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April 2022 Update:
Dear Patients and Friends,
Happy Spring! The cherry and magnolia blossoms are in full bloom, the temperature is rising, and spirits seem to be up. I wanted to update you on what’s happening at our office and our updated COVID protocols. We continue to use our window fans circulating inside air out and our air purifiers in each of the operatories. We have our UV light filtration system in our central HVAC. We continue to use high volume suction during our cleanings and dental procedures. We continue to mask up all day except at lunch and try to limit the number of staff eating lunch together.
Dr. Dahm will have been with us for 3 months at the end of March and has been extremely well received by everyone, patients, and staff alike. I have been impressed with her clinical skills along with her thoughtfulness and communication with patients and staff. She has been a huge asset at the office and is helping me manage the extreme need of dental care currently.
The amount of dentistry that is needed presently is extremely high. My sister is a family practice doctor with Kaiser in Los Angeles. She says the symposiums she has been attending says the medical system cannot keep up with the medical needs of people. People are sicker than ever. She says Kaiser is having the general practice doctors focus on educating their patients on wellness and self-compassion. We need to take care of ourselves better because the medical system is not able to keep up. We need to be mindful to take better care of ourselves on reducing stress, eating healthier, exercise, going for walks, be social, treat ourselves and others with kindness, patience, gratitude, and love. Life is short. Presently, doctors and clinics are not able to take care of everyone in a timely manner. It is the responsibility of the individual to make a concerted effort to take care of themselves. I believe the same in dentistry.
Presently, we are seeing significantly more occlusion or bite issues, TMJ related issues, cracked teeth issues, and postponed dental work issues. This is a wakeup call. A significant number of us, me included, must be mindful of keeping the muscles of our face relaxed and not clench or grind our teeth. With tension and stress up, we hold our teeth together which is clenching and activate our facial muscles generating several hundreds of pounds of force on our teeth. Normal chewing generates 20 to 40 lbs. of force on our teeth. This huge increase of force generated by our jaw muscles are wearing our enamel down exposing sensitive dentin and breaking out the enamel up near the gum line of our teeth which we call notching or abfractions. It is breaking or cracking our teeth and can create teeth and jaw pain along with loose teeth. It causes TMJ and occlusion issues along with headaches, migraines, earaches, and sleep interruptions. We have seen significant number of these teeth crack to the point of needing crowns, root canals and unfortunate tooth loss with the need of implants. We are making significantly more night guards now. Most of us are not even aware we clench. Your teeth should never touch 24/7. Remember to keep your teeth apart, tongue up against your upper palate and muscles relaxed during the day and wear a custom-made night guard at night. Be mindful of controlling stress by being aware of it and trying to reduce it. We have copied some information below for those of you experiencing any symptoms. Please ask us next time you are in if you have any questions or contact me now if you have any concerns.
Remember, your health care providers can help you with problems and improve your health by educating you on how to live a healthy lifestyle. You are the one responsible to take care of yourself and maintain health. On the dental side of things, please be mindful to keep your mouth healthy and happy by brushing twice a day, flossing, or using some type of interproximal cleaning aid a minimum of 2-3 times a week, eating healthy meals with less carbs and sweets snacking, drinking less acidic and sweet beverages and seeing us every 6-12 months! If you are on medication that dries out your mouth, please discuss this with us because you are at high risk for getting cavities with no saliva to buffer the acids in your mouth. Also, with more people working from home, we are seeing an increase amount of snacking which leads to higher risk with getting cavities and increased neck and shoulder pain from poor posture working in unideal sitting positions which increase tension in the face and TMJ muscles.
TMJ & Jaw Pain
1. Apply moist heat or cold to the joint or muscles that are sore. Heat or ice applications used up to four times per day can reduce pain and relax the muscles. For heat, microwave a wet towel for about 1 minute or until towel is warm. Then wrap the warm towel around a hot water bottle or heated gel pack to keep it warm longer. Apply it to the affected area for 15-20 minutes. For cold, use ice wrapped in a thin cloth. At first, you may feel a burning sensation, and this is normal. Keep ice on the painful area only until you first feel some numbness, but not more than 5 minutes. Use what feels best but in general, heat is used for more chronic pain conditions and cold for acute conditions. Never use heat on a tooth ache, only on joint pain.
2. Eat a pain free diet. Avoid hard foods such as French bread or bagels. Avoid chewy foods, such as steak or candy. Cut fruits and steam vegetables into small pieces. DO NOT chew gum!
3. Chew food on both sides of your teeth at the same time or alternate sides. This will reduce strain to the muscles and joints. If biting into food with your front teeth is painful, then cut up your food with a fork and knife and chew with your back teeth.
4. Keep your tongue up, teeth apart and jaw muscles relaxed. Closely monitor your jaw position during waking hours so that you maintain your jaw in a relaxed, comfortable position. This often involves placing your tongue lightly on the palate behind your upper front teeth (you can find this position by saying “n”). This allows the teeth to come apart while relaxing the jaw muscles. If it is a nighttime issue, we can make you a night guard to help relieve symptoms.
5. Avoid caffeine. Caffeine can interfere with sleep and increase muscle tension. Caffeine or caffeine like drugs are in coffee, tea, soda, power drinks, and chocolate. Note that some decaffeinated coffee has up to half as much caffeine as regular coffee.
6. Avoid oral habits and activities that put strain on the jaw muscles and joints. Oral habits such as teeth clenching, grinding (bruxism), teeth touching or resting together, biting cheeks or lips, tongue pushing against teeth, jaw tensing, biting objects, shoulder shrugging, neck tensing, and other activities such as overextending yawning, prolonged dental treatments, resting your jaw on your hand, over chewing, excessive singing, or use of musical instruments can strain the jaw. Remind yourself to check regularly to see if these activities are present through reminders such as stickers or timers. If noticed, these habits should be replaced with positive habits such as tongue up and teeth apart. Use your own good judgment to minimize activities that cause discomfort.
7. Keep head up, chin in and shoulders down and back. Closely monitor your head position over your shoulders to maintain a balanced relaxed head, neck, and shoulder muscles with a forward head posture. This will help in reducing strain to jaw, neck, and shoulder muscles.
8. Learn and practice relaxation and abdominal breathing. This will help reduce your reactions to stressful life events and decrease tension in the jaw and neck. 9. Avoid events that trigger the pain. Use a pain diary to review daily activities that aggravate the pain and modify your behavior accordingly.
10. Get a good night’s sleep. Manage your sleep environment. Reduce light and noise and lie on a comfortable mattress. Reduce stimulating activities in late evening including computer work and exercising. Avoid stomach sleeping since this puts adverse forces on the jaw and neck muscles.
11. Use anti-inflammatory and pain reducing medications. Short term use of over-the-counter ibuprofen, naproxen, acetaminophen, or aspirin (without caffeine) can reduce joint and muscle pain. If compatible with patient conditions and lifestyle, consider use of combination of analgesic and muscle relaxant in the evening. Self-care is often a first step in the management of TMJ. Recognize that this is not a life-threatening situation, even though it can be very uncomfortable. Injury to the TMJ and jaw muscles is extremely common and joint noises (clicks, pops) and locking of the jaw is also not uncommon. Most often these symptoms are transient or will come and go. Changing habits, relaxing the area, and avoiding additional strain or injury will better manage your pain.
Thanks for reading!
May Chang, DDS
Thanks again for your loyalty over the years and we appreciate all the friendships we have made at the dental chair the past 36 years.
May Chang DDS, Alexandra Dahm DDS, and staff
May M. Chang, DDS
1744 NE 42nd Ave
Portland, OR 97213