An Exploration Into Oral Health: Treatment Options for TMJ and Bruxism

Overview

• Answers to commonly asked questions from parents
• Why oral health matters
• How to maintain healthy teeth and gums
• How to treat tmj, bruxism and jaw pain from grinding

Video Transcript

Brooke Schmidt:: Hi, Dr. Polumbo. Thanks for joining us today.

Dr. Polumbo: Yes, ma’am. Thank you for having me.

Brooke Schmidt: I'd like to start off with just getting to know you a little better and hearing about your background. So tell us why you became a dentist, and where you went to college and dental school.

Dr. Polumbo: Okay. Well, I originally wanted to become a dentist when I was 14. I was in braces, being treated by Dr. Lynn Smith, who has long been retired in Sanford, North Carolina. And he was absolutely out of his mind, happy all of the time. And I didn't really understand why he was so happy cuz I thought dentists were all supposed to be nerds. So the more I looked into it, the more exciting the field looked. And I just thought, this guy is so happy all the time. This, there's gotta be something to it. So, I went ahead and looked into it. I decided UNC in North Carolina was gonna be my first choice. I took a detour. I was in the army for about five years. I served in the 82nd Airborne Division as a paratrooper. And then I got out, and looked into doing that, being an army dentist.

But I thought the civilian sector looked a little bit more appealing for the career path that I wanted to choose. So I went ahead and got out. I always had the option to get back in, which was very nice. I really appreciated that. and I ended up getting into unc, my first choice, which was really exciting. So I did four years there and a lot of my mentors told me in modern dentistry, you need to do a residency. So I got in with a fantastic residency with the University of Pacific in Union City with Dr. Allen Wong. And I got to work with some superstars where I learned a lot, a lot of, pretty, pretty intense specialty stuff, all in four stuff. Periodontal surgery, complex wisdom, tooth extractions, you name it, we did it. It was, it was pretty great.

And I decided I wanted to stay in the area. So I met a guy that I professionally kind of fell in love with. and I worked for him for a couple of years. I ended up purchasing my own practice in his ecosystem and my career just sort of went from there and I decided I wanted more of an intimate relationship with my patients. So I got out and I purchased a tiny little mom and pops out here in Yuba City where my wife and I are now. And we are just so happy. What else do you wanna know?

Brooke Schmidt: Great. Thanks for sharing. Did you always want to go into dentistry for dental surgery? I know you do some cosmetic dentistry, emergency dental surgery, and preventative care. What did that process look like of discovering what you wanted to do?

Dr. Polumbo: Originally, I thought I wanted to go into orthodontics and the more I learned, the more I was exposed to the field from about year two in dental school. I figured that I was just so all over the place as far as my interests were concerned. So general dentistry was probably a good place for me to start. So I got in and I found out that my interests are just too broad to kind of specialize. so I've remained as a general dentist. but yeah, I do a lot of my own, bone grafting, complex, periodontal surgeries. We just got trained up and purchased some implantology stuff. So, we're adding that to our repertoire. We're, we're pretty excited, excited. It's a lot of fun, but I like to kind of keep it fresh and general dentistry allows me to do something different every single day. Plus with the general dentistry field, you're more inclined to maintain those personal relationships, whereas with your specialty offices, it's more like just referrals. You're only meeting people once and then not seeing them too often. And I just kind of get a little too wrapped up in my patience and I like to hold onto them.

Brooke Schmidt: Awesome. So, tell us a little bit more about your practice and what you love most about your job.

Dr. Polumbo: I really, really like it when people have had bad past experiences. I myself had a couple of bad experiences as a patient, not really to the fault of my dentist, but sometimes anesthetic doesn't work. Sometimes there's a fear or a concern that isn't addressed that the dentist isn't aware of. So, I've had a couple of traumatic situations myself and my biggest thing is, for some reason all of the difficult patients end up finding me those with, with fears and concerns and traumatic histories with dentists. And I just like mending those relationships and getting them to the point where, you know, they're back up to health. They're okay and I can teach them how to take care of their teeth the same way that I take care of mine and so does my team. That way they don't have any future problems and then we can just get 'em on a maintenance regimen.

So that's, I think that's the most rewarding thing. It's not completely doing a full mouth rehabilitation, rejuvenating someone's smile. It's more breaking through and, and connecting with people and getting them over past traumas and making them part of, of the practices family. I think that's the most rewarding part. So that's kind of what my, I'm ending up being known as in, in the community. I also have a pretty extensive history with special needs patients. I have one in, one of my brothers, has special needs and, I just feel very comfortable around those that need a little bit extra, more tlc. I spent a lot of time in a special needs clinic at unc and that's actually one of the primary reasons I got into the residency because Dr. Alan Wong's passion is with hospital dentistry and special needs. So we did a lot of outreach, special Olympics hospital dentistry. We saw a lot of special needs people and that's just kind of what I became known for as well. So those are two special things about the way I like to practice.

Brooke Schmidt: Very cool. So tell me, when patients come in to see you, what are some of the most common questions you get from your patients or their parents?

Dr. Polumbo: Parents like to know if they should be using fluoridated toothpaste or not. and it's a big fat, it depends. Parents wanna know when should they, get evaluated for braces for their kids, Should they be swallowing fluoride Should we be using fluoride on a fluoridated toothpaste How early are we supposed to come in So I tell parents as soon as your kid gets their first tooth, then bring 'em on in. we won't traumatize 'em if all we do is shoot each other with the water guns and we give 'em a toy and a toothbrush and then say see to get in six months. It's all we do. I just don't like to traumatize the little ones. So we just kind of play it by ear and kind of build that relationship and build trust. As far as the other things, I always tell parents, you know, you know your kids better than I do up to the age of five, they're normally swallowing their toothpaste.

So I would prefer you use a non fluoridated toothpaste just because we don't want fluorosis to happen and that fluoride gets integrated in their teeth and also can build up in the adrenal system. We don't have very definitive research saying that it's a good or a bad thing, but I always tell parents, let's err on the side of caution. Then I also reassure 'em that if they aren't in a county that puts fluoride in the water, the one part per million has a ton of research stating that it's perfectly safe and healthy for everyone in the population. and then what was the other thing Yeah- There was one more thing that parents,

Oh, braces. So we wanna ride that growth spurt. So it's about age, 11 for girls and around age 14 for boys. But as a general rule of thumb, right when they're gonna be in their permanent dentition or lose all their baby teeth, that's a great time to go. and then we're always screening patients for a jaw and skull relationship. So if, if there's some sort of a developmental defect or they're in a class two or a class three relationship, meaning their jaw too far back compared to their skull or too far forward, we wanna get them seen by a specialist to kind of correct that, that discrepancy before it becomes a problem. So it just kind of depends, but those are the main things that mom and dad normally ask.

Brooke Schmidt: Great. Thank you. So when people think about going to the dentist, it's often about having their teeth cleaned. That initial thought seems to, seems to disregard the impact healthy teeth and gums can have on someone's overall health. In your experience, what role does oral care play in patients' overall health?

Dr. Polumbo: There are always extreme situations. Normally you're gonna have an infected tooth that can quite possibly affect, you know, your overall health as far as, excuse me, infection of the heart or the brain. But those are very rare cases. Normally it just has to do with a whole bunch of pain and discomfort. There's nothing like the throbbing tooth in the middle of the night and you just can't sleep. Gum infections or periodontal disease can also cause things like spontaneous fetal death, erectile dysfunction, cardiac issues, stroke issues, dementia, Alzheimer's, things of that nature. and then if you do have an active infection going on, I do not recommend you going for a major surgery because you have bacteria that's just teaming through your system. And if we're placing a, a hip replacement or anything with the heart, anything at all, it could become infected and fail. I have had a couple of patients not listen to me and then the surgery failed. So that is something to take into consideration that can factor overall health quite a bit. But, one of the big ones is dementia. We have a lot of research stating that treating periodontal disease is the first step in getting over dementia because that bacteria will make its way to the brain and colonize it.

Brooke Schmidt: Wow. I didn't know that. That's pretty crazy. So what advice do you give to your patients to ensure they maintain healthy teeth and gums?

Dr. Polumbo: I normally joke with them and say if they wave a piece of dental floss around in front of their face, they're head and shoulders better than everybody else in their family. there's a big debate on what's the best thing to do, what order, how do you do it but the big thing is if you're gonna use a Listerine or a mouthwash, you do that first and then you either brush or floss. There's a big debate on which goes first, which goes second. I do recommend an electric toothbrush. We can get into all that nitty gritty, if you want to, but there's definitely ones that work well and ones that don't. Typically speaking, if it has a unit that plugs into the wall, it's worth the money. If it has batteries that are removable, it's really not. What philosophers are great for people that have periodontal disease.

For those of us that really don't, the juice really isn't worth the squeeze. I'd like you to spend your money in other areas or save it. and then finally you're gonna use a fluoridated mouth rinse. Most dentists recommend the act and then there's a bit of controversy of the delivery system on that as well. But I personally recommend it for my patients. and then just showing 'em how to properly brush their teeth. Some people don't know that you're supposed to brush the cheek side, the chew side and the roof of the mouth side or the tongue side. and then they don't know that you're not supposed to shine your teeth like a shoe with a piece of floss, you can actually end up cutting your tooth down, sort of like cutting a piece of cheese with a string. Ooh.

So it's just showing 'em how to do it. Right. Showing 'em how we do it and then explaining how to go about doing stuff. Tell show do is what we say in the army.

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Brooke Schmidt: So, how frequently do your patients complain about jaw pain and what are the primary causes of jaw pain?

Dr. Polumbo: That's very interesting that you brought that up. In the past we would normally do orthodontics or braces for cosmetic reasons. yes, there's gonna be, you know, a select few that they need it for, jaw discrepancies, developmental issues. there are those people, but for most of us we just get braces for a pretty smile. And, and just the basic evolution of, of the field and the practice, we're finding that about 10% of us, me included, we're putting our setting our jaw too far back towards our throat, which is pushing the discs between the ball and the socket or the con in the fo in the tmj, it's pushing it forward, causing a popping and clicking that can get to the point where the disc slips completely off of the ball and you have a lock shut.

I actually experienced that and the only real way to fix it, quote unquote, is to be put into a special anterior repositioning orthotic or something that's gonna bring your jaw forward and keep it there and hopefully the joint will go back into place. This was an area that didn't really exist when it happened to me, so I just had to rip my jaw back open. so my left jaw joint is completely bone on bone and completely obliterated. This is an issue that's very near and dear to my heart. So when we, when I do orthodontics, I will normally take the jaw joint into account or I will be treating four people that have jaw joint issues because the way their teeth or their occlusion meets up does not match with the way their skull wants to meet with their job. So we need to, we need to change that discrepancy and bring it all into line.

So for me, TMJ mostly has to do with the jaw joint. Yes, you're gonna see people with grinding issues or BRS of issues and those are gonna normally either be caused by the joint issue or just from stress in general. Those are two, normally two separate issues. One can cause the other. So a hard night guard is gonna be great for those with grinding issues. if your teeth are to the point where they're cracked and the only real way to fix that is with crowns or root canals. We don't wanna get to that point. I normally try to identify those issues with my patients before they get to the point where they're doing a bunch of crowns. If you do have degenerative joint disease or TMJ issues, you know, truly with the joint, the joint will wear out and one side of your mouth will be hitting harder than the other.

So you'll have a lot of broken teeth, a lot of BRS issues, implants, root canals, crowns on one side because the joint is collapsing. So we also wanna head that off at the pass as well and, and correct things before we are doing a bunch of unnecessary dentistry. So those are the two big issues I'm seeing is grinding and that's fixed with a simple night guard, preferably hard or hard, soft. and then true joint issues and we can fix that with orthodontics by creating more space in the maxilla area of the upper arch and decreasing space on the lower arch. So the jaw is allowed to come forward where it wants to be. or we could use a bandaid through, a special if you would you think of it more as a, a snore guard. but it's not quite the same thing.

So everyone has different terminology for their stuff. I normally will call it an anterior repositioning orthotic or something that allows the bottom jaw to come forward into the proper position. I tell my patients it's more of a bandaid than anything else, but again, it's a lot cheaper and a lot quicker to do a specialized nightguard than it is to do full blown orthodontics. So it's just, we're just meeting people where they, where they're at financially time wise. I always tell my patients, there's no reason to kill a squirrel with a bazooka. Let's try and handle things on the lowest level possible and just see how it goes. We can always do more, but those are the, those are the issues that I normally run into with tmj. And since I myself have catastrophic TMJ issues on my left side, that's an issue. It's very near and dear to my heart. It also helps tremendously to have a cone BM CT or a three dimensional x-ray so you can show the patient, in three dimensions in real time what their, their judgment looks like and what's going on with it and how we can, how we can correct it. That's always a nice, nice teaching tool as well.

Brooke Schmidt: Great. What percentage of children would you say struggle with teeth grinding, bruxing, or TMJ disorder, And what are the common symptoms you see?

Dr. Polumbo: Normally very large. That's another question I forgot to mention when you said what are the common questions mom and dad bring up. Normally around the age of five they say they can hear little Johnny or Sally grind in the living heck out of their teeth and it sounds like they're dying. That's because their teeth sort of are itching and I tell mom and dad every single phase of teething is different. When they're really little they'll get sick or they'll get bubbles or purple or black marks on their gums where their teeth are coming through. everything's marked with different phases. So around the age of five you're gonna see a lot of grinding in this just because their new teeth are coming in, the permanent teeth are coming in and their baby teeth are itching cuz they're kind of plowing through the bottom or destroying them.

and then I'm not really seeing a lot of BRS or grinding issues or even TMJ issues with kids. it's normally once you get to be a little bit older and you're dealing with paying bills and going through college and all that, all that jazz. But normally around the age of five I see a really good percentage of kids grinding their teeth. It is very rare to see a younger teenager needing a night guard. But you know, always the big thing is always listening, so you listen to what they're saying and then you have a dialogue with them and then you can figure out if anything's going on. So it's kind of a case by case basis, but statistically speaking, five year olds grind the heck outta their teeth.

Brooke Schmidt: So for people who don't know what TMJ is, can you give us a brief overview and the issues related to brooking What is TMJ and what is the TMJ meaning

Dr. Polumbo: So TMJ stands for temporomandibular joint. When we will say TMJ issues as, as a dental care provider will normally say temporomandibular disorder, it's potato, potato, tomato, tomato, it really doesn't matter. But normally when I say TMJ issues, I mean there is something wrong in the joint itself. Like we discussed before, it's normally because the jaw is pushed too far back towards the throat and the padding in between the joint is being pushed forward or towards your nose and you're clicking on and off of that padding and you're destroying it. so that can, you can have a complete dislodgement of that joint and then you can have a lot closed like I did. You can actually have a lock open as well. It's a little bit rarer. It's more common to see a lock closed, especially with orthodontics or extractions.

That's why I'm not a really big fan of extracting teeth for orthodontics because it can create a space discrepancy and cause TMJ issues. The TMJ issue can then lead to bruxism or then lead to a traumatic occlusion. Traumatic occlusion just means the way your teeth come together is traumatizing to them. You'll normally see little notches of the gum line, on the cheek sides of the teeth, almost like a tiny little cartoon character's taken a little hatch or a little ax and they're chopping the tooth down like a tree. We'll call those non-car cervical lesions. I just say it looks like a little cartoon character's been chopping your teeth down. So we can correct that with orthodontics as well. but less is always more so if we can just stop the process in its path and, and you know, we're not experiencing any sensitivity, then the less I can do to my patients, the better off they are.

So we can do fillings if it's a cosmetic issue. but yeah, correcting, correcting that, that chewing issue, that jaw occlusive or biting issue is, is gonna, is gonna stop that. And then you have your grinding issues where people are just stressed out and they're just grinding their teeth and they're wearing them down. Once you get to a certain point, the only real fix is to do a full mouth rehabilitation. It's a crown on every single tooth. and we just don't wanna let people get to that point because it's very expensive to fix and you know, people are normally not happy with the price tag on that. So we try to avoid that sort of situation at all costs.

Brooke Schmidt: So would you recommend TMJ surgery? How can people find TMJ relief?

Dr. Polumbo: Traditionally speaking, you would need to go to a pain specialist. but just like back and knee, knee surgery historically speaking, we would recommend you not go through those surgeries because they can actually make you worse. With more modern techniques, people are getting very successful back in knee surgeries. So at this point in time we would prefer not to put people through jaw surgery. Sometimes it's just the way that you're made and we have to cut your skull into pieces and reposition it. Those are extreme situations. But, if we can fix things through moving the teeth or even putting you into a specialized night guard, that's gonna be much less invasive, much less painful, much less expensive, there's a lot less heartache involved in that. So I'd like to reserve jaw surgery for only very, very extreme cases and just with more modern approaches we're needing to lean on that less and less and less.

Brooke Schmidt: So finally, there are lots of opinions about custom fit night guard or mouth guards that people can buy from their dentist and similar products that people can buy from popular retailers like Amazon. What is your point of view about these products

Dr. Polumbo: So it kind of, again, it kind of depends. So a lot of times I will direct people to an over the counter night guard if there's a lot of work that we need to get done. they have a lot of cavities, they have broken teeth that we're gonna need to fix. If we do a professionally made night guard, I'll have to heavily modify that night guard in order for it to fit as we continue to fix their issues. This is only for someone that's experiencing brx or TMJ issues and we need to find some sort of relief immediately, while we still have to fix teeth. So I will recommend that they go and get a cheap over the counter night guard, very similar to a sports tooth guard. And then after everything is said and done, then we can make a professionally made one.

Or if I'm not quite sure, and I don't mind telling my patients, I don't know, let's figure this out together. Sometimes we have to do detective work. I don't want them to run into a financial situation or hardship that they don't, they don't need to incur. So I'll say, Hey, let's do an over the counter night guard, see if it helps. If it helps and we wanna do something more permanent, then we'll do a professionally made one. But I only like patients to use their insurances or use their money in ways that are gonna be effective. So I use over the counter stuff all the time as a general rule of thumb, they're inferior, however they fit into our needs, quite often. So I'll normally lead with something like that, but for a long term solution it's not gonna be our best bet.

Brooke Schmidt: Great. Well that's all the questions I have for today. Thank you so much Dr. Palumbo. You've been so helpful with providing really helpful information for people who have tmj, bruxism and jaw pain from grinding. I think people will find this really helpful in helping to guide their decisions and how to get treatment for those things moving forward. so I really appreciate you taking the time to do this interview with me and I hope you have a great rest of your day.

Dr. Polumbo: Yes ma’am. It’s been fun. Thank you for having me.