Like other healthcare providers, dentists have relied for decades on the strong pain relief of opioid (narcotic) drugs for patients after dental work. As late as 2012, doctors and dentists wrote over 250 million prescriptions for these drugs. Since then, though, those numbers have shrunk drastically.
That’s because while effective, drugs like morphine, oxycodone or fentanyl are highly addictive. While those trapped in a narcotic addiction can obtain drugs like heroine illicitly, a high number come from prescriptions that have been issued too liberally. This and other factors have helped contribute to a nationwide epidemic of opioid addiction involving an estimated 2 million Americans and thousands of deaths each year.
Because three-quarters of opioid abusers began their addiction with prescription pain medication, there’s been a great deal of re-thinking about how we manage post-procedural pain, especially in dentistry. As a result, we’re seeing a shift to a different strategy: using a combination of non-steroidal anti-inflammatory drugs (NSAIDs), particularly ibuprofen and acetaminophen, instead of a prescribed narcotic.
These over-the-counter drugs are safer and less costly; more importantly, though, they don’t have the high addictive quality of an opioid drug. A 2013 study published in the Journal of the American Dental Association (JADA) showed that when two NSAIDs were used together, the pain relief was greater than either drug used individually, and better than some opioid medications.
That’s not to say dentists no longer prescribe opioids for pain management following dental work. But the growing consensus among dental providers is to rely on the double NSAID approach as their first-line therapy. If a patient has other medical conditions or the NSAIDs prove ineffective, then the dentist can prescribe an opioid instead.
There’s often hesitancy among dental patients on going this new route rather than the tried and true opioid prescription. That’s why it’s important to discuss the matter with your dentist before any procedure to see which way is best for you. Just like you, your dentist wants your treatment experience to be as pain-free as possible, in the safest manner possible.
Dental disease doesn’t discriminate by age. Although certain types of disease are more common in adults, children are just as susceptible, particularly to tooth decay.
Unfortunately, the early signs of disease in a child’s teeth can be quite subtle—that’s why you as a parent should keep alert for any signs of a problem. Here are 3 things you might notice that definitely need your dentist’s attention.
Cavities. Tooth decay occurs when mouth acid erodes tooth enamel and forms holes or cavities. The infection can continue to grow and affect deeper parts of the tooth like the pulp and root canals, eventually endangering the tooth’s survival. If you notice tiny brown spots on their teeth, this may indicate the presence of cavities—you should see your dentist as soon as possible. To account for what you don’t see, have your child visit your dentist at least twice a year for cleanings and checkups.
Toothache. Tooth pain can range from a sensitive twinge of pain when eating or drinking hot or cold foods to a throbbing sharp pain. Whatever its form, a child’s toothache might indicate advancing decay in which the infection has entered the tooth pulp and is attacking the nerves. If your child experiences any form of toothache, see your dentist the next day if possible. Even if the pain goes away, don’t cancel the appointment—it’s probable the infection is still there and growing.
Bleeding gums. Gums don’t normally bleed during teeth brushing—the gums are much more resilient unless they’ve been weakened by periodontal (gum) disease (although over-aggressive brushing could also be a cause). If you notice your child’s gums bleeding after brushing, see your dentist as soon as possible—the sooner they receive treatment for any gum problems the less damage they’ll experience, and the better chance of preserving any affected teeth.
Dental implants to replace teeth are a popular choice as much for their durability as their life-likeness. Most implants last for decades, which can result in lower long-term maintenance costs than other replacement options.
But to achieve this longevity, you must take care of your implants. You should brush and floss them daily right along with your remaining natural teeth — and continue regular semi-annual dental visits for cleanings and checkups.
You may be wondering, though: if they're made of inorganic materials, why worry with brushing them? It's true that bacterial plaque, the thin film of food particles most responsible for dental disease, doesn't affect them.
Your implants, though, don't exist in a bubble: they're imbedded in real bone, surrounded by real gum tissue and placed next to real teeth. All these other living tissues are susceptible to infection caused by plaque, even from plaque on non-organic implants.
The bone and tissues around an implant can even have a higher susceptibility to infection. This is because an implant's attachment in the jaw differs from that of natural teeth. An implant is imbedded directly into the bone; a natural tooth, on the other hand, maintains its hold through an elastic gum tissue between it and the bone called the periodontal ligament. Tiny fibers from the ligament attach to the tooth on one side and to the bone on the other.
Besides holding the tooth in place, the ligament also contains blood vessels that supply the tooth and surrounding tissues not only with nutrients but also antibodies that help fight infection. Due to the absence of a ligament connection, an implant doesn't enjoy the same level of protection from infection. Â It's much easier for tissues and teeth around an implant to become infected, and harder to stop it.
That's why prevention through daily hygiene is so important. So, be sure to brush and floss all your teeth — including implants — every day, and keep up your regular dental visits. And at the first sign of a possible infection — swollen, red or bleeding gums — see us as soon as possible for an examination.
Consider your implants a long-term investment in both your smile and dental health. Taking care of them will pay dividends for many years to come.
If you would like more information on taking care of your dental implants, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Dental Implant Maintenance.”
The human body’s immune system has amazing defensive capabilities. Without it a common cold or small wound could turn deadly.
One of the more important processes of the immune system is inflammation, the body’s ability to isolate diseased or injured tissue from unaffected tissue. Ironically, though, this vital component of the healing process could actually cause harm if it becomes chronic.
This often happens with periodontal (gum) disease, an infection of the gums caused by bacterial plaque built up on teeth due to inadequate hygiene, which in turn triggers inflammation. The infection is often fueled by plaque, however, and can become difficult for the body to overcome on its own. A kind of trench warfare sets in between the body and the infection, resulting in continuing inflammation that can damage gum tissues. Untreated, the damage may eventually lead to tooth and bone loss.
In treating gum disease, our main goal is to stop the infection (and hence the inflammation) by aggressively removing plaque and calculus (tartar). Without plaque the infection diminishes, the inflammation subsides and the gums can begin to heal. This reduces the danger to teeth and bone and hopefully averts their loss.
But there’s another benefit of this treatment that could impact other inflammatory conditions in the body. Because all the body’s organic systems are interrelated, what occurs in one part affects another especially if it involves inflammation.
It’s now theorized that reducing gum inflammation could lessen inflammation in other parts of the body. Likewise, treating other conditions like high blood pressure and other risk factors for inflammatory diseases could lower your risk of gum disease and boost the effectiveness of treatment.
The real key is to improve and maintain your overall health, including your teeth and gums. Practice daily brushing and flossing to remove plaque, and visit your dentist regularly for more thorough cleanings. And see your dentist at the first sign of possible gum problems like bleeding, redness or swelling. You’ll not only be helping your mouth you could also be helping the rest of your body enjoy better health.
If you would like more information on the relationship between gum disease and other systemic conditions, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “The Link between Heart & Gum Diseases.”
We’ve developed a number of effective treatments for periodontal (gum) disease. Depending on how far and deep a patient’s infection has advanced, treatment can be quite invasive and even require surgery. The more invasive, the longer and more uncomfortable the healing process can be.
But using a medical laser could make that less so. Although its use for gum disease treatment is still in its infancy, the latest observations from the field seem to show patients undergoing laser treatment may have less tissue trauma and bleeding, less discomfort after the procedure and quicker healing times.
Gum disease is a bacterial infection mostly caused by dental plaque, a thin film of food particles that build up on teeth in the absence of effective oral hygiene. The infection can advance deep below the gum line, weakening gum attachment to teeth and destroying supporting bone. Ultimately the affected teeth can be lost.
Traditionally, the only way to stop the disease is to manually remove plaque buildup on teeth and gum surfaces, which is continuing to sustain the infection, with special hand instruments called scalers or ultrasonic equipment. Because it’s important to remove as much plaque and diseased tissue as possible, we may need to perform a surgical procedure called flap surgery to move some of the gum tissues out of the way to get to these deeper areas. As with any surgery, this can create tissue trauma that may cause discomfort during the healing process.
Our new alternative is to use an Nd:YAG medical laser in a procedure known as Laser Assisted New Attachment Procedure or LANAP. With light energy delivered through a small fiber no more than the width of three human hairs, the laser can pinpoint diseased tissue and destroy bacteria through intense heat. Because of the laser beam’s tiny width and pulsing action, healthy tissue is at less risk for trauma than with the traditional treatment.
Coupled with other techniques, LANAP procedures could remove as much infected tissue and plaque as traditional methods, but with less healthy tissue trauma. In the future, then, patients with advanced gum disease undergoing laser treatment could have less bleeding and discomfort and faster healing times.
If you would like more information on treating gum disease, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Treating Gum Disease with Lasers.”
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