My Blog
By Sirisha Pulapaka, DDS
June 03, 2021
Category: Oral Health
Tags: tmj disorders  
WhatWeCanLearnFromThoseWithChronicJawPainandDiscomfort

Temporomandibular joint disorder (TMD) is an umbrella term for a number of chronic jaw problems. These conditions cause recurring pain for 10 to 30 million Americans, especially women of childbearing age.

But even after decades of treatment and research, a full understanding of TMD's underlying causes eludes us. That doesn't mean, however, that we haven't made progress—we have indeed amassed a good deal of knowledge and experience with TMD and how best to treat it.

A recent survey of over a thousand TMD patients helps highlight the current state of affairs about what we know regarding these disorders, and where the future may lie in treatment advances. Here are a few important findings gleaned from that survey.

Possible causes. When asked what they thought triggered their TMD episodes, the top answers from respondents were trauma, stress and teeth clenching habits. This fits in with the consensus among experts, who also include genetic disposition and environmental factors. Most believe that although we haven't pinpointed exact causes, we are over the target.

Links to other disorders. Two-thirds of survey respondents also reported suffering from three or more other pain-related conditions, including fibromyalgia, rheumatoid arthritis and chronic headaches. These responses seem to point to possible links between TMD and other pain-related disorders. If this is so, it could spur developments in better diagnostic methods and treatment.

The case against surgery. Surgical procedures have been used in recent years to treat TMD. But in the survey, of those who have undergone surgery only one-third reported any significant relief. In fact, 46% considered themselves worse off. Most providers still recommend a physical joint therapy approach first for TMD: moist heat or ice, massage and exercises and medications to control muscle spasms and pain.

These findings underscore one other important factor—there is no “one size fits all” approach to TMD management. As an individual patient, a custom-developed action plan of therapy, medication, and lifestyle and diet practices is the best way currently to reduce the effects of TMD on your life.

If you would like more information on TMD management and treatment, 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 “Chronic Jaw Pain and Associated Conditions.”

By Sirisha Pulapaka, DDS
May 24, 2021
Category: Oral Health
Tags: gum recession  
GumRecessionCanHarmYourOralHealthandYourSmile

Your gums don't just attractively frame your teeth—they protect them as well. If they shrink back (recede) from their normal covering, portions of the teeth could become exposed to bacteria and other hazards.

Unlike the visible crown, which is protected by enamel, the tooth root depends largely on the gums as a shield against bacteria and other hazards. When the gums recede, it exposes the roots and makes them more susceptible to disease or trauma. It may also cause sensitivity to hot and cold foods as the now exposed dentin gets the full brunt of temperature and pressure sensations once muffled by the gums.

There are actually a number of causes for gum recession. In rare cases, a tooth may not have erupted normally within its bony housing, which inhibits the gums from covering it fully. Thinner gum tissues, passed down genetically, are also more susceptible to recession. And a person can even damage their gums and cause them to recede if they brush too aggressively.

The most common cause, though, is advanced periodontal (gum) disease. This bacterial infection arises from dental plaque, a thin biofilm that accumulates on tooth surfaces, usually because of poor hygiene practices. As the infection and resulting inflammation in the gums worsens, they lose their attachment to teeth resulting in a number of harmful outcomes that include recession.

The first step then in treating gum recession is to treat the underlying problem as much as possible. In the case of gum disease, effective treatment could stop mild to moderate recession and sometimes reverse it. For more extensive recession, a patient may need gum grafting surgery to help regenerate lost gum tissue.

You can help prevent gum disease, and thus lower your risk for recession, with daily brushing and flossing to remove bacterial plaque. Likewise, see your dentist at least twice a year for dental cleanings to remove any residual plaque and tartar (hardened plaque).

You should also visit your dentist promptly if you notice swollen or bleeding gums, or more of your teeth surfaces showing. The earlier your dentist diagnoses and begins treatment for gum recession, the better your chances for a healthy and more attractive outcome.

If you would like more information on maintaining good gum health, 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 “Gum Recession.”

By Sirisha Pulapaka, DDS
May 14, 2021
Category: Oral Health
PrettyLittleLiarsLucyHaleCrushesonSmiles

Is a “teeth crush” a thing? According to a recent confession by Lucy Hale, it is. Hale, who has played Aria Montgomery for seven seasons on the hit TV show Pretty Little Liars, admitted her fascination with other people's smiles to Kelly Clarkson during a recent episode of the latter's talk show (Clarkson seems to share her obsession).

Among Hale's favorite “grills”: rappers Cardi B and Post Malone, Julia Roberts, Drake and Madonna. Although some of their smiles aren't picture-perfect, Hale admires how the person makes it work for them: “I love when you embrace what makes you quirky.”

So, how can you make your smile more attractive, but uniquely you? Here are a few ways to gain a smile that other people just might “crush” over.

Keep it clean. Actually, one of the best things you can do to maintain an attractive smile is to brush and floss daily to remove bacterial plaque. Consistent oral hygiene offers a “twofer”: It removes the plaque that can dull your teeth, and it lowers your risk of dental disease that could also foul up your smile. In addition to your daily oral hygiene routine at home, professional teeth cleanings are necessary to get at those hard-to-reach spots you miss with your toothbrush and floss and to remove tartar (calculus) that requires the use of special tools.

Brighten things up. Even with dedicated hygiene, teeth may still yellow from staining and aging. But teeth-whitening techniques can put the dazzle back in your smile. In just one visit to the dental office, it's possible to lighten teeth by up to ten shades for a difference you can see right away. It's also possible to do teeth whitening at home over several weeks using custom-made trays that fit over your teeth and safe whitening solutions that we provide.

Hide tooth flaws. Chipped, stained or slightly gapped teeth can detract from your smile. But bonding or dental veneers, thin layers of porcelain custom-made for your teeth, mask those unsightly blemishes. Minimally invasive, these techniques can turn a lackluster smile into one that gets noticed.

Straighten out your smile. Although the main goal for orthodontically straightening teeth is to improve dental health and function, it can also give you a more attractive smile. And even if you're well past your teen years, it's not too late: As long as you're reasonably healthy, you can straighten a crooked smile with braces or clear aligners at any age.

Sometimes a simple technique or procedure can work wonders, but perhaps your smile could benefit more from a full makeover. If this is your situation, talk to us about a more comprehensive smile renovation.  Treatments like dental implants for missing teeth combined with various tooth replacement options, crown lengthening for gummy smiles or tooth extractions to help orthodontics can be combined to completely transform your smile.

There's no need to put up with a smile that's less than you want it to be. Whether a simple cosmetic procedure or a multi-specialty makeover, you can have a smile that puts the “crush” in “teeth crush.”

If you would like more information about cosmetic measures for enhancing your smile, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine articles “Teeth Whitening” and “Porcelain Veneers.”

SavingaDiseasedToothRatherThanReplacingItCouldBetheBetterOption

"Debit or credit?" "Buy or rent?" "Paper or plastic?"  Decisions, decisions. It's great to have more than one good option, but it can also provoke a lot of thought in making the right choice. Here's another decision you may one day have to face: "Save my tooth or replace it?"

It's hard to pass up replacing a tooth causing you misery, especially when the alternative is a functional and attractive dental implant. But before you do, consider this important message the American Association of Endodontists relay during Save Your Tooth Month in May: Before you part with a tooth, consider saving it as the best option for your oral health.

Even an implant, the closest dental prosthetic we now have to a real tooth, doesn't have all the advantages of the original. That's because your teeth, gums and supporting bone all make up an integrated oral system: Each component supports the other in dental function, and they all work together to fight disease.

Now, there are situations where a tooth is simply beyond help, and thus replacing it with an implant is the better course of action. But if a tooth isn't quite to that point, making the effort to preserve it is worth it for your long-term health.

A typical tooth in peril is one with advanced tooth decay. Decay begins when acid softens tooth enamel and creates a cavity. At this stage, we can often fill it with a tooth-colored filling. But if it isn't caught early, the decay can advance into the tooth's interior pulp, well below the enamel and dentin layers.

This is where things get dicey. As decay infects the pulp, it can move on through the root canals to infect the underlying bone. If this happens, you're well on your way to losing the tooth. But even if the pulp and root canals have become infected, we may still be able to save the tooth with root canal therapy.

Here's how it works: We first drill a tiny access hole into the infected tooth. Using special instruments, we remove all of the infected tissue from within the pulp chamber and root canals. After a bit of canal reshaping, we fill the now empty spaces with a rubber-like substance called gutta percha. After it sets, it protects the tooth from any more infection.

Contrary to what you might think, root canals aren't painful, as your tooth and the surrounding tissue are completely anesthetized. In fact, if your tooth has been hurting, a root canal will stop the pain. Better yet, it could save a tooth that would otherwise be lost—a satisfying outcome to a wise decision.

If you would like more information about tooth decay treatments, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine article “A Step-By-Step Guide to Root Canal Treatment.”

By Sirisha Pulapaka, DDS
April 24, 2021
Category: Oral Health
Tags: loose teeth  
SeeYourDentistASAPIfYouHaveaLoosePermanentTooth

Unless you're 6 years old and on speed dial with the Tooth Fairy, a loose tooth isn't a good feeling. It's also a sign something is wrong in your mouth. If you don't take prompt action, you may lose that tooth for good.

To begin with, teeth are held in place by an elastic tissue known as the periodontal ligament. The ligament lies between the tooth and bone and attaches to both through tiny fibers. The thing to note about the ligament is that it does allow for tooth movement, which serves as a “shock absorber” against the forces generated while biting and chewing.

But that movement is normally so slight, you won't perceive it. If you do, chances are there's a problem with the ligament attachment, which may have been damaged due to trauma or disease.

A hard blow to the face could certainly damage both the teeth and their attachments. But it can also happen if one tooth extends out farther than the rest and absorbs more stress during chewing. You could encounter similar damage if you attempt DIY orthodontics or wear tongue jewelry.

The more common source of ligament damage, though, is periodontal (gum) disease, usually caused by dental plaque, a thin film of bacteria and food particles left on tooth surfaces. If not treated, the infection can advance deeper into the gum tissues (and eventually the supporting bone), causing the ligaments to weaken and detach. In fact, a loose tooth is often a sign of well-advanced gum disease.

If you notice a loose tooth, you should make an appointment with us as soon as possible. Our first step is to ascertain the underlying cause and initiate any needed treatment. We may also want to splint a loose tooth to adjacent teeth to prevent excessive movement while the ligaments heal and reform their attachment to the tooth.

There will be times when a loose tooth is beyond repair. In that case, it may be best to remove the tooth and install a life-like replacement like a dental implant. But that's not inevitable. If at all possible and practical, we'll try to save your loose tooth.

If you would like more information on loose permanent 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 “When Permanent Teeth Become Loose.”





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