The purpose of these questions is to address commonly occurring problems that I see and help provide guidance on how to approach these problems. While each patient is different with unique teeth, unique medical history and unique circumstances, there are general guidelines that are followed when diagnosing and prescribing treatment. It also must be understood that a dentist is the ultimate authority in assessing and making the appropriate recommendations and one should also seek consultation before making decisions on their oral health. If you have a question that is not answered, please feel free to email us or visit our office. We typically post most questions if it has not been answered previously either on the website or through Dr.Glasmeier's blog which can be found by clicking here.

General Questions

Dental Fear and Anxiety
Pediatric Dentistry

Tooth Questions

Procedure Questions

 

Gum Questions




Click here to read questions answered by the doctor

Dental Fear and Anxiety

I have wisdom teeth that are beginning to hurt and I am worried about feeling pain and having a bad experience. Do I need them out? What do you recommend?

Wisdom teeth, often times, have to be removed for several reasons such as inability to keep clean, more prone to getting cavities, can cause shifting of teeth, can develop unusual pathology such as tumors, and can cause diffuse pain in the jaw as well as the jaw joints. Wisdom teeth can fully erupt through the gums, or partially erupt, or never erupt (called an impacted wisdom tooth). Depending on the level of eruption, a general dentist may be able to take the wisdom teeth and often times I refer to an oral surgeon who specializes in taking out more difficult teeth.

Because wisdom teeth are typically more difficult to take out, one can experience more discomfort and pain following. Again the level of eruption will determine how difficult it will be to remove which further determines how much discomfort afterwards. I typically recommend sedation for wisdom teeth in 3 different options:

  1. Nitrous oxide (laughing gas during procedure)
  2. Oral sedation(oral medication before procedure)
  3. IV sedation (“put to sleep” with medications through an IV). Ask your dentist what is most appropriate for you.

The advantage to oral and IV sedation is also that it can cause amnesia which prevents the patient from remembering the procedure. Most patients wake up without any recollection of what happened, how long it lasted and how the procedure went. So yes I would recommend removing wisdom teeth ~85% of the time and I would recommend sedation for the procedure.

Can you explain in more detail the types of sedation and what is right for me?

I would encourage you go to my sedation tab to read further regarding sedation. Bottom line is there are many different options to help make you more relaxed but the recommended choice is based on your past experiences, the work that needs to be done as well as the amount of work to be done, your medical history. More patients fear going to the dentist because of a bad experience or because they simply don't understand.

Having said that, picking a dentist just because “he can sedate you” is not enough. When looking for a dentist, you need to ask yourself several questions:

Does he understand my fears and concerns and did he offer me solutions?
Does he have up to date equipment and properly trained staff?
Did he explain everything in a manner that you understand…that is can you make an educated decision based on what he has advised you on?
Was he gentle? If you had a cleaning, was the hygienist gentle?
Was the front desk gentle and receptive to your needs?

I believe with a friendly staff and a dentist who takes the time to explain your problems as well as what caused them, offer solutions and alternatives along with the pros and cons, is just as important for helping with anxiety and fear.

Are there advances in dentistry so there is no needle or noisy drill or pain that everyone talks about?

Yes there are, but they are somewhat limited in what they can treat. For example, to not need a needle for treatment either the cavity has to be very small or the dentist uses something called “Air Abrasion” or “Laser Dentistry”. These are technologies that enable the dentist to fix cavities without using a needle or drill however they are not as effective when the cavities are deep (close to the nerve) or the tooth is sensitive.
I think an injection is much better for pain control and is better for eliminating the “what if I feel this”. An injection can almost be next to painless and the discomfort can be controlled by

  1. The strength of the topical gel
  2. The manner the injection is given by the dentist.

We have a special device we use sometimes called “The Magic Wand” that is very effective for getting patients numb and most patients report not feeling anything!!

I have a very simple rule…if I can't get you numb, I will not work on you that day…sometimes people just don't numb up well and it's hard to explain why but rest assured that if you are uncomfortable then I am too so I will not make you do anything that is uncomfortable. We generally have great success in getting you more than adequately numb which gives you a very comfortable, pleasant experience. Nitrous oxide(laughing gas) will often help drown out some of the sounds of the drill and also with analgesia(pain relief) during the procedure.

Regarding the sounds of the drill, we always play music while we are working..I don't like the sounds any better than my patients do? I love music from the 80s and 90s so there is always music in the background or we will play whatever music you like. We also play movies if you prefer to listen to a movie and if that's not enough…I might even sing or dance for you!

What percent of patients do you see have anxiety or fear going to the dentist?

I would say 70-80% of my patients have had or do have some fear of the dentist. It usually stems from a bad experience or not understanding what is going on. By simply educating the patient, much fear is eliminated when the patient knows exactly what the problem is, how to fix it, and what it takes to fix it. I take pride in most of the services I offer but the one I take the most pride in is the one you don't see listed--helping you CONQUER your fear of dentistry. I am confident I can help you not only conquer your anxiety but help you establish a routine of regular dental care that prevents you from needing frequent amounts of dental work and be proud of your oral health and smile!

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Pediatric Dentistry

When should my child start seeing a dentist?

I recommend bring your child as soon as they get their full complement of baby teeth, which is approximately 2-3 years of age. While this age is young, and very little dentistry can often be accomplished, it establishes a couple things:

  1. The dentist is able to count all the teeth to verify that all the teeth are present as well as checking for cavities. The dentist can also determine and assess for further problems such as crowding issues or potential diastemas(spaces between front teeth).
  2. By establishing a routine early, the child will typically have more positive experiences and be comfortable with future visits.
  3. Enables the dentist to help the parents establish a good system of oral hygiene to prevent further problems.

At ages 2-3, typically the teeth will be counted and will be checked for cavities and any other abnormalities. X-rays are not usually taken unless a problem is discovered and the child may or may not receive a cleaning depending on the child's temperament. By ages 4-5,the child will get the same treatment as an adult which involves an exam, x-rays and a cleaning. It is VERY important to have your child assessed before their permanent teeth start to come in as there could be preexisting problems that may affect the permanent teeth. An ounce of prevention provides defense against a ton of problems!

Should I take my child to a pediatric dentist?

This depends on several things. If the child has severe dental problems that require substantial amount of chair time, then a pediatric dentist might be better. Certainly, if the child has a great deal of anxiety, or a history of combativeness, or unwillingness to cooperate for simple tasks such as a cleaning, then a pediatric dentist is warranted. One major advantage of a pediatric dentist is that they can sedate children at a more concentrated level than the general dentist (oral sedation or general anesthesia)--this is a great treatment modality for children that are very young, require an extensive amount of work or have a complicated medical history. I always recommend bring your child to the general dentist first and then we can make a decision together whether or not a pediatric dentist is needed. Have faith in your child as they may do better than you think!

Should I be worried that my child is a thumb sucker?

ABSOLUTELY--sucking on thumbs or other inanimate objects such as pens, pencils, toys can affect the development of the baby and adult teeth. Constant pressure on the teeth will not allow the teeth to drop down into normal position and create a difficult situation called an “open bite” where none of the front teeth touch. Thumb sucking should be eliminated no later than ages 5-6 as this is typically the age that the permanent front teeth may begin to erupt.

I think my child needs braces, how would I know and what age are they referred?
This depends on the problems that you hope braces are to fix. Typically by ages 6-7 is a good time to get a referral to an orthodontist, a specialist who deals with correcting abnormalities with teeth such as spacing, bite issues, and crowding. This is typically corrected with treatment such as braces, or headgear, sometimes extractions, and sometimes all the above. The general dentist should be assessing the child on follow-up exams to determine if your child is needing an evaluation. There are circumstances where a child may be referred even earlier but it is on a case to case basis. If you have a concern about your child's teeth that is not addressed, please bring it to the dentist's attention as sometimes what seems to be very abnormal could be very normal in the dentist's eyes…e.g. generalized spacing around the baby teeth.

What is fluoride and should my child be using it?

Fluoride is a medicament found in water and most toothpastes to help prevent cavities. When used in an everyday routine, fluoride exposure can help make the teeth more resistant or “make the teeth harder” which helps prevent the onset of cavities and certainly slow down existing cavities that have not been treated. The other interesting property about Fluoride is that after repeated exposure, it has been shown to help with reducing tooth sensitivity (e.g. cold and sweets)…while this is not typically noted in children and it is very common to be used for this in adults. Children under the age of 2 should not be using toothpaste with Fluoride because of the dangers of swallowing. Swallowing small doses pose little threat but larger amounts can cause great discomfort to the child's stomach and further cause nausea and vomiting. Rather than fluoride at this age, the parent should focus more on getting the child in a routine of regular brushing and flossing. Ages 3 and up fluoride is recommended, provided the child does not habitually ingest(swallow) the fluoride.

How many teeth should a child have?

A child should have 20 teeth (10 on the top and 10 on the bottom). However as they get older they will reach a “mixed dentition” where they begin to lose baby teeth and gain permanent teeth. It is then that they could have as few as 15 teeth and probably as many as 25 teeth depending on the child.

I don't understand..if my child has a cavity on a baby teeth and they are going to get a permanent replacement anyways, why fix the baby tooth?

I get this question a lot as one would think if there is replacement what is the big deal? The big deal is that the baby teeth need to be thought of as “space holders” for the permanent teeth. If a baby tooth is lost prematurely, a permanent tooth can come in a different position which can further alter the development of the rest of the adult teeth. An adult teeth can also be affected if an infected baby tooth left untreated can cause disturbances of a permanent tooth's growth and development. In some cases I have seen an abscessed baby tooth that caused an adult tooth to become infected before it had a chance to even erupt! Once again, an ounce of prevention can prevent a ton of problems…it is much more conservative(and cheaper) to have a cavity fixed on a baby tooth rather than “letting it go” only to find out then that the child could lose a permanent tooth or have major crowding issues with the permanent teeth(much more expensive!!). Having said this, if the baby teeth has a cavity but is within 3-6 months of coming out anyways, then a filling may not be necessary. Please consult the dentist before you try to make that determination as we are knowledgeable when a child will lose a particular baby tooth.

My child is very nervous and afraid of getting shot. Is it absolutely necessary for them to get a shot and what can you do to put their mind at ease?

Most children are very nervous for the 1st dental visit but what they fear more than the “needle” is fear of the unknown. For this, we use the “Tell Show Do” model where we teach your child what to expect. We do this by telling them what we are going to do, then we show them how we are going to do it, and then we do it so the child knows that to expect. Re: the needle---yes sometimes we do not have to use a needle to fix the cavity--it just depends on the temperament of the child and the size of the cavity. We often times give the child nitrous oxide(laughing gas or also known as “Dr G's giggle gas”) which helps relax the child and put them in a much more comfortable state that they are more receptive to treatment and are also less likely to feel discomfort. Using the Tell Show Do model, laughing gas, and playing childrens movies during dental treatment has given us great success with dealing even with the “my child is more fearful than the typical child” child. Children are always rewarded for cooperation and good behavior with something out of our treasure chest!

If my child has a very loose tooth, do I need to bring them to a dentist to have it removed?

As a child's adult teeth begin to erupt they will push on the baby teeth causing the roots of the baby teeth to dissolve and to “loosen” up. You should bring your child to the dentist to have it removed if it is preventing the child from eating/drinking or if the gums are red and swollen and giving the child a great deal of discomfort. I like to think children enjoy taking the teeth out themselves and you would be surprised how well a piece of taffy or tootsie can remove a loose baby tooth. If you or child cannot tolerate doing something like this then we would be more than happy to give them some giggle gas, numb the tooth with our special “sleepy juice” (novocaine) and give them their tooth to take home to collect from the tooth fairy. Hopefully parents haven't gone cheap on the rewards for a tooth under the pillow as all I ever got was a stinkin' quarter!!