If you were recently in an accident or received a hard hit while playing sports and you have been feeling jaw pain ever since, you may be suffering from a serious injury. It is important that you make an appointment with us immediately, so that we can conduct a proper examination, make a diagnosis and prescribe a suitable treatment. Even if the pain is lessening, you should still make an appointment.

Without seeing you, we have no way of definitively diagnosing the cause of your pain. However, here are a few possibilities:

1. You displaced a tooth or teeth.
2. You indirectly traumatized or injured the jaw joint (TMJ — temporomandibular joint). This trauma will cause swelling in the joint space, and the ball of the jaw joint will not fully seat into the joint space. If this is the issue, it is likely that your back teeth on the affected side will not be able to touch. Over time, the swelling should subside, allowing the teeth to fit together normally.
3. You may have a minor fracture of your lower jaw. The most common is a “sub-condylar” fracture (just below the head of the joint), which will persist in symptoms that are more severe than simply bruising and swelling.
4. You may have dislocated the joint, which means the condyle or joint head has been moved out of the joint space.

All of the above injuries can also cause muscle spasms, meaning that the inflammation from the injury results in the muscles on both sides of the jaw locking it in position to stop further movement and damage.

The most critical step is for you to make an appointment with our office, so we can conduct a physical examination, using x-rays to reveal the extent of your injury. We'll also be able to see whether the injury is to the soft tissue or bone.

Treatment may involve a variety of things, including anti-inflammatory and muscle relaxant medications. If your teeth have been damaged, we'll recommend a way to fix this issue. If you have dislocated your jaw, we may be able to place it back through gentle manipulation. If you have fractured your jaw, we'll need to reposition the broken parts and splint them to keep them still, so that they can heal.

If you would like more information about jaw pain, please contact us or schedule an appointment for a consultation. You can also learn more by reading the Dear Doctor magazine article “Jaw Pain.”

Nothing conveys confidence quite like a bright, white smile. Unfortunately, not all smiles are created equal. And, some smiles are much whiter than others. Whether your teeth have become discolored from food and drink or general wear and tear from aging, you may find yourself looking in the mirror one day wishing that there was a simple way to enhance your smile.

You've probably seen many over-the-counter products that claim to whiten your teeth. However, the strongest and fastest whitening solutions are those that are available in our office. There are many reasons why a professional whitening treatment might be the right solution for you. Here are a few:

1. Economical. Whitening is one of the least expensive cosmetic remedies available to improve a faded smile.
2. Convenient. Depending upon your time frame, you will be able to choose from whitening at home or in our office. With in-office whitening, we will apply a gel to your teeth and leave it on for about an hour. With take-home whitening, you'll receive custom-made trays that we will ask you to fill with the whitening gel and leave on your teeth 30 minutes a day, twice a week for about six weeks.
3. Effective. With professional whitening, your teeth will get anywhere from three to eight shades lighter. It's a noticeable difference that will surely help you regain confidence in your smile.
4. Low-Risk. Since whitening is a non-invasive procedure, the side effects are minimal. You may feel a bit of tooth sensitivity or gum irritation following treatment, but if such effects do occur, they will last no more than one to four days.
5. Easy to Maintain. Whether you choose in-office or take-home, your whitening treatment will likely last from six months to two years. The good news is that your new white smile will be easy to maintain. By avoiding tobacco and foods containing tannins such as red wine, coffee and tea, you will be able to preserve the brightness of your smile. You should also continue your regular oral care routine of brushing twice a day and flossing daily.

If you would like more information about teeth whitening, please contact us or schedule an appointment for a consultation. You can also learn more by reading the Dear Doctor magazine article “Important Teeth Whitening Questions Answered.”

What is oral sedation dentistry? If you become frightened and anxious when facing a dental appointment or procedure, sedatives (also called “anxiolytics” meaning they dissolve anxiety), can completely transform the experience. Oral sedatives (taken by mouth) allow you to relax your mind and body so that you feel comfortable while in the dental chair.

How does anxiety affect my pain response? When you are afraid, your pain threshold is reduced. You experience a rush of adrenalin and you tense your muscles. As a result you end up in a state of heightened sensitivity. With sedation this sensitivity to pain vanishes along with your fear and anxiety.

What are some of the oral sedatives that my dentist may use? Most of the medications used in oral sedation dentistry belong to a class of medications called benzodiazepines, tried and tested over decades to be safe and effective. They are used in the treatment of anxiety, insomnia, and agitation. They include Valium®, Halcion®, Ativan®, and Versed®.

I'd just like to forget the experience after it is over. Can oral sedation help? Some of the medications prescribed as oral sedatives have amnesic properties (“a” – without; “mnesia” – memory). This means you will have little memory of the time in the dental chair when your procedure is finished.

What does my dentist need to know in order to prescribe the right oral sedation? We need a thorough medical and dental history, including all medical conditions you may have, and all medications you are taking — both prescription and over-the-counter (including allergies, alternative medications and even herbal supplements). We will also ask you whether you eat certain foods that could interfere with a sedative's effects.

How are the oral sedatives administered? Oral medications are either placed under the tongue (sub-lingual), and allowed to dissolve and then swallowed, or they may be swallowed whole. They are safe, effective, and fast acting. After the sedation takes effect, it will be easier to experience injections of local anesthesia if needed to numb your gums for the dental procedure.

What do I need to do before and after my appointment? Follow all directions we give you about restricting food and drink before your appointment. Until the medication wears off you may not be able to drive, operate heavy machinery or work so be sure to make arrangements to take time off and to have someone drive you to and from the appointment.

Contact us today to schedule an appointment to talk about any fears you may have about dental treatments. Using oral sedation, we can make sure that you have a relaxing experience. Oral sedation allows you to relax both your mind and body, and focus on feeling peaceful rather than anxious. You can learn more about oral sedation dentistry in the Dear Doctor magazine article “Oral Sedation Dentistry.”

Are the following statements true or false?

Thumb sucking in children may cause problems with their teeth later on.

A: TRUE

Prolonged thumb sucking may be responsible for many problems with the bite. The constant pressure of the thumb itself can create a gap between the top and bottom teeth in front, a condition called an “open bite.” It also reinforces the habit of using the “tongue thrust” motion in swallowing, where the tongue is positioned between top and bottom teeth. This habit may also block full eruption of the front teeth.

Infants and young children swallow exactly the same way that adults do.

A: FALSE

When they swallow, young children use what is called the “infantile swallowing pattern.” In this method, which begins before their teeth have erupted, the tongue is thrust forward in the mouth, sealing and supporting the lips. In adult swallowing, the tongue touches the roof of the mouth, behind the front teeth. The transition from the infantile method usually happens naturally, by around age 4.

Most open bites result from the habit of positioning the tongue too far forward.

A: TRUE

Failure to transition between the infantile and adult swallowing pattern is believed to be the cause of most open bites. The tongue's position alone may prevent the front teeth from fully developing. Allowing the thumb to rest between the teeth has the same effect — and it can also push the front teeth forward. Other causes of an open bite are skeletal or jaw-related problems.

It is harder to cure open bites caused by thumb sucking or bad tongue position than those from other causes.

A: FALSE

Open bites that are caused by skeletal factors (patterns of bone growth, etc) are often difficult to resolve. Those caused by dental factors (tongue position, tooth eruption, etc) are generally easier to fix. However, the pressure exerted by the thumb over a long period of time can influence bone growth in the jaw.

There is a dental appliance that can help discourage thumb sucking.

A: TRUE

A thin metal “tongue crib” placed behind upper and lower incisors discourages the thumb-sucking habit. It also helps to “re-train” the tongue, keeping it from going between upper and lower teeth. To successfully treat an open bite caused by dental factors, and to prevent its reoccurrence, it is essential to eliminate the unhelpful habits of both the thumb and the tongue.

If you would like more information about thumb sucking or open-bite problems in children, 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 “How Thumb Sucking Affects The Bite.”

Oral cancer is not as uncommon as people think. In 2008 an estimated 34,000 cancers of the mouth and throat were diagnosed. In order to minimize your risk of developing oral cancer, be aware of habits that increase your risk.

Risk Factors for Oral Cancer include:

• Use of smoking or chewing tobacco: Tobacco smokers have 5-9 times greater risk of developing this cancer than non-users; snuff and chewing tobacco users have a four times greater risk than non-users.
• Excessive use of alcohol: Moderate to heavy drinkers at are 3-9 times greater risk than non-drinkers.
• Exposure to sun: Chronic sun exposure is associated with development of lip cancers.
• Certain viral infections such as the human papilloma virus that can cause cervical cancer in women can also cause oral cancer.
• Compromised immune (resistance) systems that are not functioning properly can be associated with cancers.
• Poor nutrition including diets low in fruits and vegetables can increase risk for all cancers including oral cancer.
• Family history: People carry a predisposition in their DNA (the genetic material they inherited from their parents) for developing cancer.

Oral Cancers Can Mimic Harmless Sores

Early signs of oral cancer can mimic harmless sores that occur in the mouth such as canker sores, minor infections, or irritations that occur from biting or eating certain foods. Cancers in the lip area can easily be mistaken for harmless sores.

Early Detection is Key

It is important to have regular oral examinations to detect signs of oral cancer. Although 90 percent of oral cancers occur in people who are over 40, it is becoming more prevalent in younger people, particularly those who adopt risky behaviors: smoking, drinking and oral sex.

• If you notice any unusual lesions (sores or ulcers), or color changes (white or red patches), anywhere in your mouth that do not heal within two to three weeks, come and see us and have it examined immediately.
• Definitive diagnosis may require a small biopsy, the microscopic examination of a piece of tissue from the affected area.

It is important not to let a suspicious sore go unchecked. If detected and treated early, while a lesion or growth is small, survival rates can exceed 80 percent. Contact us today to schedule an appointment to discuss your questions about oral cancer. You can also learn more by reading the Dear Doctor magazine article “Oral Cancer.”