Even OTC Pain Relievers Have Risks.

Posted on Dec 09, 2021 by William J. Claiborne, DDS MS

When we see new patients in our Asheville periodontal dental office, it’s common to hear comments about how the appointment was the most thorough they have ever experienced. We pride ourselves on our dental hygienists’ skills for dental cleanings, exams of gum tissues, and in advising patients of ways to maintain good oral health at home.

As a periodontal specialist, I perform a thorough examination of the teeth and oral tissues, both visually and through digital imaging (x-rays). In some cases, we use Cone Beam 3D imaging. Our goal is to have an in-depth view of each patient’s oral anatomy and intricate areas that can reveal problems, both potential and existing.

Our hygienists also work to consider the patient’s whole health so we can tailor their treatment to unique needs. They typically begin by noting any medications the patient takes, both over-the-counter or prescription. Herbal supplements taken regularly are also noted. Why?

The number of American adults who regularly use medications for pain relief has significantly expanded. For most mild to moderate pain, preferences for non-prescription pain relievers (analgesics) now lean towards non-steroidal anti-inflammatory drugs (NSAIDs) or acetaminophen.

There are a wide variety available over-the-counter (OTC), which means they are readily available without a prescription. Because these can be purchased right off the shelf, many people assume these medications are safe.

What consumers often miss, however, is the fact that many of these can have side effects. They can also interact with other medicines, dietary supplements, and alcohol consumption. Because pain medications contain the same ingredients found in a number of prescription drugs, adults may actually be taking a risky dose when combining medications.

According to a report from NBC News, Americans are taking too much of over-the-counter pain relief meds. In a study conducted by a Boston University School of Health researcher, nearly one in five users of popular headache remedies like Advil or Aleve admitted exceeding the recommended daily maximum dose during a one-week period.

Due to the side effects and without medical oversight, this can lead to higher risk for serious health problems, including gastrointestinal bleeding and heart attacks.

https://www.nbcnews.com/storyline/americas-heroin-epidemic/americans-are-abusing-over-counter-drugs-well-opioids-study-shows-n846401

Before taking these meds, it’s important to get to know the types of pain medications (also known as analgesics) and how they work.

NSAIDs are an acronym for non-steroidal anti-inflammatory drugs. In this category are pain relievers that include aspirin, ibuprofen (Advil, Motrin), and naproxen sodium (Aleve, Naprosyn), and ketoprofen (Orudis).

Non-steroidal anti-inflammatory drugs reduce pain and inflammation by inhibiting production of prostaglandins, which are the hormone-like substances that cause them. Unfortunately, NSAIDs also block other prostaglandins that protect the stomach lining, regulate blood flow to the kidneys, and support blood clotting.

This is bad news for people who are regular users of NSAIDs or those who take high doses since they increase the potential for stomach inflammation, peptic ulcers, and intestinal bleeding. This is especially true for older adults. Taking NSAIDs in high doses or for an extended time can increase this risk even more.

An alternative is acetaminophen (Tylenol, Anacin-3, etc.), which relieves pain by affecting the areas of the brain that receive pain signals. Acetaminophen is best when the need is to reduce pain and fever, but is essentially ineffective in calming inflammation. The up side, however, is it will not cause the bleeding or clotting problems that have been associated with NSAIDs.

Yet, just as NSAIDs have a down side, so does acetaminophen. This analgesic is metabolized by enzymes in the liver. Taking too much can lead to liver damage in susceptible people, such as those who drink alcohol regularly. This is why it is important to read the labels of any medication so you don’t exceed the maximum daily dose of acetaminophen.

For most, taking non-prescription pain relievers – as directed on the label – is generally safe. The potential for trouble arises when you combine the following:

• Some NSAID and acetaminophen products, as well as cold, sinus, and allergy remedies, contain a blend of pain relievers. Kidney damage can result from extended use of painkillers that combine analgesics from different sources.

• A wide number of prescribed painkillers contain acetaminophen, such as Darvocet and Vicodin. Some prescriptions contain NSAIDS, including Celebrex and Percodan. Before you combine prescription medications with over-the-counter painkillers, be sure to check with your prescribing doctor first.

• NSAIDs can interact with other drugs, especially ACE inhibitors, anticoagulants, beta blockers, lithium, and methotrexate. Aspirin interacts with anticonvulsants, corticosteroids, insulin, and sulfa antibiotics. If you take any of these prescription medicines, check before using NSAIDs or aspirin.

• People are often surprised to learn that some herbal supplements, including garlic, ginger, feverfew, ginkgo, and ginseng, can thin blood. You should avoid taking these supplements while taking NSAIDs. When having procedures that may involve bleeding gums, these supplements, or combining them with NSAIDs, can complicate your procedure and the healing process.

One of the reasons we request updates on the medications you take at each visit is to provide you with optimal care. We want your oral health to support your overall health, and vice versa. Be a careful consumer of the medications you take, whether OTC or prescribed.

If you have questions, call 828-274-9440. You may want to begin with a free consultation to get to know us, or schedule complete periodontal examination, especially if you have signs or symptoms of periodontal (gum) disease. These include:

• Sore, tender gums that bleed easily while brushing teeth
• Frequent bad breath
• Gums that recede from the base of teeth, exposing darker, more sensitive sections of the tooth’s root
• Gums that are swollen
• Gum tissues that darken to more of a red color versus a healthy pink

If these signs exist, it is important to seek a periodontal evaluation as soon as possible. Gum disease will only worsen without treatment and is the nation’s leading cause of adult tooth loss.

At Biltmore Periodontics in Asheville, we are always happy to see new patients. A referral is not always needed.

Dental Fear Can Lead To Gum Disease, Tooth Loss

Posted on Nov 23, 2021 by William J. Claiborne, DDS MS

Fear is a natural reaction to things that may harm us; it’s a safety mechanism activated by the brain. Take snakes, for instance. Even harmless snakes tend to provoke an initial reaction that warns of impending danger.

Some fears are learned, however. Some people are afraid of dogs, usually stemming from a frightful encounter as children. The incident triggers something in the brain that reminds the individual, even into adulthood, that dogs are to be feared.

When it comes to the fear of dentistry, it often exists because of a traumatic incident in the patient’s past. Or, in some cases, it exists for unknown reasons. Too, certain smells, sounds or sights can trigger the “panicky” reaction some people have to dental visits.

As a periodontist in Asheville, I have a firsthand view of just what dental fear can do to oral health. Avoiding regular dental care is a sure recipe for cavities, periodontal (gum) disease, and eventual tooth loss.

Typically, adults who avoid dental visits feel they are doing an adequate job maintaining their oral wellness at home. In some minds, “I brush twice a day,” can be the justification to bypass recommended 6-month dental check-ups and cleanings.

Yet, even the best of at-home dental hygiene can be insufficient to the buildup of tartar.

Tartar is the hardened form of plaque, which is a sticky film of bacteria that accumulates in the mouth. In the form of tartar, this cement-hard mass of bacteria cannot be brushed or flossed away. It can only be removed by a dentist or hygienist using special tools.

While plaque can cause bad breath and a “furry” feeling mouth, tartar eats away at tender gum tissues and bores into tooth enamel. As it grows, it works its way below the gum line, creating inflammation in the gum tissues.

Early symptoms of gum disease, known as gingivitis, are tender or swollen gums. You may see blood in the sink when brushing teeth. Breath odor may be bad on a regular basis.

At this point, proper measures may be able to reverse the progression of these rapidly-reproducing bacteria. This requires thorough brushing (twice a day, at the very least), daily flossing, drinking lots of plain water, and using an oral rinse to control bacteria levels.

However, if tartar exists, it’s not going to go away. It will continue to amass and attack the gums and work its way into the tissues below. When the bacteria reach an uncontrollable level, they become infectious.

Think of gum disease bacteria as you would water in a pan on the stove. The heat will eventually cause bubbles to form on the bottom of the pan. This can be likened to gingivitis.

However, as the water heats more, bubbles start to move to the surface. This can symbolize the development of gum disease. The symptoms of gum disease include gums that turn red and bleed easily and persistent bad breath.

When advanced stage periodontal disease develops (periodontitis), imagine the water at full boil. Unfortunately, once aboil, the roil continues even after you remove the pan from the heat. This is known as systemic inflammation.

Gum disease is the nation’s leading cause of adult tooth loss. Yet, the bacteria that destroy gums and the structures that support natural teeth don’t remain confined to the mouth. Through tears in diseased gum tissues, these infectious bacteria can enter the bloodstream.

Research has correlated oral bacteria to a long list of serious health problems. Some can be activated by the bacteria of periodontitis, some are worsened. These include heart disease, stroke, Alzheimer’s disease, arthritis, diabetes, preterm babies, erectile dysfunction (ED), some cancers (including pancreatic), and more.

Obviously, these bacteria are potent and a threat to overall health. For those who avoid dental care due to anxiety or fear, knowing all this is not necessarily going to change their resistance. We understand that it’s still difficult to overcome the challenges even knowing there are risks.

There are options, however, for even high fear dental patients.

In our office, we offer I.V. sedation (“twilight sleep”) as well as oral sedation. Oral sedation is in pill form and creates a totally relaxed feeling. It enables patients to recover quickly and offers an amnesiac effect.

I.V. sedation is a deeper level of sedative. This places patients in a sleep state and erases most or all memory of the procedure after. With both sedations, however, we apply numbing medications to the area being treated to create optimal comfort for patients. We want patients to be in total comfort throughout their treatment, regardless of the addition of sedation.

We also have a reputation for treating our patients with respect and a gentle touch. We are just as committed to comfort for patients who do not want to be sedated as we are for those who are. Our goal is to help each person achieve a healthy, confident smile.

One of the most satisfying parts of my specialty is helping a once-fearful patient achieve a healthy, confident smile and see dental care as a welcomed part of their health care commitment.

If you are ready to get past your dental fears so you can have the smile you desire, begin by calling our Asheville periodontal office at: 828-274-9440 and speaking with our friendly staff. You can begin with a consultation, if desired.

 

Mouth Sores – What Is Harmless & What To Watch Closely

Posted on Nov 04, 2021 by William J. Claiborne, DDS MS

As the holiday season approaches, our risk for illness goes up. Our chances for picking up colds or the flu increases, which is worrisome on its own. Add that to already-high concerns surrounding exposure to COVID, and we’re all taking added precautions to protect our health.

As in any year, colder months mean we’re more confined to the indoors and in closer proximity to others. With heightened potential for illness, the holidays simply create more stress to our lives. Stress is a contributor to our health as it compromises the immune system. This, in turn, lowers our resistance to fight off illness.

After the holiday mingling constraints endured in 2020, people are trying to take added precautions in 2021 so our “togetherness” is not overshadowed with worries about exposure to illness. To bolster our resistance, many people have had their Covid booster and flu vaccines, practice frequent hand washing, take vitamin supplements such as C, and are trying to stay active physically inside and out-of-doors.

Certainly, we applaud the health safety efforts taken by our Northwest NC population. As an Asheville periodontist, just a added tip for your overall health and well-being: Don’t forget to monitor the inside of your mouth while being committed to the other health measures you’re taking. You may be surprised at what your mouth reveals.

In busy times of year like the holiday season, we see a greater number of individuals who develop canker and cold sores.  As stress goes up, your likelihood of getting a cold or canker sore increases as well.

The difference between Canker and Cold sores is:

Canker Sores
These are small ulcers that typically have a white or gray base and red border. Unlike cold sores, canker sores appear inside the mouth and are not contagious. The exact cause of canker sores is uncertain but fatigue, stress or allergies can increase the likelihood of a canker sore. Some experts suspect immune system problems, bacteria or viruses can also spurn eruption. A cut caused by biting the tongue or inside of the cheek as well as hot foods or beverages may contribute to canker sore development. Canker sores usually heal on their own in a week or two. Over-the-counter topical anesthetics, steroid preparations,  and antimicrobial mouth rinses can provide temporary relief. As a holistic method, you may try swishing with plain, sugar-free yogurt for a minute or so. This helps to restore a healthy bacteria balance in the mouth while soothing discomfort.

Cold Sores
These are also referred to as fever blisters or Herpes simplex and are located around the lips, under the nose or on the chin. Caused by herpes virus type 1, cold sores are very contagious. These are clusters of fluid-filled blisters that often erupt since are they are most commonly found around the edge of the lips. Cold sores are Herpes lesions that may follow a fever, sunburn, skin abrasions or emotional upset. Because cold sore blisters are on the outside of the mouth, they can be embarrassing and uncomfortable. Although they usually heal in a week, over-the-counter topical anesthetics may speed the process while providing some relief. In our office, we can use a dental laser to hasten healing, often within a couple of days. If occurrences are frequent, ask about prescription drugs that can help reduce the duration of these viral infections.

Other issues your mouth’s interior can reveal include:

White Coating On Tongue
The tiny, bumpy protrusions on the tongue’s surface are papillae. Papillae are our source for taste and touch, allowing for feeling food’s form and texture. Saliva and food residue can become embedded in the grooves between the papillae, especially on the back portion of the tongue. This can create areas for rapid bacterial growth. As bacteria accumulate, a whitish film coats the tongue, which leads to bad breath. Let your white tongue be a warning sign of too much bacteria and take measures to manage it before cavities and gum disease develop. It’s important to keep the mouth moist since a dry mouth provides a breeding ground for bacteria reproduction. Drying sources, in addition to age, include smoking, alcohol consumption, caffeinated foods and beverages, and many prescription and OTC medications. Uproot bacteria in the tongue daily by brushing the tongue with your toothbrush after brushing teeth. Some toothbrushes have a tongue scraper on the back side of the bristles or you may want to purchase a tongue scraper. These are flexible strips you use to scrape over the tongue’s surface in a back to front motion.

Cheek Biting
Cheek biting can occur from a minor accident, such as during a fall. It can also occur from careless chewing or talking while eating. Cheek bites can occur more frequently due to a bite that is misaligned. A disparity in the bite can disrupt the harmonious congruency of upper and lower teeth while chewing and speaking. Cheek biting can be a symptom of bite misalignment. Other signs may indicate temporomandibular joint (or TMJ) disorders, which often result from a misaligned bite. Thus, cheek biting can be related. Too, TMJ disorders can cause night-time clenching or grinding of teeth. During these actions, you may be unknowingly biting the inside of your cheek while asleep. Cheek biting can cause inflammation at the location of the bite and can also result in canker sores. Chronic cheek biting can result in redness, painful sores, and tears in the mouth’s inner lining. Repeated bites can cause the oral tissues to become thick, scarred, and paler in the affected area. This surface can prompt the individual to continue biting in an attempt to create a smooth surface. If cheek biting has become habitual, there may be an emotional cause, such as  stress, anxiety, depression, or even genetics. This should be discussed with your primary care physician.

Oral Cancer
It is important to pay close attention to any change to oral tissue that does not heal within 10-14 days. When oral tissue does not repair on its own in a week or so, it should be examined by your dentist or periodontist without delay. Some of these spots can be a symptom of oral cancer.
Oral cancer has one of the worst survival rates of all cancers. Because symptoms can mimic a bite on the inside of your cheek, more obvious symptoms often do not emerge until the cancer has reached advanced stages. Of those who acquire oral cancer, only 57% are estimated to still be alive 5 years later. Know the signs of oral cancer, which include:

• white or red patch of tissue
• unusual lesion in the mouth
• difficulty or discomfort when swallowing
• persistent sore throat or feeling something is stuck in the throat
• a lump or mass inside the mouth or neck
• wart-like mass
• numbness in the mouth or face

Lesions or discolorations that are early warning signs are not always visible, particularly in the back portion of the mouth. Because symptoms emerge slowly, the delay in early diagnosis and treatment can have deadly consequences. This reinforces the need to maintain regular oral hygiene exams and cleanings every six months. During these times, unusual changes in the mouth can be noted and, if concerning, further steps can be taken. Remember, never wait until your next dental check-up appointment to have anything unusual examined.

Bleeding Gums
Contrary to what some people believe, having gums bleed at any time is not normal. Seeing blood in the sink when you brush is not a sign you’re doing a good job. It’s a sign that the gum tissues are either being scrubbed too harshly or the gum tissues are infected by accumulated oral bacteria. If you notice bleeding – at all – take extra measures to maintain excellent oral hygiene at home. This includes twice daily brushing, daily flossing, using an oral rinse, keeping the mouth moist (ideally by drinking plain water), and limiting sugar. If bleeding continues for more than a couple of days, make a dental appointment. You may have developed Gingivitis, which is an early stage of gum disease. Halting this in its tracks early can save you greatly in treatment time and expenses.

The interior of your mouth can be a great indicator of your health in other areas. Just be sure to look inside and stay proactive on steps needed to keep the interior “in the pink”. Again, if an unusual spot or sore is still present after two weeks, call 828-274-9440 immediately for an appointment.

What’s Keeping You From The Dentist’s Office?

Posted on Oct 19, 2021 by William J. Claiborne, DDS MS

As an Periodontist in Asheville NC, I’ve treated many patients who, to no surprise, developed periodontal (gum) disease because of NOT going to a dentist on a regular basis.

According to the Centers for Disease Control & Prevention (CDC), nearly 65 percent of adults aged 18 and over had at least one dental visit in the past year (based on 2019).

https://www.cdc.gov/nchs/fastats/dental.htm

Unfortunately, that leaves 35 percent of adults who did not.

The reason it is recommended to see a dentist for exams and cleanings TWICE A YEAR is because tartar, which is hardened plaque, can cause cavities and gum disease. One plaque hardens into tartar, it can no longer be brushed or flossed away. It must be removed by a dentist or hygienist using special tools.

Tartar is actually a mass of oral bacteria, which has attached itself to the base of (or in-between) teeth. Tartar (also referred to as calculus), is a colony of bacteria that thrive on oral tissues. Bacteria are living organisms and reproduce rapidly. And, the more there are, the more rapidly they amass.

So, what are the common excuses for avoiding regular dental care? See if you’ve been guilty of one or more:

COST – Some individuals feel dental cleanings and exams are expensive. Actually, there is a great deal of time and training that goes into your individualized care. In addition to the measures of sterilization and instruments, hygienists and dentists are highly-trained, educated, and must stay board certified. As for the investment, these visits are what help you avoid the need for a filling, gum disease, potential damage to teeth due to bite misalignment, and even catch oral cancer at early stages. If dental insurance is not possible, ask if payment plans are available. Many dental offices offer these, most of which are interest-free with no down payment required.

DENTAL FEAR – If fear or anxiety keeps you away from a dental chair, you are not alone. It is estimated that over 70 percent of American adults have some level of this. Sometimes the fear exists because of a traumatic experience in the past or feeling helpless in the chair. Some people react to certain smells and sounds. A few have no idea what prompted their fear, but know it is beyond their control. For these, we advise seeking dental care in a modernized office. Today’s advanced technology has greatly enhanced the level of comfort during care as well as reduced treatment time. Too, offices such as our Asheville periodontal dental office offer oral sedation as well as IV sedation (twilight sleep). These are administered by highly-skilled professionals who oversee the patient using advanced safety monitoring equipment. Ask for a consultation and tour before choosing the office that is reassuring to your unique needs.

DREAD OF BEING LECTURED – If it’s been years since you’ve seen a dentist, you may be expecting a lecture from the dentist or hygienist (or both!). My staff and I believe that is a sure way to deter someone from cultivating a positive attitude towards their dental relationship. We all want to feel respected and having a caregiver talk “down” to you is unfair, especially because no one knows the story behind your delay or avoidance. If you feel that’s going to be a problem, say so. Be upfront with “a lecture is not going to help me.” If you feel it’s a recurring problem, ask to have your records transferred to an office where you are treated more appropriately.

FEAR OF EMBARRASSMENT – Some adults feel awkward having their denture or partial removed at the dentist’s office. Some people fear they’ll gag during care, which can trigger coughing and even throwing up. Some feel their mouths are so “bombed out” that it’s embarrassing to have a dentist see how much damage has occurred. To reassure you, there is nothing we haven’t seen or experienced. Dentists have quite a lot thrown at us during dental school. As a specialist in periodontics, my additional training covered even more in-depth and complex damage or disease. DO NOT worry about your caregivers. They WANT you to rely on them to help you. Almost any dentist or specialist will tell you that our greatest joy comes from taking a patient from a “hopeless” mouth to a patient who has a healthy, confident smile!

TIME IN TREATMENT – Today’s advanced technology has greatly condensed the time needed to accurately diagnose and treatment plan almost any dental problem. Many treatments can be completed in just one or two visits. For those who have more extensive needs, dentists can sometimes combine several appointments into one long one. This is made much easier for the patient with the addition of oral sedation. Oral sedation creates a totally relaxed state so the patient can “doze” in and out of treatment. It has a quick recovery and sedated patients are carefully monitored for safety and comfort throughout treatment.

Regardless of WHY you’ve avoided the dentist, your smile is worth it! Having an appealing smile you feel joyful in sharing adds to your mood, enhances appearance and makes a positive impression to others.

If you’ve avoided dental care for years (or even decades), you may have signs or symptoms of periodontal disease. These include tender gums that may bleed when brushing, gums that recede from the base of some teeth, gums that turn red in color, and frequent bad breath. Gums are the foundation for teeth, so without healthy gums, your teeth will not be healthy, either.

Too, gum disease will only worsen without treatment. If you are a reader of my articles, you may have read the findings of research that correlates the bacteria of gum disease with serious health conditions. These include stroke, heart disease, preterm babies, some cancers, arthritis, diabetes, and erectile dysfunction.

Let us help you feel the positive aspects of achieving a healthy smile. Begin with a consultation by calling 828-274-9440.