Helping To Curtail Opioid Misuse

Posted on Mar 23, 2023 by William J. Claiborne, DDS MS

No one wants to be in pain. In the dental office, dentists and dental specialists see many patients enduring a great deal of pain, some of which increases in time to excruciating levels.

To resolve the pain, treating the affected area is the first step. Healing can take time and may involve a period of continued discomfort. While a dental profession wants to help patients avoid problems and pain that can arise from them, helping you get through painful periods with ease is certainly a priority.

Like others in the health care field, the field of dentistry has become rather resistant to prescribing harsh and addictive painkillers. The opioid epidemic in the U.S. is running rampant and we want to do our part in curtailing the availability of these meds.

I felt it may be helpful to share some statistics and research findings on the opioid use in America. Hopefully, this information will reassure that the dental profession is not being “stingy” with prescribing painkillers. We are trying to help control what can easily be misused or over-prescribed.

Drug overdose deaths involving prescription opioids rose from 3,442 in 1999 to 17,029 in 2017. From 2017 to 2019, the number of deaths declined to 14,139. This was followed by a slight increase in 2020, with 16,416 reported deaths. In 2021, the number of reported deaths involving prescription opioids totaled 16,706. These numbers are headed in the wrong direction, obviously.

Although physicians, dentists and others in health care have been under close scrutiny for the number of opioids prescribed, dentists are also being more diligent in limiting patient access to pain medications. Yet, there is still a concerning number who make access easier than it should be.

According to International Association for Dental Research findings shared from two studies amongst dentists and oral-maxillofacial surgeons (OMFS) (presented in March 2023), the goal is to identify high prescribers of opioids. The study, conducted at the University of Pittsburgh, used data to detect actively prescribing dentists between 2015-2019.

The study found that during this period, 2,741,030 opioids were prescribed by 199,145 dentists/OMFS. Researchers noted that over 35% of prescribers prescribed at low rates in 2015 with this percentage falling to nearly 18% in 2019. In this period, those who were “moderate” prescribers of opioids also decreased prescribing by over 82%. A slightly more active group of prescribers also decreased their number of these prescriptions.

However, 3.5% of prescribers found to be consistent in opioid prescriptions decreased in number, yet with minimal decline. For these, the rate in 2015 averaged nearly 55%. In 2019, the average was only down to 44.7%.

A particular concern in prescribing opioids is that of prescriptions submitted for children. While total opioid prescriptions have decreased in patients under 25 years of age, trends in opioid prescribing for children, adolescents, and younger adults (under 25 years of age) remains a concern.

In a study from 2013 – 2018, researchers found the opioid dispensing rate for younger patients decreased annually at a rate of approximately 15%. The largest decreases were noted for patients ages 15 to 24 years. Among children aged 0 to 5 years for whom an opioid was dispensed, the investigators observed annual increases from 2011 to 2014. For high-dosage prescriptions, these decreased from 2014 to 2018 although high-dosage, extended-release or long-acting remained at a concerning rate — nearly 28%.

Even amid an epidemic of abuse, opioid painkillers are still commonly prescribed to teenagers and young adults for conditions like tooth and back pain. Between 2005 and 2015, opioids were prescribed to teens and college-age adults at nearly 57 million visits to doctors’ offices and emergency departments.

Although more common in an ER, 15% of visits concluded with an opioid prescription with only a small decline over the 10-year study period.

A report on opioid prescription misuse by the University of Michigan shared another concern that contributes to the problem. When people get a prescription for opioid painkillers to ease pain, it is assumed that the patient has it filled right away. However, there are now findings that show some of these prescriptions are being filled more than a month later, long after acute pain should have subsided.

In 2019, 1% of opioid prescriptions from dentists and surgeons were filled more than 30 days after writing. Although the number is low, that percentage equates to more than 260,000 opioid prescriptions a year in the U.S.

This indicates to prescribing surgeons and dentists that the medications are being used for other than intended. Whether over-prescribed by the doctor or misuse by the patient, this adds to the risk factor for opioid overdose.

These delayed-fill findings have led to call for state and federal laws to better regulate the expiration periods for filling these prescriptions. Changing the systems of monitoring along these lines has been slow in coming. In 2019, 18 states allowed prescriptions for opioids and other controlled substances to be filled up to 6 months after writing with 8 states allowing dispension up to 1 year after the prescription date.

The entire team at our Asheville periodontal dental office is highly committed to providing patients with optimal comfort throughout treatment. Here, we make oral sedation available as well as I.V. sedation (“twilight sleep”). These help patients to relax fully or snooze during treatment, erasing most (or all) memory of treatment afterward.

We also want our patients to heal comfortably after periodontal treatment or dental implant placement. As a periodontist, this is helped by being respectful of gum tissues and all areas in the mouth DURING procedures. We work with each patient to help them remain comfortable during their post-procedure time. Often, this can occur without the need for heavy medications with many patients only requiring OCT pain meds.

When it comes to your treatment, our advanced imaging technology helps us to pinpoint precise areas for incisions, which helps to minimize discomfort and speed healing time. Additionally, performing treatment at an easy pace allows for minimal disruption to sensitive gum tissues.

A periodontist has advanced skills in the treatment of all stages of gum disease, the re-contouring of gum tissues, and in the placement of dental implants. This dental specialist can help provide an optimal result while helping you enjoy the highest level of comfort – during and after treatment.

Please call 828-274-9440 if you have questions about comfort, treatment, or dental fear. New patients are always welcome and a referral is not always needed.

 

When Dentures Are “Slippery,” “Wobbly, or “Rocky”…

Posted on Mar 11, 2023 by William J. Claiborne, DDS MS

A periodontal specialist has advanced training in the selection and placement of all dental implant types. Also a specialist in the treatment of all stages of periodontal (gum) disease and the contouring of gum tissues (such as to correct a “gummy smile”), many patients who come to us have lost teeth due to gum disease.

Gum disease is the nation’s leading cause of adult tooth loss. Sadly, over 47% of Americans over the age of 30 have some level of gum disease. Many do not realize they have developed gum disease since it can begin without obvious symptoms.

Periodontitis is the advanced stage of gum disease. Its symptoms are hard to ignore. Breath odor is putrid. The gums bleed easily, at times even when eating. The gums are a dark red and may have a spongy texture. Some teeth may loosen or shift. Pus pockets form around the base of some teeth.

In this advanced stage, some (or all) natural teeth may require removal. For those who choose to replace teeth with a denture or partial (versus dental implants), something occurs below the gums that cannot be seen. However, over time, the repercussions can be quite severe.

What I’m referring to is “resorption.” This is the term used for a shrinking jaw bone.

Resorption occurs when natural tooth roots are no longer present in the jaw bone. These tooth roots actually help to provide stimulation to the bone. Tooth roots also nourish the bone mass through connective tissues that extend down through a tooth’s interior.

When a tooth is removed, the stimulation and nourishment to that area of the jaw bone is taken away. Without it, the bone begins to shrink. As it declines in height, the adjacent teeth are more vulnerable to loss. Statistics show that teeth neighboring areas where natural teeth are missing will be the most likely to be lost next.

Although a denture or partial can mimic the presence of teeth above the gum line, there is nothing to keep the jaw bones healthy beneath, which is the sturdy foundation for biting and chewing strength. As tooth loss continues, one can go from losing a few teeth to losing all teeth (being “edentulous”).

Many people are unaware that the pressure of wearing dentures or partials accelerates the pace of resorption. For people who sleep in their dental prosthetic, the 24/7 pressure applied to the jaw bones speeds up the rate of bone decline even more.

Sleeping in a denture can also add to higher risks for the flu and pneumonia. A 3-year study of more than 500 adults was published by the Journal of International Oral Health. Of the 186 (of 453 denture wearers) who did not remove their dentures for sleeping, they had over twice the risk for pneumonia than those who did. Sleeping in dentures also led to higher levels of tongue and denture plaque, gum inflammation and other oral issues.

For those who wear a denture or partial, losing jaw bone mass also causes a change in the way the denture or partial fits. For example, a denture may fit fine the first year after teeth are removed and a denture is custom-fitted. However, people eventually notice slips when biting or chewing. This is because the bone under the “arch” that supports the denture or partial is declining in height.

The changing foundation for the denture (also known as a ridge) allows it to “slip” or become “wobbly.” As bone loss continues, it causes uncomfortable rubbing on tender gums while eating.

As a result, people often adjust their diet to avoid foods that require rigorous chewing, opting for softer foods that require less chewing. Outings with friends and family become overshadowed by the fear of embarrassing slips.

Eventually, even frequent applications of denture pastes or adhesives are of little help. A reline may be recommended by your dentist to reshape the contours of the denture or partial to the slowly declining arch. Unfortunately, this process will continue as bone loss requires periodic relines as the arch flattens further.

The solution?

For most individuals who are missing one or more natural teeth, we advise replacing teeth with dental implants. A dental implant recreates the presence of a natural tooth. It provides stimulation to the bone, halting the process of bone loss.

Dental implants do not rely on neighboring teeth for support, as in a crown-&-bridge combination. The crowning of bordering natural teeth to support a bridge is not needed. Thus, the integrity of surrounding teeth is protected.

Because dental implants are supported by the jaw bone, sturdy and dependable biting and chewing strength is restored. Eating a healthy diet of the foods you love is again possible.

And, dental implants also have an exceptional success rate, higher than any implant-in-bone option. They are designed to last a lifetime, making them an excellent investment.

If you are considering dental implants to replace missing teeth, we invite you to begin with a consultation appointment. This will take place in a private room where we can discuss your needs and concerns. Call 828-274-9440 to schedule, or tap here for more contact information.

 

The “Why” & “How” of Dental Implants

Posted on Nov 09, 2022 by William J. Claiborne, DDS MS

According to the Centers for Disease Control & Prevention (CDC), over one-fourth (26%) of American adults ages 65 and older have 8 or less natural teeth. The CDC equates this number (having 8 or fewer teeth) as “severe tooth loss” since it impacts an individual’s ability to thoroughly eat a healthy diet.

An even worse statistic shared by the CDC is 1 in 6 (17%) adults ages 65 and older have lost all of their teeth.

When it comes to losing natural teeth, they also share that the most vulnerable older adults are those who are poor, have less than a high school education, or are cigarette smokers.

Being totally edentulous (having lost all teeth) amongst the 65 or older age group has fortunately declined over the years. The CDC shared that the figure dropped by more than 30% from 1999–2004 (when it was 27%) to 17% in 2011–2016. At least American adults are moving in the right direction.

https://www.cdc.gov/oralhealth/fast-facts/tooth-loss/index.html

Tooth loss is a bigger deal than is assumed by a large segment of the population. When a natural tooth is removed, its absence causes a reaction that begins below the gum line. What occurs initially is typically not obvious. Yet, the repercussions of “resorption” can become quite the dilemma.

The absence of a tooth root in the upper or lower jaw bone is a loss of stimulation to the bone mass where it was once positioned. These roots provide both stimulation and nourishment that enables the bone to maintain a healthy mass. Without the presence of tooth roots, the bone begins to “melt away.” This process is known as resorption.

Think of the stimulation that tooth roots provide to how you might muscle atrophy. We all know that muscles, not used, will shrink in mass. When the jaw bones are lacking stimulation by the tooth roots they’re designed to hold, bone mass begins to shrink.

Resorption begins shortly after the tooth root is removed. Once it starts, it continues at an ever-increasing pace. For example, the first year after a tooth root is missing, the loss of bone may be minimal. With each passing year, the pace of loss accelerates.

As the bone shrinks in height, the natural tooth roots adjacent to the area of missing teeth are subject to movement and root damage. On average, the next teeth you’re most likely to lose are the ones bordering areas of missing teeth.

Obviously, it is important to replace lost teeth before bone loss begins. For the support of remaining natural teeth, it’s also important to replace missing teeth as soon as possible so adjacent teeth can retain their proper positions. And, it’s HOW you replace them that’s most important.

Because dental implants replace the tooth above the gum line AND the root portion below it, the bone is able to retain its mass. Through the sturdy foundation of the jaw bone, dental implants are able to restore the look, feel and chewing stability like that of natural teeth.

As a periodontist, I specialize in the prevention, diagnosis, and treatment of all stages of periodontal (gum) disease. I also have advanced training and skills in the selection and placement of dental implants. In addition, periodontists are particularly skilled in performing cosmetic periodontal procedures.

Our Western NC periodontal dental office features some of the most advanced technology available. This cutting edge technology is beneficial in a number of ways, with much specifically helpful in optimal dental implant diagnosis and planning. This includes:

LANAP With PerioLase MVP 7 – Laser-Assisted New Attachment Procedure is an advanced protocol that efficiently and effectively treats advanced gum disease with the added advantages of a dental laser. For patients who are preparing for dental implant placement, resolving gum disease prior to treatment is mandatory. LANAP offers a non-surgical alternative for patients with moderate to severe periodontal disease with very little discomfort and a quick recovery time.

Cone Beam Imaging – These amazing 3D “x-rays’ are ideal for diagnosing and treatment planning. The highly-detailed images provide a clear view of the upper and lower jaw. Because cone beam radiographs show sagittal, axial, and coronal planes, locating and tracking nerve canals optimizes implant placement. The images are captured in a quick, painless process and at minimal levels of radiation.

CareStream Cone Beam Computer Tomography Imaging – This enhanced tomography works with 3D imaging for exceptional detail and range.

Computerized Dental Implant Placement – This system provides the futuristic ability to position dental implants before the process actually begins. Through computerized technology, the implants are selected and “ideally positioned” on a 3D model of the patient’s jaw. From this, a template is developed for optimal treatment success, even for complex cases.

CS 3600 Intraoral Scanner – Rather than make impressions with bulky, goopy trays, this scanner quickly and comfortably captures digital impressions accurately and easily. These are used to create precision models or appliances (dental implant crowns, bridges, or full arches). The scanner can also reach hard–to–access areas in the patient’s mouth for superior results with improved patient comfort.

Sedation – Our Asheville periodontal practice is known for its environment of comfort and respectful care. We understand that over 70 percent of the adult population have some level of dental fear or anxiety. For optimal comfort and relaxation, we offer several sedation options, including oral and IV sedation. With both sedation options, patients are closely monitored with advanced safety equipment throughout treatment.
• Oral sedation is a pill that helps patients relax. It also has an amnesiac effect, leaving most with little or no memory of treatment afterward.
• I.V. sedation (also known as ‘twilight sleep‘) places the patient in a deeper sleep state and erases memory of the procedure. It is administered by a Medical Doctor (MD) who is a board certified Anesthesiologist.

Ideal diagnosis is important, and can save the patient much in overall treatment costs. For example, when missing more than one tooth in one area, one implant can often hold two or a bridge of teeth. Several strategically-placed implants may also be used support a full arch of teeth.

Dental implants restore the ability to eat with stability, chew comfortably, laugh and speak with confidence. Dental implants do not decay and will never need root canals. They have an extremely high success rate, higher than any implant-in-bone option. And, Dental Implants are designed to last a lifetime. With proper selection and maintenance, they will never need replacing or repair.

Dental implants come in many sizes and shapes, each system designed to accommodate various needs and preferences. This means your implant can be chosen to suit your long-term goals.

Proper placement and support in caring for implants is an important part of a successful outcome. However, dental implants can fail. This is why a periodontal specialist can be an asset to your investment. When dental implants are chosen and placed by a Periodontist, he or she can select the one that will work best for you now and throughout your lifetime.

In our Asheville periodontal dental office, we combine technology with our advanced skills and compassionate approach to care so you can enjoy a comfortable, efficient experience that allows you to have optimal success.

Call 828-274-9440 to arrange a consultation. During this time, we can discuss treatment that can achieve your needs and goals as well as the process and anticipated costs.

Choose A Periodontist To Correct A Gummy Smile

Posted on Aug 29, 2022 by William J. Claiborne, DDS MS

About Periodontal Plastic Surgery

When Lauren Hutton, the model well-known for a space between her front teeth, began modeling, she felt she needed to camouflage the gap (or “diastema”). Yet, she soon began to feel it was a unique feature that set her apart from the others. She was right, and now at the age of 77, she’s been on more front covers than nearly any other model.

Each smile is unique. Hopefully, your smile makes you feel good every time you share it. And, the very act of smiling has been shown to release endorphins in the brain. Those are the chemicals that create a bit of a ‘natural high.’ Smiling is obviously an asset to our well-being.

If you have a “gummy” smile, you may be perfectly fine with it. After all, it is not detrimental to oral health if you care for your gums properly (which goes for everyone). And, it can be a positive part of your personality. Katie Couric has a gummy smile and shares hers openly.

However, not everyone with this trait feels comfortable with the look nor the way it makes them feel when smiling. Some people tend to suppress  a full smile. Others often conceal their smile with a hand when smiling fully or laughing. Some people smile with their lips only.

A gummy smile, in the periodontal specialty, is known as EGD, an abbreviation for excessive gingival display or a gingival smile (GS). The trait occurs more often in females than in males. (Gingival is of or relating to the gums.)

Esthetically, a balanced smile typically shows the front top 6 or 8 teeth. Arching each tooth, there is generally minimal gum tissues showing , and sometimes none. Another esthetic complement to a smile is having gum tissues that  show a slight arch over each tooth at a similar line as those that arch adjacent teeth. Gums that are lower over one or two teeth tend to create a jumbled look in a full smile.

When the height of gum tissues distract from the appearance of a smile, a periodontist is your expert. This dental specialist has specialized skills in all aspects of oral tissues. Through their advanced training, they are able to safely and beautifully reshape the tissues that surround teeth.  

For people who wish to have a gummy smile or uneven gum line re-contoured, a periodontist performs a gingivectomy. A gingivectomy is a procedure during which excess gum tissue is remove. During this, the gumline is sculpted to give your smile balance with a more even smile line.

In addition to repairing a gummy smile, a gingivectomy is involved in a procedure known as crown lengthening. Crown lengthening involves removing the excessive gum tissue to expose more of the crown of the tooth, as well as sculpting the gumline to make it higher up. After the gum tissues are shaped, a crown is typically placed to protect the tooth above the gum line and to create a more beautiful smile.

A crown lengthening may also help to save a tooth from removal. When a tooth breaks off near the gum line, a crown lengthening can be performed to expose a sufficient amount of the tooth’s base so it can support a crown.

Another procedure a periodontist  expertly performs is gum grafting. This is often to cover exposed roots, to reduce further gum recession, protect vulnerable tooth roots from decay, and improve your smile. Recession can occur as a result of periodontal disease, which causes tooth roots to become exposed and makes the teeth look long.

Gum tissues are very tender tissues with many nerves. Procedures that involve the gums must be performed with precision to minimize discomfort and speed healing time. A periodontist excels in the skills to create an optimal outcome with the most conservative treatment needed.

Our Asheville periodontal dental office provides some of the most advanced imaging and computerized technology available. This includes cone beam 3D imaging and laser dentistry. Additionally, we provide oral and IV sedation (“twilight sleep”) so patients are able to relax or snooze comfortably while being monitored by specially-trained team members who use advanced safety equipment.

Begin with a consultation with an experienced periodontist, who can answer your questions thoroughly and determine the best treatment option for your individual needs. Call 828-274-9440.

Some sources:

https://www.colgate.com/en-us/oral-health/mouth-and-teeth-anatomy/3-treatment-options-for-a-gummy-smile

https://www.researchgate.net/figure/Female-and-male-percentages-in-the-gummy-smile-sample_tbl1_340258838