Which Is It--Your Teeth, Your Jaw, Or Your Muscles?

Had a patient come in, complaining of some intense pain in her lower left back tooth that not even medication could help.  My instincts screamed "ROOT CANAL" for the hurting tooth, but I let my doctor brain put the brakes on that line of thinking and I thoughtfully worked through the examination.  In the end, there was no treatment recommended. WHAT?!?!? A dentist doesn't want to carve up a patient?

That scenario is more common than you think. I have treated head and neck pain for years, and I have learned about how pain can be referred from non-tooth sources. Problems with blood vessels, facial nerves, skin, and muscles can elicit tooth pain, and vice versa. These relationships are called bi-directional trigger points. 

Take the example of the primary muscles of chewing.  Not only do we use them to chew, we also use them to clench our teeth in times of stress. Wherever and whatever the nature of the stress (bruxism, apnea to name a couple), our muscles can become inflamed, and pass pain onto the nerve pathways of the teeth. The pictures below will show how upper teeth and lower teeth can be affected.

Conversely, I have anecdotal cases of patients with jaw or muscular or facial pain that is not felt in the teeth, but comes from abscessing, decayed, or inflamed teeth.

I have successfully used bite guards, night guards, Botox in the muscles, and sleep breathing appliances to deal with these aches and pains. 

The Less I See You, The Better!

I think it's common knowledge that humans with teeth go to the dentists twice a year. But I hope to give you a better explanation for why it's a good thing.

Maintenance or hygiene visits are all about risk management. Most patients have a measurable amount of risk for tooth decay and periodontal disease. If you have had a history of tooth decay, for example, that's a standard that holds true in evidence-based literature: You are susceptible to decay, therefore, you should have an inspection done every 6 months.There's a lot of risk factors to consider. But your dentist can help you understand what those are.  Here at our office, we issue a risk management sheet explaining your factors for decay and how to treat those risks.

Periodontal disease is similar, but there are different factors to consider. If you are a smoker, a diabetic, or have a history of gum and bone damage from an infection, you should see the dentist at least twice a year. For some people, those factors don't exist. If you don't have any risk of decay, and you don't have a history of gum disease, you probably don't need to see me so much. That's why it's not necessary to see all patients twice a year.  Some patients only need to be seen once annually for examination. The cliche still holds true: Flossing Each Day Keeps the Doctor Away.

Don't Run With Scissors, Don't Pour Gas On A Fire

My 3-year old daughter wanted to do some artwork last week. Upon the request to "go get some scissors," she ran to the office and ran back with the shears flailing in front of her face. Parenting Rule #856, Don't Run With Scissors, was then practiced for the umpteenth time.

There's plenty of new rules emerging in the dental world as we learn about the long-term effects of soda on teeth. My hygienist sent me a link about the wisdom of not drinking soda--'cause it's bad for your teeth--with a new twist. Not only does soda rot your teeth, it does it faster than we thought, and probably as well as meth and cocaine.

Methamphetamine and crack cocaine users suffer from dry mouth when using. Lethargy and thirst also increase, and users often turn to soda consumption to increase energy and satisfy the dry mouth. The triple whammy is that in addition to a dry mouth and acid erosion from soda, smoking the drugs will burn, erode, and decay teeth. It's like pouring gas on a fire.The photo below is pure meth mouth.

Non-drug users can suffer the same devastating results after long-term soda use. Caffeine will reduce the flow of protective saliva, and the pH of soda is so acidic, it will erode enamel quickly. This is a patient who has enjoyed Coke and Diet Coke for a decade.

 

 The good news is that soda erosion is manageable. Neutralizing the acidity of the soda immediately after drinking it will reduce the risk of this kind of decay. Chewing sugar-free gum, drinking water, or brushing your teeth are all effective choices. 

Dr. Rafoth and his dad, Dr. Rafoth

My dad, Richard Rafoth, MD, is a gasteroenterologist at the Everett Clinic in Everett, Washington. He has published 2 editions of a book. It's focused on nutrition and cycling. He has also created a blog and website devoted to cycling performance, called Cycling Performance Tips. He is the absolute best long-distance rider I know, has tons of street cred in the nutrition department, and has inspired me to ride for the rest of my life.

I thought I would share an older post from his website. I contributed an article about the research and management of tooth decay when you are a high-performance cyclist.

Happy riding!

Cascadia's Weekly Prescription

Root surface cavities happen at the gumline of teeth. Older patients typically get these cavities because of their tendency to have gum recession and exposed roots. But another population of patients is on the rise: those who routinely drink soda, energy drinks, or sport drinks. The acid from the drinks corrode tooth enamel, and the cavity pattern is similar to root cavities in older patients.

These root surface cavities are hard to restore, because they are at or below the gumline. Conventionally, dentists removed the cavity and restored it with a filling. But this can create unhealthy gum tissue at the restoration in many cases.

Today, the best first line of treatment is to remineralize teeth and stop the cavity process. Numerous studies are revealing that professional-strength topical fluoride arrests root surface decay. When combined with excellent home care and professional dental visits, routine use of topical fluorides can prevent unneccessary restorations and reduce your costs. For complete information about the disease of tooth decay, visit our website.