Help for migraine headaches

I’ve had migraine headaches for years. Most of that time, I didn’t have insurance, so I just did the best I could with over the counter pain killers, and tried to just live with the pain. Through my new job I finally have insurance, and I’ve been working with a new doctor to try and get rid of these headaches. We’ve tried some different medications, but he wants me to talk to a dentist about something called “TMJ”. I looked it up, and understand that he is talking about the joints of my jaws, but I’ve never heard of a dentist treating headaches. Is my doctor just trying to pass the buck?
–Eddie in Sacramento

Dear Eddie,

It sounds like you have a doctor that is well up on current research, and progressively trying to find a solution for you that does not have to involve drugs. That is all good!

As you learned through your research, TMJstands for temporomandibular joint, which are the joints that join your jaw bones together. “TMJ” is a lay term used to refer to TMJ disorders or dysfunctions. Problems with the temporomandibular joints are dramatically under-diagnosed, and particular to your case, are very often a source of unexplained headaches and migraines. 

You’ll want to seek a dentist who has had training above and beyond normal dental school. Look for someone who has trained at the L.D. Pankey Institute, or the Las Vegas Institute for Advanced Dental Studies. There is no official “TMJ specialist” designation, so you may have to do a little bit of detective work to find a dentist that really has the training to help you. Your doctor may even be able to recommend someone.

A dentist trained in the treatment of TMJ disorders will try to locate the source of the problem, rather than trying to mask your symptoms with drugs. He or she may try a custom-made oral device or neuromuscular dentistry techniques that address the alignment and function of your jaws and teeth. The key is finding a dentist with the right training.

Good luck, and we hope you are pain-free soon.

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I want to whiten my teeth, but have some bonding in the front.

My front tooth was chipped a few years back and I had it filled in. The dentist did a nice job of matching the material used to fill it in to the the color of my teeth, however, I can see that it is darker (yellow) than the rest of my teeth when I look at pictures of myself. I really would like to whiten my teeth, but every product I’ve found says that I cannot because I have had the tooth filled in. It is my front tooth so I am particularly anxious about this. Are there any products I can use to evenly whiten my teeth and start being confident about my smile again?

Thank you! Best,
Sarah from New York

Sarah,
It sounds like you’re trying to whiten your teeth with over-the-counter products. You need the help of an expert cosmetic dentist. The over-the-counter products are generally pretty weak and ineffective, anyway. Some of them actually make your teeth slightly lighter over the short term but then they turn even darker than they were originally.

The problem is that the bonding on your front tooth will not whiten, no matter what you use. Find an expert cosmetic dentist. I’d suggest using the mynewsmile.com cosmetic dentistry referral service to find a good cosmetic dentist. Have them whiten your teeth. Then, about two weeks after you’re done whitening, after your new whiter color has stabilized, you’ll need the bonding either re-done or at least re-surfaced, to match.

There aren’t really any shortcuts.

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Amalgam vs. composite for back teeth

Hi, Recently I had to make a decision between amalgam and composite. My dentist, who is up in the years, stated that in his opinion, amalgam is the better filling and does last longer than composite. I asked, in general, how long does an amalgam filling last vs. composite. He said there is a wide range of time difference which depends on each person’s dental habits but he has had amalgam fillings he has done last 30-40years and he felt that a good composite would last about 15 years. Is this reasonable to you? My wife, who uses a younger woman dentist, told her that nobody uses amalgam fillings anymore. The composite is much better and will last longer than amalgam - a complete opposite opinion. Thank you for taking the time.
- Shawn from Maryland

Shawn,
Your dentist is reflecting the old-fashioned view. When they were first used on back teeth, composite filling materials did not hold up as well as they do now. There is also a great variation in how good dentists are at placing them.

Another factor that may be at play in your dentist’s answer is his comfort level with the newer techniques. He prefers amalgam. He is comfortable with it. Very possibly in his hands the composite simply doesn’t work well. Don’t press him to use a filling material with which he isn’t comfortable.

As far as the lifespan, there are many factors and it’s difficult to put a number of years of lifespan on a filling. Composite wears as well as amalgam. It is bonded to the tooth, and so it is better at sealing out recurrent decay. It strengthens the tooth, where with amalgam the frequency of breaking of the tooth is greater. Composite is more technique sensitive, meaning it is easier to place a good amalgam than a good composite, so there is going to be a wider variation in quality of the filling from one dentist to another.

Related links:
Dr. McKay is a mercury-free Seattle dentist
Read about dental bonding.
Dr. David Kagan has an interesting page about gold fillings.

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What is “sleep dentistry”?

I am writing on behalf of my mother. She has not been to a dentist for many, many years, but at her most recent checkup, her regular doctor told her that she appears to have some kind of infection in her gums, and that several of her teeth look to be severely decayed. From my own experience, I know that the kind of work she needs done will not be quick or easy. She has avoided the dentist these many years because she had a bad experience and is quite frankly terrified of going to the dentist.

How can I help her? I’ve read something about “sleep dentistry”, but is that dangerous for an elderly person? Her general health is good, but she is nearly 80 years old. How is she sedated, and what are the possible side effects?

She really needs to have her teeth taken care of. Her doctor told her she might lose them all if she does not address this issue right away. Please help me find a way to help her overcome her fear.

Phyllis in Delaware

Dear Phyllis,

Thank you for taking the time to try and help your Mom. Luckily, a lot of options exist that can make her dental care experience much, much less stressful than what she has experienced in the past.

“Sleep dentistry” is a layman’s term for sedation dentistry, which is the use of oral sedatives, nitrous oxide (NO gas) and sometimes anesthesia in the administration of dental care. The level of sedation is determined by the extent of the patent’s anxiety and the potential length of the procedure. Here in our office, we use an oral sedative (a pill) for our anxious patients.

With all sedation patients, a careful case history is taken to verify that they are able to tolerate the medication, and that none of their existing medications contraindicate the use of the oral sedative. During the procedure, our patients are monitored by a trained staff member at all times, using a blood pressure machine and a pulse oximeter monitor.

Side effects include drowsiness, and occasionally nausea, which is usually brought on by not being able to eat before the appointment. Nearly all patients who experience nausea feel rapidly better after eating or drinking something post-treatment.

In all likelihood, your mother will have little or no memory of her treatments, and will experience no discomfort whatsoever. A successful visit or two will also go a long way towards easing her anxiety for subsequent visits!

I hope this helps you help your Mom. Her quality of life will really improve if she can restore her oral health.

Posted in Dental Fear, Sedation Dentistry, Sleep Dentistry | No Comments »