Tenderness; headaches; difficulty chewing; excruciating pain. These are a few of the symptoms you could endure with a jaw joint or temporomandibular disorder (TMD or TMJ). This group of disorders disrupts the daily lives of millions of people around the world.

This month is TMJ Awareness Month, to shed light on these debilitating conditions and how best to manage them. Although controlling TMD isn't always easy, it can be done with the right blend of treatments.

The temporomandibular joint—actually a pair of joints connecting the lower jaw to the skull on either side of the face—is "ground zero" for TMD. These are ball-and-socket joints similar to the hip or shoulder, but with a unique addition—a cushioning disk that lies between the adjoining points of the two bones that temper the forces generated when you eat, speak or bite down.

Researchers believe TMD can arise from a variety of sources, including traumatic injury, psychological stress or mechanical dysfunction within the joint and cushioning disk. These problems can create blood flow constriction, which in turn causes the accumulation of chemical waste byproducts in the jaw muscles. This in turn and cause the muscles to spasm and become inflamed and sore.

Treatments are also as numerous as the possible causes of TMD. But for the most part, they range along a continuum of conservative to aggressive approaches.

On the conservative end, doctors treat TMD as a joint problem and borrow heavily from orthopedics. These types of treatments include the use of anti-inflammatory and muscle relaxing medications, icing or heating, stretching exercises, physical therapy and massage. Dentists may also provide mouth guard appliances for patients with clenching or tooth grinding habits to decrease biting forces.

On the more aggressive end are interventions like orthodontics or dental work. But, while these were common recommendations 20-30 years ago, it's no longer thought to be necessary for treating most TMD disorders and should not be recommended as a cure or solution for TMD.  At the furthest extreme is actual jaw surgery to relieve symptoms or repair damage within the joints. The latter, however, has not yet amassed a solid track record, and should be considered as a last resort.

Finding the right combination of therapies to give consistent relief sometimes requires a bit of trial and error. Most doctors recommend starting first with the most conservative methods before considering more aggressive measures. You should also undergo a complete dental exam to see if teeth or gum problems are contributing to your symptoms.

TMD can make your life miserable. But with some persistence and patience, you can find what works for a life without pain and dysfunction.

If you would like more information about managing TMD, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine article “Seeking Relief From TMD.”

Dental implants have revolutionized restorative dentistry. Not only are they the top choice for individual tooth replacement, implants also improve upon traditional dental work.

Dental bridges are a case in point. A few well-placed implants can support a fixed bridge instead of natural teeth, as with a traditional bridge. Furthermore, a fixed, implant-supported bridge can replace all the teeth on a jaw.

But although convenient, we can't simply install an implant-supported bridge and forget about it. We must also protect it from what might seem at first an unlikely threat—periodontal (gum) disease.

Although the bridge materials themselves are impervious to infection, the natural tissues that underly the implants—the gums and bone—are not. An infection plaguing the gums around an implant can eventually reach the bone, weakening it to the point that it can no longer support the imbedded implants. As the implants fail, so does the bridge.

To guard against this, patients must regularly remove any buildup of plaque, a thin biofilm that feeds disease-causing bacteria, adhering to the implant surfaces in the space between the bridge and the gums. To do this, you'll need to floss—but not in the traditional way. You'll need some form of tool to accomplish the job.

One such tool is a floss threader. Similar to a large needle, the threader has an eye opening at one end through which you insert a section of floss. You then gently pass the threader between the bridge and the gums toward the tongue.

Once through, you release the floss from the threader, and holding each end, you work the floss along the implant surfaces within reach. You then repeat the threading process for other sections until you've flossed around all the implants.

You might also use a water flosser, a device that directs a spray of water between the bridge and gums. The pressure from the spray loosens and flushes away any plaque around the implants.

Whatever the method, it's important to use it every day to reduce the threat of gum disease. You should also see your dentist regularly for further cleanings and checkups. Keeping your implants clean helps ensure gum disease won't ruin your fixed bridge—or your attractive smile.

If you would like more information on keeping your dental work clean, 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 “Oral Hygiene for Fixed Bridgework.”

Advanced decay doesn't necessarily mean it's curtains for an infected tooth. Millions of teeth in that condition have been saved by a tried and true procedure called root canal therapy.

Although they may vary according to the complexity of a case, all root canal procedures share some similarities. After numbing the tooth and gum areas with local anesthesia, the procedure begins with a small hole drilled into the tooth to access the infected pulp and root canals, tiny passageways inside the root.

The dentist then uses special instruments to clear out infected tissue from the pulp and canals, followed by thoroughly sanitizing the resulting empty spaces. This is followed with filling the pulp chamber and root canals with a rubber-like substance (gutta percha) to seal the interior of the tooth from further infection. Later, the dentist typically crowns the tooth for further protection and support.

Root canals have become the standard treatment for teeth with advanced decay. There are, however, some circumstances where performing a root canal isn't a good idea. For example, a previously root-canaled tooth with a crown and supporting post. A dentist would need to fully disassemble the restoration to gain access into the tooth, which could significantly weaken it.

But there may be another option if a standard root canal is out of the picture: a surgical procedure performed by an endodontist (a specialist in interior tooth treatment) called an apicoectomy. Instead of drilling through the tooth crown, the endodontist accesses the tooth root through the adjacent gum tissue.

Like a traditional root canal, the procedure begins by anesthetizing the tooth and surrounding gums. The endodontist then makes a small incision through the gums to expose the diseased tissues at the tooth's root. After removing the infected tissue and a few millimeters of the root tip, they place a small filling to seal the end of the root canal against infection and suture the gum incision.

This is a specialized procedure that requires the state-of-the-art equipment and advanced techniques of an endodontist. But it does provide another possible option for saving a diseased tooth that might otherwise be lost.

If you would like more information on treatments for tooth decay, 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 “Apicoectomy: A surgical Option When Root Canal Treatment Fails.”

In one respect, celebrities are no different from the rest of us—quite a few famous people love to collect things. Marie Osmond collects dolls (as well as Johnny Depp, reportedly); Leonardo DiCaprio, vintage toys. And, of course, Jay Leno has his famous fleet of cars. But Victoria Beckham's collection is unusually "familial"—she's kept all of her four children's "baby" teeth after they've fallen out.

Best known as Posh Spice of the 1990s group Spice Girls and now a fashion designer and TV personality, Beckham told People Magazine that she has an "entire bucket" of her kids' primary teeth. And, she recently added to it when her nine-year old daughter lost another tooth earlier this year.

You may or may not want to keep your child's baby teeth, but you'll certainly have the opportunity. Children start losing their first set of teeth around age 6 or 7 through early puberty. During the process, each tooth's roots and gum attachment weakens to the point that the tooth becomes noticeably loose. Not long after, it gives way and falls out.

Although a baby tooth doesn't normally need any help with this, children (and sometimes parents) are often eager to accelerate the process. A loose tooth can be annoying—plus there's often a financial incentive via the "Tooth Fairy!"

First off, there's not much harm in a child wiggling a loose tooth—it may even help it come out. It's also possible to help the tooth safely detach sooner by taking a small piece of tissue, folding it over the tooth and giving it a gentle downward squeeze. If it's loose enough, it should pop out.

If it doesn't, don't resort to more forcible measures like the proverbial string and a door—just wait a day or two before trying the gentle squeeze method again. Once the tooth comes out, the empty socket may bleed a bit or not at all. If heavy bleeding does occur, have the child bite down on a piece of clean gauze or a wet tea bag until it stops. You may also have them eat softer foods for a few days to avoid a resumption of bleeding.

Beyond that, there's little else to do but place it under your child's pillow for the Tooth Fairy. And if after their "exchange" with that famous member of the Fae Folk you find yourself in possession of the erstwhile tooth, consider taking a cue from Victoria Beckham and add it to your own collection of family memories.

If you would like more information about losing baby teeth, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine article “Importance of Baby Teeth.”

In addition to daily oral hygiene and regular dental visits, a tooth-friendly diet can boost your kid's dental health and development. You can help by setting high standards for eating only nutritious foods and snacks at home.

But what happens when they're not home—when they're at school? Although public schools follow the Smarts Snacks in Schools initiative sponsored by the U.S. Department of Agriculture, those guidelines only recommend minimum nutritional standards for foods and snacks offered on campus. Many dentists, though, don't believe they go far enough to support dental health.

Besides that, your kids may have access to another snack source: their peers. Indeed, some of their classmates' snacks may be high in sugar and not conducive to good dental health. Your kids may face a strong temptation to barter their healthy snacks for their classmates' less than ideal offerings.

So, what can you as a parent do to make sure your kids are eating snacks that benefit their dental health while at school? For one thing, get involved as an advocate for snacks and other food items offered by the school that exceed the USDA's minimum nutritional standards. The better those snacks available through vending machines or the cafeteria are in nutritional value, the better for healthy teeth and gums.

On the home front, work to instill eating habits that major on great, nutritional snacks and foods. Part of that is helping your kids understand the difference in foods: some are conducive to health (including for their teeth and gums) while others aren't. Teach them that healthier foods should make up the vast majority of what they eat, while less healthier choices should be limited or avoided altogether.

Doing that is easier if you take a creative, playful approach to the snacks you send with them to school. For example, if you send them to school with their own snacks, add a little excitement like cinnamon-flavored popcorn or cheese and whole wheat bread bites in different shapes. And make it easier for them with bite-sized snacks like grapes, baby carrots or nuts.

You can't always control what snacks your kids eat, especially at school. But following these tips, you may be able to influence them in the right direction.

If you would like more information on helping your child develop tooth-friendly snacking habits, 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 “Snacking at School.”