Bruxism

Bruxism is a condition that people grind or clench their teeth.   People who grind or clench their teeth during the day and during their sleep regularly are likely to have dental problems, headaches, facial or jaw pain, and temporomandibular joint disorder.   Awake bruxism is teeth grinding or clenching during the day. Sleep bruxism is teeth grinding or clenching during sleep.  People who have sleep bruxism may have other sleep disorders, such as snoring and sleep apnea.

The exact cause of bruxism is unclear.  These are possible causes of bruxism:

·       Stress & anxiety

·       Abnormal bite, malocclusion (teeth do not meet properly when the jaw closes)

·       Missing or crooked teeth

·       Sleep disorders: snoring, sleep apnea

Signs & symptoms of bruxism may include:

·       Teeth grinding or clenching may be loud enough to wake up your sleep partner

·       Teeth that are flattened, fractured, chipped or loose

·       Worn tooth enamel, exposing deeper layers of your tooth

·       Increased tooth pain or sensitivity

·       Tired or tight jaw muscles, or a locked jaw that won’t open or close completely

·       Jaw, neck or face pain or soreness

·       Pain that feels like an earache

·       Dull headache starting in the temples

·       Sleep disruption

·       Wake up in the morning with jaw pain

Dangers of bruxism

·       Wear down tooth enamel, damage to dental fillings and crowns

·       Tension-type headaches

·       Facial or jaw pain

·       Temporomandibular joint disorder

Factors increase risk of bruxism

·       A study in the November 2016 issue of the Journal of the American Dental Association suggests that teeth grinding is also associated with alcohol and tobacco use.  People who drink alcohol and use tobacco are twice likely to grind their teeth.

·       Stress, anxiety, anger,  and frustration

·       Personality type:  person who is aggressive, competitive or hyperactive can increase the risk of bruxism

·       Smoking tobacco, drinking caffeinated beverages or alcohol, or use of recreational drugs may increase the risk of bruxism.

·       Bruxism can be associated with some mental health and medical conditions: Parkinson’s disease, dementia, gastroesophageal reflux disorder (GERD), epilepsy, sleep apnea and attention deficit disorder.

Treatment for bruxism

·       Recommend a sleep study to rule out an airway issue

·       Mouth guard fitted by the dentist.  Mouth guard is worn to protect the teeth

·       Dietary changes

·       life style changes

Prevention

·       Stress and anxiety management may help reduce or prevent bruxism

·       Good sleep hygiene: cool dark, quiet room to sleep in

·       Avoid foods and drinks that contain high concentration of caffeine or alcohol

Bruxism can create serious problems for oral health. If you notice that you grind or clench your teeth during the day or you wake up in the morning with jaw pain, call for a consultation with Dr. Anna Lee.  She can help you, diagnose the problem and provide treatment options.  Dr. Anna Lee is a general & cosmetic dentist in Glendora, CA.  Call our office at 626-335-5114 for a dental checkup or visit us at www.annaleedds.com.

Tips to overcome Dental Fear

Many people are fearful of going to the dentist.  The reason may be that you had a bad dental experience; the dental injection was painful, you were not numb enough during the treatment, or the dental visit was too long.  These are legitimate reasons that cause people to be afraid of seeking dental treatment. Dental fears are not uncommon.                                                                                                                             

Here are some tips to overcome dental fear:

Communication with the dentist & dental team

·       Talk with your dentist & dental staff and let them know you are fearful of the dental visit.

·       Start with simple treatment with short appointments.

·       You may feel more in control if you take part in decisions about your treatment. Ask the dentist to explain the procedure before the treatment.

·       Some patients want to know everything about the treatment. Tell your dentist to explain what is happening at every stage of the dental procedure.

·       Hand signal such as “thumbs up” or “thumbs down” tells the dentist to continue or stop the procedure.  Thumbs up means to continue the procedure.  Thumbs downs means stop.

·       Discuss fees and finance before the treatment.

Pain Control

·       Research has shown that pain is one of the main reasons people avoid seeing the dentist.

·       Make sure you tell the dentist if you are not numb enough before or during the dental procedure.

·       Minimize pain with using topical anesthetics. It is applied with a Q-tip to numb an area of the mouth before the injection.

·       Ask for pain medication prescriptions if needed after an extensive dental procedure.

Use Distraction

·       Watch a funny video to help you relax before the treatment

·       Wear head phone and listen to music during the treatment

·       Squeeze a stress ball

·       Imagine your happy place and visualize yourself at a relaxing place

Practice relaxation Techniques

·       Relaxation exercises: take a big breath and letting it out very slowly

·       Relax your muscle & slow your heart rate

Sedative may be needed before the procedure

·       Some patients take Valium to relax prior to the treatment

·       Sedatives help people feel calmer and more relaxed during the treatment

Bring a companion during appointments

·       Bring a friend or family member to the dental appointment for support

·       Friend or family member keeps you company during the treatment

·       Keep your mind off any unpleasant thoughts

Reward Yourself

·       Buy something nice or do something fun to reward yourself for overcoming the fear of the dental treatment

·       Rewards can help you to relate dental visits with fun activities

Dental fears are not uncommon. Finding a dentist who listens and understands your dental fears is important. Dental visits should not just be getting the dental treatment done; it should also be creating a positive experience.   Dr. Anna Lee is a general & cosmetic dentist in Glendora, CA.  She listens and understands your dental fears.  Dr. Lee and her team can help you to reduce your dental fears. Call our office for a dental visit at 626-335-5114 or visit us at www.annaleedds.com.

Orofacial Myofunctional Therapy before and after Laser Frenectomy

What is orofacial myofunctional therapy (OMT)?

·       Orofacial myofunctional therapy (OMT) is a program of specific exercises that target the facial muscles for chewing and swallowing.  These exercises help to strengthen the tongue muscles after the frenectomy procedure. 

Why is orofacial myofunctional therapy necessary before & after laser frenectomy?

·       Karen Wuertz, D.D.S. and Brooke Pettus, COMS are authors of the article published in Laser focus in DSP, fall 2018 wrote, “The removal of oral restrictions is necessary to attain optimal orofacial function and must be combined with regular pre- and post-frenectomy orofacial myofunctional therapy (OMT).”

·       OMT helps re-educate the tongue and orofacial muscles during movement and at rest to create new neuromuscular patterns for proper oral function, including chewing, swallowing, speaking, and breathing. 5,6

5. Guilleminault C. Huang YS, Monteyrol PJ, Sato R, Quo S, Lin CH.  Critical role of myofascial reeducation in pediatric sleep-disordered breathing. Sleep Med. 2013 Jun; 14(6): 518-25.  Doi: 10,1016/j.sleep.2013.01.013.

6. Guimaraes KC, Drager LF, Genta PR, Marcondes BF, Lorenzi-Filho G. Effects of oropharyngeal exercises on patients with moderate obstructive sleep apnea syndrome. Am J Respir Crit Care Med. 2009 May 15;179 (10):962-6. Doi:10.1164/rccm.200806-981OC.

*Case example by Karen Wuertz, D.D.S. & Brooke Pettus, COMS

Patient: 29 year old female

Clinical exam & symptoms:

·       Temporomandibular Disorder (TMD) symptoms with jaw deviation, clicking/popping on the right side

·       Neck pain and frequent headaches

·       Low facial muscle tone, a short upper lip

·       Mouth breathing all night, regular night time drooling, restless sleep

·       Complained of daytime fatigue & never waking well rested

·       Frequent congestion

·       Forward head/neck and forward rolled shoulder posture

·       Tension in the neck and shoulders

·       Tongue thrust during swallowing

·       Dry, chapped lips and the habits of lip licking, cheek biting and clenching

Intraoral examination:

·       Narrow, high palate

·       Tight upper labial frenum and attached gingiva

·       Tongue is short and wide with a tight, restrictive lingual frenum

·       Range of Motion (ROM) was 28mm from tongue tip to incisive papilla

Laser Surgery:

·       CO2 laser frenectomy was performed to release lip and tongue restrictions

·       Patient was asked to lift, extend, and lateralize the tongue

·       ROM was measured at 47mm.  Patient gained 19mm in the ROM with tongue tip to incisive papilla (gum tissue between upper 2 front teeth).

Postoperative care and healing:

·       Almost immediately, patient reported less neck and shoulder tension

·       Could stand up straighter

·       Her airway felt more open when breathing

·       Able to close her mouth without straining on her upper lip

·       Able to elevate the middle and posterior portions of the tongue to the palate

·       800mg ibuprofen was taken twice the day of and once the day after

·       Soft, bland diet for 48 hours

·       Continue orofacial myofunctional therapy (OMT) regimen after the revisions

-OMT helped the patient retrain and re-pattern neuromuscular movements that had been foreign to her and helped her integrate them into her everyday life

Results:

·       Proper oral posture (tongue to palate)

·       Lip (no open mouth posture at rest)

·       Nasal breathing got increasingly easier

·       Better posture, more energy, eats less, feels rested in the morning

·       Sleeps through the night

·       Tongue thrust eliminated

·       No more night time drooling

·       Decreased in clenching and biting the sides of her tongue at night

Summary:

Optimal orofacial functions in adult patients can be achieved through laser lip and tongue frenectomy procedures and regular pre- and post-frenectomy orofacial myofunctional therapy.

*“The Importanace of Orofacial Myfunctional Therapy Before and After CO2 Laser Frenectomy in Achieving Optimal Orofacial Function” by Karen M. Wuertz, DDS, ABCDSM, ABLS, FOM, and Brooke Pettus, RDH, BSDH, COMS

Dr. Anna Lee is a general & cosmetic dentist in Glendora, CA.  Dr. Anna Lee is an experienced provider for laser frenectomy.  If you have any questions about lip and tongue ties, please visit us at www.annaleedds.com or call for a consultation at 626-335-5114.