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We use local anesthesia at this office, which has a long history of safety and effectiveness. This anesthetic may be administered as a block, which affects the entire area and may numb the tongue and lip as well as the tooth, or interligmentally, which numbs only the area around the tooth to be worked on. Below are descriptions of types of anesthesia used, along with evaluation of risks.

1. No anesthesia - This is a definite possibility for much new decay, since we have a system of cavity preparation that is much gentler than a traditional drill. With no anesthesia, there is no problem with aftereffects, but occasionally discomfort during the procedure can be anticipated.

2. Local anesthetic - Lidocaine with Epinephrine - This is the most common dental anesthetic used. It is powerful and long lasting, (lasting 2 to 4 hours after administration), but can not be used in some patients who have conditions that do not allow use of epinephrine.

3. Local anesthetic - Mepivicaine without Epinephrine or Citanest - This is used for patients with high blood pressure or glaucoma, pregnant women, patients taking medicines that interact with epinephrine, and patients with a known sensitivity to epinephrine. This anesthetic is not as long acting as that with epinephrine, but does not raise blood pressure or cause epinephrine side effects.

4. Local anesthetic - Marcaine - this is a very long lasting local anesthetic, used primarily to provide sustained pain relief after extractions or surgery. It may last about twelve hours after administration.

Possible Complications From Anesthesia
Complications from local anesthesia are very rare, and are usually only mild in effect. Below are some possible problems, along with the statistical chance of their occurrence.

Soreness at Injection Site - This is generally not serious, although it can be uncomfortable for a few days. Statistically, this is more likely to occur with an interligmental injection rather than a block. This occurs about once in three hundred injections.
Reaction to Epinephrine - This involves dizziness, a jittery feeling, a feeling of cold, or elevated blood pressure. The reaction can vary from slight to severe. The reaction is generally not serious and goes away after the epinephrine is dissipated, but can require medical attention if blood pressure is elevated. This reaction may be more likely with a person who experiences panic attacks. This reaction occurs about once in a thousand injections. Anyone who has had previous reactions (or suspected reactions) should report them to us, and any epinephrine reactions that do occur in the office should be reported as part of any future medical history.
Swelling - When an injection is given, there are numerous bundles of blood vessels invisibly crisscrossing the area. Occasionally a blood vessel is affected, and a bruise may develop. This can cause facial swelling, which will go away as the injury heals, usually in about a week. This may occur about once in six thousand injections.
Nerve Stimulation - Occasionally a nerve is touched during an injection. This can result in a temporary jolt or the feeling of an electric shock. This occurs about once in five hundred injections.

Analgesia

Sometimes medicines are prescribed in advance of an appointment to help the patient relax. Valium is the most common drug used for pre-medication analgesia. The main disadvantage is that the patient must have someone drive him or her to the appointment after taking this medication.
Analgesic drugs can also be unpredictable in their effectiveness, especially in children. Although most patients react by being mildly relaxed, once in a while a person may react very strongly and be too fatigued to cooperate with the dental procedure. On the other hand, an occasional patient will show no effects from the medicine.

In this office, we use a risk assessment for determining the need for x-rays. We do not tell a patient he or she is"due" for x rays based on a set policy. You may be at a high, medium, or low risk for dental problems, based on your personal habits, your personal and family dental history, and your diet habits. Our risk assessment is based on guidelines developed by a task force of government and private agencies. The summary of this task force is available at this office for your information.

X-rays are used to diagnose between teeth cavities, periodontal disease, abscesses, abnormalities of teeth and jaw, developmental abnormalities, and other conditions, including some medical conditions. The most common diagnoses are cavities and periodontal disease.

Cavities that develop between back teeth are generally impossible to diagnose without x-rays, unless they are so large that the tooth is severely undermined. Other conditions such as periodontal disease or abscesses may display symptoms that show up without x-rays, but x-ray examination is required to confirm the diagnosis

Our risk assessment is based on your personal habits regarding flossing and brushing, past history of periodontal disease or between teeth cavities, and your diet habits as related to dental disease.

Patients at high risk for between teeth cavities or periodontal disease generally require bitewing x-rays once a year until risk factors are lowered.

Patients with developmental or medical conditions may need a panoramic x-ray every three years or as conditions warrant to diagnose or monitor condition.

High Risk For Between Teeth Cavities
Patient does not floss regularly
Patient drinks sweetened beverages, including coffee or tea, or diet soda, regularly.
Patient consumes hard candy, breath mints, or cough drops regularly
Patient has history of between teeth cavities

High Risk For Periodontal Disease
Strong family history of disease
Spouse has periodontal condition
Patient has previously diagnosed problem areas
Patient previously treated for periodontal disease

High Risk for Developmental or Medical Problems
Wisdom teeth unerupted (teen-age years through adult)
Impacted wisdom teeth present; need monitoring for cyst development
Generalized periodontal disease
TMJ symptoms
Risk factor for stroke present - this includes high blood pressure, family history, weight, periodontal disease. (A panoramic X-ray may show plaque in carotid artery, a precursor for stroke. Also, periodontal disease increases risk for stroke)

With this risk assessment, you can be assured that any x-rays taken are necessary to diagnose a condition for which you have a high risk. You can reduce your need for x-rays by reducing your risk factors in many cases - such as by changing your diet habits, reducing sugar intake, and flossing every day.

Even if you are at high risk, our x-ray system is state of the art, with the lowest radiation possible in a dental office. Our digital x-rays use one tenth of the radiation in a traditional x-ray, and we use cone columnization to prevent scatter of the x ray beam, additionally reducing radiation levels by fifty percent. You would have to have twenty x-rays taken in this office to equal the radiation dosage of a single x-ray taken in most dental offices (assuming traditional x-ray methods without cone columnization). Of course, we also use lead shields to protect you.

Fillings are so commonplace in the dental office that people tend to take them for granted. While it is true that there are seldom complications from this dental procedure, it is important to understand the different materials available for restorations and their benefits.

Types of Fillings

Composites
These are tooth colored fillings that are bonded in place. The filling material is composed of quartz ceramic particles in a matrix of liquid resin; the material is hardened, or cured by a special light. These fillings harden quickly (silver fillings take twenty-four hours to harden) and a patient can chew on them immediately after placement. We use composite materials for most fillings we place.

A tooth is prepared for a composite filling with either a drill or air abrasion (click on "technology" for an explanation of this dental equipment). The tooth is then etched with a gentle acid (about the strength of lemon juice) to make it rough to accept a bond, and a bonding agent is placed on the tooth. The filling material is then placed in layers, with light curing occurring between each layer. After the filling material is placed and sculpted, occusal (bite) adjustment is performed.

Advantages: Tooth colored fillings look good, and since the filling material is chemically bonded to the tooth, this type of filling material resists fracture. Composite fillings can also be kept smaller than silver fillings because no undercuts are necessary for retention of the material, and air abrasion technology can be used in tooth preparation when composites are used.

Disadvantages: This type of filling is very technique sensitive. If a drop of saliva leaks into the prepped filling area, the bond may not take and the filling may have to be replaced. This occurs in about 1% of composite fillings placed. Since the filling is hardened before anesthesia wear off, there may be a higher incidence of needing a filling adjustment with this type of filling. Adjustment is required about 4% of the time.

Silver Amalgam Fillings
Amalgam is the traditional filling material that has been the basic restoration material in dentistry. To place a silver filling, decay is removed with a drill, and undercuts are made into the tooth to lock the metal in place. Amalgam is placed in the tooth, packed, and carved. The filling remains soft for twenty-four hours, so care must be taken with chewing for a while.

Silver amalgam is composed of silver mixed with other metals such as copper, with mercury added to keep the material soft while working it.

Advantages: This material is easy to work, inexpensive, and durable. Silver amalgam can be placed in a wet environment; saliva does not affect a silver filling?s success.

Disadvantages: Amalgam does not look natural and can not be used where a filling is visible while smiling. The need to make undercuts destroys sound tooth structure, although it is possible to use a special bonding agent with amalgam that minimizes the need for undercuts. Silver amalgam fillings do not provide support for the rest of the tooth and are more subject to fracture than a bonding filling.

The mercury in silver amalgam has not been proven to cause any side effects except in persons with specific metal allergies. However, it is known that after placement of a silver filling, there is a rise in mercury level in that person for a period of time. There has been no proven correlation between this and any adverse health effects.

Gold, Porcelain, or Composite Inlays
While most fillings are direct placement procedures (drilling out decay and immediately filling with restorative material), indirect restoration may be an option for restoration.

With an inlay, the preparation is made to clean out the decay, and an impression is taken of the tooth. This impression is sent to a lab and a restoration is cast or fabricated in the material of choice. The patient returns after the lab work is completed and the inlay is fitted into the prepared tooth and cemented.

Complications of Fillings
"High" Feeling - Occasionally a filling needs to be adjusted because the occlusion is off. This usually happens because it can be difficult for a patient to feel a proper adjustment when he or she is numb from anesthesia. A quick visit to the office is usually all that is necessary to adjust a filling. This complication occurs in about 4% of fillings.

Sensitivity - A filling may be sensitive because it is "high" and needs adjustment, because it was a deep restoration, or because a bond may not have been successful. Call the office if sensitivity persists beyond two days.

Abscess - If a filling was very deep and near the pulp, there is a chance that the tooth could abscess and need a root canal. This is because bacteria can damage the pulp without showing up as actual decay. If you do have a filling that is close to the nerve, we will inform you that there may be a future need for a root canal. Occasionally because of unusual tooth anatomy, a filling that is not that deep can nick pulpal projections called pulp horns, and there may be no way of predicting the need for a root canal in the future.

Allergies- Rarely a person may have an allergy to a dental material used in filling placement, including metals, latex, bonding agents, or adhesives. If you have any known allergies, be sure to inform us.

Sealants are plastic coatings that coat the chewing surfaces of molars or premolars (back teeth) and prevent decay from taking hold in the grooves of these teeth. Sealants prevent decay only on the chewing surface and do not prevent between teeth cavities from forming.

Sealants do wear down over time, or can possibly develop an area of leakage, and may have to be replaced. It is important for the dentist to check them regularly as part of a semi-annual dental examination.

In some uncommon cases, it is possible for a tooth to decay around the edge of a sealant. However, if the sealant is intact, this decay is generally much less severe than if the sealant was not in place. It is possible, although rare, that if a portion of the sealant dislodges, decay could take hold and progress through a crack into the tooth under the sealant. This generally does not occur if sealants are checked during regularly scheduled dental examinations.

Since molars and premolars erupt at different times, it is unlikely that all back teeth will be sealed at one time. We usually seal first molars after eruption at age six, and second molars during the teen-age years.

Periodontal disease is a bacterial infection of the soft tissue of the mouth that can cause loss of bone that supports the teeth. In advanced cases, teeth are lost because the jawbone supporting the teeth is eaten away by toxins.

Periodontal disease is associated with an increased risk of heart attack or stroke. It is also a factor in premature birth for pregnant women with the disease. Research is showing that the bacteria from the disease enter the bloodstream and can cause a buildup of plaque in areas such as the carotid and coronary arteries.

It is common for the spouse of a periodontal patient to also develop the disease, particulary if he or she displays poor oral hygiene and/or poor resistance to the bacteria that cause the disease.

There are different stages of the disease. Below is a description of these stages.

1. Gingivitis - At this stage, there is no detectable bone loss, but soft tissue is inflamed; at this stage, there is gum tenderness when being cleaned and gums may bleed easily. Gingivitis occurs when home care is inadequate, when dental cleaning visits are infrequent, or when stress allows bacteria to take hold in the mouth. Improved home care and more frequent dental visits will generally clear up this condition. If you have this condition, we would advise you to have your teeth cleaned at three month intervals until the condition is eliminated. We may also prescribe an antimicrobial rinse for use at home and may use an antimicrobial solution during your dental cleaning to reduce the bacterial populations.

2. Isolated Pockets of Infection - This may include some bone loss. At this stage, it is important for the patient to be particularly careful in keeping these areas flossed, and to schedule an additional cleaning in three months to monitor the situation. We may also place an antibiotic powder or gel in the pocket to reduce the bacterial population.

3. Moderate Periodontal Disease - some generalized bone loss, less then six millimeters. At this point it appears that the bone loss is not too severe and the disease is treatable with periodontal scaling, antimicrobial treatment, and careful home care. A patient at this stage must have his or her teeth scaled and then follow up with antimicrobial irrigation administered at this office every three months. We may also use an antibiotic powder or gel to reduce pocket depths. At this stage, periodontal disease does not go away, it can only be controlled to keep it from advancing

4. Advanced Periodontal Disease - with isolated pockets, some bone loss greater then six milimeters. At this stage of the disease, we may not be able to remove the hardened calculus and toxins without surgery. The treatment at this stage is periodontal scaling to eliminate as much calculus as possible, and possible placement of an antibiotic powder or gel in the worst pocket areas. We follow up in six weeks after initial treatment and will refer to the periodontist for evaluation for surgical treatment of any areas that show pocket measurements of six millimeters or greater.

5. Advanced Periodontal Disease - widespread bone loss, greater then six milimeters. The disease at this stage is a serious infection, and can lead to tooth loss and affect overall health. We advise immediate referral to a periodontist for evaluation.

Atridox and Arestin are antibiotics placed directly in the gum to treat periodontal infections. Atridox contains the antibiotic doxycycline and Arestin contains minocycline. These drugs are indicated when there are several areas of periodontal infection or when periodontal pockets are deep. These products allow us to deliver a high concentration of antibiotic directly to the infected areas.

This procedure is only mildly uncomfortable, and usually no anesthesia is necessary. (Patients report to me that they feel a little poked at with the procedure, similar to perio probing.) Both products are squirted into the gum area, where they flow into the deep periodontal pockets and adhere to gum tissue. The medicine dissolves over a two -week time period, so there is no need to return to the office for removal.

Atridox and Arestin are improvements over oral antibiotics because of the concentration delivered. Oral antibiotics generally are not successful in treating periodontal disease because they can not deliver a high enough concentration of medicine to the gum area.

Possible complications - This treatment is well tolerated; the only problems noted are soreness or discomfort at the site for a very small percentage of patients. Most patients report they feel the powder or gel, but that it is not painful.

Drug Cautions- Since this drug is absorbed into the bloodstream in very minimal amounts, there is not a great concern about systemic effects; however, because it is from the tetracycline family, it should not be used by pregnant women.

Care During Treatment - You should not floss the area that has been treated for two weeks. Avoid eating hard food, especially crisp textured foods such as potato chips, since these foods could dislodge the material. If you feel that the material has come out within the first five days, give the office a call.

Long Term Effectiveness - Studies have shown that Atridox and Arestin can reduce pocket depth by up to 2 millimeters. However, effectiveness varies widely among patients. Since these are new products, long term effectiveness is not known, although studies have shown that pocket reductions remain after nine months. Patients may need periodic reapplications for long term results, particularly if the periodontal disease is more advanced.

Insurance Coverage - Insurance coverage for Atridox or Arestin treatment is limited, primarily because it is a new procedure. However, the fee for treatment is reasonable. We have received benefits from some insurance plans; we will let you know if your plan has paid for the procedure in the past.

A root canal is performed when decay reaches the pulp of the tooth, or when trauma has injured the pulp, causing it to die and an infection to occur. In this procedure, the nerve of the tooth is removed, the area is disinfected, and the pulp chamber is sealed with a rubbery substance to prevent reinfection.

Root Canal Success - Root canal therapy has a success rate of about 95%. Reasons for the small percentage that are unsuccessful may include a cracked root (the most common cause of problems), curved or hardened canals that resist treatment, difficult access canals, severe infection around the bone that will not subside, or periodontal complications. These problems may not be apparent while the root canal is performed. Additional endodontic procedures may be successful for treatment of some problems.

Alternative Treatment - Extraction of the tooth is a less desirable alternative treatment for an abscessed tooth. Loss of a tooth will affect chewing and can contribute to drifting of other teeth or bite collapse.

Complications of Root Canal Therapy
Pain -Discomfort after treatment generally is mild, like being "worked on", and should subside within two days. Any severe pain should be reported to the office. There are quick office procedures that can be performed to alleviate severe pain after treatment.
Swelling- Facial swelling can occur if the infection was spreading beyond the tooth area before the root canal was performed. If you experience swelling, you need to call the office. This can be serious and treatment should not be delayed, particularly if you have a fever or experience flu like symptoms.
Instrument Retained - Rarely, the tip of a fine metal file may break during treatment and may remain in the canal. There is often no problem with this, but statistically there is a slightly greater chance of root canal failure if this does occur.

Rebuilding the Tooth - The root canal is the surgical treatment to eliminate infection in the tooth. After the root canal is completed, the tooth still needs to be restored; there is a separate fee for restoration. Restoration generally requires a crown and buildup, especially for back teeth. Do not delay restorative treatment, a root canal treated tooth is very subject to fracture if a crown is not placed.

A crown is a porcelain or metal "cap" that protects a broken down or fractured tooth from further deterioration. It works like a barrel hoop to hold a tooth together. A crown is necessary when a tooth has a majority of structure lost to decay or fracture, when the tooth is cracked, or when a root canal therapy has been performed. Crowns may also be placed for cosmetic reasons or to correct a misshapen tooth.

Life Span - A crown can last fifteen- twenty years or longer if properly cared for. The important thing to remember is that decay can occur even if the tooth is covered with a crown. The margin where the crown meets the tooth must be kept clean or decay can take hold and undermine the crown. Proper oral hygiene, use of fluoride, and regular dental check ups will minimize the problem.

What a Crown Looks Like - A porcelain crown generally looks just like a tooth. For front teeth, we use all ceramic materials. For back teeth, we usually use porcelain fused to precious metal for added strength for chewing. We leave a small metal margin at the base of these crowns because it is softer against the gums. If you are having a crown placed, let us know if you have concerns about the cosmetic appearance of a molar crown; we can make all porcelain margins.

Temporary Crown - We lightly cement a temporary crown in place for the two-week period while the porcelain or metal crown is being fabricated. You need to take care to keep it in place. If it does come off, we can recement it at the office.

Possible Complications
Sensitivity or Pain - Some sensitivity is normal for twenty-four hours. If it persists or if you experience severe pain, we need to know.
Abscess - Because crowns are placed on teeth that have suffered major trauma through decay or fracture, there is a possibility that the tooth could abscess in the future, even though there may be no indication at time of crown placement.
"High" feeling - A crown may need occlusal adjustment after placement. If your crown does not feel right when you chew, you need to return to the office.

Aesthetics - Before we cement a porcelain crown, we ask for the patient's approval of the way it looks. For front crowns, patients have the option of bringing a spouse or a friend to approve aesthetics. It is important to carefully evaluate aesthetics, and express any concerns about cosmetics before the crown is cemented; once it is in place, the crown can not be replaced for cosmetic reasons without an additional charge.

A bridge is a fixed prosthesis that replaces missing teeth by crowning the adjacent teeth and spanning the missing space with an attached "false" tooth. Unlike a partial denture, a bridge is cemented in place and is not removed.  A bridge can be used to replace one or two missing teeth, as long as there are teeth on either side of the missing tooth on which to anchor the bridge. The false tooth part of a bridge is called a pontic.  The parts of the bridge that allow attachment to adjacent teeth are called abutments.

Alternative Treatment - Missing teeth may also be replaced through use of a removable partial denture or implants. A removable partial is less expensive than a bridge but is more uncomfortable.  Removable prostheses are also not recommended for small areas because of the danger of swallowing or choking on the appliance.  Implants involve surgically placing an artificial root on which to place a crown.  Implants may not be indicated in all situations, and involve a waiting period for the implanted post to bioattach to the jaw bone.

Life Span - A bridge can last for fifteen -twenty years or longer if properly cared for.  The important thing to remember is that decay can occur on abutment teeth even if the teeth are covered by crowns.  The margin where the abutment meets the tooth and the space under the pontic are both areas that need careful attention.  Proper oral hygiene, use of fluoride, and regular dental check ups will minimize the problem.

Care of Bridge - Since there is a space below the pontic (false tooth),bridge patients must use a special tool to clean the area of food particles. Use of a Proxi-brush or floss threaders is necessary to prevent decay from taking hold in the adjacent teeth.  We will show you how to properly care for your bridge.

What a Bridge Looks Like - Bridges are generally made of porcelain covering a precious metal base. In back teeth, we may leave a small metal margin near the gum line because it is softer on the gum, although we can use all porcelain margins if a patient has concerns about the bridge's cosmetic appearance.  For front teeth, there are now all ceramic materials available for more natural looking bridge fabrications. However, since the materials have not been used for a long period of time, it is impossible to say whether the life span of these ceramic bridges will be as long as the conventional porcelain fused to metal bridges.

Temporary Bridge - We lightly cement a temporary bridge in place for the two-week period while the porcelain bridge is being fabricated.  The patient needs to take care to keep it in place.  If it does come off, we can recement it at the office.

Aesthetics - Before we cement a bridge, we ask for the patient's approval of the way it looks.  For front teeth bridges, we offer the option of bringing a spouse or friend to approve the aesthetics.  It is important for a patient to let us know if they have any concerns about cosmetics before the bridge is cemented; once it is in place, the bridge can not be replaced for cosmetic reasons without an additional charge.

Possible Complications
Sensitivity or pain - Some sensitivity is normal for the first twenty-four hours.  If it persists, or if you experience severe pain, contact our office.
Abscess - If the abutment teeth have suffered previous trauma through decay or fracture, there is a possibility that the tooth could abscess in the future, even there may be no indication of it at the time of bridge placement.
"High" feeling - The bridge may need occusal (bite) adjustment after placement. If a bridge (either temporary or porcelain model) does not feel right when chewing or biting, a patient needs to return to the office for adjustment.

Tooth whitening involves the use of carbamide peroxide placed in clear fitted trays that snap tightly over the teeth. The trays are custom made for the patient from impressions taken at the initial visit.

The whitening process generally takes from three to six weeks for maximum effect. The peroxide filled trays are worn from one to two hours each day.

Whitening requires two main appointments, one for making the impression and one for delivery of the trays and explanation of the process. Patients frequently combine the first visit with their cleaning appointment.

After tray delivery, we do schedule quick evaluation appointments to monitor the effectiveness of the whitening agents and to check soft tissue. Occasionally a patient needs to change the strength or type of whitening agent to achieve a better effect for their teeth.

Tooth whitening is safe. The chemicals used for the process have been used for a long time as antimicrobial rinses in periodontal treatment, and we monitor all patients carefully to make sure the strength of the whitening agent is appropriate.

What to Expect from the Tooth Whitening Process

Tooth whitening varies in effectiveness among different patients. Some teeth are resistant to whitening, and some stains are difficult to remove through this process. In these cases, whitening may be achieved through bonding or porcelain veneer application.

Some teeth may whiten unevenly, and there is no way to predict this occurrence. However, one should expect that if the teeth have uneven coloration before whitening, the shade differences will remain after the whitening process.

Tooth whitening is not effective on filling materials, and old tooth colored fillings will not whiten along with the teeth. After the whitening process is completed, front teeth restorations may need to be replaced to match the whitened teeth.

Care must be taken during the whitening process to avoid foods that stain teeth, since the teeth are more susceptible to staining during this period. We advise using a straw when consuming beverages that could stain.

It is difficult to say how long the whitened color will last on teeth since it varies widely. In general, the lightened color will last longer if habits that caused them to stain in the first place are minimized (such as smoking). The whitening process can be repeated periodically to maintain the lighter tooth shade. However, the whitening trays may wear out over time, and additional ones may need to be fabricated.

Possible Complications

The only likely complication may be sensitivity to hot and/or cold. If this occurs, whitening should be discontinued until evaluation is made at the dental office. Sometimes the type and strength of bleach may be changed to a more tolerated choice.

Very rarely, soft tissue may react to the whitening agent, causing a burning sensation or a blister. If this does occur, whitening should be discontinued and an evaluation scheduled at the dental office.

Porcelain veneers are thin porcelain shells that are bonded to front teeth to improve appearance. They may also be used in some instances to strengthen a front tooth that is cracked, chipped, or weakened through decay.

To prepare for a veneer, a thin layer is removed from the front of the tooth, and a tooth impression is made and sent to a laboratory. The laboratory fabricates the porcelain veneer. At a second visit about two weeks after the initial visit, the veneer is cemented.

A veneer patient should realize that his or her teeth will look rough during the two-week period while the veneers are being fabricated. If a patient is concerned about appearance while the veneers are being fabricated, it is possible, although complicated, to make temporary veneers. There is an additional fee for this procedure.

A patient should expect some sensitivity during the fabrication period; foods and beverages that stain should be avoided since the prepared teeth will be more susceptible to staining at this time.

When the veneers are delivered, the patient must approve their appearance. If a patient has a spouse or frind who may have an opinion about the veneers' appearance, it is recommended that the patient bring them to the delivery appointment to approve the final product. Once the veneers are approved by the patient and cemented, there can be no changes made without additional charges.

It is important to have regular dental visits to keep a check on the veneers. Veneer patients should schedule dental examinations at least twice a year.

TMJ is an abbreviation for the temporomandibular joint (jaw joint). The use of the term "TMJ" often refers to damage in this joint caused by injury, most commonly a stress injury. Symptoms of TMJ can include headache or earache as well as jaw pain, and in severe cases, locking of the joint. Below are some definitions describing terms related to TMJ.

Bruxism - The term for grinding or clenching teeth abnormally. This habit can cause a stress injury that may lead to joint damage and can cause damage to the teeth as they wear down.
Myofacial Pain - Describes facial muscle pain caused by clenching or grinding of teeth.
Clenching - Refers to closing the mouth too tightly - this habit leads to headaches, facial muscle discomfort, and damage to the jaw joint. It can also cause periodontal problems as it causes damage to the bone supporting the teeth.
Grinding - The habit of moving the upper and lower teeth hack and forth against each other. This habit causes damage to teeth and may result in bite collapse as the teeth are worn down, which in turn can cause jaw joint damage. Grinding may occur with or without clenching.

Although accidental injury can cause TMJ, the most common cause is internalized stress. People develop this habit unconsciously; it usually occurs during sleep, but may also be noticed in daytime during periods of stress.

The main treatment for these problems is a bite guard, a plastic appliance that slips over the upper teeth to act as a shock absorber. It protects teeth from being worn down, and helps keep the jaw in proper position to prevent over closing. We usually prescribe one to be worn at night, but in some cases, it may need to be worn during the day.

In addition to a bite guard, it is usually recommended that a patient undergo some type of stress relief treatment to determine a more appropriate release of tension. Meditation, yoga, massage, or exercise can all help reduce bruxism. Therapy may be indicated in serious cases of anxiety or depression.

This condition may be difficult to treat once the joint has been damaged. A bite guard may not always be successful; referral to a specialist may be required in some cases.