By Kevin J Kean DDS
December 07, 2019
Category: Oral Health
Tags: tmj disorders  
SeekCoordinatedTreatmentIfYouHaveBothTMDandFibromyalgia

Fibromyalgia is a chronic condition that produces widespread pain and stiffness in the muscles and joints. The pain, muscle spasms and tingling it causes can disrupt sleep, alter moods and impair memory function.

Dealing with just this one condition can be overwhelming. But did you know 3 out 4 fibromyalgia patients also develop chronic pain and dysfunction involving their jaw joints? Known collectively as temporomandibular joint disorders (TMD), these jaw joint problems cause pain, muscle spasms and difficulty moving the jaws that can interfere with eating and speaking. TMD can also contribute to headaches and earaches.

Many researchers believe this prevalence of TMD among fibromyalgia patients stems from both conditions originating from the same primary cause—a malfunction within the central nervous system. In both cases, the brain and spinal cord may not be able to process pain signals in a normal fashion. This malfunction could also be generating and amplifying pain signals even when nerves are receiving no stimulation.

For decades now, the most effective treatment strategy for TMD has been to manage the symptoms with physical therapy and exercises, thermal therapy or medications. Relief for fibromyalgia has depended on medication and relaxation techniques like biofeedback therapy. But with the evidence of some connection between the two conditions, it may be helpful to coordinate treatment for both with a team approach involving all your healthcare providers, rather than treat them separately.

To that end, make sure both your dentist or physician treating you for TMD and your physician treating your fibromyalgia each know about the other condition. Consulting together, your healthcare team may find treatments (like certain drugs that counteract neurotransmitter imbalances) that might help reduce symptoms in both conditions. And cognitive-behavioral therapy, meditation and other therapeutic pain management techniques can help you cope with the pain.

Continued research into these two debilitating conditions and the possible links between them may have an effect on how we treat both. A holistic approach to treating them could be the wave of the future.

If you would like more information on the links between TMD and other chronic pain conditions, 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.”

By Kevin J Kean DDS
November 27, 2019
Category: Dental Procedures
Tags: orthodontics   oral surgery  
ExposingandPreservingImpactedCanineTeeth

The final emergence of permanent teeth in late adolescence marks the end of a long process beginning in the womb with the formation of our primary or “baby” teeth. Permanent teeth form in a similar way as buds high in the jaw, continuing to grow until the primary teeth ahead of them fall away. The crowns of the new adult teeth eventually break through the gum tissue and emerge (erupt) into view.

At least, that’s normally what should happen; sometimes, though, a tooth may only erupt partially or not at all, a condition known as impaction. The crown remains partially or fully submerged below the gum line, causing the tooth to press against other teeth, potentially damaging them. It can also make periodontal (gum) tissues adjacent to the area more susceptible to disease. Wisdom teeth are especially prone to this kind of impaction, to the extent they’re often surgically removed (extracted) to avoid future problems to adjacent teeth or the bite.

Upper canines (the “eye teeth” normally located directly below the eyes) are also subject to impaction. But because of their highly visible position, extracting them could have an adverse impact on the patient’s smile. In this case, we often attempt instead to expose and ultimately save the tooth.

Before taking any action, however, an orthodontic examination is conducted first to pinpoint the exact position of the impacted tooth and determine how that position might affect moving teeth into a more desired alignment. If we find the impacted canine is in a workable position, the next step is to surgically uncover the tooth from the gum tissue (a minor procedure usually performed by an oral surgeon or periodontist). Once exposed, an orthodontic bracket with a small attached gold chain is bonded to the tooth. The gums are then sutured back into place with the chain exposed and allowed to heal.

At some future point an orthodontist will attach the chain to orthodontic hardware that will pull the impacted tooth into proper position over several months. As a result, the upper canine becomes “un-impacted”; the dangers to surrounding teeth and tissues are also reduced. And, just as important, we can preserve the tooth and with orthodontics achieve an attractive, normal smile.

If you would like more information on the effects and treatment of impacted teeth, 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 “Exposing Impacted Canines.”

TeensMayNeedaTemporaryRestorationforMissingTeeth

While not as prevalent as adults, teenagers can have missing teeth, usually from injury or from never having been formed. Fortunately, life-like dental implants can replace missing teeth. But unfortunately for teens, implants aren't usually a good option—yet.

That's because a teenager's jaws are still growing, and will continue until early adulthood. Dental implants don't adjust to this growth like natural teeth and will eventually look out of place. It's best, then, to consider a temporary restoration for a teenager. And, there are two excellent options: one removable and one fixed.

The first is a removable partial denture (RPD). Like a full denture, an RPD has an acrylic base that resembles gum tissue, to which prosthetic (false) teeth are attached to match the positions of the missing teeth. It's usually held in place with metal or nylon clips that slide under part of the natural teeth at the gum line.

RPDs are versatile and durable. But they're not designed to be worn indefinitely, so they can be damaged if subjected to excessive biting forces like biting into something hard. And, peer-pressured teens may also feel self-consciousness about wearing a “denture.”

The other option is a bonded bridge. It's similar to a traditional bridge, except how it's supported in the mouth. A traditional bridge gains its support from the crowns on each end attached to natural teeth, which must be permanently altered for them. By contrast, a bonded bridge has strips of dental material extending from both sides of its back that are bonded to the back of the adjacent natural teeth.

With the bonding material behind the bridge, it can't be seen—and the natural teeth won't require permanent alteration. But a bonded bridge is usually more costly than an RPD and less secure than a traditional bridge. And not every teen is a viable candidate for one: issues like how the teeth fit together and if the teen has a tooth grinding habit could be strikes against this fixed option.

Your dentist can help you sort out the best of these options for your teen. If cared for and maintained properly, either restoration can buy you time until your teen is ready for dental implants.

If you would like more information on restoring a teenager's smile, 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 “Temporary Tooth Replacement for Teens: What Are the Options?

By Kevin J Kean DDS
November 07, 2019
Category: Dental Procedures
CharlizeTheronBackinActionAfterDentalSurgery

When they’re introducing a new movie, actors often take a moment to pay tribute to the people who helped make it happen — like, you know, their dentists. At least that’s what Charlize Theron did at the premiere of her new spy thriller, Atomic Blonde.

"I just want to take a quick moment to thank my dentists," she told a Los Angeles audience as they waited for the film to roll. "I don’t even know if they’re here, but I just want to say thank you."

Why did the starring actress/producer give a shout-out to her dental team? It seems she trained and fought so hard in the action sequences that she actually cracked two teeth!

“I had severe tooth pain, which I never had in my entire life,” Theron told an interviewer from Variety. At first, she thought it was a cavity — but later, she found out it was more serious: One tooth needed a root canal, and the other had to be extracted and replaced with a dental implant — but first, a bone grafting procedure was needed. “I had to put a donor bone in [the jaw] to heal,” she noted, “and then I had another surgery to put a metal screw in there.”

Although it might sound like the kind of treatment only an action hero would need, bone grafting is now a routine part of many dental implant procedures. The reason is that without a sufficient volume of good-quality bone, implant placement is difficult or impossible. That’s because the screw-like implant must be firmly joined with the jawbone, so it can support the replacement tooth.

Fortunately, dentists have a way to help your body build new bone: A relatively small amount of bone material can be placed in the missing tooth’s socket in a procedure called bone grafting. This may come from your own body or, more likely, it may be processed bone material from a laboratory. The donor material can be from a human, animal or synthetic source, but because of stringent processing techniques, the material is safe for human use. Once it is put in place your body takes over, using the grafted material as a scaffold on which to build new bone cells. If jawbone volume is insufficient for implants, it can often be restored to a viable point in a few months.

Better yet, when grafting material is placed in the tooth socket immediately after extraction, it can keep most of the bone loss from occurring in the first place, enabling an implant to be placed as soon as possible — even before the end of a movie’s shooting schedule.

Will Atomic Blonde prove to be an action-movie classic? Only time will tell. But one thing’s for sure: When Charlize Theron walks down the red carpet, she won’t have to worry about a gap in her smile.

If you have questions about bone grafting or dental implants, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “Dental Implant Surgery” and “Immediate Dental Implant.”

TopicalFluorideOffersaProtectiveBoosttoChildrenatHighRiskforDecay

You're doing all the right things helping your child avoid tooth decay: daily brushing and flossing, regular dental visits and a low-sugar diet. But although occurrences are low, they're still getting cavities.

Some children still struggle with tooth decay even with proper dental care. If this is happening to your child, your dentist may be able to give them an extra preventive boost through topical fluoride.

Fluoride has long been recognized as a proven cavity fighter. Often added in small amounts to toothpastes and drinking water, fluoride strengthens tooth enamel against acid attacks that create cavities. With topical fluoride, a dentist applies a varnish, foam or gel containing a more concentrated amount of the chemical directly to the teeth.

The effectiveness of this method in reducing tooth decay is well-founded: A number of scientific studies involving thousands of children and adolescents found an average 28% reduction in occurrences of decay among those who received the treatment compared to those who didn't.

Still, many parents have concerns about the higher fluoride concentrations in topical applications. But even at this greater amount, fluoride doesn't appear to pose any long-term health risks. The most adverse effects—vomiting, headaches or stomach pain—usually occur if a child accidentally ingests too much of the solution during treatment.

Dentists, however, go to great lengths to prevent this by using guards to isolate the solution during an application. And in the case of a foam or gel application, parents can further lower the risk of these unpleasant side effects by not allowing their child to eat or drink for at least thirty minutes after the procedure.

The evidence seems to indicate that the benefits of regular topical fluoride applications for children at high risk outweigh the possible side effects. By adding this measure to your prevention strategy, you can further protect your child from this danger to their current and future dental health.

If you would like more information on tooth decay prevention for your child, 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 “Fluoride Gels Reduce Decay.”





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