TMJ Disorders

Temporomandibular joint and muscle disorders, commonly called "TMJ," are a group of conditions that cause pain and dysfunction in the jaw joint and the muscles that control jaw movement. We don't know for certain how many people have TMJ disorders, but some estimates suggest that over 10 million Americans are affected. The condition appears to be more common in women than men.

What is Temporomandibular Joint?

The temporomandibular joint connects the lower jaw, called the mandible, to the bone at the side of the head - the temporal bone. If you place your fingers just in front of your ears and open your mouth, you can feel the joints. Because these joints are flexible, the jaw can move smoothly up and down and side to side, enabling us to talk, chew and yawn. Muscles attached to and surrounding the jaw joint control its position and movement.

When we open our mouths, the rounded ends of the lower jaw, called condyles, glide along the joint socket of the temporal bone. The condyles slide back to their original position when we close our mouths. To keep this motion smooth, a soft disc lies between the condyle and the temporal bone. The disc absorbs shocks to the jaw joint from chewing and other movements.

The temporomandibular joint is different from the body's other joints. The combination of hinge and sliding motions makes this joint among the most complicated in the body. Also, the tissues that make up the temporomandibular joint differ from other load-bearing joints, like the knee or hip. Because of its complex movement and unique makeup, the jaw joint and its controlling muscles can pose a tremendous challenge to both patients and health care providers when problems arise.

What are TMJ Disorders?

Disorders of the jaw joint and chewing muscles - and how people respond to them - vary widely. Researchers generally agree that the conditions fall into three main categories:

1. Myofascial pain, the most common temporomandibular disorder, involves discomfort or pain in the muscles that control jaw function
2. Internal derangement of the joint involves a displaced disc, dislocated jaw, or injury to the condyle.
3. Arthritis refers to a group of degenerative/inflammatory joint disorders that can affect the temporomandibular joint.

A person may have one or more of these conditions at the same time. Some people have other health problems that co-exist with TMJ disorders, such as chronic fatigue syndrome, sleep disturbances or fibromyalgia, a painful condition that affects muscles and other soft tissues throughout the body. 

People who have a rheumatic disease, such as rheumatoid arthritis, may develop TMJ disease as a secondary condition. Rheumatic disease refer to a large group of disorders that cause pain, inflammation, and stiffness to the joints, muscles, and bone. Both rheumatoid arthritis and some TMJ disorders involve inflammation of the tissues that line the joints. 

What are the Signs and Symptoms?

A variety of symptoms may be linked to TMJ disorders. Pain, particularly in the chewing muscles and/or jaw joint, is the most common symptom. Other likely symptoms include:

• Radiating pain in the face, jaw, or neck
• Jaw muscle stiffness
• Limited movement or locking of the jaw
• Painful clicking, popping or grating in the jaw joint when opening or closing the mouth
• A change in the way the upper and lower teeth fit together

Source:  National Institute of Dental and Craniofacial Research, U.S. Department of Health and Human Services

If You Think You Have a TMJ Disorder

After an initial consultation, if our surgeons determine that you suffer from TMJ, initial treatment will involve immediate muscle relief with the use of a pain reliever or anti-inflammatory. Other forms of stress management involve physical therapy or the use of a temporary plastic appliance known as a splint, that moves your jaw forward relieving pressure from your jaw. In some cases, surgery, such as arthoscopy and open joint repair, are required to produce optimal results. 

The main goal at our office is to assess your pain and provide you with treatment that will enable you to have a healthier, pain-free jaw. If you think you may suffer from TMJ, call our office to schedule a consultation today (512) 250-5012.

Implants: Options

Twenty-five years ago, if someone described how missing teeth could be replaced with implants, it might have been called a miracle. Ten years ago, the use of dental implants to replace missing teeth might have been called astounding. Today, implant procedures are called routine. We would like you to have a basic understanding of what implants are, what can be expected from them, and what limitations they might have in your specific area of need.

A dental implant is a synthetic metallic root substitute that is placed or implanted in the jaw bone. It can be used to replace a single missing tooth, provide an abutment (anchor or retainer), replace several missing teeth, or provide added retention to a removable dental appliance such as a full denture. In fact, if you are missing all of your natural teeth, it is possible to have maxillary (upper) and mandibular (lower) fixed replacements. The replacements do not come out and you cannot remove them yourself.

Two separate events are needed when replacing a missing tooth with an implant. First, is the surgical phase in which the implant is placed. In the second phase the replacement teeth are constructed and fixed into proper position.

The implant placement procedure involves making a small incision in the gum area where the implant is to be placed, preparing a site in the underlying bone, inserting the implant into the prepared site, and closing the tissue over the implant with several sutures. This area is left undisturbed, usually for 4 to 6 months. More healing time may vary due to the density of your bone. The lower jaw is composed of bone that is more dense than that of the upper jaw. This healing time allows for the slow integration of the implant within your jaw. The implant is held in place by the bone.

After the healing and integration of the implant, the placement site is exposed by reopening the gum. A post will then be fastened to the implant by cement or with internal threads. The crown, bridge, or other type of replacement will be attached to this post. Some dentists prefer to do all phases of the implant procedure themselves, but many choose to perform either the surgical or prosthetic (the actual construction of the replacement device) only. If this is the case, you will be referred to a periodontist or oral surgeon who will perform the surgical portion of the implant placement.

Implants are very successful. Maxillary and mandibular implants are more than 90% successful. Lower implants have a somewhat higher success rate than upper implants. Occasionally, implants fail, but it is not common. Chances of an implant failure, many times, can be determined during or after the surgical phase before the replacement tooth or teeth are constructed.

*Smokers take note:  There is a heightened risk of dental implant failure among smokers - as much as 20% greater failure rate!

We will discuss with you the requirements and options for your particular situation. There are usually several possibilities for effectively replacing missing teeth. It is important to decide on the design of the implant-retained replacement prior to the actual implant surgical procedure. Position and alignment of the replacement teeth need to be carefully considered before determining the location of the implant.

If you have any questions about implants, please feel free to call Omni Dental Group.

North location on Hymeadow Drive: (512) 250-5012
Central location on Jollyville Road: (512) 346-8424
South location on William Cannon Drive: (512) 445-5811

Scaling and Root Planing: Reevaluation

The goal of scaling and root planing is to remove all plaque, toxins, and calculus both above and below the gumline. After healing has occurred, the tissues will shrink, and a reevaluation of the condition of the gum and supporting structures will reveal any areas that may need re-treatment. Your oral self-care habits will be reevaluated at the same time and any revisions to our recommendations will be made. We will be polishing your teeth at this appointment. As you will recall, we did not polish your teeth during the root planing and scaling appointments. Although the polishing can, in theory, be done then, we believe that allowing tissues proper time to heal will allow us to make the best reevaluation of our treatment and oral self-care recommendations. That is why there is a time period of several weeks between the root planing and scaling appointment and this prophylaxis and evaluation. Once all tissues have responded and the goals of scaling and root planing are met, a recare interval will be established for you.

At the recare appointment, we will once again be evaluating your oral self-care to determine whether we need to recommend different procedures to keep your oral health at its best. We will reexamine your periodontal tissues for evidence of healing by remeasuring the probing depths around each tooth. Any areas of bleeding will be noted and treated; your teeth will then be polished and a topical fluoride treatment will be applied.

Topical fluoride provides a bacteriostatic action to the oral bacteria during treatment and for several hours afterward. It appears to be harder for the bacteria that cause gum disease to multiply and cause problems when topical fluoride is used.

If the goals of scaling and root planing have not been met, we will either re-treat those areas that have reinfected or refer you to a periodontist for specific periodontal surgery. The periodontal surgery will correct some of the hard (bone) and soft tissue defects that were caused by the periodontal infection.

At this time we may also consider using one or more of the newer nonsurgical therapies available for localized sites that have not healed as much as we would like. The site-specific therapy may be recommended for the first time or as a re-treatment. We will then monitor the results to determine whether a referral to a periodontist is appropriate.

A final word about how often you should have your teeth cleaned:  modern dentistry considers a patient who has had gum disease to be always recovering, never completely "cured." If you do not take care of your teeth and gums, the problem can come back again. It is in the best interest of your oral health to have your teeth examined and cleaned at an interval of 3 to 4 months in most cases, not every 6 months as you have heard for years.

If you have any questions about the prophylaxis and reevaluation appointment, please call Omni Dental Group at (512) 250-5012.

How Can I Keep My Mouth Healthy?: Oral Health for Children

Children's teeth begin forming before birth. As early as 4 months, the first primary, or baby teeth, erupt through the gums. All 20 of the primary teeth usually appear by age 3, although their pace and order of eruption varies.

Permanent teeth begin appearing around age 6. This process will continue until approximately age 21.

Oral Health for Children

To help ensure oral health and a lifetime of good oral care habits:

• Limit children's sugar intake
• Make sure children get enough fluoride, either through drinking water or as a treatment at the dentist's office
• Teach children how to brush and floss correctly
• Supervise brushing sessions and help with flossing, which can be a challenge for small hands

Major Obstacles to Children's Oral Health

Babies

"Baby bottle tooth decay"

• Wipe gums with gauze or a clean washcloth and water after feeding. When teeth appear, brush daily with a pea-sized amount of fluoride toothpaste.
• Put child to bed with a bottle of water, not milk or juice

Thumb sucking

• Not a concern until about 4 years of age or when permanent teeth appear; after this time, it could cause dental changes

White spots on teeth

• As soon as the first tooth appears (at about 6 months), begin cleaning child's teeth daily and schedule a dental appointment

Toddlers

Fear of the dentist

• Hold the child in the parent's lap during the exam

Difficulty creating an oral care routine

• Involve the whole family - brush together at the same time each day to create a good habit

Gradeschoolers

Love of sweets

• Give children healthy snack options, like carrots, raisins, and yogurt

Stains from antibiotics

• Speak to the pediatrician before any medication is prescribed

Teenagers

Braces

• Make sure that teens brush well around braces, using a floss threader to remove all food particles

Oral accidents from sports

• Encourage children to wear mouthguards during sports

The following are key preventative measures to preserve oral health through childhood:

Fluoride treatments to strengthen tooth enamel and resist decay.

Dental sealants to provide a further layer of protection against cavities. Sealants are made of plastic and are painted on the teeth  by a dentist.

A fun oral care regimen to help encourage children to brush more regularly. 

If you have any questions about your child's oral health, please call Omni Dental Group. We have three locations to serve you and your family.

North Austin on Hymeadow Drive:  (512) 250-5012

Central Austin on Jollyville Road:  (512) 346-8424

South Austin on William Cannon:  (512) 445-5811

Source:  Crest

Periodontal Disease and Systematic Health

Research clearly shows that there is a strong correlation between oral (periodontal) infections and generalized (systematic) medical problems. There are over 300 different types of bacteria normally found in the human mouth, and the mouth is connected to the entire body.

A gum infection is similar to an infection that might occur elsewhere in your body. Bacteria are everywhere, including in our mouths. When the bacteria multiply past a critical number, problems begin. Why would the bacterial count change? Poor oral self-care, genetics, prescription medication, illness or systematic problems, and diminished salivary flow might contribute. When the body recognizes bacterial invaders, the immune system initiates a response to fight off the invader.

                                              

You might say, "My gums have always bled like this," and not seek treatment. Imagine seeing blood gushing from your eyes when you washed your face. You would seek immediate medical attention, perhaps even go to an emergency room!

Gum disease is an infection in your mouth, no different than an infection elsewhere in your body. The bacteria invade the soft tissues and the bone and get into the blood stream.  In this way, they are then able to circulate throughout the entire body. Along with bacteria are dead cells, metabolic by-products, toxins, food debris, and viruses.

Just as we know that smoking has adverse affect on our health, science is examining a link between gum disease and many systematic conditions such as cardiovascular and respiratory disease, chronic obstructive pulmonary disease, premature birth and low birth weight, stroke, diabetes mellitus, and possibly rheumatoid arthritis. Although the scientific data have yet to confirm the links as diagnostic indicators, it is important for us to recognize the possible implications. The oral cavity is part of the human biology linked to all other body systems and is a portal of entry for a host of infective organisms. It only makes sense to keep it as clean as possible to reduce the risk of not only oral infection but possibly systematic inflammation as well.

Thorough oral self-care need not be difficult or time-consuming. The benefits are more than just sweet breath and a great looking smile. Spending just a few minutes a day caring for your teeth and gums and coming in for the professional hygiene visits at the intervals we advise can make the difference between whole body health and disease. After all, the jaw bones are connected to all our other bones!

If you have any questions about periodontal disease, please call Omni Dental Group at (512) 250-5012.

Extraction

Reasons for Recommending Tooth Extraction

Teeth may need to be extracted for several reasons, including but not limited to:

• severe periodontal disease
• irreversible damage to the nerve tissue inside the tooth (and the patient decides against saving the tooth)
• failed endodontic therapy
• extreme fracture or decay of the tooth structure
• improper positioning of the tooth or for orthodontics purposes

To a great extent, the reason for the extraction will influence the amount of discomfort you might experience subsequent to the procedure. When the tooth is to be extracted for periodontal reasons, there will be reduced bone support for the tooth and the tooth might be removed more easily than if there were full bone support. In this case there might be lessened discomfort following the extraction.

Following the Extraction

We will tell you the reason for the extraction and let you know what to expect following the procedure. Please follow the instructions given to you. If antibiotics are prescribed, take them until the prescription is completely finished. If pain medication is prescribed, take it only if necessary. If the medication prescribed contains a narcotic component, such as codeine, do not drive a motor vehicle or operate machinery that could prove dangerous to yourself or others. Expect some bleeding to occur from the extraction site for the first 24 hours. Remember, there is now a hole in your jaw from which the tooth has been removed, and the hole can be quite large. Some bleeding is to be expected.

Some infrequent complications of routine oral surgical procedures include (but are not limited to):

• fracture of adjacent teeth or restorations (which of course would mean that these affected areas must be restored to normal function after the healing of the extraction site)
• separated root tips or root fragments
• temporary or permanent nerve damage to the area, resulting in anesthesia or paresthesia (numbness)
• incomplete healing, resulting in severe pain—a “dry socket”
• fracture of the surrounding bone

If you have any question about reasons for dental extraction, please feel free to call us @ 512-250-5012.

Smoking and Adult Periodontitis

If you are a smoker, you are at a higher risk for not only lung and circulatory problems but oral disease as well. Smoking causes cell death and may be responsible for more than 50% of cases of adult periodontics. It has been reported that more than 85% or all periodontal cases are present in people who spoke. And, more than 90% of gum infections that appear to be resistant to treatment (refractory gum disease) are found among smokers. Smokers are 2.6 to 6 times more likely to have periodontal disease. Former smokers are more likely to have periodontal disease. A person who smokes will not heal as well and does not respond as well to periodontal therapy as does a nonsmoker.

Thousands of chemicals are released during smoking, which causes a profound effect on the immune system that is responsible for helping us ward off infections. And since we now know that periodontal disease is an infection, it is easy to make the connection. Many smokers show few areas of bleeding during a periodontal charting because one of the effects of smoking is reduced circulation.

If you are reading this, you are most likely a smoker who has periodontal disease. Many smokers would like to stop this habit. Quitting is not as difficult as you may imagine. The thought of it is probably the most difficult aspect. There really are many aids today to help is to make that leap to a healthy decision about our dental and general well-being. Our office can be a great source for some suggestions to help you stop smoking. If you would like us to make suggestions for a healthier lifestyle, do not hesitate to ask!

If you have any questions, please give us a call @ 512-250-5012.