The Cosmetic Dentistry Blog

September 3, 2009

Dental treatment for someone in addiction recovery

Filed under: Dental fear, Pain in teeth — iowasmiles @ 12:48 pm

I am currently on methadone maintenance for opiate addiction and I am in desperate need for extensive repair on my teeth. The last time I needed dental work the dentist refused to give me any pain medication after I had informed him that I was on Methadone. I even gave him the name and number of the clinic I attend and permission to speak to the clinic’s doctor and my counselor. I was in need of dental care and in quite a bit of pain and concerned about pain after the procedure. I already have anxiety issues about going to the dentist and my teeth are in great need of dental care. What would be the best way to go about talking to the dentist about my needs. I do not want to continue to suffer with the pain I have been nor do I want to suffer through pain after. If you could offer me any suggestions or know of a compassionate dentist in my area that would be willing to work with me, I would greatly appreciate it.
- Cheryl from California

Cheryl,
Dentists and medical doctors are afraid of the Drug Enforcement Administration, and many of them simply prefer not to deal with any issue that could raise questions from the DEA. Some dentists have gotten in trouble simply because they were trying to be compassionate, and as these stories circulate, it’s the patient that suffers.

You just need to find a dentist for whom the compassion will be a ruling factor and not fear of the DEA. I would start by looking for dentists who do sedation dentistry, and then ask them up front if they can help you with your treatment and post-operative pain control, given that you are in addiction recovery. My advice would be to just keep asking around until you find a dentist willing to help you. Dentists tend to be compassionate, but they also tend to be timid. But I’m confident you could find someone who would be a match for you.
- Dr. Hall

Related links:
Read about toothache pain

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April 7, 2008

Sensitive to novocain

Filed under: Dental fear, Porcelain veneers — iowasmiles @ 7:36 pm

Dear Dr. Hall,
I am going to have porcelain veneers done in a few days. I am very sensitive to novocaine and any other drug that can make my heart race. Is there any drug ingredient in the process (such as a caine or epinephrine) of porcelain veneers that you are aware of? A friend told me that she got very shaky during the beginning process of being fitted. She was not at all nervous, but her hands started to tremble just after a green topical agent was used prior to the impressions. Her heart started to race and her hands continued to tremble for 15 minutes. Is this possible?
Thank you.
Alison in Rhode Island

Dear Alison,
I have several points to make in answer to your question.

First, the shaking reaction wouldn’t be to the novocain, but could conceivably be due to the epinephrine that is usually present in the novocain. Epinephrine restricts the blood flow in the area of the novocain injection and thus keeps blood from carrying it away and makes it stronger.

Second, the shaking reaction, in my opinion, is more likely to be due to dental fear. Even when there is epinephrine in the novocain, that is less significant than the epinephrine your own body will produce if you have any dental fear, which most people have to some degree at least.

About your friend’s experience, I have some personal experiences as a patient that help me understand that. There were times when I would tell myself that I wasn’t nervous when I began being treated, but what happened during the appointment definitely revealed that I really was nervous. This dental fear can be a strange thing, and part of the way many people try to prepare is to convince themselves that they aren’t nervous. I think that’s what happened to your friend, because there is nothing in the topical ointment that dentists use that would cause shaking or trembling.

My advice? The best way to reduce the ephinephrine in your system is to use nitrous oxide gas or a pill with relaxant medication. Doing that has done wonders for me and for many patients I have treated that have had this sort of thing happen to them. The dentist could use a form of novocain with no epinephrine, but in my experience in treating people who have had reactions like yours, it’s more important that they are thoroughly numb, which is the purpose of that small amount of epinephrine, and a mild relaxant usually takes care of this reaction completely.
- Dr. Hall

Related topics:
sedation dentistry
sleep dentistry

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April 3, 2007

I’m getting dentures. Do I go to a general dentist or oral surgeon first?

Filed under: Dental fear, Dentures — iowasmiles @ 12:39 am

Dr. Hall:
I am a 50 year old man who grew up with a fear of dentist. At an early age I was “freaked out” by a dentist and never really wanted to go to them – unless it was to have a tooth pulled.

Now that I am older most of my teeth are broken or missing. I need to get dentures – my question is how do I know if I need a dentist or an oral surgeon to remove what teeth I have left? This is rather embarassing for me and it keeps me from a lot of activities involving my daughter because of the embarrassment.

Can you tell me which I should look for so I can have my teeth fixed and once again be able to smile in public?

Thanks in advance – I would appreciate the help.
Robert from Ohio

Robert,
I would go to a dentist who can do the tooth extractions – the surgery AND do the dentures. Doing pre-denture surgery isn’t complicated, and there are many general dentists who do it. Just call the dentist’s office and ask what the dentist USUALLY does. Don’t give any hint as to your preference before you ask the question. You just want to find out how the dentist usually handles cases like that. A dentist who usually does the surgery, too, will have plenty of experience at that.

And since you have this dental fear you talk about, you’ll also want a dentist who offers sleep dentistry. In Ohio that shouldn’t be a problem, as there are a number of dentists there who do sleep dentistry.

The reason is that there is a certain amount of coordination that is needed between the surgery and the denture. You may, for example, choose to have the denture placed the same day as the teeth are coming out. This is called an immediate denture. This eliminates the embarrassment of going for six weeks or more without any teeth. Even if you don’t do that, there are certain things the dentist can do during the surgery to help the dentures fit better and be more comfortable, and general dentists are more familiar with those things than oral surgeons.

But even if you did have an oral surgeon take out the teeth, you’d still want to go to the general dentist first, because the general dentist will coordinate the procedures.

Good luck,
Dr. Hall

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