Tag Archives: full mouth reconstruction

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.

Her Dentist is Incompetent or Dishonest

I need some advice. I have horrible dry mouth which is wreaking havoc on my daily life. I’m constantly drinking water, which means I’m also constantly in the bathroom. In addition to that, my teeth are getting super yellow. I have one crown and two porcelain veneers. When I talked to my dentist, he suggested replacing all those teeth, plus the remainder of them with crowns. He said a full-mouth reconstruction will take care of my aging restorations as well as whiten my smile. This seems pretty aggressive and I have no idea if it will also fix my dry mouth. What do you think?

Katherine

Dear Katherine,

image advising she stop with this dentist

I do not want you to see this dentist again. Either he is either incompetent or dishonest. This is a massive overtreatment. A full-mouth reconstruction is for the most severe of cases. This is not the treatment you need. So, why is he recommending it? Let’s start with the whitening of your teeth. This would bring your dentist a few hundred dollars. With a full-mouth reconstruction, he can bring in between 30-60 thousand. Which one do you think is the better moneymaker for him? To me, this speaks to dishonesty.

Now let’s talk about those two porcelain veneers. He wants to replace these with dental crowns? That can only be because he doesn’t know how to do veneers well enough. So, instead of sending you to a dentist who knows what they’re doing, he hides the fact he doesn’t do that particular procedure and suggests something more aggressive. The best dentists try to save as much tooth structure as possible. Your dentist is more interested in his reputation and his bottom line.

Now, let’s talk about that full-mouth reconstruction. This is one of the most advanced procedures a dentist can do. My gut tells me your dentist doesn’t have the training or skills to pull this off. Not only can it give you permanent dry mouth, but he could also throw off your bite so significantly you are in constant pain with TMJ disorder.

My very strong recommendation is you find a different dentist. In your case, one with great skills and cosmetic dentistry. Look for an AACD accredited dentist. They will whiten your teeth and replace your porcelain veneers and dental crown in a way that is beautiful and blends seamlessly.

About the dry mouth. This will be detrimental to your oral health, which you already know. I’d like you to talk to your medical doctor. It’s possible he has you on some medication which is causing this. If that’s not it, he or she can do some investigating to figure out what is the true cause and hopefully get you some relief.

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

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.

Does it matter who does your crowns?

I have been diagnosed with TMJ Disorder. My dentist said he’d like to do what he calls a full-mouth reconstruction to repair it. As he explained it, that means crowns on every tooth. I’ve had a single crown done before. Does it matter that I’m getting all crowned for a TMJ problem? Does that require a specialist?

Sara

Dear Sara,

Woman giving thumbs up in a dental chair
How do you know if you have the best dentist for your needs?

One of the problems patients in your situation run into is there aren’t recognized specialties in either TMJ, recognstructive, or cosmetic dentistry. All of those of important areas of knowledge and skill for a dentist to do a full-mouth reconstruction.

This is a serious procedure which costs a great deal of money. While some pretty severe cases of TMJ Disorder do require drastic treatments, I always recommend you get a second opinion from a dentist with a lot of TMJ training before moving forward to see if this is really what you need.

Finding the Best Dentist for a Full-Mouth Reconstruction

As I mentioned earlier, the best dentists for a full-mouth reconstruction have expertise in TMJ, occlusion and restoration, as well as cosmetic work.

The occlusion, TMJ, and restoration is to make sure the bite is technically correct. You need the bite to line up correctly in order to help aide in the healing of your TMJ disorder. Look for dentists who’ve studied these type of topics at one of the following school:

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

There are other great ones as well, but these are three of the best.

The cosmetic work is important so you’ll have a smile you’re proud of. In reality, it’s a great opportunity to get a stunning smile. If you are looking for the top of the line cosmetic dentists, you want to find a dentist who’s reached accreditation with the American Academy of Cosmetic Dentists. They are in the top 1% of cosmetic dentistry in the country.

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

Affordable full-mouth reconstruction

I never was able to go to the dentist as a child. My parents never had the money. I used to resent them for that. But, I had saved up money to go to the dentist and now I understand. This dentist told me I need a lot of work and suggested what he called a full-mouth reconstruction. This is way beyond anything I can afford. In fact, it costs more than all the cars I’ve owned put together. Is there an affordable way to get this done?

Keith

Dear Keith,

Woman giving thumbs up in a dental chair
How do you know if you have the best dentist for your needs?

Dear Keith,

Our parent’s actions often seem more understandable as we age, however, avoiding the dentist altogether is never recommended. It will actually end up costing you more money in the long run, something your parents just may not have understood.

That being said, I don’t think this is the best dentist for you to be seeing. He’s jumping a lot of guns. I don’t know if he’s doing that because he’s lazy or because he is trying to milk you for as much as he can. Either way, you want a different dentist.

A full-mouth reconstruction means grinding down all of your teeth and placing dental crowns on all of them. This can only be done by the top 1-2% of dentists in the country.

It takes advanced training in both restorative dentistry and aesthetics. Not many dentists have this. If it’s done incorrectly, it can completely destroy your bite, leading to severe TMJ problems.

Find a Dentist Willing to Work Hard

What you need instead is a dentist willing to work hard to preserve as much of your healthy teeth as he can while taking care of the issues that have further and need treatment.

Affording this is easier too. You simply have the dentist list out everything that needs to be done to your teeth without wasting unnecessary structure.

Ask him to list it out from most urgent to least. This way you can do what’s known as phased treatment. You work on the urgent things so you don’t end up with a dental emergency, then slowly (as you are able) get the next thing done.

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.