Posts for: October, 2013
If you have pain in your jaws or related headaches, you may have Temporo-mandibular Joint Disorder, TMD. You are probably wondering what this is — and how it can be treated. If this sounds like something you may have, read on for some answers.
What is TMD? TMD describes a group of disorders or diseases that have the same symptoms, but may have different causes, hence it is known as “The Great Imposter.” Pain in and around the temporo-mandibular joint (TMJ), the jaw joint involved in opening and closing your mouth — is characterized by pain and soreness in the region of one or both joints, ears, jaw muscles and even the sinuses.
How does the temporo-mandibular joint work? You can feel your jaw joints working if you place your fingers in front of your ears and move your lower jaw up and down. On each side the joint is composed of an almond shaped structure at the end of the lower jaw, called the condyle, which fits neatly into a depression in the temporal bone (the bone on the side of your skull near your ear). A small disc between the two bones allows the lower jaw to move forward and sideways. The joints are stabilized by ligaments and moved by muscles, like all your joints.
What is the most common cause of TMD? Many people clench or grind their teeth as a reaction to stress. This is generally a subconscious habit, and can even occur during sleep. Continual tooth grinding habits can cause the muscles to go into spasm, which is the most common cause of TMD pain. Structures associated with the jaws — teeth, air sinuses, and even neck and back muscles — share nerves with the muscles in the joints, so the pain may be felt in those structures too, making the exact source of the pain difficult to diagnose. Symptoms of TMD may limit your ability to open your jaw and talk or eat normally.
What is the treatment for TMD? Treatment will depend on the cause, but generally the first step is to relieve pain and discomfort with heat, mild painkillers, muscle relaxants, a soft diet, and simple jaw exercises. A bite guard may be recommended, which should be custom made in our office; a rigid yet unobtrusive plastic appliance that fits over the biting surfaces of your upper teeth. Properly fitted and adjusted, it aids and causes jaw muscle relaxation by preventing clenching and grinding. It is worn during times of stress when oral habits tend to recur, and can also be worn at night.
If you are suffering from TMD — whether the pain is moderate or severe — schedule an appointment with us to have it evaluated and treated. You can learn more about TMD by reading the Dear Doctor magazine article “TMD: Understanding the Great Imposter.”
For some kids, having a cavity or two is just part of growing up. Not for Giuliana Rancic. When she was a child, the TV personality didn't have a single cavity — and she still doesn't. But for her husband Bill, co-star of the Style Network reality show Giuliana and Bill, it was a different story. A cavity-prone kid, he was never certain what a visit to the dentist might hold in store. “I can still remember the anticipation,” he recently told Dear Doctor magazine. “I always hoped I would get out of the checkups without a cavity!”
Why do some people get more cavities than others? There are a number of factors at work, but to understand it better, let's look at how tooth decay occurs.
How Cavities Form
Cavities — also called dental caries — are small pits or holes in the teeth that are caused by tooth decay. Tooth decay itself is a chronic disease that can flare up when plaque isn't kept under control. A thin, bacteria-laden film, plaque sticks to tooth surfaces both above and below the gum line, and can build up in the absence of effective oral hygiene.
Of course, everyone has bacteria in their mouth, both “good” and “bad” (pathogenic) types. But when the bad guys outnumber the good, trouble can start. When you consume sweets, plaque bacteria process the sugars and release acid as a byproduct. The acid eats into tooth surfaces, causing decay — and cavities that need filling. Left untreated, decay can work its way into the tooth's pulp, resulting in infection and pain. Eventually, treatment might involve a root canal — or, in the worst case, extraction.
What can you do if you seem to be prone to cavities? One effective way to fight tooth decay is by maintaining good oral hygiene. Brush at least twice daily, for at least two minutes each time. Use a soft-bristled brush and a dab of fluoride toothpaste to clean all around your teeth. Most importantly, floss above and below the gum line, every day. And just as important, don't forget to have regular dental checkups every six months.
A Healthy Balance
Another cavity-fighting strategy is eating a balanced diet. Avoid soda, sugary “energy” drinks and sweet treats — but if you choose to consume sugar, have it with meals instead of between meals. This will give your saliva, which has natural cavity-fighting properties, a chance to work.
“It's all about maintaining a healthy balance,” Giuliana told Dear Doctor. And Bill agrees: “I love nuts and fruit for a healthy snack,” he said, adding that he's meticulous about brushing and flossing. And when the couple smiles, you can see how those healthy habits pay off.
If you would like more information on preventing tooth decay, please contact us or schedule an appointment for a consultation. You can learn more about this topic in the Dear Doctor magazine articles “Tooth Decay” and “Tooth Decay – How To Assess Your Risk.”
Your otherwise beautiful smile has one noticeable flaw — one or more of your teeth are deeply discolored or stained. More than likely this staining is deep within the teeth, what we refer to as intrinsic staining. There are a number of reasons this can occur — from fillings or use of antibiotics, for example — and our first approach should be to attempt a whitening technique.
However, if that doesn't produce the desired result, porcelain laminate veneers are another option you might consider. Veneers are made of dental porcelain, a bio-compatible material that can be shaped and colored to closely match neighboring teeth. After a minimal amount of tooth reduction (removal of some of the enamel from the tooth surface) to prepare for the laminate, the veneers are then permanently bonded to the tooth surface and cover the discolored natural tooth. Besides changing the appearance of discolored or stained teeth, veneers can also be used to correct other imperfections such as chipped or misshapen teeth.
Patients, however, have a common question: how long will the veneers last? With proper care, veneers can last anywhere from seven years to more than twenty years. It's possible, though, to damage them — for example, you can break them if you bite down on something that goes beyond the porcelain's tolerance range, such as cracking nut shells with your teeth (not a good idea even for natural teeth!). You should also keep in mind that veneers are composed of inert, non-living material and are attached and surrounded by living gum tissue that can change over time. This process may eventually alter your appearance to the point that the veneer may need to be removed and reapplied to improve the look of your smile.
If a veneer is damaged, all is not necessarily lost. It may be possible to re-bond a loosened veneer or repair a chipped area. The worst case is replacement of the veneer altogether. Chances are, though, this will only happen after the veneer has already served you — and your smile — for many years.
If you would like more information on porcelain laminate veneers, 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 “Porcelain Veneers.”
Metal braces for correcting teeth alignment have long been a fixture of adolescence. But although they're effective, they tend to put a crimp on a teenager's life with changes in diet and irritation and discomfort from the devices and regular adjustments. For many teens, though, these are minor compared to the change in their appearance that comes with traditional braces, and the embarrassment they may feel.
In recent years, there's been a growing use of another orthodontic device that reduces many of these inconveniences, especially regarding appearance. Known as the clear aligner, this transparent, “almost invisible” device can be taken out for eating, cleaning or important social events.
Clear aligners are a sequential set of clear trays made of polyurethane plastic that are generated for an individual patient using information derived from x-rays, photographs or models. Each tray in the sequence is slightly different from the previous one to account for the tooth movement achieved wearing the previous tray. The patient will wear a tray for about two weeks and then, if all looks well, move to the next tray. This process continues until the teeth arrive at the proper alignment, a period of about six to twenty-four months depending on the patient's initial condition and their progress.
Up until recently, aligners were a viable option for a limited category of patients, mainly adults. Recent advances have changed that. Aligners now include tiny “power ridges” that enable them to move teeth in more than one plane, something previous versions were unable to do. “Eruption tabs” can also be incorporated into aligner sets to hold the space for permanent teeth that haven't erupted yet — a must for many younger patients. We can also temporarily bond attachments to the teeth known as buttons (made with a composite that blends in with the natural tooth color) that give more leverage and stability to the aligner.
With these changes, clear aligners are now an effective choice for a wider group of patients, including many teens. Aligners are comfortable to wear, easy to care for, and for teens acutely conscious of their appearance, less obtrusive than traditional metal braces.
If you would like more information on clear aligners, 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 “Clear Aligners for Teens.”
Chewing tobacco has a certain cachet among its users, especially young boys and men, who believe using it makes them appear macho or “cool.” They also believe this “smokeless” variety (as it's often marketed by tobacco companies) is safer than cigarettes or cigars.
Unfortunately, nothing could be further from the truth. In reality, chewing tobacco is harmful to your health — and especially your oral health. Regular use of these products can lead to severe dental and mouth conditions resulting in disease, disfigurement, or even death.
Like the smoked variety, chewing tobacco infuses its users with nicotine, a chemical stimulant naturally produced by the tobacco plant. The body responds to the stimulant's effect and begins to crave it, leading to addiction.
The problem, though, is the other ingredients in chewing tobacco: more than thirty other substances known to cause various kinds of cancer, including oral. Oral cancer alone is extremely dangerous: many patients suffer partial or complete loss of oral tissue and facial structures, including the tongue, lower jaw or even the face. Some even lose their lives — statistics show that only half of those with oral cancer survive more than five years after diagnosis.
Although cancer may be the most harmful effect of chewing tobacco, it isn't the only one. Researchers have found tobacco users have higher rates of tooth decay and gum disease than non-users. Tobacco also causes cosmetic and hygiene problems, including tooth staining and chronic bad breath.
If you're a tobacco user in any form, and especially chewing or spit tobacco, as your dentist we would advise you to consider quitting the habit. Giving up tobacco will not only improve your oral health and appearance, it may even save your life.
If you would like more information on the dangers of chewing tobacco, 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 “Chewing Tobacco.”