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Living with chronic facial pain can be very difficult for the sufferers and their loved ones. Often, diagnosis and treatment of chronic pain can be elusive. Since the pain can radiate outward in an area, it can be difficult to pin down the source of the pain. The source of the pain may be related to infection, nerve, or muscle tissue.  Botox may be the answer for many muscular issues. Botox can cause an overactive, painful muscle to become more flaccid and therefore relieve pain from muscle spasms allowing sufferers to be pain free.

What Can Botox Do?

Botox (a brand name of Botulinum Toxin for injection) is injected directly into a targeted muscle group. Once botox enters the muscle it prevents the muscle from recieving nerve commands. Without this command the muscles will not contract thus leaving them temporarily paralyzed. The most popular use of Botox is to relax facial muscles, removing wrinkles to give a more youthful appearance. Botox can be used throughout the facial muscles to paralyze the painful, spasming muscles related to grinding, clenching, headaches, etc. This paralysis can give much needed pain relief from overactive muscles for as long as 3 months at a time.

What Types Of Dental Pain Can Botox Treat?

-Temperomandibular Joint (TMJ) Pain. The temperomandibular joint is susceptible to disorders, as it consists of delicate moving parts. When any of these moving parts are not in proper alignment pain can be the result. The major reason for damage is due to chronic bruxism (teeth grinding) or teeth clenching. With Botox use in the TMJ area, the muscles of the jaw are allowed to relax and prevent it from contracting, decreasing the grinding or clenching, and in turn decreasing pain.

-Myofacial Pain Syndrome. This is considered a chronic pain disorder. This syndrome occurs when pressure is placed on sensitive points in your muscles. These are called trigger points. When this “trigger point” pressure occurs, the pain can does not always occur at the source, but may begin at a different location from the source of the pressure. This is called referred pain and may be very difficult to accurately diagnose. Myofacial pain syndrome typically occurs after a muscle has been contracted repetitively. This can be caused by repetitive motions used in jobs or hobbies or by stress. Myofacial pain can stem from problems with your TMJ / jaw muscles, or forehead muscles. Myofacial pain can be sudden and debilitating.

-Arthritis. Early studies have shown that Botox injections appear to reduce arthritis pain in the shoulder, knee and hip. These results are promising, and may be helpful in patients with arthritis along with TMJ pain, but further research is needed.

Botox Conclusion

When it comes to chronic pain it is difficult to predict how each patient will respond. It is important to note that an infection should always be ruled out, and diagnosis by your dentist or medical doctor should be conclusive before trying  Botox treatment. Botox may just be the answer to many to relieve them of their chronic pain in the short term. While still being studied, it could be a key component in relieving the symptoms of those suffering from chronic pain.

As we get go down the inevitable path of aging, health problems arise that we never expected. This includes oral health changes that can be kept at bay with proper care. Below you will find a list of some of the common dental health issues seniors face.

Common Dental Health Issues For Seniors

-Xerostomia (Dry Mouth). This occurs when salivary flow is reduced. This can occur from many factors such as medications, Sjogren’s syndrome, or even from radiation therapy to the head and neck area. Saliva is the body’s natural defense against the bacteria and food debris that can build up in our mouths. Without proper flow, tooth decay and periodontal disease has an increased chance of developing creating problems for your oral health.

-Darker Smile. This is a  cumulative effect of thinning enamel (exposing more of the underneath layer, the dentin) and a lifetime of eating and drinking stain causing food and drink. For many a simple teeth whitening can bring back the bright, white shine for others it may require more extensive cosmetic dentistry.

-Decay Along The Roots Of Teeth. As we age and are not as diligent over time with our dental hygiene, the gum tissue surrounding our teeth can recede as we lose bone. This recession will expose portions of the tooth known as the root. These areas are much less protected and more vulnerable to developing tooth decay. Simce this area is thinner, this tooth decay can progress rapidly leading to tooth sensitivity and possibly the need for root canal therapy.

-Changes In Taste. We have all heard the sayings how our tastes change as we get older. We make different choices in our nutrition as we get older. Other items that can contribute changes to our taste sensation include disease, medications, and even dentures.

-Periodontal Disease. This is not just a disease for young or old. It affects both equally but tends to rear itself more in the older population. This is due to usually slow progression of the disease. It is important to note keeping periodontal disease at bay will stave off tooth loss as we age. A full smile is a youthful looking one.

-Tooth Loss. This can occur for many reasons including periodontal disease, trauma, or untreated tooth decay. It is important to replace lost teeth whenever possible as it prevents your bite from shifting creating issues with your Temperomandibular Joint (TMJ).

-Temperomandibular Joint Disorder. This is generally a slow developing disorder. Hence, it seems to be more likely in an older person than a younger one. The bones and the disc in this joint will break down over time from bad habits like teeth grinding or even chewing hard candy over a long period of time.

-Denture Induced Stomatitis. This is simply an inflammation of the tissues beneath a denture. This is caused by dentures that do not fit properly, poor oral hygiene, or can even be caused by a fungus (Candida Albicans, also known as thrush).

What Can Be Done To Combat These Issues For Seniors?

The main thing is to maintain dental hygiene throughout life. This includes brushing at least 2x per day, flossing at least 1x per day, and using an antibacterial rinse. Dental hygiene tends to become more difficult for many as they age due to arthritis. This makes hands dexterity and strength an issue. Luckily, there are many wonderful products on the market to help with these situations. And it is also important to keep up with your scheduled dental visits for examinations (including oral cancer screenings) and professional cleanings. Doing the right things can be hard sometimes but doing them will pay off over the long run leading to a happy, healthy more youthful looking smile as we age.

The temporomandibular joint (TMJ) is the area right in front of the ear on either side of the head where the upper jaw (maxilla) and lower jaw (mandible) meet. Muscles attached to and surrounding the jaw joint control the position and movement of the jaw. This joint is a unique sliding “ball and socket” that has a disc sandwiched between it, it is the only joint in the body which can move in all directions. The temporomandibular joint functions to move the jaw, especially in biting and chewing, talking, and yawning. It is one of the most used joints in the body.

The temporomandibular joints are very complex and are made up of muscles, tendons, a disc and bones.You have a temperomandibular joint on each side of your jaw (right and left side). Each part contributes to the smooth movement of the temperomandibular joint. When the muscles are relaxed and in balance and both jaw joints open and close comfortably, we are able to talk, chew, or yawn without discomfort or pain.

TMJ Syndromes

TMJ Symptoms

We can find the TMJ by placing a finger on the triangular area in front of the ear. The finger is moved just slightly forward and pressed firmly while opening the jaw. The motion felt is from the TMJ opening. We can also feel the joint motion if we put a little finger against the inside front part of the ear canal. If a patient is experiencing TMJ difficulty the simple act of opening and closing your mouth can cause considerable pain. Opening your mouth allows the rounded ends of the lower jaw (condyles) to glide along the joint socket of the temporal bone. The condyles are able to slide back to their original position when you close your mouth. The motion is kept smooth by a soft disc of cartilage that lies between the condyle and the temporal bone, creating a gliding cushion so that bone doesn’t rub across bone.  Chewing creates a very strong force. This disc is able to distribute the forces of chewing throughout the joint space.

TMJ disorders (also called TMJ Syndromes) are a complex set of problems of the jaw joint. The muscles and joints work as a team. A problem with either one can lead to stiffness, headaches, ear pain, bite problems ( also called a malocclusion), clicking sounds, or locked jaws. TMJ disorders can be caused by many different types of problems. These can include arthritis, trauma to the jaw, or muscle fatigue from clenching or grinding your teeth. TMJ disorders most commonly occur in women between the ages of 30 and 50, but can occur in teens after braces, and in both men and women at any age.

Behaviors that can Lead to TMJ Disorders

-Teeth grinding (bruxism) speeds up the wear and tear on the cartilage lining of the TMJ. People who grind or clench their teeth may be not even be aware they are doing it. Many patients wake in the morning with jaw pain, ear pain or even a headache. Teeth grinding as a habit can result in muscle spasm and inflammatory reactions, thus causing the initial pain. Changes in the normal stimuli or height of the teeth, misalignment of the teeth, and changes in the chewing muscles may cause temporomandibular joint changes. Generally, someone who has a teeth grinding habit usually does so during his or her sleep.

TMJ Syndrome

TMJ – Avoid Stress

-Teeth Clenching. People who clench continually bite on things while awake. This might be as simple as chewing gum, a pen or pencil, or even fingernails. The constant pounding on the joint causes the pain. Stress is often the leading cause of teeth clenching.

-Habitual gum chewing or fingernail biting

-Dental problems and misalignment of the teeth (malocclusion). Patients may complain that it is difficult to find a  comfortable bite or that the way their teeth fit together has changed.  Chewing on only one side of the jaw can lead to or be a result of TMJ  problems.

-Trauma to the jaws: Previous fractures in the jaw or facial bones can lead to TMJ disorders.

Trauma is split into 2 types: micro trauma and macro trauma.

Micro trauma is considered internal, such as grinding the teeth (bruxism) and clenching (jaw tightening). This continuous pounding on the temporomandibular joint can change the alignment of the teeth. The muscle involvement causes inflammation of the membranes surrounding the joint. Teeth grinding and clenching are habits that may be diagnosed in people who complain of pain in the temporomandibular joint or have facial pain that includes the muscles involved in chewing.

Macro trauma is from an external trauma like a punch to the face or a car accident. This trauma can fracture the jawbone, cause dislocation of the TMJ, or cause damage to the cartilage disc of the joint. Pain in the TMJ can also occur following dental treatment whereby the joint is stretched open for extended periods of time. Massage and heat application following your dental appointment can help relive the discomfort.

-Stress frequently leads to unreleased nervous energy. It is very common for people under stress to release this nervous energy by either consciously or unconsciously grinding  and clenching their teeth.

-Routine tasks or habits such as holding the telephone between the head and shoulder may contribute to TMJ disorders.

-Anatomy. You may have a malformed jawbone, joint, or disc, leading to poor function, wear and pain.

TMJ pain can usually occur because of unbalanced activity, spasm, or overuse of the jaw muscles. Symptoms tend to be chronic, and treatment is aimed at eliminating the cause. Many symptoms may not appear related to the TMJ itself.

 

Common TMJ Disorder Symptoms

-Headache. About 80% of patients with a TMJ disorder complain of headache and about 40% report facial pain, and ear pain. Pain is often worsened while opening and closing the jaw. Exposure to cold weather or air may increase muscle contraction and facial pain.

-Ear pain. About one half of patients with a TMJ disorder notice ear pain and do not have any signs of ear infection. The ear pain is usually described as being in front of or below the ear. Because ear pain occurs so commonly in TMJ patients. Ear specialists are routinely called on to make the definitive diagnosis of a TMJ disorder.

-Sounds. Grinding, crunching, clicking, or popping sounds (medical term = crepitus) are common for patients with a TMJ disorder. These sounds are not always associated with increased pain.

-Dizziness. Approximately 40% report a slight sense of dizziness or imbalance. The cause of this type of dizziness is not known.

-Fullness of the Ear. About one third of patients with a TMJ disorder describe muffled, clogged, or full ears. They may be aware of ear fullness and pain during airplane takeoffs and landings. These symptoms are usually caused by Eustachian-tube dysfunction (structure responsible for the regulation of pressure in the middle ear). It is believed that patients with TMJ syndromes have hyperactivity (muscle spasms) of the muscles responsible for regulating the opening and closing of the Eustachian tube.

-Tinnitus (ringing or noise in ear). For reasons unknown, 33% of patients with a TMJ disorder experience tinnitus. 50% of those patients will have resolution of their tinnitus after successful treatment of their TMJ disorder.

Diagnosis

Many  conditions can cause similar symptoms to TMD. These include a toothache, sinus problems, arthritis, ear infection, or gum disease. Your dentist will conduct a careful patient history, dental examination, and take necessary x-rays to determine the cause of your symptoms.  A CT scan can provide the doctor or dentist very detailed images of the bones involved in the joint and MRI’s can show issues with the joint’s disk.

Treatment

Patients TMJ issues can sometimes go away on their own. If your symptoms persist, your doctor may recommend medications or a night guard to help keep you from grinding your teeth at night. Surgery may be required (in very rare cases) to repair or replace the joint. Conventional treatment consists of a diet of soft foods along with warm compresses to settle down the tension of the muscles.

Medications for Treatment of TMJ Disorders

-Painkillers. Dentist or doctor will recommend over the counter medications (like Aleve or Motrin), or prescription medications such as Dolobid are a first option to relieve pain. If pain continues, they may prescribe something stronger to deal with pain.

-Tricyclic antidepressants (Amitriptyline or Nortriptyline). Antidepressants prescribed to be taken at bedtime have been successful in relieving TMJ pain in some patients.

-Muscle relaxants (Valium). These types of drugs are sometimes used for a few days or weeks to help relieve pain caused by TMJ disorders.

-Corticosteroid drugs. These drugs can be injected into the joint space to provide relief. This is only used in patients with sever pain and discomfort.

Aleve for TMJ Symptoms

Aleve for TMJ Symptoms

-Botulinum toxin. Injecting botulinum toxin (example Botox) into the jaw muscles may give relief to pain associated with TMJ disorders.

Therapies Available

-Night Guard. For patients who grind their teeth patients may gain from wearing a  firm custom made appliance. This night guard prevents your teeth from coming together in contact, and repositions teeth to decompress the jaw joint.

-Psychological Therapy. For patients whose main symptom is from stress or anxiety they may benefit from a visit to a psychotherapist. This would allow the patient to become self aware of stress triggers as well learning relaxation techniques to relieve stress.

Surgical Treatment

-Dental Adjustments. Your dentist may improve your bite by adjusting the biting surfaces of your teeth. This will allow for your bite to be in a more balanced state. Other options include replacing missing teeth, or replacing needed fillings or crowns. These actions sometimes worsen TMJ pain.

-Joint Aspiration (Arthrocentesis). This procedure allows for joint irrigation. The joint will be irrigated to remove debris and inflammatory by products.

-Surgery. This is considered to be a last resort. The surgery would be done to repair or replace the joint. This should be avoided when possible. Only about 1% of those with TMJ disorders requires surgery for joint replacement.

Most patients are quite successful with conventional conservative therapy (such as resting the jaw or night guard). The success of treatment depends on how severe the symptoms are and how well you comply with treatment. As always, it is best to maintain regular appointments to see your dentist and let them know if there any TMJ issues developing.