What Causes TMD?

We don’t know what causes TMD. Dentists believe symptoms arise from problems with the muscles of your jaw or with the parts of the joint itself.

• Injury to your jaw, the joint, or the muscles of your head and neck -- like from a heavy blow or whiplash -- can lead to TMD. Other causes include:
• Grinding or clenching your teeth, which puts a lot of pressure on the joint
• Movement of the soft cushion or disc between the ball and socket of the joint
• Arthritis in the joint
• Stress, which can cause you to tighten facial and jaw muscles or clench the teeth

Temporomandibular Joint Disorders (TMD, TMJ)

Your temporomandibular joint is a hinge that connects your jaw to the temporal bones of your skull, which are in front of each ear. It lets you move your jaw up and down and side to side, so you can talk, chew, and yawn.

Problems with your jaw and the muscles in your face that control it are known as temporomandibular disorders (TMD). But you may hear it wrongly called TMJ, after the joint.

Laser Use in Dentistry

Lasers have been used in Dentistry since 1994 to treat a number of dental problems. Yet, despite FDA approval, no laser system has received the American Dental Association's (ADA) Seal of Acceptance. That seal assures dentists that the product or device meets ADA standards of safety and efficacy, among other things. The ADA, however, states that it is cautiously optimistic about the role of laser technology in the field of dentistry. These lasers are different from the cold lasers used in phototherapy for the relief of headaches, pain, and inflammation.

Still, some dentists are using lasers to treat:

• Tooth decay. Lasers are used to remove decay within a tooth and prepare the surrounding enamel for receipt of the Filling. Lasers are also used to "cure" or harden a filling.
• Gum Disease. Lasers are used to reshape gums and remove bacteria during Root Canal Procedures.
• Biopsy or lesion removal. Lasers can be used to remove a small piece of tissue (called a biopsy) so that it can be examined for cancer. Lasers are also used to remove lesions in the mouth and relieve the pain of canker sores.
• Teeth whitening. Lasers are used to speed up in-office Teeth Whitening procedures. A peroxide bleaching solution, applied to the tooth surface, is ''activated" by laser energy, which speeds up of the whitening process.

How Do Lasers Work in Dentistry?

All lasers work by delivering energy in the form of light. When used for surgical and dental procedures, the laser acts as a cutting instrument or a vaporizer of tissue that it comes in contact with. When used for "curing" a filling, the laser helps to strengthen the bond between the filling and the tooth. When used in teeth-whitening procedures, the laser acts as a heat source and enhances the effect of tooth-bleaching agents.

What Are the Pros and Cons of Using a Laser in Dentistry?
Pros

Compared to the traditional dental drill, lasers:

• May cause less pain in some instances, so reduces the need for anesthesia
• May reduce anxiety in patients uncomfortable with the use of the dental drill
• Minimize bleeding and swelling during soft tissue treatments
• May preserve more healthy tooth during cavity removal

Cons

The disadvantages of lasers are that:

• Lasers can't be used on teeth with fillings already in place.
• Lasers can't be used in many commonly performed dental procedures. For example, lasers can't be used to fill cavities located between teeth, around old fillings, and large cavities that need to be prepared for a crown. In addition, lasers cannot be used to remove defective crowns or silver fillings, or prepare teeth for bridges.
• Traditional drills may still be needed to shape the filling, adjust the bite, and polish the filling even when a laser is used.
• Lasers do not eliminate the need for anesthesia.
• Laser treatment tends to be more expensive -- the cost of the laser is much higher than a dental drill. Lasers can cost between $39,000 and $45,000, compared to about $600 for a standard drill.

Oral Care

A number of conditions may require oral surgery, including:

Impacted Teeth

Wisdom teeth, otherwise known as third molars, are the last set of teeth to develop. Sometimes these teeth emerge from the gum line and the jaw is large enough to allow room for them, but most of the time, this is not the case. More often, one or more of these third molars fails to emerge in proper alignment or fails to fully emerge through the gum line and becomes entrapped or "impacted" between the jawbone and the gum tissue. Impacted wisdom teeth can result in swelling, pain, and infection of the gum tissue surrounding the wisdom teeth. In addition, impacted wisdom teeth can cause permanent damage to nearby teeth, gums, and bone and can sometimes lead to the formation of cysts or tumors that can destroy sections of the jaw. Therefore, Dentists recommend people with impacted wisdom teeth have them surgically removed.

It's not just wisdom teeth that sometimes become impacted and need to be removed. Other teeth, such as the cuspids and the bicuspids can become impacted and can cause the same types of problems described with impacted wisdom teeth.

Tooth Loss

Dental Implants are an option for tooth loss due to an accident or infection or as an alternative to bridges and Dentures. The implants are tooth root substitutes that are surgically anchored in place in the jawbone and act to stabilize the artificial teeth to which they are attached. Suitable candidates for dental implants need to have an adequate bone level and density, must not be prone to infection, and must be willing to maintain good oral hygiene practices.

Jaw-Related Problems

Unequal jaw growth. In some individuals, the upper and lower jaws fail to grow properly. This can cause difficulty in speaking, eating, swallowing, and breathing. While some of these problems -- like improper teeth alignment -- can be corrected with braces and other orthodontic appliances, more serious problems require oral surgery to move all or part of the upper jaw, lower jaw, or both, into a new position that is more balanced, functional, and healthy.

Improve fit of dentures. For first-time denture wearers, oral surgery can be done to correct any irregularities of the jaws prior to creating the dentures to ensure a better fit. Oral surgery can also help long-term denture wearers. Supporting bone often deteriorates over time, resulting in dentures that no longer fit properly. In severe cases, an oral surgeon can add a bone graft to areas where little bone remains.

Temporomandibular Joint (TMJ) disorders. Dysfunction of the TMJ, the small joint in front of the ear where the skull and lower jaw meet, is a common source of headache and facial pain. Most patients with TMJ disorders can be successfully treated with a combination of oral medications, physical therapy, and splints. However, joint surgery is an option for advanced cases and when the diagnosis indicates a specific problem in the joint.

Plaque and Your Teeth

Plaque is the sticky, colorless film of bacteria that forms on teeth. It makes teeth "feel fuzzy" to the tongue and is most noticeable when teeth are not brushed.

What Causes Plaque and Why Is It Harmful?

Plaque develops when foods containing carbohydrates (sugars and starches), such as milk, soft drinks, raisins, cakes, or candy are frequently left on the teeth. Bacteria that live in the mouth thrive on these foods, producing acids as a result. Over a period of time, these acids destroy tooth enamel, resulting in tooth decay. Plaque can also develop on the tooth roots under the gum and cause breakdown of the bone supporting the tooth.

How Can Plaque Formation Be Prevented?

• To prevent plaque buildup, brush your teeth at least twice a day with a soft, rounded-tip bristled toothbrush. Pay particular attention to the space where the gums and teeth meet. Use a fluoride-containing toothpaste.
• Floss between teeth at least once a day to remove food particles and bacteria.
• See your Dentist or oral hygienist every 6 months for a check-up and teeth cleaning.
• Ask your dentist if a Dental Sealant is appropriate for you. Dental sealants are a thin, plastic coating that are painted on the chewing surfaces of teeth to protect them from cavities and decay.
• Eat a balanced diet and limit the number of between-meal snacks. If you need a snack, choose nutritious foods such as plain yogurt, cheese, fruit, or raw vegetables. Vegetables, such as celery, help remove food and help saliva neutralize plaque-causing acids.

Root Planing and Scaling for Gum Disease

Root planing and scaling is one of the most effective ways to treat gum disease before it becomes severe. Root planing and scaling cleans between the gums and the teeth down to the roots. Your dentist may need to use a local anesthetic to numb your gums and the roots of your teeth.

Some dentists and Dental Hygienists will use an ultrasonic tool for the planing and scaling. This tool is not as uncomfortable as a standard scraping tool, but not all cleanings require this type of tool.

Your Dentist may place antibiotic fibers into the pockets between your teeth and gums. The antibiotic will help speed healing and prevent infection. The dentist will remove the fibers about 1 week after the procedure.

What To Expect After Treatment

If anesthesia is used, your lips and gums may remain numb for a few hours. Planing and scaling causes little or no discomfort.

Why It Is Done

Root planing and scaling is done when gums have either started to pull away from the teeth or the roots of the teeth have hard mineral deposits (tartar) on them.

How Well It Works

If you maintain Good Dental Care after the procedure, the progression of gum disease should stop. And your gums will heal and become firm and pink again.
Risks

Root planing and scaling can introduce harmful bacteria into the bloodstream. Gum tissue is also at risk of infection. You may need to take antibiotics before and after surgery if you have a condition that puts you at high risk for a severe infection or if infections are particularly dangerous for you. You may need to take antibiotics if you:

• Have certain heart problems that make it dangerous for you to get a heart infection called endocarditis.
• Have an impaired immune system.
• Had recent major surgeries or have man-made body parts, such as an artificial hip or heart valve.

What To Think About

Root planing and scaling is a simple procedure that can work very well to stop gum disease.
Brush and floss regularly afterward. Without Proper Dental Care, your gum disease may progress.
To promote healing, stop all use of tobacco. Smoking or using spit tobacco reduces your ability to fight infection of your gums and delays healing. To learn more, see the topic Quitting Smoking.

Dental Health: Sealants

Dental Sealant is a thin, plastic coating painted on the chewing surfaces of teeth -- usually the back teeth (the premolars and molars) -- to prevent tooth decay. The sealant quickly bonds into the depressions and grooves of the teeth, forming a protective shield over the enamel of each tooth.

Although thorough brushing and flossing can remove food particles and plaque from smooth surfaces of teeth, they cannot always get into all the nooks and crannies of the back teeth to remove the food and plaque. Sealants protect these vulnerable areas from tooth decay by "sealing out" plaque and food.

Who Should Get Sealants?

Because of the likelihood of developing decay in the depressions and grooves of the premolars and molars, children and teenagers are candidates for sealants. However, adults without decay or fillings in their molars can also benefit from sealants.


Typically, children should get sealants on their permanent molars and premolars as soon as these teeth come in. In this way, the sealants can protect the teeth through the cavity-prone years of ages 6 to 14.

In some cases, dental sealants may also be appropriate for baby teeth, such as when a child's baby teeth have deep depressions and grooves. Because baby teeth play such an important role in holding the correct spacing for permanent teeth, it's important to keep these teeth healthy so they are not lost too early.

How Are Sealants Applied?

Applying sealant is a simple and painless process. It takes only a few minutes for your Dentist or hygienist to apply the sealant to seal each tooth. The application steps are as follows:

1. First the teeth that are to be sealed are thoroughly cleaned.
2. Each tooth is then dried, and cotton or another absorbent material is put around the tooth to keep it dry.
3. An acid solution is put on the chewing surfaces of the teeth to roughen them up, which helps the sealant bond to the teeth.
4. The teeth are then rinsed and dried.
5. Sealant is then painted onto the tooth enamel, where it bonds directly to the tooth and hardens. Sometimes a special curing light is used to help the sealant harden.

How Long Do Sealants Last?

Sealants can protect teeth from decay for up to 10 years, but they need to be checked for chipping or wearing at regular Dental Check-ups. Your dentist can replace sealants as necessary.
Does Insurance Cover the Cost of Sealants?

Many insurance companies cover the cost of sealants. Check with your dental insurance carrier to determine if sealants are covered under your plan.