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.
When it comes to our children’s safety, there isn’t much nowadays that isn’t under scrutiny. Whether food, clothing, toys and more, we ask the same question: can it be harmful to children?
That also includes tried and true healthcare practices. One in particular, the routine x-ray, has been an integral part of dental care for nearly a century. As a means for detecting tooth decay much earlier than by sight, it has without a doubt helped save billions of teeth.
But is it safe for children? The reason to ask is because x-rays are an invisible form of electromagnetic radiation that can penetrate human tissue. As with other forms of radiation, elevated or frequent exposure to x-rays could damage tissue and increase the future risk of cancer.
But while there is potential for harm, dentists take great care to never expose patients, especially children, to that level or frequency of radiation. They incorporate a number of safeguards based on a principle followed by all healthcare professionals in regard to x-rays called ALARA, an acronym for “as low as reasonably achievable.” This means dentists and physicians use as low an exposure of x-ray energy as is needed to achieve a reasonable beneficial outcome. In dentistry, that’s identifying and treating tooth decay.
X-ray equipment advances are a good example of ALARA in action. Digital imaging, which has largely replaced film, requires less x-ray radiation for the same results than its older counterpart. Camera equipment has also become more efficient, with modern units containing lower settings for children to ensure the proper amount of exposure.
Dentists are also careful how often they take x-ray images with their patients, only doing so when absolutely necessary. As a result, dental patients by and large experience lower dosages of x-ray radiation in a year than they receive from natural radiation background sources found every day in the environment.
Dentists are committed to using x-ray technology in as safe and beneficial a way as possible. Still, if you have concerns please feel free to discuss it further with your dental provider. Both of you have the same goal—that your children have both healthy mouths and healthy bodies for the rest of their lives.
If you would like more information on x-ray safety for children, 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 “X-Ray Safety for Children.”
While the term “plastic surgery” might bring to mind face lifts or tummy tucks, not all procedures in this particular surgical field are strictly cosmetic. Some can make a big difference in a person’s health.
One example is periodontal plastic surgery, which corrects gum tissue loss around the teeth. Although these procedures can indeed improve appearance, they more importantly help save teeth.
Gum loss is most often a consequence of periodontal (gum) disease, a bacterial infection arising from a thin film of food particles on the teeth called dental plaque. As the disease weakens the gums’ attachment to teeth, they shrink back or recede, exposing the area around the roots. Without the protective cover the gums provide the roots, they become more susceptible to decay.
In milder cases of gum recession, treating the infection often results in the gums regaining their normal attachment to teeth. But with more advanced recession, natural gum healing may not be enough to reverse it. For such situations grafting donor tissue to the recessed area can help stimulate new tissue growth.
While gum tissue grafts can come from an animal or other human, the most likely source is from the person themselves. In one type of procedure, free gingival grafting, the surgeon locates and completely removes (or “frees”) a thin layer of skin resembling gum tissue, typically from the roof of the mouth, shapes it and then transplants it by suturing it to the recession site. Both donor and recipient sites heal at about the same rate in two to three weeks.
Another technique is known as connective tissue grafting. In this procedure the surgeon partially removes the donor tissue from its site while leaving a portion containing blood vessels intact. The palatal tissue is still used and transported to fit beneath the tissue that’s still attached to the blood supply. This connective tissue graft is then positioned and sutured to the recipient site while still maintaining its blood supply connection at the donor site. Maintaining this connection facilitates healing and increases the chances the graft will “take” and become firmly attached to the new site.
Grafting procedures require advanced techniques and skills. But with them we may be able to restore gum attachment to teeth with an impact on appearance and dental health that’s well worth the effort.
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 “Periodontal Plastic Surgery.”
Are bleeding gums something you should be concerned about? Dear Doctor magazine recently posed that question to Dr. Travis Stork, an emergency room physician and host of the syndicated TV show The Doctors. He answered with two questions of his own: “If you started bleeding from your eyeball, would you seek medical attention?” Needless to say, most everyone would. “So,” he asked, “why is it that when we bleed all the time when we floss that we think it’s no big deal?” As it turns out, that’s an excellent question — and one that’s often misunderstood.
First of all, let’s clarify what we mean by “bleeding all the time.” As many as 90 percent of people occasionally experience bleeding gums when they clean their teeth — particularly if they don’t do it often, or are just starting a flossing routine. But if your gums bleed regularly when you brush or floss, it almost certainly means there’s a problem. Many think bleeding gums is a sign they are brushing too hard; this is possible, but unlikely. It’s much more probable that irritated and bleeding gums are a sign of periodontal (gum) disease.
How common is this malady? According to the U.S. Centers for Disease Control, nearly half of allÂ Americans over age 30 have mild, moderate or severe gum disease — and that number increases to 70.1 percent for those over 65! Periodontal disease can occur when a bacteria-rich biofilm in the mouth (also called plaque) is allowed to build up on tooth and gum surfaces. Plaque causes the gums to become inflamed, as the immune system responds to the bacteria. Eventually, this can cause gum tissue to pull away from the teeth, forming bacteria-filled “pockets” under the gum surface. If left untreated, it can lead to more serious infection, and even tooth loss.
What should you do if your gums bleed regularly when brushing or flossing? The first step is to come in for a thorough examination. In combination with a regular oral exam (and possibly x-rays or other diagnostic tests), a simple (and painless) instrument called a periodontal probe can be used to determine how far any periodontal disease may have progressed. Armed with this information, we can determine the most effective way to fight the battle against gum disease.
Above all, don’t wait too long to come in for an exam! As Dr. Stork notes, bleeding gums are “a sign that things aren’t quite right.” Â If you would like more information about bleeding gums, please contact us or schedule an appointment. You can read more in the Dear Doctor magazine article “Bleeding Gums.” You can read the entire interview with Dr. Travis Stork in Dear Doctor magazine.
Repairing a decayed tooth may be as simple as removing the damaged tooth material and filling the void. Many filling materials can now match the color of a tooth, so the dental work is hardly noticeable.
Sometimes, though, the decay is too extensive or we've treated the tooth several times and it won't support another filling. If the tooth is still viable, we may be able to cover it with a custom crown.
Also known as a cap, a crown fits over and is securely affixed to the tooth with bonding material or cement. Crowns have been used for decades to restore teeth, but the materials they're made of have changed with time.
The original crowns were made of metal, usually gold or silver. They were strong and could hold up well to the daily forces produced by chewing or biting. They did, however, visually stand out and came to be regarded as unattractive. There were porcelain materials available that could closely mimic the life-likeness of teeth, but they could be weak and brittle.
Dentists came up with a hybrid crown that could supply strength as well as an attractive appearance. These were composed of two parts: an inner metal frame for strength overlaid with porcelain for appearance. These fused crowns were the most popular until the mid-2000s.
About that time, newer forms of porcelain came on the market that were not only attractive, but also durable. Although caution should still be taken when biting something hard, they've proven to stand up well to biting forces. Fused porcelain to metal is still in use, but usually for back teeth where biting forces are higher and the crown won't be as noticeable as on front teeth.
Crowns can also address cosmetic issues with chipped, fractured or excessively worn teeth. But with any crown you should be aware that much of the original tooth material must be removed to accommodate the fit. The altered tooth will require a crown or other restoration from then on. Crowns must also be custom-made by a dental technician in a process that can take weeks.
Still, the process can be well worth it. With proper care and maintenance, a crown could serve you and your smile well for many years to come.
If you would like more information on crowns and other restoration options, 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 “Crowns & Bridgework.”
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