Tenderness; headaches; difficulty chewing; excruciating pain. These are a few of the symptoms you could endure with a jaw joint or temporomandibular disorder (TMD or TMJ). This group of disorders disrupts the daily lives of millions of people around the world.

This month is TMJ Awareness Month, to shed light on these debilitating conditions and how best to manage them. Although controlling TMD isn't always easy, it can be done with the right blend of treatments.

The temporomandibular joint—actually a pair of joints connecting the lower jaw to the skull on either side of the face—is "ground zero" for TMD. These are ball-and-socket joints similar to the hip or shoulder, but with a unique addition—a cushioning disk that lies between the adjoining points of the two bones that temper the forces generated when you eat, speak or bite down.

Researchers believe TMD can arise from a variety of sources, including traumatic injury, psychological stress or mechanical dysfunction within the joint and cushioning disk. These problems can create blood flow constriction, which in turn causes the accumulation of chemical waste byproducts in the jaw muscles. This in turn and cause the muscles to spasm and become inflamed and sore.

Treatments are also as numerous as the possible causes of TMD. But for the most part, they range along a continuum of conservative to aggressive approaches.

On the conservative end, doctors treat TMD as a joint problem and borrow heavily from orthopedics. These types of treatments include the use of anti-inflammatory and muscle relaxing medications, icing or heating, stretching exercises, physical therapy and massage. Dentists may also provide mouth guard appliances for patients with clenching or tooth grinding habits to decrease biting forces.

On the more aggressive end are interventions like orthodontics or dental work. But, while these were common recommendations 20-30 years ago, it's no longer thought to be necessary for treating most TMD disorders and should not be recommended as a cure or solution for TMD.  At the furthest extreme is actual jaw surgery to relieve symptoms or repair damage within the joints. The latter, however, has not yet amassed a solid track record, and should be considered as a last resort.

Finding the right combination of therapies to give consistent relief sometimes requires a bit of trial and error. Most doctors recommend starting first with the most conservative methods before considering more aggressive measures. You should also undergo a complete dental exam to see if teeth or gum problems are contributing to your symptoms.

TMD can make your life miserable. But with some persistence and patience, you can find what works for a life without pain and dysfunction.

If you would like more information about managing TMD, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine article “Seeking Relief From TMD.”

You might have a few questions should you find out you need a root canal for a tooth infected with advanced decay. Most will be about what you should expect before, during and after a procedure.

But first, let's deal with a couple of your obvious concerns right upfront:

1. No, contrary to your Uncle Bill, it won't be painful (if the infected tooth is throbbing, though, the procedure will relieve your pain);
2. Yes, based on outcomes for millions of treated teeth over several decades, the odds are high the procedure will save your tooth.

As to other questions you might have, here's a basic 411 concerning your upcoming root canal procedure.

The "Why." Many consider tooth decay to be mainly a cavity forming in the outer enamel and dentin layers of a tooth. But tooth decay can destroy tooth structure as it advances through to the pulp, the heart of a tooth. The resulting infection will also spread into the root canals to eventually infect the roots and supporting bone. A root canal treatment removes the decay and stops the advancing infection in its tracks.

The "How." There are a number of variations on the procedure, but they all follow this basic process: After thoroughly numbing the tooth and surrounding tissues, we drill a hole into the tooth to access the pulp chamber and the root canals. We then remove all infected tissue through this access and disinfect the tooth's interior spaces. We then fill these spaces with a rubber-like filling to prevent future infection.

The "After." Once we've completed filling, we seal the access hole. Sometime later, we'll crown the tooth to provide further protection against infection and add support to the tooth. In the meantime, you may have a few days of discomfort, which is usually manageable with mild pain-killers like ibuprofen or acetaminophen.

A lot of root canals can be performed by a general dentist, but more complicated cases may require an endodontist. In either scenario, a root canal could give your infected tooth another chance at life that it wouldn't otherwise have.

If you would like more information on root canal therapy, 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 “Root Canal Treatment.”

As parents, we want to do everything possible to help our kids stay healthy—and that includes their teeth. And just like other aspects of their health, it's better not to go at dental care alone. That's why we recommend beginning your child's regular dental visits no later than their first birthday.

You may think that's a bit premature, given the few teeth a child may have when they're a year old. But there are solid reasons why early childhood dental visits are a smart move, especially if you're playing the long game for their future dental health and development.

Minimizes damaging tooth decay. If a child loses just one primary tooth to decay, it could have an adverse, cascading effect on their developing bite. Dental visits begun sooner rather than later are more likely to catch and treat tooth decay, as well as provide other preventive measures that can ensure primary teeth aren't lost prematurely.

Provides you a partner for your child's dental care. A child's dental development and health depend on what you do in the home—daily oral hygiene, monitoring for signs of disease and avoiding habits that promote tooth decay. Regular dental visits help support the home front by providing you helpful insight and advice for supporting your child's dental health.

Identifies bite problems early. Although they usually develop gradually, there are often early signs of an emerging bite problem. Pediatric dentists especially are trained to notice early signs of an abnormal bite and refer you to an orthodontist for interventional treatment.

Reduces your child's dental visit anxiety. The unfamiliarity and clinical nature of a dental office can make a child susceptible to anxiety that could follow them into adulthood. Early childhood dental visits help normalize the dentist's office for your child, reduce anxiety and make it more likely they'll continue seeing the dentist later in life.

Life can be hectic with an infant in the home. But getting into the routine of regular dental visits at an early age is a worthwhile investment in healthier teeth and gums—now and in the future.

If you would like more information on good dental care practices for your child, 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 “Age One Dental Visit.”

Half of adults over age 30, and an astounding 70% over 65, have had some form of periodontal (gum) disease. Unchecked, a bacterial gum infection can spread into the supporting bone and destroy attachments between the teeth and gums. Because of its rapidity and aggressiveness, gum disease is the number one cause of tooth loss among adults.

But there may be even more harm caused by gum disease beyond losing teeth: There's growing evidence gum disease may worsen other diseases like diabetes, heart disease or rheumatoid arthritis. Patients with gum disease are also more likely to suffer from one or more of these systemic conditions.

The link between gum disease and these other diseases appears to be inflammation. When tissue becomes injured or diseased, swelling (inflammation) occurs to isolate these tissues from the rest of the body. Under normal circumstances, this is a critical defense mechanism to protect the body overall.

But this response is a temporary measure—if it becomes chronic, it can actually damage the tissues it's trying to protect. This often happens with gum disease as inflammation can't overcome the gum infection, and both sides settle into a kind of trench warfare. The same story plays out with other diseases with an inflammatory response. And if the body is waging war with a gum infection, it can worsen these other conditions.

It's important then to take care of your gums and the rest of the body to minimize chronic inflammation. You can help prevent a gum infection by brushing and flossing every day and getting your teeth cleaned professionally at least every six months. You should also see your dentist if you notice swollen, reddened or bleeding gums, often the first signs of gum disease.

It can also benefit your gums if you're addressing other inflammatory issues in your body. Besides regular medical care, you can reduce your risk for other systemic diseases by eating a healthy diet, keeping your weight at an optimum level and avoiding smoking.

The individual parts of your body aren't isolated islands: Diseases that affect one can eventually affect all. By preventing or treating gum disease as early as possible, you'll also help reduce the effects of other systemic diseases.

If you would like more information on preventing gum disease, please contact us or schedule an appointment for a consultation.

Some things in life are almost guaranteed to make you go, "Uh, oh"—your car won't start, your a/c goes out, or, worse yet, you get an unexpected letter from the IRS.

Here's another: One of your teeth is loose. And, if you don't act quickly, that loose tooth may soon become a lost tooth.

But first, we need to find out why it's loose. It's usually due to one of two types of injury related to your bite. One type is called primary occlusal trauma. This results from your teeth encountering higher than normal biting forces. This often happens if you habitually gnash or grind your teeth together outside of normal functions like eating or speaking.

The other type is secondary occlusal trauma. In this case, the supporting gum tissues and bone have been weakened or lost by disease, with the gum tissues possibly becoming detached. Without this support, even normal biting forces could loosen a tooth.

Our treatment approach for a loose tooth may differ depending on which of these is the cause. For primary occlusal trauma, we want to reduce the biting forces that have contributed to loosening the tooth. One way to do this is to create a mouthguard that when worn prevents teeth from making solid contact during grinding episodes.

For secondary trauma, we want to first focus on treating any gum disease responsible for weakening the gum tissues. Once we have it under control, the gums and bone tissues can heal and possibly regain and strengthen their attachment with the tooth.

At the same time, we may also need to stabilize a loose tooth to prevent its loss. This usually involves splinting, whereby we use neighboring healthy teeth to support the loose tooth. One way to do this is to attach a metal strip across the backs of the loose tooth and its more stable neighbors, or by way of a channel cut through the top biting surfaces of the teeth.

If a loose tooth regains its attachment with the gums and bone, it may stabilize and any splinting can be removed. If not, splinting may become a permanent solution. Either way, prompt treatment can help us save your loose tooth.

If you would like more information on treating loose teeth, 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 “Loose Teeth: Biting Forces Can Loosen Teeth.”