There's still much about the underlying nature of chronic jaw joint dysfunction we have yet to unravel. Treating these conditions known as temporomandibular joint disorders (TMDs) may therefore require some experimentation to find what works for each individual patient.
Most TMD therapies are relatively conservative: eating softer foods, taking anti-inflammatory pain relievers or undergoing physical therapy. There have been some surgical techniques tried to relieve jaw pain and dysfunction, but these have so far had mixed results.
Recently, the use of the drug Botox has been promoted for relieving jaw pain, albeit temporarily. Botox contains tiny amounts of botulinum toxin type A, a poisonous substance derived from the bacterium Clostridium botulinum, which can cause muscle paralysis. It's mainly used to cosmetically smooth out small wrinkles around facial features.
Because of these properties, some physicians have proposed Botox for TMD treatment to paralyze the muscles around the jaw to reduce pain and discomfort. While the treatment sounds intriguing, there are a number of reasons to be wary of it if you have TMD.
To begin with, the claims for Botox's success in relieving jaw pain have been mainly anecdotal. On the other hand, findings from randomized, double-blind trials have yet to show any solid evidence that Botox can produce these pain-relieving effects.
But even if it lived up to the claims of TMD pain relief, the effect would eventually fade in a few weeks or months, requiring the patient to repeat the injections. It's possible with multiple Botox injections that the body will develop antibodies to fight the botulinum toxin, causing the treatment to be less effective with subsequent injections.
Of even greater concern are the potential side effects of Botox TMD treatment, ranging from headaches and soreness at the injection site to more serious muscle atrophy and possible facial deformity from repeated injections. There's also evidence for decreased bone density in the jaw, which could have far-reaching consequences for someone with TMD.
The best approach still seems to lie in the more conservative therapies that treat TMD similar to other joint disorders. Finding the right combination of therapies that most benefit you will help you better manage your symptoms.
If you would like more information on treatments 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.”
QB sensation Johnny Manziel has had a varied career in professional football. After playing two seasons for the NFL Cleveland Browns, he quarterbacked for a number of teams in the Canadian Football League. More recently, he joined the Zappers in the new Fan Controlled Football league (FCF). But then with only a few games under his belt, he was waylaid by an emergency dental situation.
It's unclear what the situation was, but it was serious enough to involve oral surgery. As a result, he was forced to miss the Zappers' final regular-season game. His experience is a reminder that some dental problems can't wait—you have to attend to them immediately or risk severe long-term consequences.
Manziel's recent dental problem also highlights a very important specialty of dentistry—oral surgery. Oral surgeons are uniquely trained and qualified to treat and correct a number of oral problems.
Tooth extraction. Although some teeth can be removed by a general dentist, some have complications like multiple roots or impaction that make regular extractions problematic. An oral surgeon may be needed to surgically remove these kinds of problem teeth.
Disease. Oral surgeons often intervene with diseases attacking areas involving the jaws or face. This includes serious infections that could become life-threatening if they're not promptly treated by surgical means.
Bite improvement. Some poor bites (malocclusions) arise from a mismatch in the sizes of the jaws. An oral surgeon may be able to correct this through orthognathic surgery to reposition the jaw to the skull. This may compensate for the difference in jaw sizes and reduce the bite problem.
Implants. Dental implants are one of the best ways to replace teeth, either as a standalone tooth or as support for a fixed dental bridge or a removable denture. In some cases, it may be better for an oral surgeon to place the implants into a patient's jawbone.
Reconstruction. Injuries or birth defects like a cleft lip or palate can alter the appearance and function of the face, jaws or mouth. An oral surgeon may be able to perform procedures that repair the damage and correct oral or facial deformities.
Sleep apnea. Obstructive sleep apnea is usually caused by the tongue relaxing against the back of the throat during sleep and blocking the airway. But other anatomical structures like tonsils or adenoids can do the same thing. An oral surgeon could address this situation by surgically altering obstructing tissues.
It's likely most of your dental care won't require the services of an oral surgeon. But when you do need surgical treatment, like Johnny Manziel, these dental specialists can make a big difference in your oral health.
If you would like more information about oral surgery, please contact us or schedule a consultation.
A few months into wearing braces you may notice your gums are swollen. It's likely you've developed periodontal (gum) disease.
Gum disease is a bacterial infection that usually begins with dental plaque. This thin, accumulated biofilm on teeth is filled with bacteria that cause dental disease. The more of it that remains on your teeth, the higher your risk for a gum infection.
In addition to regular dental cleanings, the best way for a person to reduce their gum disease risk is to remove plaque on a daily basis through brushing and flossing. Unfortunately, wearing braces complicates this: The brackets and wires affixed to your teeth can get in the way of your toothbrush and regular dental floss. As a result, you can easily miss plaque hidden around these bits of hardware.
Aside from gum disease, the braces themselves can irritate your gums. This irritation inflames the gums and may even cause more tissue to grow. Compound this overgrowth with a possible gum infection and it's no wonder your gums are severely swollen.
To lessen the chances of swollen gums with braces, you'll need to beef up your daily hygiene efforts. Simply put, it will typically take more time than normal to thoroughly clean around your braces. A few specialized tools, though, might make it easier.
An interproximal brush with a narrower head than a regular toothbrush is useful for accessing tight places around brackets. And a floss threader or a water flosser (which uses pressurized water to loosen and remove plaque) may help you better maneuver around wires to remove plaque between teeth.
Keeping your teeth clean as possible will certainly help you avoid gum swelling due to disease. But swelling from tissue overgrowth may not be resolved until your braces come off. In severe cases, it may even be necessary to remove the braces to treat the gums before resuming orthodontic treatment.
In any case, be as thorough as possible with your oral hygiene efforts during orthodontics and see your regular dentist for cleanings every six months. When you have completed orthodontic treatment, cleanings every six months are usually recommended. It's the best way to keep your gums healthy while you're wearing braces.
If you would like more information on dental care while wearing braces, 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.”
For some, the excitement over their braces coming off gets dampened a bit with the prospect of now having to wear a retainer. But it has to be—newly realigned teeth have a tendency to revert to their previous positions out of a kind of “muscle memory.” A retainer prevents that from happening.
But as essential as it is, the standard retainer is almost as noticeable as braces, a major reason why many patients are less than enthusiastic about wearing them. And, because it's common for them to become lost when out of the mouth, replacing one becomes an added expense.
But there's another option—the bonded retainer. This retainer consists of a metal wire bonded to the back of the teeth to prevent them from moving. Because it's fixed in place, only a dentist can remove it.
The bonded retainer addresses the previous two issues associated with a removable retainer. Because it's behind the teeth rather than in front, it's out of sight to others. And, because it's fixed in place, there's no danger of losing it.
But unlike its removable cousin, which can be taken out for oral hygiene, the bonded retainer can make flossing more difficult. And, by nature, a bonded retainer must be worn all the time; a removable retainer allows for a more flexible schedule later in the treatment of a few hours a day.
So, which retainer option is best for you or another family member? A bonded retainer may be more attractive for appearance's sake, if it must be worn indefinitely, or if there's a high probability of the teeth moving out of alignment. And, it might be the right choice where there's a concern about a patient's ability to keep up with a removable retainer.
If you do decide to go with a bonded retainer, ask your dental hygienist for training on using floss with the fixed appliance—this can help improve oral hygiene. Whatever you choose, bonded or removable, your retainer will help you keep that new, beautiful, straightened smile.
If you would like more information on orthodontic retainers, 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 “Bonded Retainers.”
When you see your dentist about mouth pain, you expect to hear that it's a decayed or fractured tooth, or maybe a gum infection. But you might be surprised if your dentist tells you there's nothing going on inside your mouth to cause the pain.
It's not that far-fetched: The pain could be originating elsewhere. This is known as referred pain, where pain radiates from its origin to another part of the body.
Unless there's an obvious oral cause for the pain, it's best not to undertake any treatment involving the mouth until we've pinpointed the actual cause. That said, the cause is usually not too far away.
Facial nerve disorders. The trigeminal nerve courses on either side of the face from the upper skull through the cheeks and ends around the lower jaw. But if portions of the nerve's protective sheathing become damaged, the slightest touch on the face could trigger prolonged pain. Because of its proximity to the jaw, the pain can often be misidentified as a toothache.
Jaw joint pain. When joints connecting the lower jaw to the skull become traumatized and inflamed, a condition known as Temporomandibular joint disorder (TMD), the pain can radiate toward the jaw. In some cases, the person may easily mistake the muscle pain and spasming for a toothache.
Ear infection. As with TMD, your "toothache" may actually stem from an ear infection or congestion radiating pain into the jaw. It can also happen in the opposite direction—ear pain could actually be the referred pain of an infected back tooth—emphasizing the importance of precisely determining the originating source of any pain in the jaws or face.
Sinus pain. The large maxillary sinuses are located on either side of the face just above the back of the upper jaw. Because of its proximity, pain from a sinus infection can seem to be coming from one of the back molars. And as with ear infections, frequent sinus infections could in fact be caused by an infected tooth penetrating through the sinus floor.
These and other examples of possible referred pain illustrate how "tricky" a presumed toothache can be. Finding the true source of oral or facial pain will ensure you receive the proper treatment for lasting relief.
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