Tenderness; headaches; difficulty chewing; excruciating pain. These are a few of the symptoms you could endure with a jaw joint or temporomandibular disorder (TMD or TMJ). This group of disorders disrupts the daily lives of millions of people around the world.
This month is TMJ Awareness Month, to shed light on these debilitating conditions and how best to manage them. Although controlling TMD isn't always easy, it can be done with the right blend of treatments.
The temporomandibular joint—actually a pair of joints connecting the lower jaw to the skull on either side of the face—is "ground zero" for TMD. These are ball-and-socket joints similar to the hip or shoulder, but with a unique addition—a cushioning disk that lies between the adjoining points of the two bones that temper the forces generated when you eat, speak or bite down.
Researchers believe TMD can arise from a variety of sources, including traumatic injury, psychological stress or mechanical dysfunction within the joint and cushioning disk. These problems can create blood flow constriction, which in turn causes the accumulation of chemical waste byproducts in the jaw muscles. This in turn and cause the muscles to spasm and become inflamed and sore.
Treatments are also as numerous as the possible causes of TMD. But for the most part, they range along a continuum of conservative to aggressive approaches.
On the conservative end, doctors treat TMD as a joint problem and borrow heavily from orthopedics. These types of treatments include the use of anti-inflammatory and muscle relaxing medications, icing or heating, stretching exercises, physical therapy and massage. Dentists may also provide mouth guard appliances for patients with clenching or tooth grinding habits to decrease biting forces.
On the more aggressive end are interventions like orthodontics or dental work. But, while these were common recommendations 20-30 years ago, it's no longer thought to be necessary for treating most TMD disorders and should not be recommended as a cure or solution for TMD. At the furthest extreme is actual jaw surgery to relieve symptoms or repair damage within the joints. The latter, however, has not yet amassed a solid track record, and should be considered as a last resort.
Finding the right combination of therapies to give consistent relief sometimes requires a bit of trial and error. Most doctors recommend starting first with the most conservative methods before considering more aggressive measures. You should also undergo a complete dental exam to see if teeth or gum problems are contributing to your symptoms.
TMD can make your life miserable. But with some persistence and patience, you can find what works for a life without pain and dysfunction.
It seems with each new election cycle another U.S. state legalizes marijuana use. It remains a flashpoint issue that intersects politics, law and morality, but there's another aspect that should also be considered—the health ramifications of using marijuana.
From an oral health perspective, it doesn't look good. According to one study published in the Journal of Periodontology a few years ago, there may be a troubling connection between marijuana use and periodontal (gum) disease.
Gum disease is a common bacterial infection triggered by dental plaque, a thin biofilm on tooth surfaces. As the infection advances, the gum tissues become more inflamed and lose their attachment to teeth. This often results in widening gaps or "pockets" between the teeth and gums filled with infection. The deeper a periodontal pocket, the greater the concern for a tooth's health and survivability.
According to the study, researchers with Columbia University's College of Dental Medicine reviewed data collected from nearly 2,000 adults, a quarter of which used marijuana at least once a month. They found the marijuana users had about 30 individual pocket sites on average around their teeth with a depth of at least 4 millimeters. Non-users, by contrast, only averaged about 22 sites.
The users also had higher incidences of even deeper pockets in contrast to non-users. The former group averaged nearly 25 sites greater than 6 millimeters in depth; non-users, just over 19. Across the data, marijuana users appeared to fare worse with the effects of gum disease than those who didn't use.
As concerning as these findings appear, we can't say that marijuana use singlehandedly causes gum disease. The condition has several contributing risk factors: diet, genetics, and, most important of all, how well a person manages daily plaque removal, the main driver for gum disease, through brushing and flossing.
Still, the data so far seems to indicate using marijuana can make gum disease worse. Further studies will be needed to fully test this hypothesis. In the meantime, anyone using marijuana should consider the possible consequences to their oral health.
A year ago, former Australian footballer Jake Edwards got married. On television. To a woman he'd just met. No, not in a Vegas wedding chapel—it was all part of a reality TV series called Married At First Sight. Unfortunately, the marriage didn't last, which led to Edwards reevaluating his life. And one area in particular that came under his inward scrutiny was his smile.
Although otherwise possessing movie star looks, Edwards' teeth were anything but handsome: Besides a few that were chipped and cracked, his teeth overall looked small. His less-than-perfect smile was no secret, and he had plenty of offers from dentists to transform his smile.
He finally decided to do so, but with a twist: In addition to his own, he offered a full smile makeover to two other people for free (each valued at $30,000). The impetus for his makeover contest undoubtedly stems from his own lifelong experience: After years of being teased and bullied about his teeth, he knew firsthand how an unattractive smile can affect your personal and social confidence.
You too might feel the same confidence drain every time you look in the mirror. The problem, though, is that a full-scale makeover may seem out of reach financially and there aren't many Jake Edwards-style contests around to enter. But not to worry! There are a few ways to change your smile for the better without taking out a second mortgage on your house.
Teeth whitening. Even a smile with straight and perfectly formed teeth can be unattractive if those teeth are stained and dull. A professional teeth-whitening procedure can change that: Using a bleaching solution, we can turn drab and dingy teeth into a bright and dazzling smile in one sitting. With a little care and occasional touchups, your whiter smile could last for quite a while.
Bonding. We can repair mild to moderate chips and other tooth deformities simply and affordably with dental bonding. We gradually apply a resin dental material color-matched to your tooth, building it up and sculpting it to look natural. In just one sitting, a chipped tooth that once stood out like a sore thumb can regain its attractiveness.
Veneers. Many people like Edwards suffer from teeth that appear overly small or have slightly widened gaps. Problems like these and other deformities can be overcome with dental veneers, thin layers of porcelain bonded to the surfaces of teeth. Veneers can mask all manner of dental defects and truly transform a smile.
These and other affordable cosmetic procedures can truly change your smile, and many only take one visit. To learn more about your personal options, see us for a complete dental exam and consultation.
If you would like more information about other cosmetic dental procedures, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine article “Repairing Chipped Teeth.”
Wearing braces can ultimately give you a healthier and more attractive smile. In the short-term, though, your gums in particular may be in for a rough ride.
While we're all susceptible to gum disease, braces wearers are more likely to encounter it. This stems from two related factors: the difficulty braces pose to oral hygiene; and the potential irritation of soft tissues by the braces themselves.
The main cause for any form of gum disease is dental plaque, a thin bacterial film that accumulates on teeth. Removing plaque through brushing and flossing greatly reduces the risk of any dental disease. But braces wires and brackets make it difficult to brush and floss—as a result, some plaque deposits may escape cleaning, which makes a gum infection more likely.
To exacerbate this, braces hardware can irritate the gums and cause swelling and tissue overgrowth, also known as hyperplasia. The one-two punch of ineffective hygiene with hyperplasia are why braces wearers have a higher incidence of gum problems compared to the general population.
To guard against this, patients with braces need to be extra vigilant about keeping their teeth and gums clean of plaque. It may be helpful in this regard to use specialized tools like interproximal brushes with narrower bristle heads that are easier to maneuver around braces.
And rather than using traditional flossing thread, orthodontic patients may find it easier and more effective to use pre-loaded flossing picks or an entirely different method called oral irrigation. The latter involves a handheld wand that directs a stream of pulsating water between teeth to loosen and flush away plaque.
It's also important for patients to see their dentist as soon as possible for any gum swelling, bleeding or pain. The dentist can determine if it relates to gum disease, hyperplasia or a combination of both, and recommend treatment. In extreme cases, it may be necessary to remove the braces until the gums heal, so catching and treating any gum problem early is a priority.
Regardless of the risk for gum disease, orthodontic treatment is still well worth the investment in your health and appearance. Practicing effective oral hygiene and keeping a watchful eye on your gums will help further lower that risk.
If you would like more information on oral care during orthodontic treatment, 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 “Gum Swelling During Orthodontics.”
At what age should you begin treating a poor bite? Many might say with braces around late childhood or early adolescence. But some bite problems could be addressed earlier—with the possibility of avoiding future orthodontic treatment.
A crossbite is a good example. In a normal bite, all of the upper teeth slightly cover the lower when the jaws are shut. But a crossbite occurs when some of the lower teeth, particularly in back, overlap the upper teeth. This situation often happens when the upper jaw develops too narrowly.
But one feature of a child's mouth structure provides an opportunity to intervene and alter jaw development. During a child's early years, the palate (roof of the mouth) consists of two bones next to each other with an open seam running between them. This seam, which runs through the center of the mouth from front to back, will fuse during puberty to form one continuous palatal bone.
An orthodontist can take advantage of this separation if the jaw isn't growing wide enough with a unique device called a palatal expander. This particular oral appliance consists of four, thin metal legs connected to a central mechanism. The orthodontist places the expander against the palate and then uses the mechanism to extend the legs firmly against the back of the teeth on both sides of the jaw.
The outward pressure exerted by the legs also widens the seam between the two palatal bones. The body will respond to this by adding new bone to the existing palatal bones to fill in the widened gap. At regular intervals, the patient or a caregiver will operate the mechanism with a key that will continue to widen the gap between the bones, causing more expansion of the palatal bones until the jaw has grown to a normal width.
The palatal expander is most effective when it's applied early enough to develop more bone before the seam closes. That's why it's important for children to undergo bite evaluation with an orthodontist around age 6. If it appears a bite problem is developing, early interventions like a palatal expander could slow or stop it before it gets worse.
If you would like more information on interceptive orthodontics, 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 “Palatal Expanders.”
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