My heel hurts …. Q: I had severe pain in my left heel. A doctor administered an injection to the heel. I felt better for about six months but now the pain has returned. Is there a permanent cure?
A: This pain occurs when there is constant friction and irritation to the area where the thick plantar fascia (bottom of the foot) joins the heel bone or calcaneum. After some time the irritation may be sufficient to cause extra bone formation called a calcaneal spur. The pain subsides after an injection of a long-acting steroid into that point, but will recur, necessitating a second or even third injection. To prevent a recurrence:
Cut lip :- Q: My grandson falls down frequently and cuts his lips. Please advise.
A: Cuts on the lip and tongue can bleed profusely. First, you need to apply an ice cube wrapped in a plastic bag to the area. This will stop the blood flow and help you see the wound clearly. If it is a shallow cut with no food or tooth chip inside, just give the child a little sugar to suck. Saliva contains natural antibodies and the wound will heal by itself in four or five days.
If the wound is deep, lacerated and contains mud, food or a chipped tooth, you need to see a doctor as soon as possible.
To clean these deeper wounds at home use eye drops, not antiseptic solutions. The latter can irritate the wound. Also, they may contain substances that should not be swallowed.
If bad breath develops, it means an infection has set in. Consult a doctor immediately.
Teething problem :- Q: When do I start brushing my child’s teeth and what should I use?
A: A child’s teeth should be brushed daily morning and evening soon after they appear. A soft toothbrush and toothpaste containing 1,000 parts per million of fluoride should be used. Brushing needs to be supervised till they are seven or eight years old.
Life after surgery Q: I had hernia surgery about two weeks ago. When can I lead a normal life? More important, when can I have sex?
A: Many patients want to know this but hesitate to ask the doctor because they are embarrassed. They then consult friends who have had the surgery and therefore double as experts.
In most cases, you may resume your sex life when the doctor says you can return to normal activity. In the case of a hysterectomy, caesarian or hernia, this may be six weeks or longer. Always listen to your body. If there is pain, particularly at the incision site, stop whatever you were doing and try again after a week.
Head spinning :- Q: I am 19 years old. Whenever I get up from bed, I feel giddy, like I am going to fall. Sometimes, I also feel that the room is spinning around. I tried to explain this to my doctor, but he says my blood pressure and sugar levels are normal.
A: You may have postural hypotension or orthostatic hypotension. This is a fall of blood pressure that occurs when there are sudden changes in posture. The diagnosis can be proven by measuring the BP separately in sitting, lying and standing positions. It is often mild and lasts just a few seconds to a few minutes after standing. The body usually adjusts to changes in posture within a few seconds. If there is a delay, it may be due to dehydration, as in your case hypertension and diabetes (the two other common causes) have been ruled out.
Try standing up slowly from a sitting position, allowing your body time to adjust to the postural change. Some yoga exercises (such as crane, tree positions) help if done regularly. You could jog, swim, run or walk for an hour a day. Alternatively, you can take up one of the martial arts.
Foul breath Q: I feel I have bad breath and that this puts off people I have contact with.
A: You are right about people being repulsed by bad breath or halitosis. It is because bad odours are equated with disease, which our bodies are conditioned to avoid. To know if you really have bad breath, you may ask your parents or spouse. They are the only people who will give you a truthful answer.
Foul breath may be due to tooth decay or gum disease, as well as colds, sinusitis, indigestion and a faulty diet. You must tackle the cause and eliminate it.
Other Names :Bad Breath, Breath odor, Mauvaise haleine (French), Mundgeruch (Deutsch), Slechte adem (Dutch), Mala respiración or Malo aliento (Spanish), Alito cattivo (Italiano) and more… Many names to one complicated situation, that has medical, dental and psychological aspects.
Halitosis, or bad breath, is a term used to describe noticeably unpleasant odors exhaled in breathing—whether the smell is from an oral source due to bacteria or otherwise. Halitosis has a significant impact—personally and socially—on those who suffer from it or believe they do (halitophobia), and is estimated to be the third-most-frequent reason for seeking dental aid, following tooth decay and periodontal disease.
Bad breath has a considerable impact on the lives of people who suffer from it or think they do, in all aspects of life – socially, professionally and personally.
Halitosis is considered to be the 3rd most frequent reason for seeking dental aid, but yet – many medical and dental professionals don’t have enough knowledge on the matter to offer the right treatment, not to talk of the layman knowledge on this problem.
In the past, bad breath was often considered to an incurable affliction, but in recent years it has become increasingly evident that bad breath is usually treatable, or at least its impact can be lessened once the causal factors are known.
In most cases (85–90%), bad breath originates in the mouth itself. The intensity of bad breath differs during the day, due to eating certain foods (such as garlic, onions, meat, fish, and cheese), obesity, smoking, and alcohol consumption. Because the mouth is exposed to less oxygen and is inactive during the night, the odor is usually worse upon awakening (“morning breath”). Bad breath may be transient, often disappearing following eating, brushing one’s teeth, flossing, or rinsing with specialized mouthwash.
Bad breath may also be persistent (chronic bad breath), which is a more serious condition, affecting some 25% of the population in varying degrees. It can negatively affect the individual’s personal, social, and business relationships, leading to poor self-esteem and increased stress.
Listerine can lay claim to the origins of the word halitosis, which is a combination of the Latin halitus, meaning ‘breath’, and the Greek suffix osis often used to describe a medical condition, e.g., “cirrhosis of the liver“.
The term “halitosis” was introduced by Listerine in 1921, but bad breath is not a modern affliction. It has been causing embarrassment for thousands of years. Records mentioning bad breath have been discovered more than 3,000 years ago, all the way back in 1550 B.C. Back then, exactly what caused bad breath was not known, but a mouthwash of wine and herbs was one recommended way of solving the problem
Foul-smelling bacterial infection and chronic mouth inflammation are the most common causes of bad breath. Dental cavities and mouth, tongue, and gum infections top the list. Bronchiectasis, an infection and enlargement of the bronchial tubes, and lung abscess can also cause halitosis. It goes without saying that many smokers have bad breath which unrelated to mouth and lung infection but is simply a result of inhaling tobacco.
There are ,however, three serious illnesses which can all give specific mouth odours:
* Liver failure causes a fishy odour (fetor hepaticus)
* Kidney failure an ammonia odour, and
* Diabetic coma (ketoacidosis) a fruity odour.
Finally, many healthy individuals have persistent bad breath through poor digestion. (There is no research suggesting a connection with hormonal cycles although it is well known that menopausal symptoms can affect digestion and the functioning of the body organs mentioned above.)
Examination of the mouth will yield the diagnosis when dental infection is responsible. A history of cough, fever and weight loss may suggest bronchiectasis or lung abscess. Diabetic ketoacidosis, liver disease and kidney failure each have a characteristic constellation of symptoms and physical and laboratory abnormalities. It is for these reasons that a full consultation and diagnosis be sought to identify the cause of the problem.
The most common location for mouth-related halitosis is the tongue. Tongue bacteria produce malodorous compounds and fatty acids, and account for 80 to 90 percent of all cases of mouth-related bad breath. Large quantities of naturally-occurring bacteria are often found on the posterior dorsum of the tongue, where they are relatively undisturbed by normal activity. This part of the tongue is relatively dry and poorly cleansed, and bacterial populations can thrive on remnants of food deposits, dead epithelial cells, and postnasal drip. The convoluted microbial structure of the tongue dorsum provides an ideal habitat for anaerobic bacteria, which flourish under a continually-forming tongue coating of food debris, dead cells, postnasal drip and overlying bacteria, living and dead. When left on the tongue, the anaerobic respiration of such bacteria can yield either the putrescent smell of indole, skatole, polyamines, or the “rotten egg” smell of volatile sulfur compounds (VSCs) such as hydrogen sulfide, methyl mercaptan, Allyl methyl sulfide, and dimethyl sulfide.
Cleaning the tongue
The most widely-known reason to clean the tongue is for the control of bad breath. Methods used against bad breath, such as mints, mouth sprays, mouthwash or gum, may only temporarily mask the odors created by the bacteria on the tongue, but cannot cure bad breath because they do not remove the source of the bad breath. In order to prevent the production of the sulfur-containing compounds mentioned above, the bacteria on the tongue must be removed, as must the decaying food debris present on the rear areas of the tongue. Most people who clean their tongue use a tongue cleaner (tongue scraper), or a toothbrush. Specially designed tongue cleaners are a lot more effective (collecting and removing the bacterial coating) than toothbrushes (which merely spread the bacterial accumulations on the tongue and in the mouth).
There are over 600 types of bacteria found in the average mouth. Several dozen of these can produce high levels of foul odors when incubated in the laboratory. The odors are produced mainly due to the breakdown of proteins into individual amino acids, followed by the further breakdown of certain amino acids to produce detectable foul gases. For example, the breakdown of cysteine and methionine produce hydrogen sulfide and methyl mercaptan, respectively. Volatile sulfur compounds have been shown to be statistically associated with oral malodor levels, and usually decrease following successful treatment.
Other parts of the mouth may also contribute to the overall odor, but are not as common as the back of the tongue. These locations are, in order of descending prevalence: inter-dental and sub-gingival niches, faulty dental work, food-impaction areas in-between the teeth, abscesses, and unclean dentures. Oral based lesions caused by viral infections like Herpes Simplex and HPV may also contribute to bad breath.
There is some controversy over the role of periodontal diseases in causing bad breath. Whereas bacteria growing below the gumline (subgingival dental plaque) have a foul smell upon removal, several studies reported no statistical correlation between malodor and periodontal parameters.
The second major source of bad breath is the nose. In this occurrence, the air exiting the nostrils has a pungent odor that differs from the oral odor. Nasal odor may be due to sinus infections or foreign bodies.
In general, putrefaction from the tonsils is considered a minor cause of bad breath, contributing to some 3–5% of cases. Approximately 7% of the population suffer from small bits of calcified matter in tonsillar crypts called tonsilloliths that smell extremely foul when released and can cause bad breath.
The Cardia, which is the valve between the stomach and the esophagus, may not close properly due to a Hiatal Hernia or GERD, allowing acid to enter the esophagus and gases escape to the mouth. A Zenker’s diverticulum may also result in halitosis due to aging food retained in the esophagus.
The stomach is considered by most researchers as a very uncommon source of bad breath (except in belching). The esophagus is a closed and collapsed tube, and continuous flow (as opposed to a simple burp) of gas or putrid substances from the stomach indicates a health problem—such as reflux serious enough to be bringing up stomach contents or a fistula between the stomach and the esophagus—which will demonstrate more serious manifestations than just foul odor.
In the case of allyl methyl sulfide (the byproduct of garlic’s digestion), odor does not come from the stomach, since it does not get metabolized there.
Systemic diseases There are a few systemic (non-oral) medical conditions that may cause foul breath odor, but these are extremely infrequent in the general population. Such conditions are:
1.Fetor hepaticus: an example of a rare type of bad breath caused by chronic liver failure.
2.Lower respiratory tract infections (bronchial and lung infections).
3.Renal infections and renal failure.
5.Trimethylaminuria (“fish odor syndrome”).
Individuals afflicted by the above conditions often show additional, more diagnostically conclusive symptoms than bad breath. People troubled by bad breath should not conclude that they suffer from these conditions or disease. Diagnosis
Scientists have long thought that smelling one’s own breath odor is often difficult due to acclimatization, although many people with bad breath are able to detect it in others. Research has suggested that self-evaluation of halitosis is not easy because of preconceived notions of how bad we think it should be. Some people assume that they have bad breath because of bad taste (metallic, sour, fecal, etc.), however bad taste is considered a poor indicator.
For these reasons, the simplest and most effective way to know whether one has bad breath is to ask a trusted adult family member or very close friend (“confidant”). If the confidant confirms that there is a breath problem, he or she can help determine whether it is coming from the mouth or the nose, and whether a particular treatment is effective or not.
One popular home method to determine the presence of bad breath is to lick the back of the wrist, let the saliva dry for a minute or two, and smell the result. This test results in overestimation, as concluded from research, and should be avoided. A better way would be to lightly scrape the posterior back of the tongue with a plastic disposable spoon and to smell the drying residue. Home tests that use a chemical reaction to test for the presence of polyamines and sulfur compounds on tongue swabs are now available, but there are few studies showing how well they actually detect the odor. Furthermore, since breath odor changes in intensity throughout the day depending on many factors, multiple testing sessions may be necessary.
If bad breath is persistent, and all other medical and dental factors have been ruled out, specialized testing and treatment is required. Hundreds of dental offices and commercial breath clinics now claim to diagnose and treat bad breath. They often use some of several laboratory methods for diagnosis of bad breath:
1.Halimeter: a portable sulfide monitor used to test for levels of sulfur emissions (to be specific, hydrogen sulfide) in the mouth air. When used properly, this device can be very effective at determining levels of certain VSC-producing bacteria. However, it has drawbacks in clinical applications. For example, other common sulfides (such as mercaptan) are not recorded as easily and can be misrepresented in test results. Certain foods such as garlic and onions produce sulfur in the breath for as long as 48 hours and can result in false readings. The Halimeter is also very sensitive to alcohol, so one should avoid drinking alcohol or using alcohol-containing mouthwashes for at least 12 hours prior to being tested. This analog machine loses sensitivity over time and requires periodic recalibration to remain accurate.
2.Gas chromatography: portable machines, such as the OralChroma, are currently being introduced. This technology is specifically designed to digitally measure molecular levels of the three major VSCs in a sample of mouth air (hydrogen sulfide, methyl mercaptan, and dimethyl sulfide). It is accurate in measuring the sulfur components of the breath and produces visual results in graph form via computer interface.
3.BANA test: this test is directed to find the salivary levels of an enzyme indicating the presence of certain halitosis-related bacteria.
4.?-galactosidase test: salivary levels of this enzyme were found to be correlated with oral malodor.
Although such instrumentation and examinations are widely used in breath clinics, the most important measurement of bad breath (the gold standard) is the actual sniffing and scoring of the level and type of the odor carried out by trained experts (“organoleptic measurements”). The level of odor is usually assessed on a six-point intensity scale
Teeth brushing, flossing, mouthwashes and breath mints are effective in many instances, but these yield only temporary, symptomatic relief. Although bad breath is a common complaint, identifying the cause and developing an appropriate treatment plan can be difficult. The underlying cause must be identified before the appropriate therapy/remedy can be chosen. In all cases, the first thing to do is to consult your dentist to check that the cause does not lie in the mouth.
Mouthwashes: – Remember, mouthwashes are only applicable when the source of the problem lies with bacteria in the mouth. Remember also that a mouthwash is symptomatic treatment and does not treat the underlying cause (eg. bacterial growth in a cavity).
A two-phase (ie. oil-water) mouthwash has recently been developed because many oral microorganisms possess hydrophobic outer surfaces and may therefore arequireoil/water base to remove such oral microorganisms.
In one study (1) olive oil and other essential oils was mixed with an aqueous phase including cetylpyridinium chloride, which is a disinfectant that promotes the adhesion of microorganisms to oil droplets. This study found that whereas a reduction of only 30% of sulfide was observed when a commercial mouthwash was used, this two-phase mouthwash led to approximately 80% reduction of sulfide. Furthermore, volatile sulfide and 2-ketobutyrate in saliva putrefaction system were completely inhibited by the two-phase mouthwash. It concluded that the two-phase mouthwash strongly inhibits the production of volatile sulfide and is therefore a valuable help in eliminating bad breath.
The mouthwash, Listerine, is a solution for washing the oral cavity consisting of essential oils (thymol, methanol, eukalyptol) and methyl salicylate. One study (2) found that Listerine inhibited the growth of microorganisms over a very broad range. The bactericidal action of Listerine against from bacteria isolated from saliva and dental plaque from 5 healthy normal subjects was tested. Listerine exhibited a potent bactericidal effect on bacteria in saliva and dental plaque. Most of the bacteria died after a 30 second exposure to Listerine. According to the results, Listerine therefore does appear to be effective as a solution used for cleansing the oral cavity and dentures.
At the current time, chronic halitosis is not very well understood by most physicians and dentists, so effective treatment is not always easy to find. Six strategies may be suggested:
1.Gently cleaning the tongue surface twice daily is the most effective way to keep bad breath in control; that can be achieved using a tongue cleaner or tongue brush/scraper to wipe off the bacterial biofilm, debris, and mucus. An inverted teaspoon may also do the job; a toothbrush should be avoided, as the bristles only spread the bacteria in the mouth, and grip the tongue, causing a gagging reflex. Scraping or otherwise damaging the tongue should be avoided, and scraping of the V-shaped row of taste buds found at the extreme back of the tongue should also be avoided. Brushing a small amount of antibacterial mouth rinse or tongue gel onto the tongue surface will further inhibit bacterial action.
2.Eating a healthy breakfast with rough foods helps clean the very back of the tongue.
3.Chewing gum: Since dry-mouth can increase bacterial buildup and cause or worsen bad breath, chewing sugarless gum can help with the production of saliva, and thereby help to reduce bad breath. Chewing may help particularly when the mouth is dry, or when one cannot perform oral hygiene procedures after meals (especially those meals rich in protein). This aids in provision of saliva, which washes away oral bacteria, has antibacterial properties and promotes mechanical activity which helps cleanse the mouth. Some chewing gums contain special anti-odor ingredients. Chewing on fennel seeds, cinnamon sticks, mastic gum, or fresh parsley are common folk remedies.
4.Gargling right before bedtime with an effective mouthwash (see below). Several types of commercial mouthwashes have been shown to reduce malodor for hours in peer-reviewed scientific studies. Mouthwashes may contain active ingredients that are inactivated by the soap present in most toothpastes. Thus it is recommended to refrain from using mouthwash directly after toothbrushing with paste (also see mouthwashes, below).
5.Maintaining proper oral hygiene, including daily tongue cleaning, brushing, flossing, and periodic visits to dentists and hygienists. Flossing is particularly important in removing rotting food debris and bacterial plaque from between the teeth, especially at the gumline. Dentures should be properly cleaned and soaked overnight in antibacterial solution (unless otherwise advised by your dentist).
Before discussing them, it is important to note that there has not been a single documented medical case of successfully cured chronic halitosis using any of the currently available mouthwashes. Mouthwashes often contain antibacterial agents including cetylpyridinium chloride, chlorhexidine, zinc gluconate, essential oils, and chlorine dioxide. Zinc and chlorhexidine provide strong synergistic effect. They may also contain alcohol, which is a drying agent. Rinses in this category include Scope and Listerine.
Other solutions rely on odor eliminators like oxidizers to eliminate existing bad breath on a short-term basis.
A relatively new approach for home-care of bad breath is by oil-containing mouthwashes. The use of essential oils has been studied, was found effective and is being used in several commercial mouthwashes, as well as the use of two-phase (oil:water) mouthwashes, which have been found to be effective in reducing oral malodor. also advances in oral science has made advice websites available world wide.
According to traditional Ayurvedic medicine, chewing areca nut and betel leaf is an excellent remedy against bad breath. In South Asia, it was a custom to chew areca or betel nut and betel leaf among lovers because of the breath-freshening and stimulant drug properties of the mixture. Both the nut and the leaf are mild stimulants and can be addictive with repeated use. The betel nut will also cause tooth decay and dye one’s teeth bright red when chewed.
Society and culture
Bad breath often evokes a reaction characteristic of disgust among those who interact with bad breath sufferers. This is a natural defensive reaction designed to protect the body from potential sources of disease: The major chemical compounds of bad breath are the same as those emitted by rotting food (Putrescine), feces (Skatole), and even dead bodies (Cadaverine), all potential sources of disease and infection.
When the brain detects these compounds, it protects the body by forcing physical recoil (which moves the body away), scrunching up the nose (which constricts the nasal passages, and prevents further intake of noxious odors), and by causing gagging (which stops anything being swallowed). It may also produce nausea and vomiting, which ejects anything that has already been swallowed. Although these reactions are involuntary, they are often misinterpreted as a personal judgement on the sufferer, and can severely damage personal relationships.
Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.
Bruxism (from the Greek (brugmós), “gnashing of teeth“) is characterized by the grinding of the teeth and is typically accompanied by the clenching of the jaw. Bruxism can be defined as the grinding of teeth for non-functional purposes. Some authors refer to nocturnal grinding as bruxism while the term bruxomania is given for grinding during the day time. It is an oral parafunctional activity that occurs in most humans at some time in their lives. In most people, bruxism is mild enough not to be a health problem. While bruxism may be a diurnal or nocturnal activity, it is bruxism during sleep that causes the majority of health issues and can even occur during short naps. Bruxism is one of the most common sleep disorders.
CLICK & SEE Bruxism led to the loss of nearly 50% of this patient’s visible tooth structure.
Bruxism is a chronic habit of clenching or grinding the teeth. Its significance lies in the potential damage the habit can cause to all three elements of the body’s “stomatognathic system” (i.e. the teeth, jaw muscles, and jaw joints).
If you find yourself waking up with sore jaw muscles or a headache, you may be suffering from bruxism — the grinding and clenching of teeth. Bruxism can cause teeth to become painful or loose, and sometimes parts of the teeth are literally ground away. Eventually, bruxism can destroy the surrounding bone and gum tissue. It can also lead to problems involving the jaw joint, such as temporomandibular joint syndrome. Signs:
BruxismFor many people, bruxism is an unconscious habit. They may not even realize they’re doing it until someone comments that they make a horrible grinding sound while sleeping. For others, a routine dental checkup is when they discover their teeth are worn or their tooth enamel is fractured.
Other potential signs of bruxism include aching in the face, head and neck. Your dentist can make an accurate diagnosis and determine if the source of facial pain is a result from bruxism.
Most bruxers are not aware of their bruxism, and only 5% go on to develop symptoms, such as jaw pain and headaches, which will require treatment. In many cases, a sleeping partner or parent will notice the bruxism before the person experiencing the problem becomes aware of it.
Bruxism can result in abnormal wear patterns of the occlusal surface, abfractions and fractures in the teeth. This type of damage is categorised as a sign of occlusal trauma.
Over time, dental damage will usually occur. Bruxism is the leading cause of occlusal trauma and a significant cause of tooth loss and gum recession. CLICK & SEE
The effects of bruxism on an anterior tooth, revealing the dentin and pulp which are normally hidden by enamel
In a typical case, the canines and incisors of the opposing arches are moved against each other laterally, i.e., with a side-to-side action, by the medial pterygoid muscles that lie medial to the temporomandibular joints bilaterally. This movement abrades tooth structure and can lead to the wearing down of the incisal edges of the teeth. People with bruxism may also grind their posterior teeth, which will wear down the cusps of the occlusal surface. Bruxism can be loud enough to wake a sleeping partner. Some individuals will clench the jaw without significant lateral movements. Teeth hollowed by previous decay (caries), or dental drilling, may collapse, as the cyclic pressure exerted by bruxism is extremely taxing on the tooth structure.
Patients may present with a variety of symptoms, including:
1.Anxiety, stress, and tension
7.Sore or painful jaw
Eventually, bruxism shortens and blunts the teeth being ground and may lead to myofascial muscle pain, temporomandibular joint dysfunction and headaches. In severe, chronic cases, it can lead to arthritis of the temporomandibular joints. The jaw clenching that often accompanies bruxism can be an unconscious neuromuscular daytime activity, which should be treated as well, usually through physical therapy (recognition and stress response reduction).
Multiple articles have incorrectly cited bruxism as a reflex chewing activity; bruxism is more accurately classified as a habit. Reflex activities happen reliably in response to a stimulus, without involvement of subconscious brain activity, and bruxism does not. All habitual activities are triggered by one kind of stimulus or another, and that does not make the habit a reflex. Chewing is a complex neuromuscular activity that is controlled by subconscious processes, with higher control by the brain. During sleep, the subconscious processes become active, while the higher control is inactive, resulting in bruxism. Some bruxism activity is rhythmic (like chewing), and some is sustained (clenching). Researchers classify bruxism as “a habitual behavior, and a sleep disorder.”
The etiology of problematic bruxism is unknown, though several conditions are known to be linked to bruxism. It is theorized that certain medical conditions can trigger bruxism, including digestive ailments and anxiety. Other Causes of Tooth Wear Bruxing isn’t the only cause of tooth wear. Here are a couple other common sources:
?Teeth that don’t mesh properly can wear at an accelerated rate, even under normal function. If you have this problem (known as “malocclusion” in dental terms), ask your dentist if orthodontic treatment might be an option.
?Factitious habits: Repeatedly chewing on hard or abrasive objects, biting your nails, grinding sunflower seed husks and other habits like these can accelerate the formation of wear facets (flattened planes) and chips on your teeth. An occlusal guard won’t help with this, but you may need the chipped or worn teeth repaired with bonding, fillings, or crowns. And you should try to quit the habit to avoid re-occurrence.
You may click to learn more: Diagnoses ›Factitious habits Diagnoses:
Bruxism can sometimes be difficult to diagnose by visual evidence alone, as it is not the only cause of tooth wear. Over-vigorous brushing, abrasives in toothpaste, acidic soft drinks and abrasive foods can also be contributing factors, although each causes characteristic wear patterns that a trained professional can identify. Additionally, the presenting symptoms may be difficult for a physician to attribute to bruxism.
The effects of bruxism may be quite advanced before sufferers are aware they brux. Abraded teeth are usually brought to the patient’s attention during a routine dental examination. If enough enamel has been abraded, the softer dentin will be exposed, and abrasion will accelerate. This opens the possibility of dental decay and tooth fracture, and in some people, gum recession. Early intervention by a dentist is advisable.
The most reliable way to diagnose bruxism is through EMG (electromyographic) measurements. These measurements pick up electrical signals from the chewing muscles (masseter and temporalis). This is the method used in sleep labs. There are three forms of EMG measurement available to consumers for use outside sleep labs. The first is bedside EMG units similar to those used by sleep labs. These units can be purchased for about $2000 and pick up their signals from facial muscles through wires connecting the bedside unit to electrodes that are adhesively attached to the user’s face. TENS electrodes or ECG electrodes may be used.
The second type of EMG measurement available to consumers is a self-contained EMG measurement headband sold under the trade name SleepGuard, available on loan from some dentists or at a rental rate of $50 per month from the manufacturer. The EMG measurement headband does not require adhesive electrodes or wires attached to the face. While it does not record the exact time, duration, and strength of each clenching incident as the most expensive bedside EMG monitors do, it does record the total number of clenching incidents and the total clenching time each night. These two numbers easily distinguish clenching from rhythmic grinding and allow dentists to quantify severity levels accurately.
Bedside EMG units and the self-contained EMG measurement headband can both be used either in silent mode as a diagnosis measurement or in biofeedback mode as a treatment.
A third method of diagnosis using EMG is available in disposable form under the trade name BiteStrip. The BiteStrip is a self-contained EMG module that adhesively mounts to the side of the face over the masseter muscle. The BiteStrip can only do one night of measurement and does not display the clench count or total clenching time, but rather provides a single-digit display related to bruxism severity. The BiteStrip provides significantly less information than an EMG bedside unit or EMG headband and costs about $60 per day to use.
Associated factors: The following factors are associated with bruxism:
*Malocclusion, in which the upper and lower teeth occlude in a disharmonic way, e.g., through premature contact of back teeth
*Relatively high levels of consumption of caffeinated drinks and foods, such as coffee, colas, and chocolate
*High levels of blood alcohol
*High levels of anxiety, stress, work-related stress, irregular work shifts, stressful profession and ineffective coping strategies
*Drug use, such as SSRIs and stimulants, including methylenedioxymethamphetamine (ecstasy), methylenedioxyamphetamine (MDA), methylphenidate and other amphetamines, *including those taken for medical reasons .
*Hypersensitivity of the dopamine receptors in the brain
*GHB and similar GABA-inducing analogues such as Phenibut, when taken with high frequency
*Disorders such as Huntington’s and Parkinson’s diseases.
*Obsessive Compulsive Disorder
Many cases of bruxism are associated with emotional and psychological disturbances. Thus appropriate psychological counseling by a psychiatrist may be initiated. Hypnosis, relaxing exercise and massage can help in relieving muscle tension. Occlusal adjustments have to carried out to eliminate prematurities. Night guards or other occlusal splints that cover the occlusal surfaces of teeth help in eliminating occlusal interference, prevent occlusal wear and break the neuromuscular adaptation.
*Relax your facial and jaw muscles throughout the day. The goal is to make facial relaxation a habit.
*Massage the muscles of the neck, shoulders, and face.
*Learn physical therapy stretching exercises to help the restore a normal balance to the action of the muscles and joint on each side of the head.
*Apply ice or wet heat to sore jaw muscles
*Avoid eating hard foods like nuts, candies, steak.
*Drink plenty of water every day.
*Try to reduce your daily stress and learn relaxation techniques.
*Get plenty of sleep.
There is no single accepted cure for bruxism. However, treatments are available.
Bruxism may be reduced or even eliminated when the associated factors, e.g., sleep disorders, are treated successfully.
Mouthguards and splints
Ongoing management of bruxism is based on minimizing the abrasion of tooth surfaces by the wearing of an acrylic dental guard, or splint, designed to the shape of an individual’s upper or lower teeth from a bite mold. Mouthguards are obtained through visits to a dentist for measuring, fitting, and ongoing supervision. There are four possible goals of this treatment: constraint of the bruxing pattern such that serious damage to the temporomandibular joints is prevented, stabilization of the occlusion by minimizing the gradual changes to the positions of the teeth that typically occur with bruxism, prevention of tooth damage, and the enabling of a bruxism practitioner to judge—in broad terms—the extent and patterns of bruxism through examination of the physical indentations on the surface of the splint. A dental guard is typically worn on a long-term basis during every night’s sleep. Although mouthguards are a first response to bruxism, they do not in fact help cure it. These mouthguards can cost anywhere from $200 to $650. Professional treatment is medically recommended to ensure proper fit, make ongoing adjustments as needed.
Another type of device sometimes given to a bruxer is a repositioning splint. A repositioning splint may look similar to a traditional night guard, but is designed to change the occlusion, or bite, of the patient. Randomly controlled trials with these type devices generally show no benefit over more conservative therapies.
Nociceptive trigeminal inhibitor
The NTI-tss device is another option that can be considered. Nociceptors are nerves that sense and respond to pressure. The trigeminal nerve supplies the face and mouth. The NTI appliance fits on top of the teeth and alters the angle at which the jaw opens, by covering only the front teeth and preventing the rear molars from coming into contact, thus limiting the contraction of the temporalis muscle. When the grinding starts in the night the pressure which is applied to the two front teeth can, it is claimed, send quite a strong alarm signal to the brain. The NTI device must be fitted by a dentist.
The efficacy of such devices is debated. Some writers propose that irreversible complications can result from the long-term use of mouthguards and repositioning splints.
Various biofeedback devices are currently available, and effectiveness varies significantly depending on whether the biofeedback is used only during waking hours, or during sleep as well. Many authorities remain unconvinced of the efficacy of daytime-only biofeedback. The efficacy of biofeedback delivered during sleep can depend strongly on daytime training, which is used to establish a Pavlovian response to the biofeedback signal that persists during sleep.
The first wearable nighttime bruxism biofeedback device (introduced in 2001), was originally sold under the trademark GrindAlert by BruxCare, and is now sold under the trademark SleepGuard by Holistic Technologies, which owns the patents on the technology. The SleepGuard biofeedback headband is a battery-powered device that sounds a tone against the forehead when it senses EMG (electromyographic) muscle activity in the temporalis muscles. The tone starts out very quiet and then gets louder, allowing people to stop clenching without waking up. This device records and displays nightly data on the number of bruxism events that last for at least two seconds and the total accumulated duration of those events. The volume of the alarm and the bite force required to trigger the device are adjustable. After proper Pavlovian training during waking hours, more than 50% of users achieve significantly reduced bruxism. The biofeedback sound on the headband is designed to come on slowly, allowing users to subconsciously respond in their sleep without waking up. The manufacturer offers a free three-week trial so that only people who find the device works well for them have to pay for it and claims that less than 15% of trial units are returned.
A mild electric shock bio-feedback device for treating Bruxism, GrindCare, has been approved by the European regulatory authorities and was introduced to the market in 2Q2008 – and was approved by FDA Authorities in the US in early 2010. The device works by using simple electrodes mounted on the skin close to the cheek bones prior to sleeping; it detects the initial muscular contractions and immediately provides mild electrical shock pulses to the facial muscles. The electric shocks serve to interrupt bruxism activity. The device is worn on the head and reportedly reduces grinding, usually without interfering with the sleep of the patient as described by Jadidi, Castrillon & Svensson. Thereby facial tension, joint defects and teeth disruption are reportedly reduced.
A taste-based biofeedback method was developed by Moti Nissani, Ph.D. and is called “The Taste-Based Approach to the Prevention of Teeth Clenching and Grinding”. The therapy involves suspending sealed packets containing a bad-tasting substance (e.g. hot sauce, vinegar, denatonium benzoate, etc.) between the rear molars using an orthodontic-style appliance. Any attempt to bring the teeth together will rupture the packets and alert the user to the habit. This approach finds favor with some people who prefer to relate to biofeedback as “aversive therapy”. The Taste-Based Approach claims to suffer less from desensitization over time than sound-based biofeedback approaches may have, but may interrupt sleep more. (There is effectively no limit to the aversive taste of certain substances. We[who?] can therefore be sure that some harmless substance exists that will alert anyone to the habit.)
One bruxism biofeedback device which was briefly on the market but is no longer available was sold under the trademark Oralsensor. This device consisted of a pneumatic pouch embedded in a soft polymer plate that fits over upper or lower teeth. When the teeth came together with a force that exceeded a set threshold, an alarm is sounded in an earpiece worn by the user; the device is no longer sold.
In 2005, a new type of occlusive device was patented that produces a movement incompatible with teeth clenching. When nighttime bruxism occurs, people breathe through the nose. The device forces people to breathe through the mouth; by forcing the opening of the mouth, the device is claimed to stop clenching. The occlusive device has an electromyogram system that monitors the electric activity of the jaw muscle via wireless electrodes. These electrodes transfer jaw-muscle activity by radio frequency to an external monitoring system. Once the signal has been interpreted by the monitoring system, if a person clenches, the monitoring unit sends a radio frequency signal to a transceiver integrated in a mechanical actuator. The mechanical actuator has two occlusive flaps that block the nostrils, forcing breathing to occur through the mouth. Once the patient stops clenching, the flaps open, allowing breathing through the nose again. The occlusive device does not wake up people since it blocks nostrils slowly, and it never closes them completely to avoid sleep disruption.
Botulinum toxin (Botox) can be successful in lessening effects of bruxism, though serious side-effects are possible. Less than one microgram ingested or inhaled is sufficient to kill an adult human. In extremely dilute form (Botox), this toxin is used as an injectable medication that weakens (partially paralyzes) muscles and has been used extensively in cosmetic procedures to relax the muscles of the face and decrease the appearance of wrinkles. In April, 2008, a study was published in the Journal of Neuroscience that showed that facially injected Botox can and does propagate into the brains of some test animals, and the U.S. Food and Drug Administration (FDA) announced that it was beginning a safety review of Botox and other similar drugs.
Botox was not originally developed for cosmetic use. It was, and continues to be, used to treat diseases of muscle spasticity such as blepharospasm (eyelid spasm), strabismus (crossed eyes) and torticollis (wry neck). Bruxism can also be regarded as a disorder of repetitive, unconscious contraction of the masseter muscle (the large muscle that moves the jaw). In the treatment of bruxism, Botox works to weaken the muscle enough to reduce the effects of grinding and clenching, but not so much as to prevent proper use of the muscle. The strength of Botox is that the medication goes into the muscle and is not supposed to get absorbed into the body (though the new research shows it does). The procedure involves about five or six simple, relatively painless injections into the masseter muscle. It takes a few minutes per side, and the patient starts feeling the effects the next day. Occasionally, some bruising can occur, but this is quite rare. Injections must be repeated more than once per year, and the risk factor of spread of the botulinum toxin is compounded by this repetition.
The symptoms that can be helped by this procedure include:
*Grinding and clenching
*Morning jaw soreness
*Muscle tension throughout the day
*Migraines triggered by clenching
*Neck pain and stiffness triggered by clenching
The optimal dose of Botox must be determined for each person as some people have stronger muscles that need more Botox. This is done over a few touch-up visits with the physician injector. This treatment is expensive, but sometimes Botox treatment of bruxism can be billed to medical insurance. The effects last for about three months. The muscles do atrophy, however, so after a few rounds of treatment, it is usually possible either to decrease the dose or increase the interval between treatments.
Other authorities caution that Botox should only be used for temporary relief for severe cases and should be followed by diagnosis and treatment to prevent future bruxism or jaw clenching, suggesting that prolonged use of Botox can lead to permanent damage to the jaw muscle.
There is anecdotal evidence that suggests taking certain combinations of dietary supplements may alleviate bruxism; pantothenic acid, magnesium, and calcium are mentioned on dietary supplement websites. Calcium is known to be a treatment for gastric problems, and gastric problems such as acid reflux are known to increase bruxism .
Damaged teeth can be repaired by replacing the worn natural crown of the tooth with prosthetic crowns. Materials used to make crowns vary; some are less prone to breaking than others and can last longer. Porcelain fused to metal crowns may be used in the anterior (front) of the mouth; in the posterior, full gold crowns are preferred. All-porcelain crowns are now becoming more and more common and work well for both anterior and posterior restorations. To protect the new crowns and dental implants, an occlusal guard should be fabricated to wear during sleep.
Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.
Until a few decades back when natural tooth was lost, it was replaced by a removable partial Denture, or a fixed prosthesis, Each of these treatment options had their own disadvantages, With the advancement of technology and research, dentistry today has a better option for the replacement of a natural tooth – with dental implants. Dental implant is an artificial substitute to replace the root portion of teeth and put into the bone and gums of mouth. Replacement teeth are then fixed on to these new roots.Dental Implants are a Functional and Desirable Alternative to Conventional Bridges and Dentures . Dental implants allow people who are with missing teeth to be able to smile, speak and chew well and comfortably. .CLICK & SEE THE PICTURES What is Dental Implant?
A dental implant is a small man-made titanium screw that serves as the replacement for the root portion of a missing natural tooth. The implant is placed in the bone of the upper or lower jaw and allowed to bond with the bone and serve as an anchor for the replacement tooth. Dental implants can be used to replace a single lost tooth or many missing teeth. Implant supported replacement teeth look, feel and if you’re missing a tooth or more, you may find that there are other things you miss. You may miss your natural smile. You may miss the ability to chew apples, crackers and other food you desire. Maybe you feel self-conscious about your teeth and mouth, or discomfort as remaining teeth shift. And perhaps you’ve experienced muscle strains, an inability to speak clearly, headaches or unease in familiar situations at work, with friends or at home…..
How Do Dental Implants Work?
Dental implants act as artificial roots. They are surgically placed into your jaw, and are the closest substitute to natural teeth in form and function. Once a dental implant is firmly integrated into your jaw, it can be used to support single crowns, bridges and dentures. Whether you are missing one tooth, several teeth or all of your teeth, dental implants may be an option for you.
1. Endosseous Implant : These implants are usually shaped like a screw or cylinder. They are placed within the jaw bone. 2. Subperiosteal Implants : These Implants consist of mental frame work that attaches on top of the jaw bone but underneath the gum tissue. 3. Transosteal Implant : These implants are either a metal pin or a U – shaped frame that passes through the jaw bone and the gum tissue, in to the mouth.
Implants are made from metals and alloys such as Titanium, Titanium-Aluminium-V alloy, Chromium-cobalt-mobedium alloy, ceramics.
Advantage of Implant over traditional prosthesis:
The goal of modern dentistry is to return patientas to oral health in a predictable fashion. The partial and complete edentulous patient may be unable to recover normal function, esthetics, comfort, or speech with a traditional removable prosthesis.
The patient’s function when wearing a denture may be reduced to 60% compared with that formerly experienced with natural dentition, however, an implant prosthesis may return the function to near normal limits. The esthetics of the edentulous patient also is affected because of bone atrophy continued resorption leads to irreversible facial changes. An implant stimulates the bone and iMPLANTmaintains its dimension in a manner similar to healthy natural teeth. As a result, the facial features are not compromised by lack of support. In addition, implant supported restorations are positioned in relation to esthetics, function and speech, not in neutral zones of soft tissue support. The soft tissues of the edentulous patient are tender form the effects of thinning mucosa decreased salivary flow, and unstable or unretentive prosthesis.
The implant retained restoration does not require soft tissue support and improves oral comfort. Speech and function are compromised with prostheses form the supporting structures during use. The tongue and peri-oral musculature may be compromised to limit the movement of the mandibular prosthesis. The implant prosthesis is stable and retentive without the efforts of the musculature.
As soon as a tooth is lost the bone will degenerate and the teeth on either side will shift or tip into the empty space. If there is a tooth directly above or below the space it will over erupt, as there will not be anything to prevent it from coming out of the gum tissue. The majority of bone degeneration will occur within the first six months but will slowly continue for years. The movement of the adjacent teeth will not occur immediately; rather it will become noticeable after three to five years. How fast it occurs will depend on the density of bone in the area, your bite and how well your teeth occlude or interlock with each other.
CLICK & SEE
If you have missing teeth and you do not replace them, these movements will occur. These movements may create gum problems and /or decay and could lead to the loss of other teeth. As you lose more teeth, you will be forced to chew in other areas, and this often leads to tooth fracture from overloading, excessive wear and or TMJ (jaw joint) problems. Eventually more extensive and expensive dentistry may be required in the future.
There are several reasons that you want to replace a missing tooth or teeth. A tooth has many functions some being to chew, to speak, to keep the facial muscles and tissue in a proper position, to smile, and to keep the other teeth from shifting. Once a tooth is lost this whole balance is disrupted and it leads to many various problems.
For certain teeth, such as your wisdom teeth, it is unlikely that you will need to replace them. As adults we have three molar teeth and we do most (about 80%) of our chewing from the first molar to the first premolar/canine area. About 20% is done in the second molar area, and very little is done in the wisdom teeth area. Therefore, we seldom miss or need our wisdom teeth if they are absent or removed. The second molar does at times need replacing, depending on each individual’s situation.
In children, baby teeth maintain space for the developing permanent teeth. If baby teeth are lost early, crowding problems may be unnecessarily created and may require orthodontic treatment to correct. Baby teeth are generally not replaced with another tooth; however, an appliance (space maintainer) is often placed until the permanent tooth erupts.
Source: This article was published in WhereinCity Medical on 22nd. Oct.2009