Friday, December 17, 2010

Bruxism (Teeth Grinding or Clenching) – part 2 of 2

This is part two of my thoughts concerning tooth grinding. The following entry will focus on treatment of bruxism.

Bruxism is the medical term for the grinding of teeth or the clenching of jaws, especially during deep sleep or while under stress. This affliction occurs in 5% to 20% of adults, and in 30 % of children in the age group of five and six years.

Treating Bruxism
Whether the grinding is caused by misaligned teeth or psychological stress, most kids outgrow it. A combination of parental observation and dental visits can also help keep the problem in check.

In more severe, chronic cases where the grinding and clenching cause facial and jaw soreness and/or damage the teeth, Dr. Martines may prescribe a special night guard. Molded to a child’s teeth, a night guard is similar to the protective mouthpieces worn by football players. Though a mouthpiece may take some getting used to, positive results are often observed.

Helping Your Child
Whether the cause is anatomical or psychological, some kids are be able to reduce dental grinding by relaxing before bedtime. For example: by taking a warm bath or shower, listening to a few minutes of soothing music or reading a book.

For bruxism that is caused by stress, try to find out if there is a specific something that is upsetting your child and find a way to help. For example: a kid who is worried about being away from home for a first camping trip might need reassurance that mom or dad will be nearby if anything happens.

If the issue is more complicated, such as managing a busy school and extra activities schedule, moving to a new town, a new school, making new friends, and especially, discuss your child’s concerns. Try to ease any fears and make changes in his/her daily routine to reduce anxiety. If you’re concerned about your child’s emotional state, talk to your physician or pediatrician.

In some cases, these basic stress relievers may not be enough to stop bruxism. If your child has trouble sleeping or is acting differently than usual, an assessment by a therapist may be beneficial. This can help determine the cause of the stress and an appropriate course of treatment.

How Long Does Bruxism Last?
Childhood bruxism is usually outgrown by early adolescence. Most kids stop grinding when they are done losing their baby teeth. However, a few children do continue to grind into adolescence or until the stress that leads to it is addressed properly.

Preventing Bruxism
Because some dental grinding is a child’s natural reaction to changing teeth and to growth and development, most cases are benign and cannot be prevented. Stress-induced bruxism can be addressed with the basic stress relievers here described and by talking with your children regularly about their feelings and helping them deal with daily-life stress.

Friday, November 19, 2010

Bruxism (Teeth Grinding or Clenching) – part 1 of 2

Bruxism is the medical term for the grinding of teeth or the clenching of jaws especially during deep sleep or while under stress. This affliction occurs in 5% to 20% of adults. Three out of every 10 kids will grind or clench with the highest incidence in children under five. Hyperactive children experience bruxism more frequently.

This is such an interesting and vast topic that I have split it in two parts. In the first part I will concentrate on explaining what bruxism is and what causes it. The next entry will focus on addressing and treating bruxism.

Causes of Bruxism
Though studies have been done, no one knows exactly what causes bruxism. In some cases, kids may grind their teeth because the top and bottom teeth aren’t aligned properly. Others do it as a response to discomfort from an earache or teething, or as a way to ease soreness, just as one might rub a sore muscle. Most kids, however, outgrow these fairly common causes for grinding by the time most or all permanent teeth have erupted.

Stress – usually expressed as nervous tension, constant worry, anxiety and even anger – is another possible cause for grinding the teeth. For instance, your child may be having trouble coping with a busy school and extra activities schedule, worrying about a test at school, or experiencing a change in routine (a new sibling or a new teacher). Even arguing with parents and siblings can cause enough distress to prompt teeth grinding or jaw clenching.

Effects of Bruxism
Generally bruxism does not hurt or harm a child’s teeth. In fact, many cases go undetected with no adverse effects, though some may result in mild morning headaches or earaches. Most often, however, this condition is more bothersome to the parents, caretakers and others in your home because of the grinding sound.

In some extreme circumstances, nighttime grinding and clenching can wear down tooth enamel, chip teeth and cause facial pain and jaw problems, such as temporomandibular joint disease (TMJ). Most kids who grind, however, do not have TMJ problems unless their grinding and clenching is chronic and persistent for many years.

Diagnosing Bruxism
Most children who grind their teeth aren’t even aware of it, so it’s often siblings or parents who identify the problem. Some signs associated with tooth grinding are:
• Grinding noises when your child is sleeping
• Complaints of a sore jaw or face in the morning
• Thumb sucking
• Fingernail biting
• Gnawing on pencils and toys
• Chewing the inside of the cheek

If damage to the teeth is detected, Dr. Martines will ask your child a few questions, such as:
• How do you feel before bed?
• Are you worried about anything at home or school?
• Are you angry with someone?
• What do you do before bed?

In my next blog entry I will write about addressing and treating bruxism, so stay tuned!

Tuesday, October 5, 2010

Damon Braces

Orthodontic technology is constantly evolving and new forms of treatment are appearing all the time. There are now alternatives to the conventional wire and metal brace which are less noticeable and more comfortable to wear.

One example of orthodontic technology is the Damon braces. The Damon braces are a "friction-free" system which means no metal or elastic ties hold the wires in the braces. Color or metal ties are used in other types of braces which exert a force on the teeth and cause them to move. On the other hand, this also causes friction which can be uncomfortable and make tooth movement progress slowly.

The Damon braces use a clever slide mechanism which holds the archwire in place and allows the teeth to move easily and comfortably. Also, because of the advanced design and the light, biologically sound forces this system applies on the teeth, it allows a gentler correction of bite problems as well as improved facial harmony and smile width.

Other types of braces require adjustments (or tightening) on a regular basis, and that can be painful. The Damon braces have a sliding mechanism which minimizes this problem, meaning less sore teeth and gums.

The color elastic ties used with conventional braces can be a magnet for food debris and are very difficult to clean. Because the Damon braces are free from these ties, it’s easier to keep your teeth clean while in braces.

In my experience with the Damon brackets compared to traditional brackets (with color elastomeric ties) I have observed:
- Improved patient oral hygiene;
- Reduced need to use expanders or remove permanent teeth before or during treatment;
- The fairly unobtrusive nature of the system that for most patients result in a shorter treatment period and more timely alignment of the front teeth;
- More convenience for patients and families due to the possibility of longer intervals between appointments and shorter in-office time for adjustments;
- More comfort during treatment and appointments.

Now you may be wondering that since the Damon System can possibly shorten treatment time, does that mean it is harsh or unsafe? The answer is no. In fact, what makes this system work in a timelier manner for some patients is that it uses far gentler, more biologically sound forces than conventional braces. Very light titanium alloy wires in association with the low-friction nature of these braces gently guide the teeth to their ideal positions and improve the smile and facial harmony.

The Damon brackets are not magic or better than any other bracket system. But they are more efficient, streamlined, comfortable and convenient for both me and my patients, making them superior in my point of view.

For all this, and with the experience I have acquired practicing orthodontics for more than 16 years and teaching at the UCLA Department of Graduate Orthodontics for the last 5 years, I am excited to offer the Damon Braces System in my office.

Tuesday, August 17, 2010

Why should bad bites be treated?

From time-to-time, people that are skeptical about braces ask me that question. Sometimes it comes in the form of “why do braces if m teeth will get crooked again?” There’s a variety of ways to answer these queries.

As a result of a “bad bite” (which dentists and orthodontists refer to as a malocclusion) your teeth may be crooked, your bite may not work correctly and – unbeknownst to you – your jaws may not be functioning in the balanced manner they should. Over the course of time, the whole chewing system can show signs of breakdown in the form of facial muscular soreness, abnormal tooth wear, loosening of some teeth and sometimes grinding and even facial joint (TMJ) discomfort.

According to studies published by renowned orthodontic journals, untreated bad bites can result in a variety of future problems such as:
- Crowded, crooked teeth are more difficult to properly brush and floss, which may contribute to tooth decay and/or gum disease (gum disease is the #1 factor for dental loss in adults);
- Protruding teeth are more susceptible to accidental chipping;
- Crossbites (when one or some upper teeth fail to cover opposing lower teeth) can result in unfavorable growth, uneven tooth wear and loosening of permanent teeth;
- Openbites can result in tongue-thrusting habits and speech impediments;
- Upper and lower teeth that do not fit well when biting may lead to difficulties or reduced efficiency in chewing.
- In some circumstances, and in addition to stress, a bad bite can contribute to TMJ pain and dysfunction, facial soreness and headaches.

A bad bite is unstable by nature because the upper and lower teeth are not fitting well together. Therefore, it only makes sense that such unstable balance over the course of time will likely make a bad bite only get worse. Of course this degenerative process does not happen overnight. The discomfort it causes, however, may be felt more readily.

Once a bite is corrected to fit the standards considered ideal – or close to ideal – and the fit of the teeth is much like that of a lid tightly covering a box all around, it’s easy to visualize how such bite relationship is more stable than a bad bite.

It’s true the individual position of some teeth may change over time (and this will be addressed in a later posting about retainer wear), but the fit and benefits of a good bite will last and stay that way in the years to come.

Ultimately, orthodontics does more than make a beautiful smile – it creates a healthier you.

Tuesday, May 18, 2010

Early Orthodontic Treatment: When and Why

Quite often parents tell me they didn’t get braces until they were fourteen, so why should their kid get treatment before that? That’s a fair question. Other people come up to me and ask me why kids nowadays get braces earlier now than before.

While saying that may be partially true, it’s definitely not the whole truth since most kids do not need braces before the eruption of all their permanent teeth. The objective of early orthodontic treatment is to intercept specific developing problems that I detect during an examination.

On a personal note, I was born in 1968, so my childhood took place in the 70’s when most people did not get braces early. Nevertheless, in 1977 when I was 9 my pediatric dentist told my mom I should see an orthodontist because it didn’t look like I was going to have enough space for my upper eye teeth to erupt. By the time I was 10 – in 1978 – I was wearing a headgear and some braces on my upper teeth. One year later, I had space for all my teeth and didn’t need braces again until I was 26.

When orthodontic intervention is not necessary, an orthodontist can carefully monitor growth and development and begin treatment when it is ideal.

Problems that should be addressed between ages 8-12 to avoid serious problems later include lack of space for eruption of all permanent teeth, crossbites (when one or some upper teeth fail to cover opposing lower teeth), and facial growth imbalances that cause severe overbites and underbites.

Some of the most direct results of interceptive treatment are:
- Reducing the need for tooth removal by creating room for crowded erupting teeth and reserving space for unerupted teeth.
- Creating facial symmetry by directing jaw growth.
- Reducing the risk of trauma to protruding front teeth.
- Reducing the risk of premature tooth wear and chipping of the teeth.
- Elimination of habits that create bad bites.

Phase I treatment simplifies or reduces – but not necessarily eliminates – the need for future comprehensive orthodontic treatment. The benefits of early treatment are the creation of an environment that promotes unimpeded optimal eruption of the permanent dentition and more balanced facial growth. This will consequently provide more pleasant dental and facial esthetics and make any needed further correction in a second phase of care more comfortable and timely.

Saturday, April 3, 2010

When is the best time to begin orthodontic treatment?

That’s a question I frequently hear from parents. I usually tell them that the American Association of Orthodontists recommends that an initial orthodontic evaluation should occur either at the first sign of bite problems or no later than age 7.

Of course that at this tender age orthodontic treatment may not be necessary. The value of such early evaluation, however, is that it can anticipate what will be the most advantageous time to begin treatment. Although an orthodontist can enhance a smile at any age, there is an optimal time period to begin treatment that will vary from person to person, from bite to bite. Beginning treatment at the time an orthodontist suggests ensures the greatest result and the least amount of time and expense.

Although seven may sound too early for a visit to the orthodontist, it’s by this age that the first adult molars erupt and establish the back bite. At this time, an orthodontist can evaluate front-to-back and side-to-side tooth relationships. For example, the presence of erupting front teeth can indicate a possible overbite or underbite in the making, an open bite or a deep bite development, and crowded or gummy smiles. Timely screening significantly improves the chances for a life-long healthy bite and a beautiful smile.

In my opinion, the main benefit of an early orthodontic evaluation is that it provides both timely detection of problems and greater opportunity for more effective treatment. Prudent intervention to guide growth, development and creation of space for seamless eruption of permanent teeth is proved to prevent serious problems later.

When orthodontic intervention is not necessary, careful monitoring of growth, development and observation of the eruption of the adult permanent teeth will allow me to make the call of when treatment start is ideal to obtain the best bite and smile possible.

Last but not least, I believe that everyone is entitled to an orthodontic evaluation. Therefore, my initial evaluations at Larchmont Village Orthodontics are complimentary they include digital photos and radiographs that allow me to clearly explain to you what I see so you can be a part of the decision of when is the best time to begin orthodontic treatment!

Thursday, April 1, 2010

Welcome to My Blog

Hello everybody,

Orthodontics is a science but it’s certainly not a mystery. I’m starting this blog to give you some insight about the work we do at Larchmont Village Orthodontics and the things I as a doctor look at when planning how to build confident smiles and healthy bites.