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.”
You could have an unattractive smile because of a chipped tooth or one slightly out of alignment. Or, it could be both of the above, plus some heavy staining to boot. Correcting each flaw individually might require a combination of different methods like orthodontics or porcelain crowns, which can take an extended period of time to complete.
But you may be able to correct numerous smile flaws with just one method—and in no more than a couple of treatment visits. It's called direct veneers.
Unlike regular veneers, direct veneers don't require a dental technician to craft a thin porcelain shell to bond over teeth. Rather, a dentist applies a tooth-colored material called composite resin to the problem teeth and "sculpts" an entirely new look that can correct multiple dental flaws at one time.
The dentist usually begins the process by creating a model ("wax-up") of proposed changes based on physical impressions of the jaw and teeth. Both dentist and patient can study the model and modify it if necessary, when finalizing the treatment plan.
At a subsequent appointment, the dentist prepares the tooth surface for bonding by removing a thin layer of tooth enamel, then shapes the teeth to better accommodate the composite resin. This tooth prep is similar to that done with traditional veneers, so it's permanent—the teeth will require some form of restoration from then on.
After applying an etchant and a bonding agent, the dentist applies the composite resin in small amounts, hardening each layer with a special light before applying the next one. With each subsequent layer, the dentist sculps the composite material to eventually resemble the wax-up model.
After completing the composite application, the dentist then uses hand tools and a dental drill to complete shaping, as well as an abrasive strip between teeth to aid future flossing. After just a few hours, the transformation is complete.
Direct veneers are durable, but not to the same extent as regular veneers or other cosmetic enhancements. They can also pick up stains over time, and may require re-treatment at some point. Still, direct veneers are a cost-effective way to improve the appearance of teeth with multiple flaws that could radically change your smile for the better.
The NBA's reigning MVP Giannis Antetokounmpo may seem unstoppable, but he proved no match for a troubled tooth. Antetokounmpo, the self-proclaimed “Greek Freak,” missed one of the final three 2020 regular season games for a dental issue that resulted in last-minute oral surgery. According to a Milwaukee Bucks spokesperson, the star underwent “a root-canal like procedure.”
Root canal therapy, often simply called “a root canal,” may be needed when there is an infection inside the tooth. When dental pulp becomes inflamed or infected, excruciating pain can result. Pulp is the soft tissue that fills the inside of the tooth. It is made up of nerves, blood vessels and connective tissue. During root canal treatment, the pulp is removed, the space inside the tooth is disinfected, it is filled with a special material, and then the hole is sealed up.
A root canal is nothing to fear. It relieves pain by getting rid of infection and is so effective that over 15 million of them are performed in the U.S. each year. This routine procedure generally requires only local anesthetic, and your mouth should be back to normal within a day or two after treatment. Antetokounmpo can attest to that, as he returned to play the next day.
However, delaying root canal treatment when you need it can have serious consequences. If left untreated, an infection inside the tooth continues to spread, and it may move into the gums and jaw and cause other problems in the body. So, how do you know if you may need a root canal? Here are some signs:
Lingering sensitivity to hot or cold temperatures. One sign of nerve damage inside your tooth is pain that is still there 30 seconds after eating or drinking something hot or cold.
Intense pain when biting down. You may feel pain deep within your tooth, or in your jaw, face or other teeth. The pain may be hard to pinpoint—and even if it improves at times, it usually comes back.
A chipped, cracked or discolored tooth. A chip or crack can allow bacteria to enter the tooth, and the tooth may darken if the tissue inside is damaged.
A pimple on the gum. A bump or pimple on the gum that doesn't go away or keeps coming back may signify that a nearby tooth is infected.
Tender, swollen gums. Swollen gums may indicate an infection inside the tooth or the need for periodontal treatment.
And sometimes there is no pain, but an infection may be discovered during a dental exam.
Tooth pain should never be ignored, so don't put off a dental visit when you have a toothache. In fact, if a bad toothache goes away, it could mean that the nerves inside the tooth have died, but the infection may still be raging. Also, be sure to keep up with your regular dental checkups. We may spot a small problem that can be addressed before it becomes a bigger problem that would require more extensive treatment.
Remember, for dental issues both large and small, we're on your team! If you would like more information about tooth pain, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine articles “Tooth Pain? Don't Wait!” and “Root Canal Treatment: What You Need to Know.”
Picture yourself with a beautiful smile…what do you see? Besides straight and uniform teeth framed by the gums, you should also see one other thing indicative of a great smile—your teeth an attractive shade of translucent white.
But as you age your teeth can begin to dull as the enamel loses its translucency and the underlying dentin thickens and yellows. You no longer have the bright smile you once had in younger days.
But if the discoloration is mainly on the outer enamel, teeth whitening could be your answer for regaining your youthful smile. This is a procedure in which we apply a solution containing a bleaching agent (usually hydrogen peroxide) to your teeth. Aided by heat or light to activate it, the solution can temporarily whiten the enamel.
Teeth whitening isn't an exclusive treatment provided by a dentist—there are a number of retail products that enable you to bleach your teeth at home. But there are distinct advantages to having your teeth professionally whitened.
For one, we can control the level of brightness by adjusting the strength of the bleaching solution. This allows you to achieve the kind of look you want—from a more natural and subtler shade to a more dazzling color often called “Hollywood White.”
Any external teeth whitening application will fade with time, regardless of whether they're professional or DIY. But a dental office whitening may last longer due to our stronger solutions and curing techniques. And, by caring for your whitening (by avoiding tobacco and food items that stain teeth) and obtaining occasional touch-ups in our office, the shine could last for a few years.
Again, this particular whitening technique only works with outer staining and yellowing. If your discoloration originates from inside the teeth, you'll need a more invasive method. And your teeth should be reasonably healthy before undergoing whitening.
All in all, though, teeth whitening is an easy and affordable way to brighten your smile. It could help you take years off your appearance.
If you would like more information on teeth whitening, 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 “Teeth Whitening: Brighter, Lighter, Whiter….”
If you're looking for a cosmetic enhancement with a “light” touch, you can't beat dental veneers. These custom-made wafers of dental porcelain are bonded to the front of teeth to mask chips, heavy staining or gaps, revitalizing your smile.
But with traditional veneers, a minimal impact doesn't mean no impact at all. Although they're quite thin—often a millimeter or less—they can still look bulky when bonded to unprepared teeth. Dentists usually remove a small amount of surface enamel to help them appear more natural.
The alteration itself is painless, and only the bare minimum of enamel is removed. Even so, the alteration is permanent—the tooth will require a veneer or other form of restoration from then on. But a new kind of veneer may make it possible to avoid any enamel removal, or much less. These no-prep or minimal-prep veneers are even thinner, between 0.3 and 0.5 millimeters.
With these ultra-thin veneers, your dentist may only perform a little minor enamel re-shaping, particularly the sides of the teeth, to ensure a good fit. As thin as they are—akin to that of a contact lens—no-prep veneers can be bonded to the teeth surface without the need for fitting them under the gum line.
No-prep veneers are ideal for people with smaller than normal teeth, or that appear smaller due to other facial features. This also includes teeth that have worn down from age or teeth grinding, or those that are misshapen in some way. They also work well with people who have a narrow smile where less teeth than normal are visible in the “smile zone.”
They can also be used with patients who have oversized or prominent teeth, but it may still require some enamel removal. The only qualification for anyone receiving ultrathin veneers is that their enamel is in reasonably good health.
Because there's little to no alteration of the teeth, no-prep veneers can be reversed. Removing them, though, is no easy task, so you'll still need to think long-term before obtaining one. All in all, though, no-prep veneers in the right setting can still transform your smile without much permanent change to your teeth.
If you would like more information on no-prep veneers, 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 “No-Prep Porcelain Veneers.”
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