Calming Smiles: The Gentle Approach of Sedation Pediatric Dentistry

A trip to the dentist can be a source of anxiety for both children and their parents. In recognizing the unique needs of young patients, pediatric dentists have embraced a gentle and compassionate approach to dental care—sedation pediatric dentistry. This specialized form of dentistry prioritizes the comfort and well-being of children, ensuring that dental visits are not just painless but also anxiety-free experiences.

Understanding Pediatric Anxiety: Nurturing Trust for Lifelong Dental Health

Children, especially those with previous dental experiences or heightened sensitivity, may develop anxiety or fear associated with dental visits. Sedation pediatric dentistry acknowledges and addresses these concerns, fostering an environment of trust and comfort that can set the foundation for a positive attitude towards dental care throughout a child's life.

Tailored Sedation Options: Ensuring Safety and Relaxation

Pediatric dentists carefully tailor sedation options to match the individual needs of each child. From nitrous oxide (laughing gas) for mild anxiety to oral conscious sedation or intravenous sedation for more significant apprehension, these options provide a spectrum of choices to ensure the safety and relaxation of young patients during dental procedures.

Promoting Cooperative Care: A Positive Experience for Young Patients

By utilizing sedation, pediatric dentists create an environment where children can receive necessary dental care without undue stress or discomfort. This cooperative care approach not only facilitates the completion of treatments but also helps children associate dental visits with positive experiences, fostering a lifelong commitment to oral health.

Enhanced Focus and Efficiency: Benefits for Both Dentist and Patient

Sedation pediatric dentistry enhances the efficiency of dental procedures by promoting a relaxed and cooperative state in young patients. This allows dentists to work more effectively, ensuring that necessary treatments are completed with precision while minimizing potential distress for the child. The result is a win-win situation that prioritizes both quality care and a positive experience.

Addressing Special Needs: A Compassionate Approach for Every Child

Children with special needs may require additional considerations during dental visits. Sedation pediatric dentistry becomes an invaluable tool in addressing the unique needs of these young patients, ensuring that they receive the dental care they deserve in a manner that is compassionate, safe, and tailored to their specific requirements.

Empowering Parents: Open Communication and Informed Decision-Making

Pediatric dentists recognize the importance of open communication with parents. Before employing sedation, they discuss the available options, potential risks, and benefits, allowing parents to make informed decisions regarding their child's dental care. This collaborative approach empowers parents to actively participate in creating a positive dental experience for their children.

In the world of pediatric dentistry, sedation techniques emerge as gentle allies, fostering an atmosphere of calm and cooperation. By prioritizing the emotional well-being of young patients, sedation pediatric dentistry ensures that dental visits become not just routine appointments but positive milestones in a child's journey toward lifelong oral health. Calming smiles, one gentle dental experience at a time.

Sedation Dentistry: Your Key to a Stress-Free Smile

Are dental visits causing you anxiety? Do the whirring sounds of dental instruments make you nervous? If so, you're not alone. Many individuals experience dental anxiety, which can deter them from seeking the essential oral care they need. Thankfully, there's a solution that can help you conquer your fears and keep your smile in tip-top shape: sedation dentistry.

What is Sedation Dentistry?

Sedation dentistry, also known as sleep dentistry or relaxation dentistry, is a dental approach that focuses on patient comfort and relaxation. It involves the use of sedatives to help patients stay calm during dental procedures, ranging from routine cleanings to more complex treatments.

Benefits of Sedation Dentistry:

1. Anxiety Relief: Sedation dentistry is a game-changer for those with dental phobias. It allows patients to feel at ease, reducing anxiety and promoting a sense of relaxation.
2. Pain Management: It ensures minimal pain or discomfort during dental procedures, making them more tolerable.
3. Time-Efficient: With patients in a relaxed state, dentists can often perform multiple procedures in one visit, saving you time and minimizing the number of appointments.
4. Improved Oral Health: When anxiety is no longer a barrier, you're more likely to seek regular dental care, leading to better oral health in the long run.
5. Lessened Gag Reflex: Sedation can help reduce or eliminate the gag reflex, making procedures more comfortable.

Types of Sedation:

There are various levels of sedation, from minimal to deep, depending on your needs. These may include:
1. Oral Sedation: Taken in the form of a pill, it induces a mild to moderate sedative effect.
2. Inhaled Nitrous Oxide: Also known as laughing gas, it provides a calming sensation during the procedure.
3. IV Sedation: Administered intravenously, this offers a deeper level of sedation and is commonly used for complex treatments.
4. General Anesthesia: Reserved for extensive oral surgery, it puts patients in a deep sleep-like state.

Is Sedation Dentistry Right for You?
Sedation dentistry is an excellent choice for those who experience dental anxiety, have a low pain threshold, sensitive gag reflex, or require extensive dental work. However, it's essential to consult with your dentist to determine the most suitable form of sedation for your specific needs.
In conclusion, sedation dentistry is a gateway to a stress-free, worry-free, and pain-free dental experience. Don't let fear of the dentist prevent you from achieving a beautiful and healthy smile. Consult with a sedation dentist, and take the first step toward a more relaxed and enjoyable dental journey. Your smile will thank you!

Dry mouth is a common problem that can harm your teeth

If your saliva flow is reduced, this can cause dry mouth which often leads to increased tooth and gum problems.

Dry mouth – known as xerostomia – is a common problem especially among older adults. It’s caused by certain medical disorders and is often a side effect of medications such as antihistamines, decongestants, pain killers and diuretics.

The common problems associated with dry mouth include:

– Constant sore throat
– Burning sensation
– Problems speaking
– Difficulty swallowing
– Hoarseness or dry nasal passages

When there is not enough saliva to lubricate your mouth, wash away food and neutralize the acids produced by plaque, there is a risk of extensive tooth decay.

If you are at risk from this condition, your dentist can recommend various methods to restore moisture.

For example, sugar-free candy or gum stimulates saliva flow, and moisture can be replaced by using artificial saliva and oral rinses.

As dry mouth is a potential side effect of many prescribed and over-the-counter medications it is a very common problem.

These medications can include antihistamines, decongestants, painkillers, high blood pressure medications, muscle relaxants, drugs for urinary incontinence, Parkinson’s disease medications, antidepressants and many others.

Fortunately there are many simple solutions available to reduce the risk to your oral health caused by dry mouth so talk to your dentist if you are on any kind of medication or you feel you may be at risk from this issue.

Common questions about dental insurance

 Understanding what’s covered by your dental insurance is an important part of making sure you get the best oral care possible.

Here are some common questions that arise when people want to understand their cover better.

– If treatment my dentist recommends is not covered by my insurance, does that mean it’s not necessary?

Some plans make exclusions such as sealants, pre-existing conditions, adult orthodontics, and specialist referrals. This depends on your dental plan and you should not let the level of cover determine whether you need treatment.

– My dental benefit will only pay for a large filling but my dentist recommends I get a crown. Which should I choose?

Some plans will only cover the least expensive solution but it may not be the best option for your needs. You should decide based on your health needs and not on your insurance cover.

– My dental plan says it will pay 100 percent for checkups and cleanings but the insurance company says I owe for part of the dentist’s charge. How can this be?

Some plans provide cover based on a “customary fee” for each procedure. So, if your dentist’s fee is higher, your benefit will be based on a percentage of the customary fee instead of your dentist’s fee. Although these limits are called “customary,” they may not accurately reflect the fees that dentists charge in your area.

– Will my plan cover the care my family will need?
If your employer offers more than one plan, check the exclusions and limitations of the coverage as well as looking at the general benefits. It’s a good idea to discuss your family’s likely needs with your dentist before choosing a plan.

The plan document should specify who is eligible for coverage under the plan.

Plans offered by the same provider or employer can vary according to the contracts involved so your dentist will not be able to answer specific questions about your benefit or predict what the coverage for a particular procedure will be.

If you have specific questions about coverage, talk to your plan provider.

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Sedation Dentistry for Children: When Is It Necessary?

Sedation dentistry is a technique used to help children relax and feel more comfortable during dental procedures. While it's not always necessary, there are certain situations where sedation dentistry may be recommended. Here are some situations where sedation dentistry may be necessary for children:

1. Dental anxiety: If a child experiences anxiety or fear when going to the dentist, sedation dentistry can help them feel more relaxed and comfortable during the procedure.
2. Special needs: Children with special needs may require sedation dentistry to help them feel more comfortable during dental procedures.
3. Lengthy procedures: For longer procedures, such as root canals or multiple fillings, sedation dentistry can help the child stay still and calm throughout the procedure.
4. Young age: For very young children who may not be able to sit still or cooperate during a dental procedure, sedation dentistry can be helpful.

It's important to note that sedation dentistry should only be performed by a qualified and experienced dentist. The type and level of sedation used will depend on the child's age, weight, medical history, and the length and complexity of the procedure.

Sedation dentistry may be necessary for children who experience dental anxiety, have special needs, are undergoing lengthy procedures, or are very young. If you have concerns about your child's ability to cooperate during a dental procedure, talk to your dentist about sedation dentistry options. With proper preparation and care, sedation dentistry can help children receive the dental care they need in a safe and comfortable manner.

The Importance of Kids' Dentistry: Tips for Healthy Teeth

As a parent, you want your child to be healthy and happy, and that includes their teeth. Regular dental checkups and cleanings are important for maintaining healthy teeth and gums, and can prevent serious dental problems down the line. Here are some tips for keeping your child's teeth healthy:

1. Start Early: The American Academy of Pediatric Dentistry recommends that children see a dentist by their first birthday. Early dental visits can help prevent tooth decay and identify any potential problems.
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3. Brush and Floss: Encourage your child to brush twice a day and floss once a day. Use a soft-bristled toothbrush and fluoride toothpaste. Make sure to supervise brushing until your child is old enough to do it on their own.
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5. Healthy Eating: A healthy diet is important for healthy teeth. Limit sugary and starchy snacks, which can lead to tooth decay. Encourage your child to eat fruits, vegetables, and dairy products, which are good for teeth.
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7. Regular Checkups: Regular dental checkups can prevent serious dental problems down the line. Your child's dentist can identify any potential problems early and provide preventive care.
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9. Be Positive: Going to the dentist can be scary for some children. Encourage your child to view dental visits as a positive experience, and praise them for good behavior during their appointments.

By following these tips, you can help your child maintain healthy teeth and gums for a lifetime. Remember, a healthy smile is a happy smile!

Crowns and how they improve your teeth

To make sure you have the best smile possible, you may need a crown to cover a tooth and restore it to its normal shape and size.

A crown is a tooth-shaped “cap” that is placed over a tooth to restore its shape, size and strength, or to improve its appearance.

The reasons you may need a crown include:

– Protecting a weak tooth
– Holding together parts of a cracked tooth
– Restoring an already broken tooth
– Supporting a tooth with a large filling when there isn’t a lot of tooth left
– Attaching a dental bridge
– Covering badly-shaped or severely discolored teeth
– Cover a dental implant

If your dentist recommends a crown, it’s probably to correct one of these conditions.

Your dentist’s primary concern, like yours, is helping you keep your teeth healthy and your smile bright.

Different types of dentist and how they help your oral care

While many people see dentists as the single group of people who look after the health of your teeth and mouth, there are various specialist categories that help you in different ways.

The categorization of a dentist will depend on their education, training and experience.

Here are some of the main specialist areas of dentistry:

Endodontics: Concerned with the dental pulp – the part in the center of a tooth made up of living soft tissue and cells and root canal therapy

Oral and Maxillofacial Pathology: This deals with the identification, and management of diseases affecting the oral and maxillofacial regions

Oral and Maxillofacial Radiology: Deals with the production and interpretation of images and data produced by radiant energy that are used for the diagnosis and management of diseases, disorders and conditions of the oral and maxillofacial region

Oral and Maxillofacial Surgery: Diagnosis and surgical treatment of diseases, injuries and defects of the tissues including extractions, facial surgery and implants

Orthodontics and Dentofacial Orthopaedics: Mainly deals with diagnosis, prevention and treatment of misaligned teeth and modification of midface and mandibular growth

Pediatric Dentistry: Provides preventive and therapeutic oral health care for infants and children through adolescence.

Periodontics: Prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth and the maintenance of the health, function and esthetics of these structures and tissues. Most periodonitist place implants

Prosthodontics: Diagnosis, treatment planning, rehabilitation and maintenance associated with missing or deficient teeth and/or oral and maxillofacial tissues. Includes dentures, bridges and the restoration of implants.

Plus, of course, general dentists provide everyday care and many specialist services to maintain your oral health.

How a baby’s first teeth develop

A newly born baby usually has no teeth visible but most have begun to develop primary or baby teeth.

These generally begin to appear about six months after birth.

Over their first few years, they will develop all 20 primary teeth and will usually have them all in place by age three.

The teething process is uncomfortable for many babies and they can become sleepless and irritable. They also might lose their appetite or drool more than usual.

If your infant has a fever or diarrhea while teething or continues to be cranky and uncomfortable, call your physician.

Sometimes when a tooth erupts, an eruption cyst may develop. The tooth will eventually rupture this as it pushes through the gums and these cysts are usually harmless and should be left alone.

If a baby has sore or tender gums when they are teething, it can help to gently rub the gum with a clean finger, a small, cool spoon or a wet gauze pad.

When this happens, your dentist or pediatrician may suggest a pacifier, teething ring or a special numbing salve for the gums.

When the teeth begin to erupt, you should brush them with a soft-bristled toothbrush and a little water to prevent tooth decay.

Toothpaste is not recommended until a child reaches age two. When a child begins using toothpaste, you need to supervise the brushing to make sure they don’t swallow it.

Regular dental checks should begin after your child’s first tooth appears or by their first birthday.

How sedation and general anesthesia can make your visit to the dentist easier

You probably don’t give too much thought to the saliva in your mouth but, if you think of it like a bloodstream you’ll realize how important it is.

Like blood, saliva helps build and maintain the health of the soft and hard tissues.

It removes waste products from the mouth and offers first-line protection against microbial invasion that might lead to disease.

Saliva is derived from blood and therefore can also be used to detect disease.

Saliva enhances enamel protection by providing high levels of calcium and phosphate ions. It contains the minerals that maintain the integrity of the enamel surface and helps protect against caries.

When salivary flow is reduced, oral health deteriorates – much in the same way body tissues suffer if blood circulation is disrupted.

Patients with dry mouths (xerostomia) experience difficulty chewing, speaking and swallowing. A major cause of dry mouth is medication – almost eighty percent of the most commonly prescribed medications lead to dry mouth.

Chewing gum after a snack or meal stimulates salivary flow, clearing food from the mouth and neutralizing plaque acid.

Your saliva is important to your oral health both for preventing disease and in helping to diagnose problems.

How to make visiting the dentist easy for kids

Your child should have their first trip to the dentist by the time they are 18 months old and it’s good to make the process as easy as possible for them from the start.

Dental staff are used to dealing with young children and they will know how to make them feel comfortable.

Sometimes, children under three may be treated on the parent’s lap. In this case, the parent sits in the dental chair facing the dentist, and the child is on their lap.

The dentist will tell the child what he or she is going to do in terms they can understand. They will usually have fun dental toys they can use to help.

They will start with an oral examination checking the teeth present and looking at the development of the jaw, gums and soft tissues.

Naturally, as in any new situation, some children are initially unsettled but this is usually short-lived as they get used to it.

Parents can help by ensuring they are calm and relaxed as any anxiety will transfer to the child.

With older children, the parents may stay in the background though sometimes children behave better when the parent is not in the room!

Work with your children and your dentist to find the best way of ensuring they get the treatment they need with minimum worries for everyone.

How a healthy diet can help you have healthy teeth

Eating the right food plays an important role in developing healthy teeth and gums.

If your diet lacks certain nutrients, it may be more difficult for tissues in your mouth to fight infection and this can contribute to gum disease.

Although poor nutrition does not cause gum disease directly, the disease may progress faster and could be more severe in people with diets which are low in nutrients.

The U.S. Department of Agriculture makes recommendations on the nutrients, vitamins and minerals needed by your body – including your teeth and gums – to promote health and prevent disease.

We have different needs at various stages life and depending on our physical activity. The DOA website provides more information and your dentist will be able to discuss how your diet affects your teeth.

Here are some steps you can take to make sure what you eat doesn’t harm your teeth.
– Maintain a healthy diet
– Drink plenty water
– Limit the number of between-meal snacks. When you must snack, choose nutritious foods that are low in sugar
– Keep a food diary for a week recording every item you eat and drink

It will also help if you brush your teeth twice a day and floss regularly. Schedule regular dental checkups and professional cleanings and talk to your dentist about how your diet affects your teeth.

How to overcome problems with teeth grinding

When under stress, many people find themselves grinding their teeth or clenching their jaws.

This habit actually has a name – bruxism – and often it’s something we do when we sleep.

It can be caused by stress and anxiety and it can also be due to sleep disorders, an abnormal bite or missing and crooked teeth.

It can lead to symptoms such as dull headache or a sore jaw.

Your dentist can fit you with a mouth guard to protect your teeth during sleep.

Severe grinding can lead to painful or loose teeth and this can lead to fractures in your teeth.

Taking stress out on your teeth in this way can lead to long term damage so, if stress is the cause, you need to find a way to relax!

Relaxants, counseling and even exercise may help reduce stress and tension and can be a big help to your teeth.

How dental implants can give you a better smile

If you have missing teeth, you dont just have to rely on crowns, conventional bridges and dentures.

Many people are now choosing dental implants as the best way to restore their smile and solve dental problems.

Implants are placed below the gums during a series of appointments. They fuse to the jawbone and provide a base for individual replacement teeth, bridges or a denture.

As they are fused to the bone, they offer greater stability. And, because they are integrated into your jaw, your replacement teeth will feel more natural.

This secure fit often also makes them more comfortable than other solutions.

In order to have implants, you need to have healthy gums and adequate bone to support the implant.

To find out whether you could be a candidate for dental implants, talk to your dentist about what they could do for you.

How medication and anesthesia can help make your visit to the dentist easier

Your dentist will do everything possible to make your visit as relaxed and comfortable as possible.

Depending on the treatment you are receiving, there are several medications available to help.

Some drugs control pain, some help you relax and others put you into a deep sleep during dental treatment.

The best approach will depend on the type of procedure being undertaken, your overall health – including any history of allergies – and the degree of anxiety you feel.

Some of the options your dentist might discuss include:

Analgesics: These are the most commonly used drugs for relief of toothache or pain following dental treatment. They includes aspirin, acetaminophen and anti-inflammatory drugs such as Ibuprofen. There is a separate category of narcotic analgesics – such as those containing codeine – which are used for more severe pain.

Local anesthesia: Topical anesthetics are applied to mouth tissues with a swab to prevent pain on the surface level. They may also be used to soothe mouth sores. Injectable local anesthetics prevent pain in a specific area of your mouth during treatment by blocking the nerves that sense or transmit pain and numbing mouth tissues.

In other cases, your dentist many recommend sedation or general anesthesia.

Your dentist will discuss the best approach to suit your needs.

Building a strong relationship with your dentist

You’ll give yourself the best chance of good oral health if you build a strong relationship with your dentist.

That can sometimes mean asking the right questions and helping them to assist you in the best way possible.

So you want to make sure you have a dentist who will first of all explain techniques that you should use to help prevent dental health problems. They should be willing to show you step-by-step what you need to do.

You should also choose a dentist who is willing to take time to answer your questions, especially when they are recommending a course of treatment.

If you don’t understand any part of what your dentist recommends, don’t be afraid to ask for more information.

You may want to ask if there are other options to the solution they recommend. For example:

– How do the options differ in cost?
– Which solution will last the longest?
– Do all the options solve the problem?

Ask the dentist which treatments are absolutely necessary, which are elective and Which are cosmetic.

Ask which procedures are urgently needed, and which ones are less urgent. Your dentist will help you prioritize between problems which need immediate attention and those that are less urgent.

Often, treatment can be planned over a period of time but make sure you understand any consequences of delaying treatment.

It’s naturally also important to make sure that you are given full information about fees and payment plans before treatment is scheduled.

How braces help both children and adults

Crowded or crooked teeth known as malocclusion not only spoil your smile, they also increase your risk of dental health problems.

Corrective procedures and appliances such as braces straighten teeth and correct jaw alignment.

Malocclusions are often noticed around ages 6 12, when the adult teeth begin to erupt.

The process of straightening out teeth, known as orthodontic treatment, often begins between ages 8 and 14. The best results are obtained when a child begins treatment while they are still growing.

This means its a good idea for a child to have an orthodontic evaluation by age 7. At this stage, they have a mix of baby teeth and adult teeth.

Its possible for braces to work later and even in adults but there are many advantages in starting as soon as possible.

Your dentist will be able to spot problems with emerging teeth and jaw growth early on, while the primary teeth are present.

Thats why regular dental examinations are important.

For adults, its not too late to correct problems such as crooked or crowded teeth, overbites, underbites, incorrect jaw position or jaw-joint disorders. The biological process involved in moving teeth is the same at any age.

The difference is that adult treatment takes a little longer than a child’s treatment. As an adult’s facial bones are no longer growing, certain corrections may not be accomplished with braces alone.

But, whatever your age, it’s never too late to improve your dental health and improve your smile.

How space maintainers help children have healthy teeth

Space maintainers can be crucial to the dental health of a child.

When a child loses a baby tooth early through decay or injury, the other teeth can shift and begin to fill the vacant space.

If this happens, the problem is that, when the permanent teeth emerge, there’s not enough room for them.

This can lead to crooked or crowded teeth and difficulties with chewing or speaking.

To prevent that, the dentist can insert a space maintainer.

This holds the space left by the lost tooth until the permanent tooth emerges.

Space maintainers might be a band or a temporary crown attached to one side of the space.

When the permanent tooth emerges, the dentist removes the device and protects the child’s future smile.

Things to look out for during pregnancy

Every woman wants to maintain their own health during pregnancy and to take whatever steps are necessary to give the baby the best possible start.

There are a few factors in your oral health to look out for during this time.

One consideration is that its common for pregnant women to have the urge to eat between meals. The risk is that frequent snacking on carbohydrate-containing foods can encourage tooth decay.

Bacteria in your mouth called plaque can convert the sugar and starch in your mouth into an acid that attacks tooth enamel. After repeated attacks, tooth decay can result.

So, when you need a snack, try to choose foods that are nutritious for you and your baby such as raw fruits and vegetables and dairy products.

During pregnancy, your bodys hormone levels rise considerably. Gum problems, such as gingivitis, are especially common during the second to eighth months of pregnancy. They may cause red, puffy or tender gums that bleed when you brush.

This is an exaggerated response to plaque caused by higher levels of progesterone in your system. Your dentist may recommend more frequent cleanings at some stages to help you avoid problems.

Occasionally overgrowths of gum tissue, called pregnancy tumors, appear on the gums during the second trimester. These localized growths or swellings are usually found between the teeth and are thought to be related to excess plaque.

They bleed easily and are often surgically removed after the baby is born.

Studies indicate that pregnant women who have severe periodontal (gum) disease may be at increased risk for pre-term delivery, which in turn increases the risk of having a low-birth-weight baby.

So its particularly important to maintain good oral health during pregnancy. Make sure you clean your teeth carefully and visit your dentist regularly.

The early years of dentistry and teeth

Although there have been huge advances in dental care in recent years, there are records of people dealing with teeth going back over thousands of years.

Here are some of the key dates from the early years in the development of dentistry.

5000 BC: A Sumerian text describes “tooth worms” as the cause of dental decay.

2600 BC: Hesy-Re, an Egyptian scribe, often called the first “dentist”, dies. An inscription on his tomb includes the title “the greatest of those who deal with teeth, and of physicians.”

500-300 BC: Hippocrates and Aristotle write about dentistry, including the eruption pattern of teeth, treating decayed teeth and gum disease, extracting teeth with forceps, and using wires to stabilize loose teeth and fractured jaws.

166-201 AD: The Etruscans practice dental prosthetics using gold crowns and fixed bridgework.

500-1000: During the Early Middle Ages in Europe, medicine, surgery, and dentistry, are generally practiced by monks, the most educated people of the period

700: A medical text in China mentions the use of “silver paste,” a type of amalgam.

1130-1163: A series of Papal edicts prohibit monks from performing any type of surgery, bloodletting or tooth extraction. Barbers often assisted monks in their surgical ministry because they visited monasteries to shave the heads of monks and the tools of the barber trade sharp knives and razors were useful for surgery. Following the edicts, barbers assume the monks’ surgical duties: bloodletting, lancing abscesses, extracting teeth, etc.

1210: A Guild of Barbers is established in France. Barbers eventually evolve into two groups: surgeons who were educated and trained to perform complex surgical operations; and lay barbers, or barber-surgeons, who performed more routine hygienic services including shaving, bleeding and tooth extraction.

1400s: A series of royal decrees in France prohibit lay barbers from practicing all surgical procedures except bleeding, cupping, leeching, and extracting teeth.