Posts for category: Dental Procedures
If you’ve suffered from problems with your jaw joints, known collectively as temporomandibular disorders (TMDs), then you know how uncomfortable and painful they can be. You may also have heard about the use of Botox injections to ease TMD discomfort.
Before you seek out Botox treatment for TMD, though, you should consider the current research on the matter. Far from a “miracle” treatment, the dental profession is still undecided on the effects of Botox to relieve TMD pain symptoms — and there are other risks to weigh as well.
Botox is an injectable drug with a poisonous substance called botulinum toxin type A derived from clostridium botulinum, a bacterium that causes muscle paralysis. The Food and Drug Administration (FDA) has approved small dose use for some medical and cosmetic procedures, like wrinkle augmentation. The idea behind its use for TMD is to relax the muscles connected to the joint by paralyzing them and thus relieve pain.
The FDA hasn’t yet approved Botox for TMD treatment, although there’s been some use for this purpose. There remain concerns about its effectiveness and possible complications. In the first place, Botox only relieves symptoms — it doesn’t address the underlying cause of the discomfort. Even in this regard, a number of research studies seem to indicate Botox has no appreciable effect on pain relief.
As to side effects or other complications, Botox injections have been known to cause pain in some cases rather than relieve it, as with some patients developing chronic headaches after treatment. A few may build up resistance to the toxin, so that increasingly higher dosages are needed to achieve the same effect from lower dosages. And, yes, Botox is a temporary measure that must be repeated to continue its effect, which could lead to permanent paralyzing effects on the facial muscles and cause muscle atrophy (wasting away) and even deformity.
It may be more prudent to stick with conventional approaches that have well-documented benefits: a diet of easier to chew foods; cold and heat applications; physical therapy and exercises; pain-relief medications and muscle relaxers; and appliances to help control grinding habits. Although these can take time to produce significant relief, the relief may be longer lasting without undesirable side effects.
The braces are finally off! But to keep your new, straighter smile you'll need to wear a retainer for some time. That's because the same structural mechanism used to move your teeth could undo what we've just accomplished.
That mechanism resides in an elastic tissue called the periodontal ligament that lies between the teeth and the bone and attaches to both with tiny fibers. While the ligament holds the teeth securely in place, it also allows for slight movement in response to bite changes. Braces "pull" the teeth in the desired new direction, and the ligament responds.
But with that pressure gone after the braces' removal, a kind of "muscle memory" can set in that moves the teeth back towards their original positions. A retainer, a dental appliance worn on the teeth, exerts just enough pressure to "retain" or keep the teeth from regressing.
Retainers are effective, but the most common type has a feature that poses potential problems: it can be removed by the wearer. Because of this, less disciplined patients might be tempted not to wear their retainer as directed. There's also a higher risk of losing one and incurring additional cost to replace it.
But there is another type, the bonded retainer, which stays permanently in the mouth until removed by an orthodontist. It's composed of a thin piece of metal that's firmly attached to the back of the teeth with dental composite material. Not only does a bonded retainer solve the problems mentioned before, it also can't be seen from the outside like a removable retainer.
A bonded retainer does have one disadvantage: because it can't be removed, it can obstruct the teeth during brushing and flossing and require more effort. You won't have as much difficulty with a removable retainer keeping teeth and gums clean. You can overcome this disadvantage, though, with specialized tools like a water flosser or a floss threader to make hygiene easier.
To choose which type of retainer is best for you or your family member, have a talk with your orthodontist. And if you choose a bonded retainer and later have it removed, be sure to switch immediately to a removable one if your orthodontist advises. With either retainer, you'll be able to preserve that hard-earned smile for years to come.
If you would like more information on bonded 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: What are the Pros and Cons.”
As the host of America's Funniest Home Videos on ABC TV, Alfonso Ribeiro has witnessed plenty of unintentional physical comedy…or, as he puts it in an interview with Dear Doctor–Dentistry & Oral Health magazine, "When people do stuff and you're like, 'Dude, you just hurt yourself for no reason!'" So when he had his own dental dilemma, Alfonso was determined not to let it turn onto an "epic fail."
The television personality was in his thirties when a painful tooth infection flared up. Instead of ignoring the problem, he took care of it by visiting his dentist, who recommended a root canal procedure. "It's not like you wake up and go, 'Yay, I'm going to have my root canal today!'" he joked. "But once it's done, you couldn't be happier because the pain is gone and you're just smiling because you're no longer in pain!"
Alfonso's experience echoes that of many other people. The root canal procedure is designed to save an infected tooth that otherwise would probably be lost. The infection may start when harmful bacteria from the mouth create a small hole (called a cavity) in the tooth's surface. If left untreated, the decay bacteria continue to eat away at the tooth's structure. Eventually, they can reach the soft pulp tissue, which extends through branching spaces deep inside the tooth called root canals.
Once infection gets a foothold there, it's time for root canal treatment! In this procedure, the area is first numbed; next, a small hole is made in the tooth to give access to the pulp, which contains nerves and blood vessels. The diseased tissue is then carefully removed with tiny instruments, and the canals are disinfected to prevent bacteria from spreading. Finally, the tooth is sealed up to prevent re-infection. Following treatment, a crown (cap) is usually required to restore the tooth's full function and appearance.
Root canal treatment sometimes gets a bad rap from people who are unfamiliar with it, or have come across misinformation on the internet. The truth is, a root canal doesn't cause pain: It relieves pain! The alternatives—having the tooth pulled or leaving the infection untreated—are often much worse.
Having a tooth extracted and replaced can be costly and time consuming…yet a missing tooth that isn't replaced can cause problems for your oral health, nutrition and self-esteem. And an untreated infection doesn't just go away on its own—it continues to smolder in your body, potentially causing serious problems. So if you need a root canal, don't delay!
If you would like additional information on root canal treatment, please contact us or schedule a consultation. You can learn more by reading the Dear Doctor magazine articles “A Step-By-Step Guide to Root Canal Treatment” and “Root Canal Treatment: What You Need to Know.”
You've seen the ads for obtaining a new tooth in one day with a dental implant. Those aren't exaggerated claims — you can leave the dental office the same day with a new tooth that looks and functions like the old one.
But the dramatic marketing aside, there is a bit more to the story. Same day tooth replacement isn't appropriate in every situation. And even when it is, there are risks for failure.
We can minimize those risks, however, by focusing on certain goals during the three distinct phases in the process: removing the natural tooth; placing the metal implant into the jawbone; and affixing the visible, crown.
It's crucial during tooth extraction that we avoid damaging the socket bone that will ultimately support the implant's titanium post. If the socket walls break down it could set up future gum recession or cause us to abort the implant procedure altogether that day.
When placing the implant, we want to focus on achieving a strong hold. Due to its special affinity with titanium, bone cells gradually grow and adhere to the post to firmly anchor the implant in time. But since we're immediately loading a crown rather than allowing the bone to fully integrate first, we need to ensure the implant has a secure hold from the get-go. We can only achieve this with precise placement based on careful examination and planning, as well as adequate bone.
Even so, the implant still needs to integrate with the bone for a lasting hold, and that takes time. Even with normal biting forces the implant risks damage during this integration period. That's why we place a temporary crown a little shorter than the surrounding teeth. Those adjacent teeth will take the brunt of the biting force and not the implant.
Once the bone has fully integrated, we'll replace the temporary crown with a permanent one the proper height proportional to the other teeth. Even with the temporary crown, though, you'll still have a life-like tooth the day we removed the older one.
The key to success is planning — first determining if you meet the criteria for a same-day implant and then mapping out and carefully executing each succeeding step. Doing this will ensure your same-day implant is a success from day one.
If you would like more information on same-day tooth replacement, 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 “Same-Day Tooth Replacement with Dental Implants.”
When die-hard music fans hear that their favorite performer is canceling a gig, it’s a big disappointment—especially if the excuse seems less than earth-shaking. Recently, British pop sensation Dua Lipa needed to drop two dates from her world tour with Bruno Mars. However, she had a very good reason.
“I’ve been performing with an awful pain due to my wisdom teeth,” the singer tweeted, “and as advised by my dentist and oral surgeon I have had to have them imminently removed.”
The dental problem Lipa had to deal with, impacted wisdom teeth, is not uncommon in young adults. Also called third molars, wisdom teeth are the last teeth to erupt (emerge from beneath the gums), generally making their appearance between the ages of 18-24. But their debut can cause trouble: Many times, these teeth develop in a way that makes it impossible for them to erupt without negatively affecting the healthy teeth nearby. In this situation, the teeth are called “impacted.”
A number of issues can cause impacted wisdom teeth, including a tooth in an abnormal position, a lack of sufficient space in the jaw, or an obstruction that prevents proper emergence. The most common treatment for impaction is to extract (remove) one or more of the wisdom teeth. This is a routine in-office procedure that may be performed by general dentists or dental specialists.
It’s thought that perhaps 7 out of 10 people ages 20-30 have at least one impacted wisdom tooth. Some cause pain and need to be removed right away; however, this is not always the case. If a wisdom tooth is found to be impacted and is likely to result in future problems, it may be best to have it extracted before symptoms appear. Unfortunately, even with x-rays and other diagnostic tests, it isn’t always possible to predict exactly when—or if—the tooth will actually begin causing trouble. In some situations, the best option may be to carefully monitor the tooth at regular intervals and wait for a clearer sign of whether extraction is necessary.
So if you’re around the age when wisdom teeth are beginning to appear, make sure not to skip your routine dental appointments. That way, you might avoid emergency surgery when you’ve got other plans—like maybe your own world tour!
If you would like more information about wisdom tooth extraction, please call our office to arrange a consultation. You can learn more in the Dear Doctor magazine articles “Wisdom Teeth” and “Removing Wisdom Teeth.”