How to manage moderate to sever pain after third molar extraction?

NSIADS such as Ibuprofen or Naproxen could be given immediately before the surgery and continued for 2 to 5 days. A combination of NSAID with Acetaminophen can even give a better analgesic effect.

Opiods such as (vicodin or percodan) are the hallmark drugs used to manage sever pain after third molar extractions; however their side effects are limiting their use. 





Alternative to opoids is ketorolac tromethamine such as sprix. This nonopoid NSAID is equivalent in strength to the opoid drugs without their side effects. 

Oral Conscious sedation

"Happy pills"! Have you heard about it?? You may or may not. But let me tell you a little about it.

Medically these drugs are named Benzodiazepines or Benzos as they like to  call them in the United  States. These are Anti- Anxiety pills and prescribed for the treatment of anxiety,insomnia, agitation,seizures & muscle spasms.
What is important to me and what I will be talking about is their use in dentistry.
Many people love to have beautiful smiles........who doesn't? but there is a small little problem that comes with it which is that they still feel anxious going to the dentist. Now, do you want a nice white smile without going through the anxiety and stress that come with it??  Oh yeah , you definitely do.
Here is the solution and it is very simple. Benzo pills are excellent to use and implement before dental appointments.
There are several dental sedative protocols that can give many patients the chance to go through their  dental treatments without feeling anxious or stressed.
Even if you don't feel stressed going to your dental appointment, you can still benefit from benzo pills and feel more calm and relaxed during the procedure.

Let us talk about some of these drugs:


Valium: this is the trade name of the drug. The generic is diazepam . Valium  has been in the market since the 1960's.It has long duration of effectiveness.It stays in your body for like 20-100 hours until it goes out totally.Dose ranges from 5-10mg.
This drug is used for insomnia in first place but it has its role in dentistry and I will come back to this later.

Halcion: this is the trade name of triazolam. This drug is very popular in the United States.It is used commonly before dental appointments; very safe drug. The popularity of this drug comes from its amnesic properties (memory loss).So after finishing your dental appointment, you  can barely remember anything.This drug is used for short appointments ranging from 1to 2 hours.The drug's half life (duration of staying in your body) is 1.5-5 hours. It can be mixed with Vistaril; an anti-histamine drug to get more extended effect.

Ativan:This is the trade name of the generic lorazepam. It is used to treat anxiety in first place. It has high level of amnesic effect.You barely remember anything after your dental treatment. Dosage ranges from 2 to 3 mg. It kicks in after about one hour.Duration of action is 6 to 8 hours and it stays up to 14 hours in your body.

Versed: The generic is midazolam.It is a short acting benzo drug.Excellent  for short appointments.It still has the same level of effectiveness as other benzos. Half life is about 1 to 3 hours. Lasts for as little as 1 hour.  Kicks in after 10 to 20 minutes. Excellent to use in dentistry. Dormicum is the alternative brand known in Lebanon .

There are two other drugs that have anti-anxiety effect without being benzos. These drugs are Vistaril and Sonata.

Vistaril: The generic is hydroxyzine; it is an antihistamine drug .It has anti-anxiety effect without amnesic properties. Can be mixed with benzo drug. Duration of action is 3-6 hours. Half life time is 3-7 hours.

Sonata is the trade name for Zaleplon. Used for insomnia. Duration of effectiveness is 1 to 2 hours. It quickly gets out of your body in an hour or two.

It is very important to mention that all benzo drugs are only given by prescription meaning that you can not get them from the pharmacy as an OTC(over-the counter) drugs.

Now you should know that you can not take benzo drug with other CNS depressants.You should not drink alcohol while taking benzo pills as well.

 Going back to Valium. The best protocol for oral sedation  to be used in dentistry  is as follows: Valium( diazepam) can be given to patients the night before the appointment while Triazolam can be given one hour before the treatment.
This is the best protocol for benzo drugs when used before dental appointments.
Valium is not always necessary to take the night before. Most of the time, it is more than enough to take one pill of triazolam one hour before the treatment.

UV toothbrush sanitizers

Everyone has a tooth brush at home....
But do you know ?
1- A single toothbrush can accumulate millions of bacteria
2- Putting your toothbrush  in the warm/ moist environment  of the average bathroom translate those bacteria into harmful ones.


Now what is the solution??
VIOlight system(emitting Ultra Violet light device) eliminates up to 99.9% of bacteria that thrive on your toothbrush. That's millions of microscopic bugs that can cause flu, colds and other illnesses, zapped in minutes!

Easy as Brush, Store and Sanitize


VIOlight uses a germicidal UV bulb — the same technology used in hospitals — to kill germs. A blue-violet glow lets you know the sanitizer is working. The entire process takes minutes. When finished, the bulb automatically shuts off and your toothbrush is fresh, clean, and protected for the next time you brush! 

VIOlight Toothbrush Sanitizer Information Report

Did You Know...?

• A number of studies suggest that oral heath is associated with general health. Advanced gum disease has been linked to heart disease, diabetes, premature delivery in pregnant women, and stroke.
  
• Researchers have found more than 10,000,000 bacteria living on a single toothbrush.
  
• Tooth decay is caused by bacteria that can survive on toothbrushes.
  
• Viruses that cause colds, flu, and fever blisters can survive for many days on toothbrushes.
  
• Droplets produced by flushing toilets can harbor bacteria and viruses that can remain airborne long enough to settle on surfaces. Thus, a person could acquire an infection from an aerosol produced by a toilet.

The Problem

USA Today Health Review for April 27, 2000 reported: "The most serious threat to your everyday health may be hanging in plain sight in your bathroom."

Influenza (the flu) virus, herpes simplex I, streptococci, staphylococci, yeasts, and the bacteria that cause gum disease, cavities, and even diarrheal illness can survive --some even thrive-- in high numbers on toothbrushes.

Some researchers have even found biofilm - colonies of breeding bacteria - on toothbrushes, and numbers as high as 100,000,000 microorganisms have been recovered from individual brushes.

Because most people keep their toothbrushes in the bathroom, bacteria from the mouth isn't the only contaminant. Flushing propels germs from the toilet into the air, where they can land on toothbrushes. Toothbrushes are usually stored together, so contact between family members' toothbrushes can spread germs from one brush to another.

Bacteria, molds, and fungi love moist environments, like the bathroom. They also do well in the dark, so the medicine cabinet provides an ideal environment for germs to survive and even multiply.

Toothbrushes become infected some time between one week and one month after initial use. The ADA and most dentists recommend changing toothbrushes only every three to four months.

Some sources report that most American are likely to change their toothbrushes only twice a year. The Solution Ultraviolet (UV) light is a proven germicide.

It kills fungi like yeasts and molds; disease-causing bacteria like strep, salmonella, and E. coli; and even some hearty viruses like influenza and hepatitis.

The Proof

Numerous studies have shown ultraviolet light to be effective in killing germs on toothbrushes.

UV toothbrush sanitizers have been reported to kill of bacteria, yeasts, and viruses.

A study* performed on the VIOlight Toothbrush Sanitizer by Dr. Philip Tierno, Jr., PhD, Director Clinical Microbiology and Immunology, Associate Professor, Departments of Microbiology and Pathology, New York University Medical Center, found that the VIOlight eliminated up to 99.9% of bacteria tested on toothbrushes.

Another study* by Bureau Veritas, a global independent testing laboratory, also found that the VIOlight Toothbrush Sanitizer eliminated up to 99.9% of germs tested on toothbrushes.

How Many Germs Are Living on Your Toothbrush? 

Power tooth brush Vs manual tooth brush

Power toothbrush and that is for many reasons:


- The Cochrane review confirmed that oscillating-rotating technology is more effective at reducing plaque and gingivitis than a manual toothbrush.
-Power toothbrush reduces up to 2 times more plaque than a manual toothbrush.
-Power toothbrush is more gentle on the gum and teeth. Patients are proven to brush nearly three times harder with a manual toothbrush than with a power toothbrush.
-Most manual toothbrushes will need to be replaced within 3 months of usage.Electric toothbrushes head last a lot longer than regular ones.


Toothbrush care:

1. Thoroughly rinse the toothbrush with running water.
2. Do not share your toothbrush with others.
3. Store in an upright position and air dry. Putting  toothbrush in cases or covering the bristles creates a moist environment that can promote the growth of bacteria.
4. Replace the head of electric toothbrush every 4 or 6 months or when the bristles become frayed or splayed .

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Innovation Today for Dentistry Tomorrow

In the Cosmetic Dental world, Integrating digital technology is essential in every cosmetic practice.In the 21st century, dental gadgets have simplified most of the elective cosmetic procedures. For example, While many conventional dental tools have changed and transformed to digital technology,there is one essential piece of equipment that has not changed for over 150 years;the dental syringe.

The wait is over.The single tooth anesthesia (STA) system from Milestone scientific features newly-patented real-time visual and audible feedback technology that scientifically ensures a successful, site specific PDL injection. This tool uses Dynamic pressure sensing (DPS) technology; the first computer-controlled dental anesthetic delivery system. STA means that you get faster onset and your patient return to their routine without collateral numbing.

Contemporary dental professionals have been inundated to innovations with restorative digital devices. As digital dentistry has evolved, open minded thinkers have paved the way for Computer-aided design and Computer aided manufacturing; CAD/CAM system to be integrated in dentistry.

The D4D Technologies has launched E4D model to create direct digital dental system that captured the natural tooth structure without the application of powder.Utilizing unique image capture technology that can scan and create a real 3D virtual model directly off tooth structure,impressions(including alginates), and stone models provide clinicians various options in restorative management.The E4D systems does not require a contrast agent (eg,powder) for digital acquisition which could be a problem in surgery sites.

The use of digital photography is a standard approach in cosmetic dentistry.Dental images are critical for the sharing of visual information among the patient, dentist and ceramist. People are instinctively visually oriented; "picture is worth a thousand words".

Camera selection is very important for cosmetic dental practices.

camera should have the following features:

1- ttl (through the lens) metering and manual exposure settings.

2-spot and matrix metering

3-has apperutre priority setting where most of dental images will be taken

with the camera set on this mode.

4-allows for exposure compensation of up to plus or minus three stops.

5- macro lense with 90-105mm focal length that allows 1:1 magnification settings.

6- ring flash or dual point light sources that give the best images.

The "crystaleye" is a dental color analysis system based on original optical technology developed by Olympus.

This shade scanner spectrophotometer has a software that can analyze the color it generates."Crystaleye" device combines digital imaging with tooth shade data. It prevents uneven photography since it illuminates the imaged tooth evenly from right to left.

This handheld device gives the laboratory the detailed information needed to fabricate natural-looking cosmetic restorations.

Minimal invasive dentistry

Dental schools have taught dental students to prepare teeth according to G.V. Black method which requires an aggressive preparation of the tooth structure. Aggressive preparation was necessary to compensate for the physical properties of amalgam and gold. Dentists were taking away way too much tooth structure than necessary to get rid of caries. In doing so, dentists were weakening and ultimately over time seeing the results of these weakened teeth -fractured cusps and broken teeth. As soon as composites, white tooth like material, came out, it becomes unnecessary to prepare teeth aggressively, but open the door for minimally invasive way of preparing teeth.

Minimal invasive dentistry (MID) should be the goal of every aesthetic dental procedure.MID has become a buzz phrase in dentistry within the past decade.

So what is it exactly MID?
MID is the practice of treating dental disease in a conservative fashion based on the best scientific evidence available.Whether it is caries, loss of tooth structure, tooth pulpitis or periodontal lesion, MID refers to the practice of providing dental therapies in the most conservative, least invasive fashion.

Using technology for practicing minimal invasive dentistry (MID):

1-Air-abrasion enables the creation of small preparations when cavitated lesions are in their infancy.
2-Hard/soft tissue lasers could replace air abrasion and eliminate the the mess of powder in the mouth.
3-Diagnodent from Kavo Dental is a laser scanner that helps in 90% more accurate than an explorer to diagnose early caries and as a result treat it more minimally invasive.
4- CAD/CAM, Adhesive dentistry play a major role in MID(minimal invasive dentistry).
5- Microscopes help dentists to see better thus removing less healthy tooth structure.