Category Archives: TMJ

Notches & Erosion at gumline

I have notches on my teeth at the gumline a type of erosion from brushing too hard. I’m thinking of getting porcelain veneers as a means of covering it. As long as I don’t brush too hard, they should be fine, right?

Lisa

Dear Lisa,

A pretty blonde with a pretty smile.
The best cosmetic dentists create beautiful smiles

I’m glad you wrote. It’s true that we used to think the kind of erosion of teeth you’re dealing with was caused by brushing too hard. We no longer believe that to be the case.

While it is still believed to wear away your gums, the notches and erosion on your teeth are now believed to be caused by bruxism. This is when you clench and grind your teeth. So, let’s see if I can’t help you with both issues.

Porcelain Veneers

Yes, you could get porcelain veneers and it will cover those notches. Whether or not you get a gorgeous smile with those veneers depends on the dentist who creates the smile.

Smile makeovers aren’t taught in dental school. It’s something a dentist will choose to study afterward if they’re interested. Some invest more in time and training than others. Some have an artistic eye and some don’t.

If you want a gorgeous smile, you need to look for an expert cosmetic dentist. Go to the website of the American Academy of Cosmetic Dentistry (aacd.com) and do a search for an accredited dentist in a realistic distance from you. AACD accredited dentists are of the highest caliber.

Bruxism and TMJ

Bruxism is biting stress on your teeth. When you grind your teeth or even clench them, it causes stress at the neck of the tooth leading to the problems you currently have, as well as weakening and cracking them. It will also lead to problems with your temporomandibular joint causing TMJ Disorder.

Even if you get porcelain veneers, this will need to be dealt with. You will continue with this habit without realizing it. Most people do it in their sleep. My suggestion is you see a TMJ dentist and get fitted for a nightguard as soon as your porcelain veneers are bonded.

If you’re not getting your smile makeover right away, be sure to get the nightguard now so you don’t do any further damage to your teeth.

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

Does TMJ Require Surgery?

I’ve been having jaw pain. I did some research to find out what it could be and all the online articles point to TMJ. They also say it can require surgery to fix. I’m only 25 but am completely on my own financially. I don’t think there is any way I can afford surgery. Are there other options? Can they give you a med that allows you time to save up for surgery?

Melissa

Dear Melissa,

Chart of TMJ and Neuromuscular Dentistry

We’re jumping the gun here a bit. The first thing you’d want to do is see a dentist to see if you are suffering from TMJ Disorder. Even if you are, surgery isn’t generally the first go to. Your TMJ Dentist will look for the cause of the TMJ pain first, before outlining any treatment plan.

As you can see from the chart above, there are many reasons why you could be in pain. Sometimes it is something other than the joint itself. For instance, your bite could be out of alignment and starting to wear down the temporomandibular joint.

If that’s the case, your dentist will decide if you need a temporary orthotic to shift your bite and align it into proper positioning, or if you need some additional dental work like a dental implant or porcelain crown.

Only in very rare cases is anything like a full-mouth reconstruction or surgery necessary.

The Key to Proper TMJ Treatment

To ensure you get the proper treatment, you need to make sure you are going to an experienced TMJ Dentist. There isn’t a recognized TMJ Specialty, so it is up to the patient to find out what type of qualifications their dentist has to give them the right treatment.

Don’t hesitate to ask your dentist what type of TMJ training they have. Dental school isn’t enough. It must be post-doctoral work. I’m going to suggest you click here to look at Dr. Burba’s TMJ Dentist page in order to know what type of training you should look for.

Bear in mind, a good dentist will recommend the least invasive treatment for this type of situation first.

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

Dentist Blamed my Bite for Broken Teeth

I kept breaking teeth when I ate. My dentist said it was because of my bite and suggested I crown every tooth so he could fix it. That was 50K+ so I expected decent results. Instead, I have several broken crowns. Now, my dentist is blaming my habits for breaking my teeth. He said I’m grinding my teeth at night and need to wear a night guard and something else during the day. I’m having trouble buying this for two reasons. First, because he originally said the cause was something else but when his repair didn’t work he’s now suddenly coming up with a bad habit that’s my fault. And this is the first time I’ve heard of this so-called habit. Second, because I break my teeth when I eat and not when I sleep. Do you have a recommendation?

Kyle

Dear Kyle,

Chart of TMJ and Neuromuscular Dentistry

I understand why you’re concerned. It doesn’t sound like your dentist really knows what he’s doing with this. After spending over $50,000 dollars, you have a right to be frustrated. I have two suggestions for you. First, I want you to get a second opinion. However, I don’t want you to get it from any dentist. Instead, I want you to find a TMJ Dentist.

While there isn’t a TMJ Specialty, there are dentists who’ve invested more time in studying the causes and treatments. You want a dentist who’s invested the time doing that post-doctoral. For instance, Dr. Burba studied at both the Dawson Academy and Spear Institute. Both are well known for their TMJ and neuromuscular training. Another great school for that is the Las Vegas Institute (LVI).

The reason I want you to see a TMJ dentist is due to the crowns you’ve had placed. What your dentist did is known as a full-mouth reconstruction. It takes expert level knowledge in occlusion to do this correctly or you could end up with serious problems with your bite. I don’t have the confidence your dentist has done this training.

TMJ and Night Guards

The second thing I’m going to recommend is you follow through with his suggestion of a mouth guard. While he didn’t run any tests or talk about evidence of teeth grinding before this problem, a night guard is not a bad idea. Though, I doubt you’ll need one during the day. The reason I say that is because people who grind their teeth at night don’t realize they’re doing it.

Teeth grinding causes a bunch of problems. Not only can it lead to TMJ Disorder, but it can also cause you to crack or break your teeth. I realize when your teeth break is during meals, however, that doesn’t mean they’re not being weakened by the habit.

One other thing. If you do grind your teeth and there was evidence of that, but your dentist didn’t mention it until now, that is severe negligence on his part. If that’s the case, I think you need a new dentist.

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

My Mouth Is Sinking In

I need some advice. You can barely see my front teeth when I smile. It makes it look like I don’t have any and is embarrassing. I do have jaw pain which I wear a night guard for. My face feels more comfortable and natural when I wear it. But, most of the time, my jaw tightens and I have trouble forming certain letter sounds. My dentist suggested porcelain veneers but I wanted to get a second opinion. What do you think?

Pamela

Dear Pamela,

A Chart showing how joints muscles and teeth all work together in TMJ

I’m concerned by some things I’m hearing. I think you need a different dentist. While it is true that getting porcelain veneers can give you a gorgeous smile, it will not help the root of your problem. In fact, it’s likely to make it worse, specifically your jaw pain and issues with pronunciation. You may actually end up with a locked jaw.

Go see a dentist with a lot of training and experience in TMJ Disorder. You’re probably thinking, “Great, that’s not a specialty. How do I find one of those?” Well, I’m glad you asked. You can look on their website or ask their staff where they received their TMJ training. If they only mention their dental school, that’s insufficient. Here are some great institutions. I’d want them to list at least one of them:

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

It sounds like this has happened over time, which may mean you’ve worn your teeth down causing them to overclose. If that’s the case, then it’s very likely you’ll need a full mouth reconstruction. Picking the right dentist for that is just as important as finding an expert in TMJ Treatment.

You want to have a functional smile, but one you’ll also be proud to show everyone. In your place, I’d start by finding an expert TMJ Dentist, but then also see if they’re an expert cosmetic dentist. It is possible to get both. For cosmetic dentistry, the ideal is to get a dentist who has attained accreditation with the American Academy of Cosmetic Dentistry.

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

General Dentist or TMJ Specialist?

I have really good teeth. Never had a cavity or any other problems, though I do grind my teeth. I had a checkup a month ago with an all clear. Yet, this week I keep getting an intermittent pain in my teeth. I can’t tell exactly where it’s from. I don’t know if it’s a cavity or not. My cubicle neighbor said she had a similar problem and it turned out to be TMJ. Should I see a general dentist or a TMJ Specialist?

Norma

Dear Norma,

Woman holding her jaw in pain from TMJ

I want to clear up a common misunderstanding. There isn’t a recognized specialty in TMJ Disorder. Any dentist who treats TMJ is just a general dentist who (hopefully) has done additional study and training in TMJ treatment.

We’ll get into how to find a qualified TMJ dentist in a moment. First, let’s address your pain. You don’t have localized pain, but generalized. That makes me think it’s not a cavity. However, if it’s referred pain, that could still make a cavity a possibility.

Your checkup wasn’t too long ago, so unless your dentist missed something a cavity wouldn’t generally pop up and suddenly hurt in that short period of time. Here’s what I’m going to recommend. Go back to see your dentist and get some x-rays done. If by chance it is decay, it’s much easier to get a simple filling than to put it off until it blows up into a dental emergency. So don’t be afraid to go to the dentist and get diagnosed. It’s better than waiting until things are dangerous.

Finding a Qualified Dentist to Treat TMJ

If it turns out there’s not decay or any other typical dental issue, then it will be time to see a TMJ Specialist. So how do you know who is qualified without that true specialty degree? You ask about their TMJ training.

It should be post-graduate and be at some place like one of the following:

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

These are just a few of the advanced training centers, but they’re among the most reputable. If they haven’t done significant post-graduate training, look elsewhere. Additionally, you should know that a good TMJ Dentist will start with the least invasive treatment. They wouldn’t start with a full-mouth reconstruction unless it was a serious and obvious problem where that was the only solution.

Best of luck to you! Hopefully, it’s a simple solution.

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

Can a Dental Crown Cause TMJ

I’ve had a problem over the last month of my jaw aching, especially in the morning. I’ve been under some stress and have caught myself tensing my jaw some throughout the day. Then, I got a dental crown. It’s made the pain so much worse. I went back to the dentist…several times. He’s adjusted it several times, but the pain never seems to go away now, plus, it’s always hitting my other teeth before the others. Could this be causing TMJ?

Beatrice

Dear Beatrice,

Woman holding her jaw in pain

Yes, a poorly placed crown can certainly cause or exacerbate existing TMJ problems. There is a lot that goes into understanding how the bite should go together. Some dentists invest more time and training in that area than others. You may have a dentist who doesn’t invest much in it.

The fact that your teeth are not meeting uniformly is a cause of concern and he should know that. Some dentists who have trouble getting it right will just adjust and adjust until the patient is too embarrassed to keep complaining and drop it. This needs to be fixed.

The fact that your jaw had already had some minor pain and you’d noticed some clenching during the day worries me too. If you notice clenching during the day, you almost certainly are doing it at night as well. You should be wearing a nightguard. They’re custom fit to your bite and comfortable. Their function is to protect your teeth and jaw from the pressures of clenching and grinding.

Finding a TMJ Dentist

It doesn’t sound like your dentist is going to deal with this properly, so you need to see one who understands TMJ. While there isn’t a recognized TMJ Specialty, there are ways to know if a dentist has a good knowledge of the condition.

You’ll want to especially look at their post-graduate training. Don’t feel weird asking them about it. It’s important knowledge for you in choosing the right dentist. For instance, Dr. Stanley Burba invested significant training on TMJ Disorder. He’s studied at both the Spear Institute and the Dawson Academy.

Some other great centers are the Kois Center and the Las Vegas Institute for Advanced Dental Studies (LVI). If a dentist has trained at any of these institutes, they’re sure to be able to help you.

Additionally, if it turns out that your dental crown isn’t properly placed the new dentist can help you get a refund from your current dentist.

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

New Crown hurts

I got a new crown a few weeks ago. It hits my other teeth funny, which makes it hurt every time I bite. I went to my dentist. He looked at it and said it’s fine and to give it time. I have given it time and it’s still hurting. What do I do?

Cammi

Dear Cammi,

Woman holding her jaw in pain
Damage to a bite can lead to TMJ

“Give it time.” That’s dentist speak for, “I don’t know how to fix this.” Here’s what needs to happen. This crown needs to be adjusted. It’s likely the crown is just too high. When you bite down, the other teeth are hitting the crown before it meshes. The pain you’re experiencing is just part of the deal. If this isn’t adjusted, it can do damage to your bite. Fortunately, there are things your dentist can be doing to deal with this.

First, he needs to determine if the crown problem is simply it is sitting too high. If so, a simple adjustment can fix everything. If that doesn’t work, there is a next step. He can have you bite down on a bite registration paper. Where it registers the bite too high he can make some adjustments.

Of course, dentists with advanced training wouldn’t have this problem to begin with. If they did, they’d fix it with a properly made crown. The key this time is to get you out of pain and make sure your bite doesn’t get damaged. The last thing you want is TMJ Disorder.

What Type of Dentist Can Treat TMJ?

Neuromuscular dentistry requires advanced training. Traning you can’t get simply by going to dental school. It needs post-graduate training. Don’t hesitate to ask where they received their TMJ training. Some schools that are very reputable are:

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

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

How Do I Know if I Have TMJ or TMD?

I’m at a loss. I’ve been doing some research and have narrowed it down to two conditions, but I can’t tell the difference between them so don’t know who to see.
Here are my symptoms:

  • Jawpain
  • Headaches
  • Clicking in jaw
  • Teeth have shifted

Do I have TMJ or TMD? Who do I see for it?

Marilyn

Dear Marilyn,

A Chart showing how joints muscles and teeth all work together in TMJ

I understand why you’re confused. These two acronyms are used interchangeably. TMD stands for Temporomandibular Disorder. TMJ stands for Temporomandibular Joint. When the joint is out of alignment, which can happen for several reasons as seen in the chart above, it causes TMD.

Your symptoms are pointing to this disorder, whether you call it TMJ or TMD. You’ll want to see a dentist, but not just any dentist. First, not all dentists treat it because it is so complex. Secondly, some do treat it who shouldn’t. You really want a dentist who’s invested significant training in diagnosing and treating this disorder. As an example, look at Dr. Burba’s TMJ Dentist credentials. This is the type of dentist you want to find in your area.

What to Look for in TMJ Treatment

Because TMJ is so complex, it is imperative your dentist finds the underlying cause of your TMJ in order to begin proper treatment. You also want to start with the least invasive treatment possible. For instance, if it turns out your problem has stemmed from nighttime grinding, the first thing to do is protect your teeth from any further damage.

From there, you can take up repairing the damage. Maybe your teeth are ground down to nubs and you need dental crowns. Or possibly, your teeth have been pushed out of place and you need Invisalign to realign your bite. Maybe you need a combination. The key is a dentist who knows what to look for.

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

Store Bought TMJ Treatment

I’m drowning in medical bills right now and don’t think I can afford a dentist. But, my jaw has locked up. My sister says TMJ does that and that I need an oral device to help. All I know is I can’t even eat. I’ve heard you can use an oral mouthguard to treat TMJ. I saw one at the pharmacy the other day and it was only about $20. I can afford that much. Is there anything I need to know about using it?

Drew A.

Dear Drew,

TMJ Treatment Dentist

Your sister is right on both points. Lock-jaw is often caused by TMJ Disorder. While, the orthotic anterior repositioning splint can be used to treat TMJ, that’s not what you saw at the store. A mouthguard is completely different. They’re used to protect people’s teeth from habitual tooth grinding. If that’s an issue you struggle with, you’ll want a mouthguard after you finish your TMJ treatment. However, the store bought ones aren’t custom fit. They just come in small, medium, or large. You can also find a one size fits all. They’re okay on a temporary basis, but you’ll grind through them rather quickly.

One made by your dentist will be more effective. I know your TMJ is the focus right now, but if you don’t protect your teeth from the grinding there are serious consequences. Not only does the grinding aggravate your TMJ, but it can lead to cracked teeth or even teeth coming loose and needing to be replaced. Best case scenario, they end up ground down to nubs and all need to be crowned. Talk about expensive!

But, back to your current issue. Here’s what I’d like you to do in the immediate so we can try to get the swelling down and get you eating again. I’d like you to take 800 mg. of ibuprofen about three times a day. In addition, you need to alternate heat and ice packs. Wear them for about ten minutes at a time, a few times a day as you’re able.

You will need to see a dentist to get the appropriate treatment. I know you’re buried in medical bills right now. Many dentists are compassionate and would be willing to work with you on payments so you can get the treatment you need right away and pay it out later.

Even if you can’t find one willing to work you, Care Credit is a fantastic option. It’s a medical “credit card”, but they let you choose your terms.

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

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.