Chronic pain can turn your life upside down. While there are a number of disorders that fit in this category, two of them—fibromyalgia and temporomandibular disorders (TMD)—can disrupt your quality of life to the extreme. And it may be the two conditions have more in common than similar symptoms—according to one study, three-fourths of patients diagnosed with fibromyalgia show symptoms of TMD.
To understand why this is, let’s take a closer look at these two conditions.
Fibromyalgia presents as widespread pain, aching or stiffness in the muscles and joints. Patients may also have general fatigue, sleep problems, mood swings or memory failures. TMD is a group of conditions that often result in pain and impairment of the temporomandibular joints that join the jaw with the skull. TMD can make normal activities like chewing, speaking or even yawning painful and difficult to do.
Researchers are now focusing on what may, if anything, connect these two conditions. Fibromyalgia is now believed to be an impairment of the central nervous system within the brain rather than a problem with individual nerves. One theory holds that the body has imbalances in its neurotransmitters, which interfere with the brain’s pain processing.
Researchers have also found fibromyalgia patients with TMD have an increased sensitivity overall than those without the conditions. In the end, it may be influenced by genetics as more women than men are prone to have either of the conditions.
Treating these conditions is a matter of management. Although invasive techniques like jaw surgery for TMD are possible, the results (which are permanent) have been inconclusive in their effectiveness for relieving pain. We usually recommend patients try more conservative means first to lessen pain and difficulties, including soft foods, physical therapy, stretching exercises and muscle relaxant medication. Since stress is a major factor in both conditions, learning and practicing relaxation techniques may also be beneficial.
In similar ways, these techniques plus medication or cognitive-behavioral therapy that may influence neurotransmission can also help relieve symptoms of fibromyalgia. Be sure then that you consult with both your physician and dentist caring for both these diseases for the right approach for you to help relieve the effects of these two debilitating conditions.
If you would like more information on managing TMD or fibromyalgia, 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 “Fibromyalgia and Temporomandibular Disorders.”
The March 27th game started off pretty well for NBA star Kevin Love. His team, the Cleveland Cavaliers, were coming off a 5-game winning streak as they faced the Miami Heat that night. Less than two minutes into the contest, Love charged in for a shot on Heat center Jordan Mickey—but instead of a basket, he got an elbow in the face that sent him to the floor (and out of the game) with an injury to his mouth.
In pictures from the aftermath, Love’s front tooth seemed clearly out of position. According to the Cavs’ official statement, “Love suffered a front tooth subluxation.” But what exactly does that mean, and how serious is his injury?
The dental term “subluxation” refers to one specific type of luxation injury—a situation where a tooth has become loosened or displaced from its proper location. A subluxation is an injury to tooth-supporting structures such as the periodontal ligament: a stretchy network of fibrous tissue that keeps the tooth in its socket. The affected tooth becomes abnormally loose, but as long as the nerves inside the tooth and the underlying bone have not been damaged, it generally has a favorable prognosis.
Treatment of a subluxation injury may involve correcting the tooth’s position immediately and/or stabilizing the tooth—often by temporarily splinting (joining) it to adjacent teeth—and maintaining a soft diet for a few weeks. This gives the injured tissues a chance to heal and helps the ligament regain proper attachment to the tooth. The condition of tooth’s pulp (soft inner tissue) must also be closely monitored; if it becomes infected, root canal treatment may be needed to preserve the tooth.
So while Kevin Love’s dental dilemma might have looked scary in the pictures, with proper care he has a good chance of keeping the tooth. Significantly, Love acknowledged on Twitter that the damage “…could have been so much worse if I wasn’t protected with [a] mouthguard.”
Love’s injury reminds us that whether they’re played at a big arena, a high school gym or an outdoor court, sports like basketball (as well as baseball, football and many others) have a high potential for facial injuries. That’s why all players should wear a mouthguard whenever they’re in the game. Custom-made mouthguards, available for a reasonable cost at the dental office, are the most comfortable to wear, and offer protection that’s superior to the kind available at big-box retailers.
If you have questions about dental injuries or custom-made mouthguards, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “The Field-Side Guide to Dental Injuries” and “Athletic Mouthguards.”
It takes only a short time neglecting your oral hygiene before you begin to notice some unpleasant things with your gums: swelling, redness or even bleeding. These are all signs of gingivitis, a periodontal (gum) disease that arises from bacterial plaque, a thin biofilm that builds up on tooth surfaces when a person doesn't brush or floss.
Fortunately, early stages of gingivitis can be treated effectively with comprehensive plaque removal during one or more office visits. If, however, it's not dealt with early, it can develop into something much more serious: acute necrotizing ulcerative gingivitis (ANUG). This form does more than leave you with unattractive teeth and gums and terrible breath — it could eventually cause you to lose your teeth.
ANUG is also known as trench mouth, a common ailment among front line World War I soldiers without access to proper dental care and hygiene. It's most prevalent today among individuals who are under a great deal of stress, not sleeping or eating well and haven't cleaned or properly cared for their teeth for an extended period of time. Tobacco smokers also seem more susceptible than non-smokers to the disease, perhaps because smoke dries the mouth and changes the bacterial environment.
Unlike common gingivitis, ANUG can be quite painful. In effect, the gum tissues begin to die (necrotize), especially the triangular peaks between teeth known as papillae. Besides the other symptoms of gingivitis, the tissues may become yellowish.
ANUG can be treated effectively. The first step is to relieve the symptoms of pain and inflammation through medication. The focus then shifts to treating the underlying cause, bacterial plaque. Besides plaque removal common in any treatment for gum disease, we may also need to initiate antibiotic therapy. Metronidazole is a common antibiotic that's been demonstrated effective against the specific bacterial strain associated with ANUG. We might also combine this with an antibacterial mouth rinse containing chlorhexidine.
The final step belongs to you: to keep ANUG or any other gum disease from reoccurring, it's important for you to adopt a daily regimen of brushing and flossing, along with regular dental visits for thorough teeth cleaning and checkups. Taking this proactive approach will help ensure you won't suffer from this painful and unattractive form of gingivitis again.
If you would like more information on acute gingivitis, 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 “Painful Gums in Teens & Adults.”
Root canal treatments are an essential part of dental care — countless teeth with deep decay would be lost each year without it. Now, this traditional dental care procedure is advancing to a new level of precision through lasers.
Root canal treatments have a simple goal: access a tooth's infected pulp and root canals, clean out the infected tissue and fill the empty pulp chamber and canals with a special filling. Once filled, the access is sealed and a porcelain crown later placed for additional protection against re-infection.
In the traditional procedure, we perform these steps manually with a dental drill and hand instruments. We may also need to remove a good portion of tooth structure, both healthy and infected tissue. A laser, on the other hand, is a highly focused beam of light with the ability to interact with healthy and infected tissues differently: destroying infected tissue while having no effect on nearby healthy tissue. The end result: we may be able to remove less healthy tissue with lasers than with the conventional procedure.
Lasers are also helpful with softening and precisely molding the filling material within each canal's particular shape. And, early reports seem to indicate a higher degree of comfort for patients (less drill noise and need for anesthesia), less bleeding and faster recovery times than the conventional approach.
But as a tool for root canal treatments, lasers do have a couple of disadvantages. While light travels in a straight line, root canals are rarely straight — conventional instruments with curved designs usually accommodate odd canal shapes better than a laser. Lasers can also raise temperatures within a tooth that can damage healthy tissue, both within the pulp and outward into the dentin.
Still, lasers for root canal treatments appear promising with some dentists using a combination of lasers and manual techniques to garner benefits from both approaches. While you won't see lasers replacing the traditional root canal treatment anytime soon, the future looks bright for more efficient ways to treat deep tooth decay.
Tooth decay is an ever present danger for your baby’s developing teeth. It begins with disease-causing bacteria feasting on leftover sugar, producing high levels of oral acid that slowly dissolves the teeth’s protective enamel. The softened enamel then becomes an open door for decay to infect the tooth.
Meanwhile, those bacteria continue to eat and produce acid….
So how can you stop this devastating cycle? Besides daily oral hygiene and regular dental visits, the most important thing you can do is deprive bacteria in your baby’s mouth of sugar through limiting their consumption of it. This means you’ll first need to identify the different sources of sugar available to your baby—and some of them might surprise you.
Here, then, are 3 not-so-obvious sugar sources your baby might be consuming.
During feeding. If you’re breast-feeding, you may not think this is causing a sugar problem for your baby. True, breast milk by itself doesn’t promote decay: it’s the combination of it with other sugar-rich foods and liquids the baby might be consuming as they get older. Together this could significantly increase their risk of pediatric tooth decay (also known as early childhood caries or ECC). So, be careful to limit sugar in other things they’re eating or drinking in addition to nursing.
24/7 Baby bottles and pacifiers. To calm infants at nap or sleep time, parents or caregivers often use bottles filled with sweet liquids or pacifiers dipped in jam, syrup or sugar. This practice increases decay risk from both the added sugar and its constant availability to bacteria in the mouth around the clock. Instead, avoid this practice and limit any sugary foods or liquids to mealtimes.
Medications. Some medications an infant may be taking for a chronic illness may contain small amounts of sugar. Additionally, medications like antihistamines can reduce the production of saliva that’s needed to neutralize acid after meals. If your child is on medication, ask your healthcare provider about its dental effects and if there are any sugar-free alternatives. Be sure to keep up daily brushing and flossing and regular dental visits too.
Limiting your baby’s sugar intake is critical in preventing tooth decay. It’s one of the most important things you can do to protect their dental health.
If you would like more information on helping your child avoid tooth decay, 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 “Age One Dental Visit: Why It’s Important for Your Baby.”
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