tmj symptoms

TMJ Symptoms and Treatment

TMJ Symptoms

The main cause of Temporomandibular Joint Syndrome (TMJ) is misalignment of the teethPain in the jaw joint, clicking of the jaw, ear pain, headaches, pain in the temple area, stiff or sore jaw muscles, and locking of the jaw are all TMJ Symptoms. 

TMJ Treatment- “The Band-Aid Approach”

If you suffer from TMJ, it’s important that you seek treatment from a dentist who has had additional post-doctoral training in treating TMJ problems. Many dentists will take “the band-aid approach” to treating TMJ Symptoms. For example, common TMJ Symptoms are Tooth Clenching and Tooth Grinding, which over time causes extensive wear and damage to teeth. To “solve” this issue, a common treatment plan by dentists without TMJ specific training is to do restorative work for any damage grinding has caused, and have the patient wear a  night guard to prevent further damage. While this may indeed restore tooth damage and help prevent further wear while sleeping, it fails to fix the root cause of the TMJ which is misalignment of the teeth.

TMJ Treatment- fixing the root cause

An experienced dentist trained in treating TMJ understands the root cause of TMJ, which as I mentioned before, is Tooth Misalignment. We most commonly treat TMJ through a series of bite adjustments which corrects Tooth Misalignment. Additionally, we create a special appliance to be worn at night which keeps your bite aligned properly and dramatically reduces, if not eliminates, night-time Tooth Grinding and Tooth Clenching. Restorative treatment is often necessary to address wear and damage caused by Tooth Clenching and Tooth Grinding.

It’s really important to correct your bad bite and improve the fit of your teeth. If this is not done, then you will continue to clench and grind, and continue to wear your teeth down. Restorative work for TMJ Damage may start out as small as fillings, but if not corrected will progress to larger fillings, root canals, crowns, and eventually even Dental Implants. Because of the progressive nature of TMJ, it is imperative that it be addressed as early as possible.

Gary Adams, DDS has over 10 years of post-doctoral clinical experience and training, beyond dental school, in the area of TMJ treatment. He offers complimentary consultations and will create a customized treatment plan for you. Call today: 301-468-6200 or click here to schedule your consultation.

embarrassed by your smile

Embarrassed By Your Smile?

Do you avoid smiling? Do you cover your mouth when you smile? If you are Embarrassed By Your Smile, you are not alone. Many people are self-concious about their smiles.

The main reasons people avoid dental treatment are Dental Anxiety and Cost.

Dental Anxiety:

It is estimated  9%-15% of people avoid going to the dentist because of their Dental Anxiety and Dental Fears. There are many Dental Fears people may have:  fear of injections, fear the injection won’t work, fear of anesthetic side effects, feelings of helplessness/loss of control, loss of personal space, and embarrassment. The most common Dental Fear we see is an overall fear of pain both during and after a procedure/treatment.

We have found most people who develop some degree of Dental Anxiety have had a previous negative experience. We most commonly see adults (vs. children) are the ones who fear the dentist due to a direct experience they had in the past when anesthesia was either not used or less effective. Anesthesia has advanced quite a bit over last several years, and dentists are also more focused on the comfort level of their patients. Due to these advancements, children are far less likely to have Dental Fears because they experience fewer negative dental experiences.

If you suffer from Dental Anxiety, you should be upfront with your dentist about your concerns, feelings and fears. There are ways your dentist can adapt your treatment in order to help you overcome your anxiety. At Rockville Dental Implant Center, we offer Sleep (Sedation) Dentistry for all procedures we perform. We can sedate for something as simple as a cleaning to as complex as a complete mouth restoration. We offer IV Dental Sedation, Oral Conscious Dental Sedation, and Nitrous Oxide Sedation.


Nearly 4 out of 10 adults surveyed said either they or a family member had put off seeing a dentist within the last year because of the out-of-pocket expense. A 3rd of those adults said they or a family member currently have a toothache or other dental issue that should be addressed.

We understand that a lot of our patients are on a budget and cost of treatment is a major concern. We can provide a complimentary consultation to assess your dental needs and create a treatment plan for you that prioritizes the most important things you should address first. A treatment plan can be spaced out over a period of time to make dental work more affordable. Additionally, for the portion of our fee that your Dental Insurance doesn’t cover, we offer financing through Care Credit.

root canal re-treatmentShould I get a root canal re-treatment or a dental implant?

It used to be the case that dentists would do everything they could do to save a natural tooth.

However, in recent years this approach has shifted somewhat. While dentists are still averse to extracting a tooth that could be saved, the increased quality of Dental Implants has changed the playing field somewhat.

It’s rare, but an unfortunate fact that Root Canal Therapy eventually fails in some cases. Either a tooth does not heal properly, or there are other complications.

The process of re-treating a Root Canal involves the same type of work your dentist performed the first time around, with the additional work involved with removing a crown. Your dentist will remove the crown and re-clean your tooth’s canals.

While most of these procedures are successful, some dentists now consider Root Canal Re-treatment to be a matter of ‘buying time’ with a tooth. Today’s Dental Implants are durable and realistic enough that Dental Implants are an increasingly attractive alternative to re-doing a Root Canal.

While it is usually the case that a Dental Implant procedure is more expensive than a Root Canal Re-treatment, it’s also the case that Dental Implants are considered to be a more permanent solution.

The American Association of Endodontists estimates that Root Canal Treatment saves 17 million teeth per year. By comparison, The American Academy of American Implant Dentistry estimates that 3 million Americans have Dental Implants, and that number increases by 500,000 per year.

As we always say, however, everybody’s mouth is different and every case is a little different. Please consult with us if you want a more specific analysis of your dental picture.

Call today: (301)468-6200 or click here to schedule a complimentary consultation.

Do I need an electric toothbrushDo I Need An Electric Toothbrush?

Some people do just great without an Electric Toothbrush. Some prefer one or the other. Without particularly endorsing one or the other, we can go through some of the pros and cons on each side. While Electric Toothbrushes have grown in popularity, many people are always going to be happy enough with their ‘Manual’ Toothbrush, so we’ll go over a tip or two for using those.

Dentally speaking, the proper use of a Manual Toothbrush should be enough to maintain a great set of teeth. But many of us breeze through the brushing process every day. Some of us don’t put lots of time or thought or effort into the process; it’s just a habitual and rote part of a bedtime or morning routine. In such cases, an Electric Toothbrush may be advantageous and apply more cleaning power to areas that tend to get neglected by careless brushers.

That doesn’t sound very researched or science-y, perhaps, so here’s the conclusion of one typical study into the matter:

“There is moderate quality evidence that Powered Toothbrushes provide a statistically significant benefit compared with Manual Toothbrushes with regard to the reduction of plaque.”

That’s a thumbs-up for Electric Toothbrushes, but it’s not an overwhelming endorsement. Whether it’s worth it to you, then, basically comes down to your budget, how much you care, and how much our hygienists bug you or don’t bug you.

We’ve found that many people tend to stranglehold their toothbrushes. Don’t do that. If you brush so hard that your brush’s bristles bend (there’s a tongue-twister), then you’re doing it wrong. Use a soft grip, light and gentle. Properly done, you hold on to a toothbrush in sort of the same light way as you might swing a golf club.

xylitol & dental cavitiesXylitol & Dental Cavities

This stuff isn’t exactly a household name in the United States, but perhaps it should be.

Xylitol—sounds like a prescription medicine, but it’s actually a sweetener that’s produced by nature. It’s also much better for your teeth than sugar.

The nifty thing about this particular sweetener is that it tamps down the occurrence of a certain type of bacteria in your mouth. This bacteria, called Mutans Streptococci, is a major cause of Dental Cavities. While Xylitol cannot reverse tooth decay, it can effectively put the brakes on further decay.

Studies, organized by respected groups such as the American Academy of Pediatric Dentistry, have concluded that this sweetener also helps reduce the formation of plaque, and it reduces the sort of acid production that leads to enamel demineralization

Do you really need more than that from a sugar replacement? Well—there is more, actually. The cavity-causing type of bacteria that can’t replicate in the presence of Xylitol is the same type of bacteria that causes colds and sinus infections. In other words, the benefits of this sweetener can contribute to your health beyond preventing tooth decay and beyond reducing your calorie count.

Some diets recommend the use of Xylitol as a sweetener for other reasons as well. This sweetener is lower in carbohydrates than sugar, for one thing, and it is also touted as having a lower glycemic rating. This means that Xylitol metabolizes in the body more slowly than sugar. (For this reason, the sweetener has long been recommended for people with diabetes.)

Xylitol is available in gum and mints; we’ve got some Xylitol-sweetened lollipops around the office that we like to give to our younger patients and some well-behaved adults. Remind us, and we’ll give you one the next time you’re in.

What causes tooth clenching?What Causes Tooth Clenching?

Tooth Clenching, also called bruxism, is typically regarded as a sign of stress. In stressful times, some people get ulcers, some people get high blood pressure—and some people take their stress out on their teeth.

One Wall Street Journal article, after a stock market crash in 2008, even tried to draw a connection between bear markets on Wall Street and booming business for the practices of doctors who treat stressed-out patients with painful, stress-related jaw disorders.

It’s said that the jaw muscles can exert 300 pounds of pressure. With that sort of pressure multiplied by a few hours every night, it’s not hard to imagine the sort of damage that could happen to a person’s teeth. (It’s probably a vicious cycle, too—tooth damage can make it difficult to eat, which only causes more anxiety, and so on…)

Some believe that Tooth Clenching can be made worse with the use of alcohol, caffeine, or nicotine. Tooth Clenching is also associated with sleep apnea. Some medications, including amphetamines and some antidepressants, are also associated with Tooth Grinding.

Many clenchers aren’t aware of the fact that they clench their teeth at night, and can cause a lot of damage without even realizing it. If it gets bad enough, habitual jaw clenchers can damage their teeth, by breaking off the enamel on a tooth. This can lead to sensitive teeth and an advanced rate of tooth decay.

While your dentist can’t address your stress level, they can work to help you protect your teeth. If your Tooth Clenching habit is bad enough that it’s grinding your teeth down, we typically propose a custom-built mouthguard. Worn while you sleep, these little gadgets clip to your front teeth and prevent your upper and lower teeth from grinding against each other.

Tooth Clenching habits affect at least 8 percent of the population, it is said. As for the question of why it is that people tend to clench up in general during stressful times, there’s a theory that jaw clenching is an adaptive trait handed down from our Paleolithic ancestors. Stronger jaw muscles meant for a more damaging bite, when it came time to defend the cave.

Possibly true, we don’t know. We’re dentists, not paleoanthropologists.

TMJ pain

How do you treat TMJ Pain?

There are lots of simple home remedies for treating TMJ Pain: stretches, hot cloths, tongue exercises.

But if your jaw pain is bad enough that you’re considering a consultation with a dentist, we can possibly assume you’ve tried these remedies and need to consider a more serious approach.

The sources of TMJ Pain are facial muscles used for chewing, TMJ joint inflammation and teeth and gums getting too much pressure from Tooth Clenching.  The cause of TMJ pain is the poor fit of the teeth top to bottom or what dentists call a bad bite.  When teeth do not fit one another properly a patient needs to dislocate their TMJ joints to get their teeth to fit.  The dislocation every time a patient chews, swallows, opens and closes causes muscles and TMJ joints to function in a poor position and causes neuromuscular pain and Tooth Clenching and Tooth Grinding and then more neuromuscular pain.

Increasingly, Botox is one treatment used by dentists and doctors in the treatment of TMJ Pain, Tooth Clenching and Tooth Grinding. From a biological standpoint, Botox impedes the body’s release of a neurotransmitter called acetylcholine in the areas where it is injected. Without the presence of this neurotransmitter, muscles in the area where Botox is injected remain relaxed. Botox is more of a supportive therapy and not a corrective therapy. 

To solve or cure TMJ Pain it is necessary to correct a patients poor bite, so the patient will stop Tooth Clenching and Tooth Grinding.  Some patients are not aware that they clench.  Most of the time the Tooth Clenching happens at night.  

Treating TMJ Pain is done in two stages: 1) indirect treatment focusing mostly on reducing joint, muscle, gum and tooth inflammation.  TMJ patients are treated by a TMJ Dentist with corrective bite Splint Therapy.  Basically, records are taken to diagnose how the patients jaws and teeth are out of alignment.  Subsequently, a corrective bite splint or Occlusal Splint is made to correct the misalignment.  A splint looks a lot like a hard plastic mouth guard, but an Occlusal Splint actually has a corrective bite and cures the patients clenching problem.  In severe cases Botox is used to medically calm down the muscles by injection of the drug into the tight chewing muscles.  2) once all the inflammation is better and the patient is asymptomatic, direct corrective treatment can be done to correct the patients bad bite.  The correction depends on the patients problem.  For example, a patients teeth may be in the wrong position and they may need to be orthodontically moved.  The fit of the teeth may be poor and the patient may need bite adjustments and possibly some crowns and fillings redone.  Occasionally, patients may have incompatible sized and shaped jaws top to bottom.  In this latter case, surgery is the only true direct correction.  Surgery is a serious decision and should not be taken lightly.  Surgery should be the last resort and only performed when the symptoms are bad and there is a lot of dysfunction and all other options have been exhausted.

Today, Botox is a household word best known, of course, for its aesthetic uses as a wrinkle relaxer, but it first caught on medically as a substance used to help people who had eye problems, particularly crossed eyes, or eye twitching.

A San Francisco-based ophthalmologist named Alan B. Scott realized in the 1960s that there could be medical uses for what we now call Botox. After testing the substance on cross-eyed monkeys for a decade or so, he received permission to test on humans in 1978.

Botox-using ophthalmologists noticed that the substance had one interesting side effect: Their patients were starting to look a little younger, because their wrinkles were disappearing after the treatment.

Since that time, Botox has also been used to treat everything from bladder spasms to excessive sweating. Lately, some Dentists have started stocking Botox as well. As it turns out, the same substance that can fix the problem of eye twitching can also be used, in many cases, to relax the jaw muscles that are at the root of TMJ pain.



TMJ stands for what?

Temperomandibular Joint. We studied this stuff, and we can’t even say or spell it correctly half the time. Much easier to use the abbreviation, TMJ. “TMJ” is also the shorthand term we use to refer to aching or pain in the muscles of the jaw. There are a variety of possible causes and fixes.

Everybody has two Temperomandibular Joints—these hinge-like joints connect the jaw to the skull. In some cases, a person’s bite can become misaligned, and the resulting unbalanced stress on these joints can cause problems throughout the face and head. Symptoms can include, worn teeth, cracked teeth, gum recession, gum disease, headaches, jaw popping and clicking, neck and shoulder tension and pain (a TMJ sufferer may feel like they need massage therapy or a chiropractor every week), ear symptoms such as the feeling of water or fullness in the ear, mild diziness or vertigo, tingling in the fingers, difficulty swallowing like your throat is stuck or tight.

TMJ symptoms are quite varied, so the diagnosis can sometimes be difficult.  Often times the patient will have gone to the regular doctor, ENT doctor, chiropractor, physical therapist, dentists and maybe even the neurologist.  Most professionals do not recognize TMJ Symptoms and will treat symptoms such as the headache.  I have seen many patients on migraine headache medication prescribed by a neurologist.  Other patients who see the Chiropractor weekly.  The condition is normally diagnosed properly by ENT doctors and Dentists, but not always.  A patient who believes they may have TMJ should see a dentist with special training in treating TMJ patients or a TMJ Dentist.  a TMJ Dentist will be able to quickly diagnose TMJ and perform effective treatment.  TMJ is a curable disease.  In fact, the only thing that needs to be done is to correct the patients jaw and teeth alignment.  The TMJ Treatment depends on what is causing the misalignment.  Some common causes are teeth that are out of position, teeth that are not a good lock and key fit top to bottom and finally differences in the shape of the bottom jaw and top jaw.  The treatment may be quick and easy or it may be more complex, time consuming and expensive.

The ultimate cause of TMJ is a misalignment between the way an individuals teeth fit and the proper path of closure of the jaw.  The feeling can be a sense of uneasiness about the way the patients jaw feels, like a comfortable resting jaw position cannot be reached…because it can’t.  The way the teeth fit dictate how the jaw has to close to chew food, swallow, even talk.  If a patients bite is off a patient will need to dislocate their jaw joints in order to get their teeth to fit.  Imagine how a jaw can feel if everytime it opens and closes it needs to dislocate to reach a bad tooth fit or position.  The jaw tooth misalignment is the cause of tooth clenching.  Most patients with TMJ will clench their teeth at night.  Some patients do not even know they clench their teeth at night.  TMJ does not usually cause tooth grinding, so the clenching at night usually does not wake up significant others.

Many people grind or clench their teeth. In some cases, this can cause pain—sometimes, significant pain. In some cases, there is no pain associated with TMJ Issues, but there’s a clicking sound every time a person opens or closes their mouth. In some cases, this sound can become so pronounced that it causes social anxiety, for people who are suddenly embarrassed about opening their mouth.

Who gets this type of issue?           

There’s such a range here, that it’s hard to put a number on this. The National Institute of Dental and Craniofacial Research estimates that over 10 million people are affected in the United States. The issue seems to hit women slightly more than men. People with high-stress jobs or who don’t get enough sleep are often affected.

Can this be fixed?

In the cases where TMJ Pain is exacerbated by stress or lack of sleep, TMJ Pain may come and go in accordance with a person’s lifestyle and habits.

There are many things to ease symptoms that are often suggested to those who suffer from TMJ Pain: Improve your posture. Get more exercise. Stretch. Avoid cradling phones between your shoulder and head while you use them. Some people also have success with heat packs or cold packs.  But ultimately the only cure is to correct the misalignment between the jaws and the teeth. The best thing to do is to give us a call at (301)468-6200 and we can very quickly assess if you have TMJ and determine the best solution for your TMJ Pain.

Does Dental Insurance pay for TMJ Treatment?  

Some Dental Insurance companies will exclude TMJ services.  Some will pay for some of the treatment, very few Dental Insurance companies will pay for 100% of comprehensive TMJ Treatment, but rather a smaller percentage such as 50% or a flat fee such as $500.


porcelain veneers and dental implant afterdental veneers and dental implantporcelain veneers

FAQ Porcelain Veneers

What are Porcelain Veneers?

Porcelain Veneers are thin shells of medical- grade porcelain that cover a tooth’s surface. In some cases, Porcelain Veneers are the most effective way to improve the appearance of a person’s smile. When made and installed correctly, Porcelain Veneers appear just like a set of natural, perfect teeth.

Are Porcelain Veneers the only way to go, if I want to improve the appearance of my smile?

In many cases, there are other options. Typically, the first solutions a Cosmetic Dentist will turn to are tooth whitening, along with Invisalign and/or reshaping.

In the cases where such methods have not been or will not be effective, Porcelain Crowns or Porcelain Veneers are generally the next step for a Cosmetic Dentist and patient to explore.

What’s the procedure involved in getting Porcelain Veneers?

 You’ll need to visit our office a few times. In an initial consultation, we’ll explain the process in a little more detail and discuss your hopes and expectations for your new smile. Some people want a smile that’s as white as possible, and some prefer a subtler enhancement to their smile. (Here, by the way, is an interesting New York Times article about trends in this area.)

During a different visit, we’ll remove a small layer—0.5 mm, to be precise—of your tooth’s outer layer. We’ll cover the teeth that are being treated with temporary Composite Veneers. Your permanent Porcelain Veneers are custom made in a lab, and that process takes about a week.

After we put your permanent Porcelain Veneers in, we’ll ask you to come in for a visit again afterwards so that we can check to make sure your bite is still correct. Sometimes, a minor adjustment or two is needed.

Will I still get cavities?

Patients with Porcelain Veneers still get cavities at the same average rate as other patients.

Will my teeth be more sensitive afterwards?

At the end of the process, no. It is possible that your teeth will be slightly more sensitive for a few days after the temporary veneers are put in.

Can Porcelain Veneers get stained?

The Porcelain Veneers themselves cannot be stained.

Is this a permanent fix for my smile?

Porcelain Veneers are a long-lasting fix. We expect our Porcelain Veneers to last at least 10 years or longer, on the average. Some of our newer ones may last a lifetime. It’s worth noting, however, that the lifespan of a Porcelain Veneer depends on a person’s habits. Porcelain Veneers will last longer in the mouth of a person who wears a protective mouthguard  or Nightguard while they sleep, or who doesn’t clench in their teeth, for example.


What Causes Teeth Sensitivity

What Causes Teeth Sensitivity?

What causes Teeth Sensitivity? In most cases, Tooth Grinding and Tooth Clenching is ultimately the cause of Tooth Sensitivity. While most people probably clench their teeth from time to time, for some people an excessive amount of Tooth Grinding can cause Gum Recession. In the case of Gum Recession, a person’s gums have pulled back from the outer surface of their teeth and exposed an inner layer, called the dentin. This is why tooth sensitivity is sometimes also referred to as ‘dentin sensitivity’ or ‘root sensitivity.’

This softer, inner layer of the tooth is usually surrounded by a protective layer of enamel. In the cases where this enamel has been damaged, there are notches in the gum line and a person can feel pain whenever there are abrupt changes of temperature in the mouth. Sweet foods can also bring dental pain in some cases; some people with sensitivity in their teeth may even find themselves wincing at a rapid change in room temperature.

Many dentists recommend toothbrushes with soft bristles in order to better preserve the Tooth Enamel. Some recommend that a person limit their intake of acidic foods. Most dentists would discourage against drinking soda, which can cause damage to the enamel over time; some recommend that soda drinkers use a straw in order to limit the tooth’s exposure. Along those same lines, it’s a good idea not to brush one’s teeth just after drinking soda or eating acidic foods, because this will increase the tooth’s exposure to substances which may soften the enamel.

There are also many toothpastes and mouthwashes available on the market that advertise themselves as helping people with the problem of Tooth Sensitivity. In some cases, these products and strategies will suffice. If a person still experiences significant dental sensitivity and pain, they should consult a dentist. A dentist may recommend procedures such as dental bonding, gum grafts or even a root canal in some more severe cases.