Category Archives: TMJ

Why Does My Jaw Keep Locking?

My jaw keeps locking. The pain was so bad last night that I couldn’t sleep. I took ibuprofen and put a warm compress on the side of my face to get a little relief, but I know this will not go away by itself. My dentist took impressions of my mouth four months ago and gave me a night guard, but it is not helping.

The pain interferes with eating, talking, working, sleeping, everything. Do I need an adjustment to the night guard? Or should I skip another visit to my dentist and get another opinion on why my jaw keeps locking? Thank you. Brielle from Chico, CA

Brielle,

Thank you for your question. We are sorry that you are experiencing such discomfort and pain. As you may know, jaw locking is often a symptom of temporomandibular joint disorder. We will explain why your jaw continually locks and what to do about it.

Why Does Your Jaw Keep Locking?

Jaw locking, or trismus, is often related to temporomandibular joint (TMJ) disorder. Other conditions can cause jaw locking, including:

  • Trauma
  • Oral surgery
  • Infection
  • Cancer
  • Radiation treatment for head or throat cancer

How Can You Find the Cause of Jaw Locking?

You can find the cause of repeated jaw locking by scheduling an exam from a dentist with post-graduate TMJ training. Depending on the severity of the issue and the tests you have already had, a thorough examination includes:

  • Analyzing your jaw joints and bite
  • Bloodwork
  • CT scan
  • Measuring your mouth opening
  • MRI
  • X-rays

Visit the TMJ Association’s website for details on the importance of ruling out other conditions.

Are Your Symptoms Related to TMJ?

A trained dentist can determine if your symptoms are TMJ related. Occasional jaw popping and clicking are not unusual and do not necessarily mean that you have a TMJ disorder. Still, you might have a TMJ disorder if you experience these signs and symptoms:

  • A bite that feels off
  • Chronic headaches
  • Dizziness
  • Ear fullness or pressure
  • Earaches
  • Jaw locking, pain, or stiffness
  • Neck and shoulder pain
  • Ringing in your ears (tinnitus)
  • Vision problems

What Is the Right Treatment for TMJ?

The proper TMJ treatment depends on the cause and severity of your signs and symptoms. A dentist may recommend any of these methods:

  • Pain reliever
  • Orthotics
  • Orthodontics
  • Splint
  • Night guard
  • Dental restorations, such as implants, crowns, or bridges
  • Warm or cold compresses
  • Temporarily eating soft foods only to minimize chewing and let your jaw rest

Schedule a Second-Opinion Appointment

If you are experiencing ongoing jaw pain and locking, search online for a dentist with advanced TMJ training. After an exam, the dentist will determine whether your concerns are TMJ related or if you need further care from another medical professional.

Salem, Massachusetts, dentist Dr. Randy Burba sponsors this post.

My Dental Crown Is Crowding Other Teeth

One of my bottom left molars was hurting. My dentist covered it with a crown because she said it could be fractured. The tooth feels fine now, but the two teeth in front of it hurt when I bite down, even on food as soft as rice.

I asked my dentist to adjust the crown because I thought that it could be crowding the two teeth in front of it. She adjusted the crown, but the teeth still hurt. The pain decreases if I put pressure on the teeth with my fingers, but the pain quickly returns. My dentist said she has never had a patient case like mine. I have two other crowns, and I do not have problems with them. I think that something is still wrong with my bite. What could be causing my tooth pain? – Thanks. Tomas from Santa Fe, NM

Tomas,

Thank you for your question.

Your description sounds like your bite is still off.

Pain from decay or infection in your teeth will not improve if you push down on them, so decay or infection is not the problem. Either your gums or the crown is causing your symptoms. A poorly placed crown can push your teeth out of alignment and cause pain.

If your dentist adjusts your bite correctly, you can clench your teeth and put pressure on them without feeling any discomfort. Your dentist might need to adjust other teeth, too. She may be hesitant about adjusting your teeth if she only worked on the tooth that has the crown. Sometimes small shifts in one tooth affect others, and adjusting adjacent teeth is the only way to align your bite correctly.

A misaligned bite can cause a variety of problems, including:

  • TMJ disorder
  • Headaches
  • Neck pain
  • Nighttime teeth grinding
  • Jaw pain

Get a second opinion if your dentist is unable to correct your bite. You can look for a dentist with advanced training in occlusion and bite.

The Salem, Massachusetts dentists at Burba Dental Partners sponsor this post.

Why Do I Have a Cavity Beneath a Crown I’ve Only Had 4 Years?

After my yearly exam and cleaning two weeks ago, my dentist said the x-ray shows a cavity beneath my upper left second molar. I’ve had a crown on the tooth for four years. So, I asked my dentist why I have a cavity beneath it. She did not give me a clear answer but said she would need to remove the crown to treat the cavity.

My insurance will not authorize a new crown because the current one is less than five years old. I prefer to see another dentist for the cavity because my dentist seems indifferent, and I do not want another cavity beneath the crown. What may have caused a cavity to form? Thank you. Julian from Omaha

Julian,

Thank you for your question. It is good that your symptoms are not TMJ-related. But issues with a relatively new crown can still be disappointing.

Insurance companies expect a crown to last at least five years before paying for a replacement crown. But most cosmetic dentists agree that a well-placed, high-quality crown lasts much longer—sometimes ten years or longer. Still, crowns cover natural teeth. Although decay will not affect a ceramic crown, you can still get a cavity in the natural tooth beneath it if bacteria can leak in.

What Causes a Cavity Beneath a Crown?

If you have a cavity beneath the crown, possible causes include a damaged or loose crown or a gap where your tooth and crown meet.

  • Damaged or loosed crown – Bacteria can get trapped beneath a crown and lead to decay.
  • Loose margin – If the margin—where your crown and tooth meet is not closed completely, bacteria can leak in. The area must be smooth and without any gaps or roughness. Otherwise, the site can attract bacteria,  plaque, and decay.

Treatment for a Cavity Beneath a Crown

If you have a cavity beneath a crown, in most cases, your dentist will remove the crown, clean the tooth, fill the cavity, and replace the crown with a new one.

Get a Second Opinion

If you have a cavity beneath your crown and are disappointed with your dentist’s response, get a second opinion from an experienced cosmetic dentist. After an examination and x-ray, the dentist can recommend a treatment plan to remove the cavity and replace the crown.  If the cosmetic dentist can examine your crown and detect faulty work, your dental insurance company and a new dentist may support you in asking for a refund from the dentist who placed the crown. The Salem, Massachusetts dentists at Burba Dental Partners sponsor

Why Does My Temporary Bridge Make My Face and Jaw Hurt?

Although the bridge was still comfortable, my dentist recommended replacing it before I began to have problems. She took impressions of my mouth and placed a temporary bridge. But I take ibuprofen every day because the bridge hurts. The entire left side of my mouth and jaw hurt. It hurt to speak and chew more than anything, and my gums are slightly swollen.

My dentist took x-rays and said they look okay. But she cannot explain my pain. Of course, I am not allowing my dentist to request the final bridge because this temporary bridge hurts so bad. My dentist recommended an endodontist, but I do not have an appointment until early next month. Based on my description, why would a temporary bridge cause ongoing pain? Thank you. Lyle from Rhode Island

Lyle,

Thank you for your question. One of our dentists would need to examine your bridge, teeth, and x-rays for an accurate diagnosis. But we will explain three factors that might cause a temporary bridge to hurt.

Why Would a Temporary Bridge Hurt?

A temporary bridge can hurt because your teeth are sensitive after preparation or irritated by bacteria, or the bridge is not in the optimal position.

  • Sensitive teeth after preparation – Placing a bridge requires shaving down teeth on the sides and top so the ends of the bridge will fit over them. Teeth prepared for a bridge can ache, be sensitive to cold and hot temperatures, food, and drinks. Removing a bridge and preparing teeth from one are traumatic events.
  • Irritation from bacteria – If a dentist finds decay beneath a bridge or its components, bacteria could have infected and irritated your teeth.
  • Bridge position – If a bridge does not fit well, it can affect your bite. When you eat, the opposite teeth (upper or lower) can hit the bridge teeth harder than normal and make them ache. You can feel jaw or neck pain and get headaches, too.

Referring You to a Root Canal Specialist

When a dentist cannot identify the cause of your pain, they may refer you to a root canal specialist (endodontist). The endodontist will examine your teeth and possible x-ray and test their sensitivity.

Although some dentists delay making the permanent bridge, others place it with temporary cement. It gives the dentist time to observe your teeth and see if the sensitivity resolves. An x-ray will show whether the tissue inside the tooth is infected or died and requires root canal treatment. And a root canal specialist can help your dentist find the cause of your pain.

Best wishes for a progressive recovery.

The Salem, Massachusetts dentists at Burba Dental sponsor this post. Explore why patients say they are among the best dentists in the Boston area.

My New Crowns Hurt When I Chew. Should I Ask for New Ones?

Man with expression of uncertainty perhaps from new crowns that hurt and create TMJ issues

Two months ago, my dentist placed crowns on my top left second bicuspid, first molar, and second molar. I do not have any wisdom teeth left. I had deep decay and old fillings on all three teeth. At least two of the teeth hurt when I chew on that side of my mouth.

New crowns on three teeth in a row make it hard to tell where the pain is coming from. When I put pressure on the three teeth with my finger, two seem to hurt more than the others.

My dentist adjusted the crowns twice but said that I have an aggressive bite when I chew. He suggested alternating chewing on the left and right sides of my mouth. I disagree with him because I did not have the problem before getting new crowns. The pain almost feels like nerve exposure. Should I ask for new crowns?

Thank you for your question.

Based on your description, it does not seem that the problem may be related to your bite (the way your upper and lower teeth fit together) rather than the new crowns.

Why Do Your New Back-Teeth Crowns Hurt?

If your new back-teeth crowns hurt when chewing, two possible causes are the bite is too high or one or more teeth are infected.

  • Adjusting your bite – When your bite is too high, the lower teeth hit the crowned teeth harder than the other. The repetitive wills make the teeth sensitive. Over time, your jaw muscles and joints can become irritated and sore. You may also experience neck pain, earaches, or headaches. These symptoms are related to TMJ disorder. But if your dentist adjusted your bite twice, an infection may be the issue.
  • Tooth infection – Your dentist can take x-rays to see if any of your problem teeth are infected. Sometimes signs of tooth infection are subtle and require a root canal specialist’s skill (endodontist). The intensity of your pain sounds like you may need root canal treatment.

Will You Need New Crowns After Root Canal Treatment?

An endodontist can make an opening through your new crowns to perform root canal treatment. You will only need new crowns if your current crowns are defective or contributing to your tooth irritation.

Cosmetic dentists Dr. Randy Burba and Dr. Stanley Burba in Salem, Massachusetts, sponsor this post.

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.