I’ve had some degree of dental anxiety ever since I was a child, but I did a fair job of keeping up with appointments until I was in my early 20s. At that point, I was having some minor jaw pain and the doctor also found a couple of cavities that needed to be filled. He knew about the jaw pain, but told me there wasn’t any cause for concern over it. He felt it was related to grinding at night. My experience with the fillings, however, was horrific. He must have made me keep my mouth open for about two hours straight. It hurt so bad and I kept telling him I needed a break, but he kept going and telling me it would only be a minute or two more. By the end of it, tears were streaming down my face and he basically told me I was acting like a child. It really hurt! I couldn’t eat normally for weeks after that and I haven’t been back since. Now, I know my teeth have some issues going on, but my jaw pain is really flaring up again too. I think I should see a TMJ dentist for that, but where do I go first? Can he treat me before I get my cavities filled, so I can get through the treatment or do I need to start with my teeth and then address my jaw? I don’t think I can do more fillings before fixing my jaw pain.

Marie E. – Pittsburg

Dear Marie,

See the TMJ dentist first. It sounds like you’re already familiar with how one can help you. A TMJ dentist can address the root cause of your jaw pain and hopefully get it to settle down so you can be comfortable getting your other dental needs seen to.

With that said, something about what you said jumped out. You mentioned that your prior dentist said you grind your teeth at night and that’s what was causing your jaw pain. If this is the case, getting a simple night guard made might be all you need to address the sore jaw. Undoubtedly, the TMJ dentist will discuss this with you if you’re a good candidate for one. However, what’s striking is that your prior doctor didn’t mention this. It was cause for concern and should have been treated back then.

Continuous grinding not only strains your jaw and muscles, but wears down your teeth. If wouldn’t be too surprising to find that you’ve weakened the biting surface of your teeth enough that they’re either sensitive or highly susceptible to decay. In extreme circumstances, you can wear them down enough or crack them so that they’ll require crowns, but most of the time fillings can repair the damage.

Although this doesn’t matter in terms of getting you out of immediate pain, you may want to keep this in mind for when you go in for a full diagnosis. It’s not the end of the world by any means. You’re on the right path and will get your dental concerns addressed, but it could take some time to restore the damage that’s occurred over years of grinding. Best of luck to you.

This blog is brought to you by Dr. Randall Burba.

Is a Defective Crown a Dental Emergency?

Several years ago, I had porcelain crowns done across all my front teeth. They look great overall, and I’m actually still very happy with the aesthetics. One of them has always had a rough spot or a divot, though. I can feel it with my tongue, but I have never been able to see anything wrong with it. I did mention it to the dentist who did the crowns and she smoothed it out some, but I’ve still noticed it over the years. It was close, but not quite perfect. Lately, it has been feeling different- much more rough,  and I can actually see a dark mark. I don’t know if it’s just attracting stains or what, but I don’t think I’ve changed my habits and I get regular cleanings. I’m a little concerned that it is failing and that I’m going to be out on a business trip and the whole thing will crumble. Is this urgent enough to warrant a trip to the emergency dentist? Should I have the crown redone now or am I worrying about nothing?

Hank B. – Kansas

Dear Hank,

This may not necessitate a trip to the emergency dentist,  but it is something you should get checked out in the near future. It’s common for crowns (and natural teeth) to have some defects, but it sounds like yours has changed. It’s possible it has cracked.

If that’s the case, you would notice that it’s picking up stains as well. If it’s cracked, it will eventually break. There’s no way to predict exactly when that will happen.

Rather than letting it turn into a trip to the emergency dentist, especially if you’re an avid traveler, you should find a dentist who is skilled at cosmetic work in the very near future and have him examine it.

Depending on the age of the crown, it might be time to start thinking about replacing them all. Don’t be surprised if the dentist mentions this. However, the only reason to update the others is age or wear and tear. If the dentist suggests switching them all out so he can make them all match, that’s a sign that you’re not working with a skilled cosmetic dentist. You should be able to have just that one replaced and have it blend naturally, without having the others redone, too. Best of luck to you.

This blog is brought to you by Dr. Randall Burba.

Can Invisalign Cause TMJ?

I am on tray 7 of my Invisalign. I have loved the treatment, but recently started having severe headaches, and pain in my jaw and side of the face. In addition, I have a hard time opening my mouth all the way. I’m wondering if this is TMJ and is it possible it was caused by my Invisalign treatment?

Elisabeth A. – Connecticut


Though there are many causes for TMJ, usually Invisalign, or orthodontics in general, is not one of them. A person is usually predisposed due to genetics, detrimental habits, or bite problems.

TMJ dysfunction can certainly result from teeth movement if the temporomandibular joints are not functioning properly to begin with. Your first step will be to review your symptoms with your dentist.

He or she may recommend temporarily halting your treatment in order to concentrate efforts on identifying and diminishing the TMJ pain. From there you guys can re-evaluate if you are a good candidate to carry on.

Changing your bite (which Invisalign does) can indeed increase the symptoms and severity of your TMJ dysfunction, if you already had it.  Even the manufacturers of Invisalign have strict recommendations regarding TMD patients using their aligners. So again, while Invisalign may not “cause” TMJ, it may have exasperated an underlying issue that was not picked up on prior to starting treatment. Making sure your TMD is resolved first, is far more important than continuing on with Invisalign. Once that issue is settled, you may resume your orthodontic treatment.

This blog is brought to you by Dr. Randall Burba.


My Dentures Ruined My Daughter’s Celebration

My daughter has been working toward a goal her whole life. She’s come up against one obstacle after another. Yet, she persevered. I’m as proud of her as any parent could be. We held a party in her honor. I baked her favorite cake. Yet, right when I’m standing over the cake giving a speech about her remarkable accomplishment, my dentures fall out and land smack on top of the cake. I was (and still am) mortified. Tell me there is something I can do about these wretched dentures.

Annette A. – Nevada


I am mortified along with you. That would be a horrible thing to experience. I don’t know your daughter, but I’m willing to wager after all she’s overcome to meet her goal, she will not allow an incident you couldn’t control to get between the two of you.

All that being said, there is definitely something you can do about the slipping dentures and prevent it from ever happening again.

Obviously, dental implants are the ideal choice. In some cases, however, they’re not possible because of financial restrictions. When that is the case, snap-on dentures are a great solution.

They can be done with as few as two implants, making it much more affordable. Though it doesn’t have all the benefits of dental implants, it will certainly anchor the dentures into your mouth, so you’ll never have to face a situation like your daughter’s celebration again.

This blog is brought to you by Dr. Randall Burba.