My Blog

By Paul D. Nifong, Jr, DDS, PA
November 11, 2018
Category: Dental Procedures
JulianneHoughSharesaVideo-andaSong-AfterWisdomTeethComeOut

Once upon a time, celebrities tried hard to maintain the appearance of red-carpet glamour at all times. That meant keeping the more mundane aspects of their lives out of the spotlight: things like shopping, walking the dog and having oral surgery, for example.

That was then. Today, you can find plenty of celebs posting pictures from the dentist on social media. Take Julianne Hough, for example: In 2011 and 2013, she tweeted from the dental office. Then, not long ago, she shared a video taken after her wisdom teeth were removed in December 2016. In it, the 28-year-old actress and dancer cracked jokes and sang a loopy rendition of a Christmas carol, her mouth filled with gauze. Clearly, she was feeling relaxed and comfortable!

Lots of us enjoy seeing the human side of celebrities. But as dentists, we’re also glad when posts such as these help demystify a procedure that could be scary for some people.

Like having a root canal, the thought of extracting wisdom teeth (also called third molars) makes some folks shudder. Yet this routine procedure is performed more often than any other type of oral surgery. Why? Because wisdom teeth, which usually begin to erupt (emerge from beneath the gums) around age 17-25, have the potential to cause serious problems in the mouth. When these molars lack enough space to fully erupt in their normal positions, they are said to be “impacted.”

One potential problem with impacted wisdom teeth is crowding. Many people don’t have enough space in the jaw to accommodate another set of molars; when their wisdom teeth come in, other teeth can be damaged. Impacted wisdom teeth may also have an increased potential to cause periodontal disease, bacterial infection, and other issues.

Not all wisdom teeth need to be removed; after a complete examination, including x-rays and/or other diagnostic imaging, a recommendation will be made based on each individual’s situation. It may involve continued monitoring of the situation, orthodontics or extraction.

Wisdom tooth extraction is usually done right in the office, often with a type of anesthesia called “conscious sedation.”  Here, the patient is able to breathe normally and respond to stimuli (such as verbal directions), but remains free from pain. For people who are especially apprehensive about dental procedures, anti-anxiety mediation may also be given. After the procedure, prescription or over-the-counter pain medication may be used for a few days. If you feel like singing a few bars, as Julianne did, it’s up to you.

If you would like more information about wisdom tooth extraction, please call our office to arrange a consultation. You can learn more in the Dear Doctor magazine articles “Wisdom Teeth” and “Removing Wisdom Teeth.”

By Paul D. Nifong, Jr, DDS, PA
November 01, 2018
Category: Dental Procedures
Tags: pain management  
Non-PrescriptionPainMedicationcanManageMostPost-ProcedureDiscomfort

The old stereotype with the words “pain” and “dental work” in the same sentence is no more. Using local or general anesthesia (or a combination of both) we can completely eliminate the vast majority of discomfort during dental procedures.

But how do you manage pain in the days after a procedure while your mouth is healing? The news is good here as well — most discomfort after dental work can be easily managed with a family of medications known as non-steroidal anti-inflammatory drugs (NSAIDs). In most cases, you won't even need prescription strength.

You're probably already familiar with aspirin, ibuprofen and similar pain relievers for the occasional headache or muscle pain. These types of drugs work by blocking prostaglandins, which are released by injured tissues and cause inflammation. By reducing the inflammation, you also relieve pain.

Most healthcare providers prefer NSAIDs over steroids or opiates (like morphine), and only prescribe the latter when absolutely necessary. Unlike opiates in particular, NSAIDs won't impair consciousness and they're not habit-forming. And as a milder pain reliever, they have less impact on the body overall.

That doesn't mean, however, you don't have to be careful with them. These drugs have a tendency to thin blood and reduce its clotting ability (low-dose aspirin, in fact, is often used as a mild blood thinner for cardiovascular patients). Their use can contribute to bleeding that's difficult to stop. Excessive use of ibuprofen can also damage the kidneys.

That's why it's necessary to control the dosage and avoid long-term use of NSAIDs, unless advised by a physician. Most adults shouldn't take more than 2,400 milligrams a day of a NSAID and only during the few days of recuperation. There's no need to overdo it: a single 400-milligram dose of ibuprofen is safe and sufficient to control moderate to severe post-procedural pain for about five hours.

Our aim is to help you manage any pain after a procedure with the least amount of pain reliever strength necessary. That will ensure you'll navigate the short discomfort period after dental work safely and effectively.

If you would like more information on pain management after dental care, 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 “Treating Pain with Ibuprofen.”

By Paul D. Nifong, Jr, DDS, PA
October 22, 2018
Category: Oral Health
Tags: mouth sores  
WecanMinimizeDiscomfortfromCankerSoreswithafewBasicTreatments

They seemingly pop up out of the blue inside your mouth: tiny sores that are sometimes painful — and always annoying. Then, in about a week to ten days these small, irritating lesions are gone.

They're known as canker sores: the most common break out in the linings of the mouth, including the cheeks, lips, under the tongue or even the back of the throat. Medically known as aphthous ulcers, you'll recognize these round lesions by their yellow-gray center surrounded by a red “halo.”

You might feel a tingling sensation a couple of days before an outbreak. Once they appear they usually last a week to ten days; during that time they can cause discomfort especially while eating or drinking.

We don't know fully what causes canker sores, but it's believed they're related to abnormalities in the immune system, the processes in the body that fight infection and disease. High stress or anxiety and certain acidic or spicy foods like citrus fruit or tomato sauce also seem to trigger them.

Most people experience canker sores that range in intensity from slight discomfort to sometimes severe pain. But about 20-25% of people, mostly women, have an acute form known as recurrent aphthous stomatitis (RAS). Thought to be hereditary, RAS produces clusters of ulcers that are almost always painful, and which come and go on a regular basis.

Our main treatment goal with canker sores is to decrease discomfort while the outbreak runs its course and promote rapid healing. There are over-the-counter ointments that often prove effective. For more resistant symptoms we can also prescribe topical or injectable steroids or other medications.

Canker sores are rarely concerning as a significant health issue. You should, however, take an outbreak seriously if it hasn't healed within two weeks, if the outbreaks seem to be increasing in frequency or severity, or you're never without a sore in your mouth. In these cases, we may need to take a tissue sample of the lesion to biopsy for signs of cancer, pre-cancer or some other skin disease.

More than likely, though, the canker sore will be benign albeit annoying. With effective treatment, though, you can get through the outbreak with only a minimal amount of discomfort.

If you would like more information on treating canker sores, 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 “Mouth Sores.”

By Paul D. Nifong, Jr, DDS, PA
October 12, 2018
Category: Oral Health
Tags: oral hygiene  
FiveTipsforTop-NotchToothBrushing

October is national Dental Hygiene month—and it’s a great time to renew your commitment to good oral health. Everyone knows that to enjoy clean teeth and fresh breath, we need to brush and floss every day. But when it comes to the finer points of tooth brushing, there’s a lot of misunderstanding. So here are five tips to help you get the most bang from your brush.

Go Soft
A soft brush is much better for your mouth than a medium or hard one. That’s because stiffer bristles can actually damage soft gum tissue, and over-vigorous brushing can result in gum recession; this may lead to tooth sensitivity and an increased chance of decay. So always choose a soft-bristled tooth brush—and change your brush every three or four months, when its bristles begin to stiffen with use.

It Isn’t (Just) the Brush…
It’s the hand that holds it. Don’t brush too forcefully, or too long. If you consistently brush too hard, try using just three fingers to grip your brush so you apply less force. And if you have questions or need a refresher, just ask us to demonstrate proper brushing and flossing techniques next time you’re here.

Think Fluoride First
With many different flavors, whiteners and other ingredients in toothpastes, which one should you choose? It’s up to you, as long as your toothpaste contains one vital ingredient—fluoride. This natural mineral has been proven to strengthen tooth enamel and fight cavities. Look for the seal of the American Dental Association (ADA) on the toothpaste tube: this certifies that it’s been tested for safety and effectiveness.

2x2 = Terrific Teeth
According to the ADA, brushing gently for two full minutes, two times a day, is the best way to get rid of plaque and prevent cavities. That’s why it should be an essential part of your oral hygiene routine. And while you’re at it, don’t forget to use dental floss (or another method) to clean the spaces in between your teeth. If you don’t remove plaque from these areas, your cleaning isn’t complete.

Preserve Your Enamel
There are some times when you should avoid brushing—like after you’ve consumed soda, or been sick to your stomach. That’s because the acids in soda and stomach juices actually soften tooth enamel, and brushing can quickly wear it away. In these situations, rinse your mouth out with water and wait at least an hour before you brush.

Practicing good oral hygiene is the best thing you can do for your teeth at home. But don’t forget to come in to the office for regular checkups and professional cleanings! Because no matter how thorough you are, you can’t clean hardened deposits (calculus, or tartar) from your teeth at home: It takes special tools and the skilled hand of your hygienist or dentist to do that.

If you would like more information about tooth brushing and oral hygiene, please contact us or schedule an appointment for a consultation. You can learn more by reading the Dear Doctor magazine articles “Sizing Up Toothbrushes” and “10 Tips for Daily Oral Care at Home.”

By Paul D. Nifong, Jr, DDS, PA
October 02, 2018
Category: Dental Procedures
NBCStarDeliversaMessageaboutthePerfectSmile

Sometimes it seems that appearances count for everything—especially in Hollywood. But just recently, Lonnie Chaviz, the 10-year-old actor who plays young Randall on the hit TV show This Is Us, delivered a powerful message about accepting differences in body image. And the whole issue was triggered by negative social media comments about his smile.

Lonnie has a noticeable diastema—that is, a gap between his two front teeth; this condition is commonly seen in children, but is less common in adults. There are plenty of celebrities who aren’t bothered by the excess space between their front teeth, such as Michael Strahan, Lauren Hutton and Vanessa Paradis. However, there are also many people who choose to close the gap for cosmetic or functional reasons.

Unfortunately, Lonnie had been on the receiving end of unkind comments about the appearance of his smile. But instead of getting angry, the young actor posted a thoughtful reply via Instagram video, in which he said: “I could get my gap fixed. Braces can fix this, but like, can you fix your heart, though?”

Lonnie is raising an important point: Making fun of how someone looks shows a terrible lack of compassion. Besides, each person’s smile is uniquely their own, and getting it “fixed” is a matter of personal choice. It’s true that in most circumstances, if the gap between the front teeth doesn’t shrink as you age and you decide you want to close it, orthodontic appliances like braces can do the job. Sometimes, a too-big gap can make it more difficult to eat and to pronounce some words. In other situations, it’s simply a question of aesthetics—some like it; others would prefer to live without it.

There’s a flip side to this issue as well. When teeth need to be replaced, many people opt to have their smile restored just the way it was, rather than in some “ideal” manner. That could mean that their dentures are specially fabricated with a space between the front teeth, or the crowns of their dental implants are spaced farther apart than they normally would be. For these folks, the “imperfection” is so much a part of their unique identity that changing it just seems wrong.

So if you’re satisfied with the way your smile looks, all you need to do is keep up with daily brushing and flossing, and come in for regular checkups and cleanings to keep it healthy and bright. If you’re unsatisfied, ask us how we could help make it better. And if you need tooth replacement, be sure to talk to us about all of your options—teeth that are regular and “Hollywood white;” teeth that are natural-looking, with minor variations in color and spacing; and teeth that look just like the smile you’ve always had.

Because when it comes to your smile, we couldn’t agree more with what Lonnie Chaviz said at the end of his video: “Be who you want to be. Do what you want to do. Do you. Be you. Believe in yourself.”

If you have questions about cosmetic dentistry, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “Beautiful Smiles by Design” and “The Magic of Orthodontics.”





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