West Maitland Dentistry Blog

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March 23, 2023 General Dentistry

TMJ disorders can be difficult to diagnose and treat. To make it even more difficult the symptoms can fluctuate depending on levels of stress.  If left untreated the over use of the jaw can lead to severe headaches, worn down teeth, fractured teeth, jaw pain and even lockjaw.  Although some patients may find relief with treatment for TMD pain with common devices like an occlusal guard, there are other procedures for those that don’t.

What is TMJ?

TMJ is short for the temporomandibular joint.  This joint acts like a hinge, connecting your jawbone to your skull. The TMJ and your muscles work together to open and close the mouth.  TMD is short for temporomandibular joint disorders.  This term is used when there is dysfunction in the joint and often stress is a major factor in this disorder.

What are signs of TMD?

  • Jaw or muscle pain
  • Popping or clicking of the jaw while opening/closing
  • Headaches
  • Limited opening of the mouth
  • Lockjaw
  • Earaches/ringing in the airs
  • Neck and shoulder pain

The first line in treating TMD pain is typically with an oral appliance like an occlusal guard or splint that prevents wear on your teeth and forces your jaw into a relaxed position.  Sometimes though this may not be enough to lessen the symptoms, especially if you cannot control your clenching during the day.  This is when a neurotoxin such as Botox® and Xeomin® may provide some relief.

What are the common side effects?

Common side effects are usually at the injection site and typically go away within a week.  These side effects can include:

  • pain
  • bruising
  • headache
  • redness
  • swelling
  • muscle weakness

More severe side effects are rare but can include:

  • flu like symptoms
  • an uneven smile or frozen smile
  • temporary eyelid droop
  • nausea
  • respiratory infection

Normal functions such as drinking, biting, eating, swallowing are left unaffected.

Dr. Dhaliwal is certified in the treatment of Botox/Xeomin® for TMD.  To see if this is a treatment that may help you give call for a consultation.



Pihut, M., Ferendiuk, E., Szewczyk, M. et al. “The efficiency of botulinum toxin type A for the treatment of masseter muscle pain in patients with temporomandibular joint dysfunction and tension-type headache”. J Headache Pain 17, 29 (2016). https://doi.org/10.1186/s10194-016-0621-1

Siphai Calis, A., Colakoglu, Z., Gunbay, S. “The use of botulinum toxin-a in the treatment of muscular temporomandibular joint disorders”. Journal of Stomatology, Oral and Maxiofacial Surgery, 120, 4 (2019). https://doi.org/10.1016/j.jormas.2019.02.015


February 15, 2023 Uncategorized

It’s a Saturday afternoon, your child is playing their team sport and all of a sudden get’s an injury to their face.  Upon further look you notice a tooth knocked out.  What do you do?  Unfortunately injuries to the mouth and teeth are common in children, in fact the American Academy of Pediatrics states 30% of children will experience a dental injury by the age of 14.  Prevention and knowing what to do in these scenarios are key to stopping permanent damage to your little one’s mouth.

What do I do if the tooth knocked out is a baby tooth?

If your child’s baby tooth gets knocked out here are some steps to follow.

    • First find the tooth.  This is to make sure it isn’t in their mouth leading to a choking hazard.
    • Gently place pressure on the gum tissue to stop any bleeding.  
    • DO NOT place the baby tooth back in the mouth as to avoid damage to the permanent tooth that is forming below.
    • If it looks like there was any damage done to the surrounding tissues (gums, cheek, lips, bone) go to the emergency room to rule out any fractures or tooth fragments lodged in the soft tissues.  
    • Make the appointment with your child’s dentist to further evaluate the need for treatment and don’t forget to bring the tooth.  The dentist may take an X-ray to evaluate the extent of the injury.  If the tooth was lost extremely premature then a device to maintain space or for esthetics may be recommended.

What do I do if the tooth knocked out is a permanent tooth?

This is a trickier situation as the permanent tooth can and should be saved.  The sooner the tooth can be placed back in its place, think within 30 minutes, the better chance of that tooth surviving.  

Tooth anatomy

    • First make sure to pick up/touch only the top portion (crown) of the tooth.  This is the part that is usually visible in the mouth.  Avoid touching the root portion of the tooth.
    • Exam the tooth and if there is any debris or dirt on the root then gently rinse with cool water. 
    • DO NOT wipe/scrub the tooth and avoid any soap or cleaner. 
    • Gently reinsert it in the space of the missing tooth, known as the socket.  
    • Have your child slowly bite down on it as you hold it in place with your finger.
    • Let them bite down on paper towels or a washcloth until you can reach your dentist.
    • If you are uncomfortable or your child won’t let you put the tooth back then store the tooth in milk.
    • DO NOT use water to store the tooth.
    • DO NOT use milk substitutes such as almond or oat milk.
    • If you do not have milk available find a container to put the tooth in and spit into it until the tooth is covered with saliva.
    • REMEMBER to keep the tooth moist and prevent it from drying out.


How do I prevent a knocked out tooth

Preventing damage to teeth is important. Here are some tips to help your child avoid an injury:

    • Do NOT open objects such as bottles, plastic or use your teeth to cut string/fishing lines. 
    • Avoid rough housing or activities with high risks of falling, such as trampolines.  
    • Have your child wear a mouthguard if they play sports where there is a high chance of physical contact or high velocity contact, such as ball to the face.
    • Check that their mouthguard is snug and fits properly and fits on the top teeth (maxilla) and covers the gum tissue to help reduce risk to the teeth, gums, lips and cheeks. 
    • Make sure it is free of any sharp or rough edges. 

Sometimes its unavoidable to have a tooth knocked out.  Remember to remain calm and rely on this new knowledge as well as your dental provider to get you through this stressful event!


September 8, 2022 Uncategorized

Pregnancy is a wonderful time for a new mom to be as well as sometimes a confusing one. With limitations on what to eat, drink and medicine to take it is no wonder that the safety of dental care during pregnancy is questioned. Most dental treatment is not only safe during pregnancy but recommended. Let’s go over some of the common dental procedures that are safe during pregnancy.


Dental radiographs aid in the diagnosis of oral problems, such as cavities, bone loss and infections. The American Congress of Obstetricians and Gynecology and the American Dental Association both agree that x-rays are safe during pregnancy. Although the amount of radiation is minimal with new dental technology it is still important that you share your pregnancy with the dental staff so that proper shielding is used.


The change in hormone levels cause gums to be easily irritated by plaque which can lead to gingivitis. The CDC estimates that nearly 60 to 75% of pregnant patients have gingivitis. Cleanings are not only safe but recommended.  Some insurance will even cover an extra cleaning a year for pregnant patients.


Pregnancy increases the chances of getting cavities. The consumption of more carbs as well as morning sickness make a nice acidic environment for cavities. It is important and safe to stop the progression of cavities during pregnancy. Your dentist will take in consideration though many factors such as what trimester you are in, how small the cavities are and the length of procedure.

Tooth Extractions and Root Canals

Dental infections can often lead to the need for a tooth extraction or root canal. A dental infection has serious consequences so it is necessary to stop that infection by one of the before mentioned treatments. Both procedures are safe during pregnancy but considerations of how far along the pregnancy is will be considered.  Local anesthetics are safe but it is recommended to avoid general anesthesia and oral sedation during pregnancy.

Elective Treatment

Elective treatment such as cosmetic procedures like tooth whitening should be avoided during pregnancy. Postponing such treatment prevents the minimal risks to the fetus.

Dental Anesthesia and Medications

Sometimes dental infections require antibiotics. Antibiotics that are considered safe during pregnancy include penicillins and amoxicillin. Your dentist will confer with your OB/GYN to ensure the proper medication is prescribed. Some dental anesthetics are not recommended during pregnancy. There are options that fall into Category B classification of drugs, such as the most commonly used lidocaine.

Even though dental care during pregnancy is safe, your dentist might modify your treatment based on recommendations by your physician. Dental treatment is ideal during the second trimester and early third trimester. If though you have any questions about your specific needs refer to your OB/GYN.


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