The Cosmetic Dentistry Blog

March 4, 2009

Should I have an oral surgeon do this extraction?

Filed under: Extractions, Sedation dentistry — iowasmiles @ 6:26 pm

Dr. Hall,
A couple of years ago, a filling came out of my tooth, and the tooth later broke. When the pain finally became too much to bear, I went to a dentist and ended up having a root canal done, although I’m not sure it was successful. I’m ashamed to admit that my apprehension about dentists has kept me from proper routine check ups and maintenance. The dentist that did the root canal failed to follow up with me and I was in no rush to have more work done, as the pain was gone for the most part, so I did not follow up either and I did not have a cap put on. The temporary filling ultimately fell out, the tooth is about half gone as well and is now infected.

I’ve seen a new dentist that was recommended by a friend, he confirmed the infection, and has advised that the tooth needs to be extracted. He explained that it would be quite invasive due to the condition of the tooth, cutting gum and bone, and that I could have it done by an oral surgeon under anesthesia, or by him with a local. Because of cost considerations, I’ve elected to NOT use an oral surgeon/anesthesia.

I guess my question is this—Due to the invasive nature of the procedure, would it be advisable to use the oral surgeon, or is it safe to assume that a ‘regular’ dentist is qualified to handle to job safely and effectively?
- Amy in New Jersey

Amy,
Giving patients options like this can leave them in a quandary. You leave them with the impression that they might not be safe taking the cheaper route. I would suggest asking more questions to help get at the answer.

It’s possible that the extraction you’re dealing with is beyond the comfort level of your dentist and the dentist could end up in trouble during the appointment. And it’s possible that this appointment could be a traumatic experience for you. Those are the two issues.

Dental anxiety can be very expensive, as you are finding out. If you had the filling replaced when it first came out, you wouldn’t have needed a root canal treatment. If you had the crown done right after the root canal (which sounds like it was done properly), you wouldn’t need the tooth extracted and now a much more expensive tooth replacement to keep your bite from collapsing. So I wouldn’t dismiss the idea of having this appointment with the best anesthesia possible, to keep you from having a bad experience and the resulting lifetime of serious dental anxiety. The end result would be that your mouth would gradually fall apart.

So I would try to pin your dentist down with some specific questions about just how comfortable he feels with this appointment, if he has done extractions like this in the past, if there is nitrous oxide sedation available for you that would help it be more comfortable, and if it is likely to be traumatic for you. Are the roots straight and tapered, or are they twisted with knobs on the end?

Having answers to these questions would help. It sounds like your dentist is trying to be fair and honest with you, so I would give his expressed opinions considerable weight. My tendency would be to encourage you to see the oral surgeon if that option is being offered—it indicates a degree of discomfort on the part of your dentist.

- Dr. Hall

Related links:
Read about dental crowns and why they are needed. In particular, you may want to find out about porcelain fused to metal crowns.
Read more about sedation dentistry here.

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June 18, 2007

How much dental work can I have done in one sitting?

Filed under: General dentistry, Sedation dentistry — iowasmiles @ 8:52 am

Dr. Hall,
I need a lot of work on my teeth. I need over 7 root canals, I have a few cavities, one tooth needs to be shortened and my teeth need to be whitened. I would like to have most of this done at once, how much work can be done in one sitting?
- Lisa in New Jersey

Lisa,
There’s a lot of variation from dentist to dentist as far as how much work they’ll get done in one sitting. You have to ask the individual dentist.

The dentists who will do the most work in one sitting will be those who do sedation dentistry. You can find listings of sedation dentists if you do a Google search on sedation dentist.

If you want a New Jersey cosmetic dentist who can also do sedation dentistry, I’d recommend Dr. Joel Singer. He is up just outside Manhattan, which is at the other end of the state, but if the appearance is important to you, you’re going to have to go that far. If your tooth whitening is not complicated, and there isn’t other work on front teeth, you could have a general dentist do that.

If you don’t want to go with sedation dentistry, then it partly depends on your endurance ability. If dentistry doesn’t make you uncomfortable at all, then you could probably do a four-hour appointment in one sitting, and if your dentist can work fast, then you can get a lot done.

If your seven root canal treatments are on front teeth, then a general dentist or a cosmetic dentist who does root canals could get them done in one appointment. If they are on molars, and it’s important to you to get them done in as few appointments as possible, I’d go to an endodontist (a root canal specialist), as they work much more quickly than non-specialists. It can take a general dentist one and a half to two hours to do a molar root canal, where a specialist will get the whole thing done in an hour, easily.
- Dr. Hall

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