T-800C TMJ/Facial Wrap with Chin Cup – Now in Black!
For years there was no choice…if you needed a bandage it was white and keeping it white was no easy feet. Cool Jaw introduces the T-800C TMJ/Facial Wrap with Chin Cup – now available in Black!
CoolJaw® jaw wraps are ideal for immediate use following wisdom tooth removal, reconstructive jaw surgery and dental implants. They are also great for use with TMJ and any other oral and maxillofacial jaw surgeries that require jaw compression and cold therapy.
Remember Michael Jackson’s Black or White Bandage statement? Apparently while shooting Black Or White one of the crew members had hurt their arm and Michael said can I borrow your arm bandage….Viola! It’s black or white fashion.
Michael Jackson’s Black or White Bandage statement…Just like Cool Jaw, there were choices.
Cool Jaw’s Black face wrap may not top Michael’s “Black and White” Statement but it sure beats the following:
Cleaning a fresh blood stain is always preferable to a dried one. Usually, a quick rinse or soak with cold water will do the trick before the stain sets in. But many times, blood will set long before you even know there is a stain.
So on the occasions where you’re dealing with a set-in stain, here are a few tried and true methods to removing dry blood stains.
Vinegar has amazing cleaning powers, and is an incredibly inexpensive way of dealing with many household messes. Vinegar tops the charts for curing dried blood stains because it’s been proven to get out the worst stains, like those that have already gone through the dryer!
If the stain is small, pour some vinegar in a bowl and submerge the stained area for about 30 minutes, then take a peek and see what is remaining and if it needs more time to soak.
If the blood stain is larger, lay a towel under the stained area then soak with white vinegar and let sit for 30 minutes. Repeat if necessary until the stain is removed.
Wash as usual but don’t put in the dryer until you are positive the stain is gone.
Another tried and true product for cleaning dried blood stains is hydrogen peroxide. Simply pour the hydrogen peroxide directly onto the stain and let sit for a about 5 to 10 minutes, then blot it with a clean sponge or rag. Although it works great on whites, for colors, make sure you start with a drop in an inconspicuous part of the clothing first to make sure that it won’t ruin the color.
Hydrogen peroxide will turn to water when exposed to light so wrap the area with plastic wrap (so it won’t be absorbed) then cover with a towel.
Ammonia will take dried blood out of anything as quick as a flash. However, it might take everything else with it. Again, with whites, ammonia is an easy solution, but you may want to use another method for any colors. But if all the other methods have failed, try ammonia. A big blood stain that won’t come out of something will be as ruined as one that’s been cleaned with ammonia, so you might as well try it as a last resort.
Tips for Treating a Dry Blood Stain:
As a first option, soak in cold water overnight then move on to other options.
Before treating, don’t leave a clean section of clothing under the stain. Move it out from under the stain or when you treat the stain it could transfer to a clean area of clothing.
If you’re not sure how a stain remover will react with your clothing, test in an inconspicuous spot first for colorfastness.*
Karen Raphael, PhD, a long-time TMD researcher now at the New York University College of Dentistry, has provided the following commentary on the Susan Herring Botox® article, along with information on her plans for clinical studies of TMD patients who have been treated with Botulinum Toxin for TMD Pain.
As a clinical research scientist focusing on the causes and treatment of TMD disorders, I had long heard that some doctors and dentists have tried to reduce TMD muscle pain by injecting Botox® into the chewing (masticatory) muscles. Although this potent biological toxin, used in minute dosages, has been approved by the Food and Drug Administration (FDA) for certain muscle-related conditions since 1989, its injection into the masticatory muscles is considered off-label and unapproved by the FDA in terms of both safety and efficacy. In the past decade, TMD patients have increasingly asked: Is Botox® safe for use in this manner? Is Botox® effective? Are potential risks worth the potential benefits? In light of aggressively marketed continuing education courses, in which more and more health professionals are being trained to use Botox® to treat a variety of painful muscle conditions, these are critical questions.
The existing clinical research literature provides little help. The National Institute of Dental and Craniofacial Research (NIDCR) still lists Botox® as a treatment option, but notes that recent clinical trials have been inconclusive about its effectiveness for chronic TMD. Indeed, existing studies have been conducted on small samples, in which it is easy to ‘miss’ either a potentially clinically significant benefit or a clinically significant adverse effect. Thus, the benefit and risks of Botox® treatment for TMD have yet to be clearly established in an adequately sized, randomized and controlled clinical trial.
The urgency to study potential risks of Botox® injections into the masticatory muscles derives from a growing body of animal studies. Most concerning are the rabbit studies conducted by Dr. Sue Herring’s lab at the University of Washington and later animal studies conducted in other countries and with other small animals. These studies generally find dramatic changes in bone quality and volume, particularly in the mandibular condyle, the head of the lower aw bone, after just a single injection of Botox®. In humans, Botox® causes a temporary partial paralysis of the injected muscle, which wears off after about 3 months. Treatment is typically repeated at 3-month intervals, if the patient perceives benefit and can afford the high cost. Thus, there is the possibility of cumulative and dramatic changes to the TMJ area as the bone responds to changing muscle loading. Bone is a dynamic tissue that normally undergoes cycles of resorption and formation in a process called remodeling. In the event that the mandible is not subjected to the forces of the masticatory muscles (because they are paralyzed) bone resorption may overwhelm bone formation. Thus patients considering or currently receiving Botox® injections for their TMD pain may be at serious risk for loss of mandibular bone density and volume. Nevertheless, whether findings from animal studies can be applied to humans remains a question. None of the existing clinical trials conducted among TMD patients has examined bone-related changes following Botox® injections.
Conducting studies in patients that parallel animal studies presents challenges. Patients cannot be “sacrificed” to precisely assess their bone volume or quality! Moreover, if serious bone-related changes do occur following masticatory injections with Botox®, it would not be ethical to conduct a large clinical trial on TMD patients. Thus, we took an observational approach to tackle the issue of bone safety in TMJ patients.
We began by conducting a pilot study; published in 2014.1 Recruitment was based in part on queries to participants in a Botox®-related survey posted on The TMJ Association website. As part of that survey, we asked participants whether they might be willing to consider participation in a Botox®-related study, if they were eligible. Ultimately, we recruited 7 women who had received at least 2 Botox® treatments for their TMD pain in the past year and 9 demographically matched TMD patients who had never received Botox® injections for their pain. We used a low-radiation technology called “Cone Beam Computed Tomography” (CBCT) to provide high quality images of their TM joint area. Two oral and maxillofacial radiologists then evaluated each image, without knowing whether the patient had or had not received Botox® treatment. They focused particularly on areas of the mandibular condyle that would be most sensitive to reduced loading caused by Botox®-induced muscle paralysis. Indeed, in rating the trabecular region (the softer, spongy type of bone) of the mandibular condyle, the radiologists agreed perfectly with one another in evaluating each image and in concluding that there was reduced bone density in all of the Botox®-treated TMD patients but in none of the patients who were not treated with Botox®. This pilot study formed the impetus for a larger grant recently funded by the National Institute of Dental and Craniofacial Research.
In our new study, we will be recruiting patients systematically from 5 clinical practices in either New York City or Los Angeles, where high-end and identical-model CBCT imaging machines are located. A group of 50 TMD patients who have had 3 or more Botox® injection sessions in their masticatory muscles will be compared with 50 TMD patients who have never had Botox® injections in their masticatory muscles. Those who have received Botox® treatment will not have done so for research purposes, but for personal reasons related to clinical preference and resources. All participants will be asked about their recent health experiences, treatment experiences and symptoms, and will be asked to undergo two types of low-radiation imaging sessions: one with CBCT imaging of their TMJ area and another with a standard clinical bone density (“DEXA”) scan of their hip and spine. We will also request that they permit us to review their treatment records, to determine whether certain doses of Botox® injections in masticatory muscles and particular treatment intervals are more likely to be associated with reduced density in TMJ bones, even after accounting for possible differences in overall bone density as assessed by standard bone density DEXA scans. Images will also be assessed for more serious changes, such as microscopic fractures, and state-of-the-art software will be used to assign specific density and volume values to different areas of bone. If no serious and significant TMJ bone differences are found between the two groups of TMJ patients, we anticipate conducting a large randomized and controlled clinical trial of Botox® efficacy for TMD pain. On the other hand, if we do find that patients receiving multiple Botox® treatments are more likely to display disturbing and potentially dangerous bone changes, we will have documented an important public health risk. These findings may have implications for some other muscle-related conditions for which Botox® treatment has already been approved by the FDA.
TMD patients have been victimized in the past by the premature use of invasive treatments of unknown efficacy and risk: failed TMJ implants. We will do everything within our power as research scientists to ensure that this type of disaster does not happen again.
Unfortunately, patients cannot directly volunteer to participate in this study, because we are enrolling “clinical practices” from which patients will be systematically evaluated for appropriateness and willingness to participate. On the other hand, if you live in the New York or Los Angeles area and receive treatment by a clinician who uses Botox® to treat at least some of his or her TMD patients, please let us know. We would welcome the opportunity to identify and potentially enroll additional clinician-collaborator locations. We are just starting patient recruitment and expect to complete recruitment within two years. Results will become available within several months after all statistical analyses are complete.
Among the many services provided by The TMJ Association, our research group at New York University benefited from a service that readers may not know that TMJA provides: the networking of researchers. This occurs not just through professional academic meetings, but through one-on-one contacts with scientists whose work may benefit by linking with the work of other scientists. In 2010, TMJA president Terrie Cowley first let me know of Sue Herring’s animal work related to Botox®. Sue and I engaged in several subsequent communications that informed the design of the current study. Based on Terrie’s scientific networking skills, we are proud to have been able to design and conduct one of the rare examples of ‘translational’ animal-to-human research.
Anyone who has had implants or even joint replacement, owes thanks to Dr. Per- Ingvar Bränemark.
In 1952, while studying the relationship between blood circulation and the healing of bone tissue, Dr. Brånemark was unable to remove the titanium housing of a microscopic lens he had placed in the leg of a rabbit. After finding that the bone had biologically fused to the metal casing, he soon realized the clinical potential of this surprising discovery: Titanium could serve as a bone-anchored foundation for dental prostheses.
In the late 1970’s, a Swedish orthopedist named Per-Ingvar Bränemark introduced what he termed osseointegrated implants to dental practice. The Bränemark technique utilized biocompatible titanium-alloy implants that were atraumatically inserted into the alveolar process. The devices were then recovered by soft tissue surgical flaps to isolate the implants from the oral cavity to permit several months of undisturbed healing. After three to six months, the then-osseointegrated implants were surgically uncovered and subsequently used as fixed foundations for oral prostheses. In the 1980’s oral surgeons and periodontists quickly sought and received approvals from the American Dental Association to include the surgical aspects of implantology into their specialties with general dentists and prosthodontists performing most of the restorative procedures. Here’s a first hand reflection
Known as the father of the modern dental implant, Per-Ingvar Brånemark, M.D., Ph.D., died on Dec. 20, 2014, in his hometown of Gothenburg, Sweden, according to the New York Times. He was 85. As memorialized in Inclusive Implant Magazine, Dr. Brånemark’s impact on medicine can be summed up as follows:
“The only thing that remains of the patient after 1,000 years is the bone and the titanium,” Dr. Brånemark once remarked. Fittingly, with the millions of lives that have improved as a result of implant treatment, and the untold millions to follow, the imprint Dr. Brånemark has left on the world will be as lasting as titanium itself.
Sure, reconstructive surgery has given Blessing Makwera a blinding smile and the ability to eat whatever he wants.
But it is his voice that makes the most difference, the 22-year-old from Zimbabwe said.
Before a team of San Diego surgeons used a bone from his left leg to replace the part of his jaw that an explosion had torn off, talking was so painfully difficult that he would just give up.
“When you’re in class and the teacher can’t understand what you’re saying, it kinda lowers you down. But if people can understand what you’re saying, you can start to enjoy talking,” Makwera said.
That sense of joy came out recently during a checkup with Dr. Thomas Vecchione, the Hillcrest plastic surgeon who is part of the team responsible for this young man’s transformation.
Makwera said far more than “thank you” as he chatted with Vecchione and Dr. James Chao, the reconstructive and plastic surgeon who crafted his new jaw from a harvested piece of his left fibula.
He described his desire to become a mechanical engineer, his newfound love of running, his temporary home in Boise, Idaho, and his phone conversations with loved ones back on the family farm in Zimbabwe.
He said the simple joy of being able to make his thoughts and feelings understood is just so … fun.
“It’s something that I’m still trying to wrap my mind around, even today,” Makwera said, flashing a smile at the doctors.
They smiled back. Vecchione offered to introduce him to his son who just landed a coveted engineering job with electric car manufacturer Tesla Motors.
“Tesla? I would love to work there some day,” Makwera said, launching into his master plan to someday help Africa develop more renewable energy.
Everything, it seems, is on the table now that people can understand what he’s saying post-injury.
Faced with the onslaught of words and smiles, Vecchione said Makwera has the one thing he needs to succeed. “Enthusiasm is the key to life, and you’ve got enthusiasm,” the plastic surgeon said.
Makwera’s still-imperfect but vastly improved voice is modulated by a mouth full of implanted teeth and meticulously rebuilt soft tissue in and around his palate, cheeks and tongue.
Those areas were damaged by an unfortunate encounter with a land mine detonator in 2008. The explosion took his teeth and most of his lower jawbone. He struggled to form words or eat even the softest foods.
Eventually, the nonprofit group Operation of Hope Worldwide in the Orange County city of Lake Forest learned about Makwera’s plight. It brought him to the United States and began looking for a health provider willing to donate reconstructive surgery. Sharp HealthCare and a team of associated surgeons answered the call to donate everything needed to rebuild what the detonator took away.
Three surgeries were required to harvest and implant bone, repair soft tissue and eventually have Dr. Joel Berger, a maxillofacial surgeon, implant permanent teeth.
Sharp and the contributing surgeons have not tabulated the value of their donated work, but it is in the hundreds of thousands of dollars.
In between operations, the patient has been able to live with an Operation of Hope volunteer in Boise. The arrangement has allowed Makwera to avoid traveling back and forth to Zimbabwe during his course of treatment, which includes months of recovery after each surgery.
He has tried to make the best use of his recuperation time by enrolling in a Boise community college. His mechanical engineering dreams may be helped significantly by his recent discovery that he is a great long-distance runner.
Jennifer Trubenbach, the president for Operation of Hope, explained that one day, Makwera decided to participate in a Boise marathon with the woman who has been his host there. Although he had not trained for the run, he did well.
“He eats two hot dogs the night before and he runs the marathon the next day and beats her by an hour,” Trubenbach said.
More recently, Makwera has tried out at a university in Idaho interested in having him join its track team.
This from a guy who is missing his left fibula.
Chao, the surgeon who crafted the bone into Makwera’s new jaw, assured the aspiring runner that he would be able to return to regular physical activity once his leg healed completely. The other bone in the lower leg, the much larger tibia, can handle a full load.
“That was pretty surprising,” Makwera said. “I thought it was going to be hard for me to even use the leg, and now I can run 26 miles no problem.”
After harvesting the left fibula, Chao made mitered cuts to help it flex and take a boomerang shape before attaching it with titanium plates to what was left of Makwera’s jaw bone. Delicate microsurgery was needed to connect a vein inside the bone that is about the width of a human hair. The surgery succeeded, enabling Makwera’s vasculature to supply the bone with enough blood to heal and remain alive.
Vecchione, the plastic surgeon, said the case was in the top ten of his career in terms of overall complexity. Chao agreed.
“We needed to get the soft tissue, the muscles, the teeth and the bone all in the same place, all functioning together,” Chao said.
The two physicians believe a fine-tuning surgery is still necessary to manipulate scar tissue preventing the left corner of Makwera’s mouth from taking a more natural shape. There also will be a little more work to make his tongue, which was damaged in the blast as well, more mobile.
“The key is to try to release the tongue as much as we can. If you can move the tip of the tongue a little bit better, you can get better definition in your speech,” Vecchione said.
For his part, Makwera said he is amazed that these doctors are continuing to help him two years after his first surgery.
“I am surprised that someone can do all of this and make everything functional. I’m just grateful to these guys for what they have done and what they are still doing,” he said.
Those suffering from TMJ disorder may find it difficult to eat because of chronic pain, inability to open the mouth, and loss of appetite. Malnutrition and Weight loss are common problems for TMD patients due to the necessity to eliminate certain food types from their diet. Pain experienced when opening the mouth, chewing and swallowing, the need for a soft diet, all may limit caloric intake, resulting in weight loss. Knowing what foods are most beneficial is the start to proper dietary planning. The TMJ Association offers a new resource through their website: “TMD Nutrition and You,” a nutritional guide booklet specifically developed for people with compromised oral function to help them maintain a healthy diet in spite of their oral disability. Here, from that guide, is a list of foods to include as well as to avoid in a soft diet.
Ouch! You know the pain of a cold sore. Caused by the herpes simplex virus (HSV), these raised red lesions on the lips and face can be triggered by stress, menstruation, sunburn, fatigue or emotional trauma.
Cold sores are painful blisters which usually appear around the mouth and nose. Cold therapy offers pain relief.
Use a Cold Pack, Like Cool Jaw’s 4″ Soft-side gel pack -The cold reduces the pain and swelling of your cold sore. 15 minutes at a time, apply the pack – move the cold around the area -not keep the ice on one area.
The temperature and weight, constricts local blood vessels and decreases tissue temperature. This constriction decreases blood flow and cell metabolism, this results in the area healing faster, and a decrease in pain.