Trypanophobia: How We Overcome Fear of Dental Needles with IV Sedation

Needle phobia photo and how we treat trypanophobia.

This makes many people nervous.

Fear of needles, often times referred to as trypanophobia, is a very common phobia. Fear of the dentist, also called odontophobia, is frequently seen in patients who are phobic of injections, needles, or other sharp objects.

Then end result is a patient who is terrified of coming to the dentist.

How do we overcome these fears, including needle phobia? With IV sedation.

But, it doesn’t take a rocket scientist to notice the irony in the above statement. After all, how are you going to overcome a fear of needles by sticking a needle into a vein in someone’s arm?

Think it’s impossible? Think again! Read on to learn how we do it.

About IV Twilight Sedation

IV sedation you will float in the clouds and not be scared of needles

You will feel like you are floating in the clouds. No fear of needles up here!

IV sedation, frequently called twilight sedation, as the name would imply, puts you into a twilight state. But what is a twilight state?

A twilight state is a level of sedation in which you are very sleepy, your eyes are heavy, all your anxieties are gone, and you don’t care what’s going on. You may fall asleep. And you will likely have no memory of anything that occurred when you are in the twilight state.

Our experience treating thousands of fearful patients is that for the majority of them – 99.9% – we can overcome trypanophobia and odontophobia – using IV sedation. If you’re floating in the clouds, your fears are long gone!

About Fear of Needles

Dental injection photo with big needle

The thought of this makes some patients very scared

Fear of needles is quite common. How common? Depending upon the source, approximately 20% to 22% of the population. In fact, there is even a diagnostic medical code for it (F40.231 for those interested).

Needle phobias are associated with health care avoidance. The result is that patients delay/defer/postpone medical and dental treatment over this. Based on our experience, we then see patients coming in severe pain – pain that has lasted for months – because they avoided treatment due to trypanophobia and/or odontophobia.

But phobic patients can get over their fears and get treatment done – under the right conditions.

How We Overcome Trypanophobia

As stated earlier, we can get you over your needle phobia using twilight sedation. But if you’re afraid of the needle, how do you get an IV in?

We get the IV in without you even knowing it. Here’s how:

  1. We give you a relaxing pill to take the morning before your appointment. This makes you super relaxed so by the time you arrive, half of your fear of needles is already gone.
  2. We begin to administer nitrous oxide. By itself, the nitrous makes you very relaxed. But combined with the relaxing pill, you won’t even feel us scanning your arm for veins.
  3. We place a little numbing agent (lidocaine to be exact) into the site.
  4. Next thing you know, the IV is in, and you didn’t even feel it. Nor did you care!

At this point, we are all ready to begin. We begin the sedation, and all the fears dissipate. It’s that simple.

Watch us Overcome Trypanophobia

Want to see us overcome this fear? See us get an IV in without a hitch. Watch this video:

Or you can view the video directly on YouTube or visit our amazing YouTube channel. We bet this video convinced you that we can overcome nearly any fear with sedation!

Request a painless IV start for sedation.Are you afraid of needles or the dentist? Interested in sedation? We are one of Connecticut’s most experienced sedation dentistry offices. Call us at (203) 799 – 2929 or visit this page to request an appointment.

Differences in Post-Operative Pain in Upper Versus Lower Wisdom Teeth Removal

In our dental office, we remove hundreds of wisdom teeth (a.k.a. third molars) per year. We perform all types of extractions – upper, lower, fully erupted, impacted, horizontal, etc. with our without IV sedation.

upper versus lower wisdom teeth which cause pain

Only 2 of these 4 third molars resulted in significant pain afterwards. Want to guess which ones? Surgery by Dr. Nicholas Calcaterra.

As part of our review of the procedure with our patients, we always discuss post-operative pain relief. And we invariably end up saying something to the effect of:

“When the numbing wears off, you’ll likely be pain free with the top extraction sites, but for the bottom, you’ll definitely need to take the pain medications”

When we see our patients a week later for a follow-up, we then get asked:

“I didn’t feel any pain during the procedure. But the next day, how come the top wisdom teeth removal didn’t hurt but the bottom ones did?”

There are many reasons why upper (also called maxillary) third molar extraction sites often give little post-operative pain but bottom (also called mandibular) extraction sites frequently do. Here are some of the key differences:

Differences in the Bone Holding in the Teeth

Teeth are held in your jaw because they are encased in bone. The bone holds them tightly in place. So it stands to reason that if some bone is denser and can hold the tooth in more securely, those teeth will be harder to remove. Right?

bone impacts why lower wisdom teeth hurt more

This photo of a human skull shows how teeth are held in place by bone.

The bone that holds upper wisdom teeth in place is neither dense nor strong. It can best be compared to Styrofoam. On the other hand, the bone that holds lower wisdom teeth is dense, thick, and strong. It can best be compared to pine wood.

So, if you have a tooth encased in either pine wood or Styrofoam, which do you think will require more effort to get out? Of course it’s the pine. So that extra strength that holds lower wisdom teeth in place – ends up resulting in greater effort to remove – and is one reason that makes lower wisdom teeth hurt more.

Dry Socket Occurs More Often with Bottom Wisdom Teeth

Dry socket, also known as alveolar osteitis, is a painful condition that can occur after any tooth extraction. Research has shown that the incidence of dry socket for all tooth extractions is 2%, but is seen 20% of the time for impacted lower wisdom teeth.

What this means is that, generally speaking, there is a 10 times greater likelihood of a dry socket with a lower wisdom tooth than an upper. This again is another reason why lowers can hurt more.

Different Types and Number of Injections

Some of the other reasons for the difference in post-operative pain include the number and site of injections.

To properly anesthetize an upper wisdom tooth, there are only a couple of injections needed. They are typically shallow and have high success rates. While one of the injections can be painful, it does not result in significant pain post-operatively.

mandibular nerve block lower third molar removal

A mandibular block injection for a lower third molar. The needle goes at least one inch deep through muscle. Expect at least two of these injections for a lower wisdom tooth extraction.

Conversely, lower wisdom will often need multiple injections, including a minimum of two that must penetrate at least an inch through muscle. And because lower wisdom teeth can have many nerves associated with them, it is not uncommon to need 5 or 6 separate injections.

If you received multiple injections into your leg through one inch of muscle until the needle hit bone versus two injections where the needle only went in an eighth of an inch, which would hurt more the next day?


After removal, there are empty sockets or holes where the teeth used to be. These holes are the perfect size for small pieces of food to accumulate. Significant accumulation of food can lead to delayed healing, infection, and pain.

Gravity ensures that the lower sockets accumulate much more food debris than the top. This is another reason why lower wisdom teeth surgery leads to more pain than the upper ones.

Proximity to Delicate Anatomy
Impacted lower wisdom tooth that will be painful the next day after removal

This impacted lower third molar is very close to a major nerve and artery.

Impacted lower wisdom teeth are often close to very important anatomical structures such as a major nerve and artery that supply the lower jaw, chin, and other areas. In order to avoid inadvertently damaging those structures, a slow approach is often taken.

The longer a surgical site it open and manipulated, the more post-op pain and swelling will result. And the greater a likelihood of infection.

While upper third molars have their own set of considerations and risks, it is very rare that such a slow approach must be taken. In the x-ray, the upper wisdom tooth took approximately 1 minute to remove, while the lower over 20 minutes.

Which site do you think hurt more the next day?

Exparel is Typically Used for Lower Wisdom Teeth

Have you heard about Exparel? Exparel is an opioid free pain management solution – designed to relieve pain after surgery. We use it in our office after extracting four wisdom teeth. For the most part, we administer it on the bottom.

The vast majority of studies – including this one – typically test the effectiveness for lower wisdom teeth. Why? Because the top ones typically don’t hurt as much.

put to sleep for third molar wisdom teeth removal and extraction.Do you need a wisdom tooth or teeth removed? Interested in a consult? Want IV sedation? Call us at (203) 799 – 2929 or visit this page for an appointment.


Lingual Frenectomies Aren’t Just for Kids!

lingual frenum that will need a frenectomy by a dentist

Large and restrictive lingual frenum in a teenage college student from Milford that we treated.

Most people, and especially those with kids, have heard of the term “tongue tie.” Tongue tie, more accurately called ankyloglossia, is an abnormality in which the tongue has very limited movement due to the attachment of the frenum. The frenum is the thin band of tissue that connects the tongue to the floor of the mouth. See the photo to the right of a typical adult tongue tie.

Severe cases of tongue tie are identified shortly after the infant is born. In those circumstances, tongue tie surgery – called a lingual frenectomy – is done early on. Failure to correct severe cases can lead to many issues including difficulty nursing, speech problems, and other problems.

However, in many patients, the frenal attachment is not so restrictive as to warrant immediate treatment. But, as those patients age, and their faces and other oral structures enlarge and mature, the frenum can then become a hindrance. Treatment is then indicated.

Before and After Laser Lingual Frenectomy Photos

These are before and after photos of a laser lingual frenectomy done in our office on a young, 20 something patient:

Before and after laser lingual frenectomy photogragh

Before and after photos showing a closeup of her tongue. This is 3 weeks after the procedure. Photos and laser surgery Dr. Nicholas Calcaterra.

In the above photos, you can see the pronounced frenum in the before picture. Notice how it is white? It is white because she is stretching her tongue with great force to allow us to even photograph it. In the after photo, it is relaxed, and her tongue is able to move much more.

laser tongue tie before and after photos

Prior to the laser tongue tie procedure, she could barely lick her lips. Now, she can extend her tongue beyond the borders of her lips. Surgery and photos Dr. Nicholas Calcaterra.

The above photo shows the degree to which her tongue mobility increased after the procedure with the laser. In this case, her mobility increased by approximately a half inch.

Reasons for a Lingual Frenectomy as an Adult

There are many reasons why teenagers and adults elect to have this procedure. This list is far from exclusive and each case is different:

  • Pain in the frenum while yawning.
  • Minor speech problems.
  • A feeling that you are unintentionally “spitting” while talking.
  • Rotation and/or crowding of the lower incisors.
  • Recession of the gum tissue on the tongue side of the front teeth where the frenum attaches to the floor of the mouth.
  • A desire to be able to lick your lips.
  • And many others…

Note that as a dental office, we can diagnose many issues related to the tongue and make treatment recommendations. But if there is a concern that the frenum is affecting the speech, we always recommend a consult with a Speech Language Pathologist.

While we perform many labial frenectomies, we do our fair share of tongue tie procedures. So, as you can see, lingual frenectomies aren’t just for kids!

Are you slightly tongue tied? Does your teenager or child have this issue? We routinely perform this procedure with our laser on patients of nearly all ages. Call us at (203) 799 -2929 or visit this page for more information.

Why Do I Have a Black Line Around My Crown?

Many times we see patients who ask us this very question:

photo of a black line at the gumline of a dental crown

Black line covered by bonding on this dental crown.

Why is there a black line at the gums with my crown?

As you can see on the photo to the right, there is a dental crown on an upper front tooth. In this case, because of an unsightly black line right where the crown meets the tooth, bonding was placed over it. Unfortunately, that didn’t make things look much better.

A black line at the margin of a dental crown can develop for many different reasons. Those reasons will be discussed in detail later on in this article.

But the most important point is that an ugly black line can be fixed!

Before and After Photos Fixing a Black Line

Don’t believe that you can fix these cases? Thing again! Let’s look at some before and after photos of patients we’ve helped:

Amazing before and after photo of fixing a black line on a dental crown

Before and after photo showing the dramatic fix of a black line around an old crown. With a new all ceramic crown (specifically an e.max crown), his smile was transformed immediately! Photos and dentistry Dr. Nicholas Calcaterra.

This patient of ours from West Haven lived for many years flashing this every time he smiled. He did not believe that it could be fixed. We believe we convinced him otherwise. What do you think?

Fixing it took extreme attention to detail and a new all ceramic crown. Note the shade match – it matches the adjacent teeth so well you can’t even tell it’s a crown!

Why Are There Black Lines?

You can see black lines for several different reasons. These can include:

  • Placement of a porcelain/metal crown in a way so that the underlying metal is visible. This could have been avoided with an all ceramic one.
  • Significant recession of the gum tissue following placement of the crown.
  • Significant darkening of the underlying tooth so that its shadow becomes visible under a very thin layer of porcelain.
  • Leakage and/or staining from an old filling on the tooth under the crown.
  • Caries (a.ka. decay or a cavity) that develops at the margin.
bad black lines on front tooth crowns

Black lines – along with brown colors – visible on these front crowns. We DID NOT do these crowns!

The above photo shows three front teeth. The black and brown originate from several factors – the use of porcelain/metal crowns, recession of the gums, and leakage/staining from old fillings. Ouch!

Black Lines Can be Fixed!

As the before and after photos show, nearly all cases of black lines can be corrected. To do so, your dentist first must understand why it occurred, and then he/she must pay extreme attention to every detail to correct it.

Are you unhappy with your front crowns? Interested in learning to see if we can improve the appearance? Call us at (203) 799 – 2929 or visit this page to request an appointment.