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The Latest Perspective on TMJ

One person gets migraine headaches, another ringing in the ears, a third clicking and locking of the jaw, a fourth pain on the sides and back of the head and neck. All are suspected of having a temporomandibular disorder or TMJ.

Up to three-fourths of Americans have one or more signs of a temporomandibular problem, most of which come and go and finally disappear on their own. According to Dr. Ryne Johnson, Prosthodontist at Newton Wellesley Dental Partners, specialists from Boston estimate that only 5 percent to 10 percent of people with symptoms need treatment.

Popularly called TMJ, for the joint where the upper and lower jaws meet, temporomandibular disorders actually represent a wider class of head pain problems that can involve this pesky joint, the muscles involved in chewing, and related head and neck muscles and bones.

But too often, experts say, patients fail to have the problem examined in a comprehensive way and undergo costly and sometimes irreversible therapies that may do little or nothing to relieve their symptoms. As scientists at the National Institute of Dental and Craniofacial Research wrote recently, “Less is often best in treating TMJ disorders.”

A New Understanding
The TMJ is a complicated joint that connects the lower jaw to the temporal bone at the side of the head. It has both a hinge and a sliding motion. When the mouth is opening, the rounded ends, or condyles, of the lower jaw glide along the sockets of the temporal bones. Muscles are connected to both the jaw and the temporal bones, and a soft disc between them absorbs shocks to the jaw from chewing and other jaw movements.

TMJ problems were originally thought to stem from dental malocclusion — upper and lower teeth misalignment — and improper jaw position.

That prompted a focus on replacing missing teeth and fitting patients with braces to realign their teeth and change how the jaws come together.

The Boston specialists wrote recently in The New England Journal of Medicine “the cause is now considered multifactorial, with biologic, behavioral, environmental, social, emotional and cognitive factors, alone or in combination, contributing to the development of signs and symptoms of temporomandibular disorders.”  According to the American Academy of Orofacial Pain, the disorder “usually involves more than one symptom and rarely has a single cause.”

Among the “mechanical” causes that are now recognized as distorting the function of the TMJ are congenital or developmental abnormalities of the jaw; displacement of the disc between the jaw bones; inflammation or arthritis that causes the joint to degenerate; traumatic injury to the joint (sometimes just from opening the mouth too wide); tumors; infection; and excessive laxity or tightness of the joint.

But the most common TMJ problem is known as myofacial pain disorder, a neuromuscular problem of the chewing muscles characterized by a dull, aching pain in and around the ear that may radiate to the side or back of the head or down the neck. Someone with this disorder may have tender jaw muscles, hear clicking or popping noises in the jaw, or have difficulty opening or closing the mouth. Simple acts like chewing, talking excessively or yawning can make the symptoms worse.

Jaw-irritating habits, like clenching the teeth during physical activity or at the gym, tooth grinding at night, biting the lips or fingernails, chewing gum or chewing on a pencil, can make the problem worse or longer lasting. Psychological factors also often play a role, especially depression, anxiety or stress.

Dr. Johnson reports that, “Often, these parafunctional, contributing factors can be controlled with an oral appliance like a night guard.  In some instances, however, a recently placed filling or crown and trigger myofacial pain and via an occlusal analysis, the problem can be corrected with a slight adjustment of the bite”.

Proper Assessment
The overwhelming majority of people with TMJ symptoms are women. Women represent up to 90 percent of patients who seek treatment, Dr. Leonard B. Kaban, chief of oral and maxillofacial surgery at the Massachusetts General Hospital in Boston, said in an interview. Most patients are middle-age adults.

Dr. Kaban urged patients to obtain a thorough assessment of the problem before choosing therapy, especially if they have symptoms like tinnitus (ringing in the ears) and migraine headaches.

He said physicians and dentists should “start with a thorough history”. This should be followed by a physical examination, checking for signs like muscle tenderness and pain in the jaw, limited jaw opening and noises.

For those with complicated problems, he suggested visiting a multidisciplinary temporomandibular clinic, found at many leading hospitals and dental schools.
 
Therapy Options
Resting the jaw is the most important therapy. Stop harmful chewing and biting habits, avoid opening your mouth wide while yawning or laughing (holding a fist under the chin helps), and temporarily eat only soft foods like yogurt, soup, fish, cottage cheese and well-cooked, mashed or pureed vegetables and fruit. It also helps to apply heat to the side of the face and to take a non-steroidal anti-inflammatory medication, for up to two weeks.

Other self-care measures suggested by the Orofacial Academy include not leaning on or sleeping on the jaw and not playing wind, brass or string instruments that stress, strain or thrust back the jaw.

Physical therapy to retrain positioning of the spine, head, jaw and tongue can be helpful.  If you clench or grind your teeth, you can be fitted with a mouth guard that is inserted like a retainer or removable denture, especially at night, to prevent this joint-damaging behavior.

But Dr. Johnson has cautioned against embarking on “any expensive, irreversible treatment” before a thorough diagnosis is completed and simple, reversible therapies have been tried and found wanting. As with other joints, he said, surgery is a treatment of last resort, when medical/dental management has proved ineffective.
 
For more information, visit www.NewtonWellesleyDentalPartners.org and remember, “See a Specialist…The Difference Will Make You Smile”

original articlewww.nytimes.com

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Digital Dental Impressions Give You Natural Dental Restorations

When you need a dental implant, crown or bridge you want that dental restoration to look, feel and work naturally. With digital dental impressions, your replacement dentistry will look and feel natural plus the fit will be impeccable.  No one should be able to tell the difference between the dentistry and your natural teeth.
 
Dr. Ryne Johnson, Prosthodontist at Newton Wellesley Dental Partners, is a pioneer with the Cadent-Itero, digital laser scanner technology and was one of the first dentists in the Boston Region to use this technology.  According to Dr. Johnson, “the Itero scanner eliminates the goopy, messy, terrible tasting tooth impression. This camera scans with 100,000 points of reference for a 3-D, undistorted, perfect impression”.

With 3-D imagery one can create computer generated epoxy models.  These models will not chip or distort. The procedure is relaxing for the patient and easy for the staff to use.  After the digital impression is made, the files are sent to a milling company to fabricate a precise-fitting coping (think very thin thimble). Then the ceramist layers different colors of porcelain to create a natural-looking restoration.  Sometimes, the ceramist will sit with Dr. Johnson and the patient in the office for a consultation.  This way, your restoration and your smile are not left to chance. Only a perfect match will do.

The scans take a few seconds, after which the patient and doctor can easily and immediately review the 3D scans. The scans take images of all your teeth and tissue surrounding the damaged or missing tooth to ensure that your bite will feel natural and work naturally.

If you are in need of a crown, implant or bridge, and want to benefit from state of the art CAD/CAM dentistry, evaluate this technique at Newton Wellesley Dental Partners.com or click here to watch a video to see how Itero digital technology works.
 
Remember, “See a Specialist…The Difference Will Make You Smile”.

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The Position of Your Teeth Can Lead to A Healthier Life

Everyone is looking for a way to stay healthy. We want to live a longer, healthier, quality-filled life, so we exercise more often and eat a well-balanced diet.

Do you know that the alignment of your spine and body has an impact on one’s overall health?  Do you also know that one’s bite can influence the alignment of one’s body?  More than 75 million Americans have a misaligned body as the result of an improper bite.  According to Dr. Ryne Johnson, prosthodontist with Newton Wellesley Dental Partners, many people experience myo-facial pain or have temporo-mandibular dysfunction (often referred to as TMJ) when the bite is unstable or maligned.  This isn’t about straight teeth, this is about how well your teeth come together in your mouth and its influence on posture, the mandibular joint and one’s well-being.

All of our muscles and bones are interrelated. If one part is out of alignment, the remaining parts are thrown off. If your jaw is out of line from an improper bite, the neck and face are affected. Headaches and pain can stop us from exercising or sleeping decreasing the quality of life.   

By fixing the alignment of your jaw, thereby relaxing the muscles of the face and neck areas, your body flows into correct position. The symptoms one didn’t even know stemmed from this imbalance disappear. Your healthy lifestyle can resume.

If you are suffering from head or neck pain or have an imbalanced bite, contact Dr. Ryne Johnson at Newton Wellesley Dental Partners or visit the website for some educational resources.  Remember, “See a Specialist…The Difference will Make You Smile.”

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Get Straight Teeth in Much Less Time

Many people have crooked or unevenly spaced teeth. This can be caused by genetics, aging or an accident. There are many orthodontic and cosmetic dentistry procedures to straighten teeth.

The length of time that it takes each orthodontic treatment to straighten teeth varies from patient to patient depending on your individual factors:  age, bone density, tooth relationships, distance teeth need to be moved, etc.   However, often conventional braces can deliver results faster than Invisalign clear aligners (see www.Invisalign.com), mainly because many people don’t wear their clear aligners as instructed.

According to Dr. Ryne Johnson, prosthodontist, of Newton Wellesley Dental Partners, regarded as one of Boston’s top cosmetic dentists, “there are prosthetic/cosmetic options which can ‘re-align’ teeth without braces or Invisalign.  If you don't have time for your teeth to slowly straighten and move into a better position, veneers or all-ceramic crowns can get the job done in just a few visits.

The other advantage to porcelain veneers is that they can address color as well. Often with braces, teeth will yellow due to the challenge of maintaining ideal oral hygiene during the years of orthodontic therapy.  With veneers you can achieve a straight, white, beautiful smile in a matter of weeks rather than months or years.

For more information on veneers or other cosmetic, dental procedures, done by a specialist, please visit: www.NewtonWellesleyDentalPartners.org.  

Remember, “See a Specialist…the Difference will Make You Smile.”

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Your Smile Can Make You Look Younger

As you age, so does your smile. Along with tooth decay, your teeth can shift as the enamel becomes thinner. Aging can also result in chipped teeth and they wear down looking smaller over time. According to Dr. Ryne Johnson, of Newton Wellesley Dental Partners, who has been regarded as one of the region's top cosmetic dentists, there are several treatments to make your smile look younger--some that can be completed in just one or two visits.

Fix gaps: If your teeth have natural gaps or if teeth are uneven in size, a set of veneers can dramatically alter your smile. Bonding, a one-time procedure, can also help with minor gaps or to elongate teeth, which can create a healthier, sexier smile that takes the years off.

Straighten teeth: When you were younger, a few crooked teeth probably didn't age you much. However, as your face starts to naturally lose volume, crooked teeth may look more pronounced, and even cause your lips to appear thinner. Veneers are a quick solution to slightly crooked teeth, but if you have more time, you might opt for traditional braces or invisible braces, depending on what your dentist recommends.

Get a "lift": If you are losing facial volume, a traditional facelift isn't your only option. Your dentist can use veneers or bonding to build out your back teeth to support your cheekbones and even soften naso-labial folds. After this you will have a younger smile and better cheekbones.

For a younger smile of you're interested in learning about veener or hearing other options, contact Dr. Johnson at Newton Wellesley Dental Partners.org

Remember, “See a Specialist…The Difference Will Make You Smile”.

New Beauty

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