Each year doctors treat about 150,000 new cases of severe facial pain. If you're one of those people, you don't have to suffer—there are ways to gain relief from these painful episodes.
Those recurring episodes are known as trigeminal neuralgia (TN). As the name implies, the source of the pain are the trigeminal nerves, which originate in the brain stem and extend on either side of the face. Each is divided into three branches (hence the "tri" in trigeminal) that serve the upper, middle and lower parts of the face and jaw.
TN can involve one or more of these branches, resulting in mild to severe pain that can last for several seconds. Jaw movements like chewing or speaking can trigger an episode, as well as a light touch to the face.
There are various proposed causes for TN, including links with inflammatory disorders like multiple sclerosis, which damages the insulating sheathing around nerve cells. The most common cause, though, appears to be a blood vessel pressing against the nerve. The compression causes hypersensitivity in that area of the nerve so that it transmits pain at the slightest sensation.
Other conditions like jaw joint pain disorders (TMD) or a dental abscess can cause similar pain symptoms, so it's important to get an accurate diagnosis. If your doctor does identify your condition as TN, you may then need a comprehensive approach to treatment involving a team of care providers, including your dentist.
For the most part, TN can be managed, beginning with the most conservative approach to gain relief, often with medications to block the nerve's pain signals to the brain or decrease abnormal nerve firings. If that proves insufficient, though, more intensive treatments are available.
One possible treatment for an impinging blood vessel is a microsurgical procedure to expose the affected nerve and relocate the vessel. While this can be effective, the surgery does carry some risk of facial numbness or decreased hearing. If the risks are too high for conventional surgery, an alternative procedure uses a precise beam of high-dose radiation to relieve the pressure from the vessel.
The most important thing to know about TN, though, is that it is possible to control it and relieve future pain episodes. If you're experiencing these symptoms, see your dentist or doctor for an exam and accurate diagnosis.
If you would like more information on trigeminal neuralgia, 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 “Trigeminal Neuralgia: A Nerve Disorder that Causes Facial Pain.”
Once upon a time, celebrities tried hard to maintain the appearance of red-carpet glamour at all times. That meant keeping the more mundane aspects of their lives out of the spotlight: things like shopping, walking the dog and having oral surgery, for example.
That was then. Today, you can find plenty of celebs posting pictures from the dentist on social media. Take Julianne Hough, for example: In 2011 and 2013, she tweeted from the dental office. Then, not long ago, she shared a video taken after her wisdom teeth were removed in December 2016. In it, the 28-year-old actress and dancer cracked jokes and sang a loopy rendition of a Christmas carol, her mouth filled with gauze. Clearly, she was feeling relaxed and comfortable!
Lots of us enjoy seeing the human side of celebrities. But as dentists, we’re also glad when posts such as these help demystify a procedure that could be scary for some people.
Like having a root canal, the thought of extracting wisdom teeth (also called third molars) makes some folks shudder. Yet this routine procedure is performed more often than any other type of oral surgery. Why? Because wisdom teeth, which usually begin to erupt (emerge from beneath the gums) around age 17-25, have the potential to cause serious problems in the mouth. When these molars lack enough space to fully erupt in their normal positions, they are said to be “impacted.”
One potential problem with impacted wisdom teeth is crowding. Many people don’t have enough space in the jaw to accommodate another set of molars; when their wisdom teeth come in, other teeth can be damaged. Impacted wisdom teeth may also have an increased potential to cause periodontal disease, bacterial infection, and other issues.
Not all wisdom teeth need to be removed; after a complete examination, including x-rays and/or other diagnostic imaging, a recommendation will be made based on each individual’s situation. It may involve continued monitoring of the situation, orthodontics or extraction.
Wisdom tooth extraction is usually done right in the office, often with a type of anesthesia called “conscious sedation.”Â Here, the patient is able to breathe normally and respond to stimuli (such as verbal directions), but remains free from pain. For people who are especially apprehensive about dental procedures, anti-anxiety mediation may also be given. After the procedure, prescription or over-the-counter pain medication may be used for a few days. If you feel like singing a few bars, as Julianne did, it’s up to you.
If you would like more information about wisdom tooth extraction, please call our office to arrange a consultation. You can learn more in the Dear Doctor magazine articles “Wisdom Teeth” and “Removing Wisdom Teeth.”
If you're suffering from jaw pain or impaired function, it may not be the only source of chronic pain in your body. Of the millions of adults with temporomandibular joint disorders (TMD), many have also been diagnosed — among other conditions — with fibromyalgia, rheumatoid arthritis or sleep problems.
TMD is actually a group of painful disorders that affect the jaw joints, muscles and surrounding tissues. Besides pain, other symptoms include popping, clicking or grating sounds during jaw movement and a restricted range of motion for the lower jaw. Although we can't yet pinpoint a definite cause, TMD is closely associated with stress, grinding and clenching habits or injury.
It's not yet clear about the possible connections between TMD and other systemic conditions. But roughly two-thirds of those diagnosed with TMD also report three or more related health conditions. Debilitating pain and joint impairment seem to be the common thread among them all. The similarities warrant further research in hopes of new treatment options for each of them.
As for TMD, current treatment options break down into two basic categories: a traditional, conservative approach and a more interventional one. Of the first category, at least 90% of individuals find relief from treatments like thermal therapy (like alternating hot and cold compresses to the jaw), physical therapy, medication or mouth guards to reduce teeth clenching.
The alternative approach, surgery, seeks to correct problems with the jaw joints and supporting muscles. The results, however, have been mixed: in one recent survey a little more than a third of TMD patients who underwent surgery saw any improvement; what's more alarming, just under half believed their condition worsened after surgery.
With that in mind, most dentists recommend the first approach initially for TMD. Only if those therapies don't provide satisfactory relief or the case is extreme, would we then consider surgery. It's also advisable for you to seek a second opinion if you're presented with a surgical option.
Hopefully, further research into the connections between TMD and other inflammatory diseases may yield future therapies. The results could help you enjoy a more pain-free life as well as a healthy mouth.
If you would like more information on 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 “Chronic Jaw Pain and Associated Conditions.”
Compared to other dental restorations—a few of which have been around for over a century—implants are a relatively recent development. But even though it's just now entering its fourth decade, recent advances have catapulted implant therapy well beyond where it began.
That's due mainly to digital technology. Two examples of this, computed tomography (CT) and 3-D printing, are increasing the accuracy and efficiency of implant placement.
Properly placing an implant is one of the most important elements in achieving a natural and attractive result. But finding the best location is often difficult due to a lack of suitable bone volume, the patient's bite or the proximity of anatomical structures like nerves and blood vessels. CT imaging, especially Cone Beam CT scanners (CBCT), is helping to make implant placement planning easier.
Unlike the static, two-dimensional views of standard x-rays, CBCT takes hundreds of images and digitally blends them together to create a virtual 3-D model of the patient's jaw and face. Dentists can view this highly detailed model on a computer monitor from various vantage points and better identify possible obstructions. With better information about what "lies beneath," they can more accurately pinpoint the best implant site.
Creating the ideal plan is one thing—successfully implementing it is another. Dentists often create a surgical guide that helps them drill in precisely the right positions during surgery. The guide, which resembles a mouthguard, fits over the gums and contains marker locations for drilling.
Many dentists are now using 3-D printing to create these surgical guides. A 3-D printer turns a digital model of the guide based on measurements of the patient's mouth and proposed implant locations into an actual physical object "printed out" layer by layer of special polymer material. The end product can be more precise than guides created by other means.
These and other technological developments are helping implant therapy rise to a new level of success. With the resulting increase in accuracy, efficiency and less treatment time, tomorrow's implant patients will be the ultimate beneficiaries.
If you would like more information on restoring missing teeth with dental implants, 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 Technology Aids Dental Implant Therapy.”
Even with modern prevention and treatment advances, losing teeth in later life is still a sad but common part of human experience. Just as generations have before, many today rely on dentures to regain their lost dental function and smile.
But although effective, dentures have their weaknesses. The most serious: they can't prevent jawbone deterioration, a common problem associated with tooth loss.
Bone health depends on chewing forces applied to the teeth to stimulate replacement growth for older bone cells. When teeth are gone, so is this stimulation. Dentures can't replicate the stimulus and may even accelerate bone loss because they can irritate the bone under the gums as they rest upon them for support.
But there's a recent advance in denture technology that may help slow or even stop potential bone loss. The advance incorporates implants with dentures to create two hybrid alternatives that may be more secure and healthier for the supporting bone.
The first is known as an overdenture, a removable appliance similar to a traditional denture. But instead of deriving its support from the gums alone, the overdenture attaches to three to four implants (or only two, if on the lower jaw) that have been permanently set into the jawbone. This not only increases stability, but the implants made of bone-friendly titanium attract and foster increased bone growth around them. This can help slow or even stop the cycle of bone loss with missing teeth.
The second type is a fixed denture. In this version, four to six implants are implanted around the jaw arch. The denture is then secured in place to these implants with screws. It's a little more secure than the overdenture, but it's also more expensive and requires good quality bone at the implant sites.
If you've already experienced significant bone loss you may first need bone grafting to build up the implant sites for these options, or choose traditional dentures instead. But if you're a good candidate for an implant-supported denture, you may find it provides better support and less risk of continuing bone loss than traditional dentures.
If you would like more information on implant-supported dental restorations, 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 “Overdentures & Fixed Dentures.”
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