Posts for: April, 2020
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.
On the big screen, Australian-born actress Margot Robbie may be best known for playing devil-may-care anti-heroes—like Suicide Squad member Harley Quinn and notorious figure skater Tonya Harding. But recently, a discussion of her role in Peter Rabbit proved that in real life, she’s making healthier choices. When asked whether it was hard to voice a character with a speech impediment, she revealed that she wears retainers in her mouth at night, which gives her a noticeable lisp.
“I actually have two retainers,” she explained, “one for my bottom teeth which is for grinding my teeth, and one for my top teeth which is just so my teeth don't move.”
Clearly Robbie is serious about protecting her dazzling smile. And she has good reasons for wearing both of those retainers. So first, let’s talk about retainers for teeth grinding.
Also called bruxism, teeth grinding affects around 10 percent of adults at one time or another, and is often associated with stress. If you wake up with headaches, sore teeth or irritated gums, or your sleeping partner complains of grinding noises at night, you may be suffering from nighttime teeth grinding without even being aware of it.
A type of retainer called an occlusal guard is frequently recommended to alleviate the symptoms of bruxism. Typically made of plastic, this appliance fits comfortably over your teeth and prevents them from being damaged when they rub against each other. In combination with stress reduction techniques and other conservative treatments, it’s often the best way to manage teeth grinding.
Orthodontic retainers are also well-established treatment devices. While appliances like braces or aligners cause teeth to move into better positions, retainers are designed to keep teeth from moving—helping them to stay in those positions. After active orthodontic treatment, a period of retention is needed to allow the bite to stabilize. Otherwise, the teeth can drift right back to their old locations, undoing the time and effort of orthodontic treatment.
So Robbie has the right idea there too. However, for those who don’t relish the idea of wearing a plastic appliance, it’s often possible to bond a wire retainer to the back surfaces of the teeth, where it’s invisible. No matter which kind you choose, wearing a retainer can help keep your smile looking great for many years to come.
If you have questions about teeth grinding or orthodontic retainers, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “Teeth Grinding” and “The Importance of Orthodontic Retainers.”
Advanced tooth decay is a serious dental problem that can threaten an affected tooth's survival. But for decades now dentists have reliably used root canal treatment to better a decayed tooth's odds. This routine procedure performed with dental drill and special hand tools removes infected tissue inside a tooth and replaces the voids with a filling to prevent future infection.
But now there's a new way to perform a root canal—with a surgical laser. Lasers, amplified and focused light beams, aren't new to healthcare—they're an integral feature of many routine medical treatments and surgeries. But their use is relatively new to dentistry, and to endodontics (treating the interior of teeth) in particular.
Lasers can be used in root canal treatment to perform a number of tasks. They can remove diseased tissue and other debris from the innermost tooth pulp. They can be used to clean and shape root canal walls in preparation for filling. And they can also be used to soften and mold the filling material to fit more precisely within a tooth's particular root canal network.
Although laser-assisted root canal therapy isn't yet widespread, laser's limited use to date has given us a fair picture of both their advantages and disadvantages. As with other medical laser applications, lasers are very precise in removing diseased tissue without too much disruption of healthy tissue. There's less need for anesthesia than with dental drills, and lasers are a lot less noisy and jarring. Patients by and large experience less bleeding, as well as less discomfort or infection afterward.
But because laser light can only travel in a straight line, they're difficult to use in many tightly curved root canals. In these cases, the traditional methods are better suited, although a laser can be used in conjunction with other tasks. Temperature with lasers must also be carefully managed lest the high heat that's often generated damages natural tissues.
Although lasers won't be replacing traditional treatment methods for decayed teeth in the foreseeable future, there's hope they'll become more commonplace as technology and techniques continue to advance. Lasers can only improve what already is an effective means of saving teeth.
If you would like more information on treatments for advanced tooth decay, 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 “Laser-Assisted Root Canal Treatment.”