Because the mouth is one of the most sensitive areas of the body, we go to great lengths to eliminate pain and discomfort associated with dental work. Anesthesia, both local and general, can achieve this during the actual procedure—but what about afterward while you’re recuperating?
While a few procedures may require prescription opioids or steroids to manage discomfort after a procedure, most patients need only a mild over-the-counter (OTC) pain reliever. There are several brands available from a group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs). NSAIDs like aspirin or ibuprofen work by blocking the release of prostaglandins into the body, which cause inflammation in tissues that have been damaged or injured.
Unlike their stronger counterparts, NSAIDs have fewer side-effects, cost less and aren’t addictive. And unlike opioids NSAIDs don’t impair consciousness, meaning patients can usually resume normal activities more quickly.
But although they’re less dangerous than opioids or steroids, NSAIDs can cause problems if taken at too strong a dose for too long. Its major side effect is interference with the blood’s clotting mechanism, known as “thinning the blood.” If a NSAID is used over a period of weeks, this effect could trigger excessive external and internal bleeding, as well as damage the stomach lining leading to ulcers. Ibuprofen in particular can damage the kidneys over a period of time.
To minimize this risk, adults should take no more than 2400 milligrams of a NSAID daily (less for children) and only for a short period of time unless directed otherwise by a physician. For most patients, a single, 400 milligram dose of ibuprofen can safely and effectively relieve moderate to severe discomfort for about 5 hours.
Some patients should avoid taking a NSAID: pregnant women, those with a history of stomach or intestinal bleeding, or heart disease (especially if following a daily low dose aspirin regimen). If you have any of these conditions or similar concerns, be sure you discuss this with your dentist before your procedure for an alternative method for pain management.
If you would like more information on managing discomfort after dental procedures, 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 Pain with Ibuprofen.”
Dental injuries result in thousands of visits to the emergency room every year, and many of these injuries occur while engaging in sports and recreational activities. Whether playing on an organized team or joining a spontaneous game with friends, athletes are much more likely to suffer a dental injury when not wearing a mouthguard. Five national dental organizations have joined together for National Facial Protection Month to urge athletes to use a mouthguard during both practice and games.
The American Dental Association and the Academy for Sports Dentistry recommend using mouthguards for over 30 sporting activities. While it comes as no surprise that mouthguards are recommended for football, hockey and basketball, the list also includes many activities that may not immediately come to mind—among them, surfing, ultimate frisbee, skateboarding, volleyball, skiing and bicycle riding.
In short, it’s wise to protect your smile while participating in any activity where your teeth may make contact with a hard surface. A properly fitted mouthguard can prevent injuries to the teeth, mouth and jaw, and may even help protect against head and neck injuries. Even those who participate in casual recreational activities should consider a mouthguard as an insurance policy against future pain and expense.
There are three types of mouthguards: a stock mouthguard that is bought ready to use from your neighborhood store, the “boil-and-bite” type that is formed to the mouth after being softened in hot water, and a custom-made mouthguard that is available from the dental office. Although any mouthguard is better than no protection at all, the best protection and most comfortable fit comes from a mouthguard that is custom-made by your dentist.
If you have questions about preventing dental injuries, please contact our office or schedule a consultation. You can learn more in the Dear Doctor magazine articles “Athletic Mouthguards” and “The Field-Side Guide to Dental Injuries.”
Ask people about the “Great American Smoke-Out,” and many could tell you about this annual promotion encouraging tobacco smokers to quit. Ask them about “The Great American Spit-Out,” though, and they may look puzzled. That’s because most of society’s attention is on quitting smoking; but the truth is smoking isn’t the only tobacco habit that needs to be kicked.
Whether chewing tobacco or the more finely ground snuff, smokeless tobacco is a popular habit especially among young athletes. It doesn’t receive the attention of smoking tobacco because it’s perceived as less dangerous. The truth is, though, it’s just as hazardous — especially to your oral health.
While any form of tobacco is considered a carcinogen, smokeless tobacco in particular has been linked to oral cancer. This is especially dangerous not only because oral cancer can lead to physical disfigurement and other negative outcomes, but it also has a dismal 58% survival rate five years from diagnosis.
And because it too contains highly addictive nicotine, smokeless tobacco can be just as difficult to quit as smoking. Fortunately, the same techniques for smoking cessation can work with chewing habits. Nicotine replacements like nicotine gum, lozenges and patches, as well as Zyban, a cessation medication, have all been shown helpful with quitting smokeless tobacco.
Often, however, it takes a change in perception — taking chewing tobacco down from its pedestal of “coolness” and seeing it for what it is: a dangerous habit that increases the risk of cancer, cardiovascular disease and even decreased sexual arousal and function. And although not life-threatening, it can also give you bad breath, dry mouth and an assortment of dental problems that incur financial and social costs. Teeth and gums in that environment aren’t so cool.
The first step is to consider the consequences of continuing the chewing or dipping habit and making the decision to quit. You may also benefit from the help of others: counselors experienced with tobacco cessation programs or a support group of others trying to quit. Following through aggressively will help ensure smokeless tobacco won’t lead to the loss of your teeth, health or life.
If you would like more information on quitting smokeless tobacco, 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 “Quitting Chewing Tobacco.”
Have you heard about dental sealants? These preventive treatments have been available for many decades, and more and more children are taking advantage of them. The National Institutes of Health (NIH) estimates that around 30% of kids from 6 to 11 years of age have had sealants applied to their molars (back teeth). Sealants are designed to reduce the incidence of cavities by filling in or eliminating the pits or crevices found in all molars, where decay-causing bacteria can hide and your brush can't reach. But do they really work?
Now, the research is in, and the answer is clear — YES!
Two major studies, each of which reviewed the results of thousands of patients over several years, recently came to the same conclusion: Dental sealants are effective at reducing cavities, and their benefits can last for four years (or more) after application. In general, the studies showed that kids who didn't get sealants were twice, three times, or even more likely to get cavities, compared to kids treated with sealants.
Sealants themselves are protective coatings made of plastic resins or glass-like materials. They are applied in liquid form, and then hardened by a special light. When “painted on” to the chewing surface of a molar, sealants fill in the tiny crevices, or “pits and fissures,” that are found there. Uneven tooth surfaces form a perfect breeding ground for the bacteria that cause tooth decay; worse yet, the bristles of a tooth brush can't usually reach them. That's what makes these areas highly susceptible to tooth decay.
Applying sealants is a quick and painless procedure that doesn't require any numbing shots or drilling. Many kids start getting sealants when the first permanent molars come in, around age 5 to 7; they may have more sealant treatments when additional molars emerge, between the ages of 11 and 14.
Sealants are recommended by the American Dental Association and the American Academy of Pediatric Dentistry, and have only a modest cost per tooth. On the other hand, having a cavity filled generally costs substantially more, and may result in more trouble (and expense) down the line — so sealants can make sense economically, as well as preventively. This is especially true for those at high risk for tooth decay.
If you have questions about dental sealants, please contact us or schedule a consultation. You can read more in the Dear Doctor magazine article “Sealants for Children,” and “Top 10 Oral Health Tips for Children.”
If you’re over age 30 there’s a fifty percent chance you have periodontal (gum) disease—and you may not even know it. Without treatment this often “silent” bacterial infection could cause you to lose gum coverage, supporting bone volume or eventually your teeth.
That’s not to say there can’t be noticeable symptoms like swollen, red, bleeding or painful gums. But the surest way to know if you have gum disease, as well as how advanced it is, is to have us examine your gums with manual probing below the gum line.
Using a long metal device called a periodontal probe, we can detect if you’ve developed periodontal pockets. These are gaps created when the diseased gum’s attachment to teeth has weakened and begun to pull away. The increased void may become inflamed (swollen) and filled with infection.
During an exam we insert the probe, which has markings indicating depths in millimeters, into the naturally occurring space between tooth and gums called the sulcus. Normally, the sulcus extends only about 1-3 mm deep, so being able to probe deeper is a sign of a periodontal pocket. How deep we can probe can also tell us about the extent of the infection: if we can probe to 5 mm, you may have early to mild gum disease; 5-7 mm indicates moderate gum disease; and anything deeper is a sign of advanced disease.
Knowing periodontal pocket depth helps guide our treatment strategy. Our main goal is to remove bacterial plaque, a thin film of food particles that collects on teeth and is the main cause and continuing fuel for the infection. In mild to moderate cases this may only require the use of hand instruments called scalers to manually remove plaque from tooth surfaces.
If, however, our periodontal probing indicates deeper, advanced gum disease, we may need to include surgical procedures to access these infected areas through the gum tissue. By knowing the depth and extent of any periodontal pockets, we can determine whether or not to use these more invasive techniques.
Like many other health conditions, discovering gum disease early could help you avoid these more advanced procedures and limit the damage caused by the infection. Besides daily brushing and flossing to remove plaque and regular dental checkups, keep watch for signs of swollen or bleeding gums and contact us for an appointment as soon as possible. And be aware that if you smoke, your gums will not likely bleed or swell—that could make diagnosis more difficult.
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 article “Understanding Periodontal Pockets.”
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