There are roughly 10 million people in the United States who have a TMJ disorder. This condition can cause quite a bit of discomfort, but it can typically be managed with the right steps. Since November is TMJ Awareness Month, now is a good time to become more familiar with the warning signs of TMJ disorder as well as how it can be treated; that way, you can make sure that you’re well-prepared when it comes to keeping this potentially painful problem under control. (more…)

I have focused the majority of my career on family preventive and general dentistry. While I enjoy most aspects of what I do, I firmly believe that a good percentage of dental problems are avoidable, which means that dentists shouldn’t be as busy as we are with routine fillings, removal of teeth, and many other procedures. While there are other factors at play, such as genetics, personal responsibility is often at the head of the pack.  

Prevention often takes a back seat to fixing problems.  Decayed, broken and worn teeth all had nothing wrong with them at some point. Granted, you have to fix what is already broken, but “How could it have been prevented?” has always been the question I ask myself, and try to make my patients understand.

What are the factors at play for the 6 new cavities? What could have been done to avoid the wearing-down of all the teeth? Could anything have been done during growth to alter how the airway develops? What factors are causing the chemical erosion of the teeth? These are important questions to be considered.

Much of what is being marketed to dentists today is technology; 20 years ago, it was cosmetics. The technology available today in dentistry is really cool, just like the technology available in most other areas of our lives. There are some things I would not want to live without since adding them to our office; digital x-rays, digital scanning instead of messy impressions, computer-generated restorations, telemedicine, etc. However, how much technology do we really need if we avoid the problems in the first place?

Let me give an example. If I had to pick the single most important “technology” that has impacted dentistry in the last 30 years, it would be dental implants. Grafting of bone and dental implants have changed the lives of many people, who would otherwise have been forced to wear something removable in their mouth to replace teeth.  And, while this is a great service to patients, I’m still always thinking, “What are the lessons I have learned to help my next patient avoid needing all this dentistry?”

More dentists are being trained to place dental implants, not only to replace one missing tooth, but to replace ALL the teeth. You may have seen the commercials from a large dental franchise with stories from “real” patients who have had dental implants change their lives. What they don’t tell you is that they remove all the teeth, even ones that can be saved, remove a ton of bone to be able to place 4-6 dental implants, to then have a piece of plastic with plastic teeth screwed to it. They claim – “You can put an end to dealing with missing teeth or repetitive dental work with dental implants.”

You have to go in for the consultation to find out that upper and lower “All-on-4” dentures attached to implants will run you $60K+. They also fail to mention in any of the advertising that there is maintenance that can be costly. And, they don’t really feel like teeth. While this treatment may be acceptable for some patients, the clear choice, is to avoid it.

Keeping your natural teeth makes much more sense. Improving and maintaining any part of our health requires time, commitment and resources. There are many great dentists out there to help you maintain your teeth for a lifetime.

Dr. St. Clair maintains a private dental practice in Rowley dedicated to health-centered family dentistry. He has a special interest in treating snoring, sleep apnea and TMJ problems. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com

Let’s use this hypothetical situation: You have not been to a dentist in a while (pick a time frame), you are well aware you need some dental work, you were given the recommendation of a dentist by a friend…..and, you decide to visit that dentist and four other dentists to compare and make a decision who is the best fit for you. (I realize that most people don’t want to and/or don’t have the time to visit five dentists….but play along).

You already have an idea of what you are looking for. It might be the dentist who says you need the least. It might be the dentist who is the cheapest. It might be the dentist who is closest to where you live. It might be the dentist who gives you the most options, or maybe the least. It might be the dentist who listens to you the best. Be prepared, because you are likely to hear a few different styles/opinions visiting five dentists.

Some practices may feel “clinical and efficient”, while others feel somewhat more home spun and laid back.  The dentist’s personality and experience are reflected in his or her treatment preferences as well.  The fact that different dentists will suggest different plans to treat your condition does not necessarily mean that one plan is better than another. Have an open mind and play an active role in the treatment planning process.

It is important to remember that there are numerous ways to treat the same situation, and it is always important for the dentist to tailor the treatment plan for each patient’s specific circumstances.  A major part of those circumstances may be financial, and since different treatment plans can vary a great deal in cost, it is important for the dentist to discuss costs and options for payment.

Think of treatment plans like various models of cars offered by different dealers.  All of the models are new, have warranties and will work well out of the lot.  The higher end models, however, have some advantages not found in the less expensive models.  Some options add years to the life of the car. Some add to the appearance and enjoyment of driving it.  Having said that, dentistry is not a commodity. There are many factors that need to be taken into consideration when choosing your provider or the treatment you choose for yourself.

What makes sense for you? What are your objectives?  Saving a badly damaged tooth with a root canal and a crown may preserve it for a long time, but what are the circumstances of how the tooth got to that point?  If you haven’t been to a dentist in many years and have many other dental needs, does it make sense?

We have so many great dental providers in our area. Think about what you are looking for in a dental care team Read that list in the second paragraph again.

The focus should be on long-term objectives and prevention. If you are a regular dentist-goer and have a dentist you like, you’re all set. If you haven’t been in a while, consider making the decision to change how you look at your dental health. Start with finding a place that fits your particular needs, and make the commitment to make routine preventive dental care part of your life.

Dr. St. Clair maintains a private dental practice in Rowley dedicated to health-centered family dentistry. He has a special interest in treating snoring, sleep apnea and TMJ problems. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com

Sleep apnea can have many side effects that you may not be aware of. One example is the impact it can have on your dreams. Some people with sleep apnea find that they don’t dream at all, but others might start experiencing particularly vivid nightmares. Your dentist is here to explain more about the relationship between sleep apnea and nightmares – as well as what you can do to improve your dreams.

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It is not uncommon to get a second opinion, or a second or third quote for things like car repairs and home improvements. When it comes to our health, it usually depends on the nature of the issue. More complex issues in medicine, such as a diagnosis of cancer, an unknown diagnosis, or other major medical issues in which we have to make decisions about significant treatment, tend to stimulate people to get more than one opinion. In dentistry, it seems that the incidence of second opinions is not as great.

Routine dental care is generally not that complicated. There are many different ways to do the simplest things in dentistry. The method is a function of the dentist’s beliefs and training. It is relatively uncommon for a patient to get a second opinion for this type of maintenance dental care. Although there is some subjectivity as to what different dentists might deem as “needing” to be done, patients usually base their decision on their perceived need. This perception of need comes from the dentist’s ability to communicate the reasons for treatment.

The patient’s trust in their provider is a big factor. If a patient trusts and genuinely likes their dentist, they may not necessarily do or want to do what the dentist wants them to, but they are comfortable enough to make the decision on treatment. It is when there is a lack of trust, for one reason or another, that patients tend to venture out for another opinion. This lack of trust usually stems from a personality conflict or the inability of the dentist to properly communicate with the patient effectively.

Even when there are more complex dental issues, it is my feeling that patients base the need for another opinion on lack of trust. Another important factor is that the patient is given choices. Patients always have the right to choose what treatment they feel is right for themselves. If choices are given and the treatment is properly communicated to the patient, they have the ability to decide in what direction to proceed.

If a dentist properly communicates the need for treatment and the patient decides to do nothing, it is the patient’s choice. It is when treatment is properly presented and it aligns with the patient’s perception of need or desire, that the patient moves forward with treatment.

Fees tend to be a less common reason for patients to seek another opinion. Fees for treatment can definitely vary. The problem with seeking treatment based on fees is that the same treatment in two different offices with different fees can also vary in the level of expertise and precision in which it is done. There are many factors.

A higher fee does not always mean a higher quality product. Fees are generally based on the time involved, the materials used, and the perceived expertise of the provider. Be cautious when seeking treatment based on fees. The fee for treatment should definitely be considered, but the entire treatment presentation and the way in which it is communicated should be used to determine your decision.

Dr. St. Clair maintains a private dental practice in Rowley dedicated to health-centered family dentistry. He has a special interest in treating snoring, sleep apnea and TMJ problems. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com

Studies have shown a link between teeth grinding, clenching and headaches. There are also links to people who have sleep breathing disorders, and those who take serotonin uptake inhibitors (SSRI). Some brand names of these drugs are Celexa, Lexapro, Prozac, Paxil and Zoloft. Many people grind and clench their teeth for many different reasons – let’s not forget STRESS!

For people who grind or clench, the muscles that open and close the jaw can become painful from overuse, causing a range of symptoms from tension to migraine headaches to jaw joint (TMJ) problems to tooth pain. Here is a simple test – look at your tongue in the mirror without sticking it out. Are the borders smooth? If they are ridged, you are probably doing something outside of normal function.

Bruxing (grinding) and clenching teeth is defined as abnormal tooth contact (parafunction). Ordinarily, teeth should only be in contact while eating and swallowing, which is about 10 to 15 minutes on a daily basis. People who grind or clench their teeth during the day, or while sleeping, can have their teeth in contact for as much as six hours a day or more. Researchers say that one night of grinding is equivalent to 80 days of normal wear. Read that last sentence again.

Clenching can be just as bad, and in some cases, worse than grinding. The average person puts about 200 lbs. of force on back molars during function, but a person who clenches can put up to 1000 lbs. on the molars. This is a lot of force for the teeth to withstand. Fractured teeth are seen on a regular basis in dental offices due to clenching. Typically, a person will come in saying that their tooth broke while they were eating something soft. While that may be the case, often times clenching and/or grinding has weakened the tooth prior to it breaking.

The American Dental Association estimates that 95 % of the American population suffers from a grinding or clenching problem at some point in their lives. Some people do so much damage over time that they need a lot of dentistry to restore their teeth back to normal function. The key is early diagnosis and treatment.

Many patients do not realize, and some refuse to accept the fact that there is a problem. The reason for this is because many, if not most, do not have symptoms. The masticatory system is a very adaptive and forgiving system. Some even think their symptoms are just normal. However, if a problem is identified, accepted, and treated, it can help prevent numerous potential issues down the road.

Therefore, successful therapy starts with acceptance of the pathology present. In addition to behavior modification, nighttime bite splints can be very effective. They should be worn every night, not just when it “seems” like you have been grinding or clenching. It’s like wearing a knee brace. You wear the brace to support the knee to help prevent more injury.

Some patients require daytime splints because their issues are affecting them during the day, and a “night” guard might not be enough. Over-the-counter appliances are typically not recommended for a variety of reasons. 

Ask your dentist whether you have any of the signs associated with grinding or clenching, and especially talk to your dentist if you have any symptoms. If the reason can be identified as to why this happening, it will direct the provider to offering the best solution for your specific situation.

One last thought: Read the first paragraph over. In most people, there is a reason for the grinding and/or clenching. There is a lot of interconnectedness between sleep and other issues. Sometimes, if you fix one thing, other things go away.

Dr. St. Clair maintains a private dental practice in Rowley dedicated to health-centered family dentistry. He has a special interest in treating snoring, sleep apnea and TMJ problems. If there are certain topics you would like to see written about or questions you have please email them to him at