CLINICAL QUESTIONS

How will I lose my teeth?

  1. Cavities, Gum disease, Grind/clench
  2. Dentist today treats:  1) Cavities,   2)  gum disease
  3. Grind/clench under supervised neglect
  4. Teeth are destroyed by grind/clench after age 55
  5. Science grind/clench is not taught dental school
  6. Dentistry teaches science of rebuilding dentition

How can I avoid loss teeth grind/clench ?

  1. Requested, recruit, search knowledge
  2. Stop-look-listen-feel for hints: Know symptoms
  3. Research ayptical toothache, atypical earache, restricted open, tension HA
  4. Research grind/clench
  5. Buy early prevention = biteguard, nightguard
  6. Become advocate 

Why is my pain resistant to single treatment?

  1. Multiple sources pain
  2. Multiple causes each pain
  3. Ongoing Pain changes pain system
  4. Complex pains require team
  5. Complex pains require multiple tools
  6. Complex pains are managed
  7. Patient most important part team

Why is my pain resistant to treatment? 

  1. Acute pain docs treating chronic pain
  2. Doctor trying to fix pain w/ shot or pill
  3. Doctor wants to be source cure 
  4. Patient demands a quick fix
  5. Each ‘Fix It” provides 10 % pain relief
  6. Chronic pains are stubborn
  7. Chronic pain requires team

Why do "I, the patient" have work on team? 

  1. Complex pain requires team power
  2. Chronic pain demands your attention, time, investment
  3. “Your” body needs to heal
  4. Improve health habits does not happen at office
  5. “You” get out pain management, what you put into it
  6. Do "You" want cure pain, or cover it up w/ pills

I am busy mom, I want quick fix? 

  1. Mom’s have 24 hrs for 36 hour day 
  2. Frequent pain distract from loving 
  3. Mom’s not happy, no one happy
  4. Mom’s take their job seriously
  5. Mom’s desperately “quick fix”
  6. Med/Dent Quick fixes market this weakness
  7. Quick fixes offer temporary or minimum relief
  8. After all the quick fixes fail, you still have your pain
  9. Research chronic pain for wiser decisions

Why did dental care nor stop my tooth pain? 1) Most test for toothache are inside nerve test. 2) If test hint it is inside nerve that inflamed, a root canal order. 3) If the inside nerve is inflamed, root canal relieves pain 4) a. If the root canal does not help pain, crack tooth suspected 5) a. If crack is suspected, a crown is ordered 6) a. If crown does not relieve. pain, extraction is ordered 7) If crown relieves pain, great, case solved 8) If the extraction does not relieve pain, refer orofacial pain specialist

Colored areas indicate a different decision or choose: 4) b. if root canal does not relieve pain, outside nerve could be inflamed 5) b If outside nerve is suspected, a referral orofacial pain specialist 6) b. If orthotic & CSO relieves pain, it was outside nerve

Atypical Toothache 1) Tooth has two sets of nerves?  Inside nerve & outside nerve. 2) Most dental care treats inside nerve 3) Are test for inside nerves accurate? No, but it gives doc clues 4) Dentist-endodontist are trained at inside nerve (90 % inside nerve) 5) We do not have great outside nerve test 6) How do I determine outside ? Refer Orofacial Pain Specialists

How is my tension headaches managed by neurologist?  1. 90% of all HA are diagnose as migraines 2. Prescription of trypans 3. Prescription another tryptan. 4. Prescription Topomax 5. We have no more offer

How is tension headache manage orofacial pain specialist ? 1. Inflammation chewing muscle-Temple 2. Other sources Inflammation neck, jaw, head, sinus, ear 3) If Temporalis inflamed? it would be called tension HA 4) Orofacial Pain specialist tx tension HA. 5) Chewing system orthopedics is therapy necessary to manage tension HA 6) Temple Muscle (side head) is chewing muscle

Why is my jaw locked? 

  1. Moderate damage inside jaw joint blocks opening
  2. Complete Disc displacement is like bean bag behind door
  3. Disc tears off top condyle by trauma-grind-tension muscles
  4. Why did I not see it coming ?  most hints are subtle & diverse, too busy
  5. Is there a quick fix ? No.   No one has time for broken leg-locked jaw 
  6. What can be done ?  Diagnose level damage, then recruit your CSO team
  7. CSO team? Chewing system orthopedic team: PT, Bio, OFP, Patient 
  8. Restrict open is complex problem in complex joint?  Requires months effort

Why does appliance break ?

  1. Did you know how much force exhibited at night ?  600 lb/sq inch
  2. Force is strong enough break metal ?   yes, my dad broke metal 
  3. What tools are available to reduce force ?   11 OFP tools
  4. Orthotic can reduce force some:   before force is 8/10, orthotic reduces 6/10,
  5. What does anxiety have to do w/ breaking? Inc. frequency & force grinding
  6. Appliance thinner in back is concern ? No, power is distributed around arch

My tooth hurts but no cavity or gum disease ?

  1. 88 % of toothaches are inside nerve, but there is 12% that is not
  2. 12 % of toothaches are caused by 6 different pathologies
  3. Most prevalent of 6: 
  4. outside nerve,  
  5.  muscle referred pain, 
  6. molar loading by space loss TMJ
  7. Least prevalent of 6: 
  8. Nerve/vascular pain
  9. Trigeminal neuralgia trigger near tooth
  10. Misc: sinus, MS, tumor

5) suspect not inside nerve: no cavity, filling near pulp, deep crack, swell

6) suspect not inside nerve: comes & goes, pattern pain-chew, bite, eat, clench

7 suspect not inside nerve: hurts worse upon awakening 

My rt ear, teeth, jaw, & head hurt, could be TMD ?

  1. If smells, looks, & feels like a duck, it’s duck
  2. What structure can cause all those near pains ? jaw joint
  3. If clicking, discomfort chew, difficult open: could it be TMD
  4. If it hurts more upon awakening ? the only force at night is grind
  5. Had other muscle/jt pains (back, neck)?  TMJ is jt/muscle system
  6. Have you noticed, stress/anxiety increase jaw pain  

  Cause 4 RC, 6 CR, 3 implant, sensitive, crack teeth

  1. Only 1 answer: destructive grinding teeth
  2. Not mild to moderate grinding
  3. Destructive grinders can go up to 4-6 times power in sleep
  4. Grinding that powerful breaks, cracks, & destroys teeth & dental structures
  5. My dad could break porcelain, enamel, thick plastic, crowns, implants
  6. Cavities are visible, gum disease is slow progressing

I have toothache in lower right? (need remove double space)

  1. Awoke w/ pain; dentist suspect wisdom tooth=extract #32

2A. Awoke w/ pain; dentist suspect crack tooth=crown #31

2B Awoke w/ pain; dentist suspect abscess = root canal #31

2C  Awoke w/ pain; 2nd dentist suspect abscess = extract #31

 3A. Awoke w/ pain; 2nd dentist suspect crack = crown #30   

3B. Awoke w/ pain; 2nd dentist suspect abscess = root canal #30

3C. Awoke w/ pain; 3rd dentist suspect abscess = extract= #30

4A. Awoke w/ pain, 3rd dentist suspect crack tooth=crown #29

4B. Awoke w/ pain, 4th  dentist suspect abscess tooth-extract #29

4C. Awoke w/ pain, 4th dentist refer UF Facial Pain, refuse tx any more teeth

Answer: muscle pain referred to teeth, causing multiple tooth therapies.

I need new clothes, not an orthotic ?

  1. I agree a beautiful lady needs beautiful clothes
  2. A woman in pain cannot share her heart
  3. Jaw/Ten HA/neck pain can reek havoic on mom’s irritability
  4. So, we get into a discussion w/ ourselves need verse want
  5. Most head-jaw-neck pain come from tension muscles & grind/clench
  6. Orthotic reduces damage to TMJ during night reduce pain
  7. You decide between clothes and pain
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