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By Paul David Epstein, D.M.D. & Associates, P.C.
August 14, 2017
Category: Dental Procedures
Tags: medication  
MildPainRelieversmaybeallyouneedforDiscomfortafterDentalWork

For most dental procedures you’re usually back to your regular routine in no more than a day or two (or even hours) afterward. For the most part, the mouth heals rather quickly.

But there may still be a short period of discomfort after tooth extraction, gum surgery or similar invasive procedures. The good news is you will most likely have no need for strong narcotic painkillers — milder, over-the-counter pain relievers are usually sufficient to manage your discomfort.

The most common of these are known as non-steroidal anti-inflammatory drugs (NSAIDs). This group of pain relievers — which include aspirin and ibuprofen — block the release of substances in the body known as prostaglandins that stimulate inflammation that increases pain in damaged tissues. They’re much preferred for mild to moderate pain because they don’t have the side effects of steroids or narcotics like morphine or codeine. They also tend to be less costly than these other prescription drugs.

But while they’re reasonably safe, they can cause problems if you exceed the recommended dosage or use them for prolonged periods. Their blockage of certain chemicals reduces the clotting mechanism in blood leading to a blood-thinning effect. Not only will this increase bleeding, it can also damage the stomach lining and cause ulcers if used over a period of weeks. Improper dosage of NSAIDs has also been linked to miscarriages and repeat heart attacks, which is why they’re not recommended for use during pregnancy or with patients with a history of heart or intestinal problems.

But if taken as directed by your physician or dentist — usually no more than 2,400 milligrams a day and only for a few days — such side effects are quite rare. The benefit is much more common: about five hours of pain relief from a single dose for most people. With the help of ibuprofen or similar drugs, you’ll be on your feet after your dental work in no time. 

If you would like more information on managing pain after a procedure, 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 David Epstein, D.M.D. & Associates, P.C.
August 06, 2017
Category: Oral Health
ActressEmmaStoneRevealsHowThumbSuckingAffectedHerTeeth

It's no secret that many of Hollywood's brightest stars didn't start out with perfectly aligned, pearly-white teeth. And these days, plenty of celebs are willing to share their stories, showing how dentists help those megawatt smiles shine. In a recent interview with W magazine, Emma Stone, the stunning 28-year-old star of critically-acclaimed films like La La Land and Birdman, explained how orthodontic appliances helped her overcome problems caused by a harmful habit: persistent thumb sucking in childhood.

“I sucked my thumb until I was 11 years old,” she admitted, mischievously adding “It's still so soothing to do it.” Although it may have been comforting, the habit spelled trouble for her bite. “The roof of my mouth is so high-pitched that I had this huge overbite,” she said. “I got this gate when I was in second grade… I had braces, and then they put a gate.”

While her technical terminology isn't quite accurate, Stone is referring to a type of appliance worn in the mouth which dentists call a “tongue crib” or “thumb/finger appliance.” The purpose of these devices is to stop children from engaging in “parafunctional habits” — that is, behaviors like thumb sucking or tongue thrusting, which are unrelated to the normal function of the mouth and can cause serious bite problems. (Other parafunctional habits include nail biting, pencil chewing and teeth grinding.)

When kids develop the habit of regularly pushing the tongue against the front teeth (tongue thrusting) or sucking on an object placed inside the mouth (thumb sucking), the behavior can cause the front teeth to be pushed out of alignment. When the top teeth move forward, the condition is commonly referred to as an overbite. In some cases a more serious situation called an “open bite” may develop, which can be difficult to correct. Here, the top and bottom front teeth do not meet or overlap when the mouth is closed; instead, a vertical gap is left in between.

Orthodontic appliances are often recommended to stop harmful oral habits from causing further misalignment. Most appliances are designed with a block (or gate) that prevents the tongue or finger from pushing on the teeth; this is what the actress mentioned. Normally, when the appliance is worn for a period of months it can be expected to modify the child's behavior. Once the habit has been broken, other appliances like traditional braces or clear aligners can be used to bring the teeth into better alignment.

But in Stone's case, things didn't go so smoothly. “I'd take the gate down and suck my thumb underneath the mouth appliance,” she admitted, “because I was totally ignoring the rule to not suck your thumb while you're trying to straighten out your teeth.” That rule-breaking ended up costing the aspiring star lots of time: she spent a total of 7 years wearing braces.

Fortunately, things worked out for the best for Emma Stone: She now has a brilliant smile and a stellar career — plus a shiny new Golden Globe award! Does your child have a thumb sucking problem or another harmful oral habit? For more information about how to correct it, please contact us or schedule an appointment for a consultation. You can learn more in the Dear Doctor magazine article “How Thumb Sucking Affects the Bite.”

By Paul David Epstein, D.M.D. & Associates, P.C.
July 22, 2017
Category: Oral Health
Tags: dental injuries  
HowtoHandle3CommonInjuriestoYourChildsMouth

Once they learn to walk, there's no stopping most children. Sometimes it can be a little jarring, as when you discover your toddler on top of the kitchen counter reaching in the cupboard on tip-toes for a snack!

Fortunately, children are fairly resilient. Unfortunately, they're not invincible — some of their adventures could result in physical injuries, especially to the highly vulnerable area of the mouth.

Even if you've carefully “child-proofed” your home, it's still best to be prepared for mishaps. Here are 3 common dental injuries and how to handle them.

Soft tissue injuries. Making contact with the ground or hard objects like furniture can injure the lips, tongue, cheeks or gums and cause bleeding, cuts or bruising. First, clean the area with clean water and a cloth or gauze as best you can, making sure there aren't any trapped pieces of tooth or dirt. Apply gentle, continuous pressure with a clean cloth to control bleeding, and apply ice packs or cold compresses for swelling. Don't apply bleach, aspirin or similar medications to open wounds. If the bleeding won't stop or the wounds look serious or deep, go to an emergency room.

Chipped or displaced tooth. A blunt force mouth injury can chip or push (displace) teeth out of position. In this case try to save any chipped pieces you find — your dentist may be able to re-bond them to the tooth. A displaced tooth is a dental emergency, so contact your dentist immediately. Don't try to re-position the tooth yourself unless it's completely knocked out.

Knocked-out tooth. Actions to take with a knocked-out tooth depend on whether it's a permanent or primary (baby) tooth. If permanent, rinse the tooth with clean water. Handle it by the crown (never by the root) and gently place it back in the empty socket. If that's not possible, place the tooth between your child's cheek and gum (if the child is old enough not to swallow it by mistake. You can also place it in a glass of cold milk. Get to a dentist or an emergency room as soon as possible — minutes count for a successful reattachment. Conversely, don't try to put a primary tooth back in its socket — you could damage the developing permanent tooth beneath the gum line. But do see a dentist as soon as possible for an examination.

If you would like more information on responding to mouth injuries in children, please contact us or schedule an appointment for a consultation.

By Paul David Epstein
July 13, 2017
Category: Dental Appliances
Tags: veneers  

Are you dissatisfied with the color or shape of your teeth? How about those gaps or crowded teeth--do they make you want to hide yourveneers smile? Paul David Epstein D.M.D. and Associates in Burlington, MA offers a permanent way to disguise dental flaws. They're called porcelain veneers, or dental laminates. Customized and bonded to the front of teeth with chips, cracks, stains, pits, gaps and more, veneers are the minimally invasive way to remake your smile.

What are porcelain veneers?

They are a durable and natural-looking way to remake teeth flawed by stains too deep for professional whitening and chips too large for composite resin bonding. In other words, they cover a variety of smile defects.

Porcelain veneers in Burlington, MA are fabricated from a dental grade ceramic, color-matched to blend in with surrounding teeth. Dr. Epstein visually inspects and X-rays teeth to determine their suitability for veneers. Ideal candidates have mouths free from decay and gum disease.

The treatment process

Dr. Epstein and the patient talk through a treatment plan, agreeing upon the goals the individual wants to achieve and exactly what Dr. Epstein sees as realistic changes. This discussion is vital to the treatment process, and Dr. Epstein may even preview the patient's finished smile so he or she can see how it will change in terms of:

  • Smoothing overcrowded teeth
  • Spanning small gaps
  • Covering chips, fine cracks, pits and other enamel defects
  • Disguising dark stains

Then, the dentist takes impressions and removes a thin layer of enamel from the front of each tooth. This minimal resurfacing allows the veneers to bond in place and to fit within the individual's mouth. Also, the patient wears temporary veneers until the dentist installs the permanent ones.

Then, the dentist sends his instructions to a lab where a ceramist sculpts the veneers individually, according to a three-dimensional model of the patient's mouth. This ensures the porcelain veneers blend in with the rest of the patient's smile by way of color, shape and size.

On a return visit to Paul David Epstein D.M.D. & Associates, Dr. Epstein removes the temporary veneers and bonds the new ones in place. He uses an adhesive which can be varied in color so the laminates match neighboring teeth.

Adjusting to veneers

While there is an adjustment period with veneers, most patients report easily getting accustomed to them. Aftercare is simple, too. Just brush and floss and see Dr. Epstein semi-annually for a check-up and cleaning.

Additionally, it pays to be gentle with your porcelain veneers. While they do not decay or stain, they can chip (as can your natural teeth) if you chew extra-hard foods or non-foods such as pencil tops or plastic packaging.

Can we help your smile?

Dr. Epstein's mastery of restorative and cosmetic treatments helps his patients achieve outstanding smiles. For a consultation, contact his office for an appointment regarding porcelain veneers. Call (781) 273-1152.

By Paul David Epstein, D.M.D. & Associates, P.C.
July 07, 2017
Category: Oral Health
FifthHarmonysCamilaCabelloChipsaToothbutConcertStillWorthIt

Everyone loves a concert where there's plenty of audience participation… until it starts to get out of hand. Recently, the platinum-selling band Fifth Harmony was playing to a packed house in Atlanta when things went awry for vocalist Camila Cabello. Fans were batting around a big plastic ball, and one unfortunate swing sent the ball hurtling toward the stage — and directly into Cabello's face. Pushing the microphone into her mouth, it left the “Worth It” singer with a chipped front tooth.

Ouch! Cabello finished the show nevertheless, and didn't seem too upset. “Atlanta… u wild… love u,” she tweeted later that night. “Gotta get it fixed now tho lol.” Fortunately, dentistry offers a number of ways to make that chipped tooth look as good as new.

A small chip at the edge of the tooth can sometimes be polished with dental instruments to remove the sharp edges. If it's a little bigger, a procedure called dental bonding may be recommended. Here, the missing part is filled in with a mixture of plastic resin and glass fillers, which are then cured (hardened) with a special light. The tooth-colored bonding material provides a tough, lifelike restoration that's hard to tell apart from your natural teeth. While bonding can be performed in just one office visit, the material can stain over time and may eventually need to be replaced.

Porcelain veneers are a more long-lasting solution. These wafer-thin coverings go over the entire front surface of the tooth, and can resolve a number of defects — including chips, discoloration, and even minor size or spacing irregularities. You can get a single veneer or have your whole smile redone, in shades ranging from a pearly luster to an ultra-bright white; that's why veneers are a favorite of Hollywood stars. Getting veneers is a procedure that takes several office visits, but the beautiful results can last for many years.

If a chip or crack extends into the inner part of a tooth, you'll probably need a crown (or cap) to restore the tooth's function and appearance. As long as the roots are healthy, the entire part of the tooth above the gum line can be replaced with a natural-looking restoration. You may also need a root canal to remove the damaged pulp material and prevent infection if the fracture went too far. While small chips or cracks aren't usually an emergency (unless accompanied by pain), damage to the tooth's pulp requires prompt attention.

If you have questions about smile restoration, please contact us and schedule an appointment. You can read more in the Dear Doctor magazine articles “Porcelain Veneers: Strength & Beauty As Never Before” and “Porcelain Crowns & Veneers.”





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