New Research: Most Effective Medicine for Dental Pain Not Opioids

Ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDs) alone or in combination with acetaminophen are better than opioids at easing dental pain, according to new research conducted with the School of Dental Medicine at Case Western Reserve University. The study examining relief of acute pain in dentistry -- recently featured on the cover of The Journal of theAmerican Dental Association -- evaluated the safety and efficacy of dozens of pain-relief options.

The clear message of this is that in dentistry, prescribing narcotics should be a last resort. Each day, more than 115 Americans die as a result of an opioid overdose, according to the National Institutes of Health. Many got hooked on opioids after a doctor or dentist prescribed, or overprescribed them.

Most patients who come in with pain have it resolved immediately with proper dental technique. However some conditions dentists treat leave the patient in some pain for a short period of time after treatment. No patient should have to endure pain from a dental procedure. That means that opioids are sometimes the best option, but certainly they are never my first option.

Interestingly, the study showed that the use of nonsteroidal medications, with or without acetaminophen, offers the most favorable balance between benefits and harms, optimizing efficacy while minimizing acute adverse events. The research found that, for adults, a combination of 400 milligrams of ibuprofen (Motrin) and 1,000 milligrams of acetaminophen (Tylenol) was superior to any opioid-containing medications studied. The study also found that opioids or drug combinations that included opioids accounted for the most adverse side effects -- including drowsiness, respiratory depression, nausea/vomiting and constipation -- in both children and adults.

This confirms my belief, and the  acetaminophen+ibuprofen  combination has long been my first course of treating dental pain issues. In fact, I haven’t prescribed opioids in several years. With the national opioid epidemic, my fellow health-care providers should take note of the findings.

Keep smiling,

Dr.Elzbieta W. Basil, DMD is a private practice dentist with offices in West Hartford Center and Downtown New Britain, Connecticut.  She is a Clinical Instructor at the UConn School of Dental Medicine, and has won several awards naming her regional “Best Dentist” and “Top Dentist.” She is an active member of the Connecticut State Dental Association and the American Dental Association. Tel: 860-561-2121

Go Green for Oral Health!

Green tea is one of the most popular beverages in the world, and it has received considerable attention because of its many scientifically proven beneficial effects on human health.

With origins dating back over 4,000 years, green tea has long been a popular beverage in Asian culture, and is increasingly gaining popularity in the United States. And while ancient Chinese and Japanese medicine believed green tea consumption could cure disease and heal wounds, recent scientific studies are beginning to establish the potential health benefits of drinking green tea, especially in weight loss, heart health, and cancer prevention.

Importantly, several recent studies also point out the dental benefits of drinking green tea. Researchers found that routine intake of green tea may also help promote healthy teeth and gums.

Green tea’s ability to help reduce symptoms of periodontal disease appear to be due to the presence of the antioxidant catechin. Previous research has demonstrated antioxidants’ ability to reduce inflammation in the body. By interfering with the body’s inflammatory response to periodontal bacteria, green tea may actually help promote periodontal health, and ward off further disease. Periodontal disease is a chronic inflammatory disease that affects the gums and bone supporting the teeth, and has been associated with the progression of other diseases such as cardiovascular disease and diabetes.

Here are just some of the study results relating to green tea and oral health:

Green Tea and Tooth Decay

The effects of green tea extract on caries inhibition of hamsters and on acid resistance of human tooth enamel have been suggested by both in vivo and in vitro studies. The results obtained from this study suggested that fluoride in green tea may play a role in preventing cavities, along with other components in tea. However, the action of fluoride does not seem to be so important because its concentration is very low. The effect of green tea on cavity inhibition as well as on the increment of acid resistance appears to be more correlative with the nondialysable substances in tea.

Green Tea and Periodontal Disease

• Various authors have studied the inhibitory effects of catechin contained in green tea on periodontal pathogens, which strongly support the daily consumption of green tea for periodontal health.
• One study found that green tea catechin inhibits the growth of P. gingivalis, Prevotella intermedia and Prevotella nigrescens and adherence of P. gingivalis on to human buccal epithelial cells.
• Another study showed green tea catechins, which are major tea polyphenols, inhibit production of toxic end metabolites of P. gingivalis.
• Yet another study showed that green tea catechin, inhibits the activity of P. gingivalis-derived collagenase.
• Alveolar bone resorption is a characteristic feature of periodontal disease and involves removal of both the mineral and the organic constituents of the bone matrix. One study concluded that green tea plays a role in the prevention of bone resorption.
• Oxidative stress plays an important role in periodontal disease as well as many other disorders, and it is believed that antioxidants can defend against inflammatory diseases.
• Daily intake of green tea was significantly associated with bleeding on probing (BOP), probing depth (PD) and clinical attachment loss (CAL), such that the more frequently subjects drank green tea, better was their periodontal condition. A study recently showed that the intake of green tea was inversely correlated with the mean PD, mean CAL and BOP (i.e., the more green tea you drank, the better your periodontal health results).

Green Tea Bad Breath

Bad breath, clinically “halitosis,” is caused mainly by volatile sulfur compounds (VSCs) produced in the oral cavity. Because tea polyphenols have been shown to have antimicrobial and deodorant effects, researchers investigated whether green tea powder reduces VSCs in mouth air, and compared its effectiveness with that of other foods that are claimed to control halitosis. The study concluded that green tea was very effective in reducing oral malodor temporarily because of its disinfectant and deodorant activities, whereas other foods were not effective.

As to the amount, it appears that optimally 3-4 cups per day keeps the Tooth Fairy away. And make sure you don’t use too much sugar!

Think green. Drink green. Next time you are throwing a tea party, your teeth would really appreciate it If you were only serving green tea.

Keep smiling,  

Dr.Elzbieta W. Basil, DMD is a private practice dentist with offices in West Hartford Center and Downtown New Britain, Connecticut.  She is a Clinical Instructor at the UConn School of Dental Medicine, and has won several awards naming her regional “Best Dentist” and “Top Dentist.” She is an active member of the Connecticut State Dental Association and the American Dental Association. Tel: 860-561-2121

New Study: Red Wine for Dental Health?

Red wine has previously been linked to a range of supposed health benefits, from helping the heart to lowering the risk of diabetes.  Now a new study suggests it contains chemicals that can help in the fight against tooth decay and gum disease. Researchers found compounds from the drink, known as polyphenols, helped fend off harmful bacteria in the mouth.

The Findings

The study compared the effects of two polyphenols from red wine against grape seed and red wine extract supplements on bacteria that stick to teeth and gums and cause dental plaque, cavities and gum disease. They found the wine polyphenols and extracts all reduced the bacteria's ability to stick to the cells, but the polyphenols - caffeic and p-coumaric acids - were more effective. When combined with the Streptococcus dentisani - believed to be an oral probiotic, which stimulates the growth of good bacteria - the polyphenols were even better at inhibiting the pathogenic bacteria. The findings, they said, could ultimately lead to new dental treatments.

Planning to buy a case of wine? Hold your horses. In my opinion, the findings do not offer a "green light" to drink more red wine. First, the report's authors acknowledge that their study was limited by the fact it was done outside of the human body with cells that simulated gum tissue. They said further research was needed to determine more about what was causing the bacteria to be inhibited. The report also found metabolites which form when the digestion of polyphenols begins in the mouth could also be responsible for some of the effects in the study.

The Acid Problem

The acidic nature of wine means that consuming a lot of these drinks will damage the enamel of the teeth. Therefore, until the benefits of this research are shown clinically, it is best to consume wine in moderation and with a meal to minimize the risk of tooth erosion. For that matter, orange and lemon juices, which are high in polyphenols, can cause erosion when frequently introduced directly to your teeth. Red wine also stains, so your dental hygiene regimen should be diligent, and you may want tooth whitening to keep your smile bright.

Other Choices for Polyphenols

Previous studies have suggested that the health benefits of polyphenols are linked to them being antioxidants that protect the body from harmful free radicals. Recent studies have also indicated that polyphenols might also boost health by working with "good bacteria" in our gut.  While red wine is rich in polyphenols, the American Journal of Clinical Nutrition says they are also found in a range of other beverages and foods:

   Beverages

• Coffee
• Green tea
• Black tea
• Cider
• Orange juice and lemon juice

   Foods

• Blueberries
• Raspberries
• Kiwis
• Black grapes
• Cherries
• Beans

Where I’d Prefer You Get Your Polyphenols

If you want to try to add polyphenols to aid in your dental health, I’d suggest green tea. It’s higher in polyphenols than red wine, and it also contains tooth-protecting fluoride.

But a glass of red wine once in a while is nice, too.

Keep smiling,  

Dr.Elzbieta W. Basil, DMD is a private practice dentist with offices in West Hartford Center and Downtown New Britain, Connecticut.  She is a Clinical Instructor at the UConn School of Dental Medicine, and has won several awards naming her regional “Best Dentist” and “Top Dentist.” She is an active member of the Connecticut State Dental Association and the American Dental Association. Tel: 860-561-2121