Frequently Asked Questions

TMJ is shorthand for temporomandibular joint, the ball-and-socket joint that connects the jaw to the skull just in front of the ear. Some people use the term TMJ to describe pain that comes from this joint, although doctors and dentists are now more likely to use the abbreviation TMD (for temporomandibular disorder, or temporomandibular joint dysfunction).

TMD appears to be caused by a variety of different problems, including arthritis, trauma to the jaw, muscle spasms from jaw clenching or stress, poor alignment of the teeth, and nighttime grinding of the teeth (bruxism).

TMD can produce many symptoms, including:

• Pain or tenderness over the joint, especially when chewing, speaking, or opening the mouth wide
• Clicking, popping, or cracking sounds when you chew or move the jaw
• Muscle spasms
• A sense that the teeth aren’t in alignment
• The sensation that the jaw cannot move, open, or shut

However, headaches also can be a major symptom of TMD. Often the headaches start at the jaw or TMJ, then spread over the top of the head. In a person prone to migraines, pain from TMD can trigger a typical migraine headache.

People suffering from this condition should see their doctor or dentist. Changes in diet and chewing habits, treatment of stress, correction of dental problems, and use of pain relievers and muscle relaxants can all be helpful.

A complete dental and medical evaluation is often necessary and recommended to evaluate patients with suspected TMJ disorders.   This exam will include a personal and medical history, manual palpation of the joints and muscles associated with the head and neck, examination of the teeth and chewing structures and more.  Damaged jaw joints are suspected when there are popping, clicking, and grating sounds associated with movement of the jaw. Chewing may become painful, and the jaw may lock or not open widely. The teeth may be worn smooth, as well as show a loss of the normal bumps and ridges on the tooth surface. Ear symptoms are very common. Infection of the ear, sinuses, and teeth can be discovered by medical and dental examination. Dental X-rays and computerized tomography (CT) scanning help to define the bony detail of the joint, while magnetic resonance imaging (MRI) is used to analyze soft tissues.

The temporomandibular joint (TMJ) is the area directly in front of the ear on either side of the head where the upper jaw (maxilla) and lower jaw (mandible) meet. Within the TMJ, there are moving parts that allow the upper jaw to close on the lower jaw. This joint is a typical sliding “ball and socket” that has a disc sandwiched between it. The TMJ is used throughout the day to move the jaw, especially in biting and chewing, talking, and yawning. It is one of the most frequently used joints of the body.

The majority of dental providers are not trained in neuromuscular diagnosis and treatment or the science behind TMJ disorders. While the causes may include tooth grinding, physical injury, or genetic defects, only specially trained neuromuscular dentists like Dr. Nasedkin and Dr. Tejani are taught to recognize these kind of bite problems.

Also, because neck pain, migraine headaches, and tooth problems can be rooted in a number of other causes, general dentists and family doctors may ignore the possibility that TMJ is the culprit. In other instances, dentists or doctors may recognize a bite problem, but are at a loss for how to find its cause or to treat it.

The development of impressive diagnostic technology has helped neuromuscular dentistry become less of a mystery to family practitioners and clinics like the Occlusal Rehabilitation Centre are here to help you.

When the jaw does not function properly, muscle spasms and trigger points occur. This tension travels like a chain reaction through other parts of the body, most commonly to the neck and shoulders. When these trigger points are released, one of the first things that people feel is deep relaxation throughout the face and jaw, as well as the neck and shoulders.

No. Most patients report that treatment is relatively painless.  The appliance is custom designed to your mouth and is readjusted often to ensure continued comfort. After the initial adjustment period, some patients tell us they forget they are even wearing the appliance.

• Whiplash (cervical acceleration/deceleration)
• Air bag deployment
• Opening the jaw too wide
• Bruxism (Clenching/grinding)
• Malocclusion (Bad bite)
• Orthodontics
• Ligament laxity
• Stress
• Systemic diseases

• Pain or tenderness of your jaw
• Aching pain in and around your ear
• Difficulty chewing or discomfort while chewing
• Aching facial pain
• Locking of the joint, making it difficult to open or close your mouth
• Headache
• Uncomfortable bite
• An uneven bite, because one or more teeth are making premature contact

TMJ disorders can also cause a clicking sound or grating sensation when you open your mouth or chew. But if there’s no pain or limitation of movement associated with your jaw clicking, you probably don’t have a TMJ disorder

A thorough examination may involve:

• A dental examination to show if you have poor bite alignment
• An MRI (http://health NULL.nytimes NULL.com/health/guides/test/mri/overview NULL.html) of the jaw area
• Feeling the joint and connecting muscles for tenderness
• Pressing around the head for areas that are sensitive or painful
• Sliding the teeth from side to side
• Watching, feeling, and listening to the jaw open and shut
• X-rays to show abnormalities

In some cases, the results of the physical exam may appear normal.

However, TMD can involve more serious and chronic problems affecting the jaw’s muscles and ligaments; this can lead to chronic jaw pain due to the misalignment. TMJ can lead to permanent joint damage; bone-on-bone contact or abnormal movement of the joint can cause abnormal wear to the bones and surrounding structures can be damaged or even pinched in the irregular joint. Therefore, proper diagnosis is essential when problems like jaw clicking arise, from this, appropriate treatment for your situation can be determined.

Treatment can be simple: with rest, avoiding chewing gum, limiting speaking and eating soft foods allowing the muscles to rest, thereby promoting healing. Or if more involved, working with physical therapists, ultra sound, low level laser therapy, neuromuscular massage therapy, and trigger point injection treatment can also be very helpful. As the condition deteriorates, bite splints or fixed orthotics may be required along with orthodontics or dental restorations to harmonize your bite.

The open locked jaw is treated by relaxing the jaw muscles to a comfortable level. Then the mandible is held with the thumbs while the lower jaw is pushed downward, forward, and backward.

The closed locked jaw is treated by freezing you until you are completely relaxed. Then the mandible is gently manipulated until the mouth opens. Then holding the jaw in the right place with a dental splint.

If your jaw is locked open or closed, see a dentist straight away.

Eating soft foods.

Applying cold and moist heat.

Avoiding extreme jaw movements (such as wide yawning, loud singing, and gum chewing)

Anti-inflammatory pain medications such as aspirin or acetaminophen (Tylenol) or ibuprofen (Motrin, Aleve) may ease the pain of TMJ. Then make an appointment to see your dentist.

Treatment time can be 6months several years depending on what needs to be done.

An occlusal splint is a diagnostic and treatment appliance of clear acrylic plastic which fits over the upper teeth. The side of the palate, insides, and just the tops of the teeth are covered. Various clasps at the back of the mouth assist retention. A precise model of the upper and lower teeth is made from accurate impressions. A registration of jaw relationships at the desired treatment position is secured. The required laboratory work takes from 10 days to 2 weeks.. Eye tooth (canine) extensions insure that jaw separation occurs in side to side movements. For the first day or so after the fitting appointment, your appliance may seem to fit tightly, but the teeth move slightly to an accommodation position. Maximum benefits are provided by maximum wearing. If it is not convenient, the appliance may be removed for eating.

Once the splint therapy has been effective and the bite and jaws are stabilizing it will be possible to complete a diagnostic wax-up of a proposed treatment position at this time. This is usually done on the lower jaw and the existing restorations are abraded and a plastic overlay is applied on top of them at the new bite relationship for wear as a TRIAL BITE:  Some refinement is required and once a stable and comfortable and repeatable position is present, we can undertake the rehabilitation needed.

The symptoms can go away overtime; ranging from weeks to years. However, TMD can involve more serious and chronic problems affecting the jaw’s muscles and ligaments; this can lead to chronic jaw pain due to the misalignment. TMD can lead to permanent joint damage; bone-on-bone contact or abnormal movement of the joint can cause abnormal wear to the bones and surrounding structures can be damaged or even pinched in the irregular joint. Therefore, proper diagnosis is essential when problems like jaw clicking arise, from this, appropriate treatment for your situation can be determined.

The temporomandibular joint, also known as TMJ, is the ball and socket joint that connects the lower jaw to the bone on each side of the head. The temporomandibular joint is stabilized by muscles that make it possible to open and close the mouth. The pain, discomfort or tenderness in or around these joints are referred to as TMJ disorders or TMD

Major signs and symptoms of sleep apnea

Other common signs and symptoms of sleep apnea include:

Sleep apnea affects the way you breathe when you’re sleeping. In untreated sleep apnea, breathing is briefly interrupted or becomes very shallow during sleep. These breathing pauses typically last between 10 to 20 seconds and can occur up to hundreds of times a night.

Untreated sleep apnea prevents you from getting a good night’s sleep. When breathing is paused, you’re jolted out of your natural sleep rhythm. As a consequence, you spend more time in light sleep and less time in the deep, restorative sleep you need to be energetic, mentally sharp, and productive the next day.

This chronic sleep deprivation results in daytime sleepiness, slow reflexes, poor concentration, and an increased risk of accidents. Sleep apnea can also lead to serious health problems over time, including diabetes, high blood pressure, heart disease, stroke, and weight gain. But with treatment, you can control the symptoms, get your sleep back on track, and start enjoying what it’s like to be refreshed and alert every day.

Types of sleep apnea

• Obstructive sleep apnea is the most common type of sleep apnea. It occurs when the soft tissue in the back of your throat relaxes during sleep, causing a blockage of the airway (as well as loud snoring).
• Central sleep apnea is a much less common type of sleep apnea that involves the central nervous system, rather than an airway obstruction. It occurs when the brain fails to signal the muscles that control breathing. People with central sleep apnea seldom snore.
• Complex sleep apnea is a combination of obstructive sleep apnea and central sleep apnea.

As with any medical treatment, there are no guarantees, but during initial consultation, after reviewing your diagnostics, and after clinical examination, your chances of successful treatment will be outlined to you so that you can make an informed decision.

While Continuous Positive Airway Pressure (CPAP) is considered the gold standard of care for severe Obstructive Sleep Apnea (OSA), dental therapy has been recognized by the American Academy of Sleep Medicine (AASM) as first line of treatment for primary snoring, mild and moderate OSA, and severe OSA if CPAP is not an option. Studies have demonstrated that CPAP has almost 100% efficacy if worn by patients, but the degree of compliance is much lower than OAT. Therefore OAT compares favorably with CPAP for total treatment effectiveness.

While it is true that any dentist can make you an appliance, national and provincial dental governing bodies agree that the chances of successful treatment are directly related to the expertise of the providing dentist and suggest that dentists attempting this treatment should be appropriately trained. Before proceeding with treatment for this potentially serious medical condition, you should be comfortable with the training and experience of the provider.

No. Most patients report that treatment is relatively painless.  The appliance is custom designed to your mouth and is readjusted often to ensure continued comfort. After the initial adjustment period, some patients tell us they forget they are even wearing the appliance.

Obstructive sleep apnea runs in the families, which means the causes of OSA often begin with how we are built. Some of the physical reasons people suffer from OSA include a small upper airway or some other airway blockage during sleep. Such blockages may be caused by airway tissues, which are too large or relax too much when you sleep (e.g. tonsils or a soft palate) or your bone structure may change the shape of your throat (e.g. a recessed chin). As we age, we tend to lose muscle mass, so many of these conditions get worse with time and may cause breathing problems as we sleep.

Although your genetics may make it more likely for you to get OSA, a number of things make OSA worse in some people.

Obesity: Being overweight is one of the largest risk factors for OSA. Although all family members may share the genetic risk of OSA, overweight people are much more likely to suffer from it.

Alcohol or Sedative Use: Both of these chemicals cause muscle relaxation resulting in the narrowing and collapse of the muscles around the throat at night.

Smoking: Smokers are more likely to suffer from OSA, because smoking irritates the upper airway and causes inflammation.

Hormone Imbalance: Low thyroid hormone (hypothyroidism) increases the risk for OSA. Hypothyroidism shares many symptoms of sleep apnea, and is similarly under-diagnosed. Symptoms include daytime sleepiness and fatigue, weight gain, nighttime snoring, and depression.

Other Medical Conditions: Other medical conditions such as nasal congestion and seasonal allergies can block airflow through the upper airway, which increases the risk for developing OSA.

Other Medications: Although sleep apnea can result in high blood pressure (hypertension), some anti-hypertensive drugs can cause sleep apnea. Similarly, several other drug families have been linked to disrupted sleep, which increases the risk for sleep apnea (e.g. long-acting benzodiazepines, beta-blockers and theophylline).

The virtually invisible aligners, which are made of a thermoplastic material uniquely developed for the Invisalign treatment plan, look similar to teeth-whitening trays. A series of Invisalign aligners are custom-made for you, to move your teeth in the sequence determined by your doctor.

Over the course of treatment, you will be supplied with a series of aligners. Each aligner will make slight adjustments to tooth position, a process that is mapped out in advance by your doctor, specifically for your situation. When the aligners are placed on the teeth, they cause the teeth to gradually shift from their current position. After approximately two weeks, you will begin using the next set of aligners, which will continue the teeth straightening process.

Through the use of our patented thermoplastic design, Invisalign aligners move your teeth through the appropriate placement of controlled force. The main difference is that Invisalign not only controls the force, but also the timing of the force application. During each stage, only certain teeth are allowed to move. These movements are determined by your doctor as he or she maps out your unique Invisalign treatment plan.

Invisalign aligners are virtually invisible. No one may even notice that you’re wearing them, making Invisalign a seamless fit with your lifestyle. Invisalign aligners are removable. For the best results and a timely outcome, aligners should be worn for 20 to 22 hours per day. However, unlike with braces, you have the flexibility to remove your aligners to eat and drink what you want during treatment. And you can also remove the aligners to brush and floss as you normally would, for fresh breath and good oral hygiene. There are no metal brackets or wires that could cause irritation to your mouth, an advantage over traditional braces. Plus, since your office visits during treatment don’t involve metal or wire adjustments, you’ll likely spend less time in the doctor’s chair. Invisalign allows you to view your virtual results and treatment plan before you start so you can see how your straight teeth will look when your treatment is complete. Instead of imagining how much better it can be, you’ll be able to see it for yourself.

The length of treatment depends on the severity of your case and can only be determined by your doctor; however, the average case takes about 12 months for adults. The length of time necessary for a teen patient may vary and can be determined by your doctor.

We find that aligners are most effective when worn 20 to 22 hours per day and removed only for eating, brushing and flossing.

Your doctor will schedule regular appointments usually about once every four to six weeks. The goal of these visits is to ensure that your treatment is progressing as planned.

While Invisalign moves your teeth without the pain and anxiety metal braces can cause, some people experience temporary discomfort for a few days at the beginning of each new stage of treatment. This is normal and is typically described as a feeling of pressure. It’s also a sign that Invisalign is working, as it moves your teeth to their final destination. This discomfort typically goes away in a couple of days.

No. The aligners must be in place a minimum of 20 to 22 hours a day for the treatment to be effective.

Similar to other orthodontic treatments, Invisalign aligners may temporarily affect the speech of some people, and you may have a slight lisp for a day or two. However, as your tongue gets used to having aligners in your mouth, any lisp caused by the aligners should disappear.

We discourage smoking while wearing aligners because it is possible for the aligners to become discolored.

Because of the high sugar content in alcohol, a moderate amount would be fine to consume, as long as care is taken to clean the teeth and the aligners soon after so as not to trap sugar between them. The same applies for any sugary beverage.

No, gum will stick to the aligners. We recommend removing your aligners for all meals and snacks.

It is very unlikely that your aligners would ever fall out, no matter what you were doing at the time: sleeping, talking, laughing, etc. The aligners are designed to fit firmly on the teeth, so this should not be a cause for concern.

No. Thanks to the removable nature of the aligners, you can eat and drink whatever you want while in treatment. In fact, you’re required to remove your aligners to eat and drink. So, unlike undergoing traditional treatment using wires and brackets, there is no need to restrict your consumption of any of your favorite foods and snacks unless you are instructed otherwise by your doctor. Also, it is important that you brush your teeth after each meal and prior to reinserting your aligners to maintain fresh breath and proper hygiene.

More than 1.3 million patients worldwide have been treated with Invisalign. The number of Invisalign smiles grows daily.

No. Invisalign aligners and Vivera Retainers do not contain Bisphenol-A or phthalate plasticizers. These aligners and retainers are made with USP Class VI medical-grade, high molecular weight, polyurethane resins. Tests have been conducted to determine the biocompatibility of these materials, and show that they are biocompatible and pass all applicable regulatory requirements and thresholds for human wear in the mouth. Of course, as with any medical device, you should consult with your health professional about your aligner or retainer treatment and any applicable risks of use.

Align Technology, Inc., the company that manufactures Invisalign, was founded in 1997.

Invisalign Teen is appropriate for patients who have shed all of their baby teeth and have second molars at least partially erupted this includes most teens. Ask your orthodontist if you qualify to start treatment now.

The best way to clean your aligners is to use the Invisalign cleaning kit, available for order at www.invisalignstore.com (http://www NULL.invisalignstore NULL.com/). As a secondary method, however, your aligners can also be cleaned by brushing them and rinsing them in lukewarm water.

This varies from person to person and depends on the outcome of the treatment. Some patients might need a positioner, or conventional retainer. Other patients might need a clear plastic retainer similar to the ones Invisalign makes, such as Align Technology’s Vivera Retainer (http://www NULL.viveraretainer NULL.com/), which is worn at night. Discuss this with your dentist. Every patient is different, and outcomes vary.

A number of Invisalign patients have undergone a previous treatment involving braces at some point in their past, often during their youth. Adults can usually have the shifting that occurs after braces corrected, without having to go through the trauma and social awkwardness of wearing metal braces.

Please consult with your Invisalign provider about any special orthodontic cases, such as veneers.

Because bridgework involves the connection of a tooth to surrounding teeth, it would be difficult for the aligners to work effectively. The aligners are designed to move each tooth separately, following the exact movements that your orthodontist will map out for you when creating your custom-made aligners.

Whenever you train or compete, the natural reaction is to clench the jaw. It’s all part of the “fight or flight” hard-wiring in the brain. Multi-patented ArmourBite® are uniquely shaped to help maintain optimal spacing, counteract the negative effects of clenching, and allow you to breathe better.

The ArmourBite® Mouthguard offers protection in addition to performance benefits, and should be used in contact sports like football, hockey and lacrosse. The ArmourBite® Mouthpiece offers performance benefits and is appropriate for non-contact activities and sports, such as running, yoga, weightlifting, soccer, baseball, golf, tennis, and training. The ArmourBite® Mouthguard fits on the upper teeth, the ArmourBite® Mouthpiece fits on the lower.

Independent, peer-reviewed studies conducted at some of the US’s top universities and research centers show that ArmourBite® works. Patented and scientifically proven, ArmourBite® helps athletes train harder and perform better than ever.

Composite fillings are usually placed in one appointment. While the tooth is numb, your dentist will remove decay as necessary. The space will then be thoroughly cleaned and carefully prepared before the new filling is placed. If the decay was near the nerve of the tooth, a special medication will be applied for added protection. The composite filling will then be precisely placed, shaped, and polished, restoring your tooth to its original shape and function.

It is normal to experience sensitivity to hot and cold when composite fillings are first placed, however this will subside shortly after your tooth acclimates to the new filling.

You will be given care instructions at the conclusion of your treatment. Good oral hygiene practices, eating habits, and regular dental visits will aid in the life of your new fillings.

Getting veneers usually requires two visits to complete the process, with little or no anesthesia required during the procedure. The teeth are prepared by lightly buffing and shaping the surface to allow for the thickness of the veneer. A mold or impression of the teeth is taken and a shade (color) will then be chosen by you and the dentist.

On the second visit the teeth will be cleansed with special liquids to achieve a durable bond. Bonding cement is then placed between the tooth and veneer and a special light beam is used to harden and set the bond.

You will receive care instructions for veneers. Proper brushing, flossing and regular dental visits will aid in the life of your new veneers.

A crown procedure usually requires two appointments. Your first appointment will include taking several highly accurate molds (or impressions) that will be used to create your custom crown. A mold will also be used to create a temporary crown which will stay on your tooth for approximately two weeks until your new crown is fabricated by a dental laboratory.

While the tooth is numb, the dentist will prepare the tooth by removing any decay and shaping the surface to properly fit the crown. Once these details are accomplished, your temporary crown will be placed with temporary cement and your bite will be checked to ensure you are biting properly.

At your second appointment your temporary crown will be removed, the tooth will be cleaned, and your new crown will be carefully placed to ensure the spacing and bite is accurate.

You will be given care instructions and encouraged to have regular dental visits to check your new crown.

The process of getting implants requires a number of visits over several months.

X-rays and impressions (molds) are taken of the jaw and teeth to determine bone, gum tissue, and spacing available for an implant. While the area is numb, the implant will be surgically placed into the bone and allowed to heal and integrate itself onto the bone for up to six months. Depending on the type of implant, a second surgery may be required in order to place the “post” that will hold the artificial tooth in place. With other implants the post and anchor are already attached and placed at the same time.

After several weeks of healing the artificial teeth are made and fitted to the post portion of the anchor. Because several fittings may be required, this step may take one to two months to complete. After a healing period, the artificial teeth are securely attached to the implant, providing excellent stability and comfort to the patient.

You will receive care instructions when your treatment is completed. Good oral hygiene, eating habits, and regular dental visits will aid in the life of your new implant.

An inlay procedure usually requires two appointments. Your first appointment will include taking several highly accurate impressions (molds) that will be used to create your custom inlay and a temporary restoration.

While the tooth is numb, the dentist will remove any decay and/or old filling materials. The space will then be thoroughly cleaned and carefully prepared, shaping the surface to properly fit an inlay restoration. A temporary filling will be applied to protect the tooth while your inlay is made by a dental laboratory.

At your second appointment your new inlay will be carefully and precisely cemented into place. A few adjustments may be necessary to ensure a proper fit and that your bite is comfortable.

You will receive care instruction at the conclusion of your treatment. Good oral hygiene practices, a proper diet, and regular dental visits will aid in the life of your new inlay.

An onlay procedure usually requires two appointments. Your first appointment will include taking several highly accurate impressions (molds) that will be used to create your custom onlay and a temporary restoration.

While the tooth is numb, the dentist will remove any decay and/or old filling materials. The space will then be thoroughly cleaned and carefully prepared, shaping the surface to properly fit an onlay restoration. A temporary filling will be applied to protect the tooth while your onlay is made by a dental laboratory.

At your second appointment, your new onlay will be carefully and precisely cemented into place. A few adjustments may be necessary to ensure a proper fit and that your bite is comfortable.

You will receive care instruction at the conclusion of your treatment. Good oral hygiene practices, a proper diet, and regular dental visits will aid in the life of your new onlay.

Getting a bridge usually requires two or more visits. While the teeth are numb, the two anchoring teeth are prepared by removing a portion of enamel to allow for a crown. Next, a highly accurate impression (mold) is made which will be sent to a dental laboratory where the bridge will be fabricated. In addition, a temporary bridge will be made and worn for several weeks until your next appointment.

At the second visit, you permanent bridge will be carefully checked, adjusted, and cemented to achieve a proper fit. Occasionally your dentist may only temporarily cement the bridge, allowing your teeth and tissue time to get used to the new bridge. The new bridge will be permanently cemented at a later time.

You will receive care instructions at the conclusion of your treatment. Proper brushing, flossing and regular dental visits will aid in the life of your new permanent bridge.