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Posts for category: Oral Health

By David E. James, DDS
January 28, 2019
Category: Oral Health
Tags: medicine  
NSAIDsCouldbeJustasEffectiveasNarcoticsManagingDentalPain

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.

If you would like more information on how dentists are safely managing pain in dental care, please contact us or schedule an appointment for a consultation.

By David E. James, DDS
January 08, 2019
Category: Oral Health
Tags: gum recession  
RecessedGumsCouldEndangerYourTeeth

A "toothy grin" might be endearing, but not necessarily healthy. More of the teeth showing may mean your gums have pulled back or receded from the teeth. If so, it's not just your smile that suffers—the parts of teeth protected by the gums could become more susceptible to disease.

There are a number of causes for gum recession. Some people are more likely to experience it because of genetically thinner gum tissues. Over-aggressive brushing could also contribute to recession. But the most common cause by far is periodontal (gum) disease, a bacterial infection triggered by dental plaque accumulating on teeth mainly as a result of inadequate hygiene.

There are some things we can do to help heal and restore recessed gums, most importantly treating gum disease. The number one goal of treatment is to uncover and remove all dental plaque from tooth and gum surfaces, which can take several sessions and sometimes minor surgery if the infection has reached the tooth roots. But removing plaque and tartar (calcified plaque) is necessary to stop the infection and allow the gums to heal.

For mild recession, this may be enough for the gums to regain normal coverage. But in more severe cases we may need to help rejuvenate new tissue with grafting surgery. In these highly meticulous procedures a surgeon uses microscopic techniques to position and attach donated tissue to the recession site. The graft serves as a scaffold on which new tissue growth can occur.

While these treatments can be effective for reversing gum recession, they often require time, skill and expense. It's much better to try to prevent gum recession—and gum disease—in the first place. Prevention begins with daily brushing and flossing to prevent plaque buildup, as well as regular dental visits for more thorough cleanings. Be on the lookout too for any signs of a beginning gum infection like swollen, reddened or bleeding gums and see your dentist as soon as possible to minimize any damage to your gums.

Caring for your gums is equally as important as caring for your teeth. Healthy gums equal a healthy mouth—and an attractive smile.

If you would like more information on preventing gum recession, 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 “Gum Recession.”

By David E. James, DDS
December 29, 2018
Category: Oral Health
FAQsAboutPediatricDentistry

Even though baby teeth are not meant to last forever, they serve some very important functions for the time they are around. Healthy baby teeth allow your child to bite and chew food, articulate sounds correctly during speech, and, of course, to smile! They also help guide the permanent teeth, which will one day replace them, into proper alignment. So it’s important to take good care of them while they’re here. Let’s answer some frequently asked questions about pediatric dentistry.

Can I get my teeth cleaned while I’m pregnant?
Yes — and you should! Both the American Dental Association and the American Congress of Obstetricians and Gynecologists recommend that women keep up with their regular schedule of dental cleanings and exams during pregnancy. Not doing so can allow disease-causing oral bacterial to flourish, which can be a health risk for both the expectant mother and her fetus.

Do infants need their teeth brushed?
Yes, it’s important to start a daily oral hygiene routine as soon as the first baby tooth appears — usually sometime between six and nine months of age. Use a very soft-bristled child-sized toothbrush and just a smear of fluoride toothpaste (the size of a grain of rice). When your child turns 3, increase the amount of fluoride toothpaste to the size of a pea.

When should I take my child in for her first dental appointment?
The answer to this one may surprise you: All children should see a dentist by the age of 1. Early dental visits get children accustomed to having their mouths examined and their teeth cleaned. Establishing this healthy habit early will go a long way toward promoting a lifetime of good oral health.

Should I worry that my child sucks his thumb?
That depends on how old he is. Thumb sucking is a normal, comforting habit for babies and toddlers. Most outgrow it by the time they are 4. But kids who don’t are at increased risk for orthodontic issues later on. If your child seems unable to break the habit, let us know; we can give you more detailed recommendations at your next appointment.

What can I do to prevent my children from getting cavities?
Make sure your children have an effective daily oral hygiene routine that includes brushing with fluoride toothpaste twice a day and flossing at least once per day. If they are too young to do a good job by themselves, help them complete these important tasks. Keep their sugar consumption as low as possible; pay particular attention to beverages — soda, sports drinks and even 100 % natural fruit juices can all promote tooth decay. We can offer individualized advice on fighting cavities, and even provide fluoride treatments and dental sealants for extra protection against cavities. So don’t forget to bring your child in to the dental office for regular exams and cleanings!

If you would like more information about caring for your child’s teeth, please contact us or schedule an appointment for a consultation.

By David E. James, DDS
December 19, 2018
Category: Oral Health
Tags: retainers  
RetainYourNewSmileAfterBraceswithaRetainer

It’s been a long road with your braces, but now they’re finally off. Hopefully the first glimpse of your new smile more than made up for the time and effort they required.

But while braces removal is a big milestone, it’s not the end of your treatment—not, that is, if you want to keep that new smile! You’ll now need to wear an appliance called a retainer for a few years or, in some cases, from now on.

Orthodontic retainers are a must after braces for the same reason braces work in the first place—your teeth can move. While the teeth attach to the jawbone via the roots, they’re firmly held in place by an elastic gum tissue network called the periodontal ligament. This tough but elastic tissue lies between the teeth and gums and attaches securely to both with tiny fibers.

While the ligament provides stability, it’s also dynamic—constantly remodeling to allow the teeth to move in response to biting pressure and other mouth factors. Orthodontists use this mechanism when moving teeth to better positions. The braces apply pressure on the teeth in the desired direction and the periodontal ligament responds as the teeth move.

Afterward, however, the ligament can still retain a kind of “muscle memory” for a time of the teeth’s old positions. Free of the pressure once supplied by the braces the teeth have a tendency, especially early on, to “rebound” to where they were.

A retainer helps prevent this by exerting just enough pressure to “retain” the teeth in their new positions. In the beginning this may require wearing the appliance around the clock, but you may be able later to reduce wear time to just a few hours a day. Rebounding is unpredictable, so you should continue to follow your orthodontist’s recommendations on retainer wear.

Wearing a retainer may seem like a drag, but it’s absolutely essential. Being diligent about it will help ensure that the beautiful smile you and your orthodontist worked so hard to obtain stays with you for years to come.

If you would like more information on getting a new smile through orthodontics, 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 “The Importance of Orthodontic Retainers.”

By David E. James, DDS
November 19, 2018
Category: Oral Health
Tags: nutrition   sports drinks  
PracticeCautionwithEnergyorSportsDrinkstoProtectYourEnamel

Although energy and sports drinks have different purposes, they have one thing in common: they often contain added citric and other acids to improve taste and prolong shelf life. Their high acid content can harm tooth enamel.

Although enamel is the strongest substance in the body, acid can dissolve its mineral content. And although saliva neutralizes acid after eating or drinking and helps restore lost minerals to the enamel, it may not be able to keep up if the mouth remains acidic for a prolonged period of time.

That could happen with both beverage types. While energy drinks have higher acid levels than sports drinks, both are high compared with other beverages.

A recent laboratory experiment studied the two beverages’ effect on tooth enamel. The researchers submerged samples of enamel in six different beverage brands (three from each category) for fifteen minutes, and then in artificial saliva for two hours to simulate mouth conditions. They repeated this cycle four times a day for five days.

At the end of the experiment the enamel in the energy drinks lost on average 3.1 % of their structure, while the sports drink samples lost 1.5%. Although energy drinks appeared more destructive, the acid in both beverages caused enamel damage. Although there are other factors to consider in real life, the experiment results do raise concerns about both beverages’ effect on dental health.

You can, however, minimize the potential harm to your enamel from energy or sports drinks. First, try other beverage choices lower in acid; water, for example, is a natural hydrator and neutral in pH. Try to only drink energy or sports beverages at mealtimes when your saliva is most active. And after drinking, rinse your mouth out with water to dilute any remaining acid.

And although it sounds counterintuitive, wait about an hour to brush your teeth after drinking one of these beverages. Your enamel can be in a softened state before saliva can re-mineralize it, so brushing earlier could remove tiny amounts of enamel minerals.

Taking these steps with energy or sports beverages could help you reduce the chances for enamel erosion. Doing so may help you avoid unnecessary damage to your teeth and overall dental health.

If you would like more information on the effect of sports and energy drinks on dental health, 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 “Think Before You Drink.”