.

Cracked and fractured teeth are common dental problems. As people retain their natural teeth longer (due to advances in dental technology), the likelihood of cracked teeth increases. There are many reasons why teeth may crack, for example, biting on hard objects, trauma, grinding and clenching of teeth. All of these behaviors place the teeth under extra strain and render them more susceptible to cracking.

When tooth enamel is cracked, pain can become momentarily debilitating. In the absence of pressure on the crack, there may be no discomfort.  However, as the cracked tooth performs a biting action, the crack widens. The pulp and inner workings of the tooth then become exposed, and painful irritation occurs. As pressure is released again, the two parts of the crack fuse back together, and pain subsides. If left untreated, the pulp becomes irreversibly damaged and constantly painful. The resulting pulp infection can affect the bone and soft tissue surrounding the tooth.

Symptoms of a cracked tooth may include:

What kind of cracks can affect the teeth?

There are many ways in which a tooth can be cracked. The specific type of crack will determine what type of treatment is viable. In cases where the crack is not too deep, root canal therapy can be performed, and the natural tooth can remain in the mouth.  In other situations, the tooth is too badly damaged and requires extraction.

Here is a brief overview of some of the most common types of cracks:

Crazes – These are generally tiny vertical cracks that do not place the teeth in danger. These scratches on the surface of the teeth are considered by most dentists to be a normal part of the tooth anatomy. A craze rarely requires treatment for health reasons, but a wide variety of cosmetic treatments can be performed to reduce the negative aesthetic impact.

Oblique supragingival cracks – These cracks only affect the crown of the tooth and do not extend below the gum line. Usually, the affected part of the tooth will eventually break off. Little pain will result, because the tooth pulp (that contains the nerves and vessels) will remain unaffected.

Oblique subgingival cracks – These cracks extend beyond the gum line and often beyond where the jawbone begins.  When a piece breaks off, it will usually remain attached until the dentist removes it. Oblique subgingival cracks are painful and may require a combination of periodontal surgery (to expose the crown) and endodontic treatment to place a crown or other restorative device.

Vertical furcation cracks – These cracks occur when the roots of the tooth separate. This type of crack almost always affects the nerve of the tooth. Because the tooth will not generally separate completely, root canal therapy and a crown can usually save the tooth.

Oblique root cracks – These cracks tend not to affect the surface of the tooth at all. In fact, the damage is only apparent below the gum line and usually below the jawbone. Root canal therapy may be possible, depending on how close the fracture is to the tooth surface.  However, extraction is almost always the only option after sustaining this classification of fracture.

Vertical apical root cracks – These cracks occur at the apex (tip of the root). Though the tooth does not require extraction from a dental perspective, many patients request an extraction because of the high degree of pain. Root canal therapy alleviates the discomfort for a while, but most often, teeth affected by such cracks are eventually extracted.

How are cracks in the teeth treated?

There are many different types of cracked teeth. Some can only be exposed using X-ray machines, while others are clearly visible to the naked eye. In cases where the tooth root is affected, root canal therapy is the most viable treatment option. The pulp, nerves, and vessels of the tooth will be removed, and the resulting space will be filled with gutta-percha.  A crown or filling will be added to stabilize the tooth, and it will continue to function as normal.

When the crack is too severe for the tooth to be saved, the dentist will perform an extraction. There are a number of restorative options in this case, such as bridges, dental implants and partial dentures. All of these structures can restore biting, chewing, and speaking functions.