Posts for: January, 2017
The old stereotype with the words “pain” and “dental work” in the same sentence is no more. Using local or general anesthesia (or a combination of both) we can completely eliminate the vast majority of discomfort during dental procedures.
But how do you manage pain in the days after a procedure while your mouth is healing? The news is good here as well — most discomfort after dental work can be easily managed with a family of medications known as non-steroidal anti-inflammatory drugs (NSAIDs). In most cases, you won't even need prescription strength.
You're probably already familiar with aspirin, ibuprofen and similar pain relievers for the occasional headache or muscle pain. These types of drugs work by blocking prostaglandins, which are released by injured tissues and cause inflammation. By reducing the inflammation, you also relieve pain.
Most healthcare providers prefer NSAIDs over steroids or opiates (like morphine), and only prescribe the latter when absolutely necessary. Unlike opiates in particular, NSAIDs won't impair consciousness and they're not habit-forming. And as a milder pain reliever, they have less impact on the body overall.
That doesn't mean, however, you don't have to be careful with them. These drugs have a tendency to thin blood and reduce its clotting ability (low-dose aspirin, in fact, is often used as a mild blood thinner for cardiovascular patients). Their use can contribute to bleeding that's difficult to stop. Excessive use of ibuprofen can also damage the kidneys.
That's why it's necessary to control the dosage and avoid long-term use of NSAIDs, unless advised by a physician. Most adults shouldn't take more than 2,400 milligrams a day of a NSAID and only during the few days of recuperation. There's no need to overdo it: a single 400-milligram dose of ibuprofen is safe and sufficient to control moderate to severe post-procedural pain for about five hours.
Our aim is to help you manage any pain after a procedure with the least amount of pain reliever strength necessary. That will ensure you'll navigate the short discomfort period after dental work safely and effectively.
If you would like more information on pain management after 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 “Treating Pain with Ibuprofen.”
If you've lost a tooth, you have a number of options for replacing it. Perhaps the best choice in terms of lifelikeness and durability is a dental implant.
All implants have the same basic architecture: a titanium metal post imbedded in the jawbone to replace the root; and an abutment, a metal collar that links the post with a lifelike porcelain crown. But implants can vary in how the crown attaches to the abutment and post — either cemented to the abutment or screwed through the abutment to the post.
Either method will permanently secure the crown to the implant. But there are advantages and disadvantages for each.
A screw-retained crown may better facilitate any future repair that might be needed. For a skilled dentist it's a simple matter of removing the screw and then the crown from the abutment. There's less risk of damage to the implant during repairs or crown replacement. Many dentists also prefer screws for crowns placed at the same time they're installing the implant post (a procedure called immediate loading).
The screw access hole, however, could pose a cosmetic problem. Although we can cover it over with tooth-colored filling, it may still be noticeable and unattractive especially for a tooth visible when you smile (in the smile zone). There's also the possibility the porcelain around the access hole could chip.
By contrast, cemented crowns have a smooth, unbroken surface and are aesthetically ideal for smile zone teeth. But the cement could interact poorly with gum and bone tissue in some patients, causing inflammation and possible bone loss.
And unlike screw-retained crowns, cemented crowns are difficult to remove for implant repair. We may have to drill through the crown to access the screw between the abutment and the post, and then repair it cosmetically if we use the same crown. Again, the final result may not be quite as visually appealing.
In the end, it will depend on the implant's location, how your body reacts to the cement or your dentist's preference. In either case, though, you'll have a tooth replacement that's functional, life-like and able to endure for many years to come.
If you would like more information on 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 “How Crowns Attach to Implants.”
Your teeth naturally wear as you age, but you may be making it worse if you grind your teeth.
Teeth grinding is a behavior that causes the teeth to gnash, grind or clench against each other generating forces greater than those produced from normal biting. These forces often result in tooth wear that cause not only functional problems but result in a more aged appearance. Grinding occurs while a person is awake, but most often episodes occur while asleep at night.
Teeth grinding is quite common in children, but not usually of great concern since most grow out of it. There's even a school of thought that teeth grinding might even help readjust an uneven bite.
Among adults, though, other factors seem to contribute to teeth grinding. Many researchers believe nighttime grinding occurs as a person passes through different sleep phases including deep REM (Rapid Eye Movement) sleep. It may also have a connection with chronic snoring.
Certain medications seem to contribute to teeth grinding, particularly psychoactive drugs like amphetamines. Nicotine falls in this category, which could be why tobacco users report twice the incidence of the habit compared to non-users. Teeth grinding is also connected to another fact of modern life: stress. People who grind their teeth tend to have higher levels of anxiety, hostility or depression.
Because there are multiple triggers, there are many treatment approaches. Whatever course we take, our aim is to eliminate or minimize those factors that contribute to your habit. For example, we can create a custom mouth guard for night wear to prevent the teeth from making solid contact and thus reduce the biting pressure.
Perhaps the most important thing is to control or reduce stress. This is particularly helpful at night to prepare you for restful sleep by changing some of your behaviors. We also encourage investigating other stress therapies like biofeedback, meditation or group therapy.
Whatever the means, bringing teeth grinding under control not only reduces problems now, but could also help prevent abnormal teeth wearing and future health issues down the road.
If you would like more information on causes and treatments for 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 “Stress & Tooth Habits.”
It takes only a short time neglecting your oral hygiene before you begin to notice some unpleasant things with your gums: swelling, redness or even bleeding. These are all signs of gingivitis, a periodontal (gum) disease that arises from bacterial plaque, a thin biofilm that builds up on tooth surfaces when a person doesn't brush or floss.
Fortunately, early stages of gingivitis can be treated effectively with comprehensive plaque removal during one or more office visits. If, however, it's not dealt with early, it can develop into something much more serious: acute necrotizing ulcerative gingivitis (ANUG). This form does more than leave you with unattractive teeth and gums and terrible breath — it could eventually cause you to lose your teeth.
ANUG is also known as trench mouth, a common ailment among front line World War I soldiers without access to proper dental care and hygiene. It's most prevalent today among individuals who are under a great deal of stress, not sleeping or eating well and haven't cleaned or properly cared for their teeth for an extended period of time. Tobacco smokers also seem more susceptible than non-smokers to the disease, perhaps because smoke dries the mouth and changes the bacterial environment.
Unlike common gingivitis, ANUG can be quite painful. In effect, the gum tissues begin to die (necrotize), especially the triangular peaks between teeth known as papillae. Besides the other symptoms of gingivitis, the tissues may become yellowish.
ANUG can be treated effectively. The first step is to relieve the symptoms of pain and inflammation through medication. The focus then shifts to treating the underlying cause, bacterial plaque. Besides plaque removal common in any treatment for gum disease, we may also need to initiate antibiotic therapy. Metronidazole is a common antibiotic that's been demonstrated effective against the specific bacterial strain associated with ANUG. We might also combine this with an antibacterial mouth rinse containing chlorhexidine.
The final step belongs to you: to keep ANUG or any other gum disease from reoccurring, it's important for you to adopt a daily regimen of brushing and flossing, along with regular dental visits for thorough teeth cleaning and checkups. Taking this proactive approach will help ensure you won't suffer from this painful and unattractive form of gingivitis again.
If you would like more information on acute gingivitis, 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 “Painful Gums in Teens & Adults.”
Unlike other tooth replacement options, dental implants require a surgical procedure. But don't let your imagination run wild — the procedure is relatively minor and easy for most people to undergo.
Implants are unique among restorations because they replace a tooth's root. A metal titanium post, substituting for the root, must be surgically placed into the jawbone. While the procedure itself is simple and no more involved than a tooth extraction, it does require careful attention to detail before, during and afterward.
Our first step is to examine the target site with x-rays (often CT scanning) to pinpoint the best location for placement. This is critical because where we place the implant will have a huge bearing on how attractive and natural the implant finally appears. From this evaluation we frequently create a surgical guide.
Surgery begins with a local anesthesia to completely numb the site. You will feel no pain during the procedure and only minimal discomfort for a few days afterward. We then make small incisions in the gums to access the bone and create a small channel or hole.
Using the surgical guide, we then initiate a drilling sequence that gradually increases the size of the channel until it's the size and shape of the implant post. One thing we must do at this point is take our time: we use gentle pressure and water-cooling to avoid overheating and damaging the bone.
Once we're finished with drilling we remove the implant from its sterile packaging and imbed it directly into the prepared channel. It's then a matter of verifying the location with x-rays and then closing the gum tissue with self-absorbing sutures if necessary.
Most patients only need mild pain medication like aspirin or ibuprofen to manage discomfort afterwards. You won't even notice it in a week or less. After several weeks in which the bone grows and adheres to the implant (a process called osseointegration), you'll be ready for the final step, attaching the life-like porcelain crown to the implant.
Although the process can take several weeks to months, your discomfort should be minimal at any stage. In the end, your patience will be rewarded with a new, more attractive smile.
If you would like more information on the process of obtaining 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 Surgery.”