Do you have pain in or around your jaw joint? Does your jaw get stuck? Do you have painful clicking or popping? Are frequent headaches, like migraines, a problem? If so, you may want to ask your dentist about temporomandibular (TEM-puh-roh-man-DIB-yoo-ler) disorders (TMDs).

Your temporomandibular joint allows you to open or close your mouth and slide your jaw from side to side or back and forth. It is a complicated system of muscles, connective tissues, and the bony joint itself. Because it is so complex, your jaw joint can develop a number of problems.

Some possible causes of TMDs include

• diseases that affect the muscles or joints, like arthritis
• injury to the jaw joint or connective tissues
• habitual movements of the teeth and jaws, like grinding or clenching.

Other things, like sinus infections, can cause pain in your jaw area.1 Your dentist may want to rule some of these out before identifying TMDs as the source of your pain.

DIAGNOSIS

Signs and symptoms of TMDs can include

• pain in or around the ear
• pain when chewing
• tender jaw muscles
• painful clicking or popping when opening or closing the jaw
• difficulty opening or closing the mouth; n pain when opening your mouth wide
• headaches, facial, or neck pain.

One large, multiyear study also found that people in whom TMDs develop are more likely to report chronic somatic symptoms like runny nose, fatigue, or dizziness.2 Anxiety and depression have also been associated with TMDs.1

If TMDs are suspected, your dentist may check your joints and muscles for tenderness. He or she may listen for noises like clicking or popping, ask you about pain, or examine how your jaw moves. Symptoms may come and go or may bother you all the time. Or may go away without any treatment.

TREATMENT

It is difficult to identify the cause of TMDs. Treatment usually focuses on relieving the symptoms associated with it. There are several things you can try that might help

• eat softer foods
• limit wide jaw movements
• avoid chewing gum or biting down on anything hard
• apply moist, warm compresses.
• If your pain is still a problem, your dentist might suggest
• exercises to strengthen your jaw muscles
• medications like muscle relaxants, pain medicine, antianxiety drugs, or anti-inflammatory medications
• a nightguard or bite plate to decrease clenching or grinding of teeth during sleep.

Your dentist also may refer you to a specialist who has experience working with patients who have dental-related pain. Be well informed before making permanent adjustments, like changing the way your teeth fit together. Ask about the credentialing and educational background of those providing the care, as well as the success rates for the particular procedure you are considering. Explore all treatment options and potential outcomes before making any permanent changes to your bite.

CONCLUSION

Because the jaw joint is so complex, it can be difficult to identify what causes pain in and around the joint. Most treatment focuses on relieving the painful symptoms. Your dentist may be able to teach you ways to reduce the discomfort that comes with TMDs or, if necessary, refer you to a specialist who can offer other treatment options.

For years, dental offices have taken steps to protect patients and dental health care team members against disease transmission during treatment. You may see some of these measures in the waiting area and the clinic, but many take place behind the scenes.

IN THE WAITING AREA

Your dental office wants to keep you and other patients safe from the minute you walk in the door. Coughing and sneezing can spread germs. For that reason, you should cover your mouth and nose whenever you cough or sneeze. To help with this, many offices provide disposable masks or tissues in the waiting area to use when you are sick.

Clean hands are also important. Often there is hand sanitizer in the waiting room. To clean your hands with a sanitizer, rub a small amount of it all over the surfaces of your hands and fingers until your hands are dry.

IN THE CLINIC

You may have heard about personal protective equipment (commonly referred to as PPE), which consists of different equipment that dental care providers wear to protect them from germs spread through blood, saliva, or airborne particles. Examples of this equipment includes gloves, jackets, gowns, safety glasses, and face masks that cover the nose and mouth. For some treatments, face shields may also be worn. Most of these items are disposable used for only 1 patient and thrown away after use. Those that are not disposable must be cleaned with disinfectant between patients.

Other surfaces in the treatment area, like chairs, countertops, blood pressure cuffs, and light handles, must also be disinfected between patients.

BEHIND THE SCENES

Rest assured, any instruments used during your treatment must be clean. Some, like the tube used to suck saliva from your mouth, are disposable.

Instruments that are not disposable must be handled carefully after every patient. After your treatment, these instruments must be taken to a special area to be washed, sorted into sets for the next use, and put in a special oven called an autoclave to expose them to high heat designed to kill germs.

Even the quality of the water used during your dental treatment must be monitored. Water from the dental unit must be the same quality as drinking water.2 To achieve this, a dental office may use water from a source other than the public water system or may treat the water system. Regardless of where the water comes from, your dental office must check the quality regularly.

CONCLUSION

Dentists work hard to keep patients safe during their visits. These are only some of the steps dentists take to reduce the risk of infection. If you have questions about infection control, ask your dentist or the dental team members. n

Dentists have a number of options for helping bring a whiter smile forward.

TYPES OF STAINS

There are 2 types of stains: extrinsic and intrinsic.

Extrinsic stains discolor the surface of the tooth over time. They develop by repeated exposure to the same types of foods or beverages that would stain your clothes. Drinks like coffee, tea, and red wine are the most common culprits. Smoking, also can make your teeth yellow or even brownish.

Intrinsic stains occur under the hard, outer surface of your teeth, called enamel. They may appear as you age when the enamel may become thinner, allowing the yellowish dentin to show through. Other causes of intrinsic stains are things that affect the whole tooth, like an injury.

OPTIONS FOR WHITENING

There are many choices for whitening:

• over-the-counter products
• dentist-dispensed trays and
• in-office treatments.

Over-the-counter options

There are a number of whitening products on store shelves. The most common are toothpastes or whitening strips. Many whitening toothpastes scrub stains from your teeth. Some also may contain low levels of peroxide, a chemical that helps lighten teeth. Many can be used every time you brush. Whitening strips have a thin layer of peroxide-containing gel that can be applied directly to your teeth. Whitening strips typically involve leaving the strip on for a few hours a day over the course of 1 through 2 weeks. As with all dental products, look for the American Dental Association (ADA) Seal of Acceptance, which shows that they meet standards for both safety and effectiveness.

Trays dispensed by the dentist

Your dentist can make a tray that you coat with a whitening gel and wear for a few hours, usually overnight. You’ll wear this tray for a few nights before seeing results. Because the amount of peroxide in this gel is greater than that of over-the-counter products, your teeth may brighten faster.

In-office procedures

In-office procedures also rely on peroxide, but the gel applied contains a stronger level of peroxide than that used in the at home versions. The dentist applies a gel, and then may use a light to speed up a chemical reaction to whiten the teeth. This is the most expensive approach, but it can often be done in just a single office visit and usually offers the most noticeable results.

SIDE EFFECTS ASSOCIATED WITH BLEACHING

When peroxide is used, whether it is in strips or gels, the whitening process is often referred to as bleaching. Bleaching relies on a chemical reaction to lighten the color of your teeth rather than just removing surface stains. Beyond lightening your teeth, bleaching can have some unintended effects, like sensitive teeth or irritated gums.1 The level of peroxide in the gel seems to determine the extent of the effect more peroxide may lead to more intense effects. The good news is, these side effects are usually temporary.

TALK TO YOUR DENTIST

You can talk to your dentist about the look you want to achieve and how much time and money you would like to invest in the process. He or she can also fill you in on limitations. For example, some stains may not be removable. And tooth-colored fillings or dental crowns will not bleach at all, so you might not achieve an even whitening.

CONCLUSIONS

Depending on how bright you would like your smile to be and the amount of time and money you are willing to invest, you have a number of choices for whitening your teeth.

Whether you have an emergency toothache or just need a dental cleaning, dentists throughout the country are ready to treat you. The American Dental Association has developed steps every dentist can take to help create a safe office environment during the COVID-19 pandemic.

BEFORE YOUR APPOINTMENT

Your appointment may be different from what you are used to. The differences may start before you even come into the office. Before your appointment, someone may call to ask questions about several symptoms related to COVID-19 to help ensure that you are not sick. The caller may also explain steps you should take when you arrive for your appointment. For example, you may be asked to wait outside the office until someone calls your mobile phone to tell you to come in, or you may be asked to bring a mask to wear when entering the office. Once you arrive at the office, someone may take your temperature, ask again about how you are feeling, and complete additional paperwork.

DURING YOUR APPOINTMENT

Dentists take several precautions to keep the clinic clean and help make treatment safe. Some equipment in the treatment room is disposable. For example, plastic covers on some handles and the plastic tube that used to remove saliva from your mouth must be thrown away after each patient. Equipment that is not discarded must be cleaned and disinfected between patients.

During treatment, dentists and the dental staff members wear personal protective equipment. This equipment can include items such as disposable gloves, specially fitted masks, protective eyewear, and sometimes a face shield.

SAFETY STEPS AFTER EACH PATIENT

Steps to keep treatment safe do not stop in the operatory. As mentioned, the treatment area must be cleaned and disinfected after each patient. In addition, instruments must always be prepared for the next patient. Some instruments are used only once and then disposed of. Instruments that are not disposable are cleaned and sterilized in an area dedicated to that purpose.

CONCLUSIONS

Regular visits to your dentist are important to help prevent and treat if needed dental diseases that can cause more serious problems if left undetected. Do not let COVID19 keep you away. Dentists are experts in infection control and are taking steps to keep their patients safe. Ask if you have any questions. Your dentist and dental team members are happy to help.