Posts for: February, 2018
If you're suffering from jaw pain or impaired function, it may not be the only source of chronic pain in your body. Of the millions of adults with temporomandibular joint disorders (TMD), many have also been diagnosed — among other conditions — with fibromyalgia, rheumatoid arthritis or sleep problems.
TMD is actually a group of painful disorders that affect the jaw joints, muscles and surrounding tissues. Besides pain, other symptoms include popping, clicking or grating sounds during jaw movement and a restricted range of motion for the lower jaw. Although we can't yet pinpoint a definite cause, TMD is closely associated with stress, grinding and clenching habits or injury.
It's not yet clear about the possible connections between TMD and other systemic conditions. But roughly two-thirds of those diagnosed with TMD also report three or more related health conditions. Debilitating pain and joint impairment seem to be the common thread among them all. The similarities warrant further research in hopes of new treatment options for each of them.
As for TMD, current treatment options break down into two basic categories: a traditional, conservative approach and a more interventional one. Of the first category, at least 90% of individuals find relief from treatments like thermal therapy (like alternating hot and cold compresses to the jaw), physical therapy, medication or mouth guards to reduce teeth clenching.
The alternative approach, surgery, seeks to correct problems with the jaw joints and supporting muscles. The results, however, have been mixed: in one recent survey a little more than a third of TMD patients who underwent surgery saw any improvement; what's more alarming, just under half believed their condition worsened after surgery.
With that in mind, most dentists recommend the first approach initially for TMD. Only if those therapies don't provide satisfactory relief or the case is extreme, would we then consider surgery. It's also advisable for you to seek a second opinion if you're presented with a surgical option.
Hopefully, further research into the connections between TMD and other inflammatory diseases may yield future therapies. The results could help you enjoy a more pain-free life as well as a healthy mouth.
If you would like more information on TMD, 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 “Chronic Jaw Pain and Associated Conditions.”
Families of children with chronic conditions face many challenges. One that often takes a back seat to other pressing needs is the prevention of tooth decay. But although difficult, it still deserves caregivers’ attention because of the dental disease’s potential long-term impact on oral health.
Chronically ill children are often at higher risk for tooth decay, most commonly due to challenges in practicing effective oral hygiene. Some conditions create severe physical, mental or behavioral impairments in children’s ability to brush and floss: for example, they may have a heightened gag reflex to toothpaste in their mouth or they may not be able to physically perform these tasks on their own.
Some children may be taking medications that inhibit salivary flow as a side effect. Saliva is critical for disease prevention because it both neutralizes mouth acid (which can erode tooth enamel) and is a first line of defense against disease-causing bacteria. And a child’s diet, while designed to support treatment of their chronic condition, may conversely not be the best for supporting their dental health.
It’s best if caregivers and their dentists develop a strategy for decay prevention, which should include the following:
- Regular dental visits beginning at Age One. Besides monitoring dental health, dental visits also provide cleanings and other preventive measures like topical fluoride or sealants;
- Brushing and flossing support. Depending on a child’s physical and mental capacities, caregivers (or an older sibling) may need to model brushing and flossing, or perform the tasks for the child;
- Medication and diet changes. If medications are causing dry mouth, caregivers can speak to their physicians about possible alternatives; likewise, they should see if modifications can be made to their diet to better support dental health.
- Boosting salivary flow. It’s especially important with children who have dry mouth to drink more water or use aids (like xylitol gum or candies) to boost salivary flow.
Although it requires extra effort and time to give attention to a chronically ill child’s dental health, it’s well worth it. By working to prevent tooth decay early in life, these children will be more likely to enjoy good dental health in the future.
If you would like more information on dental care for children with special needs, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor article “Managing Tooth Decay in Children with Chronic Diseases.”
If you’re over age 30 there’s a fifty percent chance you have periodontal (gum) disease—and you may not even know it. Without treatment this often “silent” bacterial infection could cause you to lose gum coverage, supporting bone volume or eventually your teeth.
That’s not to say there can’t be noticeable symptoms like swollen, red, bleeding or painful gums. But the surest way to know if you have gum disease, as well as how advanced it is, is to have us examine your gums with manual probing below the gum line.
Using a long metal device called a periodontal probe, we can detect if you’ve developed periodontal pockets. These are gaps created when the diseased gum’s attachment to teeth has weakened and begun to pull away. The increased void may become inflamed (swollen) and filled with infection.
During an exam we insert the probe, which has markings indicating depths in millimeters, into the naturally occurring space between tooth and gums called the sulcus. Normally, the sulcus extends only about 1-3 mm deep, so being able to probe deeper is a sign of a periodontal pocket. How deep we can probe can also tell us about the extent of the infection: if we can probe to 5 mm, you may have early to mild gum disease; 5-7 mm indicates moderate gum disease; and anything deeper is a sign of advanced disease.
Knowing periodontal pocket depth helps guide our treatment strategy. Our main goal is to remove bacterial plaque, a thin film of food particles that collects on teeth and is the main cause and continuing fuel for the infection. In mild to moderate cases this may only require the use of hand instruments called scalers to manually remove plaque from tooth surfaces.
If, however, our periodontal probing indicates deeper, advanced gum disease, we may need to include surgical procedures to access these infected areas through the gum tissue. By knowing the depth and extent of any periodontal pockets, we can determine whether or not to use these more invasive techniques.
Like many other health conditions, discovering gum disease early could help you avoid these more advanced procedures and limit the damage caused by the infection. Besides daily brushing and flossing to remove plaque and regular dental checkups, keep watch for signs of swollen or bleeding gums and contact us for an appointment as soon as possible. And be aware that if you smoke, your gums will not likely bleed or swell—that could make diagnosis more difficult.
If you would like more information on treating 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 article “Understanding Periodontal Pockets.”