If you have chronic jaw joint pain you may have heard of using Botox to relieve discomfort from temporomandibular disorders (TMD). Before you seek out this remedy, though, be sure you know the facts beforehand.
TMD is actually a group of conditions affecting the joints, muscles and overall structures of the jaw. People with TMD often experience sharp pain and reduced range of motion of the jaw joints. Although we don't know the exact causes, we believe stress (accompanied often by teeth grinding habits) is a major factor for many patients.
Treatments run the spectrum from conservative to aggressive. Conservative treatments include cold and heat packs, therapeutic exercises, and muscle pain or relaxant medication. On the more aggressive side, patients undergo surgery to reorient the lower jaw. Most people gain a significant amount of relief from conservative therapies; the results aren't as positive with surgery.
Botox falls on the aggressive side of treatments. Approved for use by the Food and Drug Administration for cosmetic uses, the drug contains botulinum toxin type A, a bacterial toxin that can cause muscle paralysis. It's often injected into facial structures to paralyze small muscles and temporarily “smooth out” wrinkle lines. Only recently has it been proposed to help relieve jaw pain.
The jury, however, is still out on its effectiveness with jaw pain. The double-blind testing performed thus far hasn't produced any relevant clinical results that the injections actually work with TMD.
And there are other complications. Some people injected with Botox encounter pain, bruising or swelling at the injection site, and some have severe headaches afterward. Botox is also a temporary solution, not a permanent cure — you'll need another injection a few months later to maintain the effect. You might even develop antibodies that diminish the drug's effect and require higher subsequent doses to compensate.
This and other concerns should give you pause before seeking out this remedy. The best strategy is to try the traditional treatments first, which are also the least invasive. If there's no significant relief, then talk to us and your physician about other options.
If you would like more information on treatment options for 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 “Botox Treatment for TMJ Pain.”
Ed Helms is best known for his role as the self-absorbed, Ivy League sales rep, Andy Bernard, on television's The Office. But to millions of fans he's also Stu, a member of a bachelor trip to Las Vegas in the 2009 movie The Hangover. In it, Stu and his friends wake up from a wild night on the Strip to find some things missing: the groom-to-be, their memories and, for Stu, a front tooth.
In reality, the missing tooth gag wasn't a Hollywood makeup or CGI (computer-generated imagery) trick—it was Ed Helm's actual missing tooth. According to Helms, the front tooth in question never developed and he had obtained a dental implant to replace it. He had the implant crown removed for the Hangover movie and then replaced after filming.
Helms' dental situation isn't that unusual. Although most of the 170 million-plus teeth missing from Americans' mouths are due to disease or trauma, a few happened because the teeth never formed. While most of these congenitally missing teeth are in the back of the mouth, a few, as in Helms' case, involve front teeth in the “smile zone,” which can profoundly affect appearance.
Fortunately, people missing undeveloped teeth have several good options to restore their smiles and dental function. The kind of tooth missing could help determine which option to use. For example, a bridge supported by the teeth on either side of the gap might work well if the teeth on either side are in need of crowns.
If the missing tooth happens to be one or both of the lateral incisors (on either side of the centermost teeth), it could be possible to move the canine teeth (the pointy ones, also called eye teeth) to fill the gap. This technique, known as canine substitution, may also require further modification—either by softening the canines' pointed tips, crowning them or applying veneers—to help the repositioned teeth look more natural.
The optimal solution, though, is to replace a missing tooth with a dental implant which then has a lifelike crown attached to it, as Ed Helms did to get his winning smile. Implant-supported replacement teeth are closest to natural teeth in terms of both appearance and function. Implants, though, shouldn't be placed until the jaw has fully developed, usually in early adulthood. A younger person may need a temporary restoration like a bonded bridge or a partial denture until they're ready for an implant.
Whatever the method, there's an effective way to restore missing teeth. Seeing us for an initial exam is the first step toward your own winning smile.
All-natural fruit juice with no additives: now what could be wrong with that? Nothing—unless your child is over-indulging. Too much of even natural fruit juice could increase their risk of tooth decay.
To understand why, we first need to look at the real culprit in tooth decay: mouth acid produced by oral bacteria as a byproduct of their digestion of sugar. Acid at high levels softens and erodes tooth enamel, which causes tooth decay. Acid levels can rise as populations of bacteria increase often fueled by sugar, one of bacteria's primary food sources.
And not just the added sugar found in soft drinks, snacks or candies—even fructose, the natural sugar found in fruit, can feed bacteria. To lower the risk of tooth decay, dentists recommend limiting the daily amount of sugar a child consumes, including natural fruit juices without added sugar.
That doesn't mean you should nix natural fruit juices altogether—they remain a good source of vitamins, minerals and other nutrients. But you'll need to keep your child's juice consumption within moderation.
As a guide, the American Academy of Pediatrics (AAP) has issued consumption recommendations for children regarding all-natural fruit juice. The academy recommends the following daily juice amounts by age:
- 7-18: 8 ounces (1 cup) or less;
- 4-6: 6 ounces or less;
- 1-3: 4 ounces or less;
- Under 1: No juice at all.
You can further reduce your child's decay risk by limiting their juice intake to mealtimes, a good practice with any sweetened beverage. Sipping through the day on juice or other sweetened beverages can cause some sugar to stay in the mouth over long periods. This can interfere with the natural ability of saliva to neutralize any acid buildup.
If you're wondering what children could drink instead of juice, low-fat or non-fat milk is an acceptable choice. But the most tooth-friendly liquid to drink is plain water. Drinking nature's hydrator is not only better for their overall health, by reducing the risk of tooth decay, it's also better for their teeth.
If you would like more information on how sugar can affect your child's dental health, 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 “Squeeze Out the Juice.”
Think dental implants only replace individual teeth? Think again—this premier technology can also support other kinds of restorations to provide better stability and comfort. And, they also help improve bone health when incorporated with any type of tooth replacement options, especially dentures.
Although traditional dentures have enjoyed a long, successful history as a tooth replacement solution, they can interfere with bone health. That’s because regular dentures fit in the mouth by resting on the bony ridges of the jaw, which has implications for the bone.
As living tissue, bone goes through a growth cycle with older bone cells dying and dissolving and newer cells forming to take their place. The teeth play a role in this growth cycle — the forces generated when we chew travel up through the teeth and help stimulate bone growth. When teeth go missing, however, so does this stimulus.
Traditional dentures can’t replace this missing stimulus. In fact, the constant pressure of dentures on the jaw may even accelerate bone loss. A sign this is happening occurs when the dentures’ once tight fit begins to loosen and they become uncomfortable to wear.
Implant-supported dentures can help eliminate this problem. We first surgically place a few implants in the jaw, the number determined by which jaw (the lower requires less) and whether the denture is removable or fixed. If removable, the denture has connective points that match the implant locations — you simply connect them with the implants. If fixed, the denture is screwed into the implants to hold it in place.
So, how does this help bone health? For one, the denture no longer puts as much pressure on the jaw ridges—the main support comes from the implants. And, the implants themselves encourage bone stimulation: The titanium in the implant has a special affinity with bone cells that naturally grow and adhere to its metal surface. This natural integration between implant and bone can stop bone loss and may even help reverse it.
If you’re interested in implant-supported dentures, you’ll first need to undergo a full dental exam with your dentist. These restorations aren’t appropriate for all dental situations. But, if they can work for you, you may be able to enjoy the benefits of an implant-supported restoration.
If you would like more information on implant-supported restorations, 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 “Overdentures & Fixed Dentures.”
Henry Ford famously said a customer could have any color they wanted on their Model T “as long as it was black.” Those days are over—today’s cars and trucks come with a slew of options, and not just their paint color.
There’s something else with a wide array of possible options: your choice of toothbrush. Your local store’s dental care aisle has dozens of toothbrushes in a myriad of sizes, shapes and features. And many promise better hygiene outcomes because of their unique design.
It’s enough to make your head spin. But you can narrow your search for the right toothbrush— just look for these basic qualities.
Bristle texture. At this all-important juncture between brush and teeth, softer-textured bristles are better. That might sound counter-intuitive, but soft bristles are just as capable at removing bacterial plaque, that sticky tooth film most responsible for dental disease, as stiffer bristles. Stiffer bristles, on the other hand, can damage gums and cause recession. Also, look too for rounded bristles (gentler on the gums), and multi-leveled or angled ones for better access around teeth.
Size and shape. Toothbrushes come in different sizes because, well, so do mouths. Look, then, for a brush and bristle head that can comfortably reach all the teeth in your mouth. If you have problems with manual dexterity, choose a brush with larger grip handles. A brush that’s comfortable to use and easy to handle can make your brushing more effective.
ADA Seal of Acceptance. The American Dental Association tests hygiene products like toothbrushes. If they pass the association’s standards, the manufacturer includes the ADA Seal of Approval on their packaging. Not all submit their brushes for this evaluation, so the seal’s absence doesn’t necessarily mean a brush is of low quality. The seal, though, does tell you the product passes muster with dental professionals.
It often takes a little trial and error to find the right brush, but since you should change yours out every six months, it’s a small price to experiment. And, no matter how great the brush, it’s only as good at removing plaque as the hand that holds it. So, be sure you learn proper brushing techniques—that and the right brush will keep your teeth and gums healthy.
If you would like more information on choosing the right toothbrush, 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 “Sizing Up Toothbrushes.”
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