Dealing With Pain The OTC Way!

Posted on Jun 20, 2016 by William J. Claiborne, DDS MS

As a periodontist, a priority with each patient is to make every appointment as comfortable as possible. For patients with problems that have become painful, my goal is to get them out of pain as quickly as possible.

While I’d like to think that everything we do is painless, the periodontal specialty often involves procedures that require penetrating tender gum tissues.

We offer sedation options and use technology and techniques designed to speed healing and minimize discomfort. However, once the patient leaves our office, post-surgical or post-treatment discomfort may occur as the tissues heal.

For example, when we place Dental Implants, we sedate patients so they will be relaxed and comfortable throughout the process. Once the patient returns home and the numbness wears off, they may experience some swelling and tenderness for a day or so.

During the healing period, we make prescription strength medications available to our patients for pain relief. Most tell us they did not need them and only took over-the-counter (OTC) medications (if any).

Although we make recommendations as to which OTC medications will be most effective for pain relief and swelling, I thought it would be helpful to explain the variations between the long list of drug store pain relief.

Once upon a time, if you had pain, you took aspirin. Drug options have greatly expanded. For most mild to moderate pain, over-the-counter pain relievers (analgesics), like non-steroidal anti-inflammatory drugs (non-steroidal anti-inflammatory drugs – commonly known as NSAIDs) or acetaminophen are the first choice.

When medications do not require a prescription, we typically assume they are safe. Yet, analgesics can have side effects and interact with other medicines, dietary supplements, and alcohol. Too, they contain the same ingredients found in many prescription drugs. This means if you’re taking several medications, you could be getting more of a particular pain reliever than you realize.

NSAIDs (aspirin, ibuprofen (Advil, Motrin, others), naproxen sodium (Aleve, Naprosyn, others), and ketoprofen (Orudis, others) are non-steroidal anti-inflammatory drugs. They reduce pain, inflammation, and fever by inhibiting production of the prostaglandins (hormone-like substances) that cause them. The down side is that they also block other prostaglandins that protect the stomach lining, regulate blood flow to the kidneys, and initiate blood clotting.
Stomach inflammation, peptic ulcers, and intestinal bleeding are major hazards for NSAID users. People who take high doses for an extended time are at greater risk, older adults especially. NSAIDs also slightly increase the risk for hemorrhagic stroke (bleeding in the brain).

Acetaminophen (Tylenol, Anacin-3, others) relieves pain and fever by affecting the parts of the brain that receive pain signals. Although acetaminophen reduces pain and fever, it has no effect on inflammation, but neither does it cause the bleeding and clotting problems associated with NSAIDs.
Acetaminophen is metabolized by enzymes in the liver. Taking too much can lead to liver damage in susceptible people, such as those who drink alcohol regularly. Taking two or more acetaminophen-containing products at the same time, or taking doses too close together, can cause overdose.
Closely read the labels of all medications to ensure you’re not exceeding the maximum recommended dose of acetaminophen — 4,000 mg per day, for people with no liver problems.

If you don’t fall into a specific risk group, taking nonprescription pain relievers as directed is generally safe. The potential for trouble emerges when you add the following:
• Some NSAID and acetaminophen products, as well as cold, sinus, and allergy remedies, contain a combination of pain relievers. Regular and long-term use of painkillers that combine analgesics can damage the kidneys.
    • Many prescription painkillers contain acetaminophen (Darvocet, Vicodin, others) or NSAIDS (Celebrex, Percodan, others). Do not take both prescription and over-the-counter painkillers without checking first with your doctor. A chart of prescription drugs containing acetaminophen and NSAIDs is available on the American Academy of Family Physicians’ website: www.familydoctor.org/otc/knowmeds.html.
    • NSAIDs can interact with many drugs, including ACE inhibitors, anticoagulants, beta blockers, lithium, and methotrexate. Aspirin interacts with anticonvulsants, corticosteroids, insulin, and sulfa antibiotics. If you take any of these prescription medicines, check before using NSAIDs.
    • Herbal supplements such as garlic, ginger, feverfew, ginkgo, and ginseng can thin blood and should be avoided when taking an NSAID.
    • NSAIDs can interfere with absorption of folic acid. If taking NSAIDs regularly, take a multivitamin daily.

It is important that your treatment and recovery result in a positive outcome without undue complications or discomfort. By understanding the advantages as well as potential adverse reactions of NSAIDs and acetaminophen, you can minimize the amount needed while gaining the most comfort from your chosen brand.

A Missing Tooth Disrupts Positions Of Other Teeth

Posted on Jun 13, 2016 by William J. Claiborne, DDS MS

Being in a periodontal specialty, a particular part of my expertise involves the diagnosis and placement of Dental Implants. While periodontal (gum) disease is the nation’s leading cause of adult tooth loss, there is another contributing factor that many people are unaware.

The position of each tooth has unique importance to neighboring tooth. Primarily, one tooth helps to hold adjacent teeth in place. This means that when one tooth is lost and not replaced, the teeth on both sides are also left without a bolstering neighbor. This gap enables neighboring teeth to move out of their proper positions.

Because an open space allows a tooth above or below to grow longer or the teeth on each side to tilt, a long list of problems are set into motion. The teeth that grow longer or tilt typically cause chips, cracks or fractures to other teeth since the bite is now out of alignment. When a tooth fractures below the gum line, it will require removal. This results in a whole net set of expenses and problems.

When a tooth is missing, it also leads to the potential shifting of other teeth. This shifting can result in crowded, crooked teeth that are more difficult to keep clean. Imagine how much more challenging it is to sweep and mop the floor in corners than it is along straight surfaces. Your tooth brush has far more challenges trying to get into tight angles.

Bite misalignment can even lead to worn teeth since it can lead to night-time clenching and grinding. This is typically due to strain on the TMJ (jaw joints) from the now-misaligned bite. Clenching or grinding during sleep can contribute to frequent headaches, migraines, sore jaw joints, facial and neck muscle pain, ear ringing and dizziness.

The open space from the missing tooth leads to yet another ordeal. Without natural tooth roots in the jaw, the bone that once held the root begins to shrink. As the bone in this area declines in mass, bordering tooth roots are now vulnerable to a shrinking foundation of bone. It is a fact that a missing tooth leaves an adjacent tooth most likely to be lost next.

When you consider all these issues, it’s no surprise that the result is a number of dental repairs and costs. The easiest way to avoid problems and associated expenses when a tooth is lost is to replace the tooth with a Dental Implant.

Dental Implants recreate the presence of tooth roots in the jaw bone. This helps to prevent bone loss from a declining jaw that occurs when tooth roots are no longer present. The replaced tooth also helps surrounding teeth to hold their proper positions, greatly reducing the potential for chips, cracks and the barrage of problems associated with bite misalignment.

Although Dental Implants are initially more expensive than most other tooth replacement options, the investment is a one-time expense. Dental Implants do not decay and are designed to last your lifetime. They also have one of the highest success rates of all implant-in-bone treatments.

And, unlike crown-&-bridge combinations, an implant will halt further bone loss. It will never need adjacent natural teeth to be crowned to support replacement teeth. Dental Implants are held in the jaw bone, just as natural tooth roots, and do not need other teeth for support. Overall, they are an ideal investment for replacing one tooth, several teeth or a full arch.

If you are missing one or more natural teeth, call us at 828-274-9440. We will explain the process and advantages of Dental Implants so you can make the decision that is right for you.

Sedation Can Help Relax Dental Patients

Posted on Jun 10, 2016 by William J. Claiborne, DDS MS

In our office, many procedures involve incisions into tender gum tissues. As a Periodontal practice, it is necessary to penetrate periodontal tissue in order to treat some levels of gum disease. It is also necessary to open up gum tissues to place dental implants. And, in repairing gum recession, performing gum grafts or recontouring gum tissues, incisions may be part of the process.

We pride ourselves on providing optimal comfort to all patients – for any procedure. However, we are aware that many people have developed gum disease or lost natural teeth as a result of dental fear. Being afraid of dental visits prevents a great many adults from having regular dental care. As a matter of fact, it is estimated that nearly 70% of American adults have some level of dental fear.

Just as a general dentist does prior to a filling or extraction, we use novocaine to numb the areas in the mouth being treated. However, we also offer I.V. sedation to help patients be totally relaxed throughout their procedure.

For fearful patients, I.V. sedation (also known as ‘twilight sleep’) places them in a sleep state prior to and throughout their procedure. Although the patient may be able to respond to my request to things like, “Turn your head a little towards me,” they are essentially sedated to the point of snoozing. This removes the anxiety of anticipating things such as sounds or smells that may evoke thoughts of pain.

Another benefit of I.V. sedation is its ability to erase most or all memory of the procedure afterwards. While a few patients may remember hearing my voice a time or two, the time is generally erased from their memory. All most remember is a peaceful sleep.

I.V. stands for intra-venous, which is translated as “in the vein.” The sedation is administered by a drip into a vein, typically in the arm. Patients are in a sleep-like state very quickly thereafter. Throughout your time, you will be closely monitored by a trained staff member who uses advanced safety equipment.

Once your treatment is completed, the I.V. is removed and you will be monitored for a recovery period in our office. Your companion will then return you home where you will relax or even nap for a brief time until you feel back to normal. We do advise that I.V. sedated patients avoid driving or using machinery for 24 hours.

Some patients who have no dental fears prefer the relaxation effects of I.V. sedation. Certain procedures that require lengthy appointments can be tiring and I.V. sedation is an advantage to the patient in being comfortable while in a dental chair in one position for long treatments.

Our ultimate goal is to restore our patients to a healthy, confident smile. We believe this can be accomplished with gentle hands and a respectful environment. In many situations, sedation can be advantageous to providing a positive experience and successful outcome.

If you have dental fears or wish to discuss comfort options related to periodontal or dental implant procedures, feel free to call us at 828-274-9440.

 

Different Types Of Dental Implants For Different Needs

Posted on Jun 06, 2016 by William J. Claiborne, DDS MS

A rose by another other name may still be a rose, but unlike Shakespeare’s writings, we know that roses come in all colors and sizes.

When the term ‘Dental Implant’ is used, it refers to the basic principle of this form of tooth replacement. Generically, the ‘implanted’ portion is what is positioned into your jaw bone to provide the same foundation as that afforded by natural tooth roots.

However, when considering the shape, size and even what is attached to an implant, the type of implant system can vary widely. For example, some implants are designed to be placed at unique angles to compensate for minimal bone depth. Some implant types are made to support a single tooth or bridge of several teeth while others are positioned to hold a full arch of teeth.

A successful outcome in Dental Implant treatment begins with the selection of the proper type of implant. In doing this, the doctor must have intricate knowledge of the specific type needed for the amount of bone mass present, location of implant sites, and the number of teeth to be supported.

Proper placement angles and depth are also important. The doctor placing the implants should also be skilled in the selection of the implant angles and positioning.

As a Periodontal specialist, my training includes the diagnosis and placement of Dental Implants. The most troubling thing I see in implant dentistry is when a patient opted for a “good deal” in Dental Implants and had a less-experienced doctor place an implant that must now be removed.

It’s amazing how seemingly minor miscalculations can become major issues that require implant removal. For example, an implant placed in the upper jaw in too-shallow bone can work its way into the sinus cavity. A lower implant in too little bone depth can reach a nerve that runs horizontally through the lower jaw.

In our office, it is a joy to see our patients who once struggled with dentures or partials complete Dental Implant treatment. They are able to resume a diet of healthy foods and feel confident in social settings. However, when we are referred an individual who learns his or her implant has ‘failed’ and must be removed, it is unfortunate.

As a dental specialist, I also must occasionally remove implants when a patient has not taken proper care of their oral hygiene at home. Oral bacteria can contribute to an infection that works its way into the bone surrounding the implant. In some cases, the only way to resolve the infection is to remove the implant.

While this is unfortunate, it is ultimately a choice the particular patient made that created the outcome. However, when a patient entrusts their implant treatment to a doctor and adheres to hygiene and healing guidelines, having an implant fail due to poor selection or placement is more than frustrating for dental specialists to witness.

If you are considering Dental Implants, increase your potential for a successful outcome by asking a Periodontist to join your dentist in team treatment. Many general dentists already have close relationships with Periodontists for implant placement and treatment of gum disease.

Feel free to discuss your specific needs and desires before you make your decision. Call (828) 274-9440 to schedule a consultation.