Chronic jaw pain can make eating, speaking or even smiling difficult. What's more, finding the right treatment approach can be just as difficult.
This is because TMD (Temporomandibular Disorder: named for the joints on either side of the lower jaw) actually describes a wide range of possible problems with the joints and connecting muscles. Any of them can result in impaired jaw function, radiating pain or even headaches.
We'll need to conduct a full dental and facial exam to accurately diagnose your jaw pain's cause. Even then, the way may still not be clear: there's considerable debate among dentists about the best treatment approach. Two basic schools of thought prevail, one conservative and non-invasive and the other more aggressive and interventional.
The conservative approach seeks to alleviate symptoms in a variety of ways, including recommending softer foods to give muscles and joints time to relax, applying cold and heat to ease soreness, massage of the jaw joint muscles, gentle stretching and jaw exercises. We may also prescribe medications like ibuprofen and other non-steroidal anti-inflammatory drugs for pain and swelling relief, and sometimes muscle relaxers to reduce spasms. If your pain stems from clenching or grinding habits, we could fit you with a custom bite guard you wear while you sleep to reduce the forces on your teeth.
The more aggressive approach is much more invasive. These methods include altering the bite or teeth position with orthodontics or dental work or surgically altering the joints themselves or the shape of the jaw. If you're recommended one of these more aggressive treatments, you should know they're not commonly used to treat TMD and they're irreversible. There's also no guarantee you'll gain relief from your symptoms, so by all means get a second opinion before undergoing any procedures.
For most people the best course of treatment is to start with the least invasive techniques, which are usually very successful. If they don't relieve your pain and limited function, we may then consider escalating treatment to more irreversible procedures to help you find relief from this unwelcome condition.
If you would like more information on jaw joint pain and how to treat it, 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.”
Shingles is a painful viral infection that could potentially recur in sufferers for years. It causes painful skin rashes, general nerve pain, fever and fatigue. In extreme cases, it can cause blindness if the eyes become infected. And because it’s highly contagious, it could affect your dental treatment.
Formally known as herpes zoster, shingles is a recurrent form of chicken pox. If you contracted chicken pox in childhood, the shingles virus could lay dormant for several years. In fact, most people who contract shingles are over 50.
Because it acutely affects the nerves around the skin, the disease’s most common symptom is a belted or striped rash pattern that often appears on one side of the body and frequently on the head, neck or face. While the severity of symptoms may vary among patients, shingles can be a significant health threat to certain people, especially pregnant women, cancer patients or individuals with compromised immune systems.
In its early stages, the shingles virus can easily pass from person to person, either by direct contact with the rash or by airborne secretions that others can inhale. Because it’s highly contagious, even a routine teeth cleaning could potentially spread the virus to dental staff or other patients. Because of the significant health threat it potentially poses to some people, your dental provider may decline to treat you if you’re showing symptoms of the disease.
To stay ahead of this, let your dentist know you’re experiencing a shingles episode if you have an upcoming dental appointment, in which case you may need to reschedule. In the meantime, you should seek medical attention from your physician who may prescribe antiviral medication. Starting it within 3 days of a shingles outbreak can significantly reduce your pain and discomfort as well as its contagiousness.
And if you’re over sixty or at risk for shingles, consider getting the shingles vaccine. This readily available vaccine has proven effective in preventing the disease and could help you avoid the pain and disruption this viral infection can bring to your life.
So you’re tearing up the dance floor at a friend’s wedding, when all of a sudden one of your pals lands an accidental blow to your face — chipping out part of your front tooth, which lands right on the floorboards! Meanwhile, your wife (who is nine months pregnant) is expecting you home in one piece, and you may have to pose for a picture with the baby at any moment. What will you do now?
Take a tip from Prince William of England. According to the British tabloid The Daily Mail, the future king found himself in just this situation in 2013. His solution: Pay a late-night visit to a discreet dentist and get it fixed up — then stay calm and carry on!
Actually, dental emergencies of this type are fairly common. While nobody at the palace is saying exactly what was done for the damaged tooth, there are several ways to remedy this dental dilemma.
If the broken part is relatively small, chances are the tooth can be repaired by bonding with composite resin. In this process, tooth-colored material is used to replace the damaged, chipped or discolored region. Composite resin is a super-strong mixture of plastic and glass components that not only looks quite natural, but bonds tightly to the natural tooth structure. Best of all, the bonding procedure can usually be accomplished in just one visit to the dental office — there’s no lab work involved. And while it won’t last forever, a bonded tooth should hold up well for at least several years with only routine dental care.
If a larger piece of the tooth is broken off and recovered, it is sometimes possible to reattach it via bonding. However, for more serious damage — like a severely fractured or broken tooth — a crown (cap) may be required. In this restoration process, the entire visible portion of the tooth may be capped with a sturdy covering made of porcelain, gold, or porcelain fused to a gold metal alloy.
A crown restoration is more involved than bonding. It begins with making a 3-D model of the damaged tooth and its neighbors. From this model, a tooth replica will be fabricated by a skilled technician; it will match the existing teeth closely and fit into the bite perfectly. Next, the damaged tooth will be prepared, and the crown will be securely attached to it. Crown restorations are strong, lifelike and permanent.
Was the future king “crowned” — or was his tooth bonded? We may never know for sure. But it’s good to know that even if we’ll never be royals, we still have several options for fixing a damaged tooth. If you would like more information, please contact us or schedule an appointment for a consultation. You can learn more by reading the Dear Doctor magazine articles “Repairing Chipped Teeth” and “Crowns and Bridgework.”
Teeth damaged by decay, periodontal (gum) disease or trauma are often removed (extracted) if they’re deemed beyond repair. But there’s another reason we may recommend an extraction: a tooth is causing or has the potential to cause problems for other teeth and your overall oral health.
Some of the most frequent cases of “preventive extraction” involve the third molars, or wisdom teeth, located in the very back of the mouth. They’re usually the last permanent teeth to come in, which is related to some of the problems they can cause. Because they’re trying to come in among teeth that have already erupted they don’t always erupt properly, often at abnormal angles or not fully erupting through the gums, a condition called impaction.
Impacted or misaligned wisdom teeth can put pressure on adjacent teeth and their roots, which can cause root resorption that damages the second molar. They can also increase the risk of periodontal (gum) disease in the gum tissues of the second molars, which if untreated can ultimately cause teeth and bone loss.
Because of current or possible future problems with wisdom teeth, we often consider removing them at some early point in the person’s dental development. Such a consideration shouldn’t be undertaken lightly, since wisdom teeth extraction is often complex and fraught with complications, and it usually requires a surgical procedure.
That’s why we first conduct a comprehensive examination (including x-ray or other imaging to determine exact location and possible complications) before we recommend an extraction. If after careful analysis an extraction appears to be the best course, we must then consider other factors like planned orthodontics to determine the best time for the procedure.
Once performed, a wisdom tooth extraction can resolve existing problems now and reduce the risks of gum disease or malocclusions in the future. When it comes to wisdom teeth, removing them may be in your or your family member’s best interest for optimal dental health.
If you would like more information on wisdom teeth, 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 “Wisdom Teeth.”
While out with friends one evening, you take a bite of ice cream. Suddenly, pain shoots through your teeth. It only lasts a second, but it's enough to ruin your good time.
This could be tooth sensitivity, a painful reaction to hot or cold foods. It often occurs when the enamel in prolonged contact with acid has eroded. Acid is a waste product of bacteria found in plaque, a thin film of food particles that builds up on tooth surfaces due to inadequate brushing and flossing. Enamel normally mutes temperature or pressure sensation to the underlying dentin layer and nerves. Loss of enamel exposes the dentin and nerves to the full brunt of these sensations.
Sensitivity can also happen if your gums have shrunk back (receded) and exposed dentin below the enamel. Although over-aggressive brushing can often cause it, gum recession also happens because of periodontal (gum) disease, a bacterial infection also arising from plaque.
The best way to avoid tooth sensitivity is to prevent enamel erosion or gum recession in the first place. Removing accumulated plaque through daily brushing and flossing is perhaps the most essential part of prevention, along with a nutritious diet low in sugar and regular dental cleanings and checkups.
It's also important to treat any dental disease that does occur despite your best hygiene efforts. Gum disease requires aggressive plaque removal, especially around the roots. While receded gum tissues often rebound after treatment, you may need gum grafting surgery to restore lost tissues if the gums have receded more deeply. For enamel erosion and any resulting decay you may need a filling, root canal treatment or a crown, depending on the depth and volume of structural damage.
While you're being treated you can also gain some relief from ongoing sensitivity by using a toothpaste with potassium nitrate or similar products designed to desensitize the dentin. Fluoride, a known enamel strengthener, has also been shown to reduce sensitivity. We can apply topical fluoride directly to tooth surfaces in the form of gels or varnishes.
Don't suffer through bouts of tooth sensitivity any more than you must. Visit us for a full exam and begin treatment to relieve you of the pain and stress.
If you would like more information on the causes and treatment of tooth sensitivity, 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 “Treatment of Tooth Sensitivity.”
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