The Headache Question

Chronic symptoms of the head and neck can often be attributed to:

 Headache — the temporalis muscle (it closes and clenches the jaw)

 Sinus pressure and pain — the lateral pterygoid muscles (it moves the jaw side to side and/or forward)

 Neck stiffness and pain — trapezius muscle (it stabilizes the skull during jaw clenching and grinding)

Dental offices have treated and helped more and more people with their headache problems. For years, we assigned all of these names to headaches, like muscle tension headaches, neuralgia, migraine and so on, and it seems that many headache patients share one very common trait- They clench or grind their teeth at night!

Most medical research has shown that headaches, even people with classical migraine headaches, have no physical reason, no vascular problems and no neurological problems; in fact their physician’s exam will give no physical reason for the pain. Many patients have had CAT scans and MRI’s that were negative, and find that drugs really don’t help their problem; instead the medication makes them groggy and “drugged out.”

What we have discovered is that people who can control their nighttime clenching and grinding will get tremendous relief for their headaches and neck aches. Many people do so much unconscious clenching of their jaw muscles that when they wake up, their teeth are sore, their muscles are already tired, and they are set up for the beginning of a headache from the start of the day, if they don’t wake up with one.

One effective treatment utilizes an NTI appliance (short for nocioceptive trigeminal inhibition), a dental device that fits between the upper and lower front teeth. (Detailed information can be gotten from the website at http://www.headacheprevention.com/ ) The simple fact is that this device reduces the intensity of nighttime parafunction by 70 percent immediately, which can explain why so many patients wake up feeling better very quickly.

A traditional dental mouthpiece, or splint, reduces the resistance to side-to-side movement, thereby, reducing the effort and resultant strain to the jaw joint and sinuses (so long as clenching intensity isn’t too intense). However, the same splint also provides an ideal clenching surface, where maximum clenching intensity may increase and/or allow jaw joint problems to perpetuate.

Many patients run the gamut of the medical world’s attempts to control their headaches- with multiple drugs, injections and so on, without ever thinking that the pain might be muscular in origin. But just like back pain is often muscle spasm, the pain we call TMJ, as well as headaches of many sorts are very much caused by overuse of the muscles of closing the jaws.

We would recommend that if you or a loved one has chronic headache problems, that you go to the web site, or give us a call and let us take a look. It can do no harm, and it might very well make a huge difference in 

A Crowning Achievement

When too much tooth structure has been lost due to decay or fracture, the best treatment choice to restore the tooth to normal function and cosmetic appearance is often the fabrication of a crown [cap]. Crowns are usually made of porcelain fused to metal or all-ceramic depending on the situation and judgment of the dentist. The restoration of the damaged tooth becomes more of an esthetic concern if it is located near the front of one’s mouth. How we perceive our smile and appearance affects our self-esteem, our moods and how we function in social and business relationships. So, when this situation occurs, there is a sense of urgency.

The tooth is prepared to allow enough room for the crown to fit over the tooth without extending too far and interfering with the person’s occlusion [bite]. This procedure usually takes 2 visits, depending on the situation. A provisional acrylic crown is made and temporarily cemented over the tooth. In the second visit, the crown is “tried in” to see how accurately it fits and to check that the ceramic color chosen matches the surrounding teeth. If both the patient and dentist are satisfied, the crown is permanently cemented or bonded to the tooth. Call our office if you think you’re a candidate for this type of procedure.

Cranberries Have Unique Benefit For Women

A recent study at Rutgers University, and published in Phytochemistry, confirmed a long-held theory that ingestion of cranberries is helpful in protecting against harmful bacterial in the urinary tract. This is due to one of its natural compounds called proanthocyanidin [PAC’s], and its anti-adhesion effect.

The anti-adhesion property of cranberries prevents bacteria from sticking to the urinary tract, which is one of the most common regions for a woman to develop a bacterial infection. Half off all women will experience at least one urinary tract infection in their lifetime. E. coli, bacteria that cause urinary tract infections, are becoming increasingly resistant to common antibiotics. The study concluded that 80% of the antibiotic-resistant bacteria were prevented from sticking by the anti-adhesion property of cranberries. There is some conjecture that PAC’s found in cranberry may minimize stomach ulcers and gum disease by the same mechanism.

This study compared the action of PAC’s in cranberries to those in other foods such as grape and apple juice, dark chocolate and green tea. Apparently, not all PAC-rich foods have the same success or offer the same protection. By means of comparison, one eight-ounce glass of cranberry juice has the equivalent PAC’s as a cup of frozen or fresh cranberries, 1/3 cup of sweetened dried cranberries or 1/3 cup of cranberry sauce. Both this study and earlier research show that the benefits of one glass of cranberry juice kicks in about two hours after consumption and lasts for about 10 hours. So, it is recommended that you drink one glass of cranberry juice in the morning and one in the evening for the maximum protection. Remember, cranberry is a food and not a treatment. Keep in mind that anyone who suspects an infection should consult the appropriate health care practitioner.

Here, Use My Toothbrush…

Ever use someone else’s toothbrush? You may think twice about doing it again after reading this:

 Toothbrushes can be a source of repeated dental infections.

 Toothbrushes can cause a bacteremia (bacteria entering the bloodstream) that may result in an endocarditis (a heart infection).

 Toothbrushes can harbor and transmit viruses and bacteria.

 Toothbrushes can retain 50% of the herpes simplex virus for one week.

 Gingival [gum] inflammation can be reduced by changing toothbrushes biweekly.

Still think it’s sexy to share a toothbrush? How about sharing food? Kissing? Certain bacteria can be transmitted from site-to-site in the mouth via dental instruments or from person-to-person sharing someone else’s eating utensil. In juvenile periodontitis, virulent bacteria can move from an infected site to an uninfected site in the same mouth. Certain bacteria can be transmitted between spouses. Certain bacteria can be transmitted between parents and children. Certain bacteria can be transmitted from dogs to children.

So you see, bacteria once thought to be localized to specific sites in the mouth, can be migratory. We’re not advocating that you stop tasting a scrumptious morsel or two at a four-star restaurant; we are advocating that everyone maintain good dental health not only for themselves but for the sake of those they love.

As far as ridding toothbrushes of bacteria, soaking them in a mouthrinse containing essential oils for 20 minutes kills 100% of the bacteria on the bristles. Ultraviolet light also sanitizes toothbrushes. But when researchers* tested the efficacy of using a toothpaste containing a common disinfectant compound – triclosan – they found little benefit when it came to eliminating the offending bacteria attached to the toothbrush bristles.

So what can you do about bacterial contamination from toothbrushes? Soak them in a suitable mouthwash, expose them to ultraviolet light, or from a practical stance, change them frequently. As for kissing someone, the benefits may still outweigh the risks …as long as you have an inkling as to their periodontal status!

*Warren DP, Goldshmidt MC, Thompson MB, Adler-Storhz K, and Keene HJ: The effects of toothpastes on residual microbial contamination of toothbrushes. JADA 132:1241-1245, 2001.

Help! I Broke My Tooth!

Almost every day we get a call from a patient who has broken a tooth, and generally it means that to save the tooth, we have to place a crown or permanent restoration over it to keep it from breaking further. Sometimes the tooth can’t be saved and that is a real bummer!

What causes teeth to break? Well, there are several factors, one of which we see in almost all tooth fractures. The most common contributing factor is Silver amalgam fillings- these fillings have the unique property of enlarging as they age. So, there seems to be some outward pressure on the tooth and if someone bites just the right (or wrong) way, you hear that crack!

Now this tooth broke in several planes at once, and had to be removed; there wasn’t enough sound tooth structure to save it! So an implant or bridge needed to be done.

This is a more common sort of fracture. The inside aspect of the tooth just shears away. Luckily, this tooth can be saved with a crown, after first making sure there is no decay present.

The second common factor is bruxism- the habit of grinding or clenching the teeth. Many bruxers break teeth that don’t even have fillings in them, but they always have a higher percentage of broken teeth than people who don’t brux or clench.

If you or someone you know does grind their teeth and are worried about a tooth or some teeth, don’t hesitate to give us a call and we will be glad to check it out for you! Don’t wait until it hurts!

Quality Dental Care

Quality dental care is essential for your child’s lifelong oral health. It’s important that your child’s first experiences with the dentist are positive. That’s why your dentist will make every effort to help your child feel comfortable and in control during each visit. Your own attitude and example also play an important role in setting the stage for a lifetime of healthy smiles!

Your child should visit a dentist as early as six months, when the baby’s first tooth appears. A first tooth’s appearance is an excellent time to schedule a dental evaluation. At that time, your dentist will diagnose and help prevent any future oral disorders. Your dentist can also answer any questions you have about caring for your child’s teeth.

During your visit your attitude can convey the message that dental visits are pleasant adventures. Emphasize the attention that your child will get while in the chair. Try to schedule the appointment for the time of day when your child is most rested and cooperative. To prepare your child, read a story together about a trip to the dentist. You may want to play dentist and take turns looking into each other’s mouth with a flashlight. Have fun; this should be a pleasant experience!

Choosing A Toothpaste

While toothpaste [dentifrice] is a valuable adjunct to a toothbrush in oral hygiene, it is the correct brushing action that removes the plaque [sticky mixture of bacteria, food & debris] from your teeth.

 Fluoride Any brand toothpaste that contains fluoride and the ADA Seal of Approval, to attest that there is evidence of its safety, reliability and effectiveness through clinical trials, is acceptable. It makes no difference if the toothpaste is a gel, paste or powder or which flavoring agent is used. However, from an individual motivational standpoint, and assuring its use, these characteristics may be important. Other than fluoride, which strengthens the enamel and fights decay, toothpastes contain abrasives to remove stain and polish the teeth and ingredients to leave the mouth with a clean, fresh feeling.

 Sensitive Teeth If your teeth are sensitive to hot or cold, choose a desensitizing paste with either strontium chloride or potassium nitrate as an added ingredient. Expect about 4-6 weeks to see real improvement.

 Tartar Control There are brands of toothpaste that advertise “tartar control” and usually have the active ingredient pyrophosphate. While it will not remove tartar, studies have shown it will reduce tartar formation up to 36%. Tartar [calculus] can only be removed with a professional prophylaxis [cleaning].

 Abrasiveness Many toothpastes now contain baking soda, which is less abrasive. This is advantageous for reducing tooth sensitivity in people with gum recession or those who have eroded their teeth by rigorous brushing with an abrasive toothpaste.

 Whitening Bleaching teeth to make them lighter has become popular. If you desire a whitening toothpaste, look for the active whitening agents of carbamide peroxide or hydrogen peroxide. These toothpastes serve best to maintain the tooth shade after bleaching procedures. Call our office if you have bleaching questions.

 Dentures If you wear partial or full dentures, they will also stain and absorb odors. Ask your pharmacist to recommend an ADA Accepted denture cleaning paste and/or solution. When brushing, it is not necessary to overload your brush with toothpaste. Squeeze a “pea-sized” amount on the top of the bristles. Correct brushing techniques will cause the paste to foam and cover all of your teeth.

The Developing Dentition: What To Expect

Usually, a baby’s teeth are not visible at birth, but they are present under the gums. However, sometimes a baby is born with 1-2 teeth. Women who breast-feed will have to be careful, or they will be bitten. We will get two sets of teeth – 20 baby teeth [also known as primary or deciduous] and 32 permanent teeth.

As the primary teeth get ready to erupt into the mouth, the gums get hard, red and swollen. This process called “teething” can also cause discomfort, excessive drooling, runny noses, low-grade temperature and/or overall crankiness. However, each child may exhibit some differences, sot there is an average range within tooth eruption occurs [see chart]. For example, if a child is breathing in second-hand smoke from one or both parent smokers, the eruption of his/her teeth can be delayed 4-5 months.

The two lower front teeth [deciduous central incisors] are typically the first to arrive when the child is 6-8 months old. There will be periodic eruption of the rest of the primary teeth, usually in pairs on both sides of the jaws. By the time your child is 2½ years old, all of the deciduous teeth should be visible. Eventually, the primary teeth will become loose and fall out or be removed easily. Their permanent counterparts should replace all of the primary teeth. It’s important, however, to maintain a child’s primary teeth. They are necessary for chewing food properly, speech, and physical appearance. If a primary tooth decays and abscesses, it could damage the developing bud of the permanent tooth underneath. Also, premature loss of a back [posterior] primary tooth could reduce the amount of space necessary for its permanent replacement. In the primary dentition, large spaces between the teeth are normal.

Usually, the first permanent teeth to erupt are the child’s four first molars that do not replace any teeth but come in directly behind the child’s deciduous second molars. This occurs are about 5½ – 6 year old [sometime called the six-year molars]. The progression of tooth replacement/eruption follows with the four permanent front teeth [central incisors] at about age 6-7. The eruption of the permanent teeth is almost complete at age 12-13 when the second permanent molars come in. the third molars [wisdom teeth] may erupt anywhere between 1- to 21 plus years. It’s quite common for wisdom teeth to be impacted in the bone and never erupt. Sometimes other permanent teeth are congenitally missing and will never be present. This is typically diagnosed with proper x-rays [radiographs]. One of the concerns that we verify at the check-up appointment is that your child’s teeth are developing properly and taking their correct position in the mouth. If you have questions regarding your child’s teeth development or eruption pattern, please call our office.

What Can I Eat If I Am Wearing Braces?

The following substances will cause damage to the braces and should absolutely not be eaten: candy apples, caramels, hard and sticky candy, candy bars, aquarium gravel, gum balls, jaw breakers, chicklets, or other gum, popcorn, bones, nuts, ice, chips, chewable vitamins, or any other crunchy or sticky items.

Foods such as apples, carrots, celery, pretzels, French bread, bagels, waffles, and meats should be cut into small pieces and chewed with your back teeth. Keep pencils, fingernails, straws, etc. out of your mouth. Please realize that the use of sugar-containing candy, soda, gum, etc. also promotes tooth decay.

If a bracket falls off, the wire bends or anything else breaks or becomes loose, the patient needs to call right away so that an appointment may be made for the appropriate length of time (generally 30-45 minutes) that we need in order to make the repair. This is especially important even if the patient already has an appointment scheduled.

We know that loose bands, poking wires and other problems can occur with even the most careful and cooperative patients and we will work with you to accommodate your needs in every way we can.

The Right Age To Consider Orthodontics

The American Association of Orthodontics recommends that a child first be seen by an orthodontist as early as age 7 or earlier should a parent or the family dentist discover a problem. The timing of orthodontic treatment is extremely important and greatly affects the treatment result. Since no two patients are alike, there is no absolute, specific age that is best to begin treatment.

Many progressive treatments are now available for patients six to eleven years old that provide significant benefits, especially in jaw irregularities. These treatments may also prevent certain conditions from worsening. Treating children during their growth stages enables us to achieve results that may not be possible when the face and jaw bones have fully developed. This early treatment can simplify or eliminate additional treatment.

Early diagnosis and treatment by an orthodontic specialist can help guide facial growth and tooth eruption, thus preventing more serious problems from developing. Our goal is to reduce treatment time in full braces and to provide the best and most stable results possible.

Potential Benefits of Timely Treatment

 Influence growth of the jaws in a positive manner

 Improve the width of the dental arches

 Reduce the need to extract permanent teeth

 Reduce or eliminate the need for jaw surgery

 Lower the risk of trauma to protruded front teeth

 Correct harmful oral habits

 Simplify and shorten treatment time

 Increase the stability of final treatment results

 Reduce the likelihood of impacted permanent teeth

 Improve speech development

 Improve the position of the first permanent molars

 Guide permanent teeth into more favorable positions

 Improve lip closure

 Preserve or gain space for erupting teeth

 Reduce the potential for damage to the Temporal Mandibular Joint

 Better cooperation before the teenage years