The daily routine of brushing and flossing your teeth can be difficult when you suffer from Temporomandibular Disorders (TMD). A study published in the Journal of Orofacial Pain states that patients felt their TMD symptoms made it difficult for them to do routine dental care at home. Also, the study found 63% of patients reported a change in seeking routine professional dental care due to their TMD. Since oral hygiene can become compromised due to limited range of motion and/or pain, regular dental exams and cleanings become even more important in maintaining your oral health.
The TMJ Association developed this guide to provide you with oral hygiene self-care tips you can do at home as well as suggestions for future dental appointments. Maintaining your teeth and gums on a routine basis should reduce the risk of dental disease and the need for invasive dental treatments.
In order to maintain healthy teeth and gums, self-care is essential. If you are not removing plaque on a daily basis, a professional cleaning will only be temporarily effective. By keeping your teeth and gums in good condition and following proper hygiene instruction, future dental visits will be more comfortable. The following are suggested daily self-care methods that may work for you.
- Use of a soft toothbrush. These range from adult to children’s sizes to small one-ended brushes, and those with greater flexibility. It is recommended that you replace your toothbrush every 3 to 4 months. A worn toothbrush may not clean effectively and may harm your gums.
- Power-assisted toothbrushes offer an excellent way to maintain hygiene if the electric motion of the brush does not cause discomfort to your jaw.
- Toothpaste designed to reduce sensitivity, such as Sensodyne®, may reduce discomfort.
- Flossing is the preferred method for cleaning between the teeth. If you cannot open your mouth wide enough to floss your teeth, alternatives include rubber tip stimulators, interdental brushes, or floss holders. Your hygienist should guide you in selecting an instrument that is right for you and provide proper instruction on how to use it.
- Ask your dentist or hygienist if a commercial oral irrigator may be useful for your oral hygiene.
- In addition to brushing and flossing, an antiseptic mouth rinse may be recommended to kill bacteria that can cause decay and gum disease.
- Fluoride rinses after each meal and prior to bed can also be effective in reducing cavities. Some dentists also recommend using a prescription high-fluoride toothpaste.
- Salt or baking soda and water solutions can be used as a rinse at home following dental and dental hygiene procedures. It is easily prepared, inexpensive, and may be effective in reducing gingival swelling. If you are on a low-salt or sodium-free diet you should not use a salt water rinse.
- If you are experiencing dry mouth, your dental team can help. Saliva plays a very important protection role in the body. It not only keeps your mouth moist, it also helps to protect your teeth from decay, helps prevents infections, and heal mouth sores.
- If your mouth opening is very limited, foam instruments called “toothettes,” or moist cotton gauze squares, can be rubbed along the teeth and gums to achieve some plaque removal.
- Appliances such as splints and partials should be brushed daily with a soft brush and mild dish soap or should be cleaned with a product such as Polident® or Efferdent®.
- If you have arch bars/wires or other appliances, it is very important to clean the area between the appliance and your gums. Your hygienist may recommend a soft brush or a bi-level brush with a middle row that is shorter and can be applied directly over the fixed appliance. Power-assisted brushes with soft bristles, a light stroke, and at low speeds can be very effective for cleaning around appliances and keeping your gums healthy. Your hygienist may also recommend other aids to clean between your teeth. They include floss threaders and interdental brushes.
What You Should Expect From Your Dental Office Visit
A dental procedure may trigger or increase your TMD symptoms. So it is imperative to find dental professionals who understand your oral disability, are willing to work with you, and will listen to your concerns. They should recognize you as an individual and adapt techniques and procedures according to your needs and limitations. Regular dental cleanings may prevent infrequent, long, or difficult treatment sessions. Keep in mind that each individual is unique and what works for one person may not work for another. Together you, your dental hygienist and dentist can determine what is best for you. The following suggestions may help improve your next dental visit.
Before a dental visit the following should be considered:
- If this is your first visit with this dental office, consider interviewing the dental hygienist or dentist before you schedule an appointment. The interview will serve many purposes including developing rapport and open communication with the dentist and dental hygienist. They should understand your apprehension concerning your oral disability and offer reassurance that they will take your concerns into consideration and act accordingly. It is also an opportunity for the dentist and hygienist to discuss their treatment plan with you and the types of procedures you can expect during your visits. By knowing what is expected, you will feel better prepared and relaxed during your appointments. Check with the office to see if there will be an additional charge for this visit.
- Discuss the appointment length with the office. Depending on preference, appointments may be long or short. Some patients prefer longer appointments to get everything done during one appointment; others prefer shorter and multiple appointments.
- Contact your insurance company to determine coverage for dental services.
- Consider scheduling your visit at the end of the day to allow rest after the appointment.
- Use heat and/or ice before your dental treatment to help reduce any pain or swelling.
- If you are usually anxious before your dental appointments, talk with your primary care doctor about this. He or she may recommend relaxation medication, self-hypnosis, biofeedback, or other techniques to reduce anxiety.
- Medications to relieve inflammation, muscle spasm and pain can be taken before your dental appointment. These can range from over-the-counter analgesics to prescription pain medications or muscle relaxants. Caution: If you do use medication, consider having someone drive you to the appointment. Also discuss any medications you take with your primary care physician to be certain they don’t interact with any other medication you may be taking. Finally, these medications may block the pain thus decreasing your ability to protect your TM joint during the dental visit.
- If you have a heart condition or a prosthetic joint (including TMJ implants), it’s best to consult with your physician and dentist to determine if antibiotic premedication is necessary for you. Each patient must be considered individually. For some conditions, medication taken prior to dental treatment may reduce the risk of infection and serious complications.
- Inform your dental team if you are anticipating surgery for a joint replacement. All needed dental work such as extractions or periodontal treatment should be completed well in advance of your surgery.
During a dental visit the following should be considered:
- Inform your hygienist and dentist of any changes in your medical or dental history as well as current medications, including over-the-counter drugs.
- Determine if you are at risk for tooth decay by discussing this with your hygienist. Sealants and fluoride treatments may be options in reducing certain types of cavities.
- Use caution when opening your mouth to avoid overextension and possible hypermobility. Hypermobility means your joints are loose and move a lot, and can lock if the mouth is open too wide. Utilization of a mouth prop or device, such as the Restful Jaw®, will help protect the jaw during a dental visit.
- Communicate with the hygienist or dentist by holding up your finger to indicate that you need to rest your jaw.
- Ask for rolled-up towels or pillows to place behind your neck or back to avoid discomfort.
- If your teeth are sensitive, let your hygienist know. It may be possible to use a desensitizing agent and make adaptations to water temperature or application of air.
- Request applications of topical anesthetics and, if needed, local anesthesia to lessen the pain.
- If you have breathing or swallowing difficulties, you may be more comfortable with the chair in a semi-upright position.
- If your eyes are especially sensitive to the dental light, consider bringing sunglasses to wear during treatment. The use of glasses will also protect your eyes from any debris or particles produced during routine cleanings.
After a dental visit the following should be considered:
- Ice or heat applications to the jaw.
- Continue using medications to relieve inflammation, muscle spasms and pain.
- Schedule your next cleaning appointment to help maintain your oral health. Research has shown a link between oral health and overall health and its relationship to systemic diseases.
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