Tooth decay, also known as dental caries, is one of the most prevalent diseases affecting both children and adults and is second only to the common cold in frequency. According to the World Health Organization 60-90% of children worldwide, and nearly 100% of adults have dental cavities. Although tooth decay is a worldwide epidemic, it is also a condition that is largely preventable with effective oral hygiene practices, a healthy diet as well as routine checkups and professional dental cleanings.

What causes cavities?

Tooth decay is the result of a process that causes progressive damage to tooth structure. The culprit behind all of this is dental plaque, a sticky film that accumulates on teeth and harbors harmful bacteria that thrive on sugar. As these bacteria metabolize sugar, they produce acids, which over time can de-mineralize or eat away at healthy tooth structure. A cavity begins as a simple pinpoint defect on the outermost enamel layer of the tooth but if left untreated will continue to compromise healthy tooth structure, eventually working its way through the inner layer of dentin to the nerve and vital tissues inside the tooth. Depending on the extent of the damage to the tooth, a cavity can cause anything from periodic, mild tooth sensitivity to extreme and continuous discomfort. Seeing a dentist for the treatment of tooth decay is essential to prevent damage to the nerve of the tooth, a dental infection, tooth loss, or more serious consequences to one’s overall health.

Factors that can increase one’s risk of developing tooth decay include the following:

• Poor oral hygiene
• A diet high in sugar
• Dry mouth
• Bruxism
• Enamel defects and deeply grooved teeth
• Receding gums

For patients at a higher risk of developing tooth decay, special toothpastes and fluoride rinses and other supplemental measures may provide an added level of protection.

The Prevalence of Temporomandibular Joint Problems

According to the National Institute of Dental and Craniofacial Research (NIDCR), temporomandibular joint disorders (TMJ), also referred to as temporomandibular disorders (TMD), are the most common source of chronic facial pain and jaw dysfunction. It is estimated that more than 10 million people in the United States are affected by temporomandibular joint problems.

What is the Temporomandibular Joint?

There are two temporomandibular joints that connect the left and right sides of the lower jaw to the temporal bone. Both joints and their associated muscles, ligaments and tendons work together to allow for all manner of oral function as the jaw moves up and down, front to back and from side to side. Containing a shock-absorbing, soft disc that sits between the rounded condyles of both sides of the lower jaw and the corresponding concavities in the skull’s temporal bone, the TMJ makes chewing, speaking, yawning and all jaw movements possible.

Since the TMJ is a joint with both up and down hinge-like movements, as well as side to side and front to back sliding motions to perform, it is often considered one of the most complicated joints in the body and one of the most difficult to treat when problems arise.

Types and Symptoms of TMJ Disorders

TMJ disorders can fall into one or more of the following three categories:

• Myofascial pain- Refers to pain in the area of the jaw joint due to various causes of increased muscle tension and spasm
• Internal derangement-Involves displacement of the disc, jaw dislocation or trauma to the condyles of the jaw
• Degenerative joint disease – Arthritis

The risk for developing a TMJ problem is greater in the presence of long-term teeth grinding or bruxism, a jaw injury or various types of arthritis such as rheumatoid arthritis and osteoarthritis. Furthermore, the manifestations of a TMJ disorder can vary from person to person with a wide range of symptoms possible, including earaches, ringing in the ears (tinnitus), headaches, back and neck pain, vertigo, muscle spasms and joint tenderness as well as jaw pain, popping or grating sounds with jaw movement, jaw locking and limited jaw movement. For some people a TMJ disorder can be resolved within a relatively short period of time, while for others it will continue to persist despite extensive therapy.

Diagnosis and Treatment

When evaluating for the presence of a TMJ disorder, the dentist will perform a thorough clinical assessment of joint symptoms and function. Special radiographic imaging and other diagnostic tests will be ordered as needed. The treatment of a TMJ disorder may include oral appliances such as night guards or stabilization splints to alleviate strain on the joints. Other types of therapy may include steroid injections, occlusal adjustments as well as orthodontic or prosthodontic treatment to improve occlusion. In cases of persistent and serious TMJ problems, surgery may be recommended.

Methods of self-care can be helpful in alleviating some of the symptoms of a TMJ disorder. Patients are typically advised to eat soft foods, avoid extreme jaw movement such as wide yawning and gum chewing, to practice stress reduction and relaxation techniques and applying ice packs or moist heat as directed. If recommended, a patient should follow the dentist or therapist’s instruction for gentle stretching exercises. The short-term use of over-the-counter, non-steroidal, anti-inflammatory drugs and pain medications may provide relief. If not the dentist or physician may prescribe stronger pain or anti-inflammatory drugs, muscle relaxants or anti-depressants.

Oral cancer accounts for 2.9% of all diagnosed cases of cancer in the United States. According to the American Cancer Society it is estimated that 51,000 people across the country will develop oral cancer this year and that 10,000 fatalities are expected from the disease.

Oral cancer can occur anywhere in the orofacial complex but is most often found on the tongue, the tonsils and oropharynx, the gums, floor of the mouth, lips, cheek lining or the hard palate. While the disease can affect anyone, men are twice as likely to develop oral cancer as women. Those particularly at risk for oral cancer are men over the age of 50 who are heavy smokers and frequently drink alcohol. Additional risk factors may include UV exposure from the sun or sunlamps, GERD (gastro-intestinal reflux disease), prior head and neck radiation treatment, exposure to certain chemicals and poor diet. While the death rate from oral cancer has been decreasing in the past several decades thanks to early detection and advanced methods of treatment improving the outcomes of care, there has been a recent rise in the incidence of oropharyngeal cancer due to increased transmission of the sexually transmitted human papillomavirus (HPV).

What are some of the signs and symptoms of oral cancer?

As part of a comprehensive exam, the dentist will perform a screening for oral cancer. To start, the dentist will review the patient’s medical and dental histories and ask if there have been any changes to his or her oral health or overall health. The dentist will then carefully check in and around the oral cavity as well as the head and neck area for any of the following signs or symptoms that may indicate the presence of a problem:

• Mouth ulcers or sores that do not heal
• Lumps
• Red or white patches
• Persistent swelling of unknown origin
• Pain when swallowing, a painful tongue or a continuing ear or neck ache
• A constant feeling that something is stuck in the throat
• Tenderness or numbness in the mouth or lips
• Loose teeth
• Jaw pain or stiffness

If a suspicious lesion, tissue abnormality or unusual symptoms are present, the dentist will refer the patient for a more comprehensive assessment. Early detection of oral cancer offers the most favorable outcomes of care.

One of the most commonly occurring lesions in the oral cavity is a mouth ulcer. While mouth sores can be annoying, uncomfortable and unsightly, they are often harmless, and will resolve within a few days without requiring any medical treatment. However, when these lesions do not get better after a couple of weeks, frequently recur, or if new symptoms begin to appear, it is important to get a more comprehensive evaluation by a dentist or other qualified healthcare provider.

While often the result of an actual injury like biting the cheek or the irritation of a sharp orthodontic wire, a mouth ulcer can also be caused by certain drugs, chemical sensitivity, diseases, or as a side effect of medical treatment like chemotherapy. A mouth ulcer such as a canker sore, which is also known as an aphthous ulcer, may even be triggered by stress and anxiety or hormonal changes.

According to statistics, up to 1 in 5 people get recurrent mouth ulcers. There are several underlying health conditions that can lead to the development of mouth ulcers including the following:

• Nutritional problems like vitamin B12, zinc, folic acid or iron deficiency
• Gastrointestinal tract diseases such as Crohn’s disease & celiac disease
• An impaired immune system due to diseases such as HIV or Lupus
• Reactive arthritis
• Certain viral infections such as cold sore virus, chickenpox, as well as hand, foot, and mouth disease in young children

It is important to be aware that occasionally, a long-lasting mouth sore may be a sign of oral cancer. A biopsy or tissue sample may be recommended when suspicious lesions in the oral cavity are present. Early detection and treatment are the best ways to ensure the most favorable outcome of care.

How are mouth sores and ulcerations managed?

Since a mouth ulcer involves the loss or erosion of a section of the delicate tissue lining the oral cavity, it can make the simple acts of eating, drinking or even talking quite uncomfortable. Treating the underlying cause (if there is one) and managing the symptoms is the best way to reduce the risk of complications until healing can take place. To ease the discomfort of mouth ulcers and promote healing, it is helpful to reduce or eliminate any sources of continuing irritation and avoid hot and spicy foods, drink plenty of fluids, use rinses or medication as recommended by a dentist or physician as well as brush and floss the teeth as gently as possible to keep the mouth clean.