Posts for: May, 2016

MildPainRelieversmaybeallyouneedforDiscomfortafterDentalWork

For most dental procedures you’re usually back to your regular routine in no more than a day or two (or even hours) afterward. For the most part, the mouth heals rather quickly.

But there may still be a short period of discomfort after tooth extraction, gum surgery or similar invasive procedures. The good news is you will most likely have no need for strong narcotic painkillers — milder, over-the-counter pain relievers are usually sufficient to manage your discomfort.

The most common of these are known as non-steroidal anti-inflammatory drugs (NSAIDs). This group of pain relievers — which include aspirin and ibuprofen — block the release of substances in the body known as prostaglandins that stimulate inflammation that increases pain in damaged tissues. They’re much preferred for mild to moderate pain because they don’t have the side effects of steroids or narcotics like morphine or codeine. They also tend to be less costly than these other prescription drugs.

But while they’re reasonably safe, they can cause problems if you exceed the recommended dosage or use them for prolonged periods. Their blockage of certain chemicals reduces the clotting mechanism in blood leading to a blood-thinning effect. Not only will this increase bleeding, it can also damage the stomach lining and cause ulcers if used over a period of weeks. Improper dosage of NSAIDs has also been linked to miscarriages and repeat heart attacks, which is why they’re not recommended for use during pregnancy or with patients with a history of heart or intestinal problems.

But if taken as directed by your physician or dentist — usually no more than 2,400 milligrams a day and only for a few days — such side effects are quite rare. The benefit is much more common: about five hours of pain relief from a single dose for most people. With the help of ibuprofen or similar drugs, you’ll be on your feet after your dental work in no time. 

If you would like more information on managing pain after a procedure, 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 “Treating Pain with Ibuprofen.”


By Edward Joseph, D.D.S.
May 18, 2016
Category: Oral Health
Tags: tooth decay   toothache  
HeresWhattoDoifYourChildhasaToothache

What should you do if your child complains about a toothache? Before calling our office, try first to learn what you can about the toothache.

You should first ask them where exactly the pain is coming from — one particular tooth or a generalized, dull ache. Also try to find out, as best they can tell you, when they first noticed the pain. Try then to look at the tooth or area where they indicate the pain is coming from: since tooth decay is a prime cause for tooth pain, you should look for any obvious signs of it like brown spots or cavities. You should also look at the gums around the teeth for any redness or swelling, a sign of an abscess or periodontal (gum) disease.

If you notice any of these signs, the pain persists for more than a day, or it has kept the child awake during the night, you should have us examine them as soon as possible. If you notice facial swelling or they’re running a fever, please call and we will see them immediately. If it’s definitely tooth decay, it won’t go away on its own. The longer we wait to treat it, the worse its effects in the mouth.

In the meantime, you should also try to alleviate the pain as best you can. If when looking in the mouth you noticed food debris (like a piece of hard candy) wedged between the teeth, try to gently remove it with dental floss. Give them ibuprofen or acetaminophen in an appropriate dosage for their age to relieve pain, or apply an ice pack on and off for about 5 minutes at a time to the outside of their jaw.

If any of these remedies stops the pain within an hour, you can wait until the next day to call for an appointment. If the pain persists, though, then an abscess could be developing — you should call that day to see us.

Regardless of when the pain stops, or whether you see any abnormal signs, it’s still important your child see us for an accurate diagnosis. Their toothache maybe trying to tell you something’s wrong — and the earlier a problem is found and treated, the better the outcome.

If you would like more information on dental problems in young children, 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 “A Child’s Toothache.”


YourCaseofGingivitisCouldDevelopintoSomethingMoreHarmful

That bit of gum bleeding after you brush, along with redness and swelling, are strong signs you have gingivitis, a form of periodontal (gum) disease. Without treatment, though, your gingivitis could turn into something much more painful and unsightly — a condition commonly known as “trench mouth.”

Properly known as Acute Necrotizing Ulcerative Gingivitis (ANUG), the more colorful name arose from its frequent occurrence among soldiers during World War I. Although not contagious, many soldiers contracted it due to a lack of means to properly clean their teeth and gums and the anxiety associated with war. Inadequate hygiene and high stress still contribute to its occurrence today, along with smoking, medications that dry the mouth and reduced disease resistance — all of which create a perfect environment for bacterial growth.

ANUG can arise suddenly and be very painful. The cells in the gum tissue begin to die (“necrotizing”) and become swollen (“ulcerative”), especially the small triangle of gum tissue between the teeth called the papillae, which can appear yellowish. Patients also encounter a characteristic foul breath and taste. Untreated, ANUG can damage tissue and contribute to future tooth loss.

Fortunately, antibiotics and other treatments are quite effective in eradicating bacteria that cause the disease, so if caught early it’s completely reversible. We start with a complete examination to confirm the diagnosis and rule out other possible causes. We then attempt to relieve the pain and inflammation with non-steroidal, anti-inflammatory drugs like aspirin or ibuprofen and begin antibiotic treatment, most notably Metronidazole or amoxicillin. We may also prescribe a mouthrinse containing chlorhexidine and mild salt water rinses to further reduce the symptoms.

We must also treat any underlying gingivitis that gave rise to the more acute disease. Our goal here is remove any bacterial plaque and calculus (hardened plaque deposits) that have built up on tooth surfaces, particularly below the gums. Only then can we fully bring the disease under control.

It’s also important you become more consistent and effective with daily brushing and flossing, quit smoking, reduce undue stress, and get better rest and nutrition. Establishing these new habits and lifestyle changes will help ensure you’ll never have to experience trench mouth again.

If you would like more information on ANUG and other periodontal gum conditions, 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 “Painful Gums in Teens & Adults.”


SedationTherapycanreduceAnxietyinChildrenduringDentalVisits

Making sure children are comfortable when visiting the dentist is an essential part of creating a lifetime habit of dental care. We recommend children start dental visits around their first birthday.

But for some children this may not be enough — despite parents’ and dentists’ best efforts they may still develop an inordinate fear of dental visits and even routine procedures. This kind of anxiety could inhibit them now and later in life from receiving needed dental care.

To relieve this anxiety, dentists have developed sedation therapy for children. Not to be confused with anesthesia, which numbs pain, sedation uses drugs to place a patient in a relaxed state. Depending on the drugs and dosage used, we’re able to achieve anywhere from a light state of relaxation to a deep suppression of consciousness. The approach is similar to one used with adults, although drug dosages and applications will differ with children.

 If we’re planning to use sedation with your child we recommend you feed them a low-fat dinner the night before and then refrain from any other foods or liquids until after treatment the next day. Just before the procedure (and after we’ve evaluated them physically to be sure they’re healthy enough for the sedation medication), we’ll administer the sedative, usually Midazolam and Hydroxyzine. Taken by mouth in a syrup form, this places them in a mildly relaxed state.

During the procedure a designated staff member will continually monitor their pulse, breathing, blood pressure and other vital signs. We may also take other protective measures like special chair positioning or immobilization to keep movement to a minimum.

After the procedure, your child will remain in the office until their vital signs return to pre-sedation levels. Once at home, you should keep an eye on them for the rest of the day. They should not return to school or regular activities until the next day.

As sedation medication and techniques continue to advance, they’re becoming a routine part of dental care. If your child experiences anxiety, this can help make dental visits more pleasant and more likely to become part of their life from now on.

If you would like more information on taking the anxiety out of children’s 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 “Sedation Dentistry for Kids.”


WeighaPoorSmilesEmotionalandSocialCostwhenConsideringRestorations

We readily understand the physical costs of a decayed tooth or infected gums — pain, discomfort and loss of function. It’s much more difficult to understand the emotional and social costs of a lost smile. Without that understanding we may be tempted to view restorative solutions as a luxury we can’t afford.

But there is a definite cost to a smile that embarrasses or makes you unhappy. It can inhibit your friendships and family relations and cause you to become withdrawn from others. Your career may suffer, especially if your vocation involves networking or similar social outreach where you no longer feel free to be outgoing. Most of all, though, your own feelings about your look can keep you from pursuing the things you love or that matter the most to you.

Viewed in that light, a “smile makeover,” a comprehensive approach to transforming your appearance, is an investment in a better life, not a frivolity. Although the word “cosmetic” can mean “a superficial outer adornment,” in the dental profession the meaning is much deeper. Dentists who specialize in smile design are focused on the overall effect of their work — not only with your mouth but with your whole face.

The process begins with a complete examination of your mouth to identify your particular dental needs. We also want to know about your expectations and desires for a better smile. We use that, along with the realities of your physical condition and other factors, to develop a treatment plan. The plan may be as singular as whitening procedures or porcelain veneers applied to the outside of your teeth — or it may be comprehensive with a variety of procedures that could include other specialties like orthodontics or oral surgery. The overall aim is to develop a plan that’s right for you, and realistically satisfies your expectations.

The end result can be life-changing. Even subtle changes can alter your own image perceptions and free you to be yourself in your personal and professional relationships. In the end the positive impact of your new smile will more than offset the costs for achieving it.

If you would like more information on smile transformation, 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 Impact of a Smile Makeover.”




Burbank, CA Dentist
Edward C. Joseph, D.D.S.
2701 West Alameda Ave, Suite #503
Burbank, CA 91505
(818) 842-7628

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