Dentist - Towson
8600 LaSalle Rd. Suite 406 Severn Bldg.
Towson, MD 21286
410-321-0551

Posts for: May, 2015

By Dr. Mark Shulman
May 25, 2015
Category: Oral Health
Tags: tmd   tmj   tmj disorders  
ClickingJawWhenShouldYouBeConcerned

Have you noticed a clicking, popping, or grating sound when you open or close your jaw? As many as 36 million U.S. adults experience this phenomenon in one or both of the joints that connect the lower jaw (mandible) to the skull.

While the sounds may be disconcerting, there’s generally no cause for concern in the absence of other symptoms. They’re most likely caused by a harmless shift in the position of the disk inside each temporomandibular (jaw) joint, and it can diminish or disappear entirely over time. But, if you’re also experiencing persistent discomfort, severe pain, or limited function in your jaw (which can include getting it “stuck” in an opened or closed position), then you may be suffering from a temporomandibular joint disorder — part of a complex set of conditions affecting one or both jaw joints, muscles and/or other surrounding tissues. (You may have heard the condition called TMJ, which is actually the abbreviation for the temporomandibular joint itself. Health care professionals prefer TMJD or TMD.)

Depending on the severity, TMD can interfere with your ability to speak, chew and even make facial expressions. The cause is unclear, but genes, gender, environment, stress and behavior are believed to play a role. It can also be symptomatic of a larger medical problem, such as fibromyalgia, which can produce pain all over the body.

Management Options for TMD

TMD traditionally was viewed as a bite problem (malocclusion) requiring mechanical correction — e.g., through orthodontic braces or surgery. But the current therapeutic model approaches TMD as an orthopedic problem (joint inflammation, muscle soreness, strained tendons and ligaments, and disk damage) and favors a sequence of conservative, reversible procedures — hot or cold compresses in the jaw area, soft foods, physical therapy/massage, medication, and/or a bite guard to decrease pressure on jaw joints from tooth clenching and grinding — prior to more aggressive, irreversible treatment alternatives.

If you would like more information about TMD, please contact us or schedule an appointment for a consultation. You can also learn more about the subject by reading the Dear Doctor magazine articles “Seeking Relief from TMD” and “Chronic Jaw Pain and Associated Conditions.”


BeyondTheirMarketingClaimsMostToothpastesareSurprisinglySimilar

In your search for the right toothpaste, you’re inundated with dozens of choices, each promising whiter teeth, fresher breath or fewer cavities. Cutting through the various marketing claims, though, you’ll find most toothpaste brands are surprisingly alike, each containing the same basic ingredients. Taken together, these ingredients help toothpaste perform its primary task — removing daily bacterial plaque from tooth surfaces.

Here, then, are some of the ingredients you’ll find — or want to find — in toothpaste.

Abrasives. A mild abrasive increases your brushing effectiveness removing sticky food remnants from teeth. And unlike the burnt, crushed eggshells of the ancient Egyptians or the brick dust used by 18th Century Brits, today’s toothpaste abrasives — hydrated silica (from sand), calcium carbonate or dicalcium phosphates — are much milder and friendlier to teeth.

Detergents. Some substances in plaque aren’t soluble, meaning they won’t break down in contact with water. Such substances require a detergent, also known as a surfactant. It performs a similar action as dishwashing or laundry soaps breaking down grease and stains — but the detergents used in toothpaste are much milder so as not to damage teeth or irritate gum tissues. The most common detergent, sodium lauryl sulfate, is gentle but effective for most people. If it does cause you irritation, however, you may want to look for a paste that doesn’t contain it.

Fluoride. This proven enamel strengthener has been routinely added to toothpaste since the 1950s, and is regarded as one of the most important defenses against tooth decay. If you’re checking ingredients labels, you’ll usually find it listed as sodium fluoride, stannous fluoride or sodium monofluorosphosphate (MFP). And since it inhibits bacterial growth, fluoride toothpastes don’t require preservative additives.

Humectants, binders and flavoring. Humectants help toothpaste retain moisture, while binders prevent blended ingredients from separating; without them your toothpaste would dry out quickly and require stirring before each use. And, without that sweet (though without added sugar) and normally mint flavoring, you wouldn’t find the average toothpaste very tasty.

The ADA Seal of Approval. Although not an ingredient, it’s still sound advice to look for it on toothpaste packaging. The seal indicates the product’s health claims and benefits are supported by the research standards set by the American Dental Society; and all ADA approved toothpastes will contain fluoride.

If you would like more information on toothpaste and other oral hygiene products, 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 “Toothpaste: What’s in it?


By Dr. Mark Shulman
May 16, 2015
Category: Oral Health
Tags: oral health  
ChronicBitingHabitsCanLeadtoLooseTeeth

Periodontal (gum) disease is the most likely cause of a loose, permanent tooth. This progressive infection causes damage to the gums and bone tissues that hold teeth in place, leading to looseness and ultimately tooth loss.

Gum disease, however, isn’t the only cause: although not as common, excessive biting forces over time may also lead to loose teeth. The excessive force stretches the periodontal ligaments that hold teeth in place, causing the teeth to become loose.

This condition is called occlusal trauma. In its primary form, the patient habitually grinds or clenches their teeth, or bites or chews on hard objects like pencils or nails. Generating 20-30 times the normal biting force, these habits can cause considerable damage. It can also be a factor when gum disease is present — supporting bone becomes so weakened by the disease, even normal biting forces can cause mobility.

If you recognize the early signs of grinding or clenching, particularly jaw soreness in the morning (since many instances of teeth grinding occur while we sleep), it’s important to seek treatment before teeth become loose. The symptoms are usually treated directly with muscle relaxants, an occlusal guard worn to soften the force when teeth bite down, or stress management, a major trigger for teeth grinding. The sooner you address the habit, the more likely you’ll avoid its consequences.

If, however, you’re already noticing a loose tooth, treatment must then focus on preserving the tooth. Initially, the tooth may need to be splinted, physically joined to adjacent teeth to hold it in place while damaged tissues heal. In some cases, minute amounts of enamel may need to be removed from the tooth’s biting surfaces to help the tooth better absorb biting forces. Other treatments, including orthodontics and gum disease treatment, may also be included in your treatment plan.

If you notice a loose tooth, it’s critical you contact us as soon as possible for an evaluation — if you delay you increase the chances of eventually losing it. The earlier you address it, the better your chances of preserving your tooth.

If you would like more information on loose 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 “Loose Teeth.”


ThreeConsiderationsforWorkingwithYourDentistonYourSmileMakeover

Cosmetic and restorative dentistry is filled with a varied array of procedures, materials and techniques that can address any shortcoming with your smile. Whatever your condition, there’s a means to correct or enhance your smile.

The real question, though, is whether we’re both, patient and dentist, on the same page as to what’s best to enhance your smile. Dentists have a different perspective on smile outcomes than the average layperson. We’re clued into aspects like tooth alignment with facial features or gum-to-lip distance influenced by our professional training and experience. You, though, may see your smile in terms of other features that define beauty like mouth expressions or lip shape.

Bridging these differing points of view requires open and honest communication. Here are three considerations to make that happen.

Build trust between you and your dentist. It’s natural for us to have differing views on what constitutes proper smile aesthetics based on the perspectives previously mentioned. Working through those perspectives to arrive at a unified plan requires trust that both of us desire the same outcome: a beautiful smile you’re happy to display to the world.

“Seeing” your future smile can help ease your misgivings. It’s one thing to try to imagine a certain treatment outcome — it’s quite another to actually see it beforehand. And you can, through computer simulation that takes a picture of your current face and smile and then augments them digitally so you can see how your smile will appear after proposed treatment. It’s also possible in some cases for you to wear temporary or “provisional” restorations so that not only can you see how they look, but also how they feel and function in the mouth.

Understand what “type” of restoration patient you are. Although everyone is different, we can usually characterize patients and their expectations in two ways. Some patients are “perfect-minded” — they want restorations that offer the maximum symmetry, regularity and tooth brightness. Others are more “natural-minded” in that the changes they seek don’t drastically alter their natural appearance, but are just enough to look different and create a sense of character. Knowing what you really want — a drastic change or a subtle enhancement — will help you communicate your desires more clearly and help us design the treatment options that best fit your expectations.

If you would like more information on fostering communication between dentists and patients, 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 “Great Expectations.”




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