Posts for category: Oral Health

By DiPiero Family Dental, LLC
June 09, 2021
Category: Oral Health
Tags: jaw pain  
ThinkTwiceBeforeYouUndergoBotoxTreatmentforChronicJawPain

There's still much about the underlying nature of chronic jaw joint dysfunction we have yet to unravel. Treating these conditions known as temporomandibular joint disorders (TMDs) may therefore require some experimentation to find what works for each individual patient.

Most TMD therapies are relatively conservative: eating softer foods, taking anti-inflammatory pain relievers or undergoing physical therapy. There have been some surgical techniques tried to relieve jaw pain and dysfunction, but these have so far had mixed results.

Recently, the use of the drug Botox has been promoted for relieving jaw pain, albeit temporarily. Botox contains tiny amounts of botulinum toxin type A, a poisonous substance derived from the bacterium Clostridium botulinum, which can cause muscle paralysis. It's mainly used to cosmetically smooth out small wrinkles around facial features.

Because of these properties, some physicians have proposed Botox for TMD treatment to paralyze the muscles around the jaw to reduce pain and discomfort. While the treatment sounds intriguing, there are a number of reasons to be wary of it if you have TMD.

To begin with, the claims for Botox's success in relieving jaw pain have been mainly anecdotal. On the other hand, findings from randomized, double-blind trials have yet to show any solid evidence that Botox can produce these pain-relieving effects.

But even if it lived up to the claims of TMD pain relief, the effect would eventually fade in a few weeks or months, requiring the patient to repeat the injections. It's possible with multiple Botox injections that the body will develop antibodies to fight the botulinum toxin, causing the treatment to be less effective with subsequent injections.

Of even greater concern are the potential side effects of Botox TMD treatment, ranging from headaches and soreness at the injection site to more serious muscle atrophy and possible facial deformity from repeated injections. There's also evidence for decreased bone density in the jaw, which could have far-reaching consequences for someone with TMD.

The best approach still seems to lie in the more conservative therapies that treat TMD similar to other joint disorders. Finding the right combination of therapies that most benefit you will help you better manage your symptoms.

If you would like more information on treatments for TMD, 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 “Botox Treatment for TMJ Pain.”

By DiPiero Family Dental, LLC
May 10, 2021
Category: Oral Health
Tags: tmj disorders  
3TipstoMakeMealtimesMoreEnjoyableWithTMD

Dinnertime is a great opportunity to enjoy not only your meal, but also the company of friends and family. But a temporomandibular joint disorder (TMD) can drain the pleasure from these dining experiences if the mere act of chewing is a painful ordeal.

Besides curbing pleasure while dining, eating difficulties caused by TMD can also affect your health: You may find yourself limiting your choices to only those that cause the least amount of discomfort. But those restricted choices may deprive you of a balanced diet essential to overall well-being.

But there are ways to reduce your discomfort and enjoy a greater abundance of healthy foods, as well as your dining experience. Here are 3 tips to make eating easier if you have TMD.

Prepare your food. Easing TMD discomfort starts while you're preparing your food to cook. First off, remove the tougher peel or skin from apples, potatoes or similar fruits and vegetables. And, be sure to chop foods into small enough pieces to reduce how much your jaws must open to comfortably chew your food.

Choose “wetter” cooking methods. One of the best ways to soften foods is to moisten them, either during the cooking process or by adding it in some form to the dish. Use braising techniques when you cook as much as possible. And try to incorporate sauces or gravies, especially with leaner meats, for added moisture.

Modify your eating habits. Food prep is only one aspect of a more comfortable dining experience with TMD—you can also benefit from modifying how you eat. Concentrate on taking smaller bites of food and slow down your chewing motion. You should also limit how much you open your jaw while chewing to keep it within your comfort range as much as possible.

With a little experimentation, you can find the right balance between a wide variety of foods and more comfortable eating. If you have TMD, using these tips could help mealtime become a delightful—and more nutritious—experience.

If you would like more information on managing TMD, 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 “What to Eat When TMJ Pain Flares Up.”

By DiPiero Family Dental, LLC
April 20, 2021
Category: Oral Health
Tags: oral health  
AnEatingDisorderMayShowItselfinTheMouth

Although dental care is our primary focus, we dentists are also on the lookout for other health problems that may manifest in the mouth. That's why we're sometimes the first to suspect a patient may have an eating disorder.

Eating disorders are abnormal dietary patterns that can arise from mental or emotional issues, the most common being anorexia nervosa and bulimia nervosa. Each has different behaviors: Anorexics abnormally restrict their food intake (“self-starvation”), while bulimics typically eat heavily and then induce vomiting (“binge and purge”).

Although bulimics are more likely to binge and purge, anorexics may also induce vomiting. That practice in particular can leave a clue for dentists. While vomiting, powerful stomach acid enters the mouth, which can then soften and erode tooth enamel.

It's the pattern of erosion a dentist may notice more than the erosion itself that may indicate an eating disorder. A person while vomiting normally places their tongue against the back of the lower teeth, which somewhat shields them from acid. The more exposed upper teeth will thus tend to show more erosion than the bottom teeth.

A dentist may also notice other signs of an eating disorder. Enlarged salivary glands or a reddened throat and tongue could indicate the use of fingers or objects to induce vomiting. Lack of oral hygiene can be a sign of anorexia, while signs of over-aggressive brushing or flossing may hint of bulimia.

For the sake of the person's overall well-being, the eating disorder should be addressed through professional counseling and therapy. An excellent starting point is the website nationaleatingdisorders.org, sponsored by the National Eating Disorders Association.

The therapy process can be lengthy, so patients should also take steps to protect their teeth in the interim. One important measure is to rinse out the mouth following purging with a little baking soda mixed with water. This will help neutralize oral acid and reduces the risk of erosion. Proper brushing and flossing and regular dental visits can also help prevent dental disease.

An eating disorder can be traumatic for both patients and their families, and can take time to overcome. Even so, patients can reduce its effect on their dental health.

If you would like more information on eating disorders and dental care, 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 “Bulimia, Anorexia & Oral Health.”

By DiPiero Family Dental, LLC
March 31, 2021
Category: Oral Health
Tags: osteoporosis  
CertainDrugsforOsteoporosisCouldImpactYourDentalCare

Osteoporosis is a serious bone weakening disease in older adults that can turn a minor fall into a major bone fracture. But the condition could also impact dental treatment—triggered ironically by the drugs used to treat osteoporosis rather than the disease itself.

From the Latin for “porous bone,” osteoporosis causes bone to gradually lose mineral structure. Over time the naturally-occurring spaces between mineralized portions of the bone enlarge, leaving it weaker as a result.

Although there's no definitive cure for osteoporosis, a number of drugs developed over the last couple of decades can inhibit its progress. Most fall into two major categories, bisphosphonates and RANKL inhibitors.

These drugs work by inhibiting the normal growth cycle of bone. Living bone constantly changes as cells called osteoblasts produce new bone. A different type, osteoclasts, clear away older bone to make room for these newer cells. The drugs selectively destroy osteoclasts so that the older bone, which would have been removed by them, remains for a longer period of time.

Retaining older cells longer initially slows the disease process. But there is a downside: in time, this older bone kept in place continues to weaken and lose vitality. In rare instances it may eventually become detached from its blood supply and die, resulting in what is known as osteonecrosis.

Osteonecrosis mostly affects two particular bones in the body: the femur (the long bone in the upper leg) and the jawbone. In regard to the latter, even the stress of chewing could cause osteonecrosis in someone being treated for osteoporosis. It can also occur after tooth extractions or similar invasive procedures.

If you're taking a bisphosphonate or RANKL inhibitor, you'll want to inform your dentist so that the necessary precautions can be taken before undergoing dental work more invasive than routine cleanings or getting a filling or crown.  If you need major dental work, your dentist or you will also need to speak with your physician about stopping the drug for a few months before and after a dental procedure to minimize the risk of osteonecrosis.

Fortunately, the risk for dental problems while undergoing treatment for osteoporosis is fairly low. Still, you'll want to be as prepared as possible so that the management of your osteoporosis doesn't harm your dental health.

If you would like more information on osteoporosis and dental health, 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 “Osteoporosis Drugs & Dental Treatment.”

By DiPiero Family Dental, LLC
March 21, 2021
Category: Oral Health
Tags: snoring   sleep apnea  
NotGettingaGoodNightsSleepYourDentistMayBeAbletoHelp

If you live an average lifespan, you'll spend more than 200,000 hours in blissful slumber. It's not a waste, though: You absolutely need this much sleep to maintain optimum physical and mental health. That's why the National Sleep Foundation recognizes each March as Sleep Awareness Month to highlight the obstacles to a good night's sleep. One such obstacle is obstructive sleep apnea (OSA)—and if you have it, we may be able to help you reduce the harm it may be causing you.

OSA is the blockage of the airway during sleep, usually when the tongue relaxes against the back of the throat. As the oxygen level falls, the brain arouses the sleeper to restore airflow. This only takes a few seconds before the person slips back into sleep, but it can occur several times an hour.

As this scenario repeats itself night after night, the person becomes deprived of the deeper stages of sleep they need to stay healthy. The long-term effect can even be life-threatening: Besides chronic fatigue and “brain fog,” there's also an increased risk of high blood pressure, disease or other serious health conditions.

But there are ways to reduce chronic OSA, the most common being a therapy known as continuous positive airway pressure (CPAP). A CPAP machine, prescribed by a medical doctor, consists of a small pump that streams pressurized air into the mouth through a hose and facemask; the increased air pressure in the mouth helps keep the airway open. It's a proven method, but not always a favorite with some patients who find it uncomfortable and restrictive to wear every night.

If you're in that camp regarding CPAP therapy, an alternative may be possible: oral appliance therapy (OAT), which dentists can provide. Worn in the mouth during sleep, this custom-fitted mouthguard-like appliance repositions the tongue so that it doesn't block the airway. There is a variety of mechanisms, but most involve a hinge that positions the lower jaw forward, which in turn pulls the tongue away from the back of the throat.

These less invasive OAT devices may be an alternative to CPAP therapy for people who have mild to moderate OSA and find CPAP machines difficult to use. If you've been diagnosed with OSA and CPAP therapy hasn't been a good fit for you, speak with us about an OAT device. It could help you overcome this common disorder and get the deep sleep you need for a healthy mind and body.

If you would like more information about a dental approach to obstructive sleep apnea, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine article “Sleep Disorders & Dentistry.”