Temporomandibular joint disorder (TMD) is an umbrella term for a number of chronic jaw problems. These conditions cause recurring pain for 10 to 30 million Americans, especially women of childbearing age.
But even after decades of treatment and research, a full understanding of TMD's underlying causes eludes us. That doesn't mean, however, that we haven't made progress—we have indeed amassed a good deal of knowledge and experience with TMD and how best to treat it.
A recent survey of over a thousand TMD patients helps highlight the current state of affairs about what we know regarding these disorders, and where the future may lie in treatment advances. Here are a few important findings gleaned from that survey.
Possible causes. When asked what they thought triggered their TMD episodes, the top answers from respondents were trauma, stress and teeth clenching habits. This fits in with the consensus among experts, who also include genetic disposition and environmental factors. Most believe that although we haven't pinpointed exact causes, we are over the target.
Links to other disorders. Two-thirds of survey respondents also reported suffering from three or more other pain-related conditions, including fibromyalgia, rheumatoid arthritis and chronic headaches. These responses seem to point to possible links between TMD and other pain-related disorders. If this is so, it could spur developments in better diagnostic methods and treatment.
The case against surgery. Surgical procedures have been used in recent years to treat TMD. But in the survey, of those who have undergone surgery only one-third reported any significant relief. In fact, 46% considered themselves worse off. Most providers still recommend a physical joint therapy approach first for TMD: moist heat or ice, massage and exercises and medications to control muscle spasms and pain.
These findings underscore one other important factor—there is no “one size fits all” approach to TMD management. As an individual patient, a custom-developed action plan of therapy, medication, and lifestyle and diet practices is the best way currently to reduce the effects of TMD on your life.
If you would like more information on TMD management and 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 “Chronic Jaw Pain and Associated Conditions.”
Not all toothaches are alike: Some are sharp and last only a second or two; others throb continuously. You might feel the pain in one tooth, or it could be more generalized.
Because there are as many causes as there are kinds of dental pain, you can expect a few questions on specifics when you come to us with a toothache. Understanding first what kind of pain you have will help us more accurately diagnose the cause and determine the type of treatment you need.
Here are a few examples of dental pain and what could be causing it.
Temperature sensitivity. People sometimes experience a sudden jolt of pain when they eat or drink something cold or hot. If it only lasts for a moment or two, this could mean you have a small area of tooth decay, a loose filling, or an exposed root surface due to gum recession. If the pain lingers, though, you may have internal decay or the nerve tissue within the tooth has died. If so, you may require a root canal treatment.
Sharp pain when chewing. Problems like decay, a loose filling or a cracked tooth could cause pain when you bite down. We may be able to solve the problem with a filling (or repair an older one), or you may need more extensive treatment like a root canal. In any event, if you notice this as a recurring problem, don't wait on seeing us—the condition could worsen.
Dull pain near the jaw and sinuses. Because both the jaws and sinuses share the same nerve network, it's often hard to tell where the pain or pressure originates—it could be either. You may first want to see us or an endodontist to rule out tooth decay or another dental problem. If your teeth are healthy, your next step may be a visit with a physician to examine your sinuses.
As you can see, tooth pain can be a sign of a number of problems, both big and small. That's why it's important to see us as soon as possible for an examination and diagnosis. The sooner we can treat whatever is causing the pain, the sooner your discomfort will end.
If you would like more information on treating dental pain, 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 “Tooth Pain? Don't Wait!”
Root canals often get a bum rap. Although the procedure saves millions of teeth every year, it's often erroneously portrayed as an unpleasant experience. And if that wasn't enough, a long-discredited medical theory has found new life on the internet asserting root canals are a health danger.
First off, root canals play an immensely important role in treating teeth with advanced decay. If not promptly treated, a cavity can turn into a major infection of the interior tooth pulp and root canals, and ultimately the supporting bone. Teeth with this level of decay are not long for this world.
A root canal treatment stops this disease process in its tracks. After numbing the tooth and surrounding gums, we drill a small hole into the tooth's interior and then remove all of the infected tissue within the pulp and root canals. After disinfecting these areas, we fill them with a rubber-like substance called gutta percha.
After sealing off the access hole—and later capping the tooth with a life-like crown—the tooth is secure from further decay. And, by the way, the procedure doesn't hurt, thanks to local anesthesia. If anything, any pain caused by the decay attacking the tooth's nerves has now been alleviated.
So, what about the idea floating on the Web that root canals are dangerous? The "root" for this conjecture is a theory by Weston Price, an early 20th Century dentist, that leaving a "dead" body part in the body leads to various health problems (including cancer). That would include a root-canaled tooth, which has had the living tissue in the pulp removed.
There's just one problem—Weston's theory was fully investigated in the 1950s and overwhelmingly discredited. The supposed cancer threat was also reviewed in a 2013 study, which found no link between root canals and increased cancer risk. In fact, dental patients who had undergone several root canals had a diminished risk.
Like all other health procedures, root canals have some risks of complication. But those complications are far from life-threatening—it's tooth-saving benefits are often worth the risk. So, fear not if your dentist says you need a root canal. It won't hurt and it won't endanger your health—and it could save your tooth.
If you would like more information on root canal therapy, 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 “Root Canal Safety.”
For over three decades, Celine Dion has amazed audiences and fans with her powerful singing voice. Best known for her recording of "My Heart Will Go On," the theme song for the movie Titanic, Dion has amassed global record sales topping 200 million. In her early singing days, though, she struggled with one particular career obstacle: an unattractive smile.
The Canadian-born performer had a number of dental defects including crooked and discolored teeth, and—most prominent of all—abnormally large cuspid or "canine" teeth (located on either side of the four front incisors). They were so noticeable that one Quebec celebrity magazine gave her the unflattering nickname "Canine Dion."
This isn't an unusual problem. Since human canines are already the longest teeth in the mouth, it doesn't take much for them to stand out. Our ancient hunter-gatherer ancestors needed these large, pointed teeth to survive. But with the evolution of agriculture and industry, canine teeth have become gradually smaller—so much so that when they're abnormally large, they don't look right in a smile.
So, what can be done if your canines embarrassingly stand out from the rest? Here are some of the options to consider.
Reduce their size. If your canines are just a tad too long, it may be possible to remove some of the enamel layer in a procedure called contouring. Using this technique, we can reduce a tooth's overall size, which we then re-shape by bonding composite resin to the tooth. It's only a good option, though, if your canines have an ample and healthy layer of enamel.
Repair other teeth. The problem of prominent canine teeth may actually be caused by neighboring teeth. When the teeth next to the canines are crooked, the canines can appear more prominent. Alternatively, other teeth around the canines may be abnormally small. Braces or clear aligners can correct crooked incisors, and applying porcelain veneers to smaller teeth could help normalize their length.
Apply dental crowns. In some instances, we can reduce the canines in size and then bond porcelain crowns to them. This is the option that Dion ultimately chose. The natural teeth are still intact, but the crowning process transforms them into properly proportioned, life-like teeth. There is, however, one caveat: The alteration to these teeth will be permanent, so they will need a crown from then on.
Besides crowning her canine teeth, Dion also underwent other dental work to straighten and whiten her other teeth. As a result, this superstar performer now has a superstar smile to match and so can you if your teeth are less than perfect. These or other cosmetic enhancements can give you the look you truly desire. All it takes is an initial visit with us to start you on the road to a transformed smile.
If you would like more information about various cosmetic solutions for your smile, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine article “Porcelain Dental Crowns.”
In a little over a century, antibiotics have changed the face of healthcare. We no longer fear cholera, strep throat or even a small cut as our forebears did a hundred years ago. Antibiotics are also an essential weapon against infection in dental situations.
But evidence is mounting that we're overusing these miracle drugs. Besides continued growth in antibiotic prescriptions, sometimes to preempt a possible infection rather than treat an existing one, food producers are increasingly adding them to animal feed and other products as a preventive measure.
The problem with expanding our uses of antibiotics is the ability of targeted microorganisms to develop defenses against our most common drugs. Some may even mutate into a kind of "super bug" like Methicillin-resistant Staphylococcus aureus (MRSA), which no longer responds to a particular antibiotic.
As older antibiotics become less effective, we must develop newer drugs to overcome the strengthened defenses of targeted microorganisms. But this takes time—meanwhile, as antibiotic options dwindle, more than 2 million people each year encounter an antibiotic-resistant infection that results in around 20,000 deaths according to the Centers for Disease Control (CDC).
But there are hopeful signs that the world is now rising to meet the threat of antibiotic resistance. For example, support is growing within the U.S., Canada and the EU to ban the use of antibiotics in animal feed except for treating actual infections.
Many healthcare organizations are also exploring ways to reduce unnecessary antibiotic prescriptions. One way is to make better use of testing, especially to identify the precise bacteria causing an infection so that it can be targeted with a specific antibiotic that will best respond to it.
We're also seeing modifications in the use of antibiotics as a preventive measure. For example, people with certain conditions like congenital heart problems or joint prosthetics have routinely received antibiotics before dental procedures to preempt infection. In recent years that list of conditions has been trimmed substantially.
The move toward a more conservative use of antibiotics will have an impact on healthcare, including dentistry. But whatever the changes, dentists and other health professionals will continue to place their patient's health at the forefront.
If you would like more information on the use of antibiotics in dentistry, 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 “Antibiotics: Use and Abuse.”
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