Grinding, clenching, and gritting your teeth are common reactions to stress — but their results can be quite complex. Here are some questions and answers that will fill you in on what you may not know about this widespread problem.

My dentist said I was bruxing. What does that mean?
Bruxing means that your teeth are grinding upon each other. Many people carry out this habit subconsciously and are not even aware that they are doing it.

Is bruxing or gritting harmful?
Such habits are called “parafunctional” (from para, meaning outside, and function, meaning purpose). This is because these stress habits exert much larger biting forces — as much as ten times more — than in normal biting and chewing activities. This excess pressure can cause damage to jaw joints and muscles, resulting in muscle spasm and pain; and to the teeth, resulting in wear, fractures or looseness. They can also cause headaches, earaches, and even neck and backaches because of the pressures on various structures in the face and mouth.

What is the usual treatment for problems arising from these stress habits?
The first thing we want to do is relieve your pain and discomfort. Second, we want to stop future damage. Application of heat or cold is helpful, and mild anti-inflammatory and muscle relaxant drugs are prescribed for pain and muscle spasm. To prevent future occurrences, we may treat you with biofeedback or refer you to someone who can offer psychotherapy.

What is a night guard and how can it help?
A night guard is an unobtrusive thin plastic appliance that is made to fit over the biting surfaces of your upper teeth. These guards are so unobtrusive that they can even be worn during the day if your stress level is so high that you grind your teeth during the day. The guard is adjusted to leave the lower teeth free to move against the surface of the guard, but they cannot bite into the upper teeth. This prevents wear on the teeth and lets the jaw muscles relax, preventing the pain of muscle spasm.

Contact us today to schedule an appointment to discuss your questions about stress and tooth grinding. You can also learn more by reading the Dear Doctor magazine article “Stress & Tooth Habits.”

Gum disease, also called periodontal disease (from the roots for “around” and “tooth”) starts with redness and inflammation, progresses to infection, and can lead to progressive loss of attachment between the fibers that connect the bone and gum tissues to your teeth, ultimately causing loss of teeth. Here are some ways to assess your risk for gum disease.

Your risk for developing periodontal disease is higher if:

1. You are over 40.
   Studies have shown that periodontal disease and tooth loss correlate with aging. The longer plaque (a film of bacteria that collects on your teeth and gums) is allowed to stay in contact with your gums, the more you are at risk for periodontal disease. This means that brushing and flossing to remove plaque is important throughout your lifetime. To make sure you are removing plaque effectively, come into our office for an evaluation of your brushing and flossing techniques.
2. You have a family history of gum disease.
   If gum disease seems to “run in your family,” you may be genetically predisposed to having this disease. Your vulnerability or resistance to gum disease is influenced by genetics. The problem with this assessment is that if your parents were never treated for gum disease or lacked proper instruction in preventative strategies and care, their susceptibility to the disease is difficult to accurately quantify.
3. You smoke or chew tobacco.
   Here's more bad news for smokers. If you smoke or chew tobacco you are at much greater risk for the development and progression of periodontal disease. Smokers' teeth tend to have more plaque and tartar while also having them form more quickly.
4. You are a woman.
   Hormonal fluctuations during a woman's lifetime tend to make her more susceptible to gum disease than men, even if she takes good care of her teeth.
5. You have ongoing health conditions such as heart disease, respiratory disease, rheumatoid arthritis, osteoporosis, high stress, or diabetes.
   Research has shown a connection between these conditions and periodontal disease. The bacteria can pass into the blood stream and move to other parts of the body. Gum disease has also been connected with premature birth and low birth weight in babies.
6. Your gums bleed when you brush or floss.
   Healthy gums do not bleed. If yours do, you may already have the beginnings of gum disease.
7. You are getting “long in the tooth.”
   If your teeth appear longer, you may have advancing gum disease. This means that infection has caused your gum tissue to recede away from your teeth.
8. Your teeth have been getting loose.
   Advancing gum disease results in greater bone loss that is needed to support and hold your teeth in place. Loose teeth are a sign that you have a serious problem with periodontal disease.

Even with indications of serious periodontal disease, it can still be stopped. Make an appointment with us today to assess your risks. You can also learn more by reading the Dear Doctor magazine article “Assessing Risk for Gum Disease.”

We have noticed that there are two types of patients when it comes to enhancing a person's smile. One type, which we'll call the “Perfect Minded” patient, expects teeth that are completely regular in their arrangement and of maximum whiteness and brightness, often beyond the range of traditional guides for tooth color. They are looking for a perfect “Hollywood” smile. The other, the “Natural Minded” patient, is looking for a more natural look. This person expects a general sense of regularity and alignment of teeth with definite brightness, but not so much that the teeth are noticeable before and above other facial features. Which type are you?

The “Perfect Minded” Patient
While you expect maximum regularity and alignment of teeth along with maximum whiteness and brightness, the “perfect minded” patient requires a smile completely symmetrical (balanced from one side to the other). If we drew a vertical line down the center of your face (midline), it would fall directly between your front teeth and your smile would look just the same on each side of the line. You also expect your smile to be horizontally symmetric, so that it matches the curvature of your lower lip and the gum lines match from side to side.

The “Natural Minded” Patient
You are looking for a more subtle, natural look produced by including some minor irregularities in your look. Like the “Perfect Minded” individual, you still expect your teeth to be generally regular and well aligned but you also want to have some minor asymmetries (not matching) as you move farther back along your jaw to make your teeth look real. Your preference in tooth color is not a super shade of white, but for a tooth color that looks very natural for your facial skin and hair color.

There is no right or wrong here. What is important is to be sure to communicate your expectations to us before embarking on a program of smile redesign.

Contact us today to schedule an appointment to discuss your questions about Smile Design. You can also learn more by reading the Dear Doctor magazine article “Great Expectations — Perceptions in Smile Design.”

Dentists often recommend bone grafting to ensure the success of dental implants. And it is likewise common for people to squirm a bit at the thought. Bone graft? That sounds serious. And maybe a bit, well, unappealing. These feelings are completely understandable. After all, this may be something you've never had to consider before. But there's no reason to worry. Here’s why:

1. Bone grafting is not new or experimental. It is actually a very routine part of the implant process, as well as other types of oral and periodontal surgery. And it is very successful when performed by an experienced doctor.
2. Bone grafting materials are processed for safety. The grafts used — whether synthetic or from a natural source, such as cow or human bone — have been specially treated for medical use.
3. Only a small amount of this bone-grafting material is needed. Once placed in the site of the missing tooth, it serves as a helpful scaffold your body uses to build more of its own bone in that spot.
4. Your implant will be more ideally positioned and may work better. It needs a good, strong foundation with which to fuse. But when teeth are lost, this supporting bone is often lost, too. This loss is often unpredictable and bone grafting limits the change that occurs. In fact that's one of the main benefits of replacing missing teeth with implants: they help prevent bone loss just as a natural tooth does.
5. Your implant will look so much better! Think about it: Your original tooth was supported to a certain height by the underlying bone. If that bone is now gone, the replacement tooth is going to be much longer because of the missing bone height. It may not look quite right without that additional support.

So if you want the best-looking and best-functioning implant possible, have no fear of bone grafting. And please contact us to discuss any of your concerns, or schedule an appointment for an implant consultation.

You can read more about this topic in the Dear Doctor magazine article “Can Dentists Rebuild Bone?”

Thinking or knowing you have an impacted wisdom tooth can be alarming news for some people. Unfortunately, one of the main reasons for this feeling is due to the mythology surrounding wisdom teeth...and especially impacted wisdom teeth. While an impacted wisdom tooth can cause intense pain, some people are quite shocked to learn that they even have impacted wisdom teeth, as it is causing no pain at all.

By definition, an impacted wisdom tooth is a third (and last) molar that gets jammed against an adjacent tooth or other important structures such as gum, bone nerves, blood vessels. And having an impacted wisdom tooth does have its consequences — even if you are unaware you have one. The most common issue is gum (periodontal) disease. This is the main reason why it is so important to have a problematic wisdom tooth removed early when you are young and before periodontal disease has started. If left untreated, you risk damaging and/or losing the impacted tooth and adjacent teeth.

The key to managing wisdom teeth is to monitor them closely through thorough routine examinations and x-rays between the ages of 17 and 25, the time when wisdom teeth typically appear. This is so vital because it allows us to predict the way your wisdom teeth will erupt (become visible) or come into proper position with useful biting function. We can use these visits and x-rays to monitor development so that we are best equipped to determine if or when wisdom teeth need to be treated or removed.

It is also important to contact us as soon as you think you may have an impacted wisdom tooth that is causing pain, swelling or even infection. We can put your mind at rest with the facts of what needs to be done after we've completed our exam.

If you feel that you or a family member has an impacted wisdom tooth, contact us today to schedule an appointment to discuss your questions. Or you can learn more now about the symptoms and treatment options of impacted wisdom teeth by continuing to read the Dear Doctor magazine article “Wisdom Teeth.”