The ongoing opioid addiction epidemic has brought together government, law enforcement and healthcare to find solutions. The focus among doctors and dentists has been on finding ways to reduce the number of opioid prescriptions.
Opioids (or narcotics) have been a prominent part of pain management in healthcare for decades. Drugs like morphine, oxycodone or fentanyl can relieve moderate to extreme pain and make recovery after illness or procedures much easier. Providers like doctors and dentists have relied heavily on them, writing nearly 260 million narcotic prescriptions a year as late as 2012.
But although effective when used properly, narcotics are also addictive. While the bulk of overall drug addiction stems from illegal narcotics like heroin, prescription drugs also account for much of the problem: In 2015, for example, 2 million Americans had an addiction that began with an opioid prescription.
The current crisis has led to horrific consequences as annual overdose deaths now surpass the peak year of highway accident deaths (just over 54,000 in 1972). This has led to a concerted effort by doctors and dentists to develop other approaches to pain management without narcotics.
One that’s gained recent momentum in dentistry involves the use of non-steroidal anti-inflammatory drugs (NSAIDs). NSAIDs like acetaminophen, ibuprofen or aspirin work by dilating blood vessels, which reduces painful inflammation. They’re available over the counter, although stronger doses require a prescription.
NSAIDs are effective for mild to moderate pain, but without the addictive properties of narcotics. There are some adverse health consequences if taken long-term, but limited use for pain or during post-procedure recovery is safe.
Many dentists are recommending NSAIDs for first-line pain management after most dental procedures. Narcotics may still be prescribed, but in a limited and controlled fashion. As part of this new approach, dentists typically combine ibuprofen and acetaminophen: Studies have shown the two work together better at reducing pain than either one individually.
Still, many aren’t eager to move away from the proven effectiveness of narcotics to primarily NSAIDs. But as these non-addictive drugs continue to prove their effectiveness, there’s hope the use of addictive opioids will continue to decrease.
Sometimes you need only a single solution to improve your smile: teeth whitening to brighten stained teeth; porcelain veneers or crowns to mask dental flaws; or a life-like dental implant to replace a missing tooth. But not all dental situations are that simple and sometimes require a combination of treatments.
A case in point: restoring a missing tooth within a poor bite. The absent tooth itself may be the cause of the bite problem if it’s been missing for some time: The nearby teeth tend to move or “drift” into the empty space, leaving no room for implant placement.
When this happens, you’ll first need orthodontic treatment to correct the bite problem. Not only will this open the space for the implant, it also comes with its own benefits. It obviously improves your smile appearance—but straighter teeth are also easier to keep clean of bacterial plaque, which reduces your disease risk. You may also experience better digestion after your teeth are properly aligned and able to function as they should during eating.
The traditional way to improve a bite is through metal braces. But there are some downsides: For one, braces can make it difficult to keep teeth adequately clean, making wearers more susceptible to tooth decay and gum disease. Braces are also quite visible and can detract from a person’s appearance (even more so if a missing tooth is involved).
Unless your situation requires braces, you can choose clear aligners as an alternative. These clear, computer-generated plastic trays are worn in sequence to gradually move teeth to their desired positions. Unlike braces, you can remove aligners for eating, cleaning or rare special occasions. And, they’re barely noticeable to others.
If you also have a missing tooth, you can have a temporary prosthetic (“false”) tooth built into your aligner trays. In this way you can still enhance your smile while undergoing aligner treatment.
Once your bite has been corrected, we can then proceed with restoring your missing tooth permanently with a dental implant. Although orthodontics adds to the time and expense of restoration, its often necessary to achieve the best result. Your future smile will be the better for it.
How many actresses have portrayed a neuroscientist on a wildly successful TV comedy while actually holding an advanced degree in neuroscience? As far as we know, exactly one: Mayim Bialik, who plays the lovably geeky Amy Farrah Fowler on CBS' The Big Bang Theory… and earned her PhD from UCLA.
Acknowledging her nerdy side, Bialik recently told Dear Doctor magazine, “I'm different, and I can't not be different.” Yet when it comes to her family's oral health, she wants the same things we all want: good checkups and great-looking smiles. “We're big on teeth and oral care,” she said. “Flossing is really a pleasure in our house.”
How does she get her two young sons to do it?
Bialik uses convenient pre-loaded floss holders that come complete with floss and a handle. “I just keep them in a little glass right next to the toothbrushes so they're open, no one has to reach, they're just right there,” she said. “It's really become such a routine, I don't even have to ask them anymore.”
As many parents have discovered, establishing healthy routines is one of the best things you can do to maintain your family's oral health. Here are some other oral hygiene tips you can try at home:
Brush to the music — Plenty of pop songs are about two minutes long… and that's the length of time you should brush your teeth. If brushing in silence gets boring, add a soundtrack. When the music's over — you're done!
Flossing can be fun — If standard dental floss doesn't appeal, there are many different styles of floss holders, from functional ones to cartoon characters… even some with a martial-arts theme! Find the one that your kids like best, and encourage them to use it.
The eyes don't lie — To show your kids how well (or not) they are cleaning their teeth, try using an over-the-counter disclosing solution. This harmless product will temporarily stain any plaque or debris that got left behind after brushing, so they can immediately see where they missed, and how to improve their hygiene technique — which will lead to better health.
Have regular dental exams & cleanings — When kids see you're enthusiastic about going to the dental office, it helps them feel the same way… and afterward, you can point out how great it feels to have a clean, sparkling smile.
Osteoporosis is a major health condition affecting millions of people, mostly women over 50. The disease weakens bone strength to the point that a minor fall or even coughing can result in broken bones. And, in an effort to treat it, some patients might find themselves at higher risk of complications during invasive dental procedures.
Over the years a number of drugs have been used to slow the disease’s progression and help the bone resist fracturing. Two of the most common kinds are bisphosphonates (Fosamax) and RANKL inhibitors (Prolia). They work by eliminating certain bone cells called osteoclasts, which normally break down and eliminate older bone cells to make way for newer cells created by osteoblasts.
By reducing the osteoclast cells, older bone cells live longer, which can reduce the weakening of the bone short-term. But these older cells, which normally wouldn’t survive as long, tend to become brittle and fragile after a few years of taking these drugs.
This may even cause the bone itself to begin dying, a relatively rare condition called osteonecrosis. Besides the femur in the leg, the bone most susceptible to osteonecrosis is the jawbone. This could create complications during oral procedures like jaw surgery or tooth extractions.
For this reason, doctors recommend reevaluating the need for these types of medications after 3-5 years. Dentists further recommend, in conjunction with the physician treating osteoporosis, that a patient take a “drug holiday” from either of these two medications for several months before and after any planned oral surgery or invasive dental procedure.
If you have osteoporosis, you may also want to consider alternatives to bisphosphonates and RANKL inhibitors. New drugs like raloxifene (which may also decrease the risk of breast cancer) and teriparatide work differently than the two more common drugs and may avoid their side effects. Taking supplements of Vitamin D and calcium may also improve bone health. If your physician still recommends bisphosphonates, you might discuss newer versions of the drugs that pose less risk of osteonecrosis.
Managing osteoporosis is often a balancing act between alleviating symptoms of the disease and protecting other aspects of your health. Finding that balance may help you avoid future problems, especially to your dental health.
If you would like more information on osteoporosis and 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 “Osteoporosis Drugs & Dental Treatment.”
While not as prevalent as adults, teenagers can have missing teeth, usually from injury or from never having been formed. Fortunately, life-like dental implants can replace missing teeth. But unfortunately for teens, implants aren't usually a good option—yet.
That's because a teenager's jaws are still growing, and will continue until early adulthood. Dental implants don't adjust to this growth like natural teeth and will eventually look out of place. It's best, then, to consider a temporary restoration for a teenager. And, there are two excellent options: one removable and one fixed.
The first is a removable partial denture (RPD). Like a full denture, an RPD has an acrylic base that resembles gum tissue, to which prosthetic (false) teeth are attached to match the positions of the missing teeth. It's usually held in place with metal or nylon clips that slide under part of the natural teeth at the gum line.
RPDs are versatile and durable. But they're not designed to be worn indefinitely, so they can be damaged if subjected to excessive biting forces like biting into something hard. And, peer-pressured teens may also feel self-consciousness about wearing a “denture.”
The other option is a bonded bridge. It's similar to a traditional bridge, except how it's supported in the mouth. A traditional bridge gains its support from the crowns on each end attached to natural teeth, which must be permanently altered for them. By contrast, a bonded bridge has strips of dental material extending from both sides of its back that are bonded to the back of the adjacent natural teeth.
With the bonding material behind the bridge, it can't be seen—and the natural teeth won't require permanent alteration. But a bonded bridge is usually more costly than an RPD and less secure than a traditional bridge. And not every teen is a viable candidate for one: issues like how the teeth fit together and if the teen has a tooth grinding habit could be strikes against this fixed option.
Your dentist can help you sort out the best of these options for your teen. If cared for and maintained properly, either restoration can buy you time until your teen is ready for dental implants.
If you would like more information on restoring a teenager's smile, 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 “Temporary Tooth Replacement for Teens: What Are the Options?”
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