Smile, Smile, Smile
By Austin Drewyer D.D.S.
July 27, 2018
Category: Pain

    Over the past couple of years we as dentists have been bombarded by news about the Opioid crisis in the United States.Not a week goes by where the American Dental Association (ADA) does not send out an email, magazine article or newsletter that mentions this important issue in healthcare. Recently, the House of Representatives were set to vote on more than 20 Bills to combat opioid addiction.

    A simple explanation of the issue: Over prescription of opioid containing pain medication can lead to abuse. Abuse leads to addiction and worse case death. This can happen by prescribing opioid pain medication in unnecessary situations or over prescribing so that unused opioids sit around our medicine cabinets within easy reach for someone else to abuse.

     A common addiction story starts with the use of prescription opioid pain pills whether prescribed to the abuser or not. If abused, these opioids cause a physical response in the human body that cause one to crave more of the drug. Soon the acquisition of more prescription opioid pills becomes too expensive or simply not available. By this time a person ‘s brain chemistry has been severely altered and they commonly turn to the easiest, cheapest way to get the high they crave. This high is commonly found in the stronger, cheaper and more dangerous street drugs like Heroine. Much of the illegal heroine found on the streets is laced with even more potent narcotics such as Fentanyl, which are often found in the blood streams of those who have overdosed.

    Think this is uncommon? Think again, start asking around your family and friends and it won’t be long before you find someone who has been closely effected by a situation similar to the one above. Recent Studies found by the ADA have reported that ER visits for Opioid overdoses are on the rise throughout the country, and have increased by as much as 30% in the U.S. (ADA, Morning Huddle 3/8/2018). Often times the population most at risk for abusing opioid medications are our youth. A recent TIME article (6/2 Ducharme) sited an alarming statistic in which it was found that Opioids were Responsible for 1 in 5 Deaths Among Young Adults.


So if not Opioids, then what?
    If you have had a toothache or if I have extracted a tooth for you here at Drewyer Dentistry you may have noticed that I have not sent you home with a prescription for an opioid. Instead I have advised taking a Non-steroidal Anti-Inflammatory, such as Ibuprofen (Advil) and if needed to combine with an Extra Strength Tylenol (Acetaminophen). This advisory of pain medication is usually accompanied by my explanation that research shows this is the best cocktail for tooth related pain.

Here is a broad guideline for treating Dental Pain:

Start with 2 tablets of 200 mg Ibuprofen. If you are not feeling better after 4 hours take 3x 200mg Ibuprofen.
If after 6 hours you are still not feeling better take a combination of 1 Extra Strength Tylenol and 3x 200mg Ibuprofen.
After 6 more hours this recipe can be increased to 1 Extra Strength Tylenol combined with 4x 200 mg Ibuprofen every 6-8 hours.

    Keep in mind that this is a general guideline for dental pain and that consulting with us is always best. I generally individualize this regimen depending on our patient’s specific needs. Not only does this pain regimen avoid the use of opioid containing pain medications, but it is backed by strong research. A recent New York Times article (4/25 Bakalar, Subscription Publication) reviewed multiple studies of medications that showed “over the counter pain pills are safer and more effective than prescription opioids for controlling the pain following dental procedures.” A Case Western Reserve University study reported that “Opioids are not the most effective way to manage dental pain” and the Journal of the American Dental Association found that a combination of ibuprofen and acetaminophen (Tylenol) provides more effective pain relief. The American Dental Association’s President Joseph P. Crowley has advised “that over-the-counter products are as effective or more effective than opioids to solve acute pain.”

So, Dr. Austin here asking you to please help me in the effort to protect our community from the dangers of opioids.
 

Patients: here’s what you can do:
-Dispose of all unused prescription medications. Find a local Drug Turn in Program, flush prescriptions down the toilet or
throw away in the trash. Check out www.fda.gov/drugs.
- Next time you are given a prescription for pain medication, ask if there are any alternative pain control options besides opioids.
Often times Doctors feel forced to prescribe opioids because that is what the public expects. As described above they are not
always needed.
-Ask about side effects or dangers of the prescriptions you are given.


My Colleagues in Healthcare:
- Consider starting with Over-the-Counter Pain measures before utilizing opioids
for pain management.
-When necessary to use opioids, consider writing for 3 days or less.
-Register with and utilize Prescription Drug Monitoring Programs (PDMPs).
-Educate patients on the dangers and side effects when prescribing opioids.
-Screen patients for abusive characteristics prior to prescribing.

    Obstructive Sleep Apnea leads to multiple co-morbidities or other diseases that can drastically shorten ones lifespan.   Picture this, you are having a breath holding contest underwater with your niece/nephew and to your surprise they take you to your absolute limits until you finally give in and rise to surface gasping for air.  How do you feel?  Your heart is racing and you feel absolutely exhausted. 

    Picture doing this over and over in your sleep and you are well on your way to realizing what Obstructive Sleep Apnea does to one’s body.   Each of these disturbances is called an Apnea.

    During an Apnea, one is forced into a flight or fight response to literally save themselves from suffocating.  In turn heart rate is elevated multiple times during the night putting extra stress on the heart which can increase blood pressure and increase risk for cardiac failure.

    This same fight or flight response during an Apnea also stimulates ones blood sugar.  Instead of actually fighting or “flighting” so to say, you are left stagnant in your bed trying to sleep.  Thus, this wasted stimulation of blood sugar over and over during the night increases the risk of someone developing Diabetes as well as becoming overweight.  The increase of blood sugar during an Apnea would be similar to having a sugary snack multiple times during the night time. 

    This does't even begin to touch the surface of how OSA effects quality of sleep.  Not only do we need sleep to recover physically but lack of sleep can also affect mental acuity and our productivity during the day.  A high percentage of car crashes are caused by drivers who are sleep deprived. Living with untreated OSA not only puts you at risk but also your passengers and other drivers on the roads.

Trying to lose weight but just can’t seem to make any progress?

                When we go for a run we need sugar in our blood to use as energy.  Running then uses this sugar in the blood to keep us going mile after mile.  But what happens when blood sugar is elevated during sleep?  This sugar is converted and stored for later use as fat.  All the diets and workouts in the world may not be able to overcome the effects of Obstructive Sleep Apnea on blood sugar.

                Chronic High Blood Pressure, Obesity and Diabetes can greatly decrease one’s life expectancy.  If your loved one is a snorer then treating their Obstructive Sleep Apnea may be the key to increasing their health for years to come.

So what do I do?

                First, a diagnosis is needed. Not all snorers have Obstructive sleep apnea and not all sleep apnea suffers snore.  The diagnosis starts with a certified sleep study that measures snoring, number of apneas and oxygen levels during the night. 

Are there any cures?

                Once diagnosed by a sleep professional there are a number of devices that can prevent Obstructive sleep Apnea.   Depending on the severity a CPAP or continuous positive airway pressure  may be prescribed to keep a patients airway open.

Are there other devices that are less invasive than a CPAP?

                Yes.  For mild OSA sufferers or patients who are unable to tolerate a CPAP, Dentists can fabricate a MAA or Mandibular Advancement Appliance .

                A MAA is similar to wearing an upper and lower mouth guard at the same time.  This device helps keep ones airway open throughout the night by preventing the lower jaw from drifting back into the throat which leads to airway obstruction or closure.

What can Drewyer Dentistry do for me?

    At our office in Burtonsville, MD we assist in both the diagnosis and care for sufferers of OSA.  We offer our patients a Free Take Home Sleep Study.  Our sleep study device in comfortable and noninvasive and consists of wearing wrist watch size bracelet, a small microphone taped to the chest  and a plastic finger cover that is smaller than a finger splint.

    Drewyer Dentistry also fabricates MAA’s in office.  Below is an example of one of the appliances we make for suffers of Obstructive Sleep Apnea. 

Check out our Oral Appliance for Sleep Breathing page to see how your dentist can help OSA sufferers.

                The sound of snoring actually comes from the suction that occurs in ones throat when soft tissues of the neck, tongue and throat close off ones airways.  The vibration of air trying to make its way through this closed space creates the loud snoring noise and when totally closed can cause suffocation and lack of oxygen multiple times during the night.  Sometimes this lack of oxygen will cause someone to wake suddenly gasping for air.  Often times the snorer is unaware of these disturbances, which is why it is so important for their spouses or family members to be educated on the danger of snoring.

         Common characteristic of OSA sufferers:

  • Large Shirt Collar size or neck size
  • Chronic Heart Burn
  • Large tongue
  • Small Mouth
  • History of Braces
  • Overweight
  • Large tonsils or never had your tonsils removed
  • Heavy wear on teeth
  • TMJ pain
  • Chronic Nasal congestion

    Chronic nasal congestion, a large neck, large tongue, large tonsils, carrying extra weight and a small mouth are all signs of a reduced size of airway opening.  In some cases, orthodontic treatment (braces) actually narrows ones palate (roof of their mouth) causing a smaller opening of the airway.     A Mallampati Classification is a score of one’s airway size from I-IV. 

    The suction of soft tissue that causes the snoring noise, also causes a suction from down in the stomach throughout the night.  This suctions up stomach acids that can cause chronic heart burn and even acidic wear on ones teeth. 

When an OSA sufferer is suffocating during the night the only way they can re-open their airway to breathe again is to rapidly thrust their lower jaw forward after it has drifted back into their airway.  This forceful motion of the lower jaw grinds teeth against teeth and puts extra stress on the jaw joint called the Temporomandibular Joint (TMJ), multiple times night after night.

Take a look at the diagram below to see how airways close during OSA.  The far right photo shows how a Dentist Fabricated Oral Appliance opens the airway:

Check out our next blog Is your Loved One’s Snoring shortening their lifespan?  

Or Check out our Oral Appliance for Sleep Breathing page to see how your dentist can help OSA sufferers.

    Everyone has that uncle or grandfather who could be mistaken for a horse while he sleeps in the recliner after a family dinner.  Snoring, usually described as funny or annoying and many times an embarrassing stigma is associated with loud snoring.  But Dangerous? Or Life Threatening?  These could be the terms that are more important when loved ones are heard snoring.

    The truth is snoring could be a sign of a condition called Obstructive Sleep Apnea (OSA) in which someone actually stops breathing multiple time during their sleep.  Here are a few signs you may be experiencing OSA:

  • Loud Snoring
  • Chronic Heart Burn
  • Daytime Sleepiness
  • Awakening with dry mouth or sore throat
  • Morning Headache
  • Abrupt awakening  while gasping or choking
  • High Blood Pressure
  • Overweight
  • Difficulty concentrating during the day
  • Spouse unable to sleep in the same room

Check out our next blog 8 Weird but Common Characteristics of Obstructive Sleep Apnea Sufferers

Or Check out our Oral Appliance for Sleep Breathing page to see how your dentist can help OSA sufferers.

By Austin D. Drewyer D.D.S.
May 19, 2017
Category: Dental Technology
Tags: Cavity   CariVu   Fillings  

CariVu Cavity Detection Camera

    Until recently, x-rays have been the number one diagnostic tool for the detection of decay (caries) in areas that are not visible by sight. Advances in technology have brought new and more efficient ways of diagnosis to the table. One of the best advances is an intra-oral camera known as Cari-Vu. The Cari-Vu is a very accurate system for detecting decay, with 99% accuracy, improving the current 91% accuracy of digital   x-rays. X-rays can be somewhat limiting due to their "view" on crowded teeth and lower radiation exposures (good news, yet bad resolution!). This means that cavities can develop unnoticed in areas until a patient experiences pain or sensitivity. These questionable lesions which sometimes may be referred to as a "watch" can now be diagnosed with Cari-Vu. The camera gets a birds eye view of the tooth, shines a powerful light (near-infrared transillumination) and records the 3D picture revealing the relative density of the tooth structure. All of this is done with NO radiation.  We can tour the entire mouth in just a few minutes, and patients can watch the live monitor to see if there are any dark spots right away. X-rays can be tricky to explain, and require a trained eye to see the potential state of a tooth. The Cari-Vu has taken a lot of guesswork out of diagnosing questionable areas of decay. Additionally, the Cari-Vu shows evidence of deep cracks around silver fillings, which often signal the risk of fracture. Patients who have experienced this know all too well that once this happens they are often left with having to place a crown on that tooth. This early detection can ultimately save a tooth from potentially needing a crown, and instead be restored with a tooth colored resin filling. Now patients can be even more     in charge of their dental wellness by knowing with confidence what exactly is going on in their mouth. Treating patients with the utmost efficient, reliable, and safe technology, we feel, is the best way to treat a patient.  We are very excited to introduce this camera to our patients, and seeing is now believing.  Check out the below pictures, the top picture was taken with the CariVu camera and the picture below shows the same cavity once the tooth has been opened up.

 





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