Facial Pain (TMJ/TMD)
No subject in dentistry is shrouded in more controversy than TMJ therapy. There are many "experts" on the subject but there is little agreement as to diagnosis and treatment. TMJ refers to the joint upon which the jaw hinges when the mouth opens and closes, located on each side the head about one inch in front of the ear.
- Muscle Disorders: By far the most common TMJ problems are caused by muscle spasms, which originate due to a lack of harmony in the muscles that move the joint on either side. Some muscle disorders cause only pain, while others can cause physical damage to the parts of the joint. One common cause of muscle disorders is a misalignment of the bite.
- Internal Derangements: Internal derangements are when internal parts of the joint are misaligned or malformed. These problems can result from muscle or arthritis-related disorders as well as trauma.
- Tumors: Though very rare, some TMJ problems can be caused by tumors in or around the joint. These are often difficult to diagnose, as different types of tumors show up differently in different types of radiographs.
Not all facial pains are caused by TMJ problems. Some other types of pain can be caused by neurological disorders and vascular disorders. Controversy arises because there are many different therapies for TMJ problems, all of which have proponents who claim the various benefits of each therapy.
Doctors Groh and Souviron treat TMJ patients according to careful diagnosis and analysis of signs and symptoms. Dental Leaders strongly believes in reversible therapies whenever possible, and commit to irreversible treatments (reconstruction, equilibration or reshaping of teeth, etc.) only after their effectiveness has been proven by reversible means. The Dental Leaders team adheres to strict standards of integrity and clearly discusses with patients limitations of care when their symptomatology is beyond that which is treatable by proven means. The practice has the most modern instrumentation to diagnose muscle disorders, as well as a strong network of consulting doctors and therapists—yielding great success in treating TMJ problems far and above that of most practices.
Any patient for whom TMJ surgery has been recommended is urged to get a competent second opinion prior to committing to surgery. While surgery can be a successful treatment modality in some cases, it is only indicated for a small number of patients and should be confirmed beforehand as the right treatment pathway.
Special Needs Dentistry
Every year children are born with physical, medical, and emotional challenges. Dr. Groh takes special pride in having dedicated approximately ten percent of his professional time to helping people with special needs. For these children requiring greater attention, a kind touch and subtle approach are often sufficient to calm a fearful patient; however, patients with special needs do not always have the innate ability to cooperate. Dr. Groh’s anesthesia background and hospital affiliations serve Dental Leaders well in assisting these individuals. The practice treats patients with Down syndrome, cerebral palsy, autism, craniofacial syndromes, mental retardation, Alzheimer's disease, epilepsy, cardiac problems, and a variety of other conditions.
There has never been a more exciting time to be a dentist! Today’s capabilities in preventing dental disease are great and information about dental care is more available than ever. With sincere effort, most people can maintain their hard-earned dental health for decades, with their only dental needs resulting from the wear-and-tear of previous treatment rather than new problems.
Following is a list of the care components that comprise an effective prevention program.
Good Home Care
There is nothing that a dentist can do that can equal the effect that good oral hygiene will have on oral health. Brushing properly and flossing properly will remove the plaque bacteria that cause cavities and the infectious process of gum disease. Home care is by far the most important component of dental health maintenance.
Routine Professional Care
The average healthy person requires two cleanings per year, along with routine examination and annual radiographs. People with lower levels of dental health require more frequent cleanings; in fact, many patients come every six to ten weeks for re-care visits. An individual’s re-care schedule must be dictated by needs and never by an insurance plan.
Excellent Quality Dental Restorations
Dental restorations must be of sufficient quality in order to maintain good dental health. Rough edges (margins) and bulky contours can create plaque traps that enable bacteria to cause cavities and gum infections. In the Dental Leaders office, tolerances of 40 to 60 microns are used in the fit of restorations! Quality decision-making and laboratory techniques allow the practice’s dental team to achieve precision in the work performed. This also accounts for the visual appeal of the practice’s cosmetic work.
Over the past forty years, the fluoride found in drinking water, the foods available to eat, and the toothpaste used for brushing have cut the prevalence of cavities in half. Flouride, however, only protects the smooth surfaces of the teeth and not the biting areas. Dental sealants, as pictured below, are a type of bonding that flows into the crevices and grooves of the biting back teeth to protect them from the accumulation of bacteria and food debris that can cause cavities, The American Dental Association recommends applying sealants to children's back teeth as soon as they erupt (starting at about 6.5 years old), with which Dental Leaders agrees. Sealants are also strongly recommended for adults who have deep grooves but have so far avoided cavities. Today there is no reason that a person with good habits, fluoride, and sealants should ever get a cavity. A small amount of prevention goes a long way.
Good Dietary Habits
Many people do not realize that there is a very real dietary component to preventing dental disease. Some people are more susceptible than others to cavities and gum infections, and the food can inadvertently play a role in feeding bacteria and accelerating those processes. In addition to treats, there is still a dental liability that goes along with eating any refined carbohydrates (sugars and starches). In fact, recent studies have shown that white bread and cookies and cakes can cause cavities as easily as pure sugars. When snacking between meals, it is important to vigorously rinse with water. Additional options include taking a toothbrush to work or school. Everyone should brush at least twice daily and floss at least once.
Dr. Groh did two years of research at the National Institute of Dental Research at the National Institutes of Health in Washington, D.C. His research clearly showed that the worst damage to tooth structure occurs in the first fifteen minutes after eating. Therefore, that quick water rinse is very important.
There is also some compelling evidence that abrasive foods such as celery, and even chewing gum, can remove some plaque bacteria that build up between brushing.
Finally, there are some foods that fight cavities—sharp cheeses are especially good at neutralizing bacterial products that cause cavities, as well as real licorice. Such foods should not be depended on for hygiene purposes, but they do serve as a hint for cautious snacking.