Our nerves serve a vital purpose, alerting us to bodily discomfort, injury or disease — we couldn’t remain in good health for long without them. But when they malfunction due to genetics or disease, they can themselves become a source of pain and discomfort.
One such nerve disorder that affects the face is known as trigeminal neuralgia (TN) or tic douloureaux (from the French for “painful”). The nerves in question are the trigeminal, a pair that travel up from the brain stem through the skull into each side of the face where they each branch into the upper, middle and lower parts of the face and jaw. The pain can radiate from one or more of these branches.
TN is characterized by recurring episodes of brief but severe pain with accompanying muscle spasms. It may begin as a short twinge recurring over weeks, months or years before becoming increasingly painful. The slightest actions can trigger a painful episode: chewing, speaking, shaving or even the wind blowing on your face.
While it may be hard to determine its exact cause, it often seems to result from an artery or vein pressing on the nerve, causing it to signal pain at the slightest stimulation and then failing to stop transmitting when the stimulation is removed. It’s also associated with other inflammatory disorders like multiple sclerosis where the protective insulation around a nerve is damaged.
Before receiving treatment you should undergo a complete examination to rule out any other facial pain causes like temporomandibular (jaw joint) disorders or a dental abscess. You may also need to undergo a neurological examination and possible MRI imaging to pinpoint the exact cause, like a tumor or blood vessel pressing on the nerve.
Although the condition may not be curable, there are several effective management treatments. The more conservative approaches usually involve medications to block the nerve’s pain signals or decrease its abnormal firing. If this isn’t sufficient to diminish symptoms, there are surgical options: passing a thin needle through the nerve to selectively prevent fibers from firing, or moving aside a blood vessel pressing on it. High-dose targeted radiation may also be effective, especially with older patients.
The best treatment approach will depend on the exact cause, your age and overall health. Whatever the approach, you can gain significant relief from the pain of TN.
The movie Bohemian Rhapsody celebrates the iconic rock band Queen and its legendary lead vocalist, Freddie Mercury. But when we see pictures of the flamboyant singer, many fans both old and new may wonder—what made Freddie’s toothy smile look the way it did? Here’s the answer: The singer was born with four extra teeth at the back of his mouth, which caused his front teeth to be pushed forward, giving him a noticeable overbite.
The presence of extra teeth—more than 20 primary (baby) teeth or 32 adult teeth—is a relatively rare condition called hyperdontia. Sometimes this condition causes no trouble, and an extra tooth (or two) isn’t even recognized until the person has an oral examination. In other situations, hyperdontia can create problems in the mouth such as crowding, malocclusion (bad bite) and periodontal disease. That’s when treatment may be recommended.
Exactly what kind of treatment is needed? There’s a different answer for each individual, but in many cases the problem can be successfully resolved with tooth extraction (removal) and orthodontic treatment (such as braces). Some people may be concerned about having teeth removed, whether it’s for this problem or another issue. But in skilled hands, this procedure is routine and relatively painless.
Teeth aren’t set rigidly in the jawbone like posts in cement—they are actually held in place dynamically by a fibrous membrane called the periodontal ligament. With careful manipulation of the tooth, these fibers can be dislodged and the tooth can be easily extracted. Of course, you won’t feel this happening because extraction is done under anesthesia (often via a numbing shot). In addition, you may be given a sedative or anti-anxiety medication to help you relax during the procedure.
After extraction, some bone grafting material may be placed in the tooth socket and gauze may be applied to control bleeding; sutures (stitches) are sometimes used as well. You’ll receive instructions on medication and post-extraction care before you go home. While you will probably feel discomfort in the area right after the procedure, in a week or so the healing process will be well underway.
Sometimes, dental problems like hyperdontia need immediate treatment because they can negatively affect your overall health; at other times, the issue may be mainly cosmetic. Freddie Mercury declined treatment because he was afraid dental work might interfere with his vocal range. But the decision to change the way your smile looks is up to you; after an examination, we can help you determine what treatment options are appropriate for your own situation.
If you have questions about tooth extraction or orthodontics, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “Simple Tooth Extraction” and “The Magic of Orthodontics.”
While braces are often the stars for straightening smiles, they're not the only cast members in an orthodontic production. Orthodontists occasionally turn to other appliances if the bite problem is challenging. Whatever the tool, though, they usually have something in common—they use the principle of anchorage.
To understand anchorage, let's first consider the classic kid's game Tug of War. With teams on either end of a rope, the object is to pull the opposing team across the center line before they pull you. To maximize your pulling force, the player at the back of your rope, usually your stoutest member, holds steady or "anchors" the rest of the team.
Like a Tug of War team, braces exert force against the teeth. This stimulates the supporting periodontal ligament to remodel itself and allow the teeth to move. The braces use the teeth they are attached to as anchors, which in a lot of cases are the back teeth. By attaching a thin wire to the brackets or braces on the teeth, the orthodontist includes all the teeth on the arch, from one end to the other. Anchored in place, the wire can maintain a constant pressure against the teeth to move them.
But not all bite situations are this straightforward. Sometimes an orthodontist needs to influence jaw growth in addition to teeth movement. For this purpose, they often use orthodontic headgear, which runs around the back of the head or neck and attaches to orthodontic brackets on the teeth. It still involves an anchor but in this case it's the patient's own skull.
In some situations, an orthodontist may feel he or she needs more anchorage as the teeth alone may not be enough. For this, they might establish a separate or additional anchor point using a temporary anchorage device (TAD). A TAD resembles a tiny screw that's inserted into the jawbone near the tooth intended for movement. The orthodontist can then attach the TAD to braces hardware using some form of elastics. After treatment, they remove the TAD.
These are just a couple examples of specialized tools an orthodontist can use for bite correction. Thanks to them and similar devices, even the most complex bite problem can be overcome to create a healthier and more attractive smile.
If you would like more information on correcting a poor bite, 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 “Orthodontic Headgear & Other Anchorage Appliances.”
When a tooth is beyond repair due to disease or injury, it may be necessary to remove it. A “simple” tooth extraction is among the most common in dentistry and certainly not the agonizing procedure depicted in common lore.
They’re referred to as simple extractions because the shape of the tooth and root allows for a fairly straightforward and uncomplicated removal. An example would be the normally cone-shaped upper front tooth that doesn’t offer a lot of resistance during the extraction process.
The process itself is fairly straightforward. Teeth are held in place by the periodontal ligament, an elastic tissue made of tiny fibers that attaches the tooth to the supporting bone. These fibers can be dislodged from the tooth with some careful manipulation — in the hands of an experienced dentist there’s a deft “feel” to the fibers loosening. Once they’ve detached, it requires little effort to remove the tooth; with the aid of local anesthesia, you won’t feel anything but a little pressure.
Immediately after the tooth is removed, we commonly insert bone grafting material in the socket to minimize bone loss until a permanent replacement like a dental implant can be installed after tissue healing. We then place sterile gauze over the site for a few minutes to control bleeding and, depending on the size of the wound opening, we may also place a few stitches to close it. We then give you instructions for caring and cleaning the site over the next few days, and prescribe antibiotics to reduce the chance of infection and anti-inflammatory drugs for any discomfort.
Although a simple extraction is a routine procedure, it’s important to perform a proper assessment of the tooth and the surrounding bone beforehand, including x-rays to determine the tooth’s exact shape and position. If we discover a complication that makes a simple extraction impractical (like multiple roots at acute angles), we may then refer you to an oral surgeon for a more complicated surgical extraction.
It’s our hope you’ll have your natural teeth for as long as you live. But if you must have one removed, you can rest assured it’s a common — and uneventful — experience.
If you would like more information on tooth extraction, 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 “Simple Tooth Extraction.”
As Spring turns to Summer, millions of students will depart high school in the time-honored rite of passage called graduation. At the same time, quite a few of these graduates will be experiencing another maturity milestone: the eruption (coming in) of their last permanent teeth.
Typically, these are the back third molars, better known as “wisdom teeth,” emerging on either end of both the top and bottom jaws sometime between the ages of 18 and 24. Their arrival heralds the end of a long development process that began in infancy.
But this auspicious event can give rise to dental problems. Because they’re the last to come in, wisdom teeth often erupt in an environment crowded by earlier teeth. Depending on jaw size and other factors, there may not be enough room for a normal eruption.
Wisdom teeth can thus erupt out of position, creating a poor bite (malocclusion). Or they might not erupt at all—becoming stuck fully or partially within the gums and bone, a condition known as impaction. Impacted teeth can also cause problems for the adjacent teeth, damaging the roots of the second molars or disrupting the surrounding gum tissue, making them more susceptible to periodontal (gum) disease.
Because of these and other issues, impacted wisdom teeth are among the most common type of teeth removed: an estimated 10 million each year. And many of these are removed before they show signs of disease or complications as a preemptive strike against developing dental problems.
Although unnecessary surgery should always be avoided, according to some research, there’s a one in three chance that erupting wisdom teeth that are not showing signs of trouble will eventually become problematic. And the earlier they’re removed, the lower the risk of post-extraction complications.
Wisdom teeth should always be evaluated on a case by case basis. Those with obvious signs of disease or complications do require prompt treatment, including possible extraction. Others that are asymptomatic can be monitored over time: If they’re tending to become problematic, we can adjust the treatment plan accordingly. Our goal is to ensure these particular teeth signaling the end of childhood won’t detract from dental health in adulthood, so a measured approach seems to be the best and safest one.
If you would like more information on treatment options for wisdom teeth, please contact us or schedule an appointment for a consultation. To learn more, read the Dear Doctor magazine articles “Wisdom Teeth: Coming of Age May Come With a Dilemma” and “Wisdom Teeth: To Be or Not to Be?”
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