My Blog
By Scott F. Bobbit, DMD
October 23, 2020
Category: Oral Health
Tags: jaw pain   tmj disorders  
TrytheConservativePathtoJawPainReliefFirst

If you have chronic jaw pain, you know how difficult eating, speaking or even smiling can be. Many sufferers will do anything to gain relief, even surgery. But before you go down that road, consider the traditional conservative approach to temporomandibular disorders (TMD) management first—it could provide the most relief with the least risk of side effects.

The temporomandibular joints connect the lower jaw to the skull on either side of the head. These ball and socket joints also contain a cushioning disk to facilitate movement. This disk is believed to be the primary focus for jaw pain problems known collectively as TMD.

Doctors now believe injury, stress, metabolic issues, jaw anatomy defects or similar factors trigger the chain reaction of muscle spasms, pain and soreness that can erupt during a TMD episode. A TMD patient may experience pain within the jaw muscles or joints themselves, clicking sensations, or an inability to open the jaw to its full range.

TMD therapy has traditionally followed an orthopedic path—treating jaw joints like any other joint. In recent years, though, a more aggressive treatment model has emerged that promotes more invasive techniques like orthodontics, dental work or jaw surgery to relieve discomfort. But the track record for this model, especially concerning jaw surgery, remains hazy at best and offers no guarantee of relief. These techniques are also irreversible and have even made symptoms worse in some patients.

It’s usually prudent, then, to try conservative treatments first. This can include pain and muscle relaxant medication, jaw exercises, stretching and massage, and dietary changes to reduce chewing force. Patients with teeth grinding habits may also benefit from a bite guard worn at night to reduce the biting force during sleep and help the joints relax.

By finding the right mix of treatments, you may be able to find significant relief from TMD symptoms with the conservative approach. If not, you might then discuss more invasive options with your dentist. But even if your dentist recommends such a procedure, you would be wise to seek a second opinion.

TMD can definitely interfere with your quality of life and peace of mind. But there are ways to reduce its effects and make for a happier life.

If you would like more information on managing chronic jaw 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 “Seeking Relief from TMD.”

TheRealTruthBehindEdHelmsMissingToothinTheHangover

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.

If you would like more information about restoring missing teeth, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine article “Dental Implants.”

By Scott F. Bobbit, DMD
October 03, 2020
Category: Oral Health
KeepYourImplantsCleantoAvoidaDamagingGumInfection

After years battling disease, your troubled tooth reached its useful life's end. It's been extracted, and we've replaced it with a life-like dental implant. So now, as far as the implant goes, disease is no longer an issue…right?

Sorry, no—though not to the same degree as a natural tooth, an implant could be endangered by gum disease. Although the implant's materials can't be infected, the supporting gums and bone can.

In fact, there's a particular type of gum disease associated with implants known as peri-implantitis (“peri” around an implant; “itis” inflammation) that first affects the gums surrounding an implant. Although peri-implantitis can arise from an excess of dental cement used to affix the crown to the implant, it most commonly starts like other forms of gum disease with dental plaque.

Dental plaque, and its hardened form calculus (tartar), is a thin, bacterial biofilm that builds up on teeth surfaces. It can quickly accumulate if you don't remove it every day with proper brushing and flossing. The bacteria living in plaque can infect the outer gum tissues and trigger inflammation.

Gum disease around natural teeth can spread quickly, but even more so with implants. That's because the natural attachment of the gums helps supply antibodies that impede infection. Implants, relying solely on their connection with the bone, don't have those gum attachments. As a result, peri-implantitis can move rapidly into the supporting bone, weakening the implant to the point of failure.

The good news, though, is that peri-implantitis can be treated successfully through aggressive plaque removal and antibiotics. But the key to success is to catch it early before it progresses too far—which is why you should see your dentist at the first sign of gum swelling, redness or bleeding.

You can also prevent peri-implantitis by practicing daily brushing and flossing, including around your dental implant. You should also see your dentist twice a year (or more, if they advise) for cleanings and checkups.

Dental implants overall have a greater than 95% success rate, better than any other tooth restoration system. But they still need daily care and regular cleanings to ensure your implants are on the positive side of those statistics.

If you would like more information on caring for your dental implants, please contact us or schedule an appointment for a consultation.

By Scott F. Bobbit, DMD
September 23, 2020
Category: Oral Health
Tags: oral health  
MouthBreathingCanLeadtoSeriousOralProblemsEspeciallyforChildren

It's normal for people to breathe through their nose. And for good reason: Nasal breathing filters contaminants, warms and humidifies incoming air, and helps generate beneficial nitric oxide. Chronic mouth breathing, on the other hand, can trigger a number of harmful effects, especially for the teeth and gums.

Because our survival depends on continuous respiration, our bodies automatically seek out the air flow path of least resistance, normally through the nose. But if our nasal passages become obstructed, as with enlarged adenoids or sinus congestion, we may involuntarily breathe through the mouth.

This can lead to oral problems like chronic dry mouth, which not only creates an unpleasant mouth feel, it also produces the ideal environment for dental disease. And, it could cause an even more serious problem for children during jaw and teeth development.

This is because the tongue rests along the roof of the mouth (palate) while breathing through the nose. In this position, the tongue serves as a mold for the upper jaw and teeth while they're growing during childhood. During mouth breathing, however, the tongue moves away from the palate, depriving the jaw and teeth of this molding effect, and possibly resulting in a poor bite.

You can prevent these and other oral problems by seeing a healthcare professional as soon as you notice your child regularly breathing through their mouth. The best professional for this is an ENT, a medical specialist for conditions involving the ears, nose and throat. ENTs provide treatment for diagnosed obstructions involving the tonsils, adenoids and sinuses.

Even so, persistent mouth breathing may already have affected your child's bite. It may be prudent, then, to also have their bite evaluated by an orthodontist. There are interventional measures that can help get jaw development back on track and minimize future orthodontic treatment.

Finally, a child who has undergone treatment to remove nasal breathing obstructions usually reverts to nasal breathing automatically. But sometimes not: To “relearn” normal breathing, a child may need to undergo orofacial myofunctional therapy (OMT) with a certified therapist to retrain their facial muscles and tendons to breathe through the nose.

Your child's tendency to mouth breathing may not seem like a major problem. But prompt attention and treatment could prevent it from interrupting their dental development.

If you would like more information on correcting mouth breathing, 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 “The Trouble With Mouth Breathing.”

By Scott F. Bobbit, DMD
September 13, 2020
Category: Oral Health
Tags: oral hygiene   oral health  
UseAppropriateHygieneProductsforMaximumSmileProtection

After years of research, we're confident in saying that brushing and flossing daily are essential for maintaining a healthy mouth. A mere five minutes a day performing these tasks will significantly lower your risk of dental disease.

We're also sure about the essentials you'll need to perform these tasks: a soft-bristled toothbrush using fluoride toothpaste, and a roll (or picks) of dental floss. The only deviation might be a water flosser appliance instead of flossing thread.

Unfortunately, some folks deviate even more from the norm for both of these tasks. One of the strangest is a social media trend substituting regular toothpaste with substances containing activated charcoal. The proponents of brushing with charcoal claim it will help whiten teeth and kill harmful microorganisms. People brushing with a black, tarry substance also seem to make for good “gross-out” videos.

There's no substantial evidence to support these claims. Perhaps proponents of charcoal's whitening ability are assuming it can remove stains based on its natural abrasiveness. It could, however, remove more than that: Used over time, charcoal could wear down the protective enamel coating on your teeth. If that happens, your teeth will be more yellow and at much greater risk for tooth decay.

When it comes to flossing (or more precisely, removing food material from between teeth), people can be highly inventive, substituting what might be at hand for dental floss. In a recent survey, a thousand adults were asked if they had ever used household items to clean between their teeth and what kind. Eighty percent said they had, using among other things twigs, nails (the finger or toe variety) and screwdrivers.

Such items aren't meant for dental use and can harm tooth surfaces and gum tissues. Those around you, especially at the dinner table, might also find their use off-putting. Instead, use items approved by the American Dental Association like floss, floss picks or toothpicks. Some of these items are small enough to carry with you for the occasional social “emergency.”

Brushing and flossing can absolutely make a difference keeping your teeth and gums healthy. But the real benefit comes when you perform these tasks correctly—and use the right products for the job.

If you would like more information on best oral hygiene practices, please contact us or schedule an appointment for a consultation.





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