My Blog

By Christopher Couri, DDS, MS
October 11, 2017
Category: Oral Health
Tags: tmj disorders  
WhytheTreatmentModelforYourJawJointDisorderMatters

Your temporomandibular joints (TMJ), located where your lower jaw meets the skull, play an essential role in nearly every mouth function. It’s nearly impossible to eat or speak without them.

Likewise, jaw joint disorders (temporomandibular joint disorders or TMD) can make your life miserable. Not only can you experience extreme discomfort or pain, your ability to eat certain foods or speak clearly could be impaired.

But don’t assume you have TMD if you have these and other symptoms — there are other conditions with similar symptoms. You’ll need a definitive diagnosis of TMD from a qualified physician or dentist, particularly one who’s completed post-graduate programs in Oral Medicine or Orofacial Pain, before considering treatment.

If you are diagnosed with TMD, you may then face treatment choices that emanate from one of two models: one is an older dental model based on theories that the joint and muscle dysfunction is mainly caused by poor bites or other dental problems. This model encourages treatments like orthodontically moving teeth, crowning problem teeth or adjusting bites by grinding down tooth surfaces.

A newer treatment model, though, has supplanted this older one and is now practiced by the majority of dentists. This is a medical model that views TMJs like any other joint in the body, and thus subject to the same sort of orthopedic problems found elsewhere: sore muscles, inflamed joints, strained tendons and ligaments, and disk problems. Treatments tend to be less invasive or irreversible than those from the dental model.

The newer model encourages treatments like physical therapy, medication, occlusive guards or stress management. The American Association of Dental Research (AADR) in fact recommends that TMD patients begin their treatment from the medical model rather than the dental one, unless there are indications to the contrary. Many studies have concluded that a majority of patients gain significant relief with these types of therapies.

If a physician or dentist recommends more invasive treatment, particularly surgery, consider seeking a second opinion. Unlike the therapies mentioned above, surgical treatments have a spotty record when it comes to effectiveness — some patients even report their conditions worsening afterward. Try the less-invasive approach first — you may find improvement in your symptoms and quality of life.

If you would like more information on treating TMD, 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 “Seeking Relief from TMD.”

By Christopher Couri, DDS, MS
September 26, 2017
Category: Oral Health
EvenCelebritiesLikeJenniferLawrenceArentImmuneFromBadBreath

Exchanging passionate kisses with big-screen star Jennifer Lawrence might sound like a dream come true. But according to Liam Hemsworth, her Hunger Games co-star, it could also be a nightmare… because J.Law’s breath wasn’t always fresh. “Anytime I had to kiss Jennifer was pretty uncomfortable,” Hemsworth said on The Tonight Show.

Lawrence said the problem resulted from her inadvertently consuming tuna or garlic before the lip-locking scenes; fortunately, the two stars were able to share a laugh about it later. But for many people, bad breath is no joke. It can lead to embarrassment and social difficulties — and it occasionally signifies a more serious problem. So what causes bad breath, and what can you do about it?

In 9 out of 10 cases, bad breath originates in the mouth. (In rare situations, it results from a medical issue in another part of the body, such as liver disease or a lung infection.) The foul odors associated with bad breath can be temporarily masked with mouthwash or breath mints — but in order to really control it, we need to find out exactly what’s causing the problem, and address its source.

As Lawrence and Hemsworth found out, some foods and beverages can indeed cause a malodorous mouth. Onions, garlic, alcohol and coffee are deservedly blamed for this. Tobacco products are also big contributors to bad breath — which is one more reason to quit. But fasting isn’t the answer either: stop eating for long enough and another set of foul-smelling substances will be released. Your best bet is to stay well hydrated and snack on crisp, fresh foods like celery, apples or parsley.

And speaking of hydration (or the lack of it): Mouth dryness and reduced salivary flow during the nighttime hours is what causes “morning breath.” Certain health issues and some medications can also cause “dry mouth,” or xerostomia. Drinking plenty of water can encourage the production of healthy saliva — but if that’s not enough, tell us about it: We may recommend switching medications (if possible), chewing xylitol gum or using a saliva substitute.

Finally, maintaining excellent oral hygiene is a great way to avoid bad breath. The goal of oral hygiene is to control the harmful bacteria that live in your mouth. These microorganisms can cause gum disease, tooth decay, and bad breath — so keeping them in check is good for your overall oral health. Remember to brush twice and floss once daily, stay away from sugary foods and beverages, and visit the dental office regularly for checkups and professional cleanings.

So did J.Law apologize for the malodorous makeout session? Not exactly. “[For] Bradley Cooper, Christian Bale, yeah, I’ll brush my teeth,” she laughed.

Hemsworth jokingly agreed: “If I was kissing Christian Bale I probably would have brushed my teeth too. With you, it’s like, ‘Eh. Whatever.’”

If you would like more information about bad breath and oral hygiene, please contact us or schedule an appointment for a consultation. You can learn more by reading the Dear Doctor magazine article “Bad Breath: More than Just Embarrassing.”

By Christopher Couri, DDS, MS
September 11, 2017
Category: Dental Procedures
Tags: oral health  
TakeProactiveStepstoProtectYourOralHealthDuringCancerTreatment

Cancer treatment can consume all of your focus to the exclusion of other health issues. But these other issues still need attention, especially how treating cancer could affect other parts of your body. That definitely includes your teeth and gums.

Treatments like radiation or chemotherapy eradicate cancer cells disrupting their growth. Unfortunately, they may do the same to benign cells — “collateral damage,” so to speak. This could cause a ripple effect throughout the body, including in the mouth. Radiation, for example, could damage the salivary glands and result in reduced salivary flow. Because saliva neutralizes acid and diminishes bacterial growth, your risk for tooth decay as well as periodontal (gum) disease could increase.

While you may be able to recover from reduced salivary flow after treatment, your health could suffer in the meantime, even to the point of tooth and bone loss. Fortunately, there are some things we can do before and during your treatment.

If you can, have any necessary dental work performed well before you begin cancer treatment. You’ll be more resistant to side effects if you can start treatment with as healthy a mouth as possible.

Keep up your regular dental visits if at all possible, or see us if you begin seeing signs of dental disease. By staying on schedule, we’ll have a better chance of detecting and treating problems before they advance too far; we may also be able to provide preventive measures like topical fluoride applications to help keep your teeth resistant to disease. If you need more extensive treatment like tooth extraction or surgery we may need to coordinate with your cancer treatment provider.

Above all, continue to practice daily brushing and flossing to remove plaque, the main cause of dental disease. Drink plenty of water or take substances that boost salivation. And be sure to eat a nutritious diet while also reducing or eliminating tobacco or alcohol from your lifestyle.

Taking these steps will help protect your teeth and gums during cancer treatment. As a result, you have a better chance for maintaining your dental health during this critical time in your life.

If you would like more information on dental care during cancer 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 “Oral Health During Cancer Treatment.”

By Christopher Couri, DDS, MS
September 03, 2017
Category: Dental Procedures
DontBreakItLikeBeckham

During his former career as a professional footballer (that's a soccer star to U.S. sports fans) David Beckham was known for his skill at “bending” a soccer ball. His ability to make the ball curve in mid-flight — to avoid a defender or score a goal — led scores of kids to try to “bend it like Beckham.” But just recently, while enjoying a vacation in Canada with his family, “Becks” tried snowboarding for the first time — and in the process, broke one of his front teeth.

Some fans worried that the missing tooth could be a “red card” for Beckham's current modeling career… but fortunately, he headed straight to the dental office as soon as he arrived back in England. Exactly what kind of treatment is needed for a broken tooth? It all depends where the break is and how badly the tooth is damaged.

For a minor crack or chip, cosmetic bonding may offer a quick and effective solution. In this procedure, a composite resin, in a color custom-made to match the tooth, is applied in liquid form and cured (hardened) with a special light. Several layers of bonding material can be applied to re-construct a larger area of missing tooth, and chips that have been saved can sometimes be reattached as well.

When more tooth structure is missing, dental veneers may be the preferred restorative option. Veneers are wafer-thin shells that are bonded to the front surface of the teeth. They can not only correct small chips or cracks, but can also improve the color, spacing, and shape of your teeth.

But if the damage exposes the soft inner pulp of the tooth, root canal treatment will be needed to save the tooth. In this procedure, the inflamed or infected pulp tissue is removed and the tooth sealed against re-infection; if a root canal is not done when needed, the tooth will have an increased risk for extraction in the future. Following a root canal, a tooth is often restored with a crown (cap), which can look good and function well for many years.

Sometimes, a tooth may be knocked completely out of its socket; or, a severely damaged tooth may need to be extracted (removed). In either situation, the best option for restoration is a dental implant. Here, a tiny screw-like device made of titanium metal is inserted into the jaw bone in a minor surgical procedure. Over time, it fuses with the living bone to form a solid anchorage. A lifelike crown is attached, which provides aesthetic appeal and full function for the replacement tooth.

So how's Beckham holding up? According to sources, “David is a trooper and didn't make a fuss. He took it all in his stride." Maybe next time he hits the slopes, he'll heed the advice of dental experts and wear a custom-made mouthguard…

If you have questions about restoring damaged teeth, please contact our office to schedule a consultation. You can read more in the Dear Doctor magazine articles “Trauma and Nerve Damage to Teeth” and “Children's Dental Concerns and Injuries.”

By Christopher Couri, DDS, MS
August 19, 2017
Category: Oral Health
DontletPeriodontalDiseaseCauseYourGumstoRecede

Although your smile wouldn't be the same without them, there's more to your gums than their looks. Besides helping to hold your teeth in place, they're also an important protective barrier for their roots.

Unfortunately, gums aren't immune to disease, especially periodontal (gum) disease. This bacterial infection, triggered by built-up dental plaque on teeth due to insufficient oral hygiene, can cause the gum tissues to detach from teeth and shrink back (recede). This can make your teeth more sensitive to hot or cold foods and beverages, as well as put them at even greater risk for tooth decay.

To treat gum recession, our first priority is to stop any ongoing gum disease through aggressive plaque removal. Depending on severity, this could require clinical procedures like scaling or root planing to remove plaque and tartar (hardened plaque deposits) at or below the gum line. This is especially crucial for improving gum tissue healing and stimulating potential reattachment.

Revitalizing gum tissues this way naturally has a better chance of occurring if we're able to prevent recession before it reaches the roots. If that does happen and we have sufficient gum tissue attachment remaining, we may need to give the gum tissue a helping hand through gum grafting surgery. There are a number of techniques depending on the circumstances, but they all use either tissue from another location in the patient's mouth or prepared tissue from another human donor. This type of surgery requires great skill and expertise, not to mention an aesthetic sense, to achieve a result that's both functional and attractive.

Other than daily brushing and flossing, the most important thing you can do for gum health is to see us as soon as you notice any signs of gum problems like swelling, bleeding or tooth sensitivity. The sooner we can diagnose and begin treating the problem, the less likely any gum recession will have a long-term impact on your health.

If you would like more information on 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.”





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