Archives for June 2019

In the following table, drinks with a pH from 1 to 5 can cause dental erosion

*This article has been published by The Australian Dental Association, Victoria Branch, 2010.

The majority of dental injuries are caused by falls and is true for all age groups. The next most common cause of dental injury is violence, followed by motor traffic accidents and then sporting injuries. Recently, there has been a substantial increase of injuries from bicycle riding. In the primary dentition the incidence of injury peaks at age 2 to 2 when motor coordination is developing and children are starting to move around on their own. Sport plays little part in traumatic dental injuries for the primary dentition. The increasing occurrence of dental injuries for boys seems to begin around 8 to 9 years of age and continues through the teenage years. Playing contact sports during the mid-teen years seems to be a peak for traumatic dental sporting injuries. The dental profession continues to promote the use of custom-built pressure laminated mouthguards in this at-risk age group.

Factors influencing dental injuries

In contact or collision sports it is easy to understand why there is a regular occurrence of dental injuries. However there are other sports and factors that can influence how dental injuries occur. These factors include:

• Athletes in the mixed dentition stage
• Recreational sports men or women
• Athletes where a helmet and possibly a face guard forms part of the protective equipment
• Sports where hard objects such as bats and/or balls are used
• Athletes involved in boxing or martial arts
• Elite athletes with specific needs
• Athletes with dental implants, crown and bridgework or other previous indications of dental injuries.

Provision of custom-built mouthguards to prevent traumatic dental injuries is strongly supported by the Australian and American Dental Associations. Today, it appears many sports previously regarded as non-contact sports are now seeing a significant number of dental injuries. Foremost amongst these sports is basketball where aggression and full body contact results in many injuries including dental. Other sports where dental injuries have been identified are softball and even T-ball. Dental injuries also occur in cricket where the batsman is most likely to be injured followed by the wicket keeper. In contact sports each athlete has a one in ten chance of a dental injury per season and one in three chance in their career. As well an athlete is 60 times more liable to sustain dental damage when not wearing a protective mouthguard.

The pattern of dental injury depends on three factors:

• The energy of the impact
• The direction and the location of the impact
• The resilience of the periodontal structures

Until recently a custom-built mouthguard made on a plaster cast of the athlete’s teeth was regarded as acceptable even though there were no specifications of thickness, material or design for the athlete’s sports. The introduction of thermoforming, which is the use of high heat and high pressure and the classification of custom-built mouthguards specific to sports have laid down a standard for care.

For many years, it was thought all dental injuries should be treated on an emergency basis. Certainly this has logic for the parents and injured patients. Immediate treatment will make them more comfortable and may reduce healing complications. However, for practical and even economic reasons a new approach is required. The clinician should assess whether the injury is classified as acute, requiring immediate treatment, subacute, treatment in the first 24 hours or delayed with treatment initiated after 24 hours. Dental injuries involving a tooth being avulsed, an extrusive luxation or an alveolar fracture are definitely acute treatment priority. When a tooth is avulsed the injury is classified as a separation injury, with cells remaining vital in the periodontal ligament and also in the alveolar socket. If the tooth can be repositioned within five minutes there will be a very acceptable outcome. The outcome of tooth avulsion depends on how long the tooth has been out of the mouth, the age of the individual and whether some storage medium has been used to preserve the cells on the outside of the tooth.

Acute requiring immediate treatment

An injury requiring acute priority is alveolar fracture. Clinical studies have found a significant relationship between the incidence of pulp necrosis and treatment delays of more than three hours. Unfortunately, there have been few studies into the effect of dental trauma on pulp health. One of the studies to look at luxation (displacement) injuries to teeth indicated there was a significant difference to healing following treatment delays of five hours. Unless new research indicates otherwise, lateral luxation and root fracture should also be included in the acute category for treatment.

Subacute treatment

A subacute approach, which is treatment within a few hours of the trauma, can be utilised for the following types of injuries. Intrusive luxation, the forceful apical positioning of the tooth, has been studied and it appears immediate surgical repositioning or delayed orthodontic repositioning had similar results. It seems reasonable to use a subacute approach for this traumatic injury. Other injuries which can be included in this subacute approach are minor luxation injuries, teeth with simple enamel/dentine fractures and teeth which have crown fractures with pulp exposure. Recent studies have shown that crown fractures with pulp exposure had the same long-term prognosis whether treated acute, subacute or delayed. However, due to discomfort of an exposed pulp it is reasonable to try for a subacute treatment approach if possible.

Primary teeth can be treated with a subacute or delayed strategy unless there is occlusal interference to the displacement indicating an acute approach should be taken. Clinical experience has shown the most common injury is an enamel/dentine fracture and the modern approach is to find the fragment, store it in water to keep hydrated then reattach it with a flowable composite using a total etch and bond system. If there is pulp exposure, it is critical the clinician understands this is a traumatic injury and there is only minor infection of the top few millimetres of the exposed pulp. If treated on a delayed basis the outcome will be the same as acute or subacute treatment options. The preferred treatment of the pulp exposure, providing it is an immature pulp is a Cvek or minimal pulpotomy using either calcium hydroxide or MTA (mineral trioxide aggregate) as the dressing material. The Cvek pulpotomy has a 98% success rate.

Severe injuries including some crown root fractures and multiple fractures of teeth with displacement cannot be treated and will have to be extracted. The modern approach in dental trauma treatment is to consider future options and whether there will be enough bone remaining to allow implant prosthetics to occur. Losing teeth at a young age is not a very good outcome with implant placement only possible after the age of 21 when the athlete will have stopped growing.

It is important for the clinician to understand all the sequale of the traumatic dental injuries and takes a long-term approach to the treatment and also the prevention of any other future injuries. Research has indicated if someone has been injured there is a one in three chance they will be injured again.

The clinician should also inform the athlete and maybe the parents that the initial injury viewed is not the total injury. Over time, other teeth adjacent to the injury site may undergo degeneration. This can include pulp necrosis, fracture or inflammatory resorption. It is critical parents are provided this information as there is often substantial cost involved in treating dental injuries and they have to be monitored over a long-term. A conservative approach is always best. This conservative approach may involve a team of the general dentist, orthodontist, periodontist and an endodontist to obtain the best result for the injured athlete.

Sporting bodies are endeavouring to make their sports more attractive by looking at reducing injuries. Government bodies and health providers are also looking at the cost of sporting injuries. It is apparent to al there are enormous benefits by recommending throughout the community the use of custom-built mouthguards for participants in a risk sports. The weight of scientific evidence and long-term clinical experience with sporting teams establishes the cost benefits of custom-built mouthguards.

Future Designs

In the future new designs and better combinations of materials will increase protection for athletes playing different sports where risk factors vary. New research from Japan indicates there will be an even greater reduction of injury in sport if the mouthguard is balanced to the lower occlusion. Today’s pressure laminating techniques will ensure the mouthguard fits accurately. New mouthguard designs using materials of different thickness and Shore hardness may also incorporate air spaces to minimise the transfer of energy.

The treatment of traumatic dental injuries requires knowledge, experience and decisive implementation of current research. An understanding of pulpal, periapical and periodontal pathology resulting from injury is critical. Inappropriate initial treatment will increase the chances of long-term complication, lessen the chance of teeth remaining vital and result in unnecessary pain, distress and cost.

*This article was published By Brett Dorney, On behalf of the Oral Health Committee ADA, The Australian Dental Association, April 2013.

If you have dry mouth, talking to your GP and seeing your dentist for a check-up can help you to find out what might be causing your dry mouth and how to improve the symptoms.

Here we explain how a dry mouth can affect your teeth and mouth, which medicines are more likely to cause dry mouth and what to talk to your GP, pharmacist and dentist about. It also gives some practical tips to help improve the symptoms of dry mouth.

Do you have any signs and symptoms of dry mouth?

• Does your mouth feel dry when eating a meal?
• Do you have any difficulty speaking due to a dry mouth?
• Do you sip liquids to help swallow dry foods?
• Do you chew on gum or suck lollies to relieve dry mouth?
• Does the amount of saliva in your mouth feel too little e.g. thick or stringy?

Have you had your annual dental check-up?

• Good oral health is important for your overall health. Your annual visit to the dentist is your best defense against poor oral health.
• Even if you have dentures, it is important to have an annual dental check-up.
• DVA funds dental services for all Gold Card holders (and for White Card holders for an accepted war or service caused injury or disease)/ For further information go to: dva.gov.au/factsheet-hsv17-dental-services
• When making an appointment, ask your dentist whether they provide services under DVA arrangements. In most cases you won’t have any out of-pocket expenses for dental services.
• Note on your calendar when your next appointment is due.
• If you feel anxious about going to your dentist, talk with your GP and dentist about this. Your dentist is trained to help you feel at ease and comfortable with any treatment that might be required.

What are the effects of dry mouth?

Dry mouth occurs when you feel as though you don’t have enough saliva in your mouth. The discomfort of having a dry mouth can range from mild to severe. If left untreated, it can make it difficult to speak, chew and swallow. It can change the taste of food and can cause a sore throat, a hoarse voice and bad breath. It can also make your gums sore and dentures painful to wear.

Saliva is important because it:

• Prevents tooth loss
• Helps you to speak, chew, swallow and digest food
• Protects your teeth and gums from bacteria and acids that can lead to dental cavities
• Helps prevent infection by balancing the number of bacteria in your mouth.

What should I talk to my GP about?

If you have dry mouth, it is important to talk to your GP so they can look at what could be causing it. Many medicines can cause dry mouth, including those prescribed by your GP or bought from a pharmacy, supermarket or health food store. They include: antidepressants, antihistamines, some blood pressure tablets, some eye drops, cough and cold medicines, medicines for pain, medicines for urinary problems and some inhaled medicines.

Your GP might be able to adjust the dose of one of your medicines to help reduce the symptoms of dry mouth. They might also suggest that you have a Home Medicines Review. In this free service, a specially trained pharmacist comes to your home and reviews your medicines. Together with your GP and pharmacist, you can work out how to best manage your medicines and whether any of your medicines need a change.

What should I talk to my dentist about?

Dry mouth increases you chance of getting dental cavities and other oral health issues. Annual visits to the dentist can ensure that your teeth, dentures (if you have them), gums and mouth stay healthy. Your dentist can also give you advice about how to help manage dry mouth and which products are best to use.

When you see the dentist, tell them that you feel as though you have a dry mouth and about all the medicines you take. This includes those prescribed by your GP or bought from a pharmacy, supermarket or health food store. Although it’s not essential, a letter from your GP would be helpful, as it provides a medical history and list of medicines.

What else can I do?

Simple measures can help to relieve the feeling of dry mouth and minimise the consequences. For specific advice, talk to your GP and dentist.

Here are some tips that might help you:

• Brush your teeth twice a day with fluoride toothpaste, use dental floss daily, and rinse your mouth with a non-alcoholic mouthwash. Talk to your dentist about which products are best to use.
• Minimise sugary and acidic foods and drinks such as fruit juices, cordial, soft drinks, alcohol. Sports and energy drinks.
• Sip on plain tap water. Suck on ice chips or spray water into your mouth. Some people find using a humidifier at night while sleeping helpful. Check with your GP about how much water you need to drink each day – this will vary depending on the time of year, how active you are and the medicines you take.
• Use a water-based lip moisturiser if your lips are dry.
• If you smoke, talk to your GP or dentist about the options for quitting. For support to quit and a personalised quitting plan contact the national smoking Quitline on 13 7848 or at: quitnow.gov.au
• Eat foods that require chewing to stimulate saliva production, especially at breakfast and chew sugar-free gum or sugar-free lollies between meals
• Ask you GP to check you inhaler technique. Use a spacer device and rinse you mouth with water immediately after each use.
• See the DVA Vetaffairs article ‘Prevent dry mouth from ruining your teeth’ available at: dva.gov.au/sites/default/files/files/about%20dva/vetaffairs/2017/vol33No3.pdf

*This article was published by the Australian Government, Department of Veterans’ Affairs, November 2018. www.veteransmates.net.au

As the outer protective layer of enamel dissolves from the tooth surface, the dentine underneath is exposed; this can make the tooth sensitive. The dentine is softer than enamel and dissolves much easier in acid. Preventing dental erosion is very important for protecting our teeth.

Where does the acid come from?

The acid that causes erosion mainly comes from the food or drink. Common sources of dietary acids that have been linked to dental erosion are:

• Soft drinks
• Energy drinks
• Sports drinks
• Vinegar
• Citrus fruits
• Fruit juices
• Fruit-flavored water
• Fruit-flavored tea (e.g. lemon, peach, rosehip)
• Cordial
• Alcoholic drinks
• Sour (acidic) sweets/lollies
• Chewable Vitamin C tablets
• Effervescent or dissolvable vitamins/medications

Remember, even sugar-free food or drink can cause dental erosion if it’s high in acid. Common acidic food additives to be aware of are:

• Citric acid (food acid acidity regulator/antioxidant 330)
• Sodium citrate (food acid/acidity regulator/antioxidant 331)
• Malic acid (food acid/preservative 296)
• Ascorbic acid (Vitamin C/antioxidant 300)
• Fruit juice concentrate

Acid rising from the stomach can also cause dental erosion. This can happen after vomiting, or in conditions such as gastroesophageal reflux (acid reflux), anorexia nervosa, bulimia and pregnancy-related morning sickness.

What else can increase dental erosion?

As well as frequent exposure to acid, low salivary flow (dry mouth) can cause the risk of dental erosion. A healthy flow of saliva protects the teeth by washing away and neutralising acid.

Dry mouth can be caused by:

• Medications and taking multiple medications together
• Radiotherapy to the head/neck
• Stress
• Sjogren’s syndrome (an autoimmune disease)
• Smoking
• Diabetes

How can I prevent dental erosion?

Avoiding acidic food or drink is the best way to prevent dental erosion and there are some other things you can do. It’s important to remember:

• Only have acidic food and drink at meal times when your saliva levels are higher to protect your teeth
• When having something acidic, avoid keeping it in your mouth for too long and swallow it as quickly as possible
• Eat whole, low-acid fruit (e.g. banana, melon, pear, papaya) rather than drinking fruit juice
• Chill acidic drinks, as warm drinks are more likely to cause dental erosion
• After having anything acidic or after vomiting/reflux, rinse your mouth with water, plain milk, or a fluoride mouth rinse as soon as possible.

Speak to your dentist or medical doctor to find out if an underlying condition is increasing your risk of dental erosion.

What about brushing my teeth?

Good oral hygiene is essential for oral health. Previously it was recommended to wait 30-60 minutes to brush your teeth after contact with stomach or dietary acid so that saliva could repair the acid damaged tooth surface. However, recent evidence has suggested this amount of time is too short for saliva to repair the acid damage and there is no benefit to postpone tooth brushing for this length of time.

Therefore it is recommended to:

• Brush your teeth twice a day with a fluoride toothpaste
• Use a soft toothbrush with gentle action
• Rinse your mouth thoroughly with water, plain milk or a fluoride mouth rinse as soon as possible if your teeth are exposed to acid

Consider using a toothpaste containing stannous fluoride (SnF2) as it can be more protective against erosion than other types of fluoride.

*This article was published by the Australian Dental Association Victoria Brunch, October 2018

Sugary drinks and your health – Need a drink? Choose tap water!*

Drinking tap water is a great, inexpensive way to stay hydrated and have a healthy smile! Choose tap water over sugary drinks when you’re thirsty. Sugary drinks can cause tooth decay, contribute to weight gain and obesity, and increase your risk of Type 2 diabetes, 13 types of cancer, heart disease and other health problems.

How much sugar is in sweetened drinks?

Sugary drinks include soft drink, energy drink, sports drink, fruit juice, flavored tea and flavored milk. Just one 600 ml bottle of soft drink can contain up to 16 teaspoons of sugar!

Sugary drinks and your body

• Sugar and Acid can cause tooth decay
• One can of soft drinks a day can lead to 6.5 Kgs of weight gain in a year
• Overweight and obesity increase the risk of Heart disease, Kidney disease, Type-2 Diabetes, Stroke and some Cancers.

How to drink more water and less sugary drinks

• When eating out, ask for tap water or sparkling water instead of a sugary drink
• Save the money you would usually spend on sugary drinks to put towards something else you can enjoy
• Tale a reusable water bottle with you when you go out to places where tap water isn’t available
• Keep a glass of water near you at work or home
• Drink tap water to re-hydrate during or after exercise – only elite athletes would benefit from the electrolytes in sports drinks
• Plain milk (or alternatives) and coffee or tea without added sugar are also good options.

The World Health Organisation recommends consuming no more than seven teaspoons of added sugar per day (27.5 gr 5%of total energy intake) to greatly reduce your risk of tooth decay, obesity and other chronic diseases.

How many teaspoons of sugar?

Source: Rethink sugary drinks, http://www.rethinksugarydrink.org.au

*This article was published by the Australian Dental Association Victoria Brunch, March 2019

The differences between traditional braces and aligners

• Unlike metal braces, aligners are made from clear plastic and do not involve any wires. The obvious benefit of aligners is that they are less noticeable than standard braces. Aligners can only be seen close-up and are often undetectable in photos.
• Aligners are removable, and each set is worn for around two weeks before being replaced by the next set. While braces are stuck to the teeth. The aligners allow the freedom of being able to take them out for a short while. Allowing you to eat crunchy, sticky or hard food that may damage braces.
• When metal braces are attached to the teeth, they trap food and bacteria around them, making cleaning your teeth hard. If the oral hygiene is not good while wearing braces, one could finish the orthodontic treatment to find he or she have white or brown spots on the teeth. These spots are either permanent or need cosmetic treatment to remove or make them less visible.
• While it is vital for all orthodontic patients to adopt good teeth brushing habits, clear aligners will be more forgiving. Since the aligners can be removed while brushing, oral hygiene habits are the same as for those without orthodontic treatment. But if the teeth are not cleaned, the aligners can cause the same white or brown spots on the teeth and there will be a need for restorative treatment after the orthodontic treatment is concluded.
• Braces and wires can move teeth into the desired position faster than aligners. Since the aligners trays are swapped out every two weeks, the changes between steps can only be minor. Braces can close large gaps and align teeth more efficiently.
• Everyone has different teeth. Therefore, some have multiple issues that require attention during their treatment while others are simple and straightforward. Aligners work well for those with mild discrepancies, but for more complicated cases, the braces are needed to bring teeth into position and correct bites

Which Option is Best for You?

It is difficult to choose what is the best way to achieve your goal of straight teeth. To help you decide, Dr. Kaufman will perform a thorough examination and consider the right way to achieve your goals. He will go through with you and explain each option and why it is suitable or not for you. Once you have all the information, It’s up to you to decide which option you prefer.

If you would like to know if you are a candidate for braces or clear aligners, please book an obligation-free appointment to discuss your options by calling 98227006 or contact us online.

Dr Kaufman will be happy to explain which option is better for you, Braces or Clear Aligners.

Who Needs a Mouthguard?

Sports such as rugby union and league, AFL, hockey and boxing are ‘no brainers’ because intentional collision are part of the game. But anyone who plays a sport or undertakes an activity where collision or contact to the face is a legitimate risk should wear a mouthguard too.

Since those participating in contact sports are aware of the risks and protect themselves, it is more often than not that accidental collision occurs when when they are not expected.  Non contact sport such as cricket, basketball, netball, touch football, and soccer are often responsible for dental trauma.

The Damage

Dental trauma from sporting injury can include damage to the tooth nerve, fractured, cracked or knocked-out teeth, a broken jaw, damage to the tongue and cut lips. Unfortunately, a single case of dental trauma can lead to a lifetime of dental treatment in order to maintain the strength and health of the damaged tooth/teeth. Repair work does not last forever so a damaged tooth will often become a lifelong problem. Prevention is always better than the cure, so play it safe and wear a mouthguard.

Protecting your mouth

Dr. Kaufman and the Australian Dental Association recommend a custom-fitted mouthguard for all Australians who participate in contact sports or sports with high risk of dental injury.

A custom-fitted mouthguard that has been designed by Dr. Kaufman makes breathing and speaking are a lot easier  and overall is a lot more comfortable than the ‘boil-and-bite’ counterparts. The risk with the mouthguards that you can purchase from a chemist or sports store is that they offer less protection. The “off the self” mouth guards are designed to adapt to a large rage of faces which makes them ill-fitted and loose in the mouth of most users. The outcome is that at the crucial time of impact they will shift and either make more damage or not protect the teeth.

Don’t risk your teeth and make an appointment to see Dr. Kaufman to keep your teeth safe.

The main reasons for non-compliance are:

• Comfort
• Poor fit
• Difficulty in breathing and speaking
• Cost

The main function of mouthguards is to protect teeth. However recent laboratory research has demonstrated that custom-made mouthguards can reduce dislocation to the mandible and acceleration of the head from the same blow. The proven benefit is the dissipation of the forces delivered to the skull and TMJ complex when the mandible receives a blow.

There will also be stabilisation for the skull through increases neck muscle activity by clenching on the mouthguard as well as a benefit from the altered open position of the condyle in the fossa. This open position, provided the mouthguard has a balanced occlusion will dramatically reduce damage to the condyle and TMJ complex.

The quality of the mouthguard, particularly the thickness of the labial and occlusal surfaces is closely related to the mouthguard’s ability to absorb and spread the impact energy.

Impact testing has shown improvement in energy absorption up to a 4 mm thickness. Generally, 4 mm is too thick for players’ comfort so the challenge is to design mouthguards thinner than 4 mm, consider new designs and investigate better materials.

Studies have examined ways to improve the energy absorption of mouthguards by including air cells, sorbothane, metal wires, sponges and harder material such as polycarbonate. Combining different materials always risks mouthguard failure through delamination.

Mouthguard research at the University of Tokyo Dental School has established a balanced occlusion is indispensable in reducing impact force ad tooth distortion.

Possibly their most exciting development is placing a hard EVA insert with a buffer space over the anterior teeth with a dramatic increase in the energy being absorbed.

Types of Mouthguards

A mouthguard is defined as a protective device worn on the upper jaw to reduce injuries to the teeth, jaws and associated soft tissues.

Boil and bite

The ’boil and bite’ mouthguard is defined as a mouthguard fitted and formed in the mouth by finger, tongue and biting pressure.

Even though they are the most common type of mouthguard used, it affords negligible protection, is poor fitting, too thin, poor durability, unstable and interferes with speech and breathing.

The Australian Dental Association and Standards Australia do not recommend ‘Boil and Bite’ mouthguards.

Mouth-formed

Mouth formed mouthguards have the disadvantages of lack of retention at impact single tooth contact, inadequate thickness and often rapid deterioration of the material increases the risk of injury.

Critical for injury prevention, a mouthguard should have an ideal thickness of 3 mm after fabrication and provide an occlusal surface balanced to the mandible teeth.

Custom-made

Custom-made mouthguards are formed on a cast of the wearer’s upper jaw, sometimes in conjunction with a cast of the lower jaw in order to obtain even occlusal contact.

A custom-made pressure laminated mouthguard offers flexibility in design and construction. Ethly vinyl acetate (EVA) of different hardness and thickness can be laminated together to provide increase protection.

Efficient and complete lamination cannot be achieved by vacuum machine but it is possible using the high heat, high pressure machines available today. The results of pressure lamination are:

• Precise adaptation
• Negligible distortion
• Capacity to thickness as required
• Ability to place inserts, air spaces or modify the shore hardness of the mouthguard blanks to achieve better fit and stiffness

Custom-made mouthguards are the most acceptable.

Consideration should be given to wearing custom-made mouthguards in all sporting activities where there is a risk of trauma to the teeth and associated structures. Such activities include bat and ball sports, all football codes, martial arts and other sports such as basketball, high level netball and water polo where close physical contact is expected.

Start wearing mouthguards early. Dental injuries are common in children and the affects can be devastating to the developing dentition. Good habits are maximised with the early introduction of using protective equipment. Children should commence wearing a custom-made mouthguard as soon as they start participating in contact sports.

Custom-made professionally fitted mouthguards can be fabricated for the deciduous dentition and also for children undergoing orthodontic treatment.

Conclusion

It is dangerous to assume all types of mouthguards provide the same level of protection. Mouthguards should be custom-made, fit accurately, have sufficient thickness, even occlusal contact and not interfere with breathing and speech. Mass produced ‘Boil and Bite’ mouthguards cannot fulfill these requirements.

The correct approach for preventing dental injuries is to prepare and fit custom-made pressure laminated mouthguards made on models from impressions of the player’s mouth. There is a cost in providing professional care but this must be evaluated against the risk of dental injuries and the associated expenses.

*This article was published by The Australian Dental Association, March 2016

Bruxism is a repetitive jaw-muscle activity characterised by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible. Bruxism can occur during sleep (indicated as sleep Bruxism) or during wakefulness (indicated as awake Bruxism)and it can result in several orofacial lesions, such as tooth wear (loss of tooth surface or structure), fracture of restorations or teeth, hypersensitive or painful teeth, loss of periodontal support, periodontal lesions, temporomandibular joint disorders and muscle pain.

Teeth grinding is controlled by the brain, and although it is not clear why it occurs, there are some possible reasons:

-genetic factors,

-Neurochemicals,

-Psychological factors like stress, anxiety, depression

-Smoking, alcohol and caffeine.

-Medications (e.g. some antidepressants) and illicit drugs (e.g. ecstasy)

Although several therapeutic modalities have been employed to treat Bruxism, including oral splint, medications and behavioural approaches, none has been reported to be fully effective.

Recent advances have shown that Bruxism is caused by centrally mediated high levels of motor activity in the jaw muscles, indicating that reductions in this activity may be helpful. Botulinum toxins, proteases that block the release of acetylcholine, can ultimately inhibit muscle contraction, rendering them applicable to Bruxism.  Thus, the application of Botulinum toxins may be indicated as therapeutic modality to reduce the effects of grinding and clenching.

Bruxism in itself does not require treatment: management is only indicated where problems arise as a result of Bruxism.

Tooth wear is normal with age. However when the amount of wear is more than what it is usually seen for a person’s age (too much too early), it can cause pain and sensitivity, affect function and appearance. If treatment is needed, the earlier it is done, the easier and less expensive it may be. The treatment of great tooth loss is complex and lengthy.

Oral appliances primarily aim is to protect the dentition from damage caused by clenching/grinding, although they may reduce muscle activity. Irreversible occlusal adjustments have no basis in evidence in the management of Bruxism. Behavioural strategies include biofeedback, relaxation and improvement of sleep hygiene. Administration of botulinum toxin (Botox) to the masticatory muscles appears to reduce the frequency of Bruxism.

Do I suffer from Bruxism?

There are some questions you may ask yourself to elicit history of bruxism and suggestive clinical indicators:

– Are you aware of grinding your teeth during sleep?

– Are you aware of grinding your teeth whilst awake?

-Has anyone told you that you grind your teeth during sleep?

-On waking, do you have your jaws clenched or thrust forward?

-On waking, do you experience pain or stiffness in the jaw muscles?

 Signs and symptoms of Bruxism

– Worn down shorter teeth

-Chipped and cracked teeth, fillings or crowns.

-Pain and tenderness in the facial and neck muscles in the morning.

-Grinding noises during sleep

-Shiny spots on restorations

-Tongue scalloping and ridging on the cheek mucosa (‘linea alba’)

– Masticatory muscle fatigue or pain on waking

What should I do? Management of teeth grinding

-Protecting your teeth and crowns wearing a custom made hard night occlusal splint. Do not use a ready -made splint without consulting with your dentist. Poorly fitted splints can cause further damage and unwanted teeth movement.

-Restoring the damaged teeth with fillings or crowns when necessary.

-Consult with a TMJ physiotherapist.

-Relaxation techniques like Meditation, Yoga, and Breathing may help to relax your muscles and decrease the grinding and clenching of your teeth.

-Consult with a medical specialist in order to address stress, anxiety or depression.

-Visit your dentist regularly to check if Bruxism symptoms are present and to get help in protecting your teeth.

-Warm heat packs may help to relax tender muscles.

-Using over the counter anti-inflammatory medications for a short period of time

– Recent research literature suggests that Botox treatment is a safe and effective strategy for controlling jaw motor activities during sleep (Sleep Bruxism) for a period of time. It reduces the intensity rather than the generation of the contraction in jaw-closing muscles during sleep. A safe and effective management of Bruxism with Botox injections may include as well a protective device (occlusal splint) of the orofacial structures from excessive forces.

For further information, please don’t hesitate to contact our practice at 9827006.

1. It will improve the health of your gums. Crooked teeth many times have areas that are inaccessible to the brush and trap food easily. Having the teeth in a correct arch will allow the tongue to cleanse them better during the day and enable the tooth brush bristles to clean them better.
2. Some people have difficulty speaking properly since there are gaps between the teeth or the teeth are not meeting in the right way. The lisp created by an “open bite” can be corrected when the teeth have a good positon.
3. When the teeth are positioned correctly, what is called a class 1 occlusion, the muscles and joints can function in a balanced way. But if the teeth are locked or the right and left side don’t meet equally then, there can be jaw joint damage and pain.
4. Uneven and severe tooth wear can be caused by poor tooth position. A poorly aligned bite may force some teeth to share the load of other teeth that don’t touch. As a consequence those teeth will wear faster or crack and fracture. Achieving a harmonious occlusion will allow all teeth to share the chewing forces evenly.
5. Having your teeth for good. A balanced bite that allows good oral hygiene, prevents the excessive wear of the teeth and protects the joint allows for the teeth to last you a lifetime.

So whilst the importance of a great smile should never be underestimated, there is so much more to having straight teeth in a good relationship.