North Austin Dentistry

The Magic of Whitening. How Does it Work?

The tooth whitening industry is a very large and ever expanding market in America.  Over $1.4 billion dollars were spent on whitening products by Americans.  Some of this money was a complete waste and some of this money was used to transform a smile.  On the more effective end of whitening products you have Zoom Whitening which is fast and efficient.  On the slower end you have whitening strips.  So let’s discuss how whitening works and how to best spend your money.


What part of the tooth is whitened?

The average person believes that the enamel is that part of the tooth that gives the tooth color and that the enamel is what needs whitened.  This is a misunderstanding of teeth.  Almost everybody knows that enamel is the outer layer of the tooth, but not many people outside of dental health professionals can name the second layer of the tooth.  This is called the dentin and this is what gives your tooth color.  If your teeth are yellow it is because your dentin is yellow, and if your teeth are grey it is because your dentin is grey.

Various things that we put into our bodies will stain the dentin different colors.  Smoking, red wine, coffee, tea, and many other things change the color of your teeth.  Also, with age teeth gradually become more and more grey.  Some of these stains are superficial and can be removed by properly brushing your teeth or by a professional cleaning at your dentist office during a regular cleaning.

How is the tooth whitened?

The enamel is made up of an interesting physical structure consisting of enamel rods.  These rods are aligned one right next to another and together they make up the hardest substance of the body.  The image below is an electron microscope view of the enamel rods of the teeth.  Hydrogen peroxide is the most common ingredient used to whiten teeth.  It penetrates the enamel and works its way through the rods to find its way into dentin.

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The dentin of the tooth is made up of tubules.  These tubes are where the hydrogen peroxide enters and the whitening begins to transform the color of the tooth.  An important factor to consider is the concentration of the hydrogen peroxide.  The higher the concentration, the better the penetration of the whitening and the more drastic the whitening changes are.  In most states, however, hydrogen peroxide for whitening can’t be sold over the counter in high enough concentrations to see any sort of significant results.  Whitening strips are the most common form of over the counter whitening products that can produce a noticeable result.  For many though, the results are not significant enough.

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What about whitening toothpaste?

This is a waste of money.  Let me repeat myself: don’t spend a dime on whitening toothpaste.  Toothpastes are not permitted to contain high enough concentrations of hydrogen peroxide to penetrate the tooth at all, so all they do is remove surface stains.  Every tooth paste can remove surface stains because toothpaste is a mild abrasive designed to remove whatever is on the surface of your tooth.  People quite obviously don’t get this because a large percentage of the toothpaste sold in the United States is whitening toothpaste.

What are the side effects of whitening?

Unfortunately, there can be side effects to whitening the teeth.  By opening up the enamel and penetrating the dentin of the teeth there can be sensitivity.  The great news is that with modern advances to the whitening formula, this sensitivity can be controlled and become almost negligible.

Another side effect is damage to the soft tissues of the mouth.  The inside of the cheeks, lips, and gums can be burned by the hydrogen peroxide formula.  The problem with do it yourself home products is that they are not aware of the damage being done to the teeth and soft tissues.  This is why whitening should be monitored by a professional.  When whitening is done at a dental office by professionals, great care is taken to avoid any damage to the soft tissues of the mouth.

Is there such a thing as too much whitening?

The short answer is yes.  Bleachaholics is a commonly used phrase in dentistry.  When and how often someone should whiten there teeth is best determined by a dentist consulting with their patient.  Chronic bleaching can harm teeth, usually unnecessarily because the teeth are already white.

There are many options out there to brighten your smile.  Consult with your dentist as to which option is best suited to helping you obtain the desired outcome.


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What is a Root Canal?

Root Canal.  This word evokes fear more than any other word used by a dentist, except for the words shot or drill.  Many people haven’t had a root canal and many more never had a negative experience with a root canal, so why do root canals have such a bad reputation?

Root canals are not performed under the same circumstances and symptoms and this makes all the difference in outcomes.  Some people don’t find out that they need a root canal until the dentist informs them.  Teeth demonstrating no symptoms typically have an easier time with a root canal than those teeth that are experiencing pain.  Those who show up in pain almost always have an infection of some sort.  When the tooth is in pain, and an infection present, getting someone numb now becomes increasingly difficult.  This is because infection cancels out the anesthetic.

So What is a Root Canal?

A root canal is a last ditch effort to save a tooth.  In the very center of the tooth is all of the nerves, blood vessels, and other tissues called the pulp.  This part of the tooth is alive.  When there are problems with this part of the tooth, the ability to heal itself is quite poor.  For this reason the dentist kills the tooth on purpose to avoid these problems from getting worse.  The picture below shows the pulp of a tooth outlined in red.

The tooth is killed by removing the vital part of the tooth found in small thin canals using files.  The canals are then widened by using progressively larger files.  It is important for the files to clean within 1 mm of the tip of the root but not beyond.  The canals are then sterilized with a substance called sodium hypochlorite.  Finally, the canals are then plugged with a rubber material called gutta percha.  A successfully completed root canal allows people to keep their teeth for decades longer.  The following picture shows a completed root canal on a different tooth.


Is a Root Canal Painful?

Typically no.  There are instances where a person has what dentists call a hot tooth meaning the tooth is in so much pain, inflammation, and infection that trying to do anything to the tooth causes pain.  Anesthetic used to numb the tooth is neutralized by the infection making it ineffective.  This is why it can be painful.  Usually this pain and inflammation can be controlled with antibiotics, but if there is too much swelling or the patient needs urgent care, then the tooth then needs work immediately.  The picture below demonstrates how swelling due to tooth infection can become quite significant.  In fact, before modern medicine, people died all the time from dental infections.

What can cause a root canal?

There are many different things that can cause the need for a root canal to be performed.  These include: 1) deep cavities 2) tooth trauma 3) tooth is already dead (called necrosis) and other such reasons.  The picture below depicts a large cavity that will lead to a root canal.

It is amazing to think that a small cavity that requires a simple filling can grow and eventually lead to this if left untreated.  If the cavity enters the pulp, then it is game over and the tooth needs a root canal.  Cavities that get to the pulp imminently cause infections and start the process of tooth death.

Acute trauma to the tooth can start the process of tooth death.  This process can be quick or slow, but always leads to the need for a root canal.  Blunt force trauma to the tooth can also cause immediate death.  When a tooth is dead, it typically is not painful and often is found on x-rays by the dentist.  A dead tooth has an infection at the root tip, and if left untreated, will spread and jeopardize the other teeth.

So what happens if I don’t get a root canal?

The only other alternative is to take out the tooth.  It is very expensive to replace a missing tooth rather than treat the existing tooth with a root canal.  If you can stand the pain and allow the tooth to die, the pain may eventually subside but the infection will still be present.  The question you need to ask yourself: are you willing to gamble all of your other teeth because you don’t want to get a root canal on one tooth.

The process may take a while and cost some money up front, but saving the tooth saves you time and money in the long run.  Don’t be afraid of the root canal because it is a tooth saver.

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I Can’t Go Without My Teeth: A Brief Explanation About Immediate Dentures

Sometimes you just have to make due.  You make the best of the situation given what you have to work with.  This doesn’t mean that you should expect inferior dentistry.  For some patients, many years can pass between dental visits and the news they receive at these visits can be bad.  In fact, this news can be so bad that the dentist has to tell the patient that there is nothing that can be done to save a tooth or any of their teeth.  The teeth then must be pulled and their #1 concern is always the same: will I have to go without my teeth?  The great answer is that no you don’t.

This was a patient of mine who first came into my office because all of the remaining teeth were wiggling.  After looking at the remaining teeth, it was determined that none of the teeth could be saved.

The results after the teeth were removed and the immediate denture placed were great.  The patient’s situation significantly improved after the move to a permanent denture.



Immediate dentures are placed right after the teeth are pulled and allow the patient to leave the office with something to chew and smile with.  The process is relatively simple.  Once a tooth or teeth are determined to be a hopeless cause, impressions are taken of the mouth with the teeth in the mouth.  The impressions are used to make casts of the teeth which are then sent to a dental lab.  The lab is then instructed by the dentist which teeth are to be removed.  The lab uses instruments to remove the teeth from the casts, simulating the tooth being pulled.  A denture is then made in these empty spaces and returned to the dentist office.

On the day of the procedure, the dentist then removes the teeth and the denture is place in the mouth immediately afterwards.  This immediate insertion provides three distinct advantages: 1) the patient leaves with something to fill the spaces 2) bleeding is controlled by the denture 3) and inflammation of the mouth is minimized with the denture in the mouth.  The important thing for the patient now is to wear the denture for a full 24 hours without taking the denture out.  The dentist will then need to see the patient back for a 24 hour denture check so that it can be adjusted for sore spots and the healing can be inspected.  The bleeding should have stopped long before the 24 hour mark.  After the 24 hour check is the one week check.  By one week, most of the swelling is gone and the denture may need further adjustment.

Another frequent question that gets asked: is this denture permanent?  The answer is no it is not permanent.  Just like with the muscles of your body where if you don’t use it you lose it, the bone in your mouth shrinks if there are no teeth there.  This process of losing bone is slow process, but is somewhat stable after 6 months.  This is why a second denture should be made at six months if the immediate denture is not fitting well by then.

If you have dental problems where you think that you might not be able to save the teeth, then please set an appointment with a dentist.  He or she probably will be able to improve your situation.

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The first step towards a beautiful, healthy smile is to schedule an appointment. Please contact our office by phone or complete the appointment request form below. Our scheduling coordinator will contact you to confirm your appointment.
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The Broken Tooth Gallery

We are living longer.  There is not disputing that.  With the constant and ever expanding advances in modern medicine, people are able to overcome many different illnesses and ailments that would have devastated entire populations 100 years ago.  With this blessing of being able to live to a ripe old age comes with one distinct disadvantage.

We are putting more miles on our bodies than ever before because we are living longer.  When it comes to teeth, there are only a certain number of miles that can be put on them before they break down.  With advances in dentistry, people are able to keep their teeth much later in life, but this doesn’t mean there aren’t signs of wear and tear.  The graph below shows how 60 years ago over half of the elderly population had no teeth.  By the 2000’s that number was cut in half.  This is great news.  Let’s see what happens though when we put more wear and tear on our teeth.

Percent of Elderly Without Teeth


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This is a very common site that I see every day in dentistry.  It is a crack on a tooth that has an old filling and a lot of use.  Seeing a crack like this scares some patients while some patients say “so what?”.  Here is the danger about these cracks: They are ticking time bombs.  This tooth may stay intact until the patient dies, but it also might not.  If this person were to live long enough, the question then becomes a matter of when will the tooth break rather than will the tooth break. When the cracks spreads and the tooth breaks, the results can be catastrophic.  Let’s take a look at some pictures.

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The break on this tooth is devastating as there is nothing that can be done to save it.  The fracture is too deep and too significant to fix.  This is another reason why very large fillings are not an ideal treatment compared to a crown.

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This is what a crack can look like without losing a part of the tooth.  This crack is a vertical fracture and will go all the way through the root.  Prognosis is hopeless as this tooth is toast.

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Once again, another cracked tooth through the root.  The tooth is not restorable and must be extracted.

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Sometimes the tooth breaks off and leaves the tooth still restorable, like the one above.  Luckily for this person, the break is shallow and a crown can be placed on this tooth.  The danger with cracks on the teeth is that there is very little that can be done to determine the extent of the crack, so there is no way to predict how catastrophic the fracture would be.

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This is a common site in every dentist’s office.  The ideal treatment is to place a crown on the tooth before it breaks.  Not only is this a more affordable treatment in the long run rather than waiting for a fracture, but it is preventative and allows you to not risk losing a tooth.  Let’s not forget that a fractured tooth can be an excruciatingly painful process.  By crowning the tooth, the forces of biting and chewing are then transferred to the crown and not the cracked tooth.  When you go in for a dental visit and the dentist points out a crack, listen up as he might be able to save your tooth.


Logan Miller, D.D.S.


6500 N. Mopac Expy

Building II Suite#2204

Austin, TX 78731


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Clean Up That Dirty Mouth…For Your Health

A popular gum company used the slogan “got a dirty mouth…clean it up.”  O’ the wisdom in that statement.  It’s too bad it was only used to sell chewing gum.  Our mouths truly are a dirty place.  It’s teaming with bacteria that consumes our left-over food in order to grow and multiply.  When these bacterial numbers aren’t held in check, many disease processes can take place that affect the rest of your body.

Image result for disgusting mouth

The body is a very intertwined system with not one part of it being independent from the other.  A common misconception is that there is dental health and then there is body health and the two are mutually exclusive.  This idea couldn’t be further from the truth.

Advances in science and research have led scientists to understand how the mouth and teeth play a role in the overall health of an individual.  Periodontal disease, more commonly known as gum disease, is present in as many as 36% of Americans.  This disease has been linked to other conditions such as chronic obstructive pulmonary disease, diabetes, heart disease, and pre-term low birth weight babies.  As research continues to advance, our understanding of the role our mouth’s play in overall health will continue to grow.

Multiple studies have shown that there is a correlation with a child’s weight and their likelihood to have cavities.  Children that are overweight and obese are more likely to have cavities than those that are normal weight. Children who are significantly underweight most frequently demonstrated severe problems with cavities.

The more teeth you have later in life, the longer you will live.  One study showed that those who had twenty or more teeth at age seventy ended up living longer than those who had less than twenty teeth.  So what do these two things have do with the other.  It is often said that the mouth is a window to the rest of the body.  The most important effect your teeth have in regards to your health is the quality of life.  The ability to smile with confidence, be free from pain, speak clearly, have good breath, eat whatever food you desire all have a profound impact on your overall health because it is directly related to your quality of life.

So how can your dentist help you achieve good overall health?  It is the job of a dentist and his team to help every patient keep the plaque in check by removing it during regular cleanings but to also help guide patients on how to keep plaque at bay through their home care.  Contrary to conspiracy theorists’ beliefs, dentist don’t take joy in their patients having cavities.  We do, truly, want you to be healthy.

Strive to keep your mouth healthy and it will pay off dividends today and in the future.  If it has been a while since your last dental visit, then it is time to schedule an appointment with your dentist and keep those teeth and your body healthy.


By Logan Miller, D.D.S.

6500 N. Mopac Expy

Building II Suite #2204

Austin, TX 78731








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Veneer vs. Crown

You want your teeth to look fantastic, but there are things that you wish you could change about them.  Crown and veneer are two terms that are thrown around when talking about cosmetic dentistry.  Do you know the difference between the two?  Well let’s briefly discuss the difference and then you can make the best decision for yourself.

A crown covers a tooth in 360 degrees while a veneer mainly covers the front and top of the tooth.  The veneer is the more conservative path while the crown is the more retentive.  A crown can be used in a variety of situations and circumstances, while a veneer is primarily used to improve esthetics.

For someone that has perfectly healthy teeth, but is unhappy with the way they look veneers are typically the better choice.  If the tooth has large amounts of decay or fracture, a crown is the more logical choice.

Veneers typically require about 0.5 mm of tooth structure to be taken from the front of the tooth while 1 mm is taken off the top of the tooth.  With veneers you don’t go onto the backside of the tooth.  This is great for preserving your remaining healthy tooth structure, but the retention is almost entirely from the cement.  What I typically like to do is provide a little bit of retention on the back side of the tooth.  So does your diet have to change when you get veneers?  The short answer is no, but the life expectancy of a veneer is shorter than that of a crown.  The picture below shows how much tooth structure has to be taken away to create a veneer.

Image result for Veneer prep before cement

Crowns are typically placed when a larger amounts of tooth structure needs to be taken away.  This includes fractures, decay, replacing large fillings, cracked teeth, etc.  The esthetics of a crown is just as excellent as a veneer.  In today’s dentistry, veneers and crowns are made of ceramics or porcelain.  As you can see from the teeth below, they were made ready for a crown and go all the way around the teeth.








Esthetic crowns and veneers can be used to fix a number of problems such as significantly stained teeth, close small spaces between teeth, fix slightly crooked teeth, and make teeth a little longer.  If you feel like you would benefit from veneers or crowns, a consult with a dentist is necessary prior to determination of what can be reasonably accomplished.









Make An Appointment

The first step towards a beautiful, healthy smile is to schedule an appointment. Please contact our office by phone or complete the appointment request form below. Our scheduling coordinator will contact you to confirm your appointment.
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Dr. Logan Miller, DDS

6500 N. Mopac Expy

Building II Suite #2204

Austin, TX 78731


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Periodontal Disease: The Silent Killer of Teeth

Periodontal Disease:  The Silent Killer of Teeth

How many times has a physician heard the words “doctor it didn’t hurt” or “doctor I didn’t feel a thing?”  Every day on this earth, countless people either die or are given a terminally ill diagnosis while experiencing no prior symptoms or at the very least being oblivious to the symptoms.  High cholesterol doesn’t hurt, but is a warning sign of a possible future cardiac episode. High blood glucose doesn’t hurt, but is a warning of the onset of diabetes.  Cancer is often painless until it is often too late for medical intervention.

In dental health there are many conditions that are painless until it is too late to reverse the damage done.  Cavities are frequently not painful until they are so large that they require a root canal.  Periodontal disease, more commonly known as gum disease, is a condition that many are unaware of and is often painless while the disease progresses.

What is Periodontal Disease?

Simply defined, periodontal disease is any disease of the bone, gums, and ligaments that support the tooth.  This disease frequently manifests itself as chronic periodontitis.  Chronic periodontitis’ most devastating problem is irreversible bone loss.  This gradual loss of the bone surrounding the teeth is painless.  If left untreated, the bone loss continues until there nothing left to hold the teeth in and they fall out on their own.  So let’s track the disease process from start to finish.

Healthy Gums and Bone

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Healthy gums are pink with a nice opaque sheen to them.  Healthy gums follow the contours of the teeth and fill in all the spaces between teeth.  Healthy gums don’t bleed when they are brushed.  For the gums to stay healthy, plaque must be brushed and cleaned off the teeth and the gums.  The picture above demonstrates what healthy gums look like.  The first step in the disease process is gingivitis.


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Gingivitis is the swelling of the gums around the teeth.  The gums go from being pink to red.  The plaque that is normally cleansed from the teeth when you brush them, become buried underneath the gums.  Your own body uses its immune system to attack the plaque and the inflammation process starts.  This inflammation is what leads to bone loss.  It doesn’t take many days of inadequate brushing to see the onset of gingivitis.

Slight Chronic Periodontitis

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This x-ray shows slight bone loss that occurs with periodontal disease.  At this bone in the disease process there is no pain, the gums will bleed a little when brushing, and a visit to the dentist would give a patient the greatest chance of a diagnosis.  The good news is that with intervention, the disease can be stabilized.  The earlier the detection of periodontitis, the better the prognosis.

Moderate Chronic Periodontitis

Image result for Moderate Chronic Periodontitis x-ray

Only 1-2 mm separates the difference slight periodontitis and moderate periodontitis.  Once again, at this stage of the disease a patient will have 3-4 mm of bone loss but it is still painless and there is a good chance the teeth are not moving.  So a patient who doesn’t make a regular visit to the dentist is oblivious to the fact they have this problem.  The good news is that with intervention, the disease can be stabilized.

Severe Chronic Periodontitis

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At this point in the disease process, the bone loss is severe and is very difficult to treat and stabilize.  The prognosis for these teeth is questionable.  Patients at this point still won’t feel pain, but there is a chance the teeth will be moving slightly by this point.  This is a difficult visit for the patient because important decisiosn need to be made such as which teeth to remove and which aggressive surgery needs to be done.

How to treat periodontal disease?

All plaque that has failed to be properly cleaned off the teeth will cause inflammation and tartar will form all over the teeth.  This “stuff” needs to be cleaned by a professional and important changes need to be made by the patient regarding their home care. Instead of getting their teeth cleaned every 6 months, a patient needs to have their teeth cleaned every 3 months to stabilize the disease.  Some patients need to have their teeth removed if they can’t be properly cleaned.

The main point to get across is to not neglect your home care and don’t avoid your regular dental visits.  Don’t wait until something hurts to visit the dentist because it might be too late.  Periodontal disease can be stabilized and treated and the prognosis is good if it is caught early on.


Dr. Logan Miller, DDS

Austin Smiles Dentistry

6500 N. Mopac Expy

Building II Suite#2204

Austin, TX 78731


Make An Appointment

The first step towards a beautiful, healthy smile is to schedule an appointment. Please contact our office by phone or complete the appointment request form below. Our scheduling coordinator will contact you to confirm your appointment.
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What is a Dental Implant?

In the modern era of dentistry, technology utilized by dentists has grown by leaps and bounds.  3D printers are leading to exciting new possibilities such as digital dentures where the dentist scans the mouth, takes a few measurements, and a machine will print you a new denture.  3D scanners such as CEREC can scan a tooth and then mill you a crown ready for cementing in about 1 hour.  Lasers are opening a whole new field in dentistry with a variety of applications where most patients don’t have to be numb for the procedure.  One technology though stands alone in terms of the amount of time, money, and research invested.  This technology is dental implants.

Prior to the advent of dental implants, if you were missing a tooth you had three choices for treatment: 1) do nothing and leave the space alone 2) a bridge or 3) a partial denture.  All three of these options have one thing in common.  They don’t give the patient their bite force back.  Doing nothing gives you 0% of your bite force back while a partial denture only provides 1/7 of the bite force of a normal tooth.  A bridge does cover the space of the missing tooth, but all chewing on that tooth is transferred to the adjacent teeth.  Studies have shown that an implant can give a person 90+% of their bite back.  A study done in 2013 by Biswas and Pal demonstrated that the bite forces of an implant are extremely close to that of a natural tooth.

So what does this mean?  If you are missing multiple teeth and decided to do nothing or only a denture, then certain foods may need to be eliminated from the diet.  Say goodbye to ribs, corn on the cob, and other such foods, that is unless you have hours to eat your dinner because that might be how long it takes you.  If you decide to restore with implants, then get out your bib and enjoy those ribs.

So what is a dental implant and why is it so effective?  A dental implant is essentially a screw that is inserted into your jaw, the bone grows around it and then a crown or denture is placed on top of it.  This of course oversimplifies the procedure to a large extent.  Implants are considered a surgery and great care needs to be taken to ensure their success.

Image result for Dental Implants before and after

Per-Ingvar Brånemark is considered the modern father of dental implants.  He discovered how to successfully place implants in the mouth using biocompatible titanium and allow for the bone to grow around them through a process called osseointegration.  Osseointegration is the key to the success of implants.  Branemark went onto develop the main tenants of placing an implant and what leads to its success.  The great news about implants is that their success rates are 90+%, and when good technique is implemented the success rate is even higher.  The goal with dental implants is for patients to keep them for their whole lives. 

Getting an implant is a commitment.  The healing doesn’t happen overnight.  Often times after an implant is placed, several months must pass before a crown can be placed on top of it because the bone needs to grow around it.  A person can’t get an implant, neglect it and expect to retain it for their whole life.  Complications can arise and the dental implant needs to be treated in order to save it.  Just like with natural teeth, implants need to be cleaned, exams need to be performed, and sometimes parts need to be switched out.  The results, however, are amazing.

Some health conditions may prevent some people from receiving an implant such as someone who has received previous head and neck radiation and those who are medically compromised.  Other medical conditions that can increase the risk of a failed implant are uncontrolled diabetes, smoking, HIV, and many others.  The video below does a great job of covering the basics of a dental implant in 90 seconds.

For those who appreciate medical videos, the video below shows a real implant placement.  Warning the video is graphic.

Logan Miller, D.D.S.

Austin Smiles Dentistry

6500 N. Mopac Expy

Building II Suite #2204

Austin, TX 78731



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If You’re Scared of the Dentist…Relax

One of the most common fears of the general population is a fear of the dentist.  Statistics cited range from 5% to 20% of the people have enough of a fear of the dentist that they put off going until it is absolutely necessary.  To put this in other terms 16.2 to 64.8 million people in the United States put off going to the dentist until they are in so much pain that they can’t stand it.  Of those who don’t see the dentist on a regular basis, they state that fear of the dentist is their top reason.  The good news that every dentist would like to convey to their patients is that there are options available to help patients cope with this fear.

The most basic but incredibly useful method to helping patients with their fear of the dentist is through communication.  Many patients can have their fears resolved by talking with the dentist prior to, during, and after the procedure.  Reassurance that everything is going alright and smoothly can help relax the patient.  Knowing what to expect before hand also helps a patient reduce their fear of the unknown.  What if the fear can’t be relieved through communication?  The next step is to be sedated.

The primary goal of dental sedation is to help a patient achieve a more relaxed state so that dental procedures can be performed under safe and calm circumstances.  Nitrous oxide, or laughing gas, is a basic but effective form of sedation for the patient.  The gas is inhaled in combination with oxygen.  Nitrous takes effect very quickly for patients and can be used with almost every patient with a few exceptions.  The levels of nitrous can be adjusted to increase or decrease sedation, and the effects wear off quickly.  A patient can walk out of the office after receiving nitrous and drive home.  The primary downside to nitrous is that it only sedates people to a certain extent and additional sedation may be required.

Pharmaceuticals can be added in conjunction with nitrous to help a patient reach that sweet spot of relaxation.  The methods for delivering these drugs can be done orally or through IV.  When delivered orally, a patient will typically arrive at the office with their prescription in hand and take it in the office.  The time for onset can vary but is typically 30-60 minutes.  After onset, nitrous is typically used in conjunction with the drug and the dental work begins.  Advantages of oral sedation is the simplicity of administration along with it’s effectiveness with most patients.  Disadvantages is that sometimes the effects don’t take as profound of effect and you can’t keep popping pills until your asleep in the chair.  That’s just not safe.  By administering the drug intravenously, the amount of the drug the patient receives can be increased, decreased, or adjusted as necessary to reach the sweet spot.  From a dentist standpoint, administering drugs intravenously can be both expensive and time consuming, and unnecessary for patients to receive general dentistry procedures.  An oral surgeon or a dentist doing surgery heavy dentistry might find it helpful to administer the drugs intravenously.

Sedation beyond intravenous administration typically involves general anesthesia and is rarely performed by general dentists.  There are risks involved with receiving sedation so it is necessary to consult with your dentist prior to the procedure.  The consult includes things such as evaluating overall health and the size of the airway.  A consult with the patients physician may also be necessary.

With the options that are available to patients who fear the dentist, there is no reason to wait until it is too late to seek treatment.  A patient that is seeking sedation can often receive large amounts of dentistry at once so they don’t have to keep coming back.  Important to note is the fact that a good experience with sedation at the dentist can help form a patients attitude about seeking future dental treatment.

Logan Miller D.D.S.

Austin Smiles Dentistry

6500 N. Mopac Expy

Building II Suite #2204

Austin, TX 78731


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Knocked Out!

We have all seen this scenario play out.  Your kids are horsing around, chasing each other, or playing in some kind of rough manner and then one of them starts crying.  Someone got hurt.  Your child quickly emerges by your side and wants a hug, to tattle on the others, and to have you inspect their injury.  What you may not have expected to see is this:

Image result for Avulsed tooth

Your kid has just knocked out their tooth.  Now what do you do?  Here is the most important thing to know:  Time is of the Essence.  The difference between getting the tooth properly placed back in the socket in under 60 minutes is drastically different than what happens if it stays out of the mouth for more than 60 minutes.

The first thing to do is inspect your child for any signs of a more serious injury such as a fractured jaw, traumatic head injury, etc.  Now go find the tooth and pick it up by the crown and try to avoid handling it by the root.  Rinse the tooth for about 10 seconds in water if visibly soiled and then try to place it back in the socket.  If your child cooperates, then great.  Call your dentist and arrange for an emergency visit.  If your child will not cooperate, then place the tooth in a glass of  milk or cup of your child’s own spit and call your dentist for an emergency visit.  DON’T place the tooth in a glass of water.

At the office, the dentist will rinse the tooth with saline and place it back in the socket.  He will visually inspect to ensure it is in it’s proper place, and then splint the tooth with the other front teeth.  Antibiotics will be prescribed for the next two weeks.  Regardless of how fast the tooth was placed back in the socket, a root canal will need to be done about 10 days later and the splint will be removed about 2 to 4 weeks later.

If the tooth has been out of the socket for more than 60 minutes, then the prognosis of the tooth is poor.  This doesn’t mean that it shouldn’t be placed back in the socket.  It just means that with time, the roots will slowly dissolve and the tooth will be lost.  You will, however, have bought yourself some time before needing to address the issue.

Image result for x-ray of open apex front tooth

X-ray above show undeveloped tooth roots.

Where knocking out a tooth can get tricky is that many kids that knock out their front tooth, have only had their new adult front teeth for a little while.  When your adult teeth poke through the gums, the roots are not completely formed.  The teeth are not fully developed and this trauma can halt their full development and in fact kill the tooth.  So the dentist would then need to carefully follow up with time to ensure that the tooth is alive and developing.  If the tooth is dead, then a root canal needs to be completed.

The protocols for adults that knock out their teeth is roughly the same.  It is just less common.


Reference for this article thanks to:


Logan Miller, D.D.S.

6500 N. Mopac Expy

Building II Suite #2204

Austin, TX 78731


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