Pain Management and Dentistry

            Knowing what kind, how much, or how often to take medication for oral or tooth pain can be confusing. Below we will discuss a few different scenarios and how to handle each scenario.

Toothache:

Unless otherwise instructed by your physician to not take any NSAIDS (non-steroidal anti-inflammatory drugs), I usually recommend taking ibuprofen as a first like of defense. This is the active ingredient in Motrin or Advil. An adult can take up to 800mg of ibuprofen every 8 hours or 600 mg every 6 hours. The important thing to remember is to not exceed 2400mg in 24 hours.

If ibuprofen is still not enough, you can take acetaminophen (Tylenol) in between your doses of ibuprofen to help with the pain (do not exceed 4000mg per 24 hours). These are allowed to be alternated because acetaminophen and ibuprofen have a different mechanism of action. But if you have to option which to take first, I would recommend ibuprofen over acetaminophen.

Sore Jaw

            If you noticed your jaw joint or associated muscles are sore during chewing, there is a possibility you have strained one of your facial muscles. And like any other sore muscle, it usually just needs time to heal. But ibuprofen can help with the inflammatory and pain response and keep you comfortable in the meantime.

• Up to 800mg of ibuprofen every 8 hours
• Rest (soft diet, no gum)
• Warm compress (if muscular)

If the symptoms do not begin to subside after a week or so, I would definitely recommend having the area examined for other factors or concerns.

Canker Sores:

            While there are some mildly effective over the counter medications, I usually recommend discussing a prescription with your dentist if they are a frequent and painful problem. Orajel is a mild topical anesthetic that can help reduce pain when eating or drinking. However, it will only address the symptoms and not the source. Acetaminophen and ibuprofen are again affective and controlling some pain associated with these sores.

            Each individual is unique and may require some adjustments to the usual protocol. The important thing to remember is to contact your dentist with any questions or concerns.

For more information, visit www.brownandkupper.com

Lee T. Brown, DDS

Brown and Kupper, DDS Inc. 

Do you do same day crowns?

            Over the past few years, technology in the dental world has continued to grow. New and exciting procedures have been developed and the possibilities for the future are endless. One of the more popular technology upgrades is the ‘same day crown.’ There is a device available that allows the dentist to prepare the tooth, create the crown at their office, and cement it in one long appointment. The elimination of the temporary crown is a huge advantage for the patient, but there are a few limitations that still exist.

Material Choice:

            Each particular person and tooth is unique and should be treated accordingly. Fortunately, a dentist has access to a number of different materials when creating a new crown. One of the limitations of the same day crown is they only offer certain types of crowns. In many situations, these crowns work very well and can have great success. However, in our opinion, there are frequently situations where other types of crowns may produce a better long term result.

Advantages of the Temporary Crown:

            Even though a temporary crown can be a nuisance, it can provide significant advantages for dentist and the long-term health of that tooth. When creating a new crown, we are creating a prosthetic device for your tooth that is new and foreign. We can use the transitional phase to determine the ideal size, shape, material, and bite for the crown before creating and cementing the final crown.

            Unfortunately, after preparing a tooth for a crown there are times when the tooth is in need of a root canal. If the tooth is symptomatic during the temporary phase, a root canal can be completed before cementing the final crown. This way we don’t have to damage the new crown when the root canal is performed.

            There are definitely circumstances where a ‘same day crown’ can be advantageous and provide an excellent restoration. However, there are still many instances where we feel the traditional crown procedure may provide better long term results. As technology continues to develop, we will continue to assess the options to provide the best treatment we can.

For more information, visit www.dentistwestchester.com.

Lee T. Brown, DDS

Brown and Kupper, DDS Inc.  

Health Signs your Tongue may reveal

Strawberry Red Tongue: It could mean you have a vitamin deficiency, particularly Vitamin B12 or Iron. Along with the red appearance, it may have a glossy feeling or look. This is more common in vegetarians as B12 is found in meats.

Black or Brown Fuzz: The condition is often referred to as ‘black hairy tongue’ and can be brought on by smoking, drinking coffee or tea, or poor oral hygiene. The best treatment is to eliminate the cause (smoking or coffee) and use a tongue scraper to clean the tongue.

Cottage Cheese White: This could mean you have a yeast infection that can be brought on by use of antibiotics. Your tongue typically has selective types of yeast, but an antibiotic can kill off bacteria and allow the yeast to take over. This is common with immunocompromised people as well and you should call your dentist for a prescription or try over the counter remedies.

Wrinkles on the Tongue: Unfortunately, as we get older this is another area that may develop wrinkles. It is harmless as long as you keep your mouth and tongue clean with good oral hygiene and the use of a tongue scraper.

Small Patches of White: It could be a normal variation, an irritation or the start of oral cancer. If it is new and does not resolve within 2 weeks, see your dentist. If you have a history of tobacco use, it is even more important to have this checked out.

Persistent Red Lesions: It could be a sign of oral cancer. If an abnormal lesion persists for longer than 2 weeks, see your dentist immediately. These can be present with or without a history of tobacco use and can be dangerous is not treated quickly and properly.

The important this is to pay attention to what is going on in your mouth and on your tongue. It is the gateway to your body and can help diagnose potential systemic issues.

For more information, visit www.brownandkupper.com.

Lee T. Brown, DDS

Brown and Kupper, DDS Inc.

Teeth Whitening Update

            A recent article in the New York Times discussed some of the latest updates and trends in teeth whitening. It can be difficult to differentiate between all of them and what may be most appropriate in you situation. Below we will go into the basics of each one, but it is important to remember to consult your dentist before beginning any type of whitening regimen.

• Whitening tooth paste: Contains agents that are designed to improve appearance by removing surface stains. Does NOT actually whiten.
• Whitening Mouth Rinse: Similar to whitening toothpaste
• Oil Pulling: Alleges to remove ‘toxins’ and whiten teeth. There is not a lot of research behind oil pulling and how it affects your oral health.
• At this time, this is not something I recommend until more is known and understood
• White Strips: These have over-the-counter bleaching strength peroxides and they can whiten teeth.
• I typically recommend trying strips when unsure if you will be sensitive to bleaching
• Not as potent as dentist prescribed bleach
• Not custom fitted
• Custom Fitted Take Home Bleaching Trays: Our most frequently used bleaching system.
• The trays are made to fit your teeth and minimize the amount of bleach used. This also limits the amount of bleach that may affect the gums.
• We can adjust the strength of the bleach for optimal results
• We can adjust frequency and length of treatment based on sensitivity and results
• Trays can be kept and re-used over many treatments and refills can be purchased
• In the long run, it typically is the most cost effective and predictable way to bleach.
• In-Office Bleaching: Very high strength bleach that must be applied in the office
• Higher frequency of tooth sensitivity
• Still need to have take home bleaching trays
• The ‘light’ that was marketed to help with in office whitening (Zoom), has been shown to have no additional effect
• We no longer offer this here because of too many variables and inconsistencies
• Mall Kiosk Whitening
• DON’T DO IT!
• You need to have a proper dental exam from a dentist to know if you’re a good candidate for teeth bleaching
• The lights they shine on your teeth don’t do anything to whiten

The bottom line is you should discuss your individual situation with your dentist to help decide the best course of action. Failure to do so could result in larger, more expensive, and more painful problems!

For more information, visit us at www.brownandkupper.com.

Lee T. Brown, DDS

Brown and Kupper, DDS Inc.

Why do we have to Sign Informed Consent at the Dentist?

            Any time a medical or dental procedure is performed to improve your current situation, there are inherent risks. Some may be more obvious than others, but we believe it is important we make you aware of some of the possible outcomes. If you have knee replaced at the hospital, you have always been asked to read and acknowledge some of the potential risks. Whether you have a tooth extracted or a cavity filled, they are also invasive procedures that could have potential problems. We feel it is beneficial for each person to have this information before procedures are performed. Below we will discuss some basic risks for some common procedures:

           

Possible risks with a filling:

            When we remove tooth decay and place a filling, the goal is to remove the diseased tissue before in encroaches on the nerve and causes sensitivity and pain. However, each person and tooth is unique and it would be impossible to predict the outcome of each filling. That’s why we want you to be aware any filling we do has the potential for tooth sensitivity and a resultant root canal. We take a number of steps during the procedure to decrease the potential for problems, but typically the earlier we treat the cavity the better the outcome. This is another key reason to maintain your regular exams and follow up quickly with recommended treatment.

Possible risks with a Crown:

            Just like a filling, a crown has the potential for sensitivity and a possible root canal. However, the risk may be greater because by the time we have reached the need for a crown, the damage and previous work on that tooth may be greater. But even with these risks, a crown is obviously a much better option than losing the tooth or allowing it to break beyond repair.

Possible risks with a root canal:

            One of the greater risks with a root canal is a root fracture. In the most extreme cases, this root fracture can lead to loss of the tooth all together. But again, the root canal is a better option than remaining in pain or keeping an infection.

            No matter what the procedure, there will always be varying degrees of risk. We will do our best to answer any questions you may have before, during, or after the procedure on what you may encounter. Using our understanding of your particular situation and the potential risks, we will work with you to determine what is the appropriate course of action.

For more information, visit www.brownandkupper.com.

Lee T. Brown, DDS

Brown and Kupper, DDS Inc.

Do I Really Need a Night Guard to Protect my Teeth?

            For some, the answer is obvious that they need to protect their teeth at night. Their spouse may complain of the grinding noise, they may wake up with a sore jaw, or their teeth are becoming visibly worn or damaged. For others, the answer may not be so clear cut. So how do we know when there is a problem and how it should be treated? We will try to answer a few of the basics for you.

            To protect your teeth at night, there are a few different types of appliances we can make depending on your symptoms and comfort. There are larger guards that cover all of the upper or lower teeth, and there are smaller ones that only rest on the front 6-8 teeth. In most cases we recommend starting with the smaller appliance because it is typically easier to adjust to and is better for treating the majority of symptoms. However, there are cases where we need to try different types of appliances with different variations to find the one that is best for you.

            But what if you aren’t sure that you really need a night guard to protect your teeth? The first thing to remember is that in most cases it is a great preventative step to take in protecting your teeth every night. Even if you don’t show any serious signs or symptoms of wear, it will continue to protect your teeth and jaw in case any issues come and go in the future. Not only will a proper fitting guard protect against wear, but it will prevent cracks and fractures in your teeth. This can potentially save you thousands in the long run. And if you have any crowns, fillings or veneers on your front teeth, wearing a night guard is strongly recommended. One bad night can chip or break a restoration and be very difficult to fix.

            So if I need a night guard, can I just get something over the counter? While there are some limited applications for a night guard that is not custom fitted, I strongly discourage you from wearing one without consulting a dentist first. While an over the counter guard will protect the teeth in the short term, it could potentially harm your jaw and cause some serious issues in the long run.

For more information, visit us at www.brownandkupper.com.

Lee T. Brown, DDS

Brown and Kupper, DDS Inc.

           

How Important are Oral Cancer Screenings?

            With each professional cleaning and examination at Brown and Kupper DDS, both the hygienist and dentist perform a thorough oral cancer screening. There are certain markers or characteristics we look for, but the most important step is maintaining regular visits to give us the opportunity to identify any potential issues as early as possible. The earlier oral cancer is identified, the better the long term prognosis.

            There is some debating over which method of screening is most useful. We have traditionally looked for unusual red patches, white patches, or mouth sores. Our hands are also a useful tool in finding any abnormal bumps or lumps. If an area of concern is found, we then decide if an immediate biopsy is necessary or if we should re-evaluate in 10-14 days. The decision depends on the severity of the area, the location, and the patient’s medical history. For example, if you have a history of oral cancer or if you have used tobacco products in the past, a referral to a specialist for a closer look is a good idea. The only definitive way to determine if you have oral cancer is to remove the abnormal cells and have them evaluated by an oral pathologist.

            There is some new technology available involving swishing with blue dye or shining a special light on the tissue during an oral cancer exam. In theory, the abnormal cells will distinguish themselves visually and we can better detect potentially harmful areas. Unfortunately, most studies show it is no more effective than a traditional oral cancer exam. In fact, it results in a large number of ‘false positives’ in areas that are not abnormal. This then leads to unnecessary and invasive biopsies. Until the technology produces more predictable results, we will continue to use the same techniques in identifying potentially harmful areas.

            If you have a history of using tobacco products (cigarettes, cigars, pipes, chewing tobacco and snuff), heavy alcohol use, or a history of oral cancer, you definitely need routine oral cancer screenings since you are at an increased risk. If you have no risk factors at all, it is still important to be checked at each visit just in case. Maintaining regular visits to the dentist is crucial in early detection, and an early diagnosis can improve your odds against oral cancer.

For more information, visit www.brownandkupper.com.

Lee T. Brown DDS

Brown and Kupper, DDS Inc.