Posts for tag: TMJ
“You crack me up” is an old saying meant as a term of appreciation for someone else’s sense of humor or ability to tell a good and funny story. It’s a positive statement. But when it is applied to teeth, it isn’t funny any more.
Teeth often develop cracks and those cracks sometimes result in the tooth breaking or splitting—not a good thing. That can lead to the loss of a tooth or, at the very least, an extensive filling or a crown (cap). Unfortunately, unlike bones, when a tooth cracks it stays cracked. By that I mean that it does not repair itself. The crack may remain the way it is or it may progress, but it never heals.
Why does this happen?
This is one of the more frequent questions I’m asked. And while there isn’t any simple answer, there are several possibilities that probably make up the large percentage of causes. One of the leading causes is people chewing on hard objects such as pens or ice cubes. If you don’t chew on ice, you probably can’t imagine anyone doing it. But for many people, it is “normal”. And essentially what those people are chewing on is equivalent to chewing on rocks. No wonder, over time, their teeth give up and crack or break.
Other common causes
Another common cause of cracks is people who either clench their teeth together or grind them. Some people do that while they sleep but others may do it while they are doing things they find stressful or when they are physically exerting themselves. Examples of that might be lifting weights, driving in heavy traffic, or concentrating intently. Again, the relatively constant stress applied to their teeth ultimately causes cracking and breaking.
Perhaps a more subtle cause, but one I suspect happens more than we might suspect, comes from eating or drinking alternating hot and cold foods. I learned at an early age not to take a dish from the refrigerator and place it in a hot oven. It broke—the temperature shift was too great for it. Yet I have been known to eat ice cream while drinking hot coffee and haven’t thought much about it. That places a huge amount of stress on our teeth over and over again…and over time, can lead to cracks or breaks.
My tooth is broken. How do I fix it?
Ironically, if your tooth breaks, the solution is fairly simple. If it is repairable, I will restore it as best I can. That may involve a filling or restoring the tooth with a complete crown if the damage is extensive. And, unfortunately, if the damage is too extensive, the tooth will need to be removed, and then together we can decide the best way to replace it.
The greater challenge for dentists, if your tooth is cracked but not broken, is to decide what treatment, if any, to recommend. If it is bothering you, you will want some type of treatment to make it feel comfortable. But if it isn’t, there are choices ranging from doing nothing to crowning the tooth. And there are a lot of variables that make that choice a complicated one.
I am currently involved with a four year study that involves dentists around the country evaluating cracked teeth, deciding what is the best way to treat them, and then monitoring those same teeth over the four years to attempt to determine which alternative worked the best. The study is done under the guidance of the National Dental Practice Based Research Network whose mission is to research topics that will be immediately relevant to dental practitioners and the people they serve—you. As a practitioner, the decision I make is sometimes easy—the crack is severe enough or has decay around it that it must be repaired. But other times it is very uncertain. In those situations there probably aren’t any “wrong” answers, but it is often not clear what the “right” or “best” answer is. I hope this study will help us all learn what that is so I can assist you and other dentists in making the best decision possible to deal with what is occurring and the best way to treat it.
When the results of the study start coming in a few years, I’ll share what we have learned! Until then, try to prevent cracking them up. If you chew ice or other hard objects, STOP! If you clench or grind, talk to us about mouth guards to help protect your teeth. And give your teeth a break (the good kind!) by not biting into super hard foods and not alternating hot and cold foods and beverages in close proximity to one another. Prevention IS still the best approach!
This article originally appeared in Dubuque 365ink magazine. It is republished with permission from the publication.
STRESS! You see it, you feel it, everyone seems to have it – some days more than others, right? That tension you experience finds its way to so many parts of your body, sometimes without your awareness, and sometimes it’s screaming at you. The tightness! The aches! The pains! For many, the discomfort lands in the head, neck, shoulders, jaws, -- and a place that is often overlooked -- the teeth.
Dr. Matthew Messina, a consumer adviser for the American Dental Association, says, “Stress, whether it’s real or perceived, causes flight-or-flight hormones to release in the body. Those released stress hormones mobilize energy, causing isometric activity, which is muscle movement, because that built-up energy has to be released in some way.” That energy may be exhibited in tooth clenching or grinding.
We often see the results of tension and stress as wear on teeth due to clenching and grinding. When we suggest that to people almost everyone tells us they don’t do it, or aren’t aware that they do it. So we suggest that they might notice how their mouth feels when they wake up in the morning; do they feel any tightness or soreness around their temples, jaws, or muscles in their face? Or when they are concentrating at the computer do they notice holding their teeth tightly together? What about the next time they are feeling angry? What’s happening with their jaw? Are they athletes? What about when they are weight lifting for strength training, or on that uphill climb on their bikes? Yep! The next time those folks are reporting, “you know, I catch myself holding a lot tension in my mouth; I find that my teeth are clenched tightly together.” Or “when I wake up in the morning, before I open my eyes, I checked and my jaws were feeling tight and sore – I must be doing that in my sleep!”
So then we need to consider the damage that this stress causes in the mouth, on the teeth, jaws, and muscles of the head and neck. We see this leading to major tooth wear and damage, or causing very sore muscles. Over time it can even lead to wear and damage to the temporomandibular joints (the TMJs), the jaw joints that are located in front of your ears.
Consider this: Dr. Robert Rawdin, a Manhattan prosthodontist, notes that when we chew we “normally exert about 20 to 30 pounds per square inch on our back molars.” As if that isn’t enough force on our teeth, he adds, “teeth grinders, especially at night without restraint, can exert up to as much as 200 pounds per square inch on their teeth.” Just think about how much damage that amount of force can create! For some people the damage is localized to extensive wear or broken or chipped teeth. For others, the muscles or jaw joints take the damage.
While the damage and wear that grinding creates can often be repaired, a far better approach is to prevent it from occurring in the first place. Most grinding and clenching creates some warning signs before the damage is extensive. Regular dental check-ups allow your dentist to monitor those signs to determine if problems are occurring before major damage is the result. And if your dentist determines that there may be a concern, it’s time for you to take steps to prevent further problems.
The first step is often to listen to your body. By choosing to integrate and practice things such as mindfulness, meditation, relaxation and yoga, people can first realize where the tension in their bodies is building up and then learn techniques to eliminate it. Some signs that you may be clenching or grinding your teeth are headaches, over-sensitive teeth, sore facial muscles, jaw pain, flat or sharp teeth, and/or damage or soreness on the inside of your cheeks.
By becoming aware of your patterns and learning to relax your jaw and those muscles, you can prevent problems before they become severe enough to require extensive dental treatment. It’s true: prevention, like honesty, IS the best policy!
This brief and effective jaw relaxer comes from our friend Deb May at YogaCare. If you find yourself carrying tension in your jaw, do this relaxer for immediate relief.
How to Relax Your Jaw in Two Minutes
With your tongue, touch each tooth, front & back, feeling where each tooth connects to the gum. Breathe deeply, stay aware and relaxed.
Use your tongue to massage the jaw hinge from the inside of your mouth. Take about 1 minute to do the left side of the mouth, then the right side, then rest your tongue at the bottom of your mouth.
Notice how it feels – your teeth slightly apart, the space at the roof of the mouth, tongue relaxed at the bottom of your mouth ... your jaw relaxed!
I was first introduced to yoga as a student at the University of Hawaii. After a long and stressful day in our student clinic, one of my dental hygiene classmates shared some poses with me. I immediately experienced help with the tension in my body, learned to relax my neck and shoulders and discovered a way to take some deep breaths between each patient.
I have been practicing yoga with Deb May of YogaCare since 2005. One of the greatest rewards of consistent practice, awareness, and intention has been the way yoga has helped me reduce stress and tension in my body and in my life.
Everyone carries tension in their body in different ways – sometimes it is in our neck, shoulders or jaw. Through yoga I have become more aware of the places tension resides in my body. Every time Deb would remind us to “relax your jaw” during a yoga pose, I found my jaw tightly clenched! This personal awareness planted the seed for what has grown into Kuttler Dental’s latest mission: To help the increasing number of people who deal with stress, jaw pain and teeth grinding.
As a dental hygienist, I see the dental effects of tooth wear every day. We have learned through studies that lifestyle changes are one of the most effective ways to address this. So I began with myself, and now want to spread the word!
Bill, Deb and I partnered to create an audio CD with a special focus on relaxation and breathing techniques to help reduce stress. You can learn ways to relax not only your jaw, but your whole way of being. We designed this CD to help everyone – it is geared toward beginners and even those who have never tried yoga. While there are two basic yoga practices on the disc, the rest of the tracks are focused on helping you to learn to relax, breathe deeply, and live freely.
If you are interested in our Relieve Stress for Dental Health CD, you can order here or give us a call at 563.583.6424. The cost is $16.00 (tax included). Shipping is an additional $2.00 or you can stop by our office in Dubuque and pick it up.
-- Sharon L. Kuttler, RDH
My day spent with Dr. Jeffrey Okeson at the Chicago Midwinter Dental Meeting last week was fascinating and helpful. He is the Director of the Orofacial Pain Program at the University of Kentucky College of Dentistry and has a very extensive academic background with a deep knowledge of research. As a result, I respect his opinions and information. And, as is often true at least for me, I resonated with him because I agree with his point of view.
Of the six hours of Dr. Okeson's presentation, he spent half of his time discussing current concepts in the causes of tempromandibular (the jaw joint known as the TMJ) disorders (referred to as TMD) that result in pain. He then reviewed various philosophies in dentistry and options for treatment in the other half of his presentation. He described five different treatment approaches based on the desired outcome for how the teeth fit and how the jaw works. This has become a very controversial topic in our profession, and treatment approaches widely vary--particularly as it pertains to the amount of treatment that is recommended in the different approaches.
I was delighted to learn Dr. Okeson's perspective is congruent with what I have learned over my years of study at the L.D. Pankey Institute. There I received ongoing post-graduate education in the area of restoring teeth to health and with attaining healthy jaw joint function.
Our approach has been research based and experience driven. We have had a great deal of success with our individualized approach, helping identify contributing habit patterns, counseling on options, and utilizing the 'less is more' philosophic approach that Dr. Okeson affirmed.
I especially smiled at Dr. Okeson's closing comments where he encouraged everyone to treat their patients in the same way that they would want their children, spouses, or parents treated - and that's the way we do it at Kuttler Dental!
--Bill Kuttler, D.D.S.