Fort Myers Dentist

Novocain in ocular nerve is culprit

Question: Recently I had several back teeth crowned. After I was given the Novocain, my right eye suddenly went numb, preventing me from being able to close my eye for more than two hours. This frightened and angered me and forced me to stay home in bed for the rest of the day. What went wrong? - Sue-Ellen, Palm Beach

Answer: This brings us to another installment of "Don’t shoot your dentist." (I have often thought of a reality show about a dental office called: As the Tooth Turns.)The fifth cranial nerve exits the base of your skull and splits into three branches: maxillary, mandibular and ocular. Very often in attempting to numb the sometimes difficult teeth of the posterior mandible (lower jaw), a bit of local anesthesia bathes this ocular branch causing temporary numbness of the muscle that closes the eyelid. It is best to go home and place a wet towel over the eyelid to keep the eye moist. I also recommend the use of OraVerse, an anesthetic reversing agent that your dentist can inject in the mouth which cuts the numbness time in half. For more info on this subject or any other dental topic, contact our office at 239-936-5252.

Multiple injections might be dental pain cause

Question: After having what I thought was routine crown-work on my lower back teeth, the following day I could barely open my mouth to eat. What did the doctor do to me? - Phil, Tequesta

Answer: Often after mandibular block injections, required to anesthetize the back lower teeth, the common side effect "trismus" occurs. Often multiple injections are needed to numb these posterior teeth due to a tricky network of nerves that must be reached. Limited opening, muscle spasms, stiffness and pain - this is caused by inflammation of the muscle fibers, hemorrhage into the muscles of mastication or low-grade infection. This will all go away. In the meantime, your dentist might recommend warm compresses, 800 mg of ibuprofen, muscle relaxants (Flexeril, Diazepam), saltwater rinses, antibiotics, and in severe cases, a steroid such as Methylprednisone. Recovery can take several weeks.

Vibrating needle eases painful injection

Question: Recently while my dentist was giving an injection, I felt a vibration and a heard a buzzing noise. I was startled at first, but I felt no pain. What was going on? - M.B., South Palm Beach

Answer:  It sounds like your doc is using some of the latest technology in the land of teeth and gums. Fifty percent of all Americans avoid dental care entirely because of anxiety about painful injections. (You Canadians are not off the hook either.) Two devices lead to extremely comfortable injections: a VibraJect and the DentalVibe. Both of these devices will vibrate the needle 400,000 times per second like a hummingbird’s wings, thereby stopping the pain stimulus from traveling through your neurons to your brain. For more info on this subject or any other dental topic, contact our office at 239-936-5252.

Most dental tools don’t affect pacemaker

Question: I’m a retired medical doctor and have an implanted pacemaker and defibrillator. I need major dental work (extractions, implants, crown and bridge work). Are there any precautions I should know about? - Dr. Bob in Tequesta

Answer: This reminds me of that episode of The Partridge Family where Laurie picks up radio stations with her braces. A recent study at the University of Kentucky tried to determine whether electromagnetic interference occurred during the use of nine different dental electronic devices. Of the nine, only two operatory devices inhibited heart-pacing activity: the ultrasonic scaler and the battery-operated composite (bonding) curing light.

However, the tests were not done with patients - only on the devices on a lab bench. Millions of patients have had extensive dental work without any problems with their implanted devices. Check with your own cardiologist and dentist. For more info on this subject or any other dental topic, contact our office at 239-936-5252.

Question: I need some crowns on my back teeth. My dentist says that I must have gold since I am a bruxer and grind my teeth excessively. I sing for a living and would prefer to show only white teeth in the back when I open wide.

Answer: I had a patient who was a ventriloquist who wanted me to perform dental work on his dummy. He returned the bill to me with a note saying: "Please bill my partner. He's the one with the insurance." The newest all-ceramic, metal-free entry for crowns and bridges is a homogenous, monolithic material called zirconia. Special dental labs can fabricate crowns made of this material called BruxZir; they are specially made for bruxers like you who demand esthetic restorations on back teeth. Although, they tend to be somewhat opaque and monotone, they still look good on back molars. For more info on this subject or any other dental topic, contact our office at 239-936-5252.

Only half of sealants remain after 5 years

Question: My child has had sealants placed on her teeth. One or two of them seem to continually fall off, requiring the dentist to re-do them every time she is in for a check up and cleaning, generating more fees. Should I be wary of this? - Maggie, Jupiter

 Answer: My mom was a clean freak. One year she had me sealed in plastic before camp to allow for easy stain removal upon returning home at the end of the summer. Sealants are thin flowable resins that fill in the pits and fissures of teeth on adults and children, preventing chewing surface decay. They do nothing for preventing decay on the sides (in between) teeth where the floss passes through. Research shows that after five years of service, only 50 percent of sealants are still in place. Researcher Dr. Gordon Christensen, whom I have shared the lecture podium with over the years, says that these dismal statistics can be improved upon "if dentists used an air-slurry polisher (a sandblaster type of device) to remove plaque from the grooves before sealant placement."

2 products have highest bonding strength

Question: My dentist placed a small white filling on the side of a front tooth earlier this year. Every couple of months it falls out and she replaces it at no charge. What do you suggest? - ‘Queeny’ from West Boca Raton

Answer: I give you credit for the sincere loyalty you have for your dentist in letting her keep taking a crack at it. Some patients change dentists more than Joan Rivers changes plastic surgeons (and I’m just talking about the month of June!). The key ingredient in bonding composite resin (tooth colored bonding) to tooth structure is the bonding agent. There have been seven generations and over 23 products on the market made by over 13 companies. A recent comparison test in the Clinicians Report Newsletter showed the highest bonding strength was found in two products: Peak SE and Clearfil SE Bond. For more info on this subject or any other dental topic, contact our office at 239-936-5252.

Question: I recently read an article in the AARP magazine that said when a dentist probes a soft spot on a tooth he could augment the decay process by spreading bacteria further into the tooth. Is this correct? - C.G., Hobe Sound

Answer: Ah, the dreaded probe. You mean the "explorer," a 4,000-year-old instrument used by the Egyptians and many a home hobbyist in assembling those pesky plastic models for Junior.

If the instrument is pressed too hard into a decalcified pit or fissure on the biting surface of a tooth, "cavitation" can occur, making the lesion more susceptible to decay. A better way to diagnose pit and fissure decay is with the Diagnodent, a laser decay detector that measures the bacteria at the bottom of fissures that are too narrow for the explorer to reach. Early diagnosis means treatment with small resin fillings.

If you’ve got a question for Dr. DeCarlo, please call our office at 239.936.5252 or email Dr. DeCarlo at smiledecarlodds@earthlink.net

Question: I fractured a front tooth, diagonally. The nerve is still fully encapsulated in the tooth and there is no pain. A dentist suggested to do a root canal, post and crown. Why can’t they simply slip a crown over what is left of the tooth? - Dave, West Palm Beach

Answer: Dave, I told you to turn off the ceiling fan before dusting the blades. If a tooth fractures through the enamel (outer coating) and the dentin (inner layer), but does not expose the pulp (nerve canal), you probably can reconstruct the tooth with composite resin bonding or a crown. However, even if the nerve was not exposed, an X-ray and a pulp test must be performed to evaluate the need to remove a damaged, dying nerve, i.e. root canal. If a pulp test using heat, cold, percussion and an electric pulp tester shows the nerve is dead; get the root canal. If all is OK, then restore the tooth and be prepared for a possible future need for root canal.

If you’ve got a question for Dr. DeCarlo, please call our office at 239.936.5252 or email Dr. DeCarlo at smiledecarlodds@earthlink.net

Question: I get cold sores frequently on my lower lip. Is there any way to get rid of these ugly things once they appear? - S.S. in West Palm Beach

Answer:: Even our creator must have had an off day when he added the herpes virus to the mix of earthly organisms. (I forgive him/her since we also got the Grand Canyon and Penelope Cruz.) Eruptions of herpes labialis often occur during periods of stress, exposure to sunlight or recent oral manipulation from dental work. A recent product comparison in the Clinicians Guide to Dental Products and Techniques newsletter showed excellent results with Viroxyn. Your dentist rubs the ampoule’s  abrasive applicator, saturated with the active ingredient benzalkonium chloride, onto your lesion. Usually, one treatment is needed. Lesions dried up in 1 to 4 days resulting in 85% of the doctors recommending this treatment.

If you’ve got a question for Dr. DeCarlo, please call our office at 239.936.5252 or email Dr. DeCarlo at smiledecarlodds@earthlink.net

Question: I recently had an implant and crown to replace my upper front center tooth. The crown sticks out too far compared to the next one. Why? - S.V., Jupiter Island

Answer: Think of the mouth as a stage in a Broadway theater. The lips are the curtains that rise up revealing the lead actors taking center stage: the central incisors.

It is very difficult to fix one central incisor without restoring its twin brother, sitting next to it. Fixing both will almost always guarantee that the two will match.

A crown over an implant can wind up a bit out of sync esthetically compared to its brother if the implant is angled too far forward. We often compensate for this by using custom abutment posts to correct odd angulations, before the crown is made.

If you’ve got a question for Dr. DeCarlo, please call our office at 239.936.5252 or email Dr. DeCarlo at smiledecarlodds@earthlink.net