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Dry Socket with Wisdom Tooth Removal

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I need to have a lower wisdom tooth extracted because of an impaction. I’ve spoken to someone else who’s had this done and they said they ended up with dry socket which was absolutely miserable. Is there anything I can do which can help to prevent this?

Katie

Dear Katie,

Woman with a boxing glove punching someone

Dry Socket Can Be Prevented.

Dry socket is what happens when the blood clot dissolves or disappears leaving the nerves and bone exposed. It’s quite painful.

Some dentists tell their patients that dry socket will happen if they suck the blood clot out unintentionally and suggest the don’t drink through a straw until after the healing process is over.

There really isn’t much evidence for this. Though, obviously, you don’t want to do anything which will intentionally remove the blood clot.

Your Dentist is the Best Defense in Preventing Dry Socket

There are two things your dentist can do to prevent dry socket.

The first is to recognize that the greater the force used in extracting the tooth, the greater the chance of dry socket. To counter this, if a dentist encounters a tooth extraction which is requiring a greater than moderate elevator force it is better to section the tooth. Sometimes bone has to be removed in order to do this, but it can be done.

The second thing which helps is for your dentist to place a square of Gelfoam soaked in a suspension of clindamycin antibiotic into the socket after the extraction and suturing the tissue over it. An experiment was done which showed this. They tried it on patients with two wisdom tooth extractions. On one side they put the Gelfoam; on the other they didn’t. Only the teeth without the antibiotic developed dry socket.

You can let your dentist see this post prior to your wisdom tooth extraction, if you are concerned.

This blog is brought to you by Auburn Family Dentist Dr. Raymond Bolt.

Wisdom Tooth Touching Nerve

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I have an impacted wisdom tooth. I keep getting food caught in it. I want to get it removed, but when my dentist did an x-ray he said it is touching a nerve. Is is still okay for me to have this removed?

Lisa

Dear Lisa,

illustration of four impacted wisdom teeth

I’m glad you wrote. Did your dentist mention a CT scan? This would be important in that case, allowing your dentist to have a 3-Dimensional image so he can know the exact placement of everything.

An experienced oral surgeon can do this without severing the nerve. There is never a guarantee there won’t be some damage, even in the ideal cases. Your surgeon can give you a percentage of the risk after he sees the scan results. They won’t underestimate the risk, so you can feel pretty confident with what they say.

The key will be to not put pressure on the nerve as he is removing the tooth.

It will be important to get this wisdom tooth extracted if at all possible. If it is trapping food, you are at a greater risk for bacteria thriving leading to decay. It’s possible you could end up with a dental emergency.

Then you won’t have as much choice as to who removes the infected tooth. Even today, people still die from tooth infections. The reason for that is people underestimate how quickly these infections can spread.

Add to that how close your jaw is to your heart and brain, you can see how these can turn life threatening rapidly.

This blog is brought to you by Auburn, AL Dentist Dr. Raymond Bolt.

My Kids are Afraid of My CPAP

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I have sleep apnea. While it it is helpful I don’t enjoy it very much. Plus, my kids are absolutely terrified of it. They won’t come near the room and they scream when I turn it on.

While I know they’ll adjust, I’m neither my wife nor I are crazy about it either. Is there an alternative or should I just start saving up for therapy for the kids now? They’re going to grow up thinking I am Darth Vader.

Mark A.

Dear Mark,

Woman covering her ears trying to block out her husband snoring

Sleep Apnea can cause a great deal of problems. Most people get a CPAP machine for the treatment because it’s been the standard treatment for years.

However, they’re bulky and loud, as your family has noticed. Fortunately there are alternatives for something which makes you sound like Darth Vader.

If You Hate Your CPAP

While there is a great alternative, I don’t want you to stop using your CPAP in the meantime.

Sleep Apnea means you are not breathing in intervals throughout the night. The stress this puts on your heart can lead to stroke and other life-threatening problems.

I’d like to suggest you see your dentist and ask him about an anterior positioning splint. This is a simple orthotic device which re-positions your jaw in such as way that the back of your throat is no longer obstructed.

It’s silent and about the size of a mouth guard. You’ll find it much more comfortable.

Even better, they’re super easy to transport if you have a business trip or family vacation.

This blog is brought to you by Auburn Dentist Dr. Raymond Bolt.

Dentist Wants Me to Whiten Before Lumineers

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I’m about to get Lumineers. I’m very excited about it but now my dentist said he’d like me to get my teeth whitened first. Is that really necessary? Isn’t one of the benefits of getting Lumineers to change the color of your teeth? Won’t the Lumineers do what the teeth whitening will?

Karen

Dear Karen,

Lumineers advert

How I answer your question depends on why your dentist is wanting you to whiten your teeth. If you are planning on getting the Lumineers brand of porcelain veneers on both your upper and lower arches, or if you are just getting them on your upper arch.

If you are getting your porcelain veneers on both upper and lower teeth, there is only a need to whiten your teeth if you have a wide smile. Most patients get between six to eight veneers. However, if you have a very wide smile, you may have ten to twelve visible teeth. If you don’t want to spend the money to get each of those teeth veneered, you would whiten your teeth ahead of time, so they will be close enough to the re-done teeth for them to look natural together.

If you don’t have a wide smile and your visible teeth will be covered, there really isn’t a reason to whiten your teeth. You’re correct that the Lumineers will do that for you.

When Do Whitening and Veneers Go Together?

However, most patients don’t want to pay for veneers on both their upper and lower teeth. Instead, they’ll just have the smile makeover done on the upper teeth, which are very visible when you smile. Then, on the bottom teeth which are only visible briefly while you’re speaking, you can use teeth whitening which makes it look like both arches are the same.

The big benefit to doing it this way is the money savings. It is significantly more affordable for you to whiten your bottom arch than it is to veneer the additional teeth. It’s likely instead of trying to get you to do an additional procedure to make money, your dentist is trying to save you money.

This blog is brought to you by Auburn, AL Dentist Dr. Raymond Bolt.

Can’t Sleep Because of My Husband’s Snoring. Help!

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I haven’t slept in weeks. I’m pregnant, which already makes sleeping a challenge for me. For some reason, my husband’s snoring seems worse. Once I wake up from the baby, I can’t get back to sleep with his rumbling through the night. I asked my doc and he said a dentist can stop snoring. Please tell me how you do this magic?

Lisa

Dear Lisa,

Woman covering her ears trying to block out her husband snoring

A dentist can stop snoring

You didn’t know dentists were snoring wizards? Fortunately for you, we are! Snoring is often caused by a mild form of sleep apnea. This is a condition where the muscles in the back of your husband’s throat relax as he starts to fall asleep. They partially block his breathing passage which leads to the rattling sound which snorers make.

He’s likely not even aware he does it, with the possible exceptions of when he gets your elbow to his ribs out of frustration. For some patients, it’s even worse and their air passages are blocked completely leading to obstructive sleep apnea. This causes him to stop breathing. If you’ve seen your husband startle himself awake and then go straight back to sleep, this may be something he struggles with.

What Can Your Dentist Do about Snoring?

In the past, treatment for sleep apnea and snoring has been to use a CPAP machine, but most patients hate them. Not only are they bulky, but they can be about as loud as the snoring, but instead of the sound of sawing logs, it sounds like you’re sleeping with Darth Vader.

Fortunately, there’s a better solution that works with many patients. A simple orthotic device will reposition his throat in a way the clears his breathing passage, giving both of you a better night’s sleep.

Sometimes a sleep study is required, but you can usually get your medical insurance to pay for that.

This blog is brought to you by Auburn, AL Dentist Dr. Raymond Bolt.

Dentist Wants Me to Remove Wisdom Teeth?

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I have partially impacted wisdom teeth. They honestly don’t bother me, but my dentist keeps nagging me about having them removed. If they’re not bothering me, why should I remove them? My dentist before college never worried about them.

Kevin

Dear Kevin,

When it comes to whether or not to extract your wisdom teeth, there are a lot of factors involved. Here are just a few considerations:

  • The type of impaction
  • The age of the patient
  • The likelihood of a problem in the future

The safest age to remove wisdom teeth is in the late teens to early twenties. That has to do with the pliability of the teeth and the lack of thickness at the end of the root. As you age, the teeth aren’t as pliable and there is an increased chance of complications.

image of a partially impacted wisdom tooth

If you were in your 40s with fully impacted wisdom teeth, I’d say the risks outweigh the benefits. However, you said you have partially impacted teeth. Look at the image above. You can see this tooth is partially impacted, meaning there is part of the tooth that broke through and another part still under the gums.

This becomes a prime source of bacteria getting trapped. It’s just a matter of time before this blows up into an infection and you’re forced to remove it.

It’s much safer to plan your wisdom tooth removal than it is to have an emergency choose for you. I’m guessing your dentist feels the same way and that’s why he’s encouraging you to get this removed.

Why Didn’t Your Last Dentist Mention This?

There are a couple of reasons your previous dentist didn’t mention this. You said it was your dentist before college, so I’m assuming you’re rather young still. It could have been that they hadn’t erupted yet and your old dentist thought there was a possibility, based on the x-rays that they’d fully erupt.

If he thought they come in fine, there’d be no reason for him to suggest you’d need them removed.

However, a second option is negligence. If your wisdom teeth were partially impacted at the time you were under his care and he didn’t mention extraction, I’d say he was doing you a huge disservice.

At some point, these will cause an infection. Best to take care of it early.

This blog is brought to you by Auburn Dentist Dr. Raymond Bolt.

Dentist Insisting on a Procedure I Can’t Afford

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What do I do if my dentist is insisting on a procedure I can’t afford. I have lost two teeth. I was hoping to do a dental bridge, especially because one of the teeth adjacent to the lost teeth is cracked and needs a crown anyway. But, my dentist said it’s more important I get dental implants on the missing teeth. I’m not sure I can afford that. What do I do if I can’t afford the procedure I need?

Louis

Louis,

Dollar sign hatched out of an egg

Cheap Dentistry isn’t Affordable Dentistry

Wouldn’t it be great if money really did hatch out of an egg like the picture above? I have to tell you I think your dentist is being remarkably unfair. If I can’t afford a mansion, does that mean I should be homeless? Of course not! Maybe I can’t afford a mansion, but I can live in a gorgeous ranch house. That’s better than being on the street. Dental work can be the same way.

Sure, dental implants are the mansions of tooth replacements. But rather than have no teeth you could have that dental bridge you mentioned. Actually, in your case, it would make sense because you mentioned one of the adjacent teeth needs to be crowned anyway.

What If Your Dentist Insists on a Procedure?

If your dentist is unwilling to give you a bridge instead of implants, there are plenty of dentists out there who will work with you. You wouldn’t necessarily need to look for someone who advertises as an affordable dentist, but they’d certainly be willing to work with you. Honestly, I think more dentist would be willing to work with you than wouldn’t.

You should never feel pressured into a procedure you can’t afford. There are almost always alternatives. Your dentist is actually ethically obligated to give you all your options. If he’s not, he’s not doing his job. Also, there are sometimes temporary solutions for times when you can’t afford even the lowest tier of treatment. For instance, sometimes a patient can’t even afford a removable partial denture but they can afford a dental flipper.

Those are only meant to be temporary, so they can have something while they save up. Though, often, Dr. Bolt is willing to allow patients to get the permanent solution and pay it out gradually. This way they’re not having to pay for two treatments.

This blog is brought to you by Dr. Raymond Bolt.

There’s a gray line at the top of my tooth. Am I Sick?

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I’ve developed a gray line at the top of my tooth. It’s on the same tooth as my crown. The crown itself is fine. Does that mean their’s something wrong with me? I’ve heard a white line on your nails means arsenic poisoning, does this line mean I’ve been poisoned by something?

Sally A.

Dear Sally,

Those white lines you’re referring to are called Mees’ lines. That particular symptom often makes an appearance in mystery plots.  The gray line at your gumline is a mystery much more easily solved and a lot less malicious.  I haven’t examined you, but I’d almost be willing to bet that you have a porcelain fused to metal crown.

These type of crowns tend to be a little opaque to cover their metal base. Additionally, they tend to develop a gray line right where you’ve described.

There’s no way to “repair” the problem without replacing the crown. If you do and get a metal-based crown again you’ll end up with the same problem. My suggestion would be to get an all-porcelain crown.  These don’t have the drawbacks mentioned above.

I hope this puts your mind at ease.

This blog is brought to you by Dr. Raymond Bolt.

Are bridges a thing of the past?

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I have a dental bridge. Recently my grandson needed a tooth replaced. He told me bridges were a thing of the past and dental implants are now the standard treatment.  Is that accurate or is his dentist just talking him into a more expensive treatment?

Bruce L. – Wisconsin

Bruce,

You are not the first person to ask that question. In 2009, a health columnist for the New York Times asked the same question. It resulted in the article, A Dental Shift: Implants Instead of Bridges.

It is true that dental implants are the ideal treatment. It makes it easier to do your oral hygiene, which reduces the risk of periodontal disease.  However, as a dentist, I will tell you that doesn’t mean that bridges are no longer a valid treatment.

There are times that you might want a bridge, instead of an implant, especially if the adjacent teeth need work as well. If his adjacent teeth don’t need any work, I wouldn’t worry too much about it. His dentist is just recommending the ideal treatment. If your grandson can afford it, in the long run it will be the best thing for his teeth and gums.

This blog is brought to you by Auburn, AL Affordable Dentist Dr. Raymond Bolt.