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Dental Pain

Nitrous Oxide Laughing Gas for Dental Visits
©Yuri Bathan/

In order to get certified to give patients nitrous oxide (commonly called laughing gas), I have to administer it several times to prove my competence.

Last Friday afternoon, I was able to give a patient nitrous oxide and literally change his perception of dentistry.

He loved it.  I asked him about his dental fear and he said something like, “You know when you’re in an airplane and there’s a sudden rush of unexpected turbulance, you grab onto the handles of your seat.  That’s how I am at the dentist.”

On Friday though, he said he felt great.  He was telling jokes in the dental chair and having a great time.  He said that the nitrous oxide made him feel great, he said he felt like he was drunk.

He was a fairly young guy that had simply avoided going to the dentist and ended up with a few lost teeth and a lot of teeth in bad shape.  Nitrous oxide has given him the ability to overcome his dental anxiety and sit in the chair.

Nitrous Oxide in Dentistry

Nitrous Oxide in Dentistry: Laughing GasAs you can see in this picture above, nitrous oxide is given to a patient through a mask that is placed over the nose.  In addition to nitrous oxide, we run oxygen into the mask so that the patient is always getting more oxygen than they would just by breathing in regular air.

An advantage of nitrous oxide over other forms of sedation is that it works pretty fast.  Within a few minutes, the patient is relaxed.  Also, when you have finished your dental procedure, the recovery is fairly rapid as well.  You are able to drive home after the appointment since you don’t remain drowsy.

Is Nitrous Oxide Dangerous?

Nitrous oxide is safe when it is administered with adequate oxygen.  Although side effects are fairly rare, the most common side effect of nitrous oxide is nausea.

Nitrous oxide may be harmful with long-term exposure.  This doesn’t really apply to patients, it’s more for those people who work at dental offices and get exposed to it every day for years.

Regarding possible long-term negative effects of nitrous oxide, Pinkham’s Pediatric Dentistry textbook states, “Retrospective survey studies of dental office personnel who were exposed to trace levels of nitrous oxide suggest a possible association with nan increased incidence of spontaneous abortions, congenital malformations, certain cancers, liver disease, kidney disease, and neurologic disease.”


Nitrous oxide can help many patients overcome their dental anxiety.  I have a patient with a lot of dental fear that gets nitrous oxide every time he comes in.  He loves how it calms him and allows him to get his needed dental work done.

Do you have any questions or comments about nitrous oxide in dentistry?  I’d love to hear what you have to say in the comments section below.  Thanks for reading!

Dental Pain Toothache

Go to the Dentist Before You Get a Toothache!This morning I saw a patient who had been in extreme pain for the last couple of weeks.  What started as a small cavity grew into a large cavity that eventually made its way to the tooth’s pulp.  We were able to take her out of pain by starting a root canal today.

If we end up fixing her tooth, rather than extracting it, it will cost her around $1200.  Even then, with the condition of the tooth, it may only last her 5-10 more years.

A bridge to replace that tooth would cost her $1350.  An implant to replace that tooth would cost her $2100.  And those are dental school prices.  It would probably be about twice that in a private practice. You can find the average dental fees in your area here.

Had she come in a couple of years ago, we could have easily removed the decayed portion of the tooth and put in a filling.  With the prices at my dental school, that would have cost her only $84 and would have most likely lasted her at least 20 years (she has several amalgam fillings that are still going strong after more than 15 years.)

Find out how long a silver filling lasts.

The Moral of the Story

What I’m trying to get across is that if your dentist recommends getting a filling in a tooth, get it (As long as you trust your dentist!)

If you put it off simply because the tooth doesn’t bother you, there’s a good chance both you and your wallet will be experiencing some pain in the future.

High Dental Filling Problems
©Adam Gregor/

Many people wonder what they should do when they come home from the dentist after getting a filling and notice that their bite isn’t quite right. If you end up having problems with a filling, it’s always best to check back with your dentist to see if you have a high filling.

If your filling is high, the dentist can simply smooth it down. High Filling ProblemsSmoothing down a filling is usually a quick procedure and doesn’t require any injections.

Here are seven problems that a high filling can cause.

Problems That a High Filling Can Cause

Keep in mind that some people with a high filling may experience many of these problems while others might not go through any of these difficulties.

1 – Biting Pain

The ligament may become inflamed around the tooth, causing the tooth to hurt when you bite down on it.  This may affect the tooth with the high filling, but it can also affect other teeth if the high filling has thrown off your bite.

2 – Aching and Sensitivity

The tooth may develop pulpitis.  It could become sensitive to hot and cold or it may simply ache.

Find out more about pulpitis here.

3 – Excessive Tooth Wear

The tooth can wear down rapidly.  Also, other teeth may wear down if the high filling causes you to shift your bite slightly.

Learn about the four ways that your teeth get worn down.

4 – Loose Teeth

The tooth can become loose.  If the high filling causes your jaw to shift, other teeth can become loose if they are subjected to high forces that didn’t exist before the high filling.

5 – Muscle Pain

The muscles in your jaw can ache because your bite has changed and the muscles are forced to adapt after so many years of moving your jaw in it’s natural bite.  This can make it difficult to open your mouth and/or chew your food.

6 – TMJ Problems

Problems with your temporomandibular joint (TMJ) can occur due to the abnormal movement that now takes place due to the high filling.

7 – Headaches and Stress

The muscle pain coupled with the TMJ pain can bring on headaches and increased stress in your life.

Don’t Ignore a High Filling

If you think that you have a high filling and you are in pain, it’s a good idea to get it checked out before a small problem turns into a bigger one.

If you have any questions, comments, or personal experiences, please share them below!

Why Teeth Hurt
©Vladimir Gjorgiev/

There are several easy answers to the question, “Why do teeth hurt?”  For example, teeth hurt because you don’t take care of them.  But, that’s not what I want to talk about in this article.  I want to talk about why it is that teeth hurt so much.  They’re so small, yet if you’ve ever had a toothache that kept you up at night, you know that teeth can hurt almost as much as any other feeling of pain you’ve ever felt.

Teeth Hurt Because They Are So Hard

Why Teeth HurtTeeth hurt because they are so hard.  When the tissue inside of the tooth (the pulp) gets hurt, it has no room to expand.  Here’s an example.  Let’s say someone punches you in the shoulder.  Your shoulder might get warm and swollen.  Your shoulder has room to get bigger.

Now let’s say that someone punches your tooth and chips the bottom of it.  The force of the blow will likely irritate the pulp of your tooth and cause it to get warm and swollen.  Here’s the problem, when the pulp gets swollen, it wants to get bigger, but there’s nowhere to go!  The pulp is encased in a hard shell known as the dentin and enamel of your tooth.  Pressure builds up inside of your tooth.  Suddenly, the tooth that was hurting due to the initial trauma is now also hurting because of the pressure.

Not sure what the difference between pulp, dentin, and enamel is?  Read my article about the anatomy of a tooth.

Here is what happens in technical terms when the pulp becomes inflamed.  It’s a quote taken from the book, Cohen’s Pathways of the Pulp by Hargreaves:

Inflammation in the pulp takes place in a low-compliance environment composed of rigid dentinal walls. Compliance is defined as the relationship between volume (V) and interstitial pressure (P) changes: C = Δ V/ Δ P. Consequently, in the low-compliant pulp, an increase in blood or interstitial volume will lead to a relatively large increase in the hydrostatic pressure in the pulp. The acute vascular reactions to an inflammatory stimulus are vasodilatation and increased vascular permeability, both of which will increase pulp interstitial fluid pressure and may tend to compress blood vessels and counteract a beneficial blood flow increase.

Other Parts of Our Body Experience Similar Pain Levels

Why Teeth HurtThe dental pulp isn’t the only tissue that experiences high levels of pain when it is inflamed.  Most places in the body that are enclosed in a rigid structure experience lots of pain.

This is why headaches can be so painful, the skull is rigid and there’s no room for the swelling to go.

Another example is when you smash your fingernail and you get lots of inflammation underneath the fingernail.  Some people have even gone so far as to burn or poke holes through their fingernails to relieve the pressure that builds up.


Teeth hurt because when the pulp gets even slightly injured, it wants to expand and there’s no room for it to expand.

Do you have any questions related to tooth pain?  Leave them below in the comments section.  Thanks for reading!

Dental Fear - Calm Your Dental Anxiety

Many of the patients we see at the dental school have developed cavities and needed extensive dental work for just one reason: They were too scared to come to the dentist before now.

Dental Fear Central LogoSomething changed within them that made them finally say, “Enough is enough.  I need to get my teeth fixed.”  Sometimes it’s severe pain, and other times it’s a badly decayed, discolored front tooth that needs some dental care and compassion.  Whatever the reason, it’s a shame that it took them so long to get in to see a dentist.  There is a lot of help online.

How Dental Fear Central Can Help You Overcome Your Fear of the Dentist

Dental Fear - You Are Not AloneFirst of all, it reinforces the fact that you’re not alone in your fear of the dentist.  There are many others out there who also get anxious when they go to the dentist.  The forums are great!  They allow you to share your own personal story.  I just read the story of a young woman who went to get her wisdom teeth out.  After a few moments in the room, she got up and left.  She eventually went back and had her wisdom teeth successfully taken out.  She described the whole process.  You can read her story here.

Another way the site helps is by detailing 19 common dental fears and how to cope with them.

Dental Fear Central has an article for those who were sexually abused and have dental fear.  There is also an article for abuse survivors, that is written by a survivor of abuse.  In it, the abuse survivor shares tips on how to cope with certain fears that are instilled in those who were abused.  For example, it can be difficult for an abuse survivor to be lying down in a dental chair with an unfamiliar person poking around in their mouth.

Finally, there is a section of the site dedicated to walking you through the steps you need to take to get you into a dental chair.  It helps you discover your fears, cope with them, and eventually make that appointment with the dentist.  You can find this section, the help section by clicking this link.


I want to disclose that I am not affiliated in any way with Dental Fear Central.  I value this website and believe that it can help people make it to the dentist and avoid losing their teeth.  Because of that, I wanted to share it with you, in hope that if you are anxious about your dental visit, you can get the help you need.

Do you have any questions or comments on dental anxiety?  If so, please leave them below in the comments section.  Thanks for reading!