If you have a question not asked here, please feel free to contact us with any question you may have.

Questions:

• Sometimes when I get an injection for dental work, my heart starts to beat fast and I feel like I want to pass out.  Why does this happen?
• I just had some fillings placed and now my teeth are sensitive.  They didn't hurt before.  Why do they hurt now?  Is this normal?
• Is dental amalgam safe?  I have heard there are high amounts of mercury in it.
• You're not on my insurance plan.  Does this mean I can't come and see you?
• Is it safe to get dental treatment while I'm pregnant?
• I have a heart murmur and my physician says it's not a significant issue.  Why is this important in dentistry?
• Are dental x-rays safe?  What dose of radiation is really safe?
• Is oral piercing safe?
• I was told I need several fillings, but my teeth don't hurt.  Why do I need them?
• I was told I need a root canal but my tooth doesn't hurt.  Is that possible?
• How often should I get a new toothbrush?
• Are baby teeth important?  Aren't they just going to fall out anyway?

A:  There are many reasons this may be happening, but the most common involves both you and the anesthetic.  Most dentists use an anesthetic called lidocaine.  (Although people often refer to it as "Novocain,"  actual "Novocain" hasn't been used for many years and is no longer even available.)  Mixed in with the lidocaine is a small amount of a drug called epinephrine, known in other countries as adrenaline.  The epinephrine is used to make the anesthetic more profound and to last longer.  The amount is very small, but in some people (especially nervous people) it can make their hearts beat faster.  Epinephrine is a normal body secretion.  Most people secrete about 1.0 micrograms of epinephrine per minute at rest although under stress, your body can secrete up to forty times that amount.  (That epinephrine or adrenaline rush is how people do the extraordinary things we hear about).  The cartridge of dental anesthetic has less than 2.0 micrograms of epinephrine but combined with your own epinephrine and/or other medications you may be taking, it could cause the reaction you are having.  There are dental anesthetics available without epinephrine and they can be just as effective but may need to be administered  again during longer procedures. (top)

Q:  I just had some fillings placed and now my teeth are sensitive.  They didn't hurt before.  Why do they hurt now?  Is this normal?

A:  It is not unusual for teeth to be sensitive after a filling is placed.  Even though the tooth didn't hurt before, the removal of the decay can cause trauma to the tooth.  The nerve can be irritated and need time to recover.  During this time, the tooth is adding new tooth structure between the filling and the nerve and providing better insulation from cold and hot things.  This can take several weeks or even months. (top)

Q:  Is dental amalgam safe?  I have heard there are high amounts of mercury in it.

A:  Dental amalgam, the silver filling, is composed of silver, mercury, copper, tin, and zinc.  It has been used as a restorative material for well over 100 years.  The metals are all bound chemically.  Many people have tried to prove that amalgam is not safe, but there is no scientific evidence that there is any danger to people from amalgam.  Amalgam has many properties that make it a suitable restorative material under certain circumstances, but the new composite materials have replaced amalgam as the primary restorative material.  I do not recommend removing any old amalgams that are intact and in good condition, but if you need a new restoration and composite materials are a viable option, I would recommend them first.  I believe amalgam is safe and I will place amalgam restorations under certain conditions, but it is not my first choice and it is not what I want for my family. (top)

Q:  You're not on my insurance plan.  Does this mean I can't come and see you?

A:  You can always come to our office.  Insurance is simply another method of payment and depending on what type of insurance you have, you may have a greater financial benefit by going to a particular office.

There are three main types of insurance.  The first is the traditional indemnity insurance plan.  This plan allows you to go to any office you choose and receive the same benefits.  The insurance company pays based on the contract you have with them and based on what they refer to as usual and customary fees (Maximum payable amounts)  Another type of insurance is called a Preferred Provider Organization (PPO).  PPO's will pay any provider but the providers listed in their booklets have agreed to a reduced fee schedule.  For example, if the regular fee for a procedure is $100, the PPO negotiated fee may be $80.  The insurance company will pay the claim based on this amount.  The third common type of insurance is an HMO.  This insurance pays the provider whether a patient goes to the office or not.  They will pay only one specific provider unless a referral is needed and they usually pay no additional benefits for treatment (top)

Q:  Is it safe to get dental treatment while I'm pregnant?

A:  When a women is pregnant, proper dental care is essential for both her and the baby.  Any dental infection that may occur can cause harm to the baby.  Furthermore, proper dental hygiene can prevent pregnancy gingivitis, a condition in which the gums of a pregnant women can become inflamed and infected.  If you are pregnant and your gums are bleeding, call your dentist immediately.  Other treatment can be done safely during pregnancy, too, with timing the treatment to specific trimesters. (top)

Q:  I have a heart murmur and my physician says it's not a significant issue.  Why is this important in dentistry?

A:  Most heart murmurs are of little significance on a daily basis.  They do not require any medication or monitoring and they rarely limit activity.  Many people in the world have heart murmurs and don't even realize it.  Even so, these murmurs can be significant in dentistry depending on the nature of the murmur.  A murmur that interrupts blood flow and allows blood to pool in even the smallest amounts can allow bacteria to collect and grow. This can lead to serious illness. A common source of these bacteria is the mouth and routine dental care can introduce these bacteria into the blood stream.  Preventing this from happening is simple.  The patient is given a dose of an antibiotic before their appointment.  The most common antibiotic is amoxicillin.  People allergic to penicillin can be given other antibiotics. Not all murmurs require premedication.  Murmurs can be classified in many ways but the most relevant terms in dentistry are "functional" and "non-functional."  A functional murmur has no interruption of the blood flow and requires no premedication.  A non-functional murmur shows an interruption of blood flow and does require premedication.  The only way to truly classify a heart murmur is through an echocardiogram.  This is a simple sonogram of the heart and is completely painless.  Electrocardiograms (EKG's) do not show murmurs.  Sometimes people are unsure of the classification of the murmur they may have.  In these cases, it is usually better to premedicate with an antibiotic unless other medical problems are present. (top)

Q:  Are dental x-rays safe?  What dose of radiation is really safe?

A:  Dental radiographs (x-rays) use a very low dosage of radiation for exposure.  The equipment is regulated and monitored by the state agencies to assure the safety of both the patients and the staff.  While there is no true safe level of radiation exposure, the amount used is so small it should make no real difference in someone's life.  A standard set of full mouth radiographs (14-20 films) exposes the patient to less radiation than they would receive from several hours outside on a sunny day or less than they would receive from a flight in an airplane from New York to California.  This does not mean we shouldn't take the exposure seriously.  It simply points out that in the scope of all other radiation exposure we receive, it has little additional significance. (top)

Q:  Is oral piercing safe?

A:  Oral piercing of any kind (tongue, lip, or cheek) presents many dangers.  It is very possible to cut a blood vessel in some of these places and cause severe blood loss or to sever a nerve and cause significant permanent damage similar to paralysis.  Another significant problem is infection.  People who perform body piercing for other people may not be sterilizing their equipment and could easily transmit diseases such as hepatitis or HIV.  Also, the normal bacteria of the mouth could infect the piercing site and cause significant damage.  Scaring can also occur and limit the function of the body part.  Piercing any body part has many risks which must be examined before having it done. (top)

Q:  I was told I need several fillings, but my teeth don't hurt.  Why do I need them?

A:  Dental decay can usually be detected long before it causes significant discomfort.  Sometimes even deep decay will not cause any discomfort because the tooth has built new tooth structure between the decay and the nerve to help insulate the nerve.  But if left untreated, the decay will eventually cause much greater damage. (top)

Q:  I was told I need a root canal but my tooth doesn't hurt.  Is that possible?

A:  The nerve of a tooth may die without you realizing it.  This can result from any kind of trauma including a bump on the tooth or a large restoration.  Sometimes the tooth will show a shadow on the radiograph (x-ray).  This indicates the nerve tissue inside the tooth has died and needs to be removed before it becomes an active infection.  These active infections can be very painful and difficult to treat.  This is where root canals have gotten their undeserved bad reputation.  Sometimes these teeth can not be saved. (top)

Q:  How often should I get a new toothbrush?

A:  I recommend to my patients that they get a new toothbrush at least every three months, but sooner if the bristles start to show signs of wear or spread out.  I also recommend a new toothbrush to anyone who has a cold or an other contagious infection and I recommend separate tubes of toothpaste for each family members.  This will help prevent the spread of contagious diseases from one person to another, especially with children. (top)

Q:  Are baby teeth important?  Aren't they just going to fall out anyway?

A:  Primary teeth (baby teeth), are very important.  They provide proper chewing and speech for children.  They also maintain the necessary space for the permanent teeth and allow for correct growth of the jaw.  Neglecting the primary teeth can lead to abcesses which can cause problems with the permanent teeth including incomplete formation and crowding.  This crowding can lead to improper function and the inability to keep the teeth clean leading to decay and periodontal disease.  If a baby tooth is lost early, an appliance called a space maintainer is often needed to hold the space open for the permanent tooth. (top)