Services Offered

Sedation

Sedation is a relaxed state whereby a patient is comfortable and minimally aware of their surroundings. It is very safe because the patient is breathing on their own and can respond to commands, and reflexes such as coughing remain intact. Yet at the same time, the patient feels drowsy and relaxed. Many times patients sleep through the entire sedation procedure. Those who do not, are usually relaxed enough to proceed.

Sedation is a continuum from mild to deep. Dr. Arnold prefers to treat patients under moderate sedation. For most cases in a dental office, especially surgical treatment, moderate sedation strikes the best balance between being sedated enough for patient comfort, but without increasing the risk of airway compromise. The main difference between moderate sedation and deep sedation is that in moderate sedation the protective reflexes and airway remain intact, a patient is able to breathe on their own. Deep sedation, while still considered safe, carries more risk than moderate sedation and is the stage just before general anesthesia. In deep sedation, protective reflexes may be compromised and sometimes patients are not able to breathe on their own and need ventilation support. We only provide moderate sedation, and if we feel a patient requires deep sedation or general anesthesia we will get them to the appropriate provider.

Sedation is not general anesthesia. General anesthesia is complete unconsciousness of the patient. Many times during general anesthesia patients do not have reflexes and breathing has to be assisted, sometimes by intubation. General anesthesia, while safe, does carry much more inherent risk than sedation. We do not offer general anesthesia. The vast majority of patients can be safely treated with sedation and when people ask to “be put to sleep” they can usually be safely treated under moderate sedation. Those who cannot and must have deep sedation or general anesthesia will be properly referred by their doctor and Dr. Arnold.

There are multiple methods for achieving sedation, most commonly used is oral sedation and IV sedation. Each has it’s own advantages and disadvantages. Depending on the specifics of the patient and the treatment being provided, the method of sedation will be selected by your doctor and Dr. Arnold.

Oral sedation involves taking pills before your appointment. Taking pills is easy, and when it works it works well. But the most glaring disadvantage of this method is it is very unpredictable. Sometimes patients do not sedate well and aren’t comfortable and the procedure has to be rescheduled or cancelled.

IV sedation involves placing a small tube in a patient’s hand or arm. For surgical procedures, Dr. Arnold prefers IV sedation. This is the most predictable route and is usually the most effective to get patients to the level of sedation they desire. The disadvantage is that the tube has to be placed with a needle and many patients are fearful of needles. In these cases, we can offer a combination of oral and IV sedation by having the patient take pills before placing the IV, or if their dental office has nitrous oxide, this is sufficient most of the time to get past the IV placement. For more information, see the “Sedation Options” document, located on the Forms link under the For Patients tab.

Simple and Surgical Extractions

Every extraction is different even on the same patient. Some teeth are out in mere minutes, while others are much more involved. Depending on the complexity of the tooth structure, position, density of surrounding bone, and sometimes amount of decay present, a tooth can only be removed by sectioning it to smaller pieces or removing bone around the tooth.

Wisdom Teeth

Wisdom teeth do not always need to be removed. But in most people, their mouths do not have room for the teeth to erupt into a functional and cleanable position. If wisdom teeth fail to erupt or fully erupt, they are called impacted. Impacted wisdom teeth are removed in efforts to relieve current symptoms or to prevent problems later. Just because someone is not having pain or other symptoms does not mean they should leave their wisdom teeth. There are many factors that play into this decision such as age, eruption path, proximity to nerve or sinus, periodontal pocketing, risk of decay or damage to adjacent teeth. As people age, wisdom teeth roots full develop and the jaw bone becomes more dense, making these teeth more difficult to remove and increase the risk of post-operative complications as well as more post-operative pain & delayed healing.

Socket Preservation (bone graft)

When a tooth is extracted, the hole in the jaw bone where the tooth was fills in with a blood clot, and is eventually replaced by bone and gums. Most of the time without a tooth to support the bone, the bone tends to collapse and is not as high or as wide as it was previously. This can cause unesthetic defects or can limit replacement options if not addressed. Specifically with implants, a patient needs a certain amount of bone height and width for an implant to integrate. It is much easier and less costly to preserve the bone by grafting the extraction socket at the time of extraction than to try to regrow bone that’s been lost.

Tori Removal & Pre-Prosthetic Surgery

Some people are born with bony protuberance in their jaws called “tori” or “exostoses.” These are not usually a problem unless they’re large and interfering with speech. But if a patient loses teeth and desires them to be replaced by a prosthesis such as a partial or full denture, these protuberances prevent adequate seating or placement of the prosthesis. Tori or exostoses will sometimes need to be removed in preparation for teeth replacement.

Frenectomy

Muscle attachments in the lips, tongue, and cheeks are called “frenum.” Occasionally a frenum is set very low or high. This can cause problems such as keeping teeth from aligning as they should, can cause gum recession, esthetic issues, and can interfere with speech. Removal of a frenum is a very simple and quick procedure and can have a noticeable effect on a patient right away.

Soft Tissue Grafting

Gums can recede or pull away from teeth for various reasons. Sometimes the gum tissue is very thin and recedes very easily. A gum graft can thicken the tissue to prevent gum recession over time, which can cause tooth sensitivity or expose teeth to decay. A graft is taken from underneath the skin of the palate and placed in the receded area. Sometimes an animal, cadaveric, or synthetic graft can be placed instead of having to obtain a graft from the palate.