Fall 2017 Newsletter

Nathan J. Pettit, DMD, MSD

Dr. Nathan Pettit

Leaving Summer behind will be difficult for many this year, with the catastrophic effects of Hurricane Harvey affecting many of us for years to come. The first major hurricane to make landfall in the United States since Wilma in 2005, our 12-year long record has been broken. It was followed by Irma, Jose, and Katia. There are not words to adequately express the devastation and loss we all feel. It remains a difficult time for many of us, but I am confident Houston remains strong.

I have been impressed with the unity created by our common struggle. Churches, communities, businesses, governments, and societies have sought to lift those affected by the floods above their debilitating circumstances. Few things have humbled me more than participating alongside my neighbors in the cleanup efforts of homes ruined by the floods.

The Greater Houston Dental Society has teamed with other organizations to coordinate relief efforts in providing dental hygiene needs to many of the displaced families. Dentists whose offices have flooded are partnering with other dental offices to allow patients care to continue despite flooded operatories. I was elected to the Board of Directors for the Greater Houston Dental Society earlier this year, and am constantly impressed with the generosity and selfless service provided by these society members.

We are fortunate our office was only affected enough to lose one week of our patient care. We are getting back into the swing of things, but are reminded of the personal impact of this hurricane each day we visit with you and hear about your experiences. Dr. Auvenshine and I are greatly interested in your success with treatment and will do all we can to help make up for any set-backs related to our recent catastrophe.

In early September, I spoke at the Greater Houston Dental Society general meeting, presenting information on advanced interpretation of TMJ imaging through cone beam technology. Our iCat FLX cone beam scanner remains the most impressive TMJ imaging system available. General dentists are beginning to see the value in obtaining cone beam scans for their patients, and in understanding that oral healthcare goes beyond having 28 teeth fitting together that look nice. My purpose in the lecture was to empower dentists to look beyond the teeth in their diagnosis and management of complex cases.

Dr. Auvenshine and I hope to have our hyoid research submitted for publication before the end of the year. Dr. Auvenshine is working closely with our prosthodontic residents at the Michael E. DeBakey VA Medical Center to continue answering new questions arising from our research. It is exciting to be involved in the discovery of scientific knowledge.

We are constantly learning and striving to provide the most advanced and conservative treatment options available for our patients. You are our greatest asset. My hope is that we all take the positive energy we have gained in our shared struggle this past season, and carry it with us, forward into the years to come. I feel blessed by those who reach beyond themselves in the service of others. As we lift one another up, remember to allow others also to lift you up. Be grateful for those in your life who strive to lift you out of your hardship. Find joy in the journey. We are forever Texas, and we are Houston strong.

Nathan J. Pettit, DMD, MSD
Diplomate, American Board of Prosthodontics

Treating TMJ Induced Nausea

The chronic pain of TMD can be debilitating for many people. Whether it’s headaches, jaw pain, back or neck pain, or some combination of these, the pain often can’t be ignored and can’t be cured with common painkillers.

And to add insult to injury, any type of chronic pain and inflammation can affect other systems in the body, including your digestion. This is why many people with TMD experience nausea regularly, though they may not realize that it is a result of TMD.

Nausea and TMJ Pain

It’s been well documented that people who live with chronic pain often experience nausea and other digestive problems. The excess of pain signals being sent to the brain can overload the nervous system, which upsets the easily-aggravated stomach. In addition, TMD pain can cause stress or several reasons, which can all easily trigger nausea. Living with chronic pain can make a person feel overwhelmed, anxious, and depressed. These are major nausea contributors. Not to mention, the stress of dealing with daily activities such as work and family while coping with pain can be a major obstacle for TMD patients.

We all know that severe headaches such as migraines can cause nausea and vomiting as well. Many people with TMD are prone to migraines, or find that the two conditions are actually connected. Finally, lack of sleep can cause nausea in many people. When the body doesn’t get the rest it needs to rejuvenate itself, it can take a toll on the gastrointestinal system. And when you have pain from TMD, proper sleep can be difficult to achieve.

Relieving Nausea the Right Way

One thing is for certain: taking pain killers on an empty stomach can set you up for severe nausea. If you must take pain relievers, be sure you’ve eaten a healthy meal or snack first. It’s hard to find an effective, safe remedy for nausea on drugstore shelves. Prescription products exist, but these should only be used in severe circumstances under a doctor’s guidance.We try to find natural, holistic ways to help patients with nausea while treating TMD symptoms. Some great ways to alleviate nausea and stomach upset related to TMD include:

  • Essential oils such as ginger, peppermint, lemon, and specialized blends that are targeted toward the digestive system
  • Herbal teas that include ginger, fennel, peppermint, and other stomach soothing herbs
  • Acupressure or acupuncture


No single nausea remedy is right for everyone. As part of your TMD treatment plan, we will discuss all your symptoms and help you find ways to effectively treat all your symptoms that are interfering with your life, whatever they may be.

How Does TMD Affect Oral Hygiene?

There’s a close link between a person’s dental health and the state of their temporomandibular joint. Abscessed or decaying teeth can aggravate the TMJ, leading to more pain and inflammation. Infections in the teeth can spread to the jaw. And, having a temporomandibular disorder can lead to oral hygiene issues, as we’ll discuss below.

Brushing and Flossing

Many people take brushing their teeth and flossing for granted as part of their daily routine. But for those with TMD, it can be a chore that’s often a dreaded part of their day. That’s because these basic oral hygiene habits require a person to open their mouth wide, stretch their jaw, and hold it there for several minutes. This can be agony for someone with TMD.

Fortunately, there are ways to get a clean and healthy mouth without unnecessary pain. We often talk with our patients about using a smaller toothbrush with soft bristles to make brushing easier. There’s no need to open the mouth extremely wide to get all the tooth surfaces. Keeping the jaw as relaxed as possible while brushing is still effective. In fact, it can help get the sides of those back molars that are so hard to reach. If brushing is still difficult, give yourself a break – literally. Take breaks while brushing to rest the jaw, and keep at it until you’ve reached all your teeth. Do this twice a day, minimum. If you’re still having trouble, use a heating pad on your jaw for 20 minutes before brushing to get the TMJ as relaxed as possible.

There’s no need to stick with old school floss if it’s not working for you. Wrapping floss around the fingers and getting it between the back teeth is extremely difficult for many people with TMD. Instead, check out the many flossing aides available on the market today. Flossers on small handles make back teeth much more accessible. Tiny toothbrush-like picks (called interdental brushes) can also be used to reach to the back without sticking your hands in your mouth.

Food Choices and Jaw Pain

Let’s face it. Some of the healthiest foods aren’t always jaw friendly. But people with TMD need to be eating healthy foods. This is because they not only promote good oral health, but can help fight inflammation in the body – a key to relieving TMD symptoms. Fruits and vegetables can be jaw-friendly if you know how to work with them. Dust off your blender and make them into smoothies, which can be a delicious treat as a snack or breakfast. Throw in some greens with fresh fruit, and you’ll get a wide array of nutrients without the greens taste. Cooked, grilled, or sautéed fruits and vegetables can also be a delicious choice. Use a splash of olive oil for flavor and anti-inflammatory benefits. Or, throw your favorite fruit, such as pineapple, on a kabob and grill it for a tender, delicious dessert without added sugar.

Early Morning Jaw Pain

Whether you’re a morning person or a night owl, no one has time for pain when they wake up. But for many people with TMD, this is a frequent – if not daily – occurrence.

Why Does My Jaw Hurt When I Wake Up in the Morning?

While many people assume that nighttime teeth grinding must be the reason for jaw pain in the morning, this is not the only possibility. Though nighttime (or daytime) grinding can contribute to TMD symptoms and cause the aches and pains when you awaken, there are other possible reasons that you may not have considered.

First, even if you don’t grind your teeth, symptoms of TMD can be aggravated by your bed, pillow, or sleeping position – leading to jaw pain when you wake up. In fact, many people with TMD find that switching to a better pillow and/or mattress can make their mornings much more comfortable. This is because the jaw and facial muscles rely on proper alignment of the rest of the body in order to run smoothly. The neck, shoulder, and back muscles play an important role in management of TMD.

Another factor related to pain in the morning is the quality of your sleep. Many people know the feeling of waking up without proper rest: your head pounds, your body aches, and your stomach may feel queasy. It’s obvious that lack of quality sleep can take its toll on your physical health – and it can also aggravate TMD symptoms. It could be in the form of a headache that radiates to your jaw, or it could simply make existing jaw pain feel worse.

There is no “quick fix” for many sleep-deprived individuals. Often, they may suffer from high stress levels, anxiety, insomnia, sleep apnea, and other health issues that need to be addressed in order to alleviate TMD pain. TMD treatment is much more complex than a night guard or pain relievers! It takes knowledge and experience with this multi-faceted condition to ensure that its symptoms can be effectively managed.

Relieving Morning Jaw Pain

If jaw pain when you wake up is interfering with your life, make an appointment with us so we can identify the root cause and create your custom treatment plan. In the meantime, try these simple fixes for some fast relief:

  • Get up 10 minutes earlier so you can rest with a heat or cold pack on your jaw before you start your day.
  • Drink your favorite warm, non-caffeinated beverage as a relaxing way to soothe soreness and help ease you into your day.
  • Make a TMD-friendly breakfast. Smoothies are a great way to eat healthy without stressing the jaw. Make it with fruits and vegetables (fresh or frozen) combined with yogurt to provide your body with the nutrients it needs to function at its best.
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