Helping To Curtail Opioid Misuse

Posted on Mar 23, 2023 by William J. Claiborne, DDS MS

No one wants to be in pain. In the dental office, dentists and dental specialists see many patients enduring a great deal of pain, some of which increases in time to excruciating levels.

To resolve the pain, treating the affected area is the first step. Healing can take time and may involve a period of continued discomfort. While a dental profession wants to help patients avoid problems and pain that can arise from them, helping you get through painful periods with ease is certainly a priority.

Like others in the health care field, the field of dentistry has become rather resistant to prescribing harsh and addictive painkillers. The opioid epidemic in the U.S. is running rampant and we want to do our part in curtailing the availability of these meds.

I felt it may be helpful to share some statistics and research findings on the opioid use in America. Hopefully, this information will reassure that the dental profession is not being “stingy” with prescribing painkillers. We are trying to help control what can easily be misused or over-prescribed.

Drug overdose deaths involving prescription opioids rose from 3,442 in 1999 to 17,029 in 2017. From 2017 to 2019, the number of deaths declined to 14,139. This was followed by a slight increase in 2020, with 16,416 reported deaths. In 2021, the number of reported deaths involving prescription opioids totaled 16,706. These numbers are headed in the wrong direction, obviously.

Although physicians, dentists and others in health care have been under close scrutiny for the number of opioids prescribed, dentists are also being more diligent in limiting patient access to pain medications. Yet, there is still a concerning number who make access easier than it should be.

According to International Association for Dental Research findings shared from two studies amongst dentists and oral-maxillofacial surgeons (OMFS) (presented in March 2023), the goal is to identify high prescribers of opioids. The study, conducted at the University of Pittsburgh, used data to detect actively prescribing dentists between 2015-2019.

The study found that during this period, 2,741,030 opioids were prescribed by 199,145 dentists/OMFS. Researchers noted that over 35% of prescribers prescribed at low rates in 2015 with this percentage falling to nearly 18% in 2019. In this period, those who were “moderate” prescribers of opioids also decreased prescribing by over 82%. A slightly more active group of prescribers also decreased their number of these prescriptions.

However, 3.5% of prescribers found to be consistent in opioid prescriptions decreased in number, yet with minimal decline. For these, the rate in 2015 averaged nearly 55%. In 2019, the average was only down to 44.7%.

A particular concern in prescribing opioids is that of prescriptions submitted for children. While total opioid prescriptions have decreased in patients under 25 years of age, trends in opioid prescribing for children, adolescents, and younger adults (under 25 years of age) remains a concern.

In a study from 2013 – 2018, researchers found the opioid dispensing rate for younger patients decreased annually at a rate of approximately 15%. The largest decreases were noted for patients ages 15 to 24 years. Among children aged 0 to 5 years for whom an opioid was dispensed, the investigators observed annual increases from 2011 to 2014. For high-dosage prescriptions, these decreased from 2014 to 2018 although high-dosage, extended-release or long-acting remained at a concerning rate — nearly 28%.

Even amid an epidemic of abuse, opioid painkillers are still commonly prescribed to teenagers and young adults for conditions like tooth and back pain. Between 2005 and 2015, opioids were prescribed to teens and college-age adults at nearly 57 million visits to doctors’ offices and emergency departments.

Although more common in an ER, 15% of visits concluded with an opioid prescription with only a small decline over the 10-year study period.

A report on opioid prescription misuse by the University of Michigan shared another concern that contributes to the problem. When people get a prescription for opioid painkillers to ease pain, it is assumed that the patient has it filled right away. However, there are now findings that show some of these prescriptions are being filled more than a month later, long after acute pain should have subsided.

In 2019, 1% of opioid prescriptions from dentists and surgeons were filled more than 30 days after writing. Although the number is low, that percentage equates to more than 260,000 opioid prescriptions a year in the U.S.

This indicates to prescribing surgeons and dentists that the medications are being used for other than intended. Whether over-prescribed by the doctor or misuse by the patient, this adds to the risk factor for opioid overdose.

These delayed-fill findings have led to call for state and federal laws to better regulate the expiration periods for filling these prescriptions. Changing the systems of monitoring along these lines has been slow in coming. In 2019, 18 states allowed prescriptions for opioids and other controlled substances to be filled up to 6 months after writing with 8 states allowing dispension up to 1 year after the prescription date.

The entire team at our Asheville periodontal dental office is highly committed to providing patients with optimal comfort throughout treatment. Here, we make oral sedation available as well as I.V. sedation (“twilight sleep”). These help patients to relax fully or snooze during treatment, erasing most (or all) memory of treatment afterward.

We also want our patients to heal comfortably after periodontal treatment or dental implant placement. As a periodontist, this is helped by being respectful of gum tissues and all areas in the mouth DURING procedures. We work with each patient to help them remain comfortable during their post-procedure time. Often, this can occur without the need for heavy medications with many patients only requiring OCT pain meds.

When it comes to your treatment, our advanced imaging technology helps us to pinpoint precise areas for incisions, which helps to minimize discomfort and speed healing time. Additionally, performing treatment at an easy pace allows for minimal disruption to sensitive gum tissues.

A periodontist has advanced skills in the treatment of all stages of gum disease, the re-contouring of gum tissues, and in the placement of dental implants. This dental specialist can help provide an optimal result while helping you enjoy the highest level of comfort – during and after treatment.

Please call 828-274-9440 if you have questions about comfort, treatment, or dental fear. New patients are always welcome and a referral is not always needed.

 

Absorbent Gums Are On Front Line of “Hidden” Toxin Intake

Posted on Mar 15, 2023 by William J. Claiborne, DDS MS

When you hear someone mention the “gums,” the word often includes the pink, moist area inside the mouth. Not just the area inside the cheeks and under teeth, your oral tissue (“gingiva”) goes beyond what covers the upper and lower jaws and that which surrounds the base of the teeth. This includes …
• the lips
• inner lining of the lips and cheeks
• hard and soft palate
• gums that surround the base of teeth
• floor of the mouth under the tongue
• area behind wisdom teeth
• front two-thirds of the tongue

By design, these moist areas within the “oral cavity” are highly absorbent, so much so that these tissues absorb from anything put inside the mouth, including that which is quickly swallowed.

To help you understand just how important it is to maintain GOOD oral health, I thought it would be beneficial to share some of the BAD that the gum tissues endure. Because the mouth is the entry point for our bodies, you may be interested in seeing what foods and beverages contain some pretty scary ingredients.

According to the Environmental Working Group (www.ewg.org), these items include:

Nitrates and nitrites – are preservatives used in cured meats and linked to stomach cancer, esophageal cancer, and possibly brain and thyroid cancers.

Artificial sweeteners – can affect the hormones that regulate metabolism and have a negative effect on weight control.

Potassium Benzoate – A main ingredient in fireworks and rockets, this chemical preservative is found in many foods and beverages. It is commonly found in fruit juice, sparkling waters, soft drinks, jams, syrups and more.

Titanium dioxide – is a color additive used mostly in candy, which can damage DNA.

PFAS (polyfluoroalkyl “forever chemicals”) are used in food packaging and known to leach into the food itself. They increase the risk of cancer and damage the immune and reproductive systems, among many other health harms.

BVO (Brominated vegetable oil) – is used to stabilize citrus flavors in sodas and fruity drinks. It can cause neurological harm.

BHA (Butylated hydroxyanisole) – is a preservative used in cured meats and other foods. Multiple sources have identified it as a possible human carcinogen.

BHT (Butylated hydroxytoluene) – is a preservative found in cereals and other foods. This chemical cousin of BHA is a possible human carcinogen.

TBHQ (Tert-butylhydroquinone) – is a preservative used in Pop-Tarts and other processed foods. It may harm the immune system and weaken the effectiveness of vaccines.

Propyl paraben – is a preservative used in pastries and some tortillas. It causes developmental and reproductive harm.

That’s quite the long list. However, an even greater challenge to the gums comes from smoking. While everyone who smokes knows it’s “not good” for their health, it is less known the harm doesn’t come from the nicotine alone.

The American Lung Association lists the chemical culprits as:

Acetone—found in nail polish remover
Acetic acid—an ingredient in hair dye
Ammonia—a common household cleaner
Arsenic—used in rat poison
Benzene—found in rubber cement and gasoline
Butane—used in lighter fluid
Cadmium—active component in battery acid
Carbon monoxide—released in car exhaust fumes
Formaldehyde—embalming fluid
Hexamine—found in barbecue lighter fluid
Lead—used in batteries
Naphthalene—an ingredient in mothballs
Methanol—a main component in rocket fuel
Nicotine—used as an insecticide
Tar—material for paving roads
Toluene—used to manufacture paint

Puffing on E-cigs as a “safer” alternative?  That doesn’t preclude your oral health from the bombardment of chemicals in the vapor. Although the Food & Drug Administration (FDA) has not begun its review of any e-cigarette or its ingredients. Unfortunately, this means they have yet to issue standards on these products or submit specific warnings of their composition and effects.

The “e-juice” that fills the cartridges of e-cigs usually contain nicotine (which is extracted from tobacco and highly addictive), propylene glycol, flavorings and other chemicals. Studies have found that even e-cigarettes claiming to be nicotine-free contain trace amounts of nicotine. Additionally, when the e-liquid heats up, more toxic chemicals are formed.

Whether your e-cigarette contains nicotine or not, you may be surprised at the toxic toxic vapors contents below …

• Nicotine – a highly addictive substance that negatively affects adolescent brain development
• Propylene glycol – a common additive in food; also used to make things like antifreeze, paint solvent, and artificial smoke in fog machines
• Carcinogens- chemicals known to cause cancer, including acetaldehyde and formaldehyde
• Acrolein – a herbicide primarily used to kill weeds, known to cause irreversible lung damage
• Diacetyl – a chemical linked to a lung disease called bronchiolitis obliterans, or “popcorn lung”
• Diethylene glycol – a toxic chemical used in antifreeze that is linked to lung disease
• Heavy metals such as nickel, tin, lead
• Cadmium – a toxic metal found in traditional cigarettes that causes breathing problems and disease
• Benzene – a volatile organic compound (VOC) found in car exhaust
• Ultrafine particles that can be inhaled deep into the lungs

What does all this mean?  As an Asheville periodontist, it shows that the gums – on the front line of intake – take the first brunt of these chemicals and toxins, often when we don’t even realize we’re providing willing intake. It also shows how important it is to keep the mouth healthy.

The periodontal dental specialty is especially attuned to how the gums are more than the pink covering in the mouth. Healthy gums are known to support your overall well-being. In addition to being consumer-aware of what your mouth encounters, it is necessary to maintain a thorough oral hygiene routine at home and an involved relationship with your general dentist.

However, if you see signs of gum disease (bleeding or sore gums, persistent bad breath, receded gums, and/or gums that are red rather than a healthy pink), it is important to see a periodontal specialist as soon as possible. Gum disease will only worsen without treatment. It can also allow infectious bacteria to enter the bloodstream, which research has linked to serious (and even deadly) health problems.

Call our Asheville periodontal dental office to schedule a consultation. If fear or anxiety has prevented you from regular dental visits, we can discuss several options (including oral or IV sedation) to provide comfortable, relaxed appointments. Our friendly staff can help you arrange this private time together by calling 828-274-9440.

Sources:
https://www.cancer.gov/publications/dictionaries/cancer-terms/def/gums
https://www.lung.org/quit-smoking/smoking-facts/whats-in-a-cigarette
https://www.ewg.org/consumer-guides/ewgs-dirty-dozen-guide-food-chemicals-top-12-avoid

Mental Health Can Adversely Affect Oral Health

Posted on Mar 06, 2023 by William J. Claiborne, DDS MS

It seems almost every week that I read findings of recent studies that correlate oral health to overall health. It is not surprising that research newly shared reveals connections of how mental health can affect oral health, and vice versa.

It shows that people with mental conditions can be a contributing factor to poor oral hygiene. These conditions include depression, mood disorders, anxiety, OCD (obsessive-compulsive disorders), mood disorders, and eating disorders. These individuals are 2.7 times more likely to experience tooth loss early.

One factor is anxiety and panic, which are often associated with dental treatment.

According to the National Institute of Mental Health, mental illnesses in the U.S. Nearly 1 in 5 adults have with a mental illness (52.9 million in 2020). These numbers have increased post-pandemic.

The Mayo Clinic shared:
“Surveys show a major increase in the number of U.S. adults who report symptoms of stress, anxiety, depression and insomnia during the pandemic, compared with surveys before the pandemic. Some people have increased their use of alcohol or drugs, thinking that can help them cope with their fears about the pandemic. In reality, using these substances can worsen anxiety and depression.”

Poor dental health can be seen in depressed people by a dentist. For example, over 46% of depressed people report tooth pain without apparent cause, known as atypical odontalgia. Too, burning mouth syndrome is an oral condition more common with adults suffering from depression.

Additionally, mental conditions have been linked to oral conditions, such as:
Gum inflammation
Periodontal disease
Cavities
Dry mouth
Chronic jaw and facial pain
Oral ulcers

The relationship between the two – oral health and mental health – seems to lie in cortisol levels. Cortisol is a stress hormone. Stress and anxiety cortisol levels that are too high adversely affect the immune system. This increases the risk of gum disease, oral sores, and infections.

Seeking professional help at the right time is essential to manage an excellent oral and mental state and overall health.

There is also a domino effect once depression or anxiety trigger an imbalance in cortisol. When one’s smile is in poor condition (cavities, stained teeth, missing teeth, bad breath), it can lead to low self-esteem and social isolation. This contributes to a lower quality of life and, in turn, disrupted mental health.

Mental health status has been shown to activate, aggravate or worsen oral problems. These include…

•Gum health and periodontitis (advanced gum disease)
When stress and periodontal disease negatively impact the body’s immune system, inflammation often worsens gum disease. Too, people who endure ongoing stress are more likely to smoke, drink alcohol, or take drugs. These can cause people to neglect maintaining good oral hygiene and be less committed to having regular dental checkups.

•Dry mouth
Eating disorders (such as anorexia nervosa and bulimia) can reduce the amount of saliva – the mouth’s bacteria-rinsing agent. A dry mouth enables the growth of bacteria. Add to this is how many antidepressant medications have a side effect of causing oral dryness.

•Pain in jaw joints
Chronic stress and anxiety are frequent contributors to facial and jaw pain. Teeth grinding and clenching are not uncommon among people with mental conditions. These actions can cause broken, worn or chipped teeth in addition to the painful conditions associated with TMJ disorders.

•Oral ulcers
Lip, tongue, and ulcers inside the mouth can occur more often in people under frequent or chronic stress.

•Developing Cavities
Individuals with mental illnesses are more likely to have dental decay due to a rise in cavity-causing bacterium with a reduced saliva flow – a recipe for developing cavities.

•Tooth erosion
Bulimia is an eating disorder in which vomiting is used to lose weight. Over a third of bulimia patients with eating disorders suffer from tooth erosion due to regurgitated stomach acids that cause tooth erosion.

•Oral cancer
When dental health neglect is coupled with heavy consumptions of alcohol and smoking, the risk of oral cancers increases. Persons who are heavy smokers and drinkers are 50 times more likely to get oral cancer compared to those who never smoke or drink heavily.

Obviously, mental health is closely connected to your oral health. Begin by speaking with a therapist or mental health specialist. Taking care of your mental health is vital to overcome related dental issues.

If you are noticing any of the signs of oral health problems, you should see a periodontal specialist as soon as possible. These signs and symptoms include:
– Bleeding gums when brushing
– Frequent bad breath
– Red, swollen gums
– Gums that are tender or sore
– Gums that pull away from the base of teeth
– Loose teeth

A periodontist is a dental specialist who can help you restore your oral health and enjoy a confident smile. If you’ve experience tooth loss, a periodontist also specializes in the placement of dental implants.

Our Asheville periodontal office also provides sedation options. These include oral and I.V. sedation (“twilight sleep”). These are administered safely by a doctor of anesthesiology who uses advanced safety equipment to monitor you throughout your procedure.

Call 828-274-9440 to schedule an exam or an initial consultation to get to know us better.

Sources include:

https://healthnews.com/family-health/dental-and-oral-health/how-mental-illness-affects-your-oral-health/

https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/mental-health-covid-19/art-20482731

https://health.uconn.edu/sbirtacademy/wp-content/uploads/sites/101/2016/08/Dental-brochure.pdf

How Good Oral Health Protects Your Heart

Posted on Feb 16, 2023 by William J. Claiborne, DDS MS

Having just celebrated Valentine’s Day, hearts were everywhere. The heart was mentioned in poems, cards, gifts and even in the shape of boxes that contained candy.

Your heart (the one in your chest) and your oral health are actually very much related. You may not realize how connected your mouth is to your heart.

Bacteria in our bodies is not always a bad thing. For example, certain bacteria in the gut actually enhance the process of digestion and help to keep the digestive system operating efficiently.

However, certain bacteria are bad. When too much bacteria invade the body, the immune system becomes overburdened. In bacteria overload, the body’s natural defense response, white blood cells, aren’t always able to conquer infection. This is when your doctor may prescribe an antibiotic – to give the immune system added reinforcements.

According to a report on the health of Americans (published by the Centers for Disease Control & Prevention), it is estimated that over 47% have some form of gum disease. Although we all aspire to have a smile that is appealing, it is what lies beneath the teeth and gums that can wreak havoc on one’s overall health.

Over time, inadequate daily oral hygiene enables an overload of bacteria in the mouth. For people who have habits such as smoking, unhealthy diets, and alcohol consumption, their vulnerability is even more susceptible to this bacterial buildup.

This is also true for people as they age. Aging contributes to a reduced ability to produce saliva, the mouth’s oral rinsing agent. When saliva flow fails to ‘wash away’ bacteria at sufficient levels, the accumulation runs rampant.

Oral bacteria are living, eating, and reproducing organisms. They thrive on rotting food particles caught between teeth. They attack gum tissues and tooth enamel. Eventually, they can work their way down tooth roots and attack the bones and tendons that support teeth.

Through tears in diseased gum tissues, this infectious bacteria can enter the bloodstream. This potent bacteria are now associated with a number of serious health conditions due to their ability to trigger systemic inflammation.

When the gum tissues can no longer combat the onslaught of bacteria, there can be very few signs of periodontal (gum) disease initially. Signs that emerge are typically frequent bad breath along with swollen, tender and beefy red gums that bleed when you brush. As they grow in number, the gum tissues become weaker and they can penetrate the bloodstream.

According to the American Academy of Periodontology (www.perio.org),

“Several studies have shown that periodontal disease is associated with heart disease. While a cause-and-effect relationship has not yet been proven, research has indicated that periodontal disease increases the risk of heart disease.

“Scientists believe that inflammation caused by periodontal disease may be responsible for the association.

“Periodontal disease can also exacerbate existing heart conditions. Patients at risk for infective endocarditis may require antibiotics prior to dental procedures. Your periodontist and cardiologist will be able to determine if your heart condition requires use of antibiotics prior to dental procedures.”

For this reason, cardiologists are more often advising their patients to be evaluated by a periodontist prior to heart surgery. As mentioned above, gums that bleed are a sign of gum disease. These oral bacteria, given an opportunity to enter the bloodstream, are able to travel anywhere, including the heart. They can reach the heart muscle and cause a severe infection.

As an Asheville periodontal specialist, I have an up-close view of the damaging affects of insufficient oral hygiene. If you are experiencing any of the following symptoms of gum disease, please know that it will only worsen without treatment.

Common signs are:
• Gums that bleed easily when brushing
• Tender or swollen gums
• Gum recession
• Frequent bad breath
• Gums that darken in color from a healthy pink to red
• Gus pockets that form near the base of some teeth

Gum disease is also the nation’s leading cause of adult tooth loss. And, studies have shown that the loss of natural teeth compromises the digestive process, social confidence and one’s lifespan.

If you’ve failed to be fully committed to your oral health, there is no better time to begin than the present. Start with a thorough periodontal examination. Call 828-274-9440.

If dental fears have prevented you from having regular dental care, consider beginning with a consultation. This occurs in a comfortable, private consultation room that is removed from the clinical side of the office. Let’s protect you, top to bottom, beginning with your smile!