Temporamandibular Joint Disorder (T.M.D)

What is the Temporomandibular Joint?

The temporomandibular joint (TMJ) is a joint that slides and rotates just in front of your ear, consisting of the temporal bone (side and base of the skull) and the mandible (lower jaw). Mastication (chewing) muscles connect the lower jaw to the skull, allowing you to move your jaw forward, sideways, and open and close.

The joint works properly when the lower jaw (mandible) and its joint (both the right and left) are synchronized during movement. Temporomandibular Disorder (TMD) may occur when the jaw twists during opening, closing or side-motion movements. These movements affect the jaw joint and the muscles that control chewing.

What is Temporomandibular Disorder?
TMD describes a variety of conditions that affect jaw muscles, temporomandibular joints, and nerves associated with chronic facial pain. Symptoms may occur on one or both sides of the face, head or jaw, or develop after an injury. TMD affects more than twice as many women than men and is the most common non-dental related chronic orofacial pain.

What causes TMD?
Normal function for this muscle group includes chewing, swallowing, speech and communication. Most experts suggest that certain tasks, either mental or physical, cause or aggravate TMD, such as strenuous physical tasks or stressful situations. Most discomfort is caused from overuse of the muscles, specifically clenching or grinding teeth (bruxism).

These excessive habits tire the jaw muscles and lead to discomfort, such as headaches or neck pain. Additionally, abnormal function can lead to worn or sensitive teeth, traumatized soft tissues, muscle soreness, jaw discomfort when eating, and temporal (side) headaches.

What TMD symptoms can I experience?

- An earache without an infection
- Jaw pain or soreness that is more prevalent in the morning or late afternoon
- Jaw pain when you chew, bite or yawn
- Clicking when opening and closing your jaw
- Difficulty opening and closing your mouth
- Locked or stiff jaw when you talk, yawn, or eat
- Sensitive teeth when no dental problems can be found

What can I do to treat TMD?
The majority of cases can be treated by unloading (resting) the joint, taking a non-aspirin pain reliever and practicing stress management and relaxation techniques. It's important to break bad habits to ease the symptoms. Most treatment for TMD is simple, often can be done at home, and does not need surgery. For example, control clenching or grinding during the day by sticking your tongue between your teeth. If you still experience pain, you may be grinding or clenching your teeth at night. So see your Mortenson Family Dental dentist for a nighttime mouthguard.

Most people will experience relief with minor treatment. More severe cases may be treated with physical therapy, ice and hot packs, posture training and orthopedic appliance therapy (splint). Eating soft foods and avoiding chewing gum also will help relax the muscles.

Is TMD permanent?
The condition is often cyclical and may reoccur during times of stress, good or bad. As the patient, you should be active in your treatment after seeing a dentist for a diagnosis regime by being aware of the causes of your jaw problems. Make routine dental appointments, so your doctor can check TMD on a regular basis.

Sources
Giblisco, Joseph A. DDS, Charles McNeill, DDS, Harold T. Perry, DDS. Orofacial Pain; Understanding Temporomandibular (TMJ) Disorders. Quintessence Publishing Co., Inc., Carol Stream, Illinois. 1994.
E. Mac Edington, DDS, MAGD, ABGD.
NIDR, Temporomandibular Disorders, Bethesda, Maryland.
Wilkinson, Tom, "New patterns of dental disease; Management of temporomandibular disorders." Australian Dental Association News Bulletin, No. 246, July 1997.

Dry Mouth - Symptoms and Solutions

POSSIBLE DRY-MOUTH SYMPTOMS:

- Your saliva will be thick and stringy.
- You may have cuts or cracks in your lips or at the corners of your mouth.
- Your dentures may no longer fit well. This may cause sores on your gums.
- You will be thirsty.
- It may be hard to swallow and talk.
- You may lose your sense of taste.
- Your tongue and mouth may feel sore.
- You may get mouth sores, mouth pain, cavities (dental caries), or gum disease.

TAKE CARE OF YOUR MOUTH!

Brush your teeth and gums 2 or 3 times a day for 2 to 3 minutes each time. Use a toothbrush with soft bristles.
When you brush, rinse your brush in hot water every 30 seconds to keep the bristles soft.
Let your toothbrush air dry between brushings.
Choose toothpaste with care.
If toothpaste makes your mouth sore, brush with a solution of 1 teaspoon of salt mixed with 4 cups of water. Pour a small amount into a clean cup to dip your toothbrush into each time you brush. Use toothpaste with fluoride.
Floss gently 1 time a day. Rinse your mouth 5 or 6 times a day. Use any of these solutions when you rinse:
1 teaspoon of salt in 4 cups of water
1 teaspoon of baking soda in 1 cup (8 ounces) of water
½ teaspoon salt and 2 tablespoons baking soda in 4 cups of water
Avoid rinses that have alcohol in them. You may use an antibacterial rinse 2 to 4 times a day for gum disease. Rinse for 1 to 2 minutes each time.
Do not eat foods or drinks that have a lot of sugar in them. They may cause tooth decay. Use lip care products to keep your lips from drying out and cracking. Sip water to ease mouth dryness.
Eating sugar-free candy or chewing sugar-free gum may also help.

TALK TO YOUR DENTIST ABOUT:
Solutions to replace minerals in your teeth
Saliva substitutes
Drugs that help your salivary glands make more saliva
Diet
You need to eat enough protein and calories from other foods to keep your weight up.

TIPS TO MAKE EATING EASIER:
Choose foods that you like.
Serve foods with gravy, broths, or sauces to make them easier to chew and swallow.
Eat small meals, and eat more often.
Cut your food into small pieces to make it easier to chew.
Ask your doctor or dentist if artificial saliva might help you.
Drink at least 8 to 10 glasses of liquid each day (not including coffee, tea, or other drinks that have caffeine).
Drink liquids with your meals.
Sip cool drinks during the day.
Keep a glass of water next to your bed at night. Drink when you get up to use the bathroom or other times you wake up.
Ask your doctor about liquid food supplements. These can help you meet your energy needs.
Avoid alcoholic drinks. They will bother your throat. Also avoid foods that are very spicy, have a lot of acid or are very hot or cold.
If pills are hard to swallow, try crushing them with some ice cream or another soft food. Ask your doctor if it is okay to crush your pills. Some pills do not work if they are crushed.

References
Taubert M, Davies MR, Black I. Dry mouth. BMJ. Mar 24 2007;334(7594):600.
Johnson R, Johnson G. Integrating palliative and curative care strategies in the practice of otolaryngology. In: Cummings CW, Flint PW, Haughey BH, et al, eds. Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2010:chap 81.

The Symptoms Of Gum Disease (Gingivitis)

It may be hard to tell if you have a mild case of gum disease. Healthy gums are pink and firm, fit snugly around the teeth, and do not bleed easily. But mild cases of gum disease (gingivitis) cause gums that are red, swollen, and tender and/or gums that bleed easily during brushing or flossing.

As gum disease gets worse (periodontitis), the symptoms are easier to see, such as:

- Gums that pull away or shrink from the teeth
- Bad breath that won't go away
- Pus coming from the gums
- A change in how your teeth fit together when you bite
- Loose teeth

HOW IS GUM DISEASE DIAGNOSED?

To find out if you have gum disease, your Mortenson Family dentist will do an exam to look for:

- Bleeding gums
- Hard buildups of plaque and tartar above and below the gums
- Areas where your gums are pulling away or shrinking from your teeth
- Pockets that have grown between your teeth and gums

Your dentist or dental hygienist may take X-rays of your teeth to look for bone damage and other problems.

HOW IS GUM DISEASE TREATED?

If you have a mild case of gum disease, you will probably be able to take care of it by brushing and flossing your teeth every day and getting regular cleanings at your dentist's office.

If your gum disease has become worse and you have periodontitis, your dentist or dental hygienist will clean your teeth using a method called root planing and scaling. This removes the plaque and tartar buildup both above and below the gum line. You may also need to take antibiotics to help get rid of the infection in your mouth. If your gum disease is severe, you may need to have surgery.

HOW CAN YOU PREVENT GUM DISEASE?

Gum disease is most common in adults, but it can affect anyone, even children. So good dental habits are important throughout your life:

Brush your teeth 2 times a day, in the morning and before bedtime, with a fluoride toothpaste.
Floss your teeth once each day.
Visit your Mortenson Family dentist for regular checkups and teeth cleaning.
Don't use tobacco products.

If you think you have a mild case of gum disease, make sure to take care of it before it gets worse. Keeping your teeth and gums healthy and getting regular checkups from your dentist can keep the disease from getting worse.

Having gum disease may increase a pregnant woman's risk of having a premature, low-birth-weight baby. Also, studies have found a direct link between heart disease and the bacteria that cause gum disease. So taking good care of your teeth and gums may have benefits beyond keeping your mouth healthy.

- WebMD

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The Shocking Dangers Of Gum Disease

Brushing and flossing may actually save your life.

If you're worried about heart disease, you can easily spend thousands of dollars each year trying to prevent it, paying hand over fist for prescription medicines, shelves of healthy cookbooks, fitness machines for your home, and a gym membership.

Or maybe not. A number of recent studies suggest that you may already have a cheap and powerful weapon against heart attacks, strokes, and other heart disease conditions. It costs less than $2 and is sitting on your bathroom counter. It is none other than the humble toothbrush.

"There are a lot of studies that suggest that oral health, and gum disease in particular, are related to serious conditions like heart disease," says periodontist Sally Cram, DDS, a spokeswoman for the American Dental Association.

So can preventing periodontal disease, a disease of the gums and bone that support the teeth, with brushing and flossing prevent heart disease?

The evidence isn't clear yet, experts say, but it's intriguing. According to the American Academy of Periodontology, people with periodontal disease are almost twice as likely to have coronary artery disease (also called heart disease). And one study found that the presence of common problems in the mouth, including gum disease (gingivitis), cavities, and missing teeth, were as good at predicting heart disease as cholesterol levels.

EVIDENCE LINKS PERIODONTAL DISEASE AND HEART HEALTH

When it comes to the connection between periodontal disease and heart disease, epidemiologist Moise Desvarieux, MD, PhD, is used to dealing with skeptics.

"One of the talks I give is called, 'Investigating the Links Between Periodontal Infection and Vascular Disease: Are We Nuts?'" says Desvarieux, from Columbia University's Mailman School of Public Health. "It's not a connection that people naturally think of."

Desvarieux was the lead author of a recent study published in Circulation: Journal of the American Heart Association that studied 657 people without known heart disease. He and his co-authors found that people who had higher blood levels of certain disease-causing bacteria in the mouth were more likely to have atherosclerosis in the carotid artery in the neck. Clogging of the carotid arteries can lead to stroke.

Atherosclerosis, also called "hardening of the arteries," develops when deposits of fats and other substances in your blood begin to stick to the sides of your arteries. These deposits, called plaques, can build up and narrow your arteries, clogging them like a plugged-up drain. If these plaques ever block the blood flow completely, you could have a heart attack or stroke, depending on the location of the blockage.

(Note: Not all plaque is alike. The plaques in your arteries have nothing to do with dental plaque your dental hygienist scrapes off your teeth. Dental plaque is a sticky residue of bacteria, acid, and food particles that can irritate your gums and eat away at tooth enamel.)

So what might hardening of the arteries have to do with gingivitis, that minor villain of toothpaste and mouthwash commercials?

No one is sure yet. Experts know that bacteria from the mouth can enter the bloodstream through the gums. These same bacteria have been found clumped in artery plaques. So one theory is that these bacteria stick to the fatty plaques in the bloodstream, directly contributing to blockages.

Other possibilities lie in the body's own defense mechanisms against bacteria. One of the body's natural responses to infection is inflammation (swelling). It's possible that as these oral bacteria travel through your body, they trigger a similar response, causing the blood cells to swell. This swelling could then narrow an artery and increase the risk of clots.

That inflammation could be the root of the problem adds to data researchers are gathering that suggest more and more diseases, including periodontal disease, heart disease, and arthritis, are partially caused by the body's own inflammatory response.

COULD PERIODONTAL DISEASE CAUSE HEART ATTACKS?

So could periodontal disease, gingivitis, or another dental disorder, pericoronitis (when gum tissue around the molars becomes swollen and infected) cause heart attacks and strokes?

"There's no question that there appears to be a connection," says Gordon Douglass, DDS, past president of the American Academy of Periodontology.

"It's like the chicken and the egg," says Desvarieux. "In our study, we know that people who had higher levels of the bacteria had more arteriosclerosis, or atherosclerosis. But we can't say whether one caused the other." The only way to know, he says, is to follow up the people in his study to see how they fare in the long term.

Periodontal disease might be an early sign of cardiovascular problems. Heart disease can be hard to catch early, because many of the conditions that precede it have no symptoms. You won't ever feel your arteries hardening or your cholesterol rising. But you might notice bleeding or painful gums.

If further studies bear out the connection between periodontal disease and heart disease, the next step would be to try treatment, Desvarieux says. Might taking antibiotics not only help heal oral infections but, as a result, also lower your risk of heart disease? No one's sure, but it's possible.

It's still too early for official preventive steps, since researchers don't know exactly how heart disease and periodontal disease are connected.

"Obviously, people worried about heart disease need to pay attention to the established risk factors," Desvarieux says. "I wouldn't want people to think that if they just started to brush their teeth more, they could go back to smoking or ignore their diabetes."

If you're at risk of heart disease, do the obvious:

- Lose weight if you're overweight
- Eat healthy foods
- Exercise most days of the week
- Control any conditions that increase risk, such as diabetes, high cholesterol, or high blood pressure

But Cram of the ADA argues that everyone should make a special effort to prevent oral health problems. That's especially true, she says, for people who are at higher risk of developing heart disease. And Douglass adds that if you already have periodontal disease, you certainly shouldn't ignore it. In many cases, you may just need to learn better brushing and flossing habits. More advanced cases of periodontal disease may require a trip to the dentist for a careful cleaning of the roots of the teeth, called scaling and root planning, or surgery.

"I think the evidence indicates that you should clear up any periodontal disease," Douglass tells WebMD. "It's fairly easy to do, and why not get rid of a potential risk factor for heart disease?"

He also stresses that people who have heart problems or recently had cardiac surgery may need to take antibiotics before having any dental procedures. Medication will lower the risk that bacteria from the mouth will wind up infecting the tissues of the heart, causing a dangerous condition called endocarditis.

For most people, however, Douglass says that sticking with commonsense tips can head off problems. "If you keep your mouth clean, it's very hard for the bacteria that cause periodontal disease to get started," he says. You'll also reap other benefits -- fewer fillings, healthier gums, and a brighter smile.

"We've always known that a little prevention goes a long way, but we used to think of it in terms of avoiding cavities and things like that," says Cram. "Now it seems that by using your toothbrush and your floss, you might also be preventing much more serious health problems down the road."

- WebMD