Common Dental Issues

Bite Balancing

Why is it important to have a balanced bite?

When the bite is uneven, patients tend to clench or brux more often. The bruxing and clenching wear down the teeth, resulting in a bite that is even more compromised and worn or fractured teeth. Some patients stop the habit entirely when the bite is balanced.Chewing is impossible when only a few teeth touch during biting. As a patient squeezes harder to engage more teeth, her bite shifts. This initiates muscle spasms and may pull the disc out of position. The bite becomes further out of balance and a damaging cycle accelerates.Finally, when the disc is permanently out of position (Disc Displacement without Reduction), the jaw joint functions by rubbing bone to bone. The consequence of the damage to the joint is a bite that is always changing as the bone wears down. A MRI of the joint will show the damage to the joint over time.All healthy and damaged temperomandibular joints remain most healthy when all of the back teeth touch simultaneously when one closes lightly.

How can you get an even bite?

When a patient is in acute TMD distress, a nightguard or appliance is often used to quiet the muscles. When the muscles are not in spasm, qualified dentists can conduct an Occlusal Analysis.The first step in balancing the bite is to find out the condition of the present bite at rest.  Your dentist will take models of your teeth and a record of the way your upper and lower teeth relate to each other when at complete rest. These models will be mounted on a simulator, which will allow your dentist to look at your teeth during rest as well as during function. Look at the photo below. Each case is different, and your dentist might recommend one or a combination of the following procedures to align the bite:

  • Bite equilibration or alignment by controlled reduction.
  • Building up teeth with fillings or crowns.
  • Replacing missing teeth with bridges or implants.
  • Orthodontics or braces to move teeth to more favorable positions.
  • Surgery to relate the upper teeth more favorably to the lower teeth.

Sleep Apnea

What is Sleep Apnea?

Obstructive Sleep Apnea occurs when there are repeated episodes of complete or partial blockage of the upper airway during sleep. During an apneic “episode”, the diaphragm and chest muscles work harder to open the obstructed airway. Breathing usually resumes with a gasp or a choke. These episodes can affect and interfere with a restful sleep, as well as that of your bed partners.

Sleep Apnea Symptoms

  • Short term memory problems
  • Weight gain
  • Tiredness
  • Gastric reflux
  • Dry mouth
  • Sore throat
  • Slow metabolism
  • Inability to lose weight
  • High blood pressure
  • Diabetes
  • Depression

How can we help treat Obstructive Sleep Apnea?

There are dental solutions for treating sleep apnea and snoring.

Mandibular Advancing Devices (MAD’s) are worn in the mouth in order to help improve sleep quality. The MAD gently positions the lower jaw and tongue slightly forward, which in turn, opens space in the back of the throat and reduces tissues obstruction. This helps keep the patient’s airway open for a restful night’s sleep.

Tooth Erosion

Tooth erosion is the loss of the hard tooth structure that protects the tooth.  This layer is called enamel and can be worn away by acid.  Have you ever had sensitive, discolored teeth, especially by the gum line?  Do your teeth look transparent near the edges of the biting surfaces, or are they cupping or cracking and chipping?  These are some signs of erosion.

Tooth erosion is mainly caused by acid.  Carbonated drinks, energy drinks, sports drinks, pure fruit juices, coffee and red wine all contain high levels of acid.  Conditions such as bulimia, acid reflux and medications that dry the mouth can also cause tooth erosion.

Some ways to prevent tooth erosion is to cut down on your consumption of drinks that are highly acidic or drink them quickly through a straw.  Water intake in conjunction with the acidic beverages can also help neutralize the acid.  Also, refrain from brushing right after acidic meals and/or beverages.  Your saliva can also be tested to evaluate its buffering capacity. Brush your teeth with a soft bristle toothbrush and chewing gum with xylitol, a natural sugar found in birch trees and starves the cavity forming bacteria will decrease your risk for erosion.

If you have suffered from erosion, especially around the gum line you  may be a candidate for gum grafting.  

Cavities

Cavities are caused by a bacterial infection of the teeth.  In a healthy mouth, there is a balance between protective bacteria and cavity-causing bacteria.

Have you ever wondered how “Johnny” hardly flosses, and doesn’t get a cavity?

General health, genetics, salivary composition and flow, dietary habits and oral hygiene habits are most notably some factors that can impact the checks and balances of the immune system to make you more or less susceptible to dental caries, also known as cavities.

Saliva is supersaturated with different forms of calcium, phosphate and apatite minerals that can also be found in the enamel of teeth.  In the presences of acid, the minerals can leach out from the enamel to the point where a cavity is formed.  However, if the saliva is working properly, and/or is not overwhelmed by risk factors like a bacterial infection, an acidic environment, foods high in sugar, then your teeth will be protected.

How do I get cavities?

Cavities are bacterial infections. The infections are communicable. The bacteria live in a clear sticky substance called plaque, which constantly forms on your teeth. Every time you eat, for 20 minutes, the bacteria feed on the sugars that form as the food is broken down. The bacteria generate acids, and the acids cause your teeth to decay.

How can I stop or reduce my chances of getting cavities?

  • By rinsing with a solution which lower your acidity
  • Controlling how often you eat (try to eat no more than 6 times a day)
  • By eating a diet low in carbohydrates and processed sugars
  • By thoroughly cleaning your teeth several times a day
  • By coating your teeth with Fluoride, which hardens the enamel on the teeth
  • By rinsing or eating Xylitol which harms the bacterial. Xylitol is a natural sugar substitute which can be found in health food stores
  • Drink lots of water. This helps you to maintain enough saliva to wash away the acids and dilute the bacterial
  • Each of us is different. You can get an assessment of your bacterial count and saliva acidity and quantity with a personalized Cavity Risk Assessment Visit. Call our office to schedule this important tool to stop getting cavities

What can I use to fight cavities?

1. Products which lower your acidity
  • CT x4 Carifree Treatment Rinse
  • CTx3 Carifree Maintenance Rinse
  • Therabreath oOral Rinse
  • ACT Anticavity Fluoride Rinse
2. Oral Care products
  • Ultra soft toothbrushes
  • Braun oral irrigators (waterpicks)
  • Braun/Oral B electric toothbrushes
3. Fluoride Treatments
  • Fluoride varnish: applied in the dental office
  • Prevident Toothpaste: prescription
  • CTx3 Carifree Maintenance Rinse
  • ACT Anticavity Fluoride Rinse
4. Xylitol
  • Gum and mints: Spry
  • Daily rinse: CTx3 Carifree

Gum Disease

Gum disease is the swelling or soreness of the gums around your teeth. It is caused by bacteria in plaque, a sticky, colorless film that forms on your teeth.

Gingivitis

This is the mildest form of gum disease. The bacteria produce by-products (toxins) which irritate the gums resulting in inflammation and infection. Gums become red, swollen and bleed easily. This stage of gum disease is reversible with effective oral care at home and professional treatment with your Registered Dental Hygienist or Periodontist.

Periodontitis

This is a form of gum disease results in the inflammation, infection, and destruction of the supporting bone and attachment fibers that hold your teeth in your mouth. As the disease progresses, pockets form allowing more bacterial plaque to form below the gum line. Tooth roots are exposed and become susceptible to acids, cold temperatures, and touch.

Early Periodontitis

  • Inflammation and infection are present
  • There is some bone loss which results in a pocket formation
  • Gums are bleeding

Moderate Periodontitis

  • Continued inflammation and infection
  • More noticeable bone loss and some tooth movement
  • Bone loss extends between the roots of the teeth
  • Gums continue to bleed
  • Teeth appear to look longer

Advanced Periodontitis

  • Bone loss and tooth mobility increases
  • Eventual loss of one or more teeth

Hygiene

Our office offers a variety of periodontal or “cleaning” options dependent on your level of oral health. As a patient entering the practice, you will undergo a thorough examination at which time Dr. Cournot or Dr. Lee will diagnose the necessary treatment level to stabilize your gum or periodontal health.

Prophylaxis

This appointment is one hour in length, performed two times per year. Patients using this option have a history of effective bacterial plaque control and limited inflammation over a six month period.

Two Visit Therapy

This category of appointments is for the patient with an increased amount of bacterial plaque which has resulted in inflammation and infection of the gums. The first of two visits is one hour in length. Patient plaque removal strategies are developed, bacterial plaque is removed, and irrigation with anti-microbial solutions is used to increase tissue healing. The second or “reevaluation” visit occurs two weeks later and is also one hour in length. All areas of the mouth are reexamined for healing, home care strategies are evaluated and fine-tuned; persistent inflammation is retreated. Polishing occurs at this visit and a yearly maintenance routine is determined.

Three Visit Therapy

As the amount of inflammation and gum infection increases, it becomes necessary to treat the mouth in segments. At these appointments, the right side of the mouth is treated in a one hour appointment. The following week, the left side of the mouth is treated. At each visit, patient plaque removal strategies are developed, bacterial plaque is removed, and irrigation with anti-microbial solutions is used to increase tissue healing. The third or “reevaluation “visit occurs two weeks later. Polishing occurs at this visit and a yearly maintenance routine is determined.

Four Quadrant Scaling with One Month Post-op

This series of appointment are for the patient with a significant amount of bacterial plaque attached to the tooth above and under the gum line on the root surfaces. The patient usually requires anesthesia for comfort while Debra is removing the bacterial deposits. The root surfaces are a sensitive part of the tooth. As with all the varieties of appointments, home care strategies are developed, evaluated, and fine –tuned for  effectiveness within the patient’s daily life. The patient is given anti-microbial rinses to use daily during the treatment phase and home care are supplied. At the one month post-op visit, all areas of the mouth are evaluated. Significant reductions in inflammation, infection, and pocket shrinkage plus and effective home care routine is expected. Polishing occurs at this visit and a yearly maintenance routine is determined.

Nightguards

What is a Nightguard?

A nightguard is any appliance which covers the teeth and protects them from wear during the night. There are many different kinds of nightguards, and they will all protect the teeth. A few types available are:

  1. Soft rubber, purchased over the counter in a drug store. Caution: May damage the jaw joint
  2. Semi-soft custom moulded by your dentist. Not adjusted to your bite. Caution: May damage the jaw joint.
  3. NTI: Small hard acrylic semi-custom nightguard balanced to your bite by your dentist.
  4. Centric Relation Nightguard: A full arch acrylic nightguard, fully custom fitted and meticulously adjusted for comfort and preservation of your jaw joint and teeth.

Which nightguards protect the jaw joint and the muscles?

Only the NTI and Centric Relation Nightguards protect your jaw joint and your muscles. The soft nightguards are chewy, and if you clench on them, you may damage your joint. If you notice any clicking or popping of your jaw, or any jaw tenderness while using a soft nightguard, immediately discontinue using it.

How does a nightguard help?

Grinding your teeth wears down the teeth and your jaw joint. The muscles become confused and can go into spasm, initiating a never-ending cycle of clench-damage-clench.

Some people are neurologic bruxers. The message to grind their teeth comes from their brain. These patients will always need to protect their teeth and their jaw joint.

Other people grind their teeth because their bite is uneven. These patients can get nighttime relief and  protect their teeth with a carefully balanced centric relation appliance. These patients will also benefit from an occlusal analysis.

TMJ

What is TMJ?

TMJ is an abbreviation for temperomandibular joint. The jaw joint is right in front of the ear. You can feel it with your fingers when you open or close your mouth. When you have pain, clicking or inability to move your jaw, you have temperomandibular joint dysfunction, or TMD. It is estimated that between 10% and 20% of the population suffer from TMD, at some time in their lives. If you think you might have TMD, this quick Risk Assessment Test will help you decide if you need to read further.

How does the temperomandibular joint work?

The following video demonstrates how the jaw joint or temperomandibular joint works. The jaw joint is a perhaps the most complicated joint in the body. Most joints, like your knee joint, are ball and socket joints. They can rotate, as your knee does when you bend it.

The temperomandibular joint can also rotate, which it does when you open and close. But it is very special. It can also translate when you move your jaw forward to touch your front teeth together. Look at the diagram below. In order to be able to do this, it has a cartilage disc between the ball and socket of the joint.

In this diagram, the disc is shaded purple. The disc is like a donut that moves with the joint when it translates forward. It is attached to the back wall of the jaw by an elastic tether. The TMJ is an elegant and sophisticated part of our anatomy, but like all complicated equipment, it is prone to breaking down.

Muscle Induced TMD

Most TMD is muscle pain. You can feel achy, stiff or sore in the muscles of your jaw, neck or temples. It can be the result of stress-related squeezing your teeth during the day or night. The muscles go into spasm, producing a cycle of spasm-pain-more clenching-more spasm-and more pain . . . Most muscle related episodes of TMD seem to be related to temporary periods of stress, and resolve on their own within a week or two.

When related TMD becomes chronic, there is an underlying cause that must be resolved. Common causes:

  • Tooth bruxism or clenching while sleeping
  • Habitual tooth clenching during the day
  • Uneven bite
  • Clenching induced by medications
  • Clenching induced by certain diseases
  • Damage to the joint by trauma to the face

What is TMJ?

TMJ is an abbreviation for temperomandibular joint. The jaw joint is right in front of the ear. You can feel it with your fingers when you open or close your mouth. When you have pain, clicking or inability to move your jaw, you have temperomandibular joint dysfunction, or TMD. It is estimated that between 10% and 20% of the population suffer from TMD, at some time in their lives. If you think you might have TMD, this quick Risk Assessment Test will help you decide if you need to read further.