Category Archives: TMJ

Did My Dentist Give Me TMJ?

I am concerned that something happened during my dental procedure which could have given me TMJ Disorder. I had my upper arch worked on with two dental crowns and eight porcelain veneers. While they look great, my jaw hurts like mad. I called the office to see what to do and they just suggested I take Advil. It’s been three days. Should this still be happening or is there something more serious going on? I’ve read that you can get TMJ with this type of dental work if it isn’t done right.

Avery

Dear Avery,

With the extent of dental work you had done, it is fairly normal for your jaw to feel achy, even for several days. Your jaw had to be propped open for quite a while. Advil is a good choice because it has an anti-inflammatory. You could also put some warm towels on your jaw. Other than that, it will just be a matter of rest and time.

When you are talking about TMJ developing from dental work, it would be a matter of the dentist doing the work incorrectly in a way that threw off your bite. That does not appear to be what you have going on.

Often when we see this happen it is when a dentist had one side of the bite that is occluding before the other, or if they opened your bite too much. You would notice if that were happening. The pain would not just be an ache. You would likely also develop some speech difficulties because your bite was now misaligned.

My advice is take the Advil and give it an other week. If it is still bothering you, go in and have your dentist examine that the teeth are meeting together properly.

This blog is brought to you by Salem, MA Dentist Dr. Randall Burba.

Crown Feels Weird

I had an upper molar crowned. It doesn’t quite feel right. It’s like it is too big for the tooth under it. They hit together before all my other teeth and it hurts. My dentist said to give it some time and I will get used to how a crown feels. It is my first dental crown so maybe this is what happens. However, it has been over two weeks and it still hurts. Would it damage the crown to maybe shorten it so they don’t hit together so soon?

Lindsey

Dear Lindsey,

Your dentist’s statement, “Give it time and you’ll get used to how a crown feels” is dental code for he has no idea how to fix this and he is hoping you will just clam up about it.

The reality is when a dental crown is done properly, you should not notice it at all. This includes when you are chewing. It should mesh perfectly with your natural teeth. It is fairly normal for some adjustments to need to be made to a new crown, but it seems like your dentist isn’t aware of the procedures to do this.

So what will happen if you don’t get it adjusted? Well, maybe nothing. Maybe you will “get used to it”. Or, maybe if this is left without adjustment, it can lead to serious problems, such as TMJ Disorder.

Most dentists would adjust the crown and have you bite on some registration paper to see where the teeth are not occluding properly. If your dentist hasn’t done that, then he is further behind in his field than I expected.

Don’t push him into doing something he isn’t comfortable with. It will end up worse than your original issue. You could go to another dentist to have this adjusted. You could ask for a refund and have the crown re-done elsewhere.

If you are otherwise happy with your dentist, you could stay with him for your general care, such as cleanings and checkups and then go elsewhere when some other procedure comes up. Another option is to switch dentists completely. The best dentists keep up learning and train in the new technologies and advancements that are made in their field. Your current dentist has not even mastered the basics yet, so I wouldn’t expect too much from him.

This blog is brought to you by Salem, MA Dentist Dr. Randall Burba.

Collapsing Mouth

My dentist is suggesting I get porcelain veneers for an issue I’ve been having. My mouth seems to be collapsing. It is getting harder and harder to see my teeth when I smile and I’ve even been having trouble saying certain letters such as P and T. I want to make sure that porcelain veneers are the right solution before I move forward. It’s a rather expensive procedure.

Elizabeth

Dear Elizabeth,

If your dentist suggested that porcelain veneers would fix your problem, he is mistaken. The only thing it will improve is the appearance of your teeth. Even that will depend on his or her skill as a cosmetic dentist.

You have a bigger issue than just the appearance. Based on your description, it sounds like your teeth are worn down. It’s likely you are grinding your teeth without realizing it. Most patients who grind their teeth do so while they are sleeping.

This grinding wears the teeth down to little nubs and causes your mouth to over close. This can lead to TMJ disorder and will give you a lifetime of jawpain and migraines.

You’ll need a dentist with extensive treatment in TMJ disorder in order to fix this properly. This is especially true with a case like yours which will be more advanced than most.

In your place, I’d look for a dentist who received training in one of the following institutions, which are all highly reputable.

  • The Dawson Academy
  • The Spear Institute
  • The Las Vegas Institute for Advanced Dental Studies
  • The Pankey Institute

A dentist with this type of training will be qualified to provide you with the solution to fix your bite and your appearance.

This blog is brought to you by Salem, MA Cosmetic Dentist Dr. Randall Burba.

A SErious Case of TMJ Disorder

I need some advice. In my late 20s I had all my teeth crowned because of severe teeth grinding. I don’t think it was done properly because those ended up ground down as well. In addition, my teeth are now on a slant and I have massive jaw pain. I became desperate and sought out a neuromuscular dental specialist. I didn’t know that wasn’t a real specialty and now worry I’ve been duped.

He had me in an orthotic for 2 years that opened up my bite too much. I’m worse off than I was at the beginning. I need to get this fixed. Here’s my questions. First, if there isn’t a specialty, how do I know who to go to for treatment? Second, do I have to choose between form and function? By that I mean is it possible to get someone who can give me a properly functioning smile that also looks good?

Marcy

Dear Marcy,

woman holding her jaw in pain

You’ve already learned some hard lessons. I’m sorry about that for you. I wish your dentist in your twenties would have recognized your teeth grinding and been proactive instead of allowing them to be ground down so far that it required you to get a full-mouth reconstruction. He or she gave you very poor care.

Now onto your questions. I am actually going to answer the second one first. You absolutely do NOT have to choose between form and function. It will take finding the right dentist, but there are dentists who are qualified in both treating TMJ Disorder and skilled in creating beautiful smiles. How you go about that will answer your first question.

Who Should Treat Your TMJ Issues

You want a dentist who has done post-doctoral training. The training that is given in dental school isn’t enough. Here are some of the top post-doctoral training centers for TMJ Disorder:

  • Spear Institute
  • The Dawson Academy
  • The Las Vegas Institute of Advanced Dental Studies

Once you’ve found a list of qualified TMJ dentists, you’ll want to see what type of cosmetic dentistry training they have. Ideally, you want a dentist who has achieved accreditation with the American Academy of Cosmetic Dentistry. AACD accredited dentists are in the top 1% of cosmetic dentists in the country.

It isn’t always easy to find a dentist with both of those qualifications in every area. If you’re having trouble finding a TMJ dentist who also is AACD accredited, you can also look on the mynewsmile.com website.

They have a “find a cosmetic dentist” link. This site is run by a retired cosmetic dentist and he pre-screens all the dentists who want to be listed for both their technical training as well as their artistry. They can’t just pay to be listed, they have to be qualified. On the list are many AACD accredited dentists as well as those who are on their way to accredidation, which takes years, and equally qualified.

This blog is brought to you by Salem, MA Dentist Dr. Randall Burba.

Can I Get a Refund from this Dentist?

I had a cracked tooth that received a crown. It has been sensitive since then. I can’t eat where that crown is because it hurts to bite down. I called my dentist a week after and he said that some people take longer for the sensitivity to calm down. Three months later and I needed to go in for another dental crown. I begged them to fix the crown from the first tooth while they were there but they just blew me off. They told me it probably just needs to be adjusted and to schedule a follow-up visit for that. Then, the pandemic hit so they canceled my appointment. I went back today and they told me that the tooth needs to be extracted. I feel like this wouldn’t have happened with timely treatment. I wanted a refund for the original crown if I’m going to lose the tooth anyway. They’re saying the tooth being infected isn’t their fault So, not only am I not getting a refund, but now they’re talking about me having to get a dental implant to replace the tooth. Is there anything I can do about this?

Miranda

Dear Miranda,

Woman grabbing her jaw from pain.

You’ve been put through the wringer with this dentist. I’m sorry. It is obvious to me this dentist doesn’t care about your best interest. While it is not uncommon for a tooth to have some sensitivity, the type of sensitivity you described isn’t normal. If there was sensitivity to temperature, I’d have suggested a little time. However, you talked about pain when you tried to chew. That is something completely different.

A well-made dental crown is not noticeable at all. So, either the crown was seated too high and needed adjusting or there was an underlyting infection that was missed. It’s possible, if there was an infection, that it was hard to see.

One thing I don’t understand is them saying the tooth must now be extracted. Have they tried a root canal treatment? My suggestion is to get a second opinion.

When you do, make sure it is a blind second opinion. By that I mean , don’t tell the second opinion dentist who did your work or what they’re recommending. Instead, just tell him the symptoms and let him give you his unbiased recommendation.

I am especially curious as to whether you really need this tooth extracted. You said there is an infected tooth. Normally, the treatment for that is a root canal treatment.

I wish your dentist would take the crown that is giving you pain more seriously. When your bite is off for an extended period of time, It could lead to TMJ Disorder. Regardless of how this turns out, I think you need to find a new dentist. One who cares about his patients.

This blog is brought to you by Salem, MA Dentist Randall Burba.

A Collapsed Bite

I need some help and advice. My “smile” is a disaster. When my mouth is relaxed, you can’t see my teeth at all. When I’m smiling, it takes an extraordinary effort to get my teeth to show. I am a grinder and have jaw pain. To help with that, I wear a nightguard. When I’m wearing that, it helps. Would investing in porcelain veneers help with this situation?

Ben

Dear Ben,

A man in pain needs to see a Salem Emergency Dentist

I am glad you are writing before making any decisions. What you are dealing with requires a dentist with advanced training. The wrong, inexperienced dentist can absolutely destroy your bite. I haven’t examined you, but based on what you’re describing you are dealing with both a collapsed bite and TMJ Disorder.

Opening your bite would be the solution. Porcelain veneers aren’t going to help without doing that first. Once that is done, you may not even need the veneers. However, this has to be done very carefully. You’ll need a dentist with extensive experience in doing a full-mouth reconstruction.

The thing which is most important for you to know is that it needs to be done first with temporaries. Before any permanent restorations are placed. Do not allow anyone to permanently bond anything onto your teeth until the provisionals are successful. So, what will successful mean?

  • You are completely out of pain.
  • You can see your upper teeth normally.
  • You absolutely LOVE how your smile looks.
  • You have no speech problems.

To get that combination will require a very special dentist, but they are out there. First, look for their restorative dentistry training. This has to be post-doctoral training. You want them to have had training in one of these schools: L.D. Pankey Institute and the Dawson Academy in Florida, and the Las Vegas Institute for Advanced Dental Studies.

Additionally, we want to make certain they can create a beautiful smile. I would look for an AACD accredited dentist. These dentists are proven in both their technical skill and as well as their artistic ability. Finding a dentist with these combined qualifications, you’ll go from having a smile you can’t show to one you are thrilled to share.

This blog is brought to you by Salem, MA Dentist Dr. Randall Burba.

Her Dentist Isn’t Helping Her

I have a puzzle I’m hoping you can help me with. I had a check-up just a couple of months ago. They said everything was good to go. Yet lately, I’ve been having this weird pain on one of my back teeth. It feels like someone is pulling at the tooth briefly and then letting go. It is sort of hard to describe. I haven’t had a cavity before so I don’t know what they feel like. The only other thing I can think of is my husband says I grind my teeth at night. Could that be it? What do I do? I don’t want to go back to the dentist unnecessarily.

Paula

Dear Paula,

Woman grabbing her jaw from pain.

I know you said your dentist gave you the all-clear, but I am quite concerned you’re not getting the proper care from your dentist. Some “bread and butter” dentists, especially those from discount clinics will check your teeth for cavities, but ignore all the peripheral issues, such as gum disease and teeth grinding. Both of those issues are extremely important to deal with.

Bear in mind I haven’t examined you and am going just on the pain as you described it. It could be either from your grinding (known as bruxism) or from gum disease. Usually, by the time you feel pain from gum disease, there has been some bone loss and that is dangerous for you. It could lead you to losing your teeth.

The grinding should have visible evidence at this point. Not only will it lead to TMJ Disorder, but eventually your teeth will be ground down to nubs requiring a full-mouth reconstruction. This means putting a dental crown on each one of your teeth that are worn down. I can pretty much guarantee your current dentist isn’t qualified to do that procedure. It takes advanced training.

You Need a Second Opinion by a TMJ Dentist

I’d like you to see another dentist. Almost all dentists should know how to recognize and treat gum disease. That won’t be the tricky part. I want you to see a dentist with advanced TMJ training. This isn’t a recognized specialty. Instead, a dentist has to take the initiative and decide it is something he or she wants to treat and get the training to enable them to do it well.

Some of the more reputable post-doctoral centers that do great training in TMJ are The Las Vegas Institute for Advanced Dental Studies (often called LVI), The Dawson Center, The Kois Center, and the Spear Institute. Look for someone with training from at least one of these schools.

This blog is brought to you by Salem, MA Dentist Dr. Randall Burba.

Full Mouth Reconstruction Disaster

I’m having a full mouth reconstruction and things keep seeming to go from bad to worse. When the temporaries were done, everything felt fine. However, once the permanent ones came in nothing is occluding well. Some of the teeth are hitting too soon and some aren’t hitting at all. My mouth feels awful. I can’t even eat. He’s tried to adjust them with grinding them down a bit but everything got progressively worse. I offered to pay lab fees to have these re-done, but he keeps trying to fix it himself. I went to see another dentist, but once he found out who did the work he wouldn’t say anything negative about the work. Before that, he seemed concerned about some things, but now I think he’s just trying to protect his colleague. What do I do?

Bruce

Dear Bruce,

A man in pain needs to see a Salem Emergency Dentist

There are two things going on here. The first is that your current dentist is in over his head. A full-mouth reconstruction is something that is very advanced. It takes a significant amount of post-doctoral study. For instance, Dr. Burba studied about TMJ Disorder and occlusion at both the Dawson Academy and the Spear Institute. This type of intentional training is necessary to do the type of procedure you are trying to get done.

Occlusion is the study of how your teeth come together properly. You noted that some of your dental crowns were hitting before others. This is why you’re in pain. Normally, your biting force is spread across a group of teeth, but when you have a tooth that is hitting before the group then it is taking all the brunt of your biting force. That is a significant amount of pressure and will lead to pain.

Please bear in mind that I haven’t examined you. However, it also sounds like he’s thrown off your bite as well. This can mess with your jaw joint. That, in turn, will lead to TMJ Disorder, which is a whole other set of pain.

You are probably going to need to have this case re-done. In order to get some of your money back to make it possible for you to get it done right, you’re probably going to need to get a second opinion.

I know you’ve tried this already, but there is a trick to doing it in a way to get an unbiased answer.

Getting an Unbiased Second Opinion

I would look for a dentist who has experience in occlusal studies. In addition to the institutes I mentioned which Dr. Burba attended, you could also look for someone in your area who has attended the Las Vegas Institute of Advanced Dental Studies, often abbreviated LVI.

Once you feel confident that the dentist has the requisite knowledge to know what is going on, tell him (or her) what you’re experiencing. Under NO circumstances should you tell them the name of the dentist who did the original work. That is where you went wrong with your last second opinion.

Dentists know one another. Some are even close friends. They may feel conflicted in criticizing the work of a close colleague. If they ask you who did the work, tell them you just want an unbiased opinion so you won’t be naming the dentist. They shouldn’t have a problem with that.

If the second opinion dentist agrees the work isn’t done properly, you should be able to get at least a partial refund.

This blog is brought to you by Salem, MA Dentist Dr. Randall Burba.

Should Dental Crowns Touch

I got a dental crown on a left rear molar. I’m a little concerned that it isn’t touching the opposing tooth. Does that matter or am I making a mountain out of a molehill?

Mike

Dear Mike,

Chart of TMJ and Neuromuscular Dentistry

I’m glad you are checking on this. It matters very much that your dental crowns touch. In fact, it even matters how they touch, this is called occlusion and it is important for proper function of your bite and jaw. If your jaw is properly aligned all your teeth touch when you clench them together.

One way to test this is to place a thin strip of plastic, 0.05 mm thick and the width of a tooth, on your back teeth. You should be able to clench your teeth together and prevent the strip from being withdrawn.

When you have back teeth which don’t touch, they will eventually drift toward each other, but that doesn’t mean they will meet in the right place. A misaligned bite is one of the causes of TMJ Disorder. That is a lifetime of pain which can be avoided by your dentist properly placing your dental crown.

Have your dentist re-do this. If you have trouble getting him to agree, show him this post.

This blog is brought to you by Salem, MA Dentist Dr. Randall Burba.

A Collapse Bite Requires You Choose Your Dentist Carefully

My smile humiliates me. I have to work extraordinarily hard for people to see my teeth. It looks unnatural. Plus, my jaw hurts. My dentist has me wear a night guard for that. It does help and my lips and teeth look more natural when I do. I think it may be that my teeth aren’t big enough. In that case, would porcelain veneers help?

Mary

Dear Mary,

Woman covering her mouth

Based on what you’ve mentioned, it sounds like you have a combination of a collapsed bite along with TMJ issues. If that is the case, porcelain veneers aren’t your solution. However, I do have one for you.

I’m actually relieved you wrote before moving forward. There are too many times we hear from people only after a dentist without the requisite training completely destroyed their bite.

In order to fix what is going on, they will have to open your bite with dental crowns. It will have to be done carefully and methodically with a dentist who knows how to do a full-mouth reconstruction. It will take restoring your bite with provisional restorations first.

This is necessary so that it is reversible until the provisionals are successful. This will mean you are completely out of pain, your upper teeth show normally, you have no speech difficulties, and you are pleased with the appearance of your new smile.

This is a tall order and there are only a small minority of dentists who are able to accomplish this. You’ll want someone who has done extensive post-doctoral work at one of these institutions:

  • L.D. Pankey Institute
  • The Dawson Academy
  • The Las Vegas Institute for Advanced Dental Studies

These are the top schools for this sort of procedural training. Anything less and you’ll end up with an even more serious problem than you are facing now. The good news is, those dentists are out there. You have hope.

This blog is brought to you by Salem, MA Dentist Dr. Randall Burba.