Category Archives: TMD/TMJ

What Are You Afraid Of? –The Scariest Dental Procedures Explained

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Dentist with Instruments

Image courtesy of Gregory Szarkiewicz / FreeDigitalPhotos.net

According to reports and our experiences, nearly half of all adults dread going to the dentist. From root canals to TMD to the smallest filling, many adults are afraid of the dental procedures they need to maintain or improve their oral health. Many even avoid going to the dentist altogether because of these fears. Check out this slideshow put together by Everydayhealth.com that explains some of the procedures that people find the most frightening. A little education can go a long way to allay patients’ fears about dentistry!

SLIDESHOW: THE SCARIEST DENTAL PROCEDURES EXPLAINED

Entertaining and Educational. A Puppet’s Explanation of TMD

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TMD (Temporomandibular Joint Dysfunction) occurs when the jaw is displaced or misaligned. If you regularly experience pain during basic facial movements like chewing, speaking and even smiling, you could have TMD. This is often referred to as TMJ.

A misalignment in the jaw joint affects the muscles, tendons and nerves of your back, neck and shoulders as well as your face, causing painful symptoms that can be felt throughout your entire body.

Dr. Nadler uses the TENS and K-7 units to determine what is occurring with your jaw’s alignment and muscles connected to the jaw. Once diagnosed, a proper orthotic appliance will be created for you to reposition the jaw to a comfortable position and to relax muscles which are in spasm.

The K-7 evaluation system assesses problems in the function and alignment of the jaw joint and bite.

The TENS (Transcutaneous Electrical Neural Stimulation) unit delivers tiny electrical impulses to the muscles responsible for jaw movement and relaxes them. In less than an hour the relaxed jaw finds its ideal positioning.

The next step is a full diagnosis of the problem with the K-7 evaluation system, which records proper alignment of the jaw. The K-7 can also assist in diagnosing if the patient’s jaw joint is damaged.

If the information gathered shows that the patient has improper jaw alignment, Dr. Nadler will recommend a course of therapy for correction.

If you suffer from any of the above symptoms and would like to schedule an appointment and exam, please call us at (908) 359-6655 or click here to request an appointment online.

An Elegantly Simple Explanation of Temporomandiular Joint Disorder (TMJ)

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I do not often “borrow” from my colleagues, but a Fellow from the Institute where I study, Dr. Scott Tamura, has created a video to help his patients to understand Temporomandibular Joint Disorder (TMD) and I absolutely love its simplicity. It’s called “TMJ FOR DUMMIES” and can help anyone to understand the fundamentals of this condition which I have spent years studying and attempting to explain to patients.

Click the link to view the video: TMJ For Dummies

For those who suffer with headaches, jaw discomfort or uncomfortable bites due to TMD, we offer relief and a feeling of renewed well-being because we use state-of-the-art technology and non-invasive techniques to relax aching muscles and return the jaw to a physiologically comfortable position. So, enjoy the show, and please feel free to call me if you have additional questions or would just like more information. I wear one of these orthotics myself and can give you a first hand account of how much it has helped me.

Feel free to call me at 908.359.6655 or via our website at www.DesignsForDentalHealth.com.

NOTE: Originally posted November 14th, 2011

Dr. Nadler is featured in NJSavvy Living Magazine, Snoring and Sleep Apnea, and the K-7 Occlusal Evaluation System

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It has been a while since my last post, and there have been some major developments in the practice during that time. This article is meant to bring you up to date; and, then, I plan to write blogs on a more regular schedule to explain in detail exactly how these improvements will help our patients.

I am also putting the finishing touches on a “Cosmetic Checklist” to assist patients in determining if they are candidates for cosmetic procedures, and specifically what issues need to be addressed. This checklist should prove very informative for patients, and allow them to become more involved in the process of developing an appropriate treatment plan for themselves. This checklist should be ready in a week or two, and, at that time, I’ll provide an overview of it on this blog as well as details of how to obtain a copy.

First, Tracy Ivie of NJSavvy Living Magazine interviewed me for the Annual Health and Beauty issue. In the article entitled “The Teeth Have It”, current trends in cosmetic dentistry ranging from whitening to implants to complete smile makeovers were explored. In the article, one of our cases was featured to demonstrate the dramatic results which can be attained using up-to-date techniques and technology. I was quoted on a variety of subjects including the importance of establishing underlying dental health before any cosmetic procedure is initiated. As you may imagine, this experience was very gratifying on a professional level. I believe that this issue of the magazine is currently on your newsstands…

Second, our team has taken advanced training in snoring and sleep apnea. This subject has proved fascinating for us, as we have always been concerned with the airway issues of our patients, especially the young ones. Patients often ask why we ask about snoring or allergies or sore throats. Such questions are meant to uncover any airway issues which may have a detrimental effect on their bites. Mouth breathing, large tonsils, large tongues, high or deep palates, improper baby bottle or pacifier shape or usage are some potential causes of malocclusion (bad bites) as well as snoring and sleep apnea. We now have a new understanding of how integrally related are the airway and the mouth and the bite. More importantly, we learned that most people with nighttime breathing issues are unaware of their problem. And, some of these patients have a potentially life-threatening condition. Many others have been diagnosed with sleep apnea and have been treated for their illness with a CPAP (continuous positive airway pressure) machine which forces air through their nose while sleeping to maintain an open airway. Unfortunately, roughly ninety percent of such patients stop using this device after the first year for a variety of reasons which places them at risk. Fortunately for these patients, alternative dental devices have been developed which help relieve snoring and sleep apnea by repositioning the jaw to reduce or eliminate closed airways. There are a variety of such appliances which are chosen based upon each patient’s individual circumstances.

Finally, we have a fantastic new technology in our office called the K-7 Evaluation System. This device measures and records jaw function and muscle activity through the computer, and provides critical diagnostic information to assist in our neuromuscular restorative dentistry. In addition, using joint sonography, the K-7 provides data about vibrations occurring in the temporomandibular (jaw) joint to evaluate the status of the joint and its cartilage disk function. Using multiple sensors, jaw movement can be tracked and analyzed. And, with a series of electrodes, we can observe jaw muscle activity and truly determine when the muscles are tensed and when they are at rest. This information is invaluable in treating TMJ problems as well as in determining the best position at which to restore a bite. This technology is totally comfortable for the patient and provides a series of on-screen displays which are easily understandable and amazing to witness.

So, now we are up to date with what is going on in the office. Thank you for your patience. I look forward to delving more into snoring and sleep apnea as well as the K-7 in upcoming blogs. If you have any questions pertaining to these or other dental concerns, please do not hesitate to call us @ 908.359.6655 or through our website at www.DesignsForDentalHealth.com.

NOTE: Originally posted April 17th, 2009

Is Tooth Wear Normal?

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Most people think that it is. If teeth do wear away, they do so very slowly; so, a typical dental patient does not even realize that he or she may have as much as twenty to fifty percent attrition. Patients with such wear rarely feel pain, are still able to eat well, and are simply unaware that a problem exists.

In fact, tooth wear is not normal, but is one of the three classic signs of an unstable bite. Dentists regularly see older folks whose teeth exhibit almost no wear. These folks have healthy bites, no destructive oral habits, and avoid foods and beverages which contribute to wear. Dentists also frequently see teenagers and twenty-somethings whose teeth exhibit wear that one would expect to see in a senior citizen. The causes of such wear run the gamut. I recently saw a 26-year-old who exhibited at least thirty percent wear on four of his front teeth. In this case, the cause was very straightforward – a tongue bar (piercing) with which he developed a habit of playing with his teeth. Simply removing the bar helped to slow his wear problem, but did not solve or reverse his attrition. Repairs are required to avoid additional wear due to the exposure of the softer layers of his teeth – but more on this later.

A more common cause of tooth enamel erosion is the presence of acid which softens exposed tooth surfaces. Sources of acid include stomach digestive fluids which enter the mouth because of chronic acid reflux through the esophagus, eating disorders like bulimia, or frequent ingestion of acidic foods like soda or citric fruit juices. Patients often do not realize that they have a potentially life-threatening problem with acid reflux (GERD). Such patients may develop severe ulcers on their esophagus and may begin to notice chronic heartburn. But, fortunately, the appearance of a specific type of tooth erosion indicates this condition, and our routine examinations will uncover it.

What is the most common cause of tooth wear? Occlusion – or really malocclusion – as I alluded to in our previous blog. Teeth that meet prematurely (before all the others) will respond by wearing down, getting loose, or moving out of position. Sometimes, teeth just do not have a “home” place to meet opposing teeth, and during the chewing movement such teeth must withstand destructive forces. Similarly, patients frequently exhibit extensive wear on teeth which oppose old crowns and bridgework. Most such dental work is made of porcelain, which is much harder than natural teeth. If the bite is not quite right in these cases, the natural teeth lose the battle of which tooth is in the way. Still other people have a habit of grinding or clenching their teeth. And, if such patients have any irregularities in their occlusion, aggressive tooth wear is a quite common consequence.

I could ramble on about the myriad of causes of tooth wear, but let us get to the crux of the matter. A tooth is composed of three basic layers. The outer layer, which is visible above the gum, is called enamel. Enamel is the hardest substance in your body and is the beautiful, white, outermost, non-sensitive layer. Just under the enamel is dentin. Dentin is yellowish in color, and much softer (some sources say seven times softer) than enamel. This layer can sometimes be sensitive if exposed. The innermost layer is called pulp. Pulp contains nerves, blood vessels and soft tissue. If the enamel wears away enough to expose dentin, the wear process will speed up because the dentin is so soft. Since dentin supports enamel, as dentin wears away, the enamel eventually begins to chip leaving a ragged appearance to the edges of the teeth. And, by the time a patient realizes that his or her teeth have worn down enough to warrant some repair, a more invasive, expensive and time-consuming service will have become necessary. In advanced cases of tooth wear, the only solution is full mouth rehabilitation if the patient chooses to save his or her teeth. Finally, as tooth wear advances, the jaws can get closer and closer together. As this occurs, the chin and nose get closer together as well, causing an aged appearance of the face. Earlier is definitely better when it comes to addressing occlusal wear problems.

If you have any concerns or questions about tooth wear, please feel free to call us to discuss your problem (908.359.6655) or you may email @ info@DesignsForDentalHealth.com. Finally, if you have any suggestions for future blog subjects, we would appreciate hearing from you.

NOTE: Originally posted on June 10th, 2008

Occlusion – The Most Mysterious Oral Affliction

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Occlusion is the single most fascinating subject pertaining to dentistry. Like dental decay and gum disease, malocclusion leads to premature tooth loss and a myriad of other dental maladies. In the simplest terms, occlusion is how the teeth meet. But, there is an entire system of nerves, muscles, bones and joints which all must work in a balanced and unstressed manner to provide a comfortable and stable bite.

If this system is not in sync, there are a host of signs and symptoms which may be displayed. From the dentist’s point of view, the three major signs of malocclusion (or bite problem) are:

1. Tooth wear
2. Loose teeth and
3. Teeth that have moved out of position

For the patient, there are several symptoms which may be experienced due to malocclusion:

• Headaches (often migraines are misdiagnosed bite problems)
• Neck and shoulder pain
• Facial pain
• Clicking or popping sounds when chewing or opening/closing
• Stuffy ears and ringing in the ears (tinnitus)
• Dizziness
• Tingling fingers
• Sleeplessness
• Difficulty chewing

Temporomandibular Joint Dysfunction (TMD) is a term which encompasses a combination of the signs and symptoms listed above. You may envision a screen door with hinges which are out of whack. To close the door completely, it must always be given an extra strong push. After some time, this forcing the door shut eventually takes its toll on the stressed hinges, and they either break or become so worn out that the door will not close completely no matter how much force is applied. Similarly, in the mouth, if the system is not aligned properly, the muscles have to work overtime to get the teeth to meet. When these muscles fatigue they begin to hurt. And, in the worst case, the jaw joints suffer damage due to their chronically being forced into a compromised position. Patients with TMD are often helped by using orthotics which reposition their jaw into its relaxed muscle position. When the muscles are freed to function normally, pain ceases very rapidly. Even chronic pain sufferers can feel relief in as little as one day.

Many patients display tooth wear to one degree or another. The wearing process is a slow one and patients are often not aware of the problem until it is quite advanced. Earlier is better when addressing wear issues, as there is more tooth to work with and a better long-term prognosis for successfully restoring the teeth.

Equally common are patients whose teeth have moved out of position and are both unesthetic and unstable as a result. We frequently see adults who had worn braces as a child, but their teeth have shifted back to their original position to one degree or another. Crowded lower front teeth which seems to be get worse with time is another common complaint. Such tooth position problems can be reversed using orthodontics, and Invisalign has been a wonderful adjunct treatment for such cases. Invisalign offers a more esthetic alternative to regular braces and can be removed for easier home care. The type of tooth movements which can be accomplished with invisalign is limited however.

There will be more on tooth wear and tooth position problems in the next blog article. If you have any questions or concerns about your occlusion, please feel free to call our office at 908.359.6655 for answers. Or, you may send email to info@DesignsForDentalHealth.com.

NOTE: Originally posted April 24th, 2008