My Blog

By Paul A. Guidi, DMD, PA
June 11, 2021
Category: Oral Health
Tags: jaw pain  
ThinkTwiceBeforeYouUndergoBotoxTreatmentforChronicJawPain

There's still much about the underlying nature of chronic jaw joint dysfunction we have yet to unravel. Treating these conditions known as temporomandibular joint disorders (TMDs) may therefore require some experimentation to find what works for each individual patient.

Most TMD therapies are relatively conservative: eating softer foods, taking anti-inflammatory pain relievers or undergoing physical therapy. There have been some surgical techniques tried to relieve jaw pain and dysfunction, but these have so far had mixed results.

Recently, the use of the drug Botox has been promoted for relieving jaw pain, albeit temporarily. Botox contains tiny amounts of botulinum toxin type A, a poisonous substance derived from the bacterium Clostridium botulinum, which can cause muscle paralysis. It's mainly used to cosmetically smooth out small wrinkles around facial features.

Because of these properties, some physicians have proposed Botox for TMD treatment to paralyze the muscles around the jaw to reduce pain and discomfort. While the treatment sounds intriguing, there are a number of reasons to be wary of it if you have TMD.

To begin with, the claims for Botox's success in relieving jaw pain have been mainly anecdotal. On the other hand, findings from randomized, double-blind trials have yet to show any solid evidence that Botox can produce these pain-relieving effects.

But even if it lived up to the claims of TMD pain relief, the effect would eventually fade in a few weeks or months, requiring the patient to repeat the injections. It's possible with multiple Botox injections that the body will develop antibodies to fight the botulinum toxin, causing the treatment to be less effective with subsequent injections.

Of even greater concern are the potential side effects of Botox TMD treatment, ranging from headaches and soreness at the injection site to more serious muscle atrophy and possible facial deformity from repeated injections. There's also evidence for decreased bone density in the jaw, which could have far-reaching consequences for someone with TMD.

The best approach still seems to lie in the more conservative therapies that treat TMD similar to other joint disorders. Finding the right combination of therapies that most benefit you will help you better manage your symptoms.

If you would like more information on treatments for TMD, 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 “Botox Treatment for TMJ Pain.”

By Paul A. Guidi, DMD, PA
June 01, 2021
Category: Dental Procedures
Tags: aging  
KnowingHowtheMouthandFaceGrowCanImproveBiteTreatment

Correcting a bite problem involves more than applying braces. Orthodontists must consider a wide range of factors, including the type of bite problem involved, complications like impacted or missing teeth, and their patient's overall dental condition.

Orthodontists must also keep in mind the future—how will a treatment implemented now impact a patient's appearance and dental function many years from now? In reality, orthodontists perform these treatments within a dynamic growth environment, especially involving children and teenagers whose mouth and facial structures are still maturing.

And although these growth changes slow in adulthood, they don't stop—orofacial structures continue to change throughout life. For example, a person's lips steadily thicken in size until the mid-teen years, and then slowly thin out over the rest of their lifetime. The distance between the lips both at rest and while smiling may also narrow in later years. Other changes continue to occur in the bones and soft tissues of the mouth and face.

Fortunately, this structural growth follows a fairly consistent track. Although variations do occur, an orthodontist can project the growth changes their patients will undergo as they age, and use that knowledge to plan out bite treatment. With this understanding, orthodontists plan not only what treatments will be needed, but when to perform them, and to what extent.

This may involve a number of treatment stages, spaced out to coincide with regular development. An orthodontist may focus first on general bite correction to bring the teeth and jaws into a reasonable state of alignment. Later, they'll use more refined methods to fine-tune corrections that better align with later adult growth.

More intensive treatments may be necessary to build a foundation for future treatment. For example, orthognathic surgery may be needed to correct a severe case of an over-extended lower jaw. During the procedure, surgeons move the lower jaw to a joint position higher on the skull. This retracts the lower jaw into a more normal alignment with the upper jaw, and can dramatically change the facial profile for the better.

Each orthodontic patient is different, and each requires their own a unique treatment plan. That plan has a greater chance of long-term success by applying knowledge of future growth changes.

If you would like more information on orthodontic treatment, 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 “Understanding Aging Makes Beauty Timeless.”

BuffaloBillsStefonDiggsKnowsTheresNeveraBadPlacetoFloss

Buffalo Bills wide receiver Stefon Diggs wrapped up the NFL regular season in January, setting single-season records in both catches and receiving yards. The Bills handily beat the Miami Dolphins, earning themselves the second seed in the AFC playoffs, and Diggs certainly did his part, making 7 catches for 76 yards. But what set the internet ablaze was not Diggs' accomplishments on the field but rather what the camera caught him doing on the sidelines—flossing his teeth!

The Twitterverse erupted with Bills fans poking fun at Diggs. But Diggs is not ashamed of his good oral hygiene habits, and CBS play-by-play announcer Kevin Harlan expressed his support with “Dental hygiene is something to take note of, kids! There's never a bad place to floss” and “When you lead the NFL in catches and yards, you can floss anytime you want.”

We like to think so. There's an old joke among dentists:
Q. Which teeth do you need to floss?
A. Only the ones you want to keep.

Although this sounds humorous, it is borne out in research. Of note, a 2017 study showed that people who floss have a lower risk of tooth loss over periods of 5 years and 10 years, and a 2020 study found that older adults who flossed lost an average of 1 tooth in 5 years, while those who don't lost around 4 teeth in the same time period.

We in the dental profession stress the importance of flossing as a daily habit—and Stefon Diggs would likely agree—yet fewer than 1 in 3 Americans floss every day. The 2016 National Health and Nutrition Examination Survey (NHANES), conducted by the CDC's National Center for Health Statistics, revealed that only 30% of Americans floss every day, while 37% floss less than every day and 32% never floss.

The biggest enemy on the football field may be the opposing team, but the biggest enemy to your oral health is plaque, a sticky film of bacteria and food debris that builds up on tooth surfaces. Plaque can cause tooth decay and gum disease, the number one cause of tooth loss among adults. Flossing is necessary to remove plaque from between teeth and around the gums where a toothbrush can't reach. If not removed, plaque hardens into tartar, which can only be removed by the specialized tools used in the dental office. Regular professional dental cleanings are also needed to get at those hard-to-reach spots you may have missed.

If Diggs can find time to floss during a major NFL game, the rest of us can certainly find a couple minutes a day to do it. While we might not recommend Diggs' technique of flossing from one side of the mouth to the other, we commend his enthusiasm and commitment to keeping his teeth and gums healthy. Along with good dental hygiene at home—or on the sidelines if you are Stefon Diggs—regular professional dental cleanings and checkups play a key role in maintaining a healthy smile for life.

If you would like more information about keeping in the best dental health, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine article “Daily Oral Hygiene.”

By Paul A. Guidi, DMD, PA
May 12, 2021
Category: Oral Health
Tags: oral health  
5ThingsYouCanDoToKeepYourTeethandGumsHealthy

While your dentist plays an important role in keeping things inside your mouth healthy, what you do every day often makes the biggest difference. Here are 5 routine things you can do for better oral health.

Brush and floss every day. The most important thing you can do for your teeth and gums is adhere to a daily schedule of brushing and flossing. These twin tasks remove the daily buildup of plaque, a thin bacterial biofilm most responsible for tooth decay and gum disease.

Check your hygiene. There's brushing and flossing—and then there's brushing and flossing effectively. To make sure you're getting the job done, run the tip of your tongue along your teeth after you brush and floss. If it feels smooth, mission accomplished! If it feels rough and gritty, though, try again. You can also use plaque disclosure products occasionally to highlight any missed plaque still on your teeth.

Say no to sugar. Chances are you love sugar—and so do the disease-causing bacteria in your mouth. As they feed on sugar, they multiply and produce acid, which in high levels can erode tooth enamel and lead to tooth decay. Limiting sugar in your diet reduces oral bacteria and the acid they produce, and thus lowers your risk for disease.

Drink plenty of water. Saliva plays an important role in oral health: It helps fight off bacteria, neutralizes acid and re-mineralizes tooth enamel. But it can't do those things if there's not enough of it. So, if your mouth consistently feels dry, drink more water to give your body what it needs to make saliva. Drinking water also washes away food particles that could become plaque and lowers your mouth's acidity.

Maintain your dental appliances. You can extend the life of dentures, retainers or other types of dental appliances by cleaning and maintaining them. You should clean your appliance regularly using regular hand soap or a designated cleaner (not toothpaste, which can be too abrasive). Unless otherwise directed by your dentist, take them out at night and be sure to store them where kids or pets can't get to them.

If you would like more information on best dental care practices, 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 “10 Tips for Daily Oral Care at Home.”

YouMayNotNeedPermanentToothAlterationWithTheseUltra-ThinVeneers

If you're looking for a cosmetic enhancement with a “light” touch, you can't beat dental veneers. These custom-made wafers of dental porcelain are bonded to the front of teeth to mask chips, heavy staining or gaps, revitalizing your smile.

But with traditional veneers, a minimal impact doesn't mean no impact at all. Although they're quite thin—often a millimeter or less—they can still look bulky when bonded to unprepared teeth. Dentists usually remove a small amount of surface enamel to help them appear more natural.

The alteration itself is painless, and only the bare minimum of enamel is removed. Even so, the alteration is permanent—the tooth will require a veneer or other form of restoration from then on. But a new kind of veneer may make it possible to avoid any enamel removal, or much less. These no-prep or minimal-prep veneers are even thinner, between 0.3 and 0.5 millimeters.

With these ultra-thin veneers, your dentist may only perform a little minor enamel re-shaping, particularly the sides of the teeth, to ensure a good fit. As thin as they are—akin to that of a contact lens—no-prep veneers can be bonded to the teeth surface without the need for fitting them under the gum line.

No-prep veneers are ideal for people with smaller than normal teeth, or that appear smaller due to other facial features. This also includes teeth that have worn down from age or teeth grinding, or those that are misshapen in some way. They also work well with people who have a narrow smile where less teeth than normal are visible in the “smile zone.”

They can also be used with patients who have oversized or prominent teeth, but it may still require some enamel removal. The only qualification for anyone receiving ultrathin veneers is that their enamel is in reasonably good health.

Because there's little to no alteration of the teeth, no-prep veneers can be reversed. Removing them, though, is no easy task, so you'll still need to think long-term before obtaining one. All in all, though, no-prep veneers in the right setting can still transform your smile without much permanent change to your teeth.

If you would like more information on no-prep veneers, 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 “No-Prep Porcelain Veneers.”





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