Keith and Associates

Botox: A Surprising Source of TMJ Relief

Botox: A Surprising Source of TMJ Relief

A stressed jaw is a painful jaw. Whether it is caused by stress or a misaligned bite, TMJ (also known as TMD or temporomandibular joint disorder) causes aches and discomfort for nearly 10 million Americans.

To those that suffer from TMD, it can be both painful and frustrating. Simple tasks like eating or sleeping can be disrupted by pain radiating from your jaw. Sometimes, something as simple as yawning is painful.

The tension caused by TMJ causes more than simple jaw pain. In fact, it has been known to cause chronic pain and stiffness in the neck, back, and shoulder, as well as trigger migraines. This disorder can also trigger inflammation in your facial muscles that puts pressure on your ear canals, which can sometimes cause hearing loss or ringing in the ears.

Traditionally, treatment for TMJ is done through mouthguards, stretches, and anti-inflammatory pain relievers and the success of these methods tends to vary. Fortunately, there is a new treatment available with encouraging results.

What is TMJ/TMD?

TMJ or TMD isn’t a singular disorder. This pain in your jaw joint and surrounding muscles can have multiple sources and causes.  On each side of your head, near the front of your ears, is the temporomandibular joint. This sliding hinge controls the up and down movement of your jaw. When this joint aches, clicks, grates, or freezes, it’s possible you have a TMJ disorder.

 Symptoms of TMJ disorders

The symptoms of TMJ vary from person-to-person, but in general, they may include:

  • Pain, swelling or aching at your jaw joint
  • Aches or pain in your jaw muscles
  • Aches or pain inside or near your ear
  • Pain, clicking or locking when chewing or opening/closing your mouth
  • Aches and pains around the lower half of your face
  • Pain, crackling, ringing or popping in the ears
  • Difficulty chewing from stiff jaw
  • Experiencing lockjaw after opening mouth wide
  • Blurred vision, dizziness or vertigo

 What causes TMJ/TMD?

In many cases, it is difficult to pinpoint the exact cause of TMJ. However, some common risk factors are often associated with this kind of pain:

  • Arthritis, including rheumatoid arthritis and osteoarthritis
  • Poor posture in the neck and back
  • A misaligned bite or crooked teeth
  • A recent or past jaw or teeth injury
  • Grinding or clenching of teeth when stressed or sleeping
  • Connective tissue diseases like Ehlers-Danlos Syndrome
  • Heightened stress or anxiety
  • Previously wore orthodontic braces
  • Excessive gum chewing

Traditional Treatments for TMJ

Many sufferers of TMJ go untreated or try to treat the pain using anti-inflammatory medications, ice packs, and stress management. However, there are many ways that doctors and dentists approach treating this disorder. Unfortunately, many find the recommended treatments for TMJ to be uncomfortable, invasive, or even ineffective.

Dental splint or TMJ bite guard

A dental splint or bite guard is one of the most commonly prescribed measures to help fight TMJ pain. In general, these guards are used to protect your teeth from clenching or grinding while you sleep, as well as treat some bite alignment issues.

While these splints are relatively economical, most wearers find them to be uncomfortable or they don’t work well with other health appliances like CPAP machines. In many cases, while these splints help protect your teeth, they don’t always relieve jaw pain.

TMJ Surgery

There are several surgeries performed for moderate to advanced levels of TMJ that are not responsive to other treatments.


A simple and minimally invasive procedure that involves washing the inflammatory byproducts from your joint to reduce pressure and stiffness.


A slightly more complex procedure where a surgeon makes a few very small incisions to insert a camera and tube into the joint to remove scar tissue, reshape the joint, or provide other pain relief techniques.

Open-joint surgery

This surgery involves a much larger incision, normally a few inches long, and involves surgery directly on the joint for severe cases. This surgery is normally done when there is a lot of tissue or bone blocking the joint, the joint has fused or the intended surgery cannot be done using arthroscopy.

Physical therapy

Physical therapy for TMJ can take many forms. Either led by your dentist or in conjunction with a physical therapist, these treatments can involve simple stretches, exercises, and massages. Since TMJ can also be caused by poor posture and alignment in the upper neck and shoulders, these areas will also be checked for muscle contractions, tension, and inflammation. Further treatments include TENS (transcutaneous electrical nerve stimulation), ultrasound therapy, and removal of scar tissue through focused temporomandibular joint movement.

Steroid injections

Steroid injections into your jaw joint can help reduce the pain and inflammation you may suffer while talking or chewing. These injections generally help with the pain for about a month but can have serious side effects including the risk of damage to your cartilage and bone, as well as effect diabetic treatments.

Anti-anxiety and anti-depressant medications

Since many sufferers of TMD or TMJ clench and grind their teeth due to stress or anxiety, some patients find relief after medical intervention for their mental health troubles.

Muscle relaxers

During severe flare-ups, muscle relaxers can be used to block pain and reduce muscle spasms. These drugs are best used only for a short period when symptoms are at their most painful as muscle relaxers cannot be used while working, operating a vehicle, or performing most daily tasks.

Botox Treatments for TMJ

You may be familiar with Botox injections from the cosmetic health industry. These simple injections have been used for years by doctors to reduce the signs of aging. This works by blocking the nerves’ ability to send signals to the muscle to contract, which helps wrinkled facial features relax around the eyes and frown lines.

Many patients are eager to treat their TMJ symptoms but struggle with the other treatments out there. Some find that mouthguards are uncomfortable or don’t work in conjunction with their other medical issues. Using Botox is a quick treatment with fast results, patients can often find relief quicker than with traditional dental appliances and without the hassle of daily management.

How it works

Much like treating wrinkles by stopping nerve signals to contract, Botox can work the same way when injected into your jaw. When the movement in your masseter and temporalis muscles is limited, they relax over time. Once they’re relaxed, patients feel less pain, decreased headaches, less popping and clicking, and general relief from many of their TMJ symptoms, and no further treatment is needed.

In advanced cases of TMJ, a nightguard may still be needed to protect teeth from grinding or clenching and keep muscled relaxed while sleeping.

How long does it take to go into effect?

Botox treatments are not immediate. After your injection, it can take anywhere from 2-10 days for the therapeutic effects to take hold. Remember, it often takes years of clenching, grinding, and stressing to create the type of pain and tension TMJ patients experience. It’s natural for your muscles to take a while to return to a relaxed state. Most patients note that in between 2-3 months, their symptoms have improved over time.

Additional treatments

If the trapezius muscle trigger points don’t return to a relaxed state through Botox treatment, dry needling can help the process along. This treatment involves inserting a dry needle into trigger points to break up fibers causing the tension. Along with this procedure, the dentist provides a numbing agent and Botox to offer immediate relief.

When should I see a dentist?

If you suspect you have TMJ and it is causing you pain, don’t ignore it. Take a step to protect your teeth, jaw, ears, and facial muscles from grinding, clenching, and tension. There are safe, effective measures the skilled dentists at Keith & Associates can use to relieve your TMJ symptoms. Give us a call today at 913-384-0044 to book an appointment.

Keeping you safe in a post COVID-19 world

As we all prepare to come back to some semblance of normalcy, we at Keith + Associates Dentistry, wanted to take a few moments to outline what we do to keep you, our patients safe. Some of these items are precautions we have always taken; some are new to keep you safe in a post COVID-19 world. Regardless, the safety of both you and our team are of the utmost priority. Should you have any questions or concerns during your visit you are all welcome to contact me directly at the email address below.

We have always taken infection control extremely seriously. We abide by the American Dental Association (ADA), Kansas Dental Board and Kansas Department of Health and Environment (KDHE) recommendations to use Standard Precautions.

This includes:

  • Sterilizing instruments
  • Using Cavicide to wipe all services each room between each patient
  • Wearing gloves, masks and glasses while treating patients
  • Regular hand washing in-between patients
  • High Speed Evacuation used in doctors rooms
  • Nightly cleaning of our entire office
  • Comprehensive health history being updated regularly

Some new precautions we have implemented which you may see when you are in the office include:

  • Pre-appointment screening questions to avoid sick patients entering the office when not necessary
  • Screening temperature taken at front desk prior to entering reception area
  • Screen of team members when they arrive each day
  • DryShield high speed suction used in hygiene rooms to remove aerosols
  • Additional cleaning done regularly in the non-treatment areas (we already did this in treatment rooms between patients)
  • Contact-less check-in/check-out

COVID-19 is a very real concern and one which we do not take lightly. With that said, there are numerous other diseases which we are also protecting you from and have for years. These include HIV, Hepatitis A, B and C, tuberculosis,  influenza, norovirus, and numerous others. The precautions to reduce the spread of COVID-19 are not significantly different than those mentioned above. Standard Precautions are in place to prevent the spread of any disease from patient to patient, patient to healthcare provider, or healthcare provider to patient. With that said, we have taken this opportunity to review our policies and improve them where we can. We feel implementing these additional measure will take an extra step to keep both our patients and team safe from all pathogens, even long after the COVID-19 crisis has passed.

Current guidelines allow us to only see emergent appointments. Our regulators have defined this as something which could become a life threatening problem in the next few weeks. If this is you please give us a call we have a team answering the phones as well as our emergency line.

As of now we are planning to return in early May to see urgent cases. This would include anything causing pain, lost crowns, broken teeth, gum infections, etc. We currently do not have a timeline to return to normal elective treatment such as implant placement, but expect it to return sometime over the summer. We are also working with the ADA and KDHE to determine when we can begin routine cleanings. As you are all aware, they are extremely important for your oral health as well as your overall health.

Should you have any questions or concerns please let us know. Our family is here for yours!

Dr. Bill

Contact Dr. Bill

Myths About Whitening

Everyone wants to have a whiter smile but making the decision to pursue whitening treatment can be tough. Myths and stereotypes can lead to negative connotations, inhibiting you from moving forward with treatment. Below are three misconceptions about teeth whitening:

1. Teeth whitening treatments at my doctor’s office are no more effective than those purchased at drugstores.
On the contrary, the maximum strength bleach that our dentists provide delivers the best and fastest teeth whitening results. Another factor that makes dentist-provided whitening kits most effective is the fact that the trays are customized to fit each individual patient perfectly which keeps the gel in closer, more precise contact with your teeth. Don’t waste your time at the drugstore when you can get a brighter, whiter smile from us in record time!

2. Tooth whitening harms enamel.
Despite this negative misconception, teeth whitening does not actually harm the enamel of a tooth. Bleaching works by opening the pores of a tooth. This allows for the peroxide to enter the inner structure of the tooth and remove stains. The pores will close again over time, leaving the enamel unharmed.

3. You can never drink coffee or wine again after whitening.
While patients are told to stay away from heavy staining and acidic foods, such as red wine and coffee, it’s not forever! Dentists recommend this just for the first few days after treatment because the pores in your teeth remain open and the chemical reaction takes place over the course of a few days.

Whitening treatments can be intimidating, especially if you are not properly informed. It’s important to know the facts when making decisions about your teeth! We want you to have a smile that will make you feel confident. If you have any questions about teeth whitening, contact our office today. We are always here to help!

Oral Health: All About Gums

Why should teeth get all the fame? Since the beginning of time, teeth have taken center stage in the oral health arena, while their close cousins, the gums, have occupied more of a back-seat role. So, we have decided to dedicate this article to gums! What makes them healthy, what makes them sick, and why they are so important for whole-body health?

Gingiva, or “gums”, are the mucosal tissue that cover the jaw and hold the teeth in place. When they are healthy and properly intact, they offer a protective barrier for the jaw and tooth roots against food and bacteria.

Healthy Gums:
Healthy gums typically are coral pink in color, and not recessed far above the tooth. They show a scalloped appearance over each tooth, are firm and resist movement. They take brushing and flossing well, usually with no reaction whatsoever.

Unhealthy Gums:
By contrast, unhealthy gums may exhibit red, white and even blue hues, have a puffy or orange peel texture and may bleed when brushed or flossed. Untreated periodontal disease can affect the whole body, as it is related to health problems such as diabetes and heart disease. Also, it can result in lost teeth and poor nutrition down the road.

Prevention is Key:
The good news is that most cases of periodontal disease are preventable. While we don’t know exactly what role genetics play in terms of periodontal health, we do know that practicing good oral health is the first step to preventing periodontal disease. Habits such as brushing twice and flossing once per day and regular exams and cleanings can help many people prevent or slow the progression of gum disease.

We hope you have learned something new about your gums!

If you have any questions about your gums, don’t hesitate to give us a call!

Dental Implants: Aftercare

Are you considering dental implants but are worried about the recovery time?
Don’t worry, we’re here to give you the facts!

The recovery time following dental implant surgery tends to vary but is usually based on the number of teeth being implanted, whether or not a bone graft was needed and how well the individual manages his or her recovery. The science and technology behind dental implants have improved drastically over the last few years, improving post-surgery pain and comfort for patients.

Recovery Time
Typically, you will have the fastest recovery time if you had a standard, single dental implant placed with no bone grafting. With a simple procedure like this one, there is very little discomfort or pain after the surgery. Mild bruising and soreness can occur, but this can typically be managed with over the counter pain relievers. In more severe implant cases, such as those where multiple teeth are implanted or severe bone grafts are needed in order to accomplish the implant, the recovery time tends to be longer and the discomfort can be more intense.

It is important to keep your mouth clean after surgery, which can be done by rinsing your mouth gently with saltwater beginning the day after surgery. You may begin brushing your teeth the night after the surgery, but make sure to be extremely gentle around the surgery area as to not disrupt the healing process. Remember that in the week following your surgery, there should be no smoking and no sucking through a straw, as this can seriously inhibit your healing process. Stick to a diet primarily consisting of soft foods for the first 7-10 days following your surgery before beginning to return to your normal diet.

As you can see, the recovery process after receiving a dental implant is fairly predictable and comfortable. It is important to follow the instructions that we give you, and always remember that if you have any questions or concerns regarding a procedure or following your surgery, you can always give us a call.

Can You Whiten Teeth Naturally?

whitennaturalblogFrom powders to pastes, there are many ways people try to whiten their teeth. However, not every recipe we see online truly whitens correctly. It may be tempting to think ingredients in our own kitchens could hold the key to a brighter smile, but just because a method is natural doesn’t mean it’s healthy. In fact, DIY whitening may do more harm than good to your teeth.

With Fruits, like acid packed lemons and apple cider vinegar, you put your pearly whites at risk with prolonged contact. Using baking soda and lemons, for example, to scrub your teeth can wear away your enamel. Enamel is the thin outer coating of your teeth that protects you from tooth sensitivity and cavities. This enamel cannot be grown back, so it is very important to keep it in tip top shape.

With Scrubs like activated charcoal and baking soda mixes you may be using materials that are too abrasive on your teeth! This can end up actually making them look more yellow. Enamel is what you’re looking to whiten, but if you’re using a scrub that is too rough, you can wear it away. When that happens, the next layer of your tooth can become exposed – a softer, yellow tissue that’s called Dentin.

With Spices and Oils, like coconut oil and turmeric, there is really no evidence that these are helpful. Over using coconut oil has potential to be poor for your body, so using these strictly when cooking could be more beneficial than using them to whiten your teeth.

To best ways to whiten your teeth naturally is to maintain a healthy, balanced lifestyle.
• Brushing your teeth twice a day for two minutes
• Use a whitening toothpaste with the ADA Seal of Acceptance
• Cleaning between your teeth once a day
• Limiting foods that stain your teeth, like coffee, tea and red wine
• Not smoking or using tobacco
• Regular visits to your dentist for checkups and cleanings

With these steps you should be well on your way to achieving that sparkling smile you are looking for, naturally! Call us today for more info, and to schedule an annual teeth cleaning Keith + Associates Dentistry Phone Number 913-384-0044

Teeth Discoloration

Teeth-DiscolorationWhat color are your teeth? Of course, there is no “right” answer. Teeth come in endless shades and ranges. When we talk about tooth color in our office, we try to break it down into no fewer than 40 shades (light to dark) and ranges (color). Everyone’s teeth are unique, and the possibilities are endless.

You may be wondering, what makes a tooth the color it is now or will be in the future? We all know about coffee and tobacco as being major culprits of stained teeth, but what else goes into the making of a tooth color?

Things We Can’t Control:
• Genetics – Inheriting your tooth color is a high possibility for your current color as well. You can also inherit your tooth’s propensity for staining.
• Aging – As we age, our teeth inevitably turn more yellow.
• Medicine Use – some medicines, such as certain antibiotics, can cause your tooth color to change.
• Injury – Traumatic tooth injuries can cause intrinsic discoloration of the inner part of the tooth, the “dentin”, which is difficult to remedy. Have you ever seen a tooth that looks “dead”? That gray tone has most likely been brought on by a traumatic tooth injury.

Things We Can Control:
• Food and Drinks – Certain foods and drinks, such as berries, sauces, coffee, dark soda, black tea and red wine, cause staining over time. Limit these foods and practice good oral hygiene habits!
• Over-fluoridation – Too much fluoride in children, while teeth are still developing, can cause tooth discoloration. Be sure to follow guidelines for safe fluoride use. Don’t abandon the use of fluoride altogether though. Fluoride offers numerous benefits such as: preventing tooth decay by making teeth more resistant to acid attacks and reversing early tooth decay. But we’ve all heard that too much of a good thing can be a bad thing!
• Tobacco Use – It is well known that cigarettes and other tobacco products turn teeth yellow and eventually brown. Don’t smoke or chew.

What can you do about stained teeth? We’re glad you asked! We offer professional teeth whitening options for the best and safest results. No matter what tooth shade you’ve inherited (or created), we can help make it whiter. Give us a call today to find out more!

Flossing: Absolutely Necessary!

flossing-absolutely-necessaryYes, You Still Have to Floss. No, the dance move “flossing” does not count. The AP recently released an article making the claim that “there’s little proof that flossing works”. Their review cited a series of studies that found flossing does little or nothing to improve oral health. Here’s the problem: the studies were flawed. The AP concluded that floss does little for oral health, but it’s important to note that the evidence they cited was very weak at best. In fact, they said so themselves.

As acknowledged by the AP, many of these studies were extremely short. “Some lasted only two weeks, far too brief for a cavity or dental disease to develop” (Associated Press). They also say that “One tested 25 people after only a single use of floss” (Associated Press).

Of course, the evidence is unreliable. You don’t simply develop gum disease because you forgot to floss yesterday. Cavities and gum disease do not happen overnight. Gum disease is preventable by maintain great oral health habits for a long period of time. Lets put it this way: If a study claims drinking milk does nothing for bone health, but draws conclusions after only three glasses of milk, is it a reliable study?

The fact of the matter is floss removes gunk from teeth. You can see it. Gunk feeds bacteria which leads to plaque, cavities, poor gum health, and eventually gum disease. Floss has the ability to reach the food particles that your brush can’t get to. Using a sawing motion instead of moving up and around the teeth to clean the cracks. Positive results come from correct use and it’s critical that people learn to use a tool properly before discarding it as useless.

That’s just what floss is: a tool. Just like your toothbrush, it is designed to keep your mouth clean, and therefore keep your body safe from infection. Both your toothbrush and floss are designed to do what the other can’t, and both successfully remove bacteria from your mouth. Just like proper brushing technique, it is important that you know how to use floss properly, so that you can reap the long-term health benefits of good oral hygiene.

Oral hygiene is a long-term process and requires long term observations to make worthwhile conclusions. In the meantime, it’s obvious that you should continue to do everything you can to protect your well-being, and floss is one of many tools that can help you do that. If you would like a refresher on the best, most efficient techniques for floss use feel free to call our office today

Why You Should Whiten Your Teeth


Just like we all have different hair and skin color, people also have different teeth color. Some teeth are naturally more yellow than others, while some yellow with aging. Your natural tooth color can also be affected by many factors like:

Using tobacco (smoked or chewed)
Drinking coffee, tea, or red wine
Eating pigmented foods such as cherries and blueberries
Accumulation of plaque and tartar deposits
The natural aging process

Because of this people often choose to whiten their teeth. Whitening your teeth can help boost your confidence and self-esteem but can also help if you want to cosmetically achieve a more youthful appearance, brighten your smile for s special event, or just simply reverse years of staining and yellowing.

Teeth whitening works very simply! The teeth whitening products contain one of two tooth bleaches (hydrogen peroxide or carbamide peroxide). These bleaches break stains into smaller pieces, which makes the color less concentrated and your teeth brighter.

A patient interested in whitening has a few different options including stain removal toothpastes, in-office bleaching, at-home custom bleaching, or over-the counter bleaching products. Talk to your dentist before starting and see what the best way is to put the shine back in your smile!

Once you’ve completed a whitening treatment, there are a few steps you can take to maintain your whiter smile:
Avoid stain-causing foods and beverages like coffee, tea, and wine
Use a straw when drinking beverages to keep stain-causing dyes away from your teeth
Eliminating tobacco because tobacco can cause teeth to become discolored

Before beginning any whitening procedure, be sure to consult with your dentist. Only he or she can evaluate whether you’re a suitable candidate for a particular treatment! These are just a few of the options you should consider when getting a whitening treatment. For more information on how we can brighten your smile with a teeth whitening procedure, contact our practice today at Keith + Associates Dentistry Phone Number 913-384-0044 !

What the fluoride?

3 tips to keep gums healthy and happy

Fluoride is often called nature’s cavity fighter, and for good reason! Fluoride, a naturally-occurring mineral, helps prevent cavities by making your enamel more resistant to the acid that causes tooth decay.

Before teeth are fully grown, the fluoride taken in from foods and beverages help make tooth enamel stronger. This provides what is called a “systemic” benefit. After teeth are grown, fluoride helps rebuild weakened tooth enamel and reverses early signs of tooth decay. When you brush your teeth with fluoride toothpaste, the fluoride is applied to the surface of your teeth. This provides what is called a “topical” benefit.

In addition, the fluoride you take in from foods and beverages continues to provide a topical benefit because it becomes part of your saliva, constantly bathing the teeth with tiny amounts of fluoride that help rebuild weakened tooth enamel.

How Do You Get Fluoride?

#1 Drink Water with Fluoride
Fluoride is naturally found in most water sources. For the past 70 years, fluoride has been added to public water supplies to bring fluoride levels up to the amount necessary to help prevent tooth decay. Studies show that water fluoridation continues to help prevent tooth decay by at least 25% in children and adults, even with fluoride available from other sources, such as toothpaste.

#2 Use Toothpaste and Mouthwash with Fluoride
Toothpaste with fluoride has been responsible for a significant drop in cavities since 1960. Make sure to look for one with the ADA Seal of Acceptance to make sure it contains fluoride! Be sure to brush twice a day (morning and night) or as directed by your dentist and physician.
Mouthwash with fluoride can help make your teeth more resistant to decay, by bathing your teeth and creating a topical benefit.

#3 Visit Your Dentist for a Professional Application
If you have a good chance of getting cavities, your dentist can apply fluoride directly to your teeth during your dental visit with a gel, foam or rinse.

These three steps in getting fluoride can help significantly fight against cavities and help keep your teeth strong and long lasting! If you have any more questions about the benefits of fluoride, give us a call today at Keith + Associates Dentistry Phone Number 913-384-0044 !