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Julie M. Gillis, DDS, PC Blog

Are Dentists Contributing to Prescription Opioid Abuse?

January 10, 2017

Filed under: Pain control,Pain Medications — Tags: , — Dr Gillis @ 7:00 am

Are Dentists Contributing to Prescription Opioid Abuse?  The answer is probably!

Are Dentists Contributing to Prescription Opioid Abuse?  Our dental office hopes to do what we can to prevent contributing to narcotic abuse.  The questions we will be asking are:

  1. Do our patients need a narcotic prescription after their dental treatment?
  2. How many tablets is appropriate?

Have you ever had dental surgery?  Have you ever been prescribed opioids for pain?  Were you one of the many who left several tablets unused and not disposed of correctly?  That is Prescription Opioid Abuse.

Prescription Opioids - sometimes needed, sometimes not!

Prescription Opioids – sometimes needed, sometimes not!

The rate of overdose deaths due to prescription narcotics or  Prescription Opioids has more than tripled in the past 20 years!  And, it is a fact that using narcotic pain pills when they are not needed can contribute to addiction.

A recent study noted that 100 million prescription opioids go unused every single year following tooth extractions.  Another study conducted by the University of Pennsylvania Schools of Medicine and Dental Medicine found that more than half of opioids prescribed were left unused by the patients.  There is an opioid epidemic currently.  Evidence shows that people who abuse prescription opioids often use leftover pills that were prescribed for friends or family members.  Your dentist should not be contributing to this epidemic!

Pain following a typical dental procedure such as an uncomplicated extraction is effectively managed with over-the-counter (OTC) medications.   Most dental pain is due to inflammation,and most NSAIDS like ibuprofen have strong anti-inflammatory effects.

What we want! Smiling, comfortable patients!

What we want! Smiling, comfortable patients!

Many articles confirm that  providing opioids like oxycodone or hydrocodone

  • Does not decrease inflammation any more than ibuprofen
  • Does not prevent opioid abuse, and
  • May lead directly to opioid overdoses, exposing you to opioid abuse, leading to possible dependence and opioid overdose death!

Although Hydrocodone/Tylenol combinations are the most wisely prescribed analgesic in the United States, there is no published data indicating that they result in pain relief any better than common NSAIDS like Ibuprofen or Naprosyn.  My recommendation (ooh the self promoting blog!) would be to read our blog on pain management after dentistry (http://blog.juliegillisdds.com/). If you do have leftover prescription narcotics or opioids – dispose of them correctly!

Yours for better dental health,

Julie Gillis DDS, PC

Restoring Smiles/Restoring Health

Managing Pain After Dentistry

January 3, 2017

Filed under: Pain control,Pain Medications — Tags: , , — Dr Gillis @ 7:00 am

It is very important to our office that we effectively manage pain during and after dentistry!  Managing pain after dentistry is typically done with Prescription opioids but may be more effectively managed with other safer medicines.

Pain following a typical dental procedure such as an uncomplicated extraction is effectively managed with over-the-counter (OTC) medications.   Manage inflammation and you will be managing pain after dentistry! Most dental pain is due to inflammation, so this is important to prevent.  Most NSAIDS (Non-steroidal anti inflammatory drugs)  like ibuprofen have strong anti-inflammatory effects.

Trauma to front tooth led to the surrounding inflammation, gum recession and pain.

Managing pain after dentistry or dental trauma is important!  Trauma to the front tooth led to the surrounding inflammation, gum recession and pain.

What is inflammation? Inflammed skin or gums may appear red, swollen and painful. The tissue may also feel warm, and may have lost function.  Inflammation is part of the body’s response to harmful stimuli, such as bacteris,  damaged cells from surgery, or trauma.  This is your body’s response at a cellular level that includes your immune cells and your blood vessels.  Evidently, tissue becomes inflammed to help remove the cause of the cell injury, and begin the process of repair.  The downside of this is pain or discomfort.

Managing pain after dentistry leads to happier patients!

Managing pain after dentistry and of course, during dental treatment leads to happy, comfortable, satisfied patients.

Here are a couple other suggestions your dentist may do to help with managing pain after dentistry or dental trauma and be as comfortable as possible following dental treatment:  Note: goal is minimize inflammation, to delay the onset of pain, minimize the pain intensity and prevent acute pain.

  1. Give NSAID before pain occurs or while you are still numb!
  2. It is helpful to take prescription dose of NSAID (400 mg to 600 mg Ibuprofen) prior to your procedure.  Try taking two OTC Ibuprofen about 30 minutes before your appointment.
  3. Your dentist can add additional long-acting anesthetic (0.5% bupivacaine with epinephrine) at the start of a short procedure or near the end of a longer procedure.
  4. Take NSAIDs in the appropriate amount by the clock for 48 – 72 hours after treatment.
  5. Add OTC Tylenol as part of the medications taken after surgery if not taking Ultracet which contains acetaminophen. Tylenol 600/650 mg by the clock either with the Ibuprofen listed above or alternated every 3 hours to maintain blood levels of both medications.
  6.  Use ice if swelling present, 20 minutes on/20 minutes off for 24 hours
  7. Prescribing Tramadol (Ultracet) for 3 days may be very beneficial without the abuse potential of other narcotics. Ultracet combined acetaminophen with tramadol which is an orally effective opioid drug with much less abuse potential than an oxycodone or hydrocodone combination.  (2 tablets of 325-mg acetaminophen plus 37.5 mg tramadol (Ultracet) every 4 – 6 hours)
  8. For mild to moderate pain you may just need ibuprofen 400 mg to 600 mg every 4-6 hours by the clock for the first 48 – 72 hours until pain subsides.

Together we can help decrease opioid abuse!

Yours for better dental health,

Julie Gillis DDS, PC

Restoring Smiles/Restoring Health

 

Prescription Narcotics or Opioids Are Prescribed Too Often!

December 29, 2016

Filed under: Pain control,Pain Medications — Tags: , , — Dr Gillis @ 9:45 pm

Narcotics or Opioids Are Prescribed Too Frequently!

Prescription Narcotics or Opioids have contributed to too many deaths recently!

The over prescribing of narcotic pain relievers had become a big problem.  An article in the June 2016 COMPENDIUM had these things to say about pain prescriptions and pain management.  A 2015 study showed that it takes less tablets of fast acting Ibuprofen 400mg to obtain 50% pain relief following all types of surgery than Ibuprofen 400mg with ocycodone 5 mg (a Prescription Narcotics or Opioids)!  Ketoprofen 24 and Diclofenac potassium 100 required even less tablets.  The number of tablets of Codeine needed to provide 50% pain relief over 4 to 6 hours was more than four times as many as ibuprofen 400 mg  (2 tablets vs 9 tablets)!

What we want! Smiling, comfortable patients!

What we want! Smiling, comfortable patients!  If this can be achieved with minimal prescription opioids or narcotics that is even better.

 

Prescription Narcotics or Opioids are sometimes needed

What can happen! Prescription Narcotics or Opioids – sometimes needed, sometimes not!

Prescription narcotics or opioids may not even be needed after uncomplicated dental treatment or surgery.  The June COMPENDIUM article noted that 400 mg Ibuprofen (that’s two OTC tabs of Advil) is superior to 650 mg aspirin, or 1000 mg Tylenol (acetaminophen), or even combinations of aspirin and Tylenol plus 60 mg of codeine or 30 mg of dihydrocodeine.  Someone taking more than 400 mg ibuprofen may modestly prolong the duration of pain relief but will likely not result in increased pain relief.  Other NSAIDs such as naproxen sodium may achieve comparable pain relief without the narcotic complications.

Our office would like to do what we can to prevent prescription narcotic abuse.  We also want to make sure you are comfortable after dental treatment!

It is interesting to look at how pain medications work.  I think your mind contributes a lot to this.  So, if you think something like a prescription narcotics or opioid will work it has a much better chance of working!  My dad, a Family Medicine MD for 40+ years, often told us the story of being in terrible pain one night and going to the bathroom cupboard for a pain pill.  (He had some narcotics at home in case this was needed).  He accidentally took a tablet of penicillin which was in a similar bottle and his pain went away.  Of course, the penicillin had nothing to do with the relief of his pain.  His mind, however, had everything to do with his pain relief!

You are welcome to call our office for more information. (970) 242-3635

We are very concerned about your comfort during and after dental treatment!

Yours for better dental health,

Julie Gillis DDS, PC

Restoring Smiles/Restoring Health

 

Flossing, necessary or optional??

December 14, 2016

Filed under: Dental floss,Dental Hygiene,Oral Hygiene,Uncategorized — Dr Gillis @ 1:43 am

Flossing, necessary or optional??

People are still asking is it necessary to floss?  They read the recent news article that said in effect that no studies have proven that flossing is beneficial.   Many people were left questioning, ‘flossing, necessary or optional?’ It is amazing to me what a controversy a news article can cause.  The simple answer is YES we should floss!

Let me be more clear.  We should floss or do some activity to clean between our teeth that is as good as flossing every day!

Just a tip - do this to avoid strangling your fingers when you floss!

Just a tip – do this to avoid strangling your fingers when you floss!

This is in response to ‘an ADA News inquiry about why flossing was not included in federal dietary guidelines released in 2015.  The Associated Press noted the omission in an August news story that questioned the benefits of using dental floss’. (See ADA News August 8th, 2016 ‘National media focus on floss; government confirms importance’ for many comments in this blog)

Dental floss or the use of tools such as between the teeth cleaners really is important oral hygiene if you want to have healthy teeth, and gums.  Professional cleanings remove the hard deposits and stain that you cannot do at home.  Brushing your teeth and cleaning between the teeth has been shown to remove gooey plaque.  Plaque is the sticky film that contains bacteria and food that builds up constantly and must be removed daily to maintain or to obtain health.  The U.S. Department of Health and Human Services agreed to this in a statement August 3rd, 2016 (also from the ADA News article August 8th, 2016).

Flossing, necessary or optional Wrap the floss gently around the tooth in a "C" shape to clean the side of the tooth.

Wrap the floss gently around the tooth in a “C” shape to clean the side of the tooth.

Flossing is beneficial starting at an early age - whenever there are teeth touching!

Flossing, necessary or optional? Flossing is beneficial starting at an early age – whenever there are teeth touching!

The ADA News asked the governmental agency why the guidelines did not mention flossing.  The U.S. Department of health and Human Services sent a statement that called flossing “an important oral hygiene practice” and said that by not mentioning flossing it did not imply otherwise.

 

The ADA News August 8th, 2016 article goes on to say that the ‘primary emphasis (of the guidelines) was on the nutrition-based recommendations to reduce added sugars’.

In our office, we routinely see the improved health changes that result from using dental floss.  Flossing is great especially when done well but there are alternatives out there for people that just don’t like to floss.

If you are one of the people that wants the benefits of floss without sticking your floss holing fingers in your mouth, try one of these:

  • soft picks or go betweens
  • floss holders
  • the air flosser
  • water pics
  • toothpicks (especially when used carefully in a toothpick holder that allows better access to the insides of the teeth)

Our office loves to help our patients improve their oral health and we will be glad to come up with a plan that works with your life to help you achieve and maintain ideal oral health!

Yours for better dental health,

Julie Gillis DDS, PC

Restoring Smiles/Restoring Health

 

You Just Had a Tooth Filling. Was It Done Well?

December 3, 2016

Filed under: Fillings,General Dentistry — Tags: — Dr Gillis @ 12:13 am
POH

POH dental floss. Note how the floss separates into a lot of very fine threads. If a tooth filling flosses well with this type of floss, it will floss well with any floss!

So, you just had a tooth filling?

  • Can you tell if it was done well?
  • Can you tell if your dentist is concerned about the quality of his or her treatment?
  • What should you expect to feel?

Was your tooth filling done well?  This can be a very difficult question to answer! This article discusses some of the things patients should be aware of to evaluate if their filling was done as well as possible.

At this point, you are probably seeing the photos of floss and wondering, “What in the world does shredded floss have to do with the quality of a filling or tooth colored restoration.?” I am so happy you asked!

What should your dentist do to check for a high quality tooth filling?

In our office, tooth fillings are always tooth colored.  We haven’t done a silver/mercury or amalgam filling since 1995!  I realized that If I didn’t want silver fillings in my own mouth, why would I do it on others?  Other blogs address the benefits of tooth colored fillings over silver fillings, so I won’t go into that here.  Here are some of the things we do to make sure our fillings are done as well as possible:

  • We make sure you are comfortable throughout the procedure.  This helps us achieve better quality tooth fillings. When our patients are calm, we can focus on you and your filling!
  • We use the highest quality filling materials and techniques to achieve the best result.
  • We assure that the area is clean and dry before the filling is placed.
  • We use special cleaning agents and medications to decrease tooth sensitivity and for a better, stronger bond to your tooth.
  •  We carefully shape your filling to restore the healthy tooth contours that should be present.
  • We adjust your bite so that you tooth will be comfortable and strong when you chew.
  • We polish the filling so that it will feel smooth to your tongue, and
  • We always check tooth fillings with two types of dental floss.
OLYMPUS DIGITAL CAMERA

Note the wonderful shredding of POH floss. If your tooth filling is not smooth we will know it!

Finally!  The floss comes into play.  The two flosses I like to use to test fillings are Glide and POH.

Glide Glide floss is strong and a great way to tell if there is a solid contact present.  Because it shreds so easily,  POH floss is a wonderful way to see if the edges of the filling are smooth.  If there is roughness present, we polish until the POH slides through without catching or ‘snagging’.  We appreciate the opportunity to serve you and we strive to do the highest quality dentistry possible.  This is the type of dental treatment we would want completed on our own teeth!  Please call our office if you have any questions or concerns (970) 242-3635.

Julie Gillis DDS

Restoring smiles/Restoring Health

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1190 Bookcliff Ave. Suite 201, Grand Junction, CO 81501 USA
Julie M Gillis DDS Grand Junction, CO cosmetic, general, & restorative dentist. (970) 242-3635 (970) 242-8479 jgillis@juliegillisdds.com