What to do for Jaw Pain?!

Today I am all full of information. Maybe it is the spirit of St. Patrick's Day...who knows. I had 2 patients come to me in the past few days with Jaw Pain. Interestingly both are right handed and both had right side pain. One patient had an accident many years ago and the Jaw has Locked open at times ever since. This happened while he was in my chair. The thing to do was and is: remain calm, massage the side of the jaw muscles. Right around the area of the bull's eye in the photo above. After a little time of gentle (GENTLE) effort it closed. Another patient had a stressful week at work and it has been hurting. Her entire masseter muscle was tense to the touch and almost rock hard. With a little massaging we broke the spasm it has been fine since. Stress causes tension, tension and constant clenching of the muscle can result in "Little Charlie Horses" in the joint and masseter muscles of the jaw. A warm towel will help to bring blood to the area and warmth to RELAX that muscle. As some of my prior posts have said, rest (in the form of sleep, muscle rest, etc) is so important.
Hopefully everyone will enjoy. The DAY today.

Why do I need a Dental Implant?

This week I saw a few of my patients who have had me surgically replace teeth with dental implants. It made me proud to see my work function well and look like a real tooth. The dental implant is the closest replacement dentists have to a brand new tooth. One day I expect to inject genes below the surface of the gum and generate a new tooth biologically. Until then I must rely on my training as a surgeon....which is along the lines of an orthopedic surgeon actually. When a tooth is lost immediately the gum tissue and bone below start to heal. If nothing is done this will heal completely, however significant changes will occur to the shape of the area. If we were to place bone or some grafting material into the socket and cover it up there is much less change to the site. The body will deposit bone and grow new gum tissue. Minimal changes occur. An implant placed here will do well. If the space is left alone the lack of use (lack of tooth) will allow the bone to deteriorate and shrink. Finally if a tooth is removed and it is possible to place an implant immediately minimal changes occur to the site. In fact one of the patients that I saw this week was such a case. The photos before and after show the gum tissue has really not changed at all. This is ideal when a front tooth and there is little room for change. As for the other patient timely implant placement has allowed little change in the area. In both instances we are very happy with the results. Dental implants have been in dental use for about 25 years. They have a great success rate (98%) when placed and cared for properly. I look forward to the day when we can clone teeth or grow them in the site. Until then, my artistic and surgical skills will be an important thing to maintain.

The Digital Makeover

The Digital Makeover Term may have been coined by someone else, but I like to think it is my invention...

I majored in Studio Art in my college years. Sculpting in bronze, clay and wax and painting in oil and watercolour I have gained a skill set I believe is perfect for dentistry. In the digital world we live in I am happy to have trained in Photoshop. Merging digital ability to change photographs and knowing the limitations of dentistry I can effectively show my patients realistic before and afters. When we are going to commit much time, energy and finances to a large proceedure I produce a digital mockup of what we should expect. I find this helps patients physically see what I can do for them and not just "trust me"....For the most part it gets us to share the vision and come into agreement on proposed treatments. Above you will see an actual case that we have completed and continues to looking and feeling great two years later. In fact...people think their teeth look better than the Digital Makeover does!

The Antidote, Anesthesia Reversal

Recently I have adopted a new product. Oraverse. Essentially this is the antidote to numbness. Many patients hate to get numb simply because the after-effects are bothersome. Only a handful of people opt not to have anesthesia because the alternative is possible pain. I "unlike the popular belief" do not like pain, nor do I wish to inflict it. So obviously for the most part we will get patients numb BEFORE working. On occassion it is useful to cause the anesthsia wear off faster.

For example I had a patient going to a parent teacher meeting after his appointment. Not wanting to drool and give a bad impression to his son's teacher he opted for the Oraverse.

As we were finishing up his eyes got wide and he touched his face...he gasped "WOW".

I questioned his comment and he said that the anesthesia wore off like a wave. His feeling had come back in a few minutes rather than a few hours.

Although reversing anesthesia is not necessary...we can leave the body alone and it does wear off on its own. If necessary technology has allowed us (as I call it) the antidote to anesthesia.

Why are my Teeth Senstive?

This Monday I will be interviewed by a writer about sensitive teeth. Interestingly enough this month I have had many patients (more than usual) tell me their teeth are sensitive. I am attributing it to the cold snap we have here in New York. It is not just cold air that afflicts the teeth, it can be cold water, sweets, tooth paste, or brushing. To give some background all teeth have pores. These pores are not on the white enamel that we smile with, rather they are right at the border of the tooth and gum. As we abuse our teeth with brushing too hard, grinding our teeth, not flossing, or even not having cleanings often enough our gums can receed. That yellow line you see at the border of the gum and enamel is exposed root. Roots are porous. These pores will go all the way down to the nerve of the tooth. So if something covers these pores, like gum tissue, enamel or calicium (as it should) the tooth is NOT sensitive. If an acidic diet (any drink having Citric Acid), brushing too hard, grinding our teeth, brushing with too strong of a toothpaste (for your mouth) can cause the tooth to be cold sensitive. Cold sensitive to: water, foods, ice, or the COLD New York air. There is a simple solution: cover the pores. This can be done by your dentist by multiple products, or by you at home with Sensodyne ProNamel toothpaste. The paste with Potassium Nitrate "quiets" the nerve of the tooth and soon via Calcium, Fluoride and saliva repair the pores get plugged up. A more "quiet" tooth means a more comfortable tooth. That being said on a tooth that is very sensitive, after brushing and flossing, one could rub a bit of the paste on that sensitive tooth (right at the level of the gum) and let it sit overnight.

Of course more can be wrong with the tooth, the sensitivity could be from a dying nerve and need a root canal, it could be from grinding your teeth, it could be from a crack in the tooth or a cavity, but this is a good start. I have to of course end with the comment "you should seek the advice of your dentist if symptoms persist for more than 2 weeks". That is just good advice no matter who is interviewing you. :)

There is some good information to also review on the Sensodyne website.

http://www.pronamel.us/

Invisalign Braces and Straight Teeth

Around 4 years old I was sitting in the dental chair having my first filling. I thought it was cool. You might think I was crazy but truly it was the birth of my career. I found all through my schooling that the things I enjoyed were just the skills I would need to be a dentist. It was a perfect match..or maybe a calling. I went through my teen years with a mouthful of metal. I had major orthodontic work due to a missing tooth. In my situation with our current technology I would still have needed traditional braces. Invisalign is a great new (relative to my orthodontic treatment) technology available. The principles of tooth movement work if we use metal, plastic or rubber bands. The beautiful thing about invisalign is that it can be removed. The teeth can be brushed, and flossed normally. Yes there is physically something on your tooth most of the day, however with metal braces this is true as well AND unsightly. With mild to medium movements invisalign is a great choice. I have patients from family members to TV stars who find using invisalign quite simple. Usual treatments range from 6 months to one year. Straighter teeth that are easier to clean and keep clean, the gum tissue also remains healthier.
Dental proceedures and products have changed dramatically since I was in braces but straight teeth have always looked nicer. The great thing is now they can look nice AS we straighten!

TMJ Appliance part II

I have worn my night guard (created special to keep my jaw in the proper resting position) for two nights now. I noticed my muscles more at rest on morning one. For the second morning I realize that my jaw sits more forward with the new appliance. Due to my missing lateral incisors my top jaw is smaller than the bottom. This should be opposite in fact. My bottom jaw is then constantly held to far backward. This produces muscle stress which builds over time. It seems that this new appliance allows my bottom jaw to rest in a more forward position and my muscles are resting. In reference to my post yesterday, rest is good for the muscles of the face as well!

Sleep Apnea and the Dentist

Rest is a vital part of our general health. During the night our bodies repair our cells. Without proper rest even the mind suffers. Recognizing sleep deprivation is important for everyone especially those of us in health care. If you are feeling tired through the day, if you fall asleep during the day or if you feel a general mental cloudyness there is a chance you are not resting properly. Some of us just need to get an early night and ACTUALLY REST. At times we find that there are other underlying issues. Sleep Apnea is at times an unrecognized root cause. Sleep Apnea can be caused by many issues: be they genetic, small lower jaw size, excess weight, alcohol consumption etc. Apnea is occurs when during deep sleep the soft palate or the tongue touches the back of our throat. This stops air flow and thus stops oxygen from getting into the body. The lack of oxygen causes us to wake up just a little bit. We don't remember this happening but it stops rest. If this continues for a long time it can cause deadly health problems.

Sleep Apnea can be recognized by your dentist. If confirmed with a sleep study dentists can actually fabricate a special night-guard that can alleviate or improve symptoms. By holding the bottom jaw more forward we open the passageways that allow us to breathe. If we are breathing normally we are sleeping properly and resting properly. With proper rest we will remain healthy longer!

TMJ appliance

As the Hair Club president was also a client; so I must also tend to dental issues.
I am genetically missing a tooth. A lateral incisor to be exact. As a result my orthodontist did the best he could with a compromised situation. My jaw as you could imagine is not perfectly lined up. I wear a night guard and this helps greatly. It relieves the clicking and popping. The guard buffers improper pressures and helps to relax the muscles. I have taken a course on such problems and learned to take specific measurements and realign the jaw. Today I received my new "Digitally Corrected" night guard. By placing the jaw in a corrected position (allowing my muscles to relax) I should help relieve muscle tension and jaw stiffness. I will wear it tonight and give feedback as to what I am feeling.

New Office Photo

This coming week I will be mounting a six foot version of this photograph in our reception area.
I took this just after our big "pre-Christmas" snow storm this year.

this is a link to the Flickr site in case you cannot see it here.
http://farm5.static.flickr.com/4001/4270968661_c4dac7964c_o.jpg

I suppose the bridge motif is echoed within the dental profession :)

Thyroiditis

Today we had a patient return to thank us for referring her to an ENT.
She had a sore throat for weeks. Her physician had her on antibiotics but with no help.
On her dental examination we noted that she had swelling in her neck (near her Adam's Apple).
It turns out that her sore throat was due to Thyroiditis. An endocrinologist who completed a blood work up which diagnosed the condition. Fortunately the Thyroiditis resolved on its own.

Volumetric Tomography

This is an image from our newest addition to radiographic equipment.

Not only can it take a two dimentional image but it can scan a section of the jaw in a "Pseudo" three dimentional pattern to display bone thickness. This is extremely useful information for placement of dental implants. visible here is a section of the bottom jaw.