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ANewDentalPainManagementApproachReducestheNeedforNarcotics

Narcotics have long played an important role in easing severe pain caused by disease, trauma or treatment. Healthcare professionals, including dentists, continue to prescribe them as a matter of course.

But narcotics are also addictive and can be dangerous if abused. Although addictions often arise from using illegal drugs like heroin, they can begin with prescriptive narcotics like morphine or oxycodone that were initially used by patients for legitimate reasons.

As a result, many healthcare providers are looking for alternatives to narcotics and new protocols for pain management. This has led to an emerging approach among dentists to use non-addictive non-steroidal anti-inflammatory drugs (NSAIDs) as their first choice for pain management, reserving narcotics for more acute situations.

Routinely used by the public to reduce mild to moderate pain, NSAIDs like acetaminophen, ibuprofen or aspirin have also been found to be effective for managing pain after many dental procedures or minor surgeries. NSAIDs also have fewer side effects than narcotics, and most can be obtained without a prescription.

Dentists have also found that alternating ibuprofen and acetaminophen can greatly increase the pain relief effect. As such, they can be used for many more after-care situations for which narcotics would have been previously prescribed. Using combined usage, dentists can further limit the use of narcotics to only the most severe pain situations.

Research from the early 2010s backs up this new approach. A study published in the Journal of the American Dental Association (JADA) concluded that patients receiving this combined ibuprofen/acetaminophen usage fared better than those only receiving either one individually. The method could also match the relief power of narcotics in after care for a wide range of procedures.

The NSAID approach is growing in popularity, but it hasn't yet displaced the first-line use of narcotics by dental professionals. The hesitancy to adopt the newer approach is fueled as much by patients, who worry it won't be as adequate as narcotics to manage their pain after dental work, as with dentists.

But as more patients experience effective results after dental work with NSAIDs alone, the new approach should gain even more momentum. And in the end, it promises to be a safer way to manage pain.

If you would like more information on dental pain management, 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 “Are Opioids (Narcotics) the Best Way to Manage Dental Pain?

HowYouCanPreventTeethGrindingFromDamagingYourOralHealth

Life has changed dramatically over the centuries. But although our ancient forebears wouldn't recognize much of our modern world, they would be well acquainted with one particular oral habit that still persists. There's some evidence from archeological dental examinations that our ancestors also clenched or ground their teeth.

This habit of involuntarily gnashing, clenching or grinding the teeth together is most prevalent among children, although not considered a major problem at these younger ages. But it can continue into adulthood, as it does for one in ten people, and lead to an array of problems from worn teeth to jaw joint pain.

As to why adult teeth grinding occurs, researchers have proposed a number of possibilities. Some believe it may be related to the arousal response that occurs when a person passes through various stages of sleep. It also appears that certain psychoactive drugs can trigger it. But at the top of the cause list, teeth grinding is believed to be a physical outlet for stress.

Because of the possibility of multiple causes, there is no one method for treatment—instead, it's better to tailor treatments to the individual. Universally, though, patients who use drugs, alcohol or tobacco, all of which are considered contributing factors, may reduce grinding episodes by restricting their use of these substances.

It's also possible to reduce the incidence of teeth grinding through better stress management. People can learn and use individual relaxation techniques like meditation, mindfulness or biofeedback. For sleep-related teeth grinding it may also be helpful to forgo use of electronic devices before bedtime for a better night's sleep.

Dental treatments like an occlusal guard worn mainly during sleep can minimize the effects of nocturnal teeth grinding. This custom-made appliance prevents teeth from coming fully into contact with each other, thus lowering the intensity of the biting forces generated and preventing cumulative damage to teeth and dental work.

If you have symptoms like sore teeth and jaws, reports from your family hearing you grind your teeth, or catching yourself during the day clenching your teeth, make an appointment for a full examination. From there, we'll help you find the right combination of solutions to keep this old habit from complicating your oral health.

If you would like more information on teeth grinding, 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 “Teeth Grinding.”

By Art of Dentistry
April 13, 2021
Category: Oral Health
Tags: oral health  
4TipsforMaintainingHealthyToothEnamel

Enamel is the hardest substance in the human body, and for good reason—it's your teeth's first line of defense against wearing and harmful oral bacteria. But although enamel can “take a licking and keep on ticking,” it can lose its mineral content, soften and eventually erode to expose the teeth to bacteria.

Here are 4 tips for protecting your enamel so it keeps on protecting you.

Practice sound brushing techniques. Brushing is necessary for removing bacterial plaque that can trigger dental disease. But how you brush could prove not only ineffective, but also harmful to your enamel. So, be sure you're brushing all tooth surfaces, but not too forcefully or too often (twice a day is enough)—otherwise, you could wear down enamel and damage your gums.

Wait to brush after eating. The acid levels in the mouth go up during eating, causing an immediate softening of enamel. But saliva then goes to work neutralizing acid and helping to restore enamel's mineral content. Since it takes saliva about thirty minutes to an hour to complete this task, wait on brushing at least that long. Otherwise, you might remove tiny traces of temporarily softened enamel.

Avoid eating right before bed. While we sleep, our saliva flow decreases until we wake up. If you eat just before bed, you may not be giving your saliva enough time to neutralize acid before it “goes to sleep” with you for the night. So, give your saliva ample time to neutralize any remaining acid by not eating anymore at least an hour before you turn in.

Limit drinking acidic beverages. Some of our favorite drinks—sodas, energy and sports drinks, and even some juices—can be high in acid. To protect your enamel, reduce your consumption of these types of beverages in favor of water or milk (the calcium in the latter will also benefit your enamel). When you do drink acidic beverages, use a straw to minimize contact of the fluid with your enamel.

Healthy and strong enamel is the key to healthy and strong teeth. It's worth taking these steps to protect this important defense against destructive tooth decay.

If you would like more information on personal dental care, 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 “6 Tips to Help Prevent the Erosion of Tooth Enamel.”

SupermodelAshleyGrahamsUnpleasantDentalEncounterWithaFrozenCookie

Ashley Graham has a beautiful and valuable smile—an important asset to her bustling career as a plus-size model and television host. But she recently revealed on Instagram a “confrontation” between one of her teeth and a frozen oatmeal cookie. The cookie won.

Holding her hand over her mouth during the video until the last moment, Graham explained how she sneaked a cookie from her mom's freezer and took a bite of the frozen treat. Taking her hand from her mouth, she revealed her broken tooth.

Okay, maybe it wasn't an actual tooth that was broken: the denticle in question appeared to have been previously altered to accommodate a porcelain veneer or crown. But whatever was once there wasn't there anymore.

Although her smile was restored without too much fuss, Graham's experience is still a cautionary tale for anyone with dental work (and kudos to her for being a good sport and sharing it). Although dental work in general is quite durable, it is not immune to damage. Biting down on something hard, even as delicious as one of mom's frozen oatmeal cookies, could run you the risk of popping off a veneer or loosening a crown.

To paraphrase an old saying: Take care of your dental work, and it will take care of you. Don't use your teeth in ways that put your dental work at risk, tempting as it may be given your mouth's mechanical capabilities.

 Even so, it's unwise—both for dental work and for natural teeth—to use your teeth and jaws for tasks like cracking nuts or prying open containers. You should also avoid biting into foods or substances with hard textures like ice or a rock-hard cookie from the freezer, especially if you have veneers or other cosmetic improvements.

It's equally important to clean your mouth daily, and undergo professional cleanings at least twice a year. That might not seem so important at first since disease-causing organisms won't infect your dental work's nonliving materials. But infection can wreak havoc on natural tissues like gums, remaining teeth or underlying bone that together often support dental enhancements. Losing that support could lead to losing your dental work.

And it's always a good idea to have dental work, particularly dentures, checked regularly. Conditions in the mouth can change, sometimes without you noticing them, so periodic examinations by a trained dental provider could prevent or treat a problem before it adversely affects your dental work.

We're glad Ashley Graham's trademark smile wasn't permanently harmed by that frozen cookie, and yours probably wouldn't be either in a similar situation. But don't take any chances, and follow these common sense tips for protecting your dental work.

If you would like more information on care and maintenance of cosmetic dental work, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine articles “Porcelain Veneers: Strength & Beauty as Never Before” and “Dental Implant Maintenance.”

By Art of Dentistry
March 24, 2021
Category: Oral Health
Tags: osteoporosis  
CertainDrugsforOsteoporosisCouldImpactYourDentalCare

Osteoporosis is a serious bone weakening disease in older adults that can turn a minor fall into a major bone fracture. But the condition could also impact dental treatment—triggered ironically by the drugs used to treat osteoporosis rather than the disease itself.

From the Latin for “porous bone,” osteoporosis causes bone to gradually lose mineral structure. Over time the naturally-occurring spaces between mineralized portions of the bone enlarge, leaving it weaker as a result.

Although there's no definitive cure for osteoporosis, a number of drugs developed over the last couple of decades can inhibit its progress. Most fall into two major categories, bisphosphonates and RANKL inhibitors.

These drugs work by inhibiting the normal growth cycle of bone. Living bone constantly changes as cells called osteoblasts produce new bone. A different type, osteoclasts, clear away older bone to make room for these newer cells. The drugs selectively destroy osteoclasts so that the older bone, which would have been removed by them, remains for a longer period of time.

Retaining older cells longer initially slows the disease process. But there is a downside: in time, this older bone kept in place continues to weaken and lose vitality. In rare instances it may eventually become detached from its blood supply and die, resulting in what is known as osteonecrosis.

Osteonecrosis mostly affects two particular bones in the body: the femur (the long bone in the upper leg) and the jawbone. In regard to the latter, even the stress of chewing could cause osteonecrosis in someone being treated for osteoporosis. It can also occur after tooth extractions or similar invasive procedures.

If you're taking a bisphosphonate or RANKL inhibitor, you'll want to inform your dentist so that the necessary precautions can be taken before undergoing dental work more invasive than routine cleanings or getting a filling or crown.  If you need major dental work, your dentist or you will also need to speak with your physician about stopping the drug for a few months before and after a dental procedure to minimize the risk of osteonecrosis.

Fortunately, the risk for dental problems while undergoing treatment for osteoporosis is fairly low. Still, you'll want to be as prepared as possible so that the management of your osteoporosis doesn't harm your dental health.

If you would like more information on osteoporosis and dental health, 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 “Osteoporosis Drugs & Dental Treatment.”





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