Do Dental Visits Hit A Nerve?

Have no fear. Advanced techniques help comfort anxious patients.

Nearly 80 percent of college students change majors at least once before graduating, according to federal data. Many do so simply because they can’t pass the math classes required to complete the curriculum in their initial major.

Karen Laws

That’s how it was for Karen Laws.

“When I first went to college, I wanted to get into computer programming,” Karen relates. “But math and I were not good friends. So, I decided that studying the languages might be a better choice. I think it worked out pretty well.”

Now 72, Karen retired seven years ago after completing a 40-year career as a Spanish teacher. All but one of those years was in Brevard County, where she taught higher-level Spanish at the junior and senior high school level.

She started at DeLaura Junior High in Satellite Beach, then spent a year in Atlanta before returning to teach at Johnson Junior High in Melbourne.

“I was there for about 18 years, then moved to Palm Bay High School in Melbourne and finished out my teaching career there in 2013,” Karen explains.

Except Karen is still teaching. She has “kept her foot in the door” by tutoring, which she does remotely now to avoid contact with students during the COVID-19 pandemic.
Unfortunately, Karen recently paid the price for avoiding contact with her dentist for too long.

“I’ve always been dentist-averse, so much so that a few years ago after a crown came off and I knew I needed to get to the dentist, I kept putting it off,” Karen relates. “Then in November 2019, I had a gold filling pop out. At that point, I knew I had to go see him.”

Karen’s dentist is Richard Leong Jr., DDS, P.A., but he had not seen her in a few years when she came in with the missing filling and crown. Dr. Leong found additional issues when he examined her.

“The second lower right molar was the tooth that lost the filling, and the tooth right in front of it, the lower right first molar, lost the crown,” Dr. Leong reports. “It took some work, but I was eventually able to cement the crown and the gold filling back on.

“Because it had been so long since I’d seen Karen, I thought it best to take some x-rays to make sure there wasn’t another problem somewhere else that I couldn’t find through a visual examination. It’s a good thing I did because there was another problem.”

The molar that lost the crown had a large cavity.

“The only reason she hadn’t noticed it was because that tooth had been given a root canal and there was no nerve left in it,” Dr. Leong says.

“I also found that the second molar on her lower left side had a lot of infection around it. So that tooth and the one where she lost the crown both needed to come out. The trick was doing the work and getting around her fear of dentists.”

Fear Management

Dr. Leong has become quite adept at managing dentophobia, or fear of dentists. He has developed several techniques to alleviate the panic, no matter the level of distress.

“I have a number of arrows in my quiver,” Dr. Leong states. “One is the ability to deliver a local anesthetic injection painlessly. That’s something I learned 50 years ago. But for someone such as Karen, there are other tools that I can pull out of my arsenal.

“One is a sedative that we sometimes give patients in pill form prior to their visit to relax them. We also offer patients nitrous oxide, or laughing gas, which will relax them even more.

“In addition, we have what we call conscious sedation. You can do that through medication or intravenously. It puts the patient in a sedative state where they’re still awake and can respond to commands, but they’re very calm and don’t feel anything or remember the procedure afterward.”

Dr. Leong applied some of these techniques with Karen over multiple visits. While treating her gums for infection prior to the tooth extractions, Dr. Leong gave Karen nitrous oxide. She was then sedated for the extractions and the work that followed.

That work included replacing the failed teeth with dental implants, which are root-shaped, screw-like bodies surgically placed into the jawbone. These become the foundation for an abutment and replacement teeth.

For Karen, the replacement teeth were two crowns cemented to the abutment, but replacement teeth can also come in the form of a partial bridge attached to one or more implants or a full denture fastened to a series of implants.

Prior to placing an implant, some patients require a bone grafting procedure designed to enhance the volume of the jawbone so that it can properly support the implant. Karen required a bone graft.

“During the extraction process I found a lot of infection around the two teeth I’d taken out, but I have a special dental laser that is used to decontaminate that area to prepare it for the implants,” Dr. Leong educates.

Karen finally found a dentist she can be comfortable with.

After treating the infection, Dr. Leong performed the bone graft, which can be done using cadaver bone, a synthetic bone substitute or bone material taken from the patient. He also performed a technique to speed up the bone-growing process.

“That calls for something called platelet-rich fibrin,” Dr. Leong explains. “We get that by drawing blood from the patient’s arm and spinning it in a centrifuge that separates the fibrin clot material, which is high in growth factors.

“When you mix the platelet-rich fibrin with the bone grafting material, you get a much better bone graft. We completed the bone graft, placed the implant and then waited three months for the new bone to grow around the implant.”

Some patients can be fit with temporary crowns, bridges or dentures while they wait for the bone to grow around the implant. Because of the infection, Karen could not be fit with temporary crowns. She received permanent crowns in March 2020.

“I learned about the importance of molars during that time because I had to chew with my side teeth,” Karen recounts. “And in the end, it was worth it because I am thrilled with the outcome. Since I got the permanent crowns placed on the implants, I have not had one bit of trouble with them and I’m eating with confidence again. I’m back to going to the dentist regularly for cleanings, So far, all of my checkups have been good.

Karen no longer avoids the dentist.

“Everything is going very well, she explains.

“Dr. Leong and his staff do such a wonderfully good job of making sure their patients are comfortable and at ease. They’re really good people and I recommend them to anyone.

In fact, I already have. One of the teachers I used to work with was having some problems, and I told her to go see Dr. Leong. He’s been caring for her for about three months now.”

© FHCN article by Roy Cummings. FHCN file photos. mkb
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