5 dental treatments you must always choose with care

No matter what the reason for your dental visit, the dentist checks for signs of decay, gums disease, etc. during the check-up. He/she may suggest certain procedures based on their examination. But before you blindly agree to whatever is suggested, it is important to know what these procedures are so that you can question your dentist to figure out whether the procedure is necessary and what your options are. It is important for a dentist to explain exactly what the situation is, and exactly why he/she thinks you need these treatments.

If you feel that your dentist fails to do so, you can get a second opinion from another dentist to know exactly what the problem is, what options are available, and which procedures are absolutely necessary.

1. You think your teeth are clean but your dentists suggests you to get them professionally cleaned

When you visit a dentist chances are that he/she will advise you to get ‘scaling’, ‘professional cleaning’, or ‘oral prophylaxis’ done. You may wonder whether you really need to. Plaque and tartar (dirty-looking mineral deposits) on the teeth near the gums are most often the cause for gum disease. Professional cleaning or scaling is the only way these deposits can be removed to reverse gum disease or prevent its progression to periodontal disease.

But do you think your teeth look perfectly clean? Go ahead and tell you dentist. Ask him/her to show you the tartar. If you indeed have deposits on your teeth your dentist will be able to show them to you. The tartar can be seen on the tongue side of your lower front teeth or the cheek side of upper back teeth. And then there is something called ‘sub-gingival calculus’ – the hard deposit below your gum line which is usually not visible. You dentist may be able to chip off a piece and show it to you.

Get your teeth professionally cleaned only after you are convinced. The next question is how often do you need to get it done? It depends on how well you maintain your oral hygiene. The recommended practice is twice a year. If you maintain your oral hygiene exceptionally well, you may need to get it done once a year.

2. Are dental x-rays really necessary?

Cavities, especially the ones wedged between two teeth and the ones affecting the root, are best detected by radiographic (x-ray) examinations. Dental x-rays also help find the extent of cavity. They are the best way to check for any loss of teeth supporting the bone structur, and also help diagnose abscesses in the gums and periodontium. Sometimes X-rays may be recommended to monitor cavities.  If your dentist suspects decay between two teeth, which is not clinically evident, and you have high risk for cavities (poor oral hygiene, etc.) you may be advised X-rays after 6-12 months. But x-rays should be used sparingly and only as necessary. They should be taken only after clinical evaluation of your teeth and gums and after assessed by other ways.

Worried about x-ray exposure?

Low dose x–rays used in dental radiography usually pose no threat. The collective radiation dose accumulated over time can have an effect though.

According to a new study, frequent dental x-rays have been linked with higher risk of developing meningioma, the most commonly diagnosed primary brain tumour. But your exposure to radiation can be minimized with good radiological practices like use of lead apron, high-speed film, etc. During pregnancy the x-rays can be harmful for the baby, especially during the first trimester when the vital organs of your baby are just developing. But the amount of radiation your baby will get from your dental x-ray is well within the safe range.

When you change your dentist, more often than not, your new dentist will accept dental x-rays taken at your previous dentist’s office provided they are clear and recently taken. But if your dentist insists on a new x-ray you have the right to question him/her.  Some dentists insist on a new x-ray because they believe in ‘my x-ray, my diagnosis’. The logic is that if you have changed your dentist because he/she could not solve your problem then chances are that the previous x ray may not have accurately revealed some tooth pathology or the treatment rendered may not have been right and the new dentist wants to confirm it before he/she makes the treatment plans. If the reason given by your new dentist is not satisfactory, you can take a second opinion.

3. Does a child need to be anaesthetized for dental treatment?

Anaesthesia is one among the wide range of approaches a dentist uses to make a child feel comfortable with the dental treatment, which in turn also allows the dentist to relax, concentrate and work with ease. It helps control pain and sensation during treatment. Local anaesthesia is very safe and effective. Use of anaesthesia depends on the cooperation of the child and type of treatment being rendered. Procedures that require drilling of enamel – especially if the underlying dentin is not exposed – typically do not require anaesthesia. For other procedures, numbing the tooth with local anaesthesia will help make treatment pain free and anxiety-free.

If your child is still anxious nitrous oxide, commonly known as laughing gas, may be safely administered to help him/her relax. For very young and apprehensive children and for children with special health care needs, sedation is used to relax the child to reduce anxiety and increase cooperation. With adequate precautions and monitoring the risks of sedation are minimal.

General anaesthesia (GA) for pain and anxiety management while performing the treatments should be used as a last resort. It may be recommended for a child with a mental/physical disability or with severe anxiety. Extensive dental needs needing lengthy, extensive dental work may also warrant it. GA comes with inherent risk of adverse events. A thorough examination and history of the patient are necessary to determine the type of anaesthetic and the dosage to be used. An overdose of anaesthesia due to opting for the wrong anaesthetic, using too much anaesthetic, problem with the equipment, etc., can cause severe fall in blood pressure. If this fall isn’t raised almost immediately, it can cause severe damage and probably death.

In most cases it is advised not to eat for at least 8-12 hours prior to the procedure. While this may seem like an unnecessary bother to you, it’s extremely important because consumption of food prior to GA can increase the risk of various complications. Allergy or hypersensitivity to the anaesthetic used can also cause adverse events. Dental treatment performed under GA is generally considered safe when the anaesthesia is administered by highly qualified health professional with strict protocol, adequate monitoring and emergency equipment and trained support staff.

However, if you are concerned about the use and necessity of anaesthesia, it is advisable to discuss your concerns with your dentist.

4. You are advised root canal treatment for a decayed tooth? Is it mandatory? 

When your dentist advises root canal treatment for your decayed tooth, you might question its necessity. Is it really required?

When your dentist says the pulp is infected the idea of treating with antibiotics may cross your mind. In fact, antibiotics are not necessary for a tooth that does not have an active infection. Prescribing antibiotics for a tooth that has active infection can kill the infecting bacteria and help reduce the pain and infection temporarily.

But, antibiotics alone aren’t effective in treating root canal infections. The dead pulp tissue always remains a source of infection and can cause abscess (accumulation of fluid or pus) around the root. During a root canal, the pulp is removed, surfaces of the root smoothed by filing and the canal is filled with a material to seal the roots and prevent them from getting re-infected.

With proper pain control, RCT can be least discomforting to the patient. But a localized infection (an acute abscess) can lessen the effectiveness of local anaesthesia. Still feel the pain even after the treatment? Well, some infected teeth might take a while to settle down after root canal treatment. The procedure, the medicaments used and the healing process can cause discomfort for a few days. But if the root canal is not properly cleaned before filling, there might be certain complications leading to reinfection and hence pain.

5. Your dentist is going to drill your sound tooth structure to place a dental crown. So do you really need the crown?

Different dentists have different criteria for case selection and treatment planning. Hence there may be diverse recommendations for a dental crown. When your dentist advises a crown for your tooth it should be the best option to extend its life. In general, crown is recommended to restore extensively decayed tooth, reinforce root canal filled tooth and cement over the implant post to provide a tooth-like shape and structure.

So you have been given the best option. But you may begin to doubt it when your dentist drills some more tooth structure, worse still when he/she files the opposing sound tooth, before cementing the crown on your tooth. With proper tooth preparation, and right materials and impression technique a well-fitting crown can be fabricated which will need little or no adjustments during its cementing. Minor high points on the crown, if any, may be filed with special polishing instruments to adjust the bite. Grinding the opposing vital tooth to adjust the bite is not recommended and if done, it should be with the informed consent of the patient. You do not want more adjustments. You want the tooth fixed and rightly so. If you are not satisfied with the fit of the crown, and if lot of adjustments need to be made to fit it, ask your dentist to get a new crown made.

Originally published on www.thehealthsite.com