If you’ve ever woken up to frequent or recurring jaw pain or headaches, but don’t know why, you could be suffering from bruxism, or grinding your teeth. But before you stop reading because you’re sure this isn’t about you because you don’t grind your teeth, don’t be so sure. A 2005 study conducted by Children’s Hospital in Boston MA estimated that 8% of adults grind their teeth at night, but this number could be much higher, because most teeth grinders, or ‘bruxers', don’t even realize they’re doing it! So, how can you tell if you grind your teeth- and why is it so bad for you?Teeth grinding can be a difficult problem to self-diagnose- especially if you do it in your sleep. In fact, even if you grind your teeth when you’re awake, it can still be difficult to ‘catch yourself in the act,’ especially if you are grinding your teeth due to stress and aren’t focusing on what your mouth is doing. The best way to tell if you’re grinding your teeth is at your dental exam. You may or may not already suspect something is up if you’re experiencing jaw soreness, headaches, or TMJ disorder, but a dentist can tell quite easily if you’ve been grinding your teeth based on the wear to the teeth themselves. Some chronic bruxers may have excessive wear on their teeth, broken or cracked fillings, and even broken or cracked teeth. These are all things your dentist will be able to see based on a simple exam to your mouth- and by comparing x-rays from your last visit if possible.

Picture this. It’s Saturday night, and you’re sitting down on the couch, chips in hand, watching the latest sci-fi thriller, when suddenly the crunch of your potato chip sounds more like a crack. Just like that, the crown on your tooth has broken in half in your mouth and ruined your relaxing evening. What do you do now? Even dentists with Saturday hours are closed this late, and nobody is open on Sunday. It will be at least a day before you can even call to make an appointment. Before you panic or try a risky DIY repair procedure, follow these steps to protect your teeth, and maybe even save your crown!

A recent study by the University of Buffalo has revealed that postmenopausal women with periodontal disease are at a higher risk of death than their healthier peers. The study was published in the Journal of the American Heart Association and revealed that women who had suffered previous bouts of periodontitis with tooth loss were at a seventeen percent higher risk of death than those who did not fit those criteria. Postmenopausal women who suffered from periodontitis but did not lose teeth were still at a 12 percent higher risk of early death than those who did not develop the disease.

Fans of the Bravo reality show "The Real Housewives of New York" may have noticed something a little different about the show’s breakout star, Bethenny Frankel. Famous for her outspoken opinions and strong jaw, Frankel’s mandibles have been looking a lot smaller in recent years. For her part, Frankel denies getting plastic surgery. Instead, she claims Botox is to thank for her softer new appearance, and the reason why may surprise you. When most people think of Botox, they think of the cosmetic medication’s paralyzing effects on facial wrinkles and fine lines, but more and more, people like Frankel are using Botox to treat something completely different: TMJ disorder.For cosmetic use, Botox works by temporarily paralyzing the muscles of the treated area, and blocking the signal from the nerves to the muscles. This causes the treated muscles to relax, smoothing and softening the wrinkles. When injected into the temporomandibular joint, or TMJ, Botox relaxes the TMJ and nearby jaw muscles, causing them to weaken and alleviating the hyperactivity of the TMJ muscles that could be contributing to the TMJ pain the patient experiences. But while patients of this procedure like Frankel have found relief with Botox, Dr. Alexandra George of Pittsburgh, Pennsylvania cautions that Botox may not be the miracle TMJ treatment it is purported to be.

If you’ve ever been told by your dentist that you should consider getting a T-Scan bite test, you may be wondering what it is and what it can do for you. The T-Scan bite test is a small diagnostic device that fits in the palm of your hand, and when connected to a computer measures the timing and force of dental occlusion. Dental occlusion is where your teeth meet when you bite. Under ideal conditions, your teeth should all meet together at the same time and with equally applied force. However, if your bite is off- even by just a little bit, you can experience a long list of painful side effects. Thankfully, by measuring for dental occlusion, your dentist can determine where your mouth’s "problem areas" lie, and find the best way to fix whatever problems you may be having.

If you’re one of the 28% of Americans who hide their smile because they don’t like their teeth, you may want to consider getting a cosmetic dental device called porcelain veneers. Porcelain veneers, or simply ‘veneers’ are thin pieces of porcelain that are permanently adhered to the front surfaces of your teeth, to improve everything from color to the shape of the tooth. Veneers can even correct some minor crookedness of the teeth, eliminating the need for lengthy and painful procedures like dental implants or braces.

If you’re one of the estimated 178 million Americans missing at least one adult tooth, or the nearly 40 million Americans missing all of their adult teeth, you may also be considering a tooth replacement solution. If you’re interested in replacing your missing teeth but aren’t sure which tooth replacement option is best for you, don’t despair. We asked Dr. Alexandra George of Pittsburgh, Pennsylvania to help explain the pros and cons of each tooth replacement option to help you make the most informed decision."There are three basic categories of tooth replacement prosthetics: dentures, bridges and implants." George said. "Within each category, there are many variations, but each variety follows the same general structure, varying slightly by materials and design."Each main category of dental device varies in both permanence and cost, but which one you choose depends on many factors, which vary by individual patient.  So while you may not know which solution is best for your mouth without speaking to your dentist, knowing as much as you can about each appliance can help you make an informed decision when it’s time to decide.DenturesThe least permanent of the three dental appliances, dentures are fake teeth which are secured to a flesh colored acrylic base that sits on your gums."Today’s dentures look extremely natural," George said. "In fact, most people cannot tell you are wearing them."Dentures have gotten a bad name in the the past for being uncomfortable, but technology has improved in recent years, and modern dentures are more durable and comfortable than ever before. Within the denture category, there are two main types of dentures: full or partial. Full dentures are used when the wearer has no natural teeth on either the upper, lower or both jaws.  Full dentures fit over the gums and can be secured in-place with denture adhesive.On the other hand, partial dentures can be used to replace anywhere from one or two to several teeth, and stay in place by hooking on to existing teeth, via a metal frame. Because dentures are not permanent, they can be taken out at any time and should be taken out daily to be cleaned after each meal. Dentures should also be removed each night and soaked in a denture soak when not in use, because according to George, the acrylic base can that attaches to your gums can easily dry out, causing your dentures to warp and no longer fit properly. Dentures and partials are usually the most affordable tooth replacement solution, but even despite their lower price point, they can still look just as beautiful and natural as their more expensive counterparts.BridgesThe next option for tooth replacement is a bridge. A bridge is a permanent device that "bridges" across the space that is missing the tooth. The bridge is secured to the mouth by creating two crowns on the teeth, flanking the space created by the missing tooth. The crowns then fit onto the two shaved down teeth, with a third, center tooth that is attached to the abutting crowns. This creates the appearance of successive, natural teeth. Because the bridge is permanently secured to the two crowned teeth, it is considered a permanent device, which cannot be removed for cleaning. A bridge is treated just as you would natural teeth, taking care to floss between crowned teeth to avoid gum infection. A bridge is a great solution for patients with a healthy mouth who are only missing a few teeth. Bridges are more expensive than dentures, but many patients prefer them because they are permanent.Dental ImplantsDental Implants are the Cadillac of the cosmetic dentistry world. These permanent tooth replacements consist of a metal post that is secured to the jawbone beneath the gums, and an artificial crown tooth that screws on top. After the post sets in the bone and heals, your dentist can then attach the artificial tooth or crown directly onto the post. Because the post is set into your jawbone, the implant is considered permanent. The tooth looks natural and sits on the gum the same way a regular crown does. According to George, the downside to implants is that they cost more than bridges and dentures and require the patient to have healthy gums and jaw bones to be a good candidate."Even under the best conditions, there is still a chance that dental implants may not ‘take’ and the post may not stay secured to the jawbone," George said.If this happens the post must be removed, and depending on the situation, may never be able to be reattached.So, which solution is best? According to Dr. George, that’s between the patient and his or her dentist."When deciding which tooth replacement to use, you need to consider many factors," George said. "Your dentist is trained to assist in identifying these factors, and helping you make an educated decision that takes into account your health, budget, and lifestyle."

According to the American Tinnitus Association, a staggering fifty million Americans experience the constant, noticeable, ringing or buzzing in their ears known as tinnitus. Tinnitus can range in severity from slightly annoying to bothersome, and for a small portion of the population, it can be unbearable. But while there are many potential causes for tinnitus, one such cause may surprise you: temporomandibular joint disorder or TMD. We spoke to Dr. Alexandra George of Pittsburgh, Pennsylvania about why TMD and tinnitus often go hand-in-hand and what you can do about it.TMD is a condition of the temporomandibular joint muscles of the jaw. It is estimated that this puzzling condition affects approximately 10 million people a year in America. There is no one cause for TMD nor is there one tried and true treatment. TMD can be caused by any number of things, such as genetics, accidental injury or improper bite. TMD can also cause a wide variety of symptoms, from jaw soreness and tightness to headaches, neck, sinus, and eye pain- and even tinnitus-based hearing loss, which scientists believe could be caused by the TMJ muscles throwing the nerves in the ears out of balance.

If you’re one of the estimated ten million Americans who suffers from Temporomandibular Joint (TMJ) pain or a Temporomandibular Joint Disorder (TMD) you, may be wondering how you struck the bad-luck lottery and ended up with this often-debilitating disorder. TMJ pain is classified as pain and dysfunction of the jaw joints and related muscles. TMD can cause anything from pain in the face, jaw, and neck, to difficulty speaking, opening the mouth, chewing, muscle pain, stiffness, altered bite alignment, and even migraines. So, what causes this type of pain? Some of the answers may surprise you! Genetics Though most TMJ disorders are caused by external factors, about 15% of all TMJ disorders are genetic.  This may seem like a bad thing, but even genetic TMD responds well to treatment- plus, you get the benefit of advanced warning that you may be more susceptible to one if it is common in your family tree. Braces It may seem counterintuitive that the very devices used to treat a bad bite could trigger a disorder that’s caused by a bad bite. But in some cases, forcing the muscles of the jaw to realign can cause TMJ pain. If you wear braces or other orthodontic devices and are experiencing TMJ pain, speak with your dentist or orthodontist about adjusting your appliances. A minor adjustment here or there may help ease some of the discomforts. Grinding Teeth You may not even realize you grind your teeth while you sleep- in fact, some people aren’t even aware they’re doing it during the day- but clenching or grinding your teeth can be a big TMD trigger.  Teeth grinding can be doubly problematic because, in addition to TMJ pain, it can also wear down your teeth, causing chips and cracks that may make your teeth more susceptible to cavities. A great solution to both the TMJ pain and tooth damage associated with teeth grinding is a mouthguard or night guard. Many over the counter guards are available for very little money, but may not be comfortable- but a custom guard made right at your dentist’s office is not only more comfortable, many are nearly invisible and work well for daytime wear. Medicine Certain medicines may exacerbate TMJ pain, such as serotonin reuptake inhibitors (SSRI’s) which are used to treat clinical depression. Drugs and Alcohol You already know that abusing drugs and alcohol is horrible for your entire body- but it also can make your TMJ pain worse, because the overstimulation from these addictions can increase teeth grinding. Stress and Anxiety When we are stressed or anxious, we may be more likely to grind our teeth, but also to hold tension in our muscles. If we are constantly tense or rigid, we can put added strain on our jaw, even if our teeth aren’t touching. Accidental Injury Patients who have been in automobile accidents and have experienced whiplash or who have hit their face or head on a steering wheel or airbag could easily damage the temporomandibular joints and muscles. When a car is ‘rear ended’ the force on the neck can cause the jaw to open, and pressure to be applied to the TMJ. Arthritis Yes, unfortunately, you can get arthritis anywhere- including the joints in the jaw. Much like TMD’s, arthritis is not just one illness but a family of illnesses that affect the joints, causing pain, swelling, stiffness, and decreased range of motion. In fact, there are over one-hundred different types of arthritis!While it definitely helps to know what is causing your TMJ pain, even if it’s a complete mystery we can still treat and possibly eliminate your TMJ disorder and pain. Treatment begins by performing scans to measure the activity of the muscles in your jaw. We then use a special device called a Tens unit to stimulate the nerves and relax the muscles of the jaw, this part of the process can actually give you pain relief as it's being conducted! A third device is then used to calculate your best point of bite balance. From there, a custom orthotic is created to help align the jaw. With repeated use of your custom orthotic, TMJ pain should subside, and more permanent solutions to your TMD can be explored, such as crowns, braces, or continued orthotic use.

If you’re interested in making an appointment to get help for your TMD symptoms, give Dr. George’s office a call at 724-934-3422.

Three main TMJ complaints - headache, neck pain and jaw painA few days ago a woman named Dorothy came in complaining of TMJ symptoms. She was in the office because she was having headaches, neck and jaw pain. Dorothy is not my typical TMJ pain patient. Yes, she has three of the main complaints I hear: headaches, neck pain and jaw pain, but, she is 85 years old.I automatically took a strong liking to Dorothy and her husband, Richard.  Their personalities and humor are very up-lifting.  They have been married for 64 years. I have never had a patient that was in so much pain be so happy!  She had been suffering with headaches every day for many years.  Richard saw my commercial on TV and said to his wife "You are going to see Dr. George or we are going to get a divorce."  Needless to say, I saw her as a challenge just because she has been suffering so long and I wanted to break the pain cycle.  During her TMJ exam, Richard told me that they ordered the "My Pillow" for her neck pain and sent it back for the money back guarantee because it didn’t work.  I laughed because being an infomercial sucker myself, I ordered the same pillow and realized it didn't work. Kindred spirits we are!As we age, things change in our mouths.  We may lose and break some teeth. Through the years we replace them with crowns, bridges or dentures.  Every time a change is made in your mouth your jaw balance maybe thrown a little bit off. Over time it may start to cause TMJ symptoms.Treatment with Dorothy began, and within three weeks her headaches and pain were gone. Even her neck pain has disappeared.  She can chew her food better and sleep better too.  The moral here is, it is never too late to get help and start to live your life pain-free.Dr. Alexandra George, DDS, LVIF

Advanced Technology and Non-Surgical Methodologies for Treatment of TMJ Pain

My fellow dentists,

Amachi Pittsburgh is excited to launch a new program, Strong African American Families (SAAF) to help strengthen and reunify families impacted by parental incarceration, through support from Dr. Alexandra George, Staunton Farm Foundation, POISE Foundation and Eden Hall FoundationSince inception in 2003, Amachi Pittsburgh has been the only organization with a specialized focus on children of the incarcerated in Allegheny County. Amachi historically empowers these children and families through one-on-one mentoring, family strengthening and reunification support, and youth organizing.As of this year, Amachi Pittsburgh has the opportunity to implement an evidence-based curriculum called Strong African American Families (SAAF) to enhance its existing family strengthening work. The SAAF program is a 7-week interactive educational program for African American parents and their early adolescent children. Early adolescence is the period in which children gain increasing control over their behavior, begin forming friendships based on similarities and common interests, and develop attitudes toward substances and substance use. The attitudes and behaviors that they develop during this time influence their achievement, motivation, academic performance and friendship selections, which in turn lead them toward or away from risky behaviors. SAAF is designed to strengthen positive family interactions and to enhance parents’ efforts to help their children establish and reach positive goals during this critical transition between childhood and adulthood. Thus, by design, SAAF is structured to address the problem Amachi Pittsburgh tackles as part of our mission: the personal, family and community deficits that perpetuate intergenerational cycles of poverty, crime, and incarceration.SAAF is supported by Dr. Alexandra George, Staunton Farm Foundation, POISE Foundation and Eden Hall Foundation.

"Mentoring through Amachi has been one of the most rewarding experiences of my life,” said Dr. Alexandra George. “There are so many great kids in the SAAF program. I want them to realize that there is more to the world than what they see on a daily basis, and that they can be whatever they want to be.  Thanks to Amachi and the SAAF program, that opportunity now exists for them.”

Interested in joining Amachi’s “A-Team”? Visit www.AmachiPgh.org or call (412) 281-1288 to learn more about our services, get involved as a volunteer or mentor, and make a tax-deductible donation to support programming for children challenged by parental incarceration in Allegheny County. 

By Alexandra S. George, DDS, LVIF

The subject of replacing a toothbrush came up the last time I visited my sister, Cindy. As a Pittsburgh dentist for more than 25 years, she ought to know that I’ll always ask about her dental health!

To Floss or Not to Floss…That is the question

The other day the girls at the office brought to my attention a video on social media that showed someone getting a procedure done to make their cheek bones look more pronounced. This was also a video from a plastic surgeon and I’ll warn you before you watch it; it is graphic.

The answer to that question is yes and no.

Let’s start with the “yes” answer. Some people are born with big noses. The boney structure is big. The only way to reduce the size of the structurally big nose is visiting a plastic surgeon for a rhinoplasty or “nose job”. When I think of a structurally big nose, Barry Manilow and Barbara Streisand pop into my head.

It depends on what you are looking to find. There are three kinds of offices. Most people will fit into one of these office types.

First type of office is an Emergency Office. I will get a call once in the while from a toothache patient. These patients are looking only for a quick fix to get out of pain and have no intention of going to the dentist again until another emergency arises. I often refer these patients to another office. I choose not to be an “On Star” dentist. I like to treat patients that I can develop a relationship with and want a comprehensive treatment plan.

Years ago I was a participating dentist with a dental insurance. I was young and thought this was a good way to build my practice with the help of a dental insurance company. By agreeing to participate, I agreed to take a cut in what I was paid for a procedure. I thought every dentist participated, so I better join them.

Then one day I did a case on a patient. I placed eight beautiful porcelain crowns in the front of her mouth. What we call the “esthetic zone”. She worked for a school district at the time and had good insurance coverage, according to the patient. Once all was done, the insurance paid for the procedure. I ended up making pennies on the procedure. I called the insurance company because I thought there was a mistake. I wrote a letter explaining my fees, lab fees, cost to run the office etc. I finally talked with a supervisor and she told me two things: one- I needed to use cheaper labs and two- I spent too much time with my patients! I then sat down and wrote another letter to stop my participation with the insurance company. I thought how could an insurance company tell me how to run my office? I was in “private” practice. I wouldn’t use a cheap lab or cheap product on my family members, why would I use cheaper products on my patients?

When patients visit our office we are always reviewing the three ways people lose their teeth. The three ways are decay (cavities), periodontal disease (gum/bone disease) and the way they come together or the bite. Our job is to inform the patient of the condition of their mouth. The patient’s job is to decide what to do. It’s very simple, patients are given a couple of options. They may opt to do nothing. That won’t cost anything! No money, no time spent.