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.”
Porcelain veneers are a great way to enhance an unattractive smile. But are they appropriate for teenagers? The answer usually depends on a patient’s current development stage and the type of veneer used.
Veneers are thin layers of porcelain bonded to the front of teeth. But even though quite thin, they can appear bulky if we don’t first remove some of the tooth’s enamel surface. This is irreversible, so the tooth may require a restoration from then on.
This could be a major issue for teens whose permanent teeth are still developing. During this period the tooth’s central pulp is relatively large and the dentin layer not fully developed. As a result, the pulp’s nerves are often closer to the surface than in an adult tooth. This increases risk of nerve damage during veneer preparation; if nerve damage occurs, the tooth could ultimately require a root canal treatment to save it.
On the other hand, some types of veneers don’t require tooth alteration (or only very little) beforehand. These “no-prep” or “minimal prep” veneers are best for certain situations like abnormally small teeth, so we must first determine if using such a veneer would be appropriate for your teen.
In effect, we’ll need to weigh these and other factors before determining if veneers are a safe choice for your teen. That being the case, it may be more advisable to consider more conservative cosmetic techniques first. For example, if enamel staining is the main issue, you could consider teeth whitening. Although the often amazing results eventually fade, whitening could still buy some time until the teeth have matured to safely apply veneers.
Slight deformities like chipping can often be corrected by bonding tooth-colored composite material to the tooth. In artistic hands it’s even possible to create a full veneer effect with very little if any tooth preparation. How much we can apply, though, depends on tooth size, and it won’t be as durable as a porcelain veneer.
With that said, veneers could be the right solution to enhance your teen’s smile. But, we’ll need to carefully consider their dental situation to ensure their new smile remains a healthy one.
It’s a common sight to see someone wearing braces—and not just teens or pre-teens. In the last few decades, people in their adult years (even late in life) are transforming their smiles through orthodontics.
If you’re an adult considering treatment to straighten your teeth, this particular dental specialty might be an unfamiliar world to you. Here are 3 things you may not know about orthodontics.
Orthodontic treatment cooperates with nature. There would be no orthodontics if teeth couldn’t move naturally. Teeth are actually held in place by an elastic tissue called the periodontal ligament that lies between the teeth and bone. Small fibers from the ligament tightly attach to the teeth on one side and to the bone on the other. Although it feels like the teeth are rigidly in place, the ligament allows for micro-movements in response to changes in the mouth. One such change is the force applied by orthodontic appliances like braces, which causes the bone to remodel in the direction of the desired position.
Treatment achieves more than an attractive smile. While turning your misaligned teeth into a beautiful, confident smile is an obvious benefit, it isn’t the only one. Teeth in proper positions function better during chewing and eating, which can impact digestion and other aspects of health. Misaligned teeth are also more difficult to keep clean of bacterial plaque, so straightening them could help reduce your risk of tooth decay or periodontal (gum) disease.
Possible complications can be overcome. Some problems can develop while wearing braces. Too much applied force could lead to the roots dissolving (root resorption), which could make a tooth shorter and endanger its viability. Braces can also contribute to a loss of calcium in small areas of tooth enamel, which can make the teeth more vulnerable to oral acid attack. However, both these scenarios can be anticipated: the orthodontist will watch for and monitor signs of root resorption and adjust the tension on the braces accordingly; and diligent oral hygiene plus regular dental cleanings will help prevent damage to the tooth enamel.
If you’re dreaming of a straighter and healthier smile, see us for a full examination. We’ll then be able to discuss with you your options for transforming your smile and your life.
If you would like more information on orthodontic treatment, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor article “Moving Teeth with Orthodontics.”
Once upon a time, celebrities tried hard to maintain the appearance of red-carpet glamour at all times. That meant keeping the more mundane aspects of their lives out of the spotlight: things like shopping, walking the dog and having oral surgery, for example.
That was then. Today, you can find plenty of celebs posting pictures from the dentist on social media. Take Julianne Hough, for example: In 2011 and 2013, she tweeted from the dental office. Then, not long ago, she shared a video taken after her wisdom teeth were removed in December 2016. In it, the 28-year-old actress and dancer cracked jokes and sang a loopy rendition of a Christmas carol, her mouth filled with gauze. Clearly, she was feeling relaxed and comfortable!
Lots of us enjoy seeing the human side of celebrities. But as dentists, we’re also glad when posts such as these help demystify a procedure that could be scary for some people.
Like having a root canal, the thought of extracting wisdom teeth (also called third molars) makes some folks shudder. Yet this routine procedure is performed more often than any other type of oral surgery. Why? Because wisdom teeth, which usually begin to erupt (emerge from beneath the gums) around age 17-25, have the potential to cause serious problems in the mouth. When these molars lack enough space to fully erupt in their normal positions, they are said to be “impacted.”
One potential problem with impacted wisdom teeth is crowding. Many people don’t have enough space in the jaw to accommodate another set of molars; when their wisdom teeth come in, other teeth can be damaged. Impacted wisdom teeth may also have an increased potential to cause periodontal disease, bacterial infection, and other issues.
Not all wisdom teeth need to be removed; after a complete examination, including x-rays and/or other diagnostic imaging, a recommendation will be made based on each individual’s situation. It may involve continued monitoring of the situation, orthodontics or extraction.
Wisdom tooth extraction is usually done right in the office, often with a type of anesthesia called “conscious sedation.”Â Here, the patient is able to breathe normally and respond to stimuli (such as verbal directions), but remains free from pain. For people who are especially apprehensive about dental procedures, anti-anxiety mediation may also be given. After the procedure, prescription or over-the-counter pain medication may be used for a few days. If you feel like singing a few bars, as Julianne did, it’s up to you.
If you would like more information about wisdom tooth extraction, please call our office to arrange a consultation. You can learn more in the Dear Doctor magazine articles “Wisdom Teeth” and “Removing Wisdom Teeth.”
One of the most important revolutions in healthcare in recent decades is the increasing use of lasers. Now, laser technology is making a showing in dental care for the treatment of periodontal (gum) disease.
Lasers (an acronym for "Light Amplification by Stimulated Emission of Radiation") narrowly focus and amplify light within a small area. First developed in the early 1960s, laser technology rapidly advanced in the ensuing decades with more compact and precise devices that were eventually safe and effective for many types of medical procedures. Its remarkable features are now available for the primary focus of gum disease treatment—removing bacterial plaque.
Plaque is a thin, built-up film of bacteria and food particles on tooth and gum surfaces that serves as a haven for the bacteria that cause gum disease. The continuing presence of plaque and calculus (tartar) enables the infection to thrive and advance within the gum tissues, ultimately damaging them along with supporting bone. As the tissues weaken and bone volume diminishes, the teeth are at greater risk for loss.
It's necessary, therefore, first and foremost to remove all detectable plaque and calculus to stop the infection. This is traditionally done with special hand tools called scalers used to manually remove plaque, or with ultrasonic equipment that vibrates plaque loose to be flushed away with water. These procedures can take numerous sessions and may result in some minor post-procedural discomfort and bleeding during the cleaning.
But lasers specifically designed for plaque removal can minimize tissue damage and resulting discomfort. Because the particular laser light used reacts only with plaque and diseased tissue, it can remove them without disturbing nearby healthy tissue usually more efficiently than traditional scaling. Dentists who've used the technology frequently report less bleeding and higher patient satisfaction.
But before lasers for gum disease treatment are widely adopted, the procedure must undergo further scrutiny. Reports from dentists notwithstanding, not enough research studies have been performed to date that meet the necessary scientific criteria. But if the evidence so far from the field holds up, it's quite possible lasers will one day become a regular part of dental practice for treating gum disease.
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 “Lasers Versus Traditional Cleanings for Treating Gum Disease.”
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