timberlake dental

Can a Sinus Infection Make my Teeth Hurt?

Spring is here.  And with it come seasonal allergies.  It is very common for dentists to see an increase in “toothaches” during this season.  We put “toothaches” in quotes because while the tooth definitely aches, it is not a tooth problem.  Many patients will call us with a toothache and come in for an evaluation, only to be told that the tooth is perfectly fine.

Why does sinus pressure make my teeth hurt?

The natural anatomy of our upper teeth, jawbones and sinus cavities predisposes us to this problem.  The maxillary sinus cavities are large, air-filled spaces located just inside our cheekbones.  They extend inward toward the nose and downward toward the upper teeth.  Often the jawbone separating our upper teeth from the above sinus cavity is extremely thin.

The sinus cavities are supposed to be empty.  These air-filled spaces allow for the passage of air as we breathe and lighten the weight of our skull so that we can hold our heads up.  Anyone who has ever experienced sinus congestion knows that it can be hard to breathe and make your head feel heavy.

When the sinuses are filled instead of empty, pressure is created in that bone-encased space.  Many people feel this pressure inside their cheekbones or under their eyes.  Many also feel this pressure on their upper molars and premolars.  The nerves that supply sensation and feeling to our teeth enter the tooth at the very tip of its root.  Many upper molars’ roots protrude up into the sinus cavity.  When there is an increase in pressure in the sinus, it can cause sensitivity, soreness or just a plain old toothache.

What symptoms are commonly associated with sinus pressure toothaches?

  • Because the toothaches associated with sinus cavities are caused by an increase in pressure, anything that changes the pressure would change the pain in the tooth. Things like the impact of running or jumping and tossing your head upside down to blow-dry your hair will affect the pain of a toothache caused by sinus pressure.
  • Because of the pressure on the tooth’s nerves, the teeth may be more sensitive to cold air or liquids.
  • The increase in pressure on the roots of the teeth also causes a soreness or tenderness when chewing, grinding, or tapping on the side of the tooth.

What can I do about it?

First of all, you should rule out any problems with your teeth.  If you have not seen a dentist in a while, you should schedule a visit to have the tooth or teeth evaluated.

If you have been seen regularly by your dentist and know that you have no cavities or other problems with your teeth, you may want to begin by treating your sinus pressure.  Take over-the-counter decongestants and antihistamines.  If these do not help, you should see your medical doctor to treat your sinus condition, allergies, cold or flu.

Many patients have experienced this multiple times and are able to recognize it as a sinus problem and not a tooth problem.  If you are not sure, come see us anyway.  When in doubt, rule out a real toothache!

Have a toothache that could be from sinus pressure?

Call our office at 940-382-1750 to set up a consultation with Dr. Chowning. He will do a thorough evaluation of the area that is bothering you and distinguish between a tooth problem and a sinus problem.

How Does Aging Affect Oral Health?

There are two reasons aging is important to oral health: 1) the population of elderly people in America is growing rapidly, and 2) more and more of those people are keeping their natural teeth!

Research projects that by the year 2030, twenty percent of the U.S. population will be over the age of 65.  This rapid growth results from advances in healthcare, which allows people to live much longer than in previous generations.  Advances in dental care result in more of these elderly people keeping their natural teeth much later in life.

It is important to understand the value of oral health in an aging population and the changes necessary to protect oral health in aging individuals.

What Factors of Aging Affect Oral Health?

As we age, certain bodily functions naturally decrease.  There are other important bodily functions that are affected by the prevalence of systemic diseases or health conditions and the medications necessary to treat them.

This list includes the most common links between aging and oral health.

Dry Mouth

The body naturally produces less saliva as we age.  This problem is often compounded by prescription medications that cause dry mouth as a side effect.  Because our aging population takes more medications, the risk for dry mouth in elderly people is extremely high.

Saliva performs several very important functions, including protection of the mouth against cavities, gum disease, and mouth sores.  When saliva is decreased, the risk for all of these problems increases exponentially.

Elderly patients with dry mouth are at a high risk for cavities, especially on the roots of the teeth.  They are more likely to experience progressive gum disease, and they have a greater chance of suffering from painful ulcers and mouth sores.

Multiple Health Concerns

Aging patients typically have one or more systemic health concerns, like high blood pressure, arthritis and diabetes.  These conditions all affect the body’s ability to fight infection, function normally and heal completely.  This means oral health problems like cavities and gum disease can be more destructive in the presence of these diseases.

Arthritis affects oral health in two separate ways.  1) Arthritis can affect the jaw joints, making chewing difficult or painful.  2) Arthritis in the hands makes maneuvering a toothbrush and floss much more difficult and less effective in cleaning the teeth.

Decreased Manual Dexterity

Aging can affect one’s ability to brush and floss teeth effectively.  Patients may have trouble opening wide enough to clean their teeth properly.  Using a manual toothbrush or flosser becomes increasingly frustrating as hands become less flexible or shaky.

Decreased Cognitive Function

Many elderly people suffer from conditions affecting their mental abilities, like Alzheimer’s disease or dementia.  Patients without cognitive diseases can also suffer from forgetfulness, which leads to lack of proper self-care.

This contributes to poor oral hygiene and home care of the teeth and gums.  As the risk for dental disease goes up and home care goes down, elderly people are very likely to suffer problems with their oral health.

Why is Oral Health So Important to Aging Adults?


Chewing is the first step in the digestive process.  Elderly patients are more likely to be missing teeth and have a dry mouth.  Missing teeth reduce a person’s ability to properly chew his food.  This carries an increased risk for choking and decreased digestion of food.

A dry mouth, or lack of saliva, also affects the digestive process because saliva contains important enzymes for breaking down food particles.  Without them, food is not broken down the way it should be.

These interruptions in the digestive process affect the way the body absorbs nutrients from food.

Quality of Life

Enjoying a nice meal is one of the greatest pleasures in life.  Being able to smile, laugh and speak well improve one’s quality of life.

When oral health is affected, there is no question that the quality of life is decreased.  Everyone deserves to eat, speak, and smile comfortably into their old age!

How Can You Protect an Aging Loved One’s Oral Health?

There are several important steps you can take to ensure your aging loved ones maintain good oral health.

  1. Monitor or assist in oral hygiene.  At a certain point in life, your elderly parents or loved ones may need help cleaning their teeth properly.  If they live with you, check on them regularly.  If they live in a nursing facility, check with their caregivers to make sure someone is keeping up with oral hygiene.
  2. Maintain consistent dental visits.  It is easy to forget about routine dental visits when patients have many other health concerns.  Make it a priority to have regular check-ups with their dentist.  Many nursing facilities have dentists who do on-site dental care.
  3. Proceed with any recommended preventive dental care.  There are many prescription dental materials available today which can help fight cavities and reduce the risk of decay and gum disease.  These preventive options are wonderful for elderly patients who may not be able to tolerate extensive dental treatment.

Do You Have an Aging Loved One in Need of Dental Care?

Please call us today at 940-382-1750 to schedule a consultation with Dr. Chowning.  He will advise you on how to best care for your loved ones and keep their oral health in the best possible shape!



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Spring Cleaning

Spring has sprung!  This time of year is a time for new beginnings and fresh starts.  Trees are budding, and flowers are in bloom.  Most people are familiar with the concept of spring-cleaning.  We clean out our closets and our flowerbeds.  We throw out things we do not use anymore.

Obviously, spring-cleaning carries with it the idea of cleaning up the things to keep.  It also implies cleaning out things that are past their usefulness.

When you spring-clean, you strive for a clean slate, bringing things back to a state that is more easily maintained so that they stay cleaner for longer.

As your dental experts, of course we want you to apply this concept to your mouth!

Spring Cleaning for Your Mouth

Cleaning Up the Things to Keep

We want you to keep your teeth.  Forever.  We want your teeth to outlast you!  In order to keep your teeth for the rest of your life, they must have healthy gums and supporting bone.  They also need to stay cavity free.

The key to keeping teeth free of decay with healthy gums and bones is keeping them as clean as possible.  There are two essential steps you must take to keep your mouth clean.

  1. Professional Teeth Cleanings – To achieve a perfectly healthy mouth, it is absolutely necessary for you to have professional teeth cleanings on a consistent basis. Our wonderful dental hygienists are masters at removing every trace of bacteria from your teeth and gums.  No matter how diligent you are, you can never clean every bit of plaque and tartar on your own at home.  Professional teeth cleanings are a must for a clean mouth.
    • Interval of Teeth Cleanings – All men are not created equally when it comes to plaque and tartar buildup. We are all unique, with specific risks and needs.  For this reason, some people need to have professional teeth cleanings at different intervals than the average of six months.  Ask your dentist and dental hygienist which interval will give you the healthiest outcome!
  2. Great Home Care – As amazing as our hygienists are, they cannot do all of the work for you. Their job stops when you walk out of our doors, and the ball is then in your court.  They leave you with a clean slate and all the information you need to keep it clean.  If you have a particularly difficult area to clean on your own, ask one of our hygienists.  They each have customized ways of teaching you how to clean your teeth to the best of your ability.  Follow this regimen for great home care.
    • Brush twice daily with a fluoride toothpaste after breakfast and before bedtime. If possible, use an electric toothbrush, which is proven to remove more plaque buildup than a manual toothbrush.
    • Floss every night before bed. Brushing alone does not get the job done.  Flossing is the only way to remove plaque and food debris from between the teeth.
    • Add a mouthwash to your daily routine. There are so many different types of mouthwash available today, and they have different purposes.  Ask your hygienist which type is best for your specific needs.

Cleaning Out Useless or Obsolete Things

Okay, this may seem like a strange concept when applying it to your oral health.  We have two ways that you should “clean out” things related to your mouth.

  1. Throw Out Your Toothbrush – Toothbrushes are wonderful tools that have greatly improved dental healthcare. But they do not last forever.  If yours is frayed or splayed or otherwise “worn out”, toss it.  For electric toothbrush users, buy the replacement heads, and throw this one out.  Old toothbrushes can harbor bacteria and even grow mold.  Once the bristles are worn out, they may not even touch the tooth surface as they should.
  2. Take a Tip from Marie Kondo – The bestselling author of “The Life-Changing Magic of Tidying Up” has a unique tactic for cleaning out your closet. Hold up an item and think about how it makes you feel.  If it does not bring you joy, get rid of it.  If we were to apply that tactic to your mouth, what would you get rid of?  Is there an old discolored filling that you hate?  Do you have a tooth that you try to hide when you smile?  If there is something in your smile that does not bring you joy, please schedule a consultation with Dr. Chowning to discuss how we can change that for you.

Maintaining a Clean Mouth

Have you noticed the phenomenon that it is much easier to keep something clean once it is clean?  The fact that the countertops are free of clutter makes you want to keep any clutter from building up.

The same is true for your teeth.  The feeling of a perfectly clean mouth just after your professional teeth cleaning is so good that you are more motivated to follow a great home care regimen.  Don’t let that momentum fizzle out.  Commit to keeping up that great home care routine so that your “spring clean” lasts all year!

Do You Need a “Spring Cleaning”?

It is time for a fresh start!  Call 940-382-1750 today to schedule your professional teeth cleaning with our fabulous hygienists or a consultation with Dr. Chowning.

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Dry Mouth

What is dry mouth?

Dry mouth or xerostomia is a condition in which the salivary glands do not function properly.  In some cases, there is some limited salivary flow. In others, there is no salivary flow at all.  At rest (when not eating), your body is supposed to produce more than 1/10mL of saliva per minute, and when chewing, more than 7/10mL of saliva per minute.  Anything less than this is considered dry mouth.  Some people can tell when their mouth feels dry, but others are unaware of it.  If you’re not sure, ask your dentist, hygienist or dental assistant.  As dental professionals, they know what normal salivary function looks and feels like and will be able to tell you if your mouth is normal or dry.

What causes dry mouth?

The causes of dry mouth vary, and the most common form of dry mouth is medication-induced.  According to the Surgeon General’s Report on Oral Health in America, more than 400 over-the-counter and prescription medications contribute to dry mouth!  The more medications you take, the worse the dry mouth can be.  The risk for decreased salivary function also increases as you get older, which can be compounded by the prescription medications you take.

Another common cause of dry mouth is damage to the salivary glands by radiation therapy for the treatment of head and neck cancers.  There is also some evidence of dry mouth caused by certain chemotherapies, and these tend to be temporary, resolving once the chemotherapy is discontinued.  Radiation therapy, however, can create permanent dry mouth by killing cells in the parotid salivary glands, if they are in the target area for the radiation.  There is an FDA-approved drug shown to decrease the risk of salivary damage from radiation therapy if it is administered IV 15-30 minutes before radiation therapy.  If you find yourself in need of head & neck radiation therapy, ask your doctor about Amifostine!

The other causes of dry mouth can be grouped into one section of systemic or autoimmune diseases.  This means that the dry mouth is simply one symptom of a disease that can affect multiple systems of the body.  Sjögren’s disease causes severely dry mouth and dry eyes, along with many other symptoms.  Dry mouth is also a symptoms of diseases like Cystic Fibrosis, Hep C, HIV/AIDS, and can be a complication of hormone changes or head and neck injury.

What are the important functions of saliva?

  • The first step in digestion via enzymatic breakdown of food
  • Maintenance of a neutral pH in the mouth
  • Protection of the teeth and gums against bad bacteria and fungus
  • Lubrication of the cheeks, tongue, floor of mouth and lips

What are the dangers of dry mouth?

  • Improper chewing and digestion of food à increased risk of choking and decreased nutritional absorption of food
  • A prevailing pH in the mouth that is acidic à increased risk of tooth erosion and cavities, especially at the gumline and on root surfaces that may be exposed by gum recession
  • An increased accumulation of bacterial plaque à increased risk of cavities, gingivitis, periodontal disease, and fungal infections
  • Increased risk of mouth ulcers, sores, cheek- and tongue-biting, and increased discomfort of removable partials or dentures

What can you do about dry mouth?

  • Talk to your medical doctor. Confirm that you are on the proper dose of all of your medications.  Ask if any could be lowered or redistributed to taking smaller doses more frequently instead of very large doses once per day.  If your dry mouth is severe, discussed the possibility of taking a salivary stimulant prescription that could increase your body’s production of saliva.  Caution: this would involve taking an additional prescription medication, which also has its own series of side effects.  This should only be considered in an extreme case.
  • Stimulate natural saliva production! The very best way to do this is by chewing sugar-free gum with a strong flavor.  Our favorite is Ice Cubes, which contains up to 2g of xylitol per piece.  You can also use sugar-free mints if you have any concerns with chewing gum; research studies have shown the salivary stimulation is much higher with chewing gum than using mints.
  • Stay away from other mouth-drying irritants like alcohol, tobacco, and caffeine! This includes alcohol-containing mouthwashes. Check the label of the mouthwash you are using to see if it contains alcohol.  If your mouth is dry, try a mouthwash like Biotene.
  • Don’t miss a dental visit! Because of the increased risk for cavities and gum disease, it is even more important that you have consistent visits with your dentist and dental hygienist.  Follow your dentist’s recommendations for oral care products.  Most likely, he will recommend a prescription fluoride toothpaste or gel to be used daily and a professional fluoride varnish application at your teeth cleaning visits to strengthen the teeth and make them less susceptible to cavities.  He may also recommend more frequent teeth cleanings to fight against the increased accumulation of plaque.

Do You Suffer from Dry Mouth?

Call our office at 940-382-1750 today to schedule a consultation with Dr. Chowning.  He will evaluate the quantity and quality of your saliva, and give you recommendations on taking great care of your mouth.

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High Risk for Teeth Grinding

What is Bruxism?

Bruxism is the medical term for the grinding of teeth or the clenching of jaws. Bruxism often occurs during deep sleep or while under stress.  Clenching and/or grinding the teeth can be a subconscious act, meaning you are unaware that you are doing it.  Many people clench or grind their teeth when they are concentrating, driving or working out in addition to while they are sleeping.

What are the Causes of Bruxism?

Bruxism can have several different causes.  Some people have irregularities in the way the teeth come together (occlusion) that cause increased muscle activity.  Other people clench or grind their teeth when they are under stress.  Often, bruxism is a sign of a sleep-disordered breathing problem, like sleep apnea.  It can also be a side effect of certain medications, including some antidepressants and ADHD medications.

What Does it Mean that I am High Risk?

There are multiple factors that can show your dentist that you are at high risk for clenching or grinding your teeth.

  • Wear facets – damage to the biting surfaces of teeth that looks like flattened areas
  • Tightness or soreness in the muscles of the jaws
  • Excessive muscle force – evidenced by large facial muscles
  • Recession – loss of gum attachment, teeth appear longer
  • Abfractions – notching of enamel at the gumline
  • Potholes on the biting surfaces of back teeth – the enamel is completely worn away, and the underlying tooth structure becomes deep and concave, just like a pothole in the road
  • Linea alba – white callous line on inner cheeks
  • Scalloped tongue – the outer edges of the tongue become shaped like the inner edges of the teeth

 What Can I Do About it?

You can prevent some of the damage to your teeth and gums by having a dental nightguard custom made for your mouth.  When you sleep in a protective nightguard, you decrease the stressful forces applied to the teeth as you sleep and protect them from further breakdown.  If you find yourself clenching during the daytime, talk with Dr. Chowning about techniques to help break that habit.

 What if I Don’t Do Anything?

Bruxism can lead to multiple complications of your oral health.  Inside the mouth, bruxism can cause cracked teeth, loss of tooth structure, shortened teeth, gum recession, abfraction or notching of the teeth at the gumline.  These complications can result in many different types of damage to the teeth and an increased cost of dental care over your lifetime.  Outside the oral cavity, bruxism can cause problems in the chewing muscles or in the jaw joint itself.  Muscle tension can lead to facial pain or headaches.  Problems in the joint can lead to arthritis and slipped disks within the jaw joint.  This all can lead to pain, limited function, and decreased overall quality of life.

How Do I Find out if I am Grinding my Teeth?

Call our office at 940-382-1750 to set up a consultation with Dr. Chowning.  He will assess all of your risk factors and let you know if you are high risk for clenching and grinding your teeth.  He can also guide you in choosing a treatment option to prevent long-term damage.


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April is Oral Cancer Awareness Month!

Cancer is a disease caused by uncontrolled growth of abnormal cells in a part of the body.  Oral cancer is a type of cancer in which these abnormal cells originate in the mouth.  Cancer is classified by the original site of abnormal cells.  Oral cancer kills approximately one person every hour in the United States.  About 50,000 new cases of oral cancer are diagnosed each year.

What are the different types of oral cancer?

The most common type of oral cancer is squamous cell carcinoma, and it occurs in the tissues lining the inside of the mouth or on the lips.  Squamous cell carcinoma makes up over 90% of all oral cancer.  A much smaller percentage of oral cancers develop in other types of tissue in the mouth, like the salivary glands causing adenocarcinoma, the lymph nodes or lymph tissue like tonsils causing lymphoma, or in pigmented tissue causing melanoma.

What are the risk factors for oral cancer?

The risk factors most closely associated with oral cancer are:

  • Tobacco use of any kind
  • Alcohol consumption
  • Infection with human papilloma virus (HPV)
  • Chronic oral infections
  • Persistent trauma to oral tissues
  • Poor oral hygiene, lack of dental care
  • Poor nutrition

Who is most likely to get oral cancer?

  • People who work outdoors and have a large amount of sun exposure on their lips are at a high risk for developing cancer on their lips.
  • People who smoke, use smokeless tobacco and/or drink alcohol have a high risk for oral cancer inside the mouth. Tobacco use combined with alcohol consumption creates a risk level that is higher than either one alone because they act synergistically together. 
  • People infected with the human papilloma virus (HPV) have a higher risk for developing oral cancers at the back of the throat and base of the tongue. Certain strains of the virus have a higher risk than others.  HPV is the newest known cause of oral cancers and accounts for the changing demographics of oral cancer.  Historically, oral cancer was a disease of old men who smoked and drank alcohol a lot.  The average age of oral cancer has dropped in the last two decades, and it now affects more women than in the past.
  • People with chronic infections and persistent trauma in their mouths have an increased risk for developing oral cancers. This means patients with untreated gum disease are more likely to get oral cancer than patients with healthy gums.

What can I do to lower my risk for oral cancer?

  • Limit sun exposure and use SPF chapstick!
  • Stop ALL tobacco use, both smoking and smokeless tobacco!
  • Limit alcohol consumption.
  • Practice good oral hygiene. Treat any persistent infections in the oral cavity including cavities and periodontal disease.
  • If you have an area of your mouth that is prone to trauma (cheek biting, a sharp tooth cutting your tongue), see your dentist to discuss treatment options to reduce the occurrence of this trauma.
  • See your dentist for regular oral cancer screenings. At Timberlake Dental, this is included in every comprehensive and periodic oral evaluation you have with Dr. Chowning.  In its initial stages, oral cancer is typically painless and easily goes unnoticed without a visual evaluation.  This is why consistent oral cancer screenings are so important.  Early detection is key!
  • Perform a self-screening exam once every month.

What should I look for in my mouth?

Any ulcer, sore, blister, lump or abnormal tissue that does not heal within 14 days needs professional evaluation by a dentist.  A very common presentation for oral cancer is an overgrowth of white tissue on the sides of the tongue or the floor of the mouth.  Cancerous lesions can also be bright red in color.  As you are screening yourself, simply search for anything that does not blend in with the surrounding tissue both by look and by feel.  Because of some locations in your mouth being difficult to see, you may be able to feel something unusual without seeing it.  Remember, oral cancer rarely causes any discomfort or pain in its early stages, so you have to be looking on a consistent basis to catch it early.

What do I do when I find something in my mouth that could be oral cancer?

Monitor it closely, noting what date you first saw or noticed the lesion.  Take photos of it, if possible.  Any sore, ulcer, or bump that does not heal within 14 days needs professional evaluation by a dentist.  Make an appointment with Dr. Chowning for an evaluation as soon as possible.

What is the treatment for oral cancer?

Treatment for oral cancer depends on the stage of cancer diagnosed.  Early detection is the most important factor in beating oral cancer!  The first step is always a biopsy of the abnormal tissue.  Depending on the location of the tissue, this will be done either by a periodontist (gum specialist), oral and maxillofacial surgeon, or an ENT (for lesions on the tonsils or throat).  Once biopsy results confirm a diagnosis of cancer, treatment will commence with the surgeon working in coordination with an oncologist and can include surgical removal of cancerous tissue, chemotherapy and radiation.  Dr. Chowning will work in cooperation with your doctors to ensure that the rest of your mouth stays as healthy as possible throughout treatment.

More information on oral cancer can be found online at The Oral Cancer Foundation and the American Association of Oral and Maxillofacial Surgeons.

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What Does It Mean to be High Risk for Gum Disease?

What is Gum Disease?

Gum disease, referred to as periodontal disease, is a disease that affects the structures supporting the teeth, including both the gums and the jawbone.  Its primary cause is bacterial buildup on the teeth, and some people have a higher risk due to genetic factors, systemic disorders (such as diabetes), and habits (such as smoking or oral tobacco use).

What are the Stages of Gum Disease?

The earliest stage of periodontal disease is called gingivitis, which means inflammation of the gums.  Inflammation can involve one or more of the following:

  • A bright red color to the gums
  • Swollen or puffy gums
  • Gums that bleed easily when brushing, flossing or having teeth professionally cleaned

How Does Gum Disease Happen?

Periodontal disease begins with the accumulation of bacteria and plaque on the teeth.  This can be due to poor oral hygiene, and it can also be due to the presence of very difficult-to-clean areas on your teeth.  When teeth are crooked or rotated, they collect more bacteria.  We all have different types of bacteria in our mouths, and some types are more destructive than others, meaning they are more likely to cause disease.  Research studies show that the types of bacteria that gather on crooked teeth are more likely to cause periodontal disease than the types of bacteria that collect on straight teeth.  Periodontal disease progresses as the bacteria and plaque harden on the teeth into tartar, which can only be removed with a professional cleaning.  If no professional dental care is completed, the tartar accumulation will grow, causing more inflammation and more serious damage to the gum and bone.  In severe periodontal disease, the supporting structures have become so damaged that they can no longer hold the teeth, which become loose and have to be extracted.

What Does it Mean to be High Risk?

If, during your evaluation, you presented with some signs of gingivitis, you would be classified as high risk for periodontal disease.  As stated earlier, gingivitis is the first step to periodontal disease, and if left untreated, it can lead to a progression of disease.  The good news is that in the early stages, periodontal disease is completely reversible!

Risk Factors Noted During a Dental Evaluation:

  • Gum pockets measuring ›3mm
  • Poor oral hygiene
  • Crowded teeth
  • Previous gum disease
  • Bone loss
  • Mobility (loose teeth)
  • Gum recession
  • Mucogingival defect (gum tissue that is not attached to the bone underneath it)
  • Abnormal muscle attachments

What Can I Do About it?

  1. Have a professional dental cleaning.  This removes the bacterial accumulation from the teeth, essentially giving you a “clean slate”.
  2. Change your oral hygiene routine as directed by your dentist or hygienist. This may involve different toothbrushing techniques, an electric toothbrush, consistent flossing, interdental brushes, etc . . .
  3. If prescribed by your dentist, begin an antibiotic mouthrinse daily. The more bacteria you kill, the less there are to accumulate on your teeth.
  4. Return for a follow-up professional cleaning in 6-8 weeks. This allows us to assess the home care, suggest any positive changes to be made, and again remove bacteria that have accumulated.

What if I Don’t Do Anything?

Without treatment, bacterial levels will increase, causing more accumulation of plaque and tartar.  More plaque and tartar causes more inflammation and response from the gums and bone.  As the bone migrates away from the tartar buildup, which it considers a foreign substance, the support for the teeth is slowly lost.  In a worst case scenario, untreated periodontal disease eventually leads to loss of all teeth and loss of the underlying jawbone, which makes future treatment with either dentures or dental implants less predictable.

Concerned About Gum Disease?

Call our office today at 940-382-1750 to schedule a consultation with Dr. Chowning.  He will evaluate your gums and assess your risk factors.  You can get started with treatment as soon as possible!

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What Does It Mean to be High Risk for TMJ Problems?

What is the TMJ?

The TMJ is arguably the most complicated joint in the body.  It is a ball-in-socket joint, just like your shoulder and hip joints.  The complicated part is that during normal function, the ball comes out of the socket!

The “ball” of the joint is the condyle of the mandible (lower jaw).  You can usually feel the condyle. It feels like a small bony bump right in front of your ear that moves when you open and close your mouth.

The “socket” is an upside-down depression on your skull that the ball fits into.

Between the ball and the socket is a small cartilage disc.  It separates the bones, just like the discs in your back between the vertebrae.  The disc protects the bones and moves with the ball as you open and close your mouth.

Why Do So Many People Have Problems with their TMJs?

There are several reasons that TMJ problems are so common.

  1. It is a complicated joint, and it is fairly easy for problems to happen.
  2. The TMJs are joints we use constantly for speaking, eating, smiling, laughing, etc . . . Some people even use the joints all night by clenching or grinding their teeth.
  3. Injuries to the head and neck are common with sports, auto accidents, and even in conflicts. Any impact to the head and neck can damage the TMJs.
  4. Bad habits, like clenching or grinding your teeth, cause consistent microtrauma, which adds up over time to worsen the joints’ health.

What Things Make You High Risk?

Many different factors put people at risk for problems with the TMJs.  The list includes, but is not limited to:

  • Weak joints – Any predisposition to joint problems will weaken the TMJs and make them more likely to suffer problems over your lifetime. This includes things like arthritis, degenerative joint disease, and hormonal joint problems.
  • Any prior trauma to the head and neck – There is a high prevalence of TMJ problems among people with a history of sports or cheerleading injuries, auto accident injuries, or any blows to the head and neck.
  • Growth defects or problems – In some cases, the joints do not grow properly and develop small, weak condyles that cannot withstand the necessary forces of the jaws.
  • Clenching/grinding your teeth – As noted above, these bad habits are considered “microtrauma”. This means the joint is sustaining small injuries consistently over a long period of time.  Eventually, the small injuries add up to cause a big problem.

How Do I Know if I am High Risk?

There are many different symptoms of TMJ disorder or dysfunction.  Some patients experience no symptoms at all because they have adapted to a weak or dysfunctional joint.  If you do have symptoms, they may occur only on one side or on both.  Some of the symptoms you could experience include:

  • Pain in your facial muscles, headaches or neck pain
  • Ringing in your ears
  • Pain or discomfort in the joints right in front of your ears
  • Pain on opening your mouth wide or moving it side to side
  • Popping or clicking noises in your joint with you move your jaw
  • Gravelly or crunching sounds in your joint
  • Jaw locking closed, feeling like you cannot open your mouth
  • Jaw locking open, unable to close your mouth after opening wide

What Can I Do About It?

The first step is a proper diagnosis.  It is important to see a dentist who has been trained in diagnosis and treatment of TMJ problems.  You should also know that there is currently no board-certified specialty in the TMJ.  Any practitioner who advertises “TMJ Specialist” is self-proclaimed and has not received any special certification by a college or university.


Dr. Chowning has been trained in the diagnosis and treatment of TMJ problems by the esteemed Pankey Institute.  He will perform a thorough evaluation of your jaw joints, taking into account any symptoms you experience, and give you an accurate diagnosis.  There are many different treatment options available for managing TMJ problems, and they range from minor physical therapy exercises to wearing a mouthguard while you sleep to major TMJ surgery.

Have Problems with Your TMJ?

Call us today at 940-382-1750 to schedule a consultation with Dr. Chowning.  He will discuss all of your options and help you choose the treatment that will best manage your TMJ problems.

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Not Sleeping Well?  Maybe It’s Sleep-Disordered Breathing

Did you know that snoring can be a sign of a serious health problem called obstructive sleep apnea?  Snoring is the sound of turbulence as air moves through the back of the mouth, nose and throat.  The human airway is composed of collapsible walls of soft tissue.  Because the muscle tone of the body ordinarily relaxes during sleep, this collapsed tissue can obstruct breathing during sleep.  When breathing stops for a period of time, it is called an apnea.

Obstructive sleep apnea falls into one of three classifications of severity: mild, moderate or severe.  The classification depends on the duration of apnea (it can last for a few seconds up to over a minute) and the frequency of these breathing events per hour of sleep.  Common symptoms include loud snoring, gasping or choking sounds, restless sleep, and sleepiness during the daytime.

Am I At Risk?

People with low muscle tone and soft tissue around the airway and people with a structurally narrow airway are at high risk for OSA.  Elderly people are more likely to suffer from sleep apnea than younger people are, and men are more likely than women are.  Risk for obstructive sleep apnea rises with increasing body weight, smoking and age.  In addition, patients who are diabetic or borderline diabetic are up to three times more likely to have sleep apnea.

Why Should I Care?

Sleep apnea is important to identify because of its related health problems.  Sleep-disordered breathing is associated with an increased risk of cardiovascular disease, stroke, high blood pressure, arrhythmias, diabetes, and sleep deprived driving accidents.   When high blood pressure is caused by sleep apnea, it is distinctive in that the readings do not drop significantly when the individual is sleeping.  This is different from normal hypertension, or high blood pressure, which noticeably lowers when the person is sleeping.

Research studies estimate that in the U.S. the average untreated sleep apnea patient’s annual health care costs twice as much more than an individual without sleep apnea.  Patients with sleep apnea are also fifteen times more likely to be involved in a car accident.

How Do I Know If I Have It?

  • Have you been told that you snore?
  • Do you wake up choking or gasping?
  • Have you been told that you stop breathing in your sleep?
  • Do you have problems keeping your legs still at night or need to move them to feel comfortable?
  • Are you very likely to doze off when sitting and reading or watching TV?
  • Are you tired during the day even after 7 or more hours of sleep?

What Can I Do About It?

The first step is to find out if you have a form of sleep-disordered breathing.  This requires some testing either in a sleep lab with a polysomnogram (PSG) or in the comfort of your own bed with a take-home apnea risk evaluation system.

The results from these tests give a diagnosis of mild, moderate, or severe sleep apnea.  For moderate to severe sleep apnea, the most common treatment is the use of a continuous positive airway pressure (CPAP) device, which ‘splints’ the patient’s airway open during sleep by means of a flow of pressurized air into the throat.

In addition to CPAP, dentists specializing in sleep disorders can prescribe Oral Appliance Therapy (OAT). The oral appliance is a custom-made mouthpiece that shifts the lower jaw forward, opening up the airway. OAT is usually successful in patients with mild to moderate obstructive sleep apnea.  OAT is a relatively new treatment option for sleep apnea in the United States, but it is much more common in Canada and Europe.  Dr. Chowning has been extensively trained in the treatment of sleep apnea with oral appliance therapy.

Do You Have a Sleep Problem?

Does your partner complain about your snoring?  Are you tired even after a full night’s sleep?  Maybe you have already been diagnosed with a sleep-disordered breathing problem.  Call us today at 940-382-1750 to set up a consultation with Dr. Chowning.  Dr. Chowning has successfully been treating snoring and sleep apnea with oral appliances for years, and he will be happy to help you with your sleep problem.

Why Mouth Breathing is a Big Deal

We are not supposed to breathe through our mouths.  Our bodies function best on air that is warm and humid after passing through our noses and sinus passages.  Constant mouth breathing is like always using a back-up plan.  It gets oxygen to our brains, and it keeps us alive, but it is not the best way to breathe.

What is Mouth Breathing?

The definition of mouth breathing is a simple one: inhaling and exhaling through the mouth.  The reason it needs a definition is that mouth breathing is not the normal or appropriate way to breathe.

A normal, healthy baby does not breathe through his mouth.  Babies must breathe through their noses in order to obtain the proper nutrition through breast-feeding.  Babies do not have the proper reflex system to open their mouths to breathe if their noses are stuffy.  Nasal breathing is mandatory.

What Causes Mouth Breathing?

  • Temporary Nasal Obstruction – Things like seasonal allergies or sinus congestion clog up our nasal passages and sinuses, making nose breathing difficult or even impossible. This is considered temporary nasal obstruction, but in many cases, it becomes a chronic problem.  When someone cannot breather through his nose, the mouth opens to compensate.
  • Permanent Nasal Obstruction – A permanent nasal obstruction involves a structural problem in the nose or sinus cavities. This includes things like a deviated nasal septum, enlarged bones in the nose called turbinates, enlarged adenoids and tumors.  Someone with a serious injury to the face may also suffer a permanent nasal obstruction.
  • Inability to Close Lips – When a person is unable to close his lips without straining, it is called lip incompetence. A common cause of lip incompetence is the position of the front teeth.  Teeth flared out toward the front of the  mouth make it difficult, or even impossible, to keep the lips closed.  Another cause of lip incompetence is an abnormal jaw relationship called an open bite.  An open bite is a condition in which the back teeth touch, but the front teeth are unable to close together.  This separation of the front teeth creates a larger distance for the lips to cover.

What Does Mouth Breathing Cause?

  • Dry Mouth – Keeping the lips closed is vital to creating the ideal oral environment, with saliva continually moisturizing the teeth and gums. If breathing occurs through the mouth, all of the tissues in the mouth become dry from the air that is constantly through the mouth.
  • Gingivitis – Gingivitis, or inflamed gums, is a very common symptom of mouth breathing. Research studies show that mouth breathers have a consistently higher level of inflammation of the gums than normal breathers.  What is really interesting is that mouth breathers have more gingivitis without having more plaque!  This means you can be a great brusher and flosser, but still have red, irritated, bleeding gums because you breathe through your mouth.
  • Cavities – Because mouth breathing creates dry mouth, it also increases the risk for cavities. Saliva fights bacteria.  Teeth need constant moisture from saliva to stay healthy.  A dry mouth is an unhealthy mouth that is prone to cavities.
  • Bad Breath – A dry mouth is a stinky mouth. Since saliva fights bacteria, a dry mouth allows bacteria to grow quickly.  An overgrowth of bacteria always smells bad.
  • Crooked Teeth – If a child constantly breathes through his mouth, the growth of the mouth and jaws has an elongating and narrowing effect. A narrow dental arch does not have enough room for the teeth to come in straight.  Therefore, they come in crooked.
  • Abnormal Facial Growth – As noted in the previous bullet, mouth breathing affects the way the mouth and jaws grow. The upper jaw becomes narrow with a very high palate.  The lower jaw also narrows and grows downward in an elongated fashion.  This growth gives the face a long, skinny appearance with lips that do not close over the teeth.

What Can You Do about Mouth Breathing?

  1. Treat any nasal obstructions. This may require a visit to your family doctor or an ENT. Temporary nasal obstructions typically clear up with various medications.  Permanent nasal obstructions may require surgical intervention to create room for air to flow smoothly through your nasal passages and sinus cavities.
  2. Move the teeth. Adults with flared front teeth benefit from orthodontic treatment, which moves the teeth into a better position.  Then the lips can close over the teeth, allowing you to breathe through your nose.
  3. Guide the jaw growth. While there is still movement and growth of the jaws, that movement and growth can be guided to create the appropriate shape of the upper and lower jaws.  A nighttime appliance, like Healthy Start™, actually promotes development of the airway, properly aligns the jaws, and directs the permanent teeth coming into the mouth.
  4. See your dentist. It is important to manage the dental complications that arise from mouth breathing. Your dentist can help with preventive options to reduce your risk for cavities and gum disease that occurs with mouth breathing.

Do You Have More Questions about Mouth Breathing?

Call our office today at 940-382-1750 to schedule a consultation with Dr. Chowning.  He will answer all of your questions and advise you of your specific risk for dental complications from mouth breathing.

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