Do I Really Need to Destroy Healthy Teeth to Fix TMJ?

I’ve been having horrible jaw pain and merciless migraines. Sometimes it’s so bad I can’t even eat and have to drink my dinner of broth through a straw. I went to several doctors and two different dentists before I was diagnosed with TMU. But, he says the only way to fix it is to crown all my teeth to fix my bite. That would mean not only a fortune in dental bills, but destroying healthy tooth structure as well. Is that really the way to go?

Sydney C.

Dear Sydney,

Sometimes a full-mouth reconstruction is the only option, but it’s usually used as a last resort. There are several other treatments which should be tried before that. Additionally, it takes a significant amount of reconstructive and TMJ training to do a full mouth reconstruction. Done incorrectly, it can cause even more pain then what you’re currently in now.

Also, if you do need it, you may find a dentist who uses the composite resin, like you get for white fillings to adjust the bite instead of porcelain crowns. However, don’t push a dentist to use one type of treatment or another. It’s best they use the materials they’re most comfortable with.

In your place, I’d like to see you get at least two more opinions from dentists with lots of TMJ expertise. For instance, Dr. Burba studied at both the Dawson Academy and Spear Institute. Both of these give advanced training in TMJ. There’s never any harm in asking a dentist what type of training and success they’ve had in specific procedures, especially when you’re talking about such a huge, invasive procedure.

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

Is There a Treatment Between Dentures and Dental Implants?

I’m losing my teeth. I was hoping to get dental implants, but after looking into it with more detail, there’s absolutely no way I can afford it. At the same time, I don’t want dentures. I spent too many years watching my grandmother’s dentures slipping out constantly. It totally grossed me out as a child. I don’t want to be that grandma. Is there any chance there’s a treatment that meets in the middle?

Lisa (too young to be gross).

Dear Lisa,

It’s amazing how many times when we’re little we think, “That will never be me!” Then the years pass and we’re shocked to find ourselves squinting and pushing our eye-glasses down to the ends of our noses because someone shrunk all the print in books.

When you have to replace all your teeth it can be distressing. Yes, dental implants are the ideal treatment and I can see why you wanted them. But, their cost sometimes puts it out of reach. You’re also right that dentures have lots of problems. Slipping and sliding is a big one.

Fortunately, there is a middle ground. Snap-on dentures address some of the problems that come with dentures. Obviously, they’re still not as stable as dental implants, but they’re not going to fall out of your mouth without some serious force.

They’re also useful in that they’ll allow you to work your way up to more implants. You can start with as few as two, which is much more affordable and give you time to save up for further implants as you’re able.

Talk to your dentist and I’m sure the two of you can work out a plan to get you stable replacements for your teeth that repair your smile without destroying your bank account.

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

Why Is My Veneer Turning Dark at the Top?

I received two porcelain veneers on my front teeth a couple of years ago. I only needed one but ended up getting two. The dentist said that was necessary to make sure my two front teeth match. It worked out, they matched and looked very nice. I’m concerned because one of them has developed a dark line at the very top. Will this happen to both of them? Is there any way to fix it? It’s a little embarrassing.

Stephanie H.

Dear Stephanie,

Porcelain veneers shouldn’t ever develop a line at the top. There are two possible scenarios, but both mean your dentist didn’t do the job correctly. That actually wouldn’t surprise me because he told you he needed to do two veneers in order to get them to match. If he were a skilled cosmetic dentist that wouldn’t be true. He could match a single veneer to the rest of your teeth.

First, the veneers should have been made flush with your natural tooth. If your dentist didn’t do that, it would leave a ledge which can gather all kinds of food and bacteria. That would be a possible explanation of the dark line. It will also lead to decay so he should repair this free of charge.

A second possibility is the dentist didn’t bond the veneer properly. This allows things to slip in between. This would more likely make the entire veneer look darker. Unfortunately, it also will lead to decay and should be repaired free of charge.

I’d get a second opinion from an expert cosmetic dentist, just to get an objective opinion as to what is going on. Don’t be surprised if he tells you what you actually have are two porcelain-fused-to-metal crowns and not porcelain veneers. Those DO develop a dark line at the gumline as a matter of course, but generally it takes more than two years for that to pop it’s ugly head out. If this is the case it’s just another piece of evidence that your dentist isn’t qualified in cosmetics. Front teeth require all-porcelain crowns. The metal based ones are better for back teeth.

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

Do I Really Have to Remove ALL My Teeth?

I’m a complete wreck. I haven’t been to the dentist since I was a child. They terrify me. But, I had a horrible toothache so I had to do something. I called around to an emergency dentist and he offered to see me the first thing in the morning. When I got there, I explained my situation and which tooth was hurting me. He offered to check all of them, which I thought was very generous. Then he told me that not just the aching tooth needed to be pulled, but ALL my teeth needed to be pulled. I couldn’t believe it. He said I’d need to get a full set of dentures. I couldn’t believe my ears. He wanted to do it right then, but I refused, except for the tooth which is killing me. Please tell me there’s another solution. I’m still in my 20s. I can’t look like a grandmother yet.

Stacey A.

Dear Stacey,

In your place, I would get a second opinion. I know you don’t have a dentist, but I’m afraid this emergency dentist didn’t do his do diligence. Surely at least a few of your teeth could be saved or you’d be in much more pain than just that one tooth. You’d probably also have a few loose teeth due to gum disease.

Even if on the off-chance none of them can be saved, you’re not condemned to wear dentures. There are much better options in tooth replacement. If you don’t have gum disease, I’d suggest you get dental implants. They’re as close to having your own natural (but healthy) teeth back in your mouth as you can get. If you do have gum disease, get that dealt with and then get the implants. Not only will you not look like a grandmother, but if you go to an expert cosmetic dentist you can receive a stunningly gorgeous smile.

I wanted to take a moment to address your dental fear. There are gentle, kind dentists who work with fearful patients. They have techniques and procedures which can make your appointment very pleasant. Those with the strongest anxiety often find sedation a lovely solution. They can get their teeth worked on while they sleep.

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