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 braces are finally off! But to keep your new, straighter smile you'll need to wear a retainer for some time. That's because the same structural mechanism used to move your teeth could undo what we've just accomplished.
That mechanism resides in an elastic tissue called the periodontal ligament that lies between the teeth and the bone and attaches to both with tiny fibers. While the ligament holds the teeth securely in place, it also allows for slight movement in response to bite changes. Braces "pull" the teeth in the desired new direction, and the ligament responds.
But with that pressure gone after the braces' removal, a kind of "muscle memory" can set in that moves the teeth back towards their original positions. A retainer, a dental appliance worn on the teeth, exerts just enough pressure to "retain" or keep the teeth from regressing.
Retainers are effective, but the most common type has a feature that poses potential problems: it can be removed by the wearer. Because of this, less disciplined patients might be tempted not to wear their retainer as directed. There's also a higher risk of losing one and incurring additional cost to replace it.
But there is another type, the bonded retainer, which stays permanently in the mouth until removed by an orthodontist. It's composed of a thin piece of metal that's firmly attached to the back of the teeth with dental composite material. Not only does a bonded retainer solve the problems mentioned before, it also can't be seen from the outside like a removable retainer.
A bonded retainer does have one disadvantage: because it can't be removed, it can obstruct the teeth during brushing and flossing and require more effort. You won't have as much difficulty with a removable retainer keeping teeth and gums clean. You can overcome this disadvantage, though, with specialized tools like a water flosser or a floss threader to make hygiene easier.
To choose which type of retainer is best for you or your family member, have a talk with your orthodontist. And if you choose a bonded retainer and later have it removed, be sure to switch immediately to a removable one if your orthodontist advises. With either retainer, you'll be able to preserve that hard-earned smile for years to come.
If you would like more information on bonded retainers, 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 “Bonded Retainers: What are the Pros and Cons.”
Dental veneers, thin layers of porcelain bonded to chipped, stained or slightly crooked teeth, are an effective and affordable way to transform your smile. Their color, translucence and shape blend so well with the rest of your teeth that it's often difficult to tell them apart.
But traditional veneers have one drawback: although they're less than a millimeter in width, they can still appear bulky on unprepared teeth. To help them look more natural, we often have to remove some of the enamel layer from the tooth surface. Enamel doesn't grow back, so this alteration is permanent and the prepared teeth will require a restoration from then on.
But you may be able to avoid this—or at least keep the alteration to a minimum—with no-prep or minimal-prep veneers, two new exciting choices in cosmetic dentistry. About the width of a contact lens, we can bond these much thinner veneers to teeth with virtually no preparation at all or, in the case of a minimal-prep veneer, needing only an abrasive tool to reshape and remove only a tiny bit of the enamel.
These ultra thin veneers are best for teeth with healthy enamel, and can be placed in as few as two appointments. And besides being less invasive, the procedure is reversible—we can remove them and you can return to your original look without any follow-up restoration. One caveat, though: because of the strong bonding process used, it's not always easy to remove them.
Although their thinness makes it possible to avoid or minimize alterations, there are some dental situations like oversized teeth that may still require extensive tooth preparation. With some poor bites (malocclusions) orthodontic treatment to straighten the teeth may also be needed first.
All in all, though, no-prep or minimal-prep veneers could help you avoid the permanent tooth alteration that usually accompanies their thicker cousins. What's more, you'll have the beautiful, transformed smile that veneers can achieve.
If you would like more information on minimal or 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.”
Academy Award-winning actress Kathy Bates knows how important it is to present your best face to the world — and one of the most important features of that face is a beaming smile. But there came a point when she noticed something was a little off. “I've always had good teeth, but it seemed to me as I was getting older that they weren't looking as good,” Kathy explained in a recent interview with Dear Doctor magazine.
That's when she decided it was time to take action. Kathy had orthodontic treatment when she was in her fifties, and she keeps her smile bright with tooth whitening treatments. She uses a kit provided by her dentist with a safe, effective whitening solution.
Of course, a bright, healthy smile looks great anywhere — whether you're on the red carpet or “off the grid.” And you don't have to be a Hollywood star to have professional whitening treatments. In fact, teeth whitening is one of the most popular and affordable cosmetic treatments modern dentistry offers.
The basic options for professional teeth whitening include in-office bleaching or take-home kits. Both types of dentist-supervised treatments offer a safe and effective means of getting a brighter smile; the main difference is how long they take to produce results. A single one-hour treatment in the office can make your teeth up to ten shades lighter — a big difference! To get that same lightening with at-home trays, it would take several days. On the plus side, the take-home kit is less expensive, and can achieve the same results in a bit more time.
It's important to note that not all teeth can be whitened with these treatments. Some teeth have intrinsic (internal) stains that aren't affected by external agents like bleaches. Also, teeth that have been restored (with bonding or veneers, for example) generally won't change color. And you can't necessarily whiten your teeth to any degree: Every tooth has a maximum whiteness, and adding more bleach won't lighten it beyond that level. Most people, however, find that teeth whitening treatments produce noticeable and pleasing results.
What about those off-the-shelf kits or in-the-mall kiosks? They might work… or they might not. But one thing's for sure: Without a dentist's supervision, you're on your own. That's the main reason why you should go with a pro if you're considering teeth whitening. We not only ensure that your treatment is safe — we can also give you a realistic idea of what results to expect, and we will make sure that other dental problems aren't keeping you from having a great-looking smile.
How often does Kathy Bates see her dentist for a checkup and cleaning? “I go about every four months,” she noted. “I'm pretty careful about it.” And if you've seen her smile, you can tell that it pays off. If you would like more information about teeth whitening, please contact us or schedule an appointment. You can learn more in the Dear Doctor magazine articles “Important Teeth Whitening Questions Answered” and “Teeth Whitening.”
We've known for decades that fluoride strengthens tooth enamel and lowers the risk for decay. And while adding it to toothpaste and drinking water are the more common ways for getting it into the body, an increasingly popular way—especially for children—is to apply fluoride directly to the teeth.
But is topical fluoride really worth the effort and expense? And, are there any side effects to treating teeth this way?
As to the first question, researchers have performed numerous studies measuring fluoride's effectiveness for preventing tooth decay. The Cochrane Oral Health Research Group recently reviewed studies on topical fluoride applications involving nearly 10,000 children and adolescents between the ages of 2 and 15. The combined average for all the studies showed a 28% reduction in decayed teeth for patients who received topical fluoride compared to those who didn't.
This was especially true for children at high risk for decay: directly applying fluoride gels, foams or varnishes to teeth reduces that risk substantially. But there are also side effects to this application. Fluoride in general has only one known safety concern, a condition known as fluorosis. Too much fluoride over time can cause heavy discoloration of the teeth. This does not affect the health of the teeth, but it can look unattractive and require cosmetic treatment to reduce its effect.
There's little to no risk for fluorosis with the controlled treatments offered by dentists; the fluoride solution remains on the teeth no more than a few minutes. But there is a possible side effect during treatment due to the relatively high dose of fluoride used. If the patient accidentally swallows some of the solution, the concentration of fluoride can cause stomach upset, vomiting or headaches.
Dentists minimize the chances for this by usually using the more difficult to swallow varnish form of topical fluoride on younger patients, and using trays or other barrier devices to isolate the fluoride solution from the rest of the mouth. Under professional supervision, it's rare for an accidental ingestion to occur.
The risks for these side effects are quite low, and the benefits of topical fluoride for reducing the chances for decay can more than outweigh them. Fluoride applications are one of many ways we can protect your child's current and future dental health.
If you would like more information on decay prevention techniques like topical fluoride, 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 “Fluoride Gels Reduce Decay.”
This website includes materials that are protected by copyright, or other proprietary rights. Transmission or reproduction of protected items beyond that allowed by fair use, as defined in the copyright laws, requires the written permission of the copyright owners.