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Electric Toothbrush Etiquette

April 19th, 2018

Are you using your electric toothbrush correctly? Brushing for too long or pressing too hard can hurt your gums and enamel over time. Many of us at Got Smile use the Oral-B Genius and love that its technology includes a pressure sensor and unique position detection. But no matter what electric brush you use, it is important to know how to use it. Thankfully, this article from Oral-B has some great information on how to correctly (and safely!) use your electric toothbrush:

Using a Rechargeable Electric Toothbrush

Using Rechargeable Electric Toothbrush

A rechargeable electric toothbrush (also known as a “power” toothbrush) can help you do more to maintain the health of your teeth and gums. Many rechargeable toothbrushes use oscillating-rotating technology to provide better oral health results than regular manual toothbrushes. This brushing action is very different from that of regular manual toothbrushes, as it provides the movement, while you need only guide it.

For that reason, some people may find brushing with an electric toothbrush easier once they learn how to do it properly. Just remember that the key to brushing well with an electric toothbrush is to guide the brush head to all parts of your mouth.

How to Start Brushing Your Teeth

Before you begin brushing, be sure to ask your dental professional for recommendations on technique. It also might be helpful to refer to the brushing instructions supplied with your electric toothbrush.

To start, apply a fluoride toothpaste to the brush head (and by the way, remember to replace the brush head on your power toothbrush every three months).

How Often Should You Brush Your Teeth?

To brush your teeth correctly, spend at least two minutes using a recommended technique, which includes 30 seconds brushing each section of your mouth (upper right, upper left, lower right and lower left), both morning and night. Most Oral-B rechargeable electric toothbrushes have built-in two-minute timers, and some even have professional timers that parse out 30 seconds for each quadrant to help you keep track.

Using Proper Electric Toothbrush Technique

When using a rechargeable electric toothbrush, it isn't necessary to press hard or scrub. Simply guide the brush while it provides the brushing action. In fact, some Oral-B electric toothbrushes have pressure sensors that alert you when you’re brushing too hard.

Step 1: Make sure your toothbrush is charged. Many electric toothbrushes have charge level indicator lights, so you can actually see when the toothbrush is charged.
Step 2: Start with the outside surfaces of the teeth. Guide the brush head slowly from tooth to tooth, holding the brush head in place for a few seconds against each tooth before moving on to the next one. Follow along with the shape of each tooth and the curve of the gums.
Step 3: Repeat Step 2 on the inside surfaces of the teeth.
Step 4: Repeat Step 2 on the chewing surfaces of the teeth as well as behind the back teeth.
Step 5: Direct the brush head along the gum line and upon the gums. Again, do not press hard or scrub.
Step 6: Try grazing the brush head along your tongue and the roof of your mouth, back to front, to help freshen your breath.

With proper brushing technique with a rechargeable electric toothbrush, a little practice every day will help make it feel like second nature. Before you know it, you’ll be brushing with confidence knowing you’re using the clinically proven technology of a rechargeable electric toothbrush to clean your teeth.

Osteoporosis

April 12th, 2018

Do you or does someone close to you have osteoporosis? The medications used to treat osteoporosis contain bisphosphonates, which help to prevent bone loss. However, bisphosphonates can also affect the bone healing process. For this reason, special precautions must be taken for patients using these medications. Some cancer patients may also be prescribed a bisphosphonate-containing medication to help with certain symptoms. Always tell your dentist the medications you are taking!

This article from MouthHealthy gives a great overview of osteoporosis and the medications used to treat it:

Osteoporosis and Oral Health

It’s important to let your dentist know about all the medications that you take. That’s because certain medications can influence dental treatment decisions.

In the case of antiresorptive agents—medicines that help strengthen bones—these medications have been associated with a rare but serious condition called osteonecrosis (OSS-tee-oh-ne-KRO-sis) of the jaw (ONJ) that can cause severe damage to the jawbone.

Some antiresorptive agents, such as Fosamax, Actonel, Atelvia, Didronel and Boniva, are taken orally to help prevent or treat osteoporosis (thinning of bone) and Paget's disease of the bone, a disorder that involves abnormal bone destruction and regrowth, which can result in deformity. Others antiresorptive agents, such as Boniva IV, Reclast or Prolia, are administered by injection. Higher and more frequent dosing of these agents is given as part of cancer therapy to reduce bone pain and hypercalcemia of malignancy (abnormally high calcium levels in the blood) associated with metastatic breast cancer, prostate cancer and multiple myeloma.

How do these medications affect dental treatment plans?

While osteonecrosis of the jaw can occur spontaneously, it more commonly occurs after dental procedures that affect the bone or associated tissues (for example, pulling a tooth). Be sure to tell your dentist if you are taking antiresorptive agents so he or she can take that into account when developing your treatment plan.

It’s not possible to say who will develop osteonecrosis and who will not. Most people (more than 90 percent) diagnosed with ONJ associated with these medications are patients with cancer who are receiving or have received repeated high doses of antiresorptive agents through an infusion. The other 10 percent (of people with ONJ) were receiving much lower doses of these medications for treatment of osteoporosis. It may be beneficial for anyone who will be starting osteoporosis treatment with antiresorptive agents to see their dentist before beginning treatment or shortly after. This way, you and your dentist can ensure that you have good oral health going into treatment and develop a plan that will keep your mouth healthy during treatment.

Continue regular dental visits

If you are taking antiresorptive agents for the treatment of osteoporosis, you typically do not need to avoid or postpone dental treatment. The risk of developing osteonecrosis of the jaw is very low. By contrast, untreated dental disease can progress to become more serious, perhaps even involving the bone and associated tissues, increasing the chances that you might need more invasive treatment. People who are taking antiresorptive agents for cancer treatment should avoid invasive dental treatments, if possible. Ideally, these patients should have a dental examination before beginning therapy with antiresorptive agents so that any oral disease can be treated. Let your dentist know that you will be starting therapy with these drugs. Likewise, let your physician know if you recently have had dental treatment.

Talk to your physician before ending medications

It is not generally recommended that patients stop taking their osteoporosis medications. The risk of developing bone weakness and a possible fracture is higher than those of developing osteonecrosis.
Talk to your physician before you stop taking any medication.

Symptoms of osteonecrosis of the jaw include, but are not limited to:

  • pain, swelling, or infection of the gums or jaw
  • injured or recently treated gums that are not healing
  • loose teeth
  • numbness or a feeling of heaviness in the jaw
  • exposed bone

Contact your dentist, general physician or oncologist right away if you develop any of these symptoms after dental treatment.

From White Spots to Root Canal

April 5th, 2018

All dental abscesses begin the same way - with a tiny white spot of an early cavity. That is why it is important to understand the process of how an abscess forms! By catching enamel damage early you can save yourself the pain and hassle of an infected tooth and the treatment that comes along with it. This image illustrates the progression of cavity (dental caries) to abscess.

Image result for what is a root canal

You can see how the infection slowly eats its way through the enamel, into the tooth pulp, then through the root into the tissue below! Fortunately there are warning signs that alert you to tooth damage long before it gets too serious. It's your job to listen to what your teeth are telling you and seek treatment at the first sign of discomfort!

The following article from PatientConnect365 gives a great overview of the stages of tooth decay, and includes the stage just before the enamel is damaged - characterized by reversible white spots!

Did you know there are five distinct stages of tooth decay? And, that in the first stage of decay, you can actually take steps to reverse the progression of the disease? Indeed, it’s true. In the first stage of decay, whether you’re a child or an adult, the application of fluoride via fluoride treatments, your toothpaste and even the local water supply can stop a cavity from penetrating through the enamel and reaching its second stage. Even the saliva in your mouth and the foods you eat help to re-mineralize a tooth in jeopardy. But that’s just the first stage! What about the rest?

Understanding how a cavity progresses can assist you in preventing each successive stage from occurring in your children. There’s always a lot going on in that little mouth!

  1. Stage One: White Spots
    In stage one, the tooth begins to show signs of strain from the attack of sugars and acids, and white spots will begin to materialize just below the surface of the enamel. These white spots are representative of the demineralization of the tooth and can be easy to miss because they’re likely to occur on your child’s molars. A dental exam, of course, is designed to catch such cavities! Can you see why regular visits to the dentist are recommended?  As mentioned previously, at this stage, the cavity can be repaired without the need to excavate the tooth.
  2. Stage Two: Enamel Decay
    Stage two marks the beginning of the end for the surface enamel that is being attacked. Initially, the tooth erodes from the underside outward, so the outer enamel will still be intact for the first half of this second stage. Once the cavity breaks through the surface of the enamel, there is no turning back, and your child will need to have the cavity corrected with a filling.
  3. Stage Three: Dentin Decay
    If a cavity in your child’s mouth were to progress beyond stage two without you knowing, you’d tend become aware of it when it started to hit stage three because it would probably start to cause some pain. At this level, the cavity begins to eat away at the second level of tooth material that lies beneath the enamel: the dentin. A filling can still be used to stop the onslaught of bacteria assaulting the tooth in order to prevent the cavity from reaching the tooth’s most critical component: the pulp.
  4. Stage Four: Involvement of The Pulp
    Once the cavity reaches the pulp, it’s going to hurt. A lot. So if you’ve unfortunately missed all the signs to this point, a screaming child or moaning teenager will certainly let you know there is a big problem. Stage four is serious, and a root canal is the only option of treatment at this stage, save for a complete extraction.
  5. Stage Five: Abscess Formation
    In the fifth and final stage of a cavity, the infection has reached the tip of the root and exited the tip of the tooth’s structure. This in turn infects the surrounding tissues and possibly the bone structure. Swelling would be commonplace and pain severe. In children (as well as adults) an abscess can be fatal if not dealt with immediately. Root canal or extraction would be the order of the day should decay reach this stage.

As you can see, cavities don’t happen overnight. In the early stages, regular visits can stall and reverse the progression of these dastardly little devils, so it really does pay to visit the dentist at pre-selected intervals. You can keep your kids far from stage five their whole lives, and if a little bit of prodding to get them to the dentist accomplishes that, you can rest easy despite the griping.

Jaw Pain

March 29th, 2018

We all have heard the acronym - TMJ. But what is it exactly? More accurately, it's called TMD, and it can cause a lot more than just popping and clicking of the jaw joints! AsktheDentist has a wonderful and thorough article that provides all the information you need to understand TMD:

The Complete Guide to Temporomandibular Joint Disorder (TMD, TMJ)

If you have TMJ pain, I think you’ll agree with me that it’s one of the most frustrating conditions to have. It can be jaw pain, ear pain, neck pain, or even a headache—and you never know when it’s going to show up.

Not only is it painful, it can feel impossible to treat—you’ve probably been told to stop chewing gum and just “wait and see” if it gets better. The lack of a clearcut solution combined with intense, unpredictable pain is enough to drive anyone crazy.

The key thing with treating TMD is to go slowly. I’ve outlined everything you need to know and do, step-by-step, below.

But first, what is TMJ disorder? Is it the same thing as TMD? How do you know if you have it? What are treatment options? Who do I see for treatment? We’ll break down this and more in this article.

What is TMJ Disorder (TMD)?

TMJ is the anatomical abbreviation for the temporomandibular joint, which is the joint connecting your lower jawbone to the base of your skull. It allows us to form words and chew food, and open our mouths for breathing. The TMJ is referred to as single joint, but there are actually two hinge points in front of each ear that enable movement. To accomplish all of these movements, the joint has the ability to rotate in several different directions and essentially create a hinging, or translatory, gliding movement. One example of this motion is chewing. The TMJ allows for rotation, gliding and hinging all at the same time by being relatively mobile within the socket. And this is where it gets complicated. There are a series of complex tendons, muscles and joint pads (called the meniscus) that help move and help protect the joint while it is in motion. Because of this anatomical and functional complexity, the TMJ is susceptible to having many things go wrong.

Because this joint is one of the most frequently used joints in the body, when it gets inflamed, it can be very painful and impact many aspects of normal activities. Problems with the TMJ are called TMD, temporomandibular disorder, or TMJ disorders. But people (and often even dentists) often simply refer to this condition as “TMJ”.

More than 15 percent of American adults suffer from chronic facial pain, such as jaw pain, headaches or earaches all of which may be related to TMD. The disorder disproportionately affects women ages 20-40. Sometimes it only lasts for a few weeks or months before resolving on its own, but often it can last indefinitely.

What are TMD symptoms?

TMD affects many people differently. Many sufferers end up seeing multiple doctors for various other symptoms before realizing that they are originating from the TMJ. Symptoms include:

  • Pain and tenderness around jaw, cheeks, ears, and neck
  • Headaches or migraines
  • Jaw pain or stiffness
  • Popping, grating, or clicking jaw
  • Earache
  • Inability to open jaw completely, locking jaws
  • Painful chewing
  • Tired feeling in face
  • Change of facial expression
  • A change in how your lower and upper teeth fit together, e.g., can’t make one side of one’s bite or the other meet

How is TMD diagnosed?

Unfortunately, no one type of doctor is responsible for diagnosing or treating TMD. Many TMD sufferers may be become frustrated by the amount of time it takes to diagnose, since they may have previously visited an ENT for ear pain, their dentist for tooth pain, or a neurologist for headaches.

If you suspect you have TMD, talk to your primary care physician or your dentist. They will be able to check for symptoms and help you develop a treatment plan. You may consider visiting a TMD specialist in your area for further treatment if the problems persist.

If you truly believe your symptoms are due to TMD your best choice for a correct diagnosis and efficacious treatment is to seek out a dentist that specializes in the treatment of TMD (link to a TMD list of doctors?) To diagnose, the dentist will ask you questions about symptoms and areas of pain, and will physically inspect the joint as you move your jaw around. They will check your bite to inspect how your teeth come together.

In checking your bite, the dentist may check for a CR/CO discrepancy. CR stands for “centric relation” and CO stands for “centric occlusion”. In layman’s terms, CR is the ideal state of your upper and lower jaw positioning and CO is the actual state of affairs. To simplify this concept, consider this analogy…. if the front wheels of your car are not in alignment the suspension joints will wear prematurely and cause other alignment issues with your car. Similarly if your TMD is out of alignment the joint will wear prematurely and cause cause pain and inflammation.

In some cases, your doctor or dentist may recommend other tests to rule out other possibilities, such as lupus, arthritis, or gout. They may also recommend imaging tests, such as x-rays, CTs, MRIs, or ultrasound to look more closely at the joint and surrounding tissue.

What causes TMD?

There is no one cause of TMD. Anything that causes tension in the jaw and temporal muscles or a CR/CO discrepancy can lead to problems with the TMJ. There are often multiple factors that coincide to cause the disorder and pain. These could be:

  • Injury to the jaw or neck (e.g. hit in the face or whiplash): This is one of the most frequent causes of sudden onset of severe pain
  • Grinding or clenching your teeth (also called bruxism)
  • Sleep disordered breathing occurring when your airway collapses while you’re asleep blocking your breathing. the lower jaw’s instinct is to clamp down or thrust forward in an attempt to open the airway
  • Arthritis: arthritis can occur in any joint, including the TMJ
  • Dislocation or erosion of the joint
  • Improper bite alignment
  • Poor dentistry, such as high crowns or fillings, that change how your teeth are coming together

Stress is often considered a cause of TMD. However in my experience I have seen stress as exacerbating a condition that already exists.

I prefer to DIY. What are some at-home remedies for TMD?

Many doctors and dentists will recommend at home treatments as a first step for treating mild TMJ disorder. Since it is a joint, with tissue and muscle, like any other in the body, the treatments are similar to how you would treat any other inflamed joint or muscle with rest and relaxation.

Here are some easy, at-home treatments to try:

  • Rest the joint: eat soft food, avoid gum chewing
  • Apply ice in the beginning and later heat packs to decrease muscle inflammation
  • Experiment with different pillows to allow for proper neck support. Practice jaw exercises to stretch and relax the muscles
  • Over-the-counter pain medicines or anti-inflammatories can help provide short term relief
  • Correct your posture: slouching can push your lower jaw forward, putting stress on the TMJ. This often happens with people who spend many hours at a desk
  • THC/marijuana treatment (if you’re in a state where it’s legal)
  • In addition to direct muscle relaxation, decreasing your stress levels can help treat the symptoms and causes of TMD. Practicing stress reduction techniques such as meditation, yoga, or mindfulness are great additions to any TMD treatment plan.

What to discuss with your dentist and doctor: TMD Treatment Options

Since TMD symptoms can involve the jaw, ear, nose, throat, face, neck, upper back, and even eyes, dentists and ENT doctors often pass TMD patients back and forth, not really knowing what to do with them or how to treat them. This makes things difficult when deciding which TMD treatment is right for you. Take it slow and make sure you fully understand your options, and any potential side effects, before agreeing to treatment.

I’ve listed these treatments for TMD in the order you should approach them—start at the beginning of the list and work your way down. It’s best to conservatively treat in the beginning to see if TMD symptoms go away first before getting to the more serious treatment options, like surgery. All of these should be chosen in consultation with your dentist, TMD specialist, or ENT doctor, or a combination.

Also be aware: There are several things that can be the root cause. Sometimes TMD can heal quickly on its own, and sometimes it can take months of treatment or even surgery to resolve. For some people, it never fully resolves, and it’s a matter of learning how to reduce the pain so you can get back to your life. Depending on your unique situation, your doctor or dentist may recommend more than one treatment.

Give your jaw a break: In many milder cases, TMD symptoms will go away just by letting the overworked jaw muscles rest. If you’re getting clicking or popping when you yawn or open your mouth wide, try not to open wide for the next several days. Cut smaller pieces of food so that you don’t have to open as wide to take a bite or chew as hard. Limit the amount of tough chewing with a softer diet. Cut out chewing gum.

Treat it like a muscle injury: Try treating your jaw the same way you would a pulled muscle. Massage the jaw muscle, put a hot washcloth on it, take an anti-inflammatory like ibuprofen, and let it rest.

Try muscle relaxation exercises: Just like a muscle that cramps from overuse, the jaw can cramp from too much use. Simple exercises can help you learn how to correct abnormal jaw positioning and relax tense jaw muscles that can contribute to TMD pain. All exercises should be done during times when you do not have any pain. If your jaw starts to hurt while you are performing the exercises, stop and rest. Jaw positioning exercises should be done in front a mirror so you can watch your progress. Many people who have TMD have a deviation in the way the joint moves, but are capable of learning a new, more correct position. Put a small sticker on the middle of your chin and open your mouth. If your jaw shifts to the side when you open your mouth, the sticker will shift also. When you see this happening, make a conscious effort to keep your jaw perfectly aligned when you open your mouth. It may feel unnatural at first but over time it will feel more normal and you may notice a reduction in your joint pain. Muscle relaxation and stretching exercises can be done anywhere, at home, in the car or while you read a book. Gently open your mouth as wide as you can without discomfort. Close your mouth slowly. Once your muscles have loosened up, you can use your hand very carefully to open your mouth a little bit wider. This type of stretching can prevent your jaw from becoming locked or unable to open and close smoothly.

Check your posture: Poor posture places the spine in a position that causes stress to the jaw joint. When people slouch or hunch over, the lower jaw shifts forward, causing the upper and lower teeth to not fit together properly, and the skull moves back on the spinal column. This movement puts stress on muscles, joints and bones and, if left untreated, can create pain and inflammation in muscles and joints when the mouth opens and closes.

Get a sleep study: TMD is often caused by grinding the teeth at night, which is a sign that you’re struggling to keep your airway open while you sleep. Recent studies are showing that TMD symptoms are often indicators of a larger disorder – and that includes sleep apnea. A mandibular advancement device, which is made by your dentist and used to treat sleep apnea, often cures TMD because it positions the jaw in a such a way that forces it to relax completely. Assuming the device is worn at night, eight hours of forced relaxation every day can be very effective in reversing TMD symptoms.

Check your stress levels: We often clench without realizing it—and TMD can often be resolved by treating a root cause of major stress, unhappiness in work or at home, etc.

Bite guards: Many dentists will recommend custom bite guards to reduce clenching and grinding of teeth at night to reduce stress on the TMJ. These guards will help the jaw alignment so that the joint can rest. However, make sure that you and your dentist have ruled out sleep apnea as a night guard has the potential to interfere with your sleep and make your grinding worse.
Sleep apnea treatment: A sleep apnea specialist will work with you to design a specific treatment plan if you are diagnosed with sleep apnea. Grinding all night long to keep your airway open is not conducive to TMJ health.
Medical marijuana: if you’re in a state where medical marijuana is legal, your doctor may be able to prescribe it for stress and pain relief. This is palliative only and will not treat the root cause of your TMD.

Join a support group: The TMJ Association is a non-profit organization that focuses on patient advocacy. Especially for severe sufferers of TMD, this is important because you don’t want doctors and dentists pressuring you into treatment you don’t need.
Invisalign: If the root cause of your TMD is an occlusion issue, Invisalign may be able to fix the alignment your jaw, and thus help TMD symptoms. Also, many Invisalign patients achieve immediate relief from their TMD symptoms as the liners prevent you from biting in a misaligned position.

Take over-the-counter meds: Taking ibuprofen, or another anti-inflammatory, can give you immediate relief by reducing swelling or tenderness in the jaw, face, head, or neck. This kind of treatment, however, won’t work in the long term. Being dependent on painkillers is no way to live your life. Pain is also the body’s way of telling you to stop hurting yourself—and taking this away can cause you to further damage your body. Painkillers are great for immediate relief, but be sure you are searching for and treating the root cause. Be wary of any TMD specialist, dentist, doctor or medical professional that advises you to treat your TMD with painkillers alone.

Try occlusional equilibration: This method can take several visits that are weeks apart until the muscles adjust and find a new position. What your dentist will try to do here is aim to equilibrate your bite in a way that gets rid of your jaw pain or other TMD symptoms. Many people have an “actual” bite that differs from their “ideal” bite. Bringing the two positions into harmony is key in treating TMD. This requires strong 3D thinking and premodeling on a model by your dentist in order to treat your TMD and make the teeth less of a trigger point for grinding. A stable well balanced bite puts less stress on the jaw joint. You may need work done to reshape your teeth or jaw through braces or other appliances. A dentist can also fit you with a mouth guard that will help you stop clenching your jaw and grinding your teeth at night. Think of this like an orthotic shoe insole for the mouth. It works to attain that balance and comfort, at least while you’re wearing it.
Orthodontic treatment to adjust for proper bite: In some cases you will need regular metal braces to expand the arches and reverse improper facial development and to improve the bite.
Surgery: Surgery should only be used as a last resort after trying multiple other, non-invasive treatments. However, in extreme cases, surgery on the jaw or on the joint may be necessary. This should only be as a last resort after going through all of the treatment options above, experimenting with different combinations of treatments, working closely with your dentist, and getting a second (or even a third) opinion. Surgery on the actual joint has fallen out of favor. Orthognathic surgery, while an extreme option, may be necessary. As with everything, research your options and understand what TMD is and what causes it before committing to any heavy duty treatment. Depending on the severity of your TMD, you might need to go through some trial and error to figure out which treatment or combination of treatments works for you, but that’s where a good dentist, TMD specialist, or ENT doctor should take care of you and be your advocate throughout the process.

TMD is a complicated condition with many possible combinations of causes and symptoms. Do not get discouraged if your symptoms do not go away quickly after trying one treatment option! It often takes some trial and error to figure out what works best for you. But with patience and diligence, your symptoms can either be well-managed or completely healed.

Dr. Mark Burhenne DDS

What other questions do you have about TMD? How were you able to cure it or reduce the pain? Let me know in the comments—I read them all!

Read more at Ask the Dentist: https://askthedentist.com/tmd-treatment/

 

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