Sedation Dentistry

Important Facts to Know  |   Medication Used   |   Equipment

There is more and more news about "sedation dentistry" and all its benefits. But what does all of this actually mean?
This type of sedation has existed for decades. The new resurgence in the media (you've all heard the ads) is a marketing gem by a dentist in the northeast. He began a new dental organization and teaches courses on how to safely administer the medications, market and churn out as many cases as possible. This is a service that has been available thru this office for the past 20+ years.

Very simply put... you take a pill or two... you get VERY relaxed...and your dentistry can be performed in more psychological comfort than being fully "awake".

Our office offers "sedation dentistry" and we would be pleased to discuss your options with you. 

There are some facts that are important to realize.

There are 2 primary kinds of 'sedation'. They are:

  1. UNCONSCIOUS sedation - like in the hospital. This is most commonly referred to as 'general anesthesia'. The reason this is referred to as 'unconscious sedation'....that is....among other things....your muscles stop working and that is why the anesthesiologist has to oversee the fact that the machines in the operating room keep breathing for you.
    - A major advantage to this type of anesthesia is that you are COMPLETELY "out".
    - Major disadvantages are the expense, equipment and demand put on the body.
  2. CONSCIOUS sedation - ....that is.....all body functions remain intact or normal.
    - This type of sedation is a very very deep relaxation. You can still speak and respond to requests.
    - This type of sedation medication has a very profound amnesic effect......you will remember virtually none of the drive to the office, procedures, nor the trip back home.
    - There are 2 most common forms of this 'conscious sedation'...
    •  I.V. (intravenous) sedation administered usually in an office/out patient surgery center. This uses medications administered directly into the persons blood stream. The HUGE advantage here is that if someone is not as "deep" as the doctor would like them to be (for their comfort) he/she may easily use more medication and its effects are instantaneous.
    • Orally administered sedation. This comes in the form of a pill or liquid and the patient swallows the medication. The disadvantages with this method are that the level of anesthesia for each person is not as predictable as a general anesthesia nor an I.V. sedation.   Why not?  Because this is administered by mouth in the form of a pill. Body weight, genetics, previous drug history, etc all combine to increase or decrease the amount of actual sedation a person experiences. Since it is swallowed, there is a time delay to increase the dosage (unlike placing medications directly into the blood stream). 


The type of sedation that is being referred to as "sedation dentistry" is the last one described above listed as "orally administered sedation". So why do dentists use this if there are some disadvantages?


Because the advantages are there as well...
... the patient does not have the fees associated with an I.V. sedation.
... it is much easier to administer by mouth than by I.V. 
... and the fact is that almost all people respond very favorably to orally administered sedation.

What is the medication used orally ?

 The most common drug prescribed is Halcion (also known as triazolam) this is very closely related to Valium chemically. The differences are that with Halcion there is a much deeper relaxation and amnesic effect than there is with Valium. 

 

 

Equipment

One very important aspect of sedation dentistry is the use of an oxipulsimeter. This piece of equipment allows the continuous monitoring of blood oxygen saturation, pulse and blood pressure.

 

 

Insurance Myths


Discover The REAL Truth About Dental Insurance
Dental insurance plays a role in helping people obtain dental treatment. Since we strongly feel our patients deserve the best possible dental care we can provide, and in an effort to maintain the high quality of care, we would like to share some myths and facts about dental insurance with you.

Myth #1 Dental insurance is meant to be a PAY-ALL.
Fact - Dental insurance is meant to be an aid.

Myth #2 Plans pay up to 80% or 100%.
Fact - In spite of what you're told, we've found most plans cover about 40% to 50% of an average fee. Some plans pay more some less. The amount your plan pays is determined by how much your employer paid for the plan. The less he paid for the insurance, the less you'll receive.

Myth #3 The insurance company will pay the fees that the dentist charges.
Fact - It has been the experience of many dentists that some insurance companies tell their customers that "fees are above the usual and customary fees" rather than saying to them that "our benefits are low". Remember you get back only what your employer puts in less the profits of the insurance company.

Myth #4 All services are covered by insurance.
Fact - Many routine dental services are NOT covered by carriers.

Myth #5 Insurance over the years has kept up with inflation.
Fact - When dental insurance first came on the scene in the 1960's there was an average yearly maximum coverage of $1,000 per year. Now 60 years later the average yearly maximum is still $1,200. Using the annual Consumer Price Index (CPI) for just the past 40 years the yearly maximum should be over $15,000 now in 2016 !
Question Have the premiums increased over the past 50 years?

If they have where has this additional increase gone?
Only one guess allowed !!

Question What do you know of that has not increased in price in the past 40 years??

Myth #6 The new alternative insurance plans are the same as the traditional plans.
Fact - The new alternative insurance plans such as:
Dental Maintenance Organization (DMO)
Preferred Provider Organization (PPO)
and others like them are simply DISCOUNT PLANS. All these type plans require participating dentists to discount their fees on average between 35% and 45%.

Another word concerning alternative insurance plans

Although this is a "different" type of dental insurance, some basics NEVER change. In any insurance plan there are four parties involved - the PATIENT, EMPLOYER, INSURANCE COMPANY and DENTIST.

In discount plans

  • The PATIENT enjoys the lower costs for the "same" care.
  • The EMPLOYER enjoys the fact that they can still stand in front of their employees and tell them they have dental insurance (at less cost to them)!
  • The INSURANCE COMPANY still make their same profit
  • The DENTIST absorbs the loss.

But, Don't think it is in the doctor salary! Practically all loss is made up in quality of care.

  • Less expensive materials are used.
  • Less time is allowed per patient per procedure.
  • Another thing that I have seen NUMEROUS times is that a patient coming to my office for a 2nd opinion on dental treatment diagnosed from a (usually multi-doctor) discount insurance office has been told they need MUCH more treatment than they actually do. Why? Because the discount office must make up business with volume of dentistry performed.
  • Etc, etc.

It is a very simple decision in regards to these type plans. Do I wish to discount my fees so that more new patients are "guaranteed"?? No, I (and other dentists like myself), would rather do the absolute best we can, and not hurry a large number of people through the office. I have personally seen what can result from quick treatment in some of these plans.

Please do not be hesitant in asking us any questions about our office policies. We want you to be comfortable in dealing with these matters and we urge you to consult us if you have any questions regarding our services and/or fees. We will do all we can to assure you of maximum benefits.

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Bruxism (Nightgrinding)

Causes
Signs & Symptoms
Nightguard

Definition

The term bruxism is defined as: “to grind the teeth, a clenching of the teeth, associated with forceful jaw movements, resulting in rubbing, gritting, or grinding together of the teeth, usually during sleep.”

What causes bruxing to occur?

This is a very difficult question to answer. Some researchers say that if the occlusion (bite) of someone is not correct they will brux. Others say that it is a central nervous system disorder. Others say it is a multifaceted problem.

For all practical purposes……EVERYONE bruxes. Therefore, the question is NOT whether a person does in fact brux. Rather, the better question is to what degree do they brux. There is not a scale of bruxing that exists, but, we could imagine that there is such a scale. This scale could run from a 1 indicating a very very slight habit to a 10+ which would indicate a severe bruxer. A person at level 1 would not show any signs of bruxing at all. On the other hand the people in the higher end on the scale would show one or several signs. The pressure that can be generated across the teeth can range from 100 to 600psi (pounds per square inch) this is an incredible amount of force. The problems outlined below occur as a result of these forces being applied over many years - slowly - and it can be difficult to recognize the cause/effect sequence.

Stress - As with so many things in life, stress is a very large factor. In the paragraph above, in regards to the scale of bruxing, people stressed will often dial up the level of bruxing and develop temporary symptoms (cold sensitivity the most common) that decrease after the stressful episode ends.

Possible signs, complications or damage that may occur are:

1. Wearing of teeth.
Wear occurs from the movement of the teeth harshly against one another. Although all teeth may show this type wear, it is especially noticeable when a person has front teeth that appear having the same length - as if they were filed down.

2. Breaking of teeth.
As teeth wear, the edges of front teeth and the cusps or corners of back teeth will begin to show microfractures or cracks. These cracks can not be seen on x-rays. It takes magnified vision and/or an intraoral magnified image to diagnose them. Where this becomes especially important, is that teeth with these type of fractures will either eventually chip, break a corner, or yet require root canal therapy. The reason for root canal therapy is that the fracture begins on the surface of the tooth and eventually deepens until the crack enters the area of the nerve.

3. Sensitive teeth.
Usually a generalized soreness and/or a cold sensitivity.


4. Receeding gums and/or teeth with gum line “notches”.
bruxism

Most people have been told or assume that receeding gums occur because of age, using a hard bristle brush or the occurence of gum (periodontal) disease. In fact none of these reasons are correct in a majority of the cases. These are referred to as abrasion areas. When teeth grind hard against each other year after year, they flex at the gum line and the enamel (which ends thinly at the gum line) microfractures away. The end result is an area at the gum line that you can catch your fingernail in and may get extremely sensitive to touch and/or cold.

In this picture, there is exposed root surface and advanced abrasion areas.

 

 

5. Loose teeth.
Teeth loosen because of the "rocking" back forth that occurs. The best analogy is the example of getting a fence post out of the ground by rocking it back and forth.

6. Periodontal pockets (loss of supporting bone around the teeth).
Sometimes instead of the tooth getting loose, there may be a generalized horizontal loss of supporting bone and/or localized areas of bone loss.


7. Bony ridges (tori).
Instead of losing bone support - some people actually form "extra" bone to support the teeth (this appears as bony ridges that can be seen and felt on the jaw bones as a smooth raised area about at the level of the roots.

The image on the left is of the lower jaw showing extra bone in the "floor" of the mouth by the tongue. On the right, the picture shows the cheeks pulled back and the ridge along and above the upper back teeth.

8. Cheek irritation.
A ridge or line of fibrosed (toughened) tissue on the inside of the cheek that corresponds to where the teeth come together. Sometimes a person will actually bite themselves along this line (especially in the most posterior molar area).

9. Sore muscles (especially in the cheek and temple area).
When these two muscles are overused. They may get sore - just like when you over exercise, your other muscles get sore.


10. Headaches (especially upon waking in the same muscle areas mentioned above).
Instead of soreness, the muscle aches will appear as a headache.

11. TMJ Problems (jaw joint pain / soreness / etc).
The jaw joint may be over loaded and resulting problems occur.

These signs take time (usually decades of years) to show themselves.

Does everyone show every problem? No they don't, we are all very different. Some of us will exhibit none of these problems (thank your genetic code for that), some of us will exhibit severe problems (curse your genetic code for that). So any combination, or NO problems may exist for any one person.

So, what should anyone do about bruxism?
Is there a cure?

This is a very difficult thing to answer. For a large number of people, the problem is that their bite is off - this triggers through a series of physiological signals, a dramatic increase in the amount of bruxing.

NIGHTGUARD
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It would be logical to think that an acrylic nightguard is simply a piece of plastic used to cover and prevent the teeth from coming together while sleeping at night. This is true - BUT - most importantly, when in place it provides a correct bite so that muscles will relax and problems in a persons bite will not trigger the bruxing action.. The aspect of making and delivering a nightguard CORRECTLY is difficult to explain but you may see this process by clicking here. A point needs to be made that tooth wear still slowly occurs when using a nightguard. The reason for this is that a person (especially severe bruxers) will clench and very slightly grind during the day time when their guard is not being worn.

A nightguard is NOT a solution, rather a method of greatly decreasing the damage caused by bruxing. It is possible to alter a bite so that a guard may not be needed - the method varies from case to case.

Invisalign / ClearCorrect

We offer complimentary (free) initial consultation / evaluation!

There are now new companies entering into this type (clear aligner therapy) of orthodontic care.

The one we use is - ClearCorrect - the simple, effective way to straighten your teeth, so you can get a smile you'll love.

The primary difference between Invisalign and ClearCorrect is cost, and we pass this savings on to you.

ClearCorrect is the clear and simple alternative to braces, a series of clear, custom-made, removable aligners that gradually straighten your teeth as you wear them, each aligner moving your teeth just a little bit at a time.

They're practically invisible, so most people won't even know you're in treatment, they fit you perfectly, so they're more comfortable than regular braces, and they're removable, so you can eat whatever you like and clean your teeth normally.


How does it work?

Dr. Hafernik will take impressions, x-rays, and photos of your teeth, then send them to the ClearCorrect laboratory with instructions for the tooth movements you need to achieve your ideal smile. At the lab, they will create a 3D model of your mouth and then a series of clear plastic aligners custom-fitted to your teeth. Each aligner will apply targeted pressure to the teeth selected by Dr. Hafernik, slowly moving them into alignment. Every six weeks or so, Dr. Hafernik will check on your progress and give you your next two sets of aligners. Unlike other aligner companies, ClearCorrect laboratory manufactures your aligners in phases, so Dr. Hafernik can request changes at any time. Treatment usually takes 6-18 months, but you'll start to see results right away.


What can it do?

ClearCorrect can treat a wide variety of issues that keep people from achieving their ideal smiles. Straighter teeth don't just look better, they work better too. Poorly-aligned teeth can interfere with bite function, wear out quicker, and are more prone to cavities. Ask anyone here at Dr. Hafernik's how ClearCorrect can help you.

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Dr. Maury Hafernik
11645 Angus Road, Suite 10
Austin, Texas 78759
P: (512) 345-5552

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