Posts for: February, 2018
After ruling out other causes for your jaw pain, your doctor or dentist has made a diagnosis: a temporomandibular joint disorder (TMD). With TMD, your pain symptoms and other dysfunctions are due to a problem associated with the temporomandibular joint (TMJ) that connects your lower jaw (mandible) to your upper skull (cranium).
There are a number of treatment options, but most can be classified as either aggressive or conservative. Aggressive treatments are more interventional and target problems with the teeth such as bite problems or jaw relationships as they relate to the bite, which are thought to be underlying causes for TMD. Such treatments include orthodontics to realign teeth, crown or bridgework, or surgical treatment to the jaw or joint itself. These treatments are controversial and irreversible — with no guarantee of symptom relief.
It’s thought by many to be appropriate, then, to start with more conservative treatments. Many of these are based on treating the TMJ — which is a joint, a moveable bony structure connected by muscles and tendons — with an orthopedic approach, using treatments similar to those used for other joint problems.
Here, then, are some of those conservative therapies that may relieve your TMD pain and other symptoms.
Physical Therapy. Commonly used to treat pain and dysfunction in other joints, physical therapies like manual manipulation, massage, alternating hot and cold packs or exercises can be used to relax, stretch or retrain the muscles that operate the TMJ while reducing pain and inflammation.
Medications. Medications may be incorporated into the treatment plan to relieve pain, reduce inflammation or relax tense muscles. Besides prescription drugs, over-the-counter anti-inflammatory drugs (such as ibuprofen or acetaminophen) are also commonly used.
Bite Appliances. If night-time teeth grinding or clenching habits are a primary cause for the TMD, you may benefit from wearing an occlusal bite guard while you sleep, designed to specifically fit your upper teeth. Because the lower teeth can’t grip the guard’s smooth plastic surface when biting down, they’ll more likely produce less force. This gives the jaw muscles a chance to relax during sleep.
Diet changes. Changing to softer foods, which don’t require strenuous chewing, and eliminating the chewing gum habit will further help reduce stress on the TMJs and also give your muscles a chance to relax and heal.
If you would like more information on TMD and treatment options, 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 “Seeking Relief from TMD.”
Athletes in contact sports are at significant risk for traumatic injury to their teeth and mouth. It’s estimated 600,000 emergency room visits each year involve a sports-related dental injury.
Athletic mouthguards have become the premier safeguard against sports-related oral injuries. First worn by professional boxers in the 1920s, mouthguards are now required for use by various sports associations and leagues — from amateur youth to professional — for a number of sports. The National Collegiate Athletic Association (NCAA), for example, requires their use during play for hockey, lacrosse, field hockey and football. The American Dental Association recommends mouthguards for 29 sports or exercise activities.
But do mouthguards actually prevent injury? To answer that question in a scientific manner, the Journal of Sports Medicine published an evidence-based report in 2007 on mouthguard effectiveness for preventing or reducing the severity of oral-facial injuries and concussions. While the report objectively analyzed many of the problems and issues associated with mouthguards (like materials, design and durability), it concluded the risk of an oral-facial injury was nearly two times greater without the wearing of a mouthguard.
That being said, most dentists and other professionals in sports safety would advise not all mouthguards are alike. The stock, “off the shelf” mouthguard found in many retail stores with limited size offerings is the least expensive, but also least protective, of mouthguard types. Mouth-formed or “boil-and-bite” protectors, which are softened in boiling water and then bit down on by the player to form the fit, are better than the stock version — however, they often don’t cover all of the player’s back teeth.
The best option is a custom-designed guard made by a dentist for the individual patient. Although relatively expensive (costs range in the hundreds, compared with $25 or less for a stock guard), they provide the highest recognized level of mouth protection.
The bottom line: a mouthguard is a must-wear part of any uniform for any sport that involves contact or high velocity objects of play. If you or a family member is a contact sport athlete, it’s essential you protect your teeth and mouth with a custom-fit, high quality mouthguard.
If you would like more information on mouthguards, 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 “Athletic Mouthguards.”
Restoring missing or unattractive teeth can often be a lengthy process. Months may elapse between initial teeth preparation and final placement to allow time for tissue healing and permanent crown manufacturing. During that period you will likely wear temporary (provisional) crowns to protect the teeth while improving function and appearance.
In the past, provisional crowns were fairly uniform. Today, though, there are provisional crowns available that conform exactly to a patient’s individual mouth. These crowns not only enhance function and appearance, they’re an excellent way to “try out” your new smile before the permanent restoration.
Customized provisional crowns are part of a concept known as “smile analysis.” A new smile involves more than restoring affected teeth: we also consider the overall health of your mouth, the shape of your face, and your own desires and expectations. Your final smile design is a joint collaboration between you, our office and the dental laboratory that will fashion the final restoration.
There are a number of techniques for creating customized provisional crowns. Some techniques involve bonding tooth-colored materials like composite resin directly to the teeth. Others use impression models of your teeth to create an outline or shell that’s filled with an acrylic material and then affixed to your teeth. The aim with any of these techniques is to produce a provisional crown that accurately reflects the final crown’s appearance.
With these types of provisional crowns, we can see how the new teeth will look (their color, shading, shapes and proportions) against the gums, and if they appear to be in balance and harmony with the entire face, including your lips, jaws and facial contour. We can also evaluate how well the new teeth function as you chew, speak or smile.
It takes some extra effort to prepare customized provisional crowns rather than the more uniform version. But this effort is well worth it: by helping us anticipate more accurately how your new restorations will appear and function, customized crowns help ensure your new smile is an attractive and satisfying one.
If you would like more information on temporary restorations, 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 “Concepts of Temporary Restorations.”
“Cut down on sweets, especially between meals” is perhaps one of the least popular words of advice we dentists regularly give. We’re not trying to be killjoys, but the facts are undeniable: both the amount and frequency of sugar consumption contributes to tooth decay. Our concern isn’t the naturally occurring sugars in fruits, vegetables, grains or dairy products, but rather refined or “free” sugars added to foods to sweeten them.
The World Health Organization and the U.S. Food and Drug Administration both advise consuming no more than 50 grams (about ten teaspoons) of sugar a day. Unfortunately, our nation’s average per person is much higher: we annually consume around 140 pounds per capita of refined sugars like table sugar or high fructose corn syrup, more than three times the recommended amount. Soft drinks are the single largest source of these in our diets — Americans drink an average of 52 gallons every year.
The connection between sugar and tooth decay begins with bacteria that ferments sugar present in the mouth after eating. This creates high levels of acid, which causes the mineral content of tooth enamel to soften and erode (a process called demineralization) and makes the teeth more susceptible to decay. Saliva naturally neutralizes acid, but it takes about thirty minutes to bring the mouth’s pH to a normal level. Saliva can’t keep up if sugars are continually present from constant snacking or sipping on soft drinks for long periods.
You can reduce the sugar-decay connection with a few dietary changes: limit your intake of sugar-added foods and beverages to no more than recommended levels; consume sweets and soft drinks only at meal times; replace sugar-added foods with fresh fruits and vegetables and foods that inhibit the fermentation process (like cheese or black and green teas); and consider using mint or chewing gum products sweetened with xylitol, a natural alcohol-based sugar that inhibits bacterial growth.
Last but not least, practice good oral hygiene with daily brushing and flossing, along with regular office cleanings and checkups. These practices, along with limits on refined sugar in your diet, will go a long way toward keeping your teeth and mouth healthy and cavity-free.
If you would like more information on the relationship of sugar and dental disease, 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 “Nutrition & Oral Health.”
Periodontal (gum) disease is a devastating infection that eventually causes tooth loss if not treated. Plaque removal, antibiotics and possible surgical intervention have proven quite effective in stopping the infection and restoring diseased tissues; however, the more advanced the disease, the more difficult it can be to treat. It’s important then to know the warning signs of gum disease.
Bleeding gums are the most common early sign of gum disease. The infection triggers tissue inflammation, the body’s defensive response to isolate and fight bacteria. As the inflammation becomes chronic, however, it can weaken the gum tissues, which will then bleed easily.
Bleeding, though, is often overlooked as normal, perhaps from brushing too hard. In actuality, bleeding gums is not normal: if your gums routinely bleed during normal brushing and flossing, you should contact us for an examination as soon as possible. Similarly, if your gums are red, swollen or tender to the touch, this is also a sign of inflammation and an indication of infection.
Gum disease is often called a “silent” disease, meaning it can develop without any indication of pain or discomfort. Sometimes, though, bacteria can concentrate in a particular portion of the gum tissue to form a periodontal abscess. In this case, the abscessed tissue can become very painful, swollen and red, and may even discharge pus.
There are also advanced signs of gum disease. If your teeth are painfully sensitive when you brush, consume something hot or cold, or when you bite down, this may mean the gums have pulled back (receded) from the teeth and the highly sensitive dentin and roots are now exposed. Teeth that appear to have moved or that feel loose may mean the gum tissues have significantly detached from the teeth as increasing amount of bone loss occurs. If you see any of these signs you should contact us without delay.
Regardless of the level of disease advancement when diagnosed, prompt treatment should begin as soon as possible. This is the only way to bring the infection under control and give the gum tissues a chance to heal and rejuvenate. From then on, it’s a matter of renewed dental hygiene, frequent cleanings and checkups and an ever vigilant eye for signs of returning infection.
If you would like more information on the diagnosis and treatment of gum disease, 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 “Warning Signs of Periodontal (Gum) Disease.”