Temporomandibular Disorder

Millions of Americans suffer from chronic facial and neck pain as well as recurrent headaches. In some cases this pain is due to Temporomandibular Disorder, or TMD.

Your temporomandibular joints, or jaw joints, connect your lower jawbone to your skull. As you may imagine, these joints get quite a lot of use throughout the day as you speak, chew, swallow, and yawn. Pain in and around these joints can be unpleasant and may even restrict movement.

Symptoms of TMD include:

• Pain in the jaw area
• Pain, ringing, or stuffiness in the ears
• Frequent headaches or neck aches
• Clicking or popping sound when the jaw moves
• Swelling on the sides of the face
• Muscle spasms in the jaw area
• A change in the alignment of top and bottom teeth
• Locked jaw or limited opening of the mouth

Should you notice any of these symptoms, let us know! We can help advise you as to whether they indicate the presence of TMD, and what sort of treatment is appropriate for you.

If you don’t have any of these symptoms, let’s keep it that way! There are some simple things you can do at home or work to prevent TMD from occurring in your jaw joints:

• Relax your face – remember the rule: “Lips together, teeth apart”
• Avoid grinding your teeth
• Avoid gum chewing
• Don’t cradle the phone receiver between your head and shoulder – either use a headset or hold the receiver to your ear
• Chew food evenly on both sides of your mouth
• Do not sit with your chin rested on your hand
• Practice good posture — keep your head up, back straight, and shoulders squared

Two-Phase orthodontic treatment is a very specialized process that encompasses tooth straightening and physical, facial changes. The major advantage of two-phase treatment is to maximize the opportunity to accomplish the ideal healthy, functional, aesthetic result that will remain stable over time.

During Early Treatment or Phase I, the growth relationships of the upper and lower jaws can be guided and enhanced with appliance therapy. Initiating orthodontic therapy when a child is in early to mixed dentition can minimize the need for complex orthodontic treatment, possibly eliminating the need for extractions and/or orthognathic surgery in the future. Early intervention can make the completion of treatment less time-consuming and far less costly.

After the Phase I treatment has been completed, the remaining teeth are then allowed to erupt during a resting period between phases. Retention and/or tooth guidance appliances may be recommended at the end of treatment. It is important to understand that at the end of Phase I treatment, teeth are not in their final positions. Selective removal of certain primary teeth may be in the best interest of enhancing eruption during the resting phase.

The second phase of treatment is initiated when all permanent teeth have erupted and usually requires braces. The majority of Early Treatment cases benefit from Phase II treatment, which is intended to position all of the teeth in an ideal position where they will be in harmony with the face and other teeth. With this equilibrium established, the teeth will function properly, stay healthy and look attractive.

Although many young children suck their thumbs, the majority stop at an early enough age to avoid permanent dental problems.  However, a handful of young children continue to suck their thumbs past the age of five or six.  These children need to be identified and treated before their thumbsucking can lead to severe malocclusions.

Chronic thumbsucking can cause large open bites and posterior crossbites (the constriction of the upper back teeth.)  The effect of thumbsucking depends upon the child’s age and the duration, consistency and force of the thumbsucking.  Fortunately, if we can identify the thumbsucking child before the maxilla (upper arch) is completely formed, usually around ages eight to nine, many of the occlusal problems created from thumbsucking can self-correct.  If these children go undetected, the dental malocclusion caused by thumbsucking can require complex orthodontic treatment.

The American Association of Orthodontics recommentds that all children be seen by an orthodontist by the age of seven, while thumbsuckers may be referred as early as age six.  Their is a very successful habit training technique that is approximately 90% effective, without the use of any orthodontic appliance.  With the few patients that we cannot motivate to stop thumbsucking, a fixed appliance such as a thumb crib may be indicated.

I remember when the Tooth Fairy left $ .25 a tooth   That was the going price for the Baby Boomers.

Securian Dental’s 2008 Tooth Fairy price poll reveals that per-tooth prices jumped 22% this year to an amazing $2.09 per tooth on average.

Securian reports that $1 is the most common price tag on a lost baby tooth.  An online poll of more than 20,000 readers at ParentCenter.com comfirms this trend: 52% of respondents report paying a dollar a tooth. In Securian’s survey, $5 per tooth was the second most poopular payment.  With 20 baby teeth to lose, today’s children are looking at a nice little nest egg.

As we study the poll results we found that the Tooth Fairy leaves more money per tooth on the East Coast than on the West Coast.  New York teeth go for about $1 more than California teeth and $1.25 more than Mid-western teeth.  I have heard of the Tooth Fairy leaving as little as a nickel per tooth and as large as $50 per tooth.

Ask any child with less-than-perfect teeth about the nicknames and teasing… and you’ll no doubt hear a sad story.  We hear them every day – Goofy, Bugs Bunny, Fang.  That’s rough!  There is real substance to such a child’s social pain.

One study on childhood harassment found that protruding or misaligned teeth were the single most common target of name-calling among kids.  Further, children with orthodontic problems are more subject to bullying than their luckier peers.

We’ve all experienced the hostility of childhood epithets – it’s part of growing up.  But for some of us, the bad memories don’t “go away.”  Early and persistent humiliation can become an adult’s psychological baggage.

Part of our job as orthodontists is a social one.  We know how a child with a problem bite feels.  We know that it’s a situation that can be prevented.  We have the means of correcting every “bad bite” out there – and with it, the social brutality so devastating to young self-esteem.

We would like every child in our community to have the advantages of a normal, healthy countenance.  Orthodontic evaluation is the first step.  The VALUE of a healthy, beautiful SMILE…. PRICELESS!!!!

ST. LOUIS-Because orthodontists can spot subtle
problems with jaw growth or teeth while a child still has primary or
“baby” teeth present, the American Association of Orthodontists (AAO)
recommends all children get a check-up with an orthodontic specialist
no later than age 7.

Some problems are not so subtle and may not be noticed by parents.
The AAO has gathered examples of these kinds of problems, also known as
malocclusions, in a short educational guide, Problems to Watch for in
Growing Children now posted at www.braces.org in the “About Orthodontics” section.

Among malocclusions pictured in Problems to Watch for in Growing
Children are crossbites, open bite, protrusion, deep bite, underbite,
spacing problems, and oral habits. Orthodontists want to identify these
kinds of problems in patients as early as possible so that the
appropriate care can be initiated at the appropriate time for the
individual patient.

Other indicators of the need for a check-up with an orthodontic specialist include:

Will braces set off the metal detectors in the airport?

* The lightweight materials used in braces will not affect metal detectors.  You are cleared for take-off.

Can braces rust?

* Absolutely not!  Today’s braces are made of new stronger materials… and will not rust!

Can a musical instrument be played while in braces?

* Yes… just be sure that you do not get them on or have them removed on theday of a concert.

Can sports be played while in braces?

* Yes… an orthodontic mouth guard is a must for any contact sport.

Will braces interfere with radio signals or other electrical devices?

* No.  Radio-loving gadget fanatics can rest easy.

If two people with braces kiss, can their braces become locked together?

* It would be extremely difficult (almost impossible) with today’s types of braces.Also, braces are not magnetic… if you feel an “attraction”… it is not the braces

During the Halloween season, the most frequently asked question of people in braces is, “What candy am I allowed to eat at Halloween?”
To avoid breaking the braces, steer clear of the following treats, or recipes  with these ingredients, as they could lengthen treatment time:
•    All hard candies
•    All chewy candies
•    Caramel
•    Nuts
•    Licorice
•    Taffy
•    Jelly beans
•    Hard pretzels
•    Bubblegum
•    Popcorn (including unpopped kernels
•    Tortilla chips
•    Ice
For alternatives, look for foods that are softer, such as soft chocolate or peanut butter cups.  Candies that are not sticky, chewy, hard, or crunchy are generally OK.  Check out the brace friendly recipes for yummy Halloween treats from the AAO:  http://www.braces.org/nohm/braces.htm
Of course, as usual, it is vital to keep your teeth, gums, and braces clean in order to maintain good oral hygiene.   Remember to floss and brush after any Halloween treats!

One of today’s popular forms of “body art” is PIERCING.  If you are thinking about getting a piercing…. or you already have one…. there are some health risks you should be aware of.
Your mouth a lot of bacteria, and infection is a common complication of oral piercing.  Just touching your mouth jewelry (tongue barbells and lip and cheek labrettes) can lead to infection.  Many people who have piercings tend to regularly touch them—which is a perfect opportunity for bacteria from hands to enter piercing sites.  Also, food particles that collect around piercing sites can lead to infection.
Pain and swelling are other possible side effects of piercing.  The most popular piercing site in the mouth is the tongue, which could swell large enough to close off our airway!  Piercing also can cause uncontrollable bleeding or nerve damage.  Damage to the tongue’s blood vessels can cause serious blood loss.
The hoop ring, stud, and barbell-shaped jewelry can hinder ones ability to talk and eat.  Some people also develop a habit of biting or playing with their piercings – which can lead to cracked, scratched teeth; gum damage and recession; and sensitive teeth.  There may also be a need for restorations, such as crowns or fillings, and additional dental treatment due to piercings.
Consider the potential pitfalls of piercing carefully before getting one.  Keep in mind that it will be an added responsibility to your life; and will need regular upkeep.  Make sure that you’re committed to the task of taking care of it for the full healing  period and beyond.
If you have an oral piercing, pay special attention to it.  Clean the piercing with antiseptic mouthwash after eating, and brush the jewelry when you brush your teeth.

It’s All About the Retainer!

Finished with braces? The next step is so important!
THE RETAINER…. This appliance keeps your teeth in place (but only if you wear it).

Now that you have spent about 2 years in braces, they are removed, and you have an AWESOME SMILE! Wow, you feel so free. No more food catch all, timely brushing, etc…

… What, now I have to wear a retainer?

Most patients who have spent time in braces need to wear a retainer after the braces are removed. There are a couple of different types of retainers. A common one is a small, curved piece of plastic and metal that is custom made to fit inside the mouth. Its function is to hold the teeth in their new position.

Why Do I Need a Retainer?

The Orthodontist and you have worked hard to bring your teeth into perfect alignment, and they don’t want to see them lapse back into crookedness. So they take a special precaution to enforce their new position. That special precaution is a RETAINER.

When—- And For How Long Should I Wear My Retainer?

A good rule of thumb….
The first year wear them all the time, the second year wear them to sleep, and beyond that…. wear them enough to keep them fitting. Just like everyone’s teeth are different, everyone has different schedules and timelines for wearing a retainer. For some that is once a month to sleep, others… once a week, and some twice a week. Research has shown that teeth often get progressively more crooked with age, so the longer you wear your retainer, the better the chance of keeping that AWESOME SMILE.

Will It Feel Weird?

A retainer is an adjustment. It feels a little different; you will feel that you talk funny at first. Soon you will forget it is even there.

How Do I Take Care of My Retainers?

It is easy! When you remove it to brush your teeth, simply brush it with toothpaste as well. It is also suggested that you use a denture cleaner (such as efferdent) to give your retainer a super clean. One tablet in cool water…. soak retainer for 20 minutes daily or at least 3 times a week.

Are All Retainers Removable?

There are permanently fixed retainers or “bonded” retainers meant to be placed behind the lower front teeth as they are the most prone to becoming crooked again.
The advantage is that it is not removable and therefore you cannot lose it. The disadvantage is that the teeth are hard to keep clean… which can cause other complications.

What If I Lose My Retainer?

Of course, the best case for the retainer is the mouth, but when you must take it out use a retainer case.
The #1 way to lose a retainer is at mealtime. It is common to remove a retainer to eat, wrap it in a napkin, and put it on a lunch tray in the cafeteria…. and then forget it is there. Where does it end up? Absolutely… in the trash! Many a child and parent have gone dumpster diving. Trust me, you don’t want to do that!
The # 2 way is for a pet to eat it. If it is not in your mouth or in a retainer case… the smell of saliva on the retainer is like a magnet to an animal. Consider it gone.

What If My Retainer Breaks?

If the retainer breaks, many times it is repairable.