Category Archives: TMJ

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.

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.