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About Bruxisim (Clenching and Grinding)

On June 3, 2017


Do I clench? Am I a grinder? How can I tell? What’s the difference between one and the other anyway?

These are important questions that some of you may have asked. Others may have been told by their dentist that they are doing it, usually followed up by recommending the use of a mouth guard or night guard. In some circumstances, when a dentist detects signs of clenching and grinding he may recommend crowns, tmj treatment (temporal mandibular joint, located right next to your ear canal), selective  tooth grinding, among other things. I agree on all these treatments as relief for someone who suffers from this malady and I also like to get to the root of the problem, to know why my patient clenches and grinds.

So, let’s start by the title of the problem and take it from there. If you bring your teeth together and all upper and lower teeth are in contact and remain in this position, that’s clenching. If, while holding this position without bringing your teeth apart, you begin to move your mandible back and forth, left and right, even if it’s just a minor movement, then that’s grinding. And a bruxist is the patient who does the combination of both. Simple, right? In my opinion, you can’t be a grinder without being a clencher.

Ok, so let’s go back to the definition of clenching. Take into consideration that your upper teeth should only  make contact with their antagonist lower teeth while 1) chewing, 2) swallowing food, liquids or saliva 3) if you are using a protective guard, like during sports and 4) when your jaw searches for its ‘rest position’, lateral and prognathic movements… technical stuff not worth explaining. So this means that in any other situation other than these four, if you find yourself making upper and lower teeth contact, you are probably a clencher. Think about it, if while reading a book, driving, watching TV., even walking and you catch yourself making teeth contact, you are perhaps a clencher. Then, if after this you move your mandible around, then you are maybe a grinder as well; this normally occurs during the night.

Signs that might indicate you grind during sleep hours:

• You wake up feeling like you were chewing gum all night, like if you were lifting weights with your cheek muscles (weird, I know), you feel your whole body relaxed and ready to start your day but you feel your mouth tired.
• You see signs of wear and tear on the chewing surfaces of your teeth or around the gum line
• Your teeth are sensitive, especially around the gum line
• You begin to break teeth, fillings or crowns
• You have tmj pain

If you are assessed by a traditional dentist and he detects one or some of these signs, then he will recommend the according treatments. It is usually something like this:

• Sore chewing muscles = night guard
• Teeth wear and tear = fillings
• Sensitive teeth = sensitive tooth paste
• Broken fillings, teeth = crowns
• Tmj pain = referred to tmj specialist

Now let’s quickly review why you could clench or grind:

1.- Stress
2.- Anxiety
3.- Nervousness
4.- You developed a nervous tick
5.- Restlessness
6.- Traumatic reaction
7.- A previous dental filling was left too high
8.- You need braces ( malocclusion)

Personally, reasons #1 through #6 are all the same to me. They all come down to being stressed. Number 7 and 8 need to be attended accordingly. In my point of view, the main reason why the majority of people clenches and grinds their teeth is due to stress. Any type of stress, you name it: going through traffic, work, neighborhood, family issues, money, love, losing a love one or your job, expecting a child, winning the lottery, bills, among other. The first question to ask you is: “What could be stressing me out?” If you don’t have an answer, try guessing one. And this is step number 1: Identifying what is stressing you out. It is often the toughest step of all since it involves some deep inner awareness. Step number 2 is to deal with that issue appropriately to bring your level of stress down. It can be something as simple and routine as reading a book all the way to going to Yoga classes. It’s all about identifying what is the cause of stress and then dealing with it ; if it’s done naturally, all the better, although in some cases pharmaceuticals or non pharmaceuticals remedies are necessary. This might include one or many of the following:

• Doing Yoga, meditation or similar
• Praying
• Reading a book
• Walk in the beach or in a natural setting
• Begin your spiritual path
• Talking to a religious figure of your church
• Taking up a sport
• Breathing exercises
• Homeopathic
• Being assertive
• Among others

Easier said than done, right? Choose one or two that resonates to your lifestyle, something that would be simple for you to do and ease your way into them. So what can I, as a dentist, do for you in the mean time? Offer you a night guard, also called mouth guard or splint.

The guard is not the treatment for bruxism; it’s only a palliative solution while you work on what is stressing you out. The guard does two things for you: 1) keeps from grinding your tooth structure away (you’ll be grinding the acrylic away and you will need to replace it once you puncture through it) and 2) it will reprogram your jaw muscles and tmj to bring your grinding level / force down.

The trick is to control your stress level so you don’t have to depend on a mouth guard for the rest of your life.

On a personal note, every one of us needs to deal with stress in some way / level or another. Very few people live a stress-free life; I only know of one friend who lives like this, Johnny Blackburn. It is hard to get around stress, especially if it’s waiting for your right around the corner, on the next traffic light or once your reach your office. You cannot control any of these factors; it’s impossible to get rid of them; since you didn’t create them you cannot destroy them. The only thing you CAN control is how YOU are going to react to it. How your body is going to respond to stress…. and here is the magic of it all, you have absolute power over this. You can look stress right in the face and then be cool about it since you now have the information and tools to work on how your body will reply to it.

And in the mean time, let’s do your mouth guard.

What you need to know about Periodontal Disease

On April 3, 2017


Many of us have heard the term ‘periodontal disease’ but few have really considered this problem as a disease, that is to say, as an actual ailment.

Periodontal disease or periodontitis is the second stage of a first one, gingivitis. If you have it and do not take care of it, it can escalate to periodontitis, thus being more destructive and even more difficult to control. It can be with or without pain, reason why is considered very aggressive. If detected by your traditional dentist, they will probably offer deep pocket cleanings and antibiotic remedies as a treatment.

The approach that I like to take is, first of all, educating the patient of what this disease consist of. I believe that this is the first and most crucial step of all, having the patient actually understanding what his disease is, how it started and how to treat it at home by changing some routine oral hygiene habits. Think about it. This is an illness that the patient is living with 24/7 and is important that he acknowledges and address this malady with its importance. I consider that treating it is 80% patient compliance along with home care treatments and remedies and 20% dental chairside attention. It is very easy for the traditional dentist to just say “You need several appointment of deep pocket cleanings; after that, I will need to see you 4 times a year to continue with them”. Two things happen when saying this statement: 1) First, the dentist is taking away all sense of wellbeing responsibility from the patient; he is practically saying “I will do all the treatments; there is nothing you can do on your own”. And, 2) the dentist is almost giving a lifelong sentence of ‘deep pocket cleanings’ to him.

I prefer to empower my patients into being proactive in their gum care.

The dentist will clean his patient’s teeth, let’s say in about 60 min at the dental chair. But what will happen once the patient steps out of the dental office and has a taco and is not properly instructed on how to keep his deep pockets clean? Exactly, he will turn into a lifetime patient for deep pocket cleanings. A pretty awesome scenario for the dentist, not for the patient.

After educating the patient and providing him with sufficient knowledge to comprehend the whole scenario, he understands how his disease is directly linked with heart conditions and blood circulatory problems, such as diabetes and high blood pressure. You cannot completely take care of one without addressing the other; they go hand in hand.

Part of the education is to offer alternatives to traditional gum disease treatments. Many patients previously diagnosed with this ailment have had treatments and have continued struggling with his problem even after many years have passed since first detected. Gum disease can be controlled and, often, reversed but not if you continue doing your routing oral care habits at home and on the road. My approach is with support from holistic and alternative dentistry, remedies that can help you recover bone loss and receding gum line, often being able to improve deep pockets depths, teeth mobility and reduce tartar formation. Adding Schussler’s cell salts and xylitol into your diet can have a great impact on your oral and systemic health. Working with ozone gas and ozonated water greatly improves the outcome of your treatment. Reviewing the basics also helps a lot, that is to say re-learning how to brush, floss and the type of mouthwash to use.

Feel free to schedule an appointment to have a dental consultation in Tijuana along with gum probing and full dental x ray series to determine if you have gingivitis or periodontitis an to know and learn how to address it with a natural approach and you’ll be on your way to a better, healthier lifestyle.

Wisdom Teeth

On August 12, 2016

The wisdom teeth are the last ones to form, they erupt outside the gum approximately around the age of 17 and 22, but if there isn’t enough space in the mouth to fit them or if these molars come in a bad position (inclined) it could cause a lot of discomfort and pain. The most common problems caused by wisdom teeth in a bad position are cavities, either on them or on the tooth next to it, infection, bad breath, gum and crowded teeth problems. Also for being in the back of the mouth brushing becomes more complicating which favours bacteria to accumulate.

In my experience I recommend to extract these molars between the age of 16 and 24, because at this age the roots are less developed and the complications are minimal when removing them. Besides being young the tissue heals up better than when you are an adult.   

The way we evaluate how your wisdom teeth are doing is with a routine consultation, where we take an X ray which we’ll be able to determine if it’s better to keep the tooth or extract it.

If your molars comes in a good position we can do a routine extraction, if the molars comes inclined or blocked by bone, an oral surgery needs to be done.

Wisdom teeth are unpredictable and can cause discomfort at any moment, taking a pain killer will only make it better momentarily, it is better to take away the pain by its root.  

Teeth Whitening

On July 27, 2016

Teeth whitening is one of the most requested procedures done these days in the dental office because it is a simple and painless process and that gives an aesthetic benefit in only one hour.

We have to keep in mind the reasons why teeth start to turn darker. The first reason is age, because you start to lose the enamel layer and the dentin makes the tooth look more yellow; the second reason is the metal and/or composite restorations. With time, metal starts to pigment the rest of the tooth a greyish color and the composite when turning porous starts to pigment because of the drinks and food we eat. The third reason would be that the tooth has a root canal which devitalizes it and turns it grayish; and lastly the external agents like tobacco, coffee, wine and other tinted foods.

There are two types of teeth whitening, the interior and the exterior; the interior whitening is only done when a tooth has lost its pulp (root canal) turning grayish. The exterior whitening is a procedure that is done the most because of its aesthetic purpose, here we use a 40% hydrogen peroxide based gel which is applied to the surface of the teeth in 2 intervals of 20 minutes each.

It is important to know that the only side effect produced by a teeth whitening is dental sensitivity, which can be controlled by desensitizers.

The cares after doing the whitening will help the result last for more time, therefore the patient must be aware that his diet and habits will be what contributes to this result.