Dental/ Oral Health Los Angeles

Your oral health is more important than you might realize. Get the facts about how the health of your mouth, teeth and gums can affect your general health from Dr. A. J. Boyajian. With over 20 years experience, he has been focused on patient health that goes beyond just fixing a tooth problem.

Locked Jaw – What To Do

This week brought two new patients that have locked jaws. Their “TMJ joints” either have been displaced or they are having muscle spams. There was a significant differences in age as well as both sexes.

So what do we do? First, I always start with a full exam. This includes history of the injury or event along with full dental exam. I check muscles and all the related supporting structures to get an idea of the extent of the problem.

A word about x-rays: I recommend a complete set of x-rays as well as additional x-rays of the TMJ. For the x-rays of the TMJ, there is a single cone x-ray called an I-Cat. The I-Cat gives a great hard tissue view of the bone. If I need additional information after I see the I-Cat, I may request an MRI. This kind of X-ray will fill in the blanks of soft tissue information that the I-Cat will not have.

With the combination of the exam, history and supporting documentation can give me a great idea as to the health of the TMJ and a prognosis. Having an accurate diagnosis is what dictates treatment and projected outcome. Based upon this information, I design and make a TMJ splint. A well designed TMJ splint is essnetial for TMJ treatment as well as for aiding in the diagnosis.

Locked jaws are nothing to waste time about. One of the most important factors determining recovery is the time lapse between the event and a visit to your dentist. Time is critical. The sooner care is started the better the chance of complete recovery. I am pleased to say that I expect these two patients from last week to make good recoveries.

Dr. Boyajian, West Los Angeles

www.dentalwellnessarts.com

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Why Does My Veneer Keep Falling Off?

This is a true story told to me by a new patient named Stacey.

Stacey is originally from the East Coast and was given my name by a dentist who attended the Pankey Institute, an entity that teaches a sophisticated way to repair mouths.

Anyway, back to my story. Stacey asked me how long a veneer should last. The answer is usually a long time. Some of the first ones I placed almost 25 years ago are still in the mouth and functioning well. Stacey, on the other hand, has had three replacements of her veneer in the last three years. This is obviously far too frequent, especially since she had had to pay each time. To make matters worse, these three replacements did not include the multiple times she had to have them re-cemented them. When I met Stacey today, she was missing her right front tooth. Obviously this was not a pretty sight and she was not happy. I asked her if she wanted to find out WHY and, to her credit, she decided to let us discover the problem and plan the cure.

So this is what we did…

I started with a complete exam. This told me Stacey’s mouth has three problems:

1. She has been grinding her teeth!
2. The way her bite hit was causing all the force of the bite to come down right on the veneers which caused them to break the cement junction!
3. Her teeth are significantly worn down. This changes the the forces and dynamics of her mouth accentuating the harmful forces.

After completing the exam, I placed a temporary bonding on the front teeth. Stacey was ecstatic and I thought, “not bad if I did not say so myself.”

I also made some molds of her teeth to make her a TMJ splint called a MAGO. This appliance is used to help diagnose the true jaw position called CR (Centric Occlusion) and then we can find true, neutral position. Finally, after discovering the CR and the neutral positions, we are ready for the full diagnosis and we can develop the PLAN.

In the meantime, I think the temporary bonding will last through this time, giving Stacey a temporary beautiful smile while we work to give her her permanent, stable one. I will keep you posted.

Dr. Boyajian, West Los Angeles

www.dentalwellnessarts.com

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Help! I’m Grinding My Teeth!

Renee, one of our blog readers, posted this question:

I have a bad habit of grinding my front teeth. I think it’s just a nervous habit. I’ve done it for about 5 years. I do it all the time day and night. My bottom front three teeth are now smooth across the top. Do I need a mouth guard or anything else to break this nasty habit?

Thanks!
Renee

Dear Renee,

Uncontrolled grinding of teeth is never good. In healthy mouths, the amount of time teeth are in contact is very little. It is important to find the reason for your grinding. For some people, some medications can be the cause, but in the majority of cases I see, it has to do with a mal-alignment of teeth.

Teeth serve many roles for the body. One of the important roles is to help position the upper and lower jaws in relation to each other. They act as nerve extenders that are highly sensitive (about 20 million nerves per tooth) so if the teeth do not send the correct message to your brain like “Do not grind” then your natural defense mechanisms are not working. In other words, grinding is used by the body to help keep the jaw in alignment by wiping away the interferences that keep you from closing properly. This is why it is important to find the cause of the interference and address it to protect both the jaw joint and the tooth structures.

Regarding mouth-guard /splints: when made well and properly adjusted, they can be highly effective in protecting the mouth. The key is properly understanding how the mouth is supposed to function so that the splint works in harmony with the jaw joint. I use splints to help me diagnose the extent of the mal-alignment. This help me decide what are the best choices to present to the patient for solution. Once the plan is devised then the implementation can take place. I feel a significant amount of dental problems are related to uncontrolled grinding.

I hope this helps answer your question.

Dr. Boyajian, West Los Angeles

www.dentalwellnessarts.com

What is a TMJ Exam?

A TMJ exam is the reviewing of the systems that move and support the temporal-mandibular joint. In our office, this has several componants:

1. We examine all the muscles and palpate the joints for discomfort. Healthy TMJs are not sensative to touch.
2. We listen to the movement joint with a Doppler. We are listening for bones rubbing and discs slipping. What we hear can also give us an idea of the health of the bone surfaces and the cartilaginous disc.
3. We also measure the range of motion that the jaw can move. Normal ranges are from 38-45 mm for women and 42-50mm for men.
4. Pain evaluation.

Healthy joints do not pop, click or hurt. If any of these conditions are present, or if other concerns are found during the exam, the patient may be referred for additional diagnostic x-rays, such as the I-CAT.

Dr. Boyajian, West Los Angeles

www.dentalwellnessarts.com