Posts for: January, 2019
The March 27th game started off pretty well for NBA star Kevin Love. His team, the Cleveland Cavaliers, were coming off a 5-game winning streak as they faced the Miami Heat that night. Less than two minutes into the contest, Love charged in for a shot on Heat center Jordan Mickey—but instead of a basket, he got an elbow in the face that sent him to the floor (and out of the game) with an injury to his mouth.
In pictures from the aftermath, Love’s front tooth seemed clearly out of position. According to the Cavs’ official statement, “Love suffered a front tooth subluxation.” But what exactly does that mean, and how serious is his injury?
The dental term “subluxation” refers to one specific type of luxation injury—a situation where a tooth has become loosened or displaced from its proper location. A subluxation is an injury to tooth-supporting structures such as the periodontal ligament: a stretchy network of fibrous tissue that keeps the tooth in its socket. The affected tooth becomes abnormally loose, but as long as the nerves inside the tooth and the underlying bone have not been damaged, it generally has a favorable prognosis.
Treatment of a subluxation injury may involve correcting the tooth’s position immediately and/or stabilizing the tooth—often by temporarily splinting (joining) it to adjacent teeth—and maintaining a soft diet for a few weeks. This gives the injured tissues a chance to heal and helps the ligament regain proper attachment to the tooth. The condition of tooth’s pulp (soft inner tissue) must also be closely monitored; if it becomes infected, root canal treatment may be needed to preserve the tooth.
So while Kevin Love’s dental dilemma might have looked scary in the pictures, with proper care he has a good chance of keeping the tooth. Significantly, Love acknowledged on Twitter that the damage “…could have been so much worse if I wasn’t protected with [a] mouthguard.”
Love’s injury reminds us that whether they’re played at a big arena, a high school gym or an outdoor court, sports like basketball (as well as baseball, football and many others) have a high potential for facial injuries. That’s why all players should wear a mouthguard whenever they’re in the game. Custom-made mouthguards, available for a reasonable cost at the dental office, are the most comfortable to wear, and offer protection that’s superior to the kind available at big-box retailers.
If you have questions about dental injuries or custom-made mouthguards, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “The Field-Side Guide to Dental Injuries” and “Athletic Mouthguards.”
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.
Periodontal (gum) disease is as common as it is destructive. Almost half of all adults 30 and older have some form—and those numbers increase to nearly three-quarters by age 65.
Fortunately, we have effective ways to treat this bacterial infection, especially if we catch it early. By thoroughly removing all plaque, the disease-causing, bacterial biofilm that accumulates on tooth surfaces, we can stop the infection and help the gums return to normal.
Unfortunately, though, you're at a greater risk for a repeat infection if you've already had gum disease. To lower your chances of future occurrences, we'll need to take your regular dental exams and cleanings to another level.
Although everyone benefits from routine dental care, if you've had gum disease you may see these and other changes in your normal dental visits.
More frequent visits. For most people, the frequency norm between dental cleanings and exams is about six months. But we may recommend more visits for you as a former gum disease patient: depending on the advancement of your disease, we might see you every three months once you've completed your initial treatment, and if your treatment required a periodontist, we may alternate maintenance appointments every three months.
Other treatments and medications. To control any increases in disease-causing bacteria, dentists may prescribe on-going medications or anti-bacterial applications. If you're on medication, we'll use your regular dental visits to monitor how well they're doing and modify your prescriptions as needed.
Long-term planning. Both dentist and patient must keep an eye out for the ongoing threat of another gum infection. It's helpful then to develop a plan for maintaining periodontal health and then revisiting and updating that plan as necessary. It may also be beneficial to perform certain procedures on the teeth and gums to make it easier to keep them clean in the future.
While everyone should take their oral health seriously, there's even greater reason to increase your vigilance if you've already had gum disease. With a little extra care, you can greatly reduce your chances of another bout with this destructive and aggressive disease.
If you would like more information on preventing recurring gum disease, 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 “Periodontal Cleanings.”