Dental Articles

Woman with dental fear

The Real Deal on Dental Phobia – Easing Fear and Anxiety at the Dentist Office

This article was featured in Apex Suburban Living Magazine in April 2020.

If the thought of going to the dentist makes you break out in a cold sweat, you are not alone.  “Fear of the dentist” is more common than you might think.  While nearly 75% of adults admit they experience some level of anxiety or nervousness about going to the dentist, many people have a severe enough dental phobia they avoid the dentist completely, until pain compels them to go. If you find yourself nervous or scared about going to the dentist, read on for some strategies you can use to help yourself feel more comfortable in the dental office as well as ways your dentist can help you get the treatment you need in the most comfortable way possible.

“I’m scared it’s going to hurt.”

Nearly every patient says this, and if they don’t, they’re definitely thinking it. Anticipation before a procedure causes our minds to race and imagine the worst case scenario. Your dentist wants you to be comfortable, so they will make sure the area is completely numb before beginning the procedure. You should talk with your dentist beforehand to establish clear signals, such as raising your hand, so the dentist will know to stop if needed.  Communicating with your dentist in this way can go a long way to establish mutual trust and assure you do not feel “loss of control” during the appointment.

“I can’t stand the sound of the drill!”

While the sounds of the office may not be completely removed, there are ways you can distract yourself  from the inevitable whirring noises. For example, you could wear earphones and listen to music or a podcast. Some offices have an overhead TV screen so you can stream your favorite movie while in the dental chair.  Some patients manage this issue through progressive muscle relaxation, where they slowly stretch and relax different muscle groups throughout the appointment. Your dentist can also suggest other techniques to help take your mind off the unpleasant noises inherent to dental procedures.

“I don’t want to get a shot.”

The fear of needles and injections is real, and dentists know it. Dental procedures often require numbing and understandably, this is one of the most common causes of apprehension for patients. It is important to remember that numbing actually makes the appointment MORE comfortable for you.  Thankfully, there are numerous techniques your dentist can use to lessen the sting of the needle. For example, a topical gel can help numb the gums before placing the anesthetic. The anesthetic can also be warmed to your body temperature beforehand to decrease nerve stimulation.   Your dentist might even gently wiggle your lip or cheek to “confuse” the nerves while giving the injection. Through these methods, most patients do not feel much more than a small pinch. However, if you suffer from a true needle phobia, you may need sedation medications to relax, or even sleep through the whole procedure.   

“I’m worried my dentist will make me feel guilty for waiting so long to come in.”

Bottom line: No one should ever feel ashamed or embarrassed to go to the dentist no matter how long it has been since their last visit. And if you are at the point where you’re afraid to show your smile, it’s definitely time for a visit. Ask around or read online reviews to find a dentist in your area who you think will be compassionate and understanding. Remember, dentists have spent an incredible amount of time studying and honing their skills in order to care for patients in any situation, from healthy mouths to broken teeth and everywhere in between. Dentists are not glad you have problems, but they are glad they can help you overcome these problems and get you on your journey to a healthy and happy smile. That is usually why they became dentists in the first place!

“I’ve tried everything and I’m still too nervous to go to the dentist.”

If this is you, then it is time you talk to your dentist about sedation.  Gripping the arm rests till your knuckles turn white is no way to get through a dental appointment.  Sedation is the use of certain medications to produce relaxation. It is safe and effective, and can be used for nearly any dental procedure.  There are different levels of sedation depending on your level of anxiety or fear, or the difficulty of the procedure.

Nitrous Oxide

The lowest level of sedation has actually been used in dentistry for over 150 years. Nitrous Oxide, or more popularly known as laughing gas, is inhaled through your nose and creates a calming, pleasant sensation throughout the body.  Nitrous oxide works by slowing the nervous system so your responses are slower and less inhibited, which is why some people might start giggling, hence the name “laughing gas.”  Most people report feeling gentle tingling in their toes and fingers, and may even have a sense of floating.

Nitrous oxide is best used for those patients who are mildly anxious and just need a bit of help to relax.  Because the effects disappear almost immediately after the dentist turns off the gas, you can drive yourself home or back to work afterward. It is frequently used for treating children because of its rapid on, rapid off effects.  There are some situations where it is not advised, so you should discuss this with your dentist.

Oral Sedation

As the name suggests, this type of sedation is when you take a small pill before your appointment to help you relax.  The medication is usually a type of “sleeping pill” and will make you slightly drowsy.  Usually one pill is enough to “take the edge off”, but if you are especially nervous, you would need additional doses to maintain an appropriate level of comfort, in which case your dentist would need to have special certification.  Oral sedation medications have a long, successful history in dentistry and can be used for many different situations. Talk to your dentist to see if it is available and if it is right for you. With oral sedation you would need to have someone drive you to and from the appointment.

IV Sedation

If you suffer from true dental phobia or are undergoing a larger procedure and you don’t want to remember any of it, you might consider IV sedation.  Here, sedating medications are placed intravenously to induce a greater state of relaxation, often to the point you fall asleep.  Afterward you have little to no memory of the procedure, and you can expect to be a bit drowsy for the rest of the day.  You would have to not eat or drink for several hours before the appointment, and someone would need to drive you home afterward.  There are certain medical conditions that preclude IV sedation as well as some inherent risks, so be sure to have a frank discussion with your sedation dentist at the consult appointment.  Because of the rigorous training and special certification required, only a small number of general dentists choose to perform IV sedation in their offices.

Your comfort matters

From the person greeting you at the front desk to the dental assistant in the back, everyone in the dental office is there to help you achieve your goal to have a healthy mouth and to feel comfortable reaching that goal. By telling your dentist if you have any level of worry or fear, they  can assure you receive the extra care you need. Gone are the days where going to the dentist is synonymous with pain and suffering.  From simple techniques you can perform yourself, to sedation methods your dentist may provide, you no longer need to avoid taking care of your smile.

Dr. Robert Watson, originally from Montana, graduated from the University of Minnesota School of Dentistry.  After dental school he attended an Advanced Education in General Dentistry residency, then worked as a dentist in the Air Force for eight years, living overseas in Japan and England,  before moving to North Carolina in 2016.  He is now partners with Dr. Bass at Bass & Watson Family Dental in Apex, NC, where he continues to practice sedation dentistry.

Dr. Michael Bass is a North Carolina native and graduated from the UNC School of Dentistry.  He has been in private practice for over 19 years, and has made continuing education an uncompromising ambition, always staying at the forefront of dentistry.  He is receiving his Mastership Award from the Academy of General Dentistry this summer in Las Vegas, an honor fewer than 2% of dentists obtain.  He is a partner with Dr. Watson at Bass & Watson Family Dental in Apex, NC.

Lasers in Dentistry

LASERS ARE THE FUTURE

I bought my first dental laser in 2008. I thought it was the coolest thing to be able to reshape gums with it or cut away a growth for a biopsy.

I have since purchased several other lasers. Each laser offers a different wavelength guided by a sophisticated computer to enable different procedures. Some lasers are best for cutting soft tissues such as gums, cheeks, and tongue. Other lasers are best for working on hard tissues such as teeth and bone. There are a few lasers that can cut both types of tissues, but remain cost prohibitive for most general use applications(more than $120,000 initially plus ongoing costs). There is also photobiomodulation – a technique of using low level light energy (cold laser) that does not cut at all, but is used to stimulate faster healing in the body.

WHY USE LASERS?

Lasers slowly cut away diseased tissue in a way that triggers less inflammatory response from the body than scalpel or drill. Lasers sterilize the area because they destroy good and bad cells alike as they cut, thus bacteria and viruses are destroyed in the process. The power and effectiveness of harnessing different light energies is truly amazing. Scientists are still researching the best wavelengths and power outputs for numerous applications.

PAIN FREE?

Not yet…We recently used a very high end laser in our office for 9 months. While the manufacturer claimed there was no need for anesthetic, our experience was that this was true for only about half of the patients. The other half of patients very much would have appreciated numbing first. We deemed this to be not good enough and have discontinued its use without anesthetic. We want our patients to be able to relax and not worry that they will feel pain midway through a procedure.

CONCLUSION

Lasers should eventually replace the drill and scalpel for most if not all dental procedures, however, the cost of this technology needs to come down considerably before it can see widespread adoption. We will continue to keep a close eye on the laser market and adopt the technologies that make the most sense for our patients’ welfare.

For more information on lasers, call Dr. Bass at 919-362-6789.

Wisdom Teeth Surgery and Services

Wisdom Teeth – Should they stay or should they go?
by Michael E. Bass, DDS, FAGD

What should you do about your 3rd molars (wisdom teeth)? Nearly every teenager and adult has to face this question at some point. The quick answer is that as soon as they are developed enough to remove, then get them removed (typically some time between age 16 and 20). Each year you wait beyond that, you increase the chances of collateral damage. Once you reach your 30’s and beyond, you now have to weigh the pros and cons much more closely as you just don’t heal as well as you once did.

Why do we even have wisdom teeth?

Anthropologists who have studied this have given some interesting insights. Thousands of years ago, our diet was much more coarse and so teeth would not only wear down on the tops, but in between the teeth as well. This would have created more space in the mouth for all the teeth to fit. Also, life spans were shorter and so some of the end stage diseases (like periodontal disease) that we see with wisdom teeth now may not have happened because people didn’t live long enough. Finally, over the years there has been more scrambling of the genetic code as small people with smaller teeth and jaws marry bigger people with bigger teeth and jaws, you begin to get more variability and randomness in the amount of space people have available for the size of teeth in their mouths.

How do you know if you can keep your wisdom teeth?

Let’s be clear – very few people these days will benefit from keeping them. The ironic thing is that while you are young and healthy, your wisdom teeth may not bother you at all and so you assume that all is well. It is not until you are much older that you realize problems are developing, but, by then you may be past the time in life where you will heal as quickly and uneventfully. A dentist will tawisdom teeth gumske a panoramic x-ray that will show the wisdom teeth, what angle they are coming in, and how developed they are. Many of the wisdom teeth do have enough room to come, but they don’t have enough room to have the type of gums around them (keratinized gingiva) that will create a good long term seal around the backs of them. It is more like your cheek tissue is running right up against the back of the tooth. This will eventually be the weak link where gum disease and bone loss begins. Other wisdom teeth may be at an angle where they won’t be able to come in all the way (impacted). These can cause damage to the back side of your good molars (2nd molars) that you do want to keep.

In my 20 years of experience in dentistry, I have seen that people usually aren’t able to keep their wisdom healthy enough even if they do have enough room for them to come in because they are so far in the back of the mouth. They don’t get brushed and flossed well enough and
food lingers back there causing cavities and gum problems. Most of your chewing takes place in front of these teeth. Studies have shown that less than 2% of adults with wisdom teeth at age 65 and beyond are able to maintain them without cavities or gum disease.

Wisdom teeth xray

What’s the best timing for removing wisdom teeth?

Most dental surgeons prefer to wait until the roots of the wisdom teeth are at least one third developed (typically between age 16 and 20) because it is easier to get a hold of them for removal. As you wait longer than that, the roots continue to get longer and more matured and can approach an important nerve in the lower jaw that you don’t want to damage. So, sooner is usually better.

How hard is going to be to have wisdom teeth removed?

Most people are nervous about removing their wisdom teeth because they are afraid of pain or the cost. Recovery is going to be different for everyone. It is really case by case. It is best to visit with your dental surgeon to let them discuss with you your specific situation and the risks and benefits involved. If you generally recover fairly quickly from illnesses, then this will likely apply to this surgery. You may want to take advantage of modern medicine and be sedated so that you are not aware of what is going on. For most people, a combination of over the counter pain relievers will be prescribed by your dental surgeon to keep you comfortable for a few days along with a softer food diet.