Painless dental anesthesia injections
DentalVibe® is a revolutionary, patented, award-winning device invented by a dentist that uses vibration to block the sensation of pain. So when you get a shot, you don't feel it. DentalVibe is gentle, fast, and safe. There are no pills to take, no gas to inhale, no drowsy after-effects to worry about.
Over 50% of Americans avoid dental care entirely due to the fear of pain! By using DentalVibe, Patients will no longer have to worry and stress-out about the fear of injection pain. The fear of pain will no longer prevent patients from getting the care they desperately need and elective treatments they truly desire.
DentalVibe uses unique, microprocessor-controlled VibraPulseTM technology to provide the most effective way to "close" the Pain Gate to the brain and block the discomfort of dental injections.
Because the brain can readily adapt to a constant stimulus, negating a closure of the pain gate, our engineering and design team has equipped DentalVibe with the world's first, micro-processor controlled VibraPulse Technology.
The micro-sonic oscillations of DentalVibe's comfort tips are pulsed in a controlled synchronized wave pattern. Along with an enhanced amplitude, VibraPulse Technology sends a soothing percussive, or tapping stimulation deep into the oral mucosa, gently exciting the submucosal sensory nerve endings.
Brilliantly, it is this pulsed re-stimulation that maintains a closure of the gate, blocking the pain of an injection.
The incorporation of LASER technology in periodontal therapy has provided for state-of-the-art safe, effective, less invasive treatment to correct a variety of periodontal and aesthetic concerns. The use of LASERs often results in little to no discomfort, and many times requires little to no local anesthetic. LASER therapy is widely used in our practice for the following conditions:
Removal of tooth decay (cavity) without shots:
Within the last few years, several types of lasers have been developed that can effectively remove decay and prepare teeth for fillings, thereby reducing the need for the dental drill. The laser light is highly absorbed in water. The water content is higher in decay than it is in healthy dental hard tissue. Depending on the energy settings of the laser, the decay removal can proceed more rapidly than the removal of the tooth structure. This precision will allow for healthier tooth to remain, while removing the disease.When the dentist scans over the tooth with the tip of the laser and an accompanying water spray, the patient will hear a low popping sound. Most patients relate that this sound is less annoying than that of the dental drill. Dentists report that they are able to treat more than 90% of the cases without dental anesthetics, so your dentist can treat several teeth in one visit. Bonded fillings can be placed, cured and polished allowing you to resume normal activities immediately. This treatment is suitable for children and adults.Research has shown that certain types of lasers can be used to treat dental enamel and reduce the progression of decay by as much as 85%. While this work has only been done in the laboratory, the results are promising. It will be necessary to conduct human studies to confirm these laboratory assessments
Aesthetic Smile Enhancement
Excessive gums, more commonly termed the “gummy smile”, can be simply, quickly and comfortably corrected using LASER therapy. Healing is usually complete in three days, and no adjustment to activity level or diet is necessary.
A frenulum is the fold of tissue that is visible when you pull your lip out away from your teeth or is seen attached to your tongue when you lift your tongue to the roof of your mouth. A frenulum serves no true physiological purpose; however, when it is attached too close to your teeth or it is attached too close to the tip of your tongue ("tongue tied"), this can lead to recession, bone loss, root cavities and speech impediments. LASER therapy to correct frenulums is very quick and precise, and usually involves no “stitches” or bleeding. As with most LASER therapies, results are instanteous.
Periodontal Pocket Sterilization
LASER therapy is also incorporated as a modality of treatment against gum disease, or “periodontitis.” If periodontal disease is recognized in its early stages, LASER therapy is an extremely successful option for gingival pocket sterilization. This simply means that the LASER’s affinity for diseased tissue allows for vaporization of the diseased tissue and associated bacteria. The healthy tissue remains and can grow back to the tooth to provide a manageable pocket depth with excellent dental hygiene. The procedure is performed under local anesthesia (novacaine) in conjunction with scaling and root planing (“deep cleaning”).
Root Canal Treatment (endodontic treatment)
At the center of a tooth is a hollow area that houses soft tissue, known as pulp. This hollow area contains a relatively large space towards the chewing surface of the tooth called the pulp chamber. This pulp chamber is connected to the tip of the tooth root via thin, hollow, pipe-like canals—hence, the term "root canal". Human teeth normally have one to four canals, with teeth toward the back of the mouth having the greatest number. These canals run through the centre of the roots like pencil lead runs through the length of a pencil. The tooth receives nutrition and sensory function through the blood vessels and nerves traversing these canals. Occasionally, a cavity on the outer surface of the tooth may cause this soft tissue to become inflamed or infected. Left untreated, a serious jaw infection can result. The infection and inflammation is very painful in most cases. Treatment is available and should take place before this happens.
Sometimes a tooth is considered so threatened (because of decay, cracking, etc.) that future infection is considered likely or inevitable, and a pulpectomy, removal of the pulp tissue, is advisable to prevent it. But usually some inflammation and/or infection is already present, within or below the tooth. To cure the infection and save the tooth it is necessary for the dentist to drill into the pulp chamber and remove the infected pulp by scraping it out of the root canals. Once that is done, the dentist fills the cavity with an inert material and seals up the opening. This procedure is known as root canal therapy. If enough of the tooth has been damaged or removed as a result of the treatment, a crown may be required.
The standard filling material is Gutta-percha, a thermoplastic polymer of isoprene, which is melted and injected to fill the root canal passages. Barium is added to the isoprene so the material will be opaque to X-rays, allowing verification afterwards that the passages have been properly and completely filled in without voids.
For patients, root canal therapy is one of the most feared procedures in all of dentistry; dental professionals assert that modern root canal treatment is relatively painless because the pain can be controlled. Lidocaine is a commonly used local anesthetic. Pain control medication may be used either before or after treatment. However, in some cases it may be very difficult to achieve pain control before performing a root canal. For example, if a patient has an abscessed tooth with a swollen area or "fluid-filled gum blister" next to the tooth, the pus in the abscess may contain acids that inactivate any anesthetic injected around the tooth. In this case, it is best for the dentist to drain the abscess by cutting it to let the pus drain out which releases the painful pressure built up around the tooth. The dentist then prescribes a week of antibiotics such as penicillin, which will reduce the infection and pus making it easier to anesthetize the tooth when the patient returns one week later.
The dentist could also open up the tooth and let the pus drain through the tooth and could leave the tooth open for a few days to help relieve pressure. At this first visit, the dentist must ensure that the patient is not biting into the tooth, which could also trigger pain. Sometimes the dentist performs preliminary treatment of the tooth by removing all of the infected pulp of the tooth and applying a dressing and temporary filling to the tooth. This is called a "pulpectomy". The dentist may also remove just the coronal portion of the dental pulp, which contains 90% of the nerve tissue, and leave pulp in the canals intact. This procedure, called a "pulpotomy", tends to essentially eliminate all the pain. A "pulpotomy" may be a relatively definitive treatment for infected primary teeth. The pulpectomy and pulpotomy procedures eliminate most all pain until the follow-up visit for finishing the root canal. But if the pain returns, it means any of three things: the patient is biting into the tooth, there is still a significant amount of sensitive nerve material left in the tooth, or there is still more pus building up inside and around the infected tooth.
After removing as much of the internal pulp as possible, the root canals can be temporarily filled with calcium hydroxide paste. This strong alkaline base is left in for a week or more to disinfect and reduce inflammation in surrounding tissue . Ibuprofen taken orally is commonly used before and/or after these procedures to reduce inflammation.
After receiving a root canal, the tooth should be protected with a crown that covers the cusps of the tooth. Otherwise, over the years the tooth will almost certainly fracture, since root canals remove tooth structure from the tooth and undermine the tooth's structural integrity. Also, root canal teeth tend to be more brittle than teeth not treated with a root canal. This is commonly due to the fact that the blood supply to the tooth, which nourishes and hydrates the tooth structure, is removed during the root canal procedure, leaving the tooth without a source of moisture replenishment. Placement of a crown or cusp-protecting cast gold covering is recommended also because these have the best ability to seal the root canaled tooth. If the tooth is not perfectly sealed, the root canal may leak, causing eventual failure of the root canal. Also, many people believe once a tooth has had a root canal it cannot get decay. This is not true. A tooth with a root canal still has the ability to decay, and without proper home care and an adequate fluoride source the tooth structure can become severely decayed – without the patient's knowledge since the nerve has been removed, leaving the tooth without any pain perception. Therefore it is very important to have regular X-rays taken of the root canal to ensure that the tooth is not having any problems that the patient would not be aware of.
In the last ten to twenty years, there have been great innovations in the art and science of root canal therapy. Dentists now must be educated on the current concepts in order to optimally perform a root canal. Root canal therapy has become more automated and can be performed faster, thanks to advances in automated mechanical instrumentation of teeth and more advanced root canal filling methods. Dentists also possess newer technologies that allow more efficient, scientific measurements to be taken of the dimensions of the root canal that must be filled. Many dentists use microscopes to perform root canals, and the consensus is that root canals performed using microscopes or other forms of magnification are more likely to succeed than those performed without them. Although general dentists are becoming versed in these advanced technologies, they are still more likely to be used by specialist root canal doctors (known as endodontists). Dr. Arnaldo Castellucci, an Italian dentist, has recently authored a three-volume treatise on endodontics which thoroughly covers these modern concepts.
Sometimes root canals fail. Patients should be educated on some of the reasons why root canals may fail. They may fail if the dentist does not find, clean and fill all of the root canals within a tooth. For example, on a top molar tooth, there is a more than 50% chance that the tooth has four canals instead of just three. But the fourth canal, often called a "mesio-buccal 2", tends to be very difficult to see and often requires special instruments and magnification in order to see it. So it may be missed, and this infected canal may cause a continued infection or "flare up" of the tooth. Any tooth may have more than one canal, which may be missed while performing the root canal. Sometimes the canal may be unusually shaped, making it impossible to fill it completely, so that some infected material is still left in the canal. Sometimes the canal filling does not extend deeply enough into the canal, or it does not fill the canal as much as it should. Sometimes a tooth root may be perforated while the root canal is being performed, making it difficult to fill the tooth. The hole may be filled with a material derived from natural cement called "MTA", although usually a specialist would perform this procedure. Fortunately, a specialist can often re-treat and definitively heal up these teeth, often years after the initial root canal procedure.
Sometimes a tool can break while it is in the tooth. If the the tip of a spiral metal file used by the doctor breaks off during the procedure, it is usually left behind and not extracted, leaving the patient with a small amount of retained metal. The occurrence of this event is proportional to the narrowness, length, and number of roots on the tooth being treated. Complications resulting from retained metal are not well studied, but the occurrence of tool breakage is well documented.
An infected tooth may endanger other parts of the body. People with special vulnerabilities, such as prosthetic joint replacement or mitral valve prolapse, may need to take antibiotics to protect from infection spreading during dental procedures. Both endodontic therapy and tooth extraction can lead to subsequent jaw bone infection. The American Dental Association (ADA) asserts that any risks can be adequately controlled .
Recent studies indicate that substances commonly used to clean the interior of the tooth provide a low overall chance of succeeding in completely sterilizing a tooth internally ; however, a properly restored tooth following root canal therapy yelds long-term success rates near 97% (Salehrabi R. Rotstein I. Endodontic treatment outcomes in a large patient population in the USA: an epidemiological study. Journal of Endodontics. 30(12):846-50, 2004 Dec.).
Since 2006, two independent studies have used PCR to identify methanogenic Methanobrevibacter oralis-like species in root canal infections.
Advice for patients requiring root canal treatment
If a tooth requires root canal treatment it is unlikely that any other form of therapy (other than extraction of the tooth) will be successful in the long term.
In the short term, for controlling pain and discomfort, many over the counter NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen can be used.
In certain cases (if prescribed by the dentist) antibiotic therapy may be of benefit to control a severe infection of the tooth.
Despite popular belief to the contrary, modern root canal treatment can be performed quite comfortably. Avoiding or delaying the treatment can reduce the chances of a positive outcome for the infected tooth.
List of root canal irrigants
The following substances are used as root canal irrigants during the root canal procedure:
· 5.25% sodium hypochlorite (NaOCl)
· 2% chlorhexidine gluconate
· 0.2% chlorhexidine gluconate plus 0.2% cetrimide (Cetrexidin)
· 17% Ethylenediaminetetraacetic acid (EDTA)
· framycetin sulfate (Septomixine)
TMJ Disorder and treatment
Temporomandibular disorders can cause symptoms that are similar to other diseases.
Do you notice clicking or popping when you open your mouth? Is it difficult or painful to open your mouth? Does your jaw occasionally lock, so it is stuck open or closed? If so, you should see your dentist for a consultation and examination. You may have a temporomandibular disorder (TMD). These disorders include problems of the chewing muscles, the jaw joint (called the temporomandibular joint or TMJ), or both.
Here are some key symptoms linked to TMD:
Unusual sounds — Clicking, grinding or popping sounds when you open your mouth are common in people with TMD. The sounds may or may not be accompanied by pain. According to the National Institute of Dental and Craniofacial Research, researchers believe that most people with popping or clicking in the jaw joint probably have a displaced disc. However, they also note that as long as the displaced disc causes no pain or problems with jaw movement, no treatment is needed.
Locking or limited movement — The jaw joint is similar to a ball-and-socket joint except that the socket itself is movable. The jaw joint sometimes may lock in an open or closed position. You may have difficulty opening your mouth either because the joint is locked or because of pain.
"Ear" pain — You may think you have an ear infection, but ear pain may be related to jaw joint inflammation or muscle tenderness. Pain from TMD is usually felt in front of or below the ear.
Headaches — People with TMD often report headaches. Your dentist can help to determine if your specific headache symptoms are a result of TMD. In some situations, you may need to consult a physician to help diagnose and treat certain headaches not related to TMD.
Morning stiffness or soreness — If your jaw muscles are stiff and sore when you wake up, it may by a sign that you are clenching or grinding your teeth in your sleep. Clenching or grinding teeth can exhaust jaw muscles and lead to pain.
Difficulty chewing — You may have difficulty chewing as a result of a change in your bite—the way your upper and lower teeth fit together. This shift in your bite may be related to TMD.
Previous injuries and related conditions — A recent injury to the jaw joint or one from many years past can lead to TMD symptoms. Arthritis in the joint also may arise from injury. Arthritis already affecting other joints may affect the jaw joint and lead to TMD.
Others — Though the research is controversial, a feeling of fullness of the ears or ringing in the ears may sometimes be related to TMD. In these cases, consultation with an "ear, nose and throat" physician can help establish the final diagnosis.
If these symptoms sound familiar, talk to your dentist. Your dentist will test your ability to open and close your jaw, examine other jaw movements, and feel the jaw joint and muscles for pain or tenderness. The dentist will listen with a stethoscope in front of the ear for any clicking, popping or grinding sounds and will feel the jaw joint while you open and close it.
X-rays are often taken to look at the jaw joint and to rule out other diseases. In some cases, a computed tomography (CT) scan may be needed to further examine the bony detail of the joint. In addition, magnetic resonance imaging (MRI) is sometimes recommended to analyze the soft tissues.
While it is advisable to discuss any TMD symptoms with your dentist, occasional discomfort in the jaw joint and chewing muscles is quite common and usually not a cause for concern. However, if you are diagnosed with TMD, the good news is that simple self-care practices are highly effective in relieving the discomfort. These include eating soft foods, applying heat or ice packs and avoiding extreme jaw movements. Effective, conservative treatments include nonsteroidal anti-inflammatory drugs, muscle relaxants, physical therapy and oral appliances.
Often the first step in successful, long-term treatment of TMDs (temporomandibular disorders), is occlusal splint therapy. This treatment involves designing an acrylic splint from impressions and jaw relation records to enable the upper and lower teeth to meet in a way that is compatible with proper jaw function. The splint fits between the upper and lower teeth and is usually worn only at night to alleviate night-time clenching and grinding. Occlusal splint therapy is both therapeutic and diagnostic. It relaxes the muscles and enables the jaw to function properly, resulting in decreased discomfort. The splint also helps determine the precise bite relationship that will facilitate proper TMJ function, which in turn allows patients to create a healthy, natural bite by having their teeth reshaped or repositioned.