Tag Archives: TMJ Disorder

A Healthy Smile with Lupus

Ever since my lupus has gone active, my teeth have become a mess. I have had to have several fillings and a dental crown. The crown is on my front tooth and I read whenever you have dental work Supersmile toothpaste is the right toothpaste. Will it also help my regular teeth are do I need to brush wtih two different types of toothpaste?

Diana

Dear Diana,

I am sorry you are having to go through this. For those who are unfamiliar with this, Lupus is a horrible disease that effects every system in your body. Essentially your immune system goes haywire and your body starts to fight itself.

Your oral health is greatly impacted along with the rest of your body. According to Lupus.org, oral lesions occur in 40% of people with Lupus. These mouth ulcers can lead to oral cancer. If that weren’t enough, 100% of patients with Lupus have tooth decay and they are more likley to develop TMJ Disorder. Fun, right?

This means regular dental care is essential if you want any shot at healhty teeth and gums. The good news for you is that you seem to be staying on top of things. It is great that you are using Supersmile toothpaste. This removes stains without using any abrasives, that will destroy the protective glaze on your dental work.

There is no need to use more than one toothpaste. It is equally able to clean your natural tooth structure and even contains an appropriate amount of fluoride, which will help prevent decay.

One thing you will want to be aware of to protect your dental crown along with any other dental work you have is actually your dental cleaning appointments.

You do not want your hygienist to use anything like acidulated fluoride or a power prophy jet during the cleaning process. Both of these, while excellent tools for natural teeth, will damage or completely remove the glazing on your dental crown. As mentioned above, the glazing is what protects them from picking up stains.

Unfortunately, if your dental work does pick up stains, they will have to be replaced. Some patients are under the mistaken impression that they can just have teeth whitening done, but that isn’t the case. Even professional teeth whitening will only work on natural tooth structure.

One other bit of counsel. Make sure your fillings are mercury-free composite fillings. Your immune system has enough going on and is already in overdrive. You don’t want it reacting to the mercury, which it may perceive as an enemy to your body because of its toxic properties. Having white fillings placed should prevent that.

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

Problem Speaking After Porcelain Veneers

I had ten porcelain veneers put on ten teeth. Ever since then, I have had trouble speaking. I’m not sure what to do. It feels like the backs of my teeth are too thick and my tongue is pushed. It’s making me talk weird. My dentist has no idea what is wrong. Have you heard of this?

Brooke

Dear Brooke,

A single porcelain veneer being held up by a dental instrument

Looking at the image of porcelain veneers above, you can see that it doesn’t have any part of it that goes on the back of your teeth. It won’t affect your speech there. However, there are some dentists who place porcelain crowns and tell their patients it is porcelain veneers. If they surround your teeth, they’re crowns. If they just go on the front of your teeth, they’re porcelain veneers. Sometimes the length of porcelain veneers can affect your speech, but you said it was bothering you from the back. That’s not the same.

If it turns out he place crowns, then he’s not only been dishonest, he’s also thrown off your bite. If that’s what happened, you can get him to pay for these to be re-done by a dentist who has both cosmetic dentistry training (preferably someone who is an AACD accredited dentist) as well has having done post-doctoral TMJ training. That’s the kind of dentist who will know how to repair the bite’s position as well as give you a beautiful smile.

Another possibility is your dentist did place porcelain veneers and the thick feeling in your tongue is completely unrelated. You could have had an allergic reaction to something and that is why you’re having trouble speaking.

How Can You Get Help

The first thing I would do is get a second opinion. I again suggest going to a skilled cosmetic dentist. There is a trick to this, though. Dentists know each other. They are one another’s peer group. So one dentist might hesitate to say something unkind about work their friend did.

This is why you won’t tell them who did the work. First, ask him if you received porcelain veneers or dental crowns. Then, ask him if he knows why you’re having trouble speaking. If he asks for the name of the dentist tell him, you want a blind, unbiased second opinion so you won’t be sharing any names.

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

How Long Can I Wait for a Dental Implant?

I have a tooth where decay grew under the crown. My dentist doesn’t feel he can get it all out and recommended I see an oral surgeon to pull the tooth and then come back for a dental bridge. I’m not too keen on that so I’m thinking of seeing someone else about the decay. I’ve also been doing some research and it looks like a dental implant will be a better option for replacing a missing tooth. I’ve got fairly new dental insurance which has six more months of a waiting period before I can get any coverage for work done. If I pull this tooth, how long can I wait before there are problems?

Catherine

Dear Catherine,

illustraition of a dental implant next to natural teeth

I’m going to be blunt and tell you that you are not being well served by your dentist. Most skilled dentists will do everything possible to save a tooth. What does he mean he can’t get all the decay out? Has he tried and failed? Based on what you said, he didn’t even bother trying.

Next, he suggested a dental bridge instead of a dental implant. Your research is correct. Yes, it is a much better tooth replacement than a bridge. The one exception to that would be if the adjacent teeth already need dental crowns. If they don’t, then you are just grinding down healthy tooth structure.

I’m sorry, but this dentist seems too willing to get rid of teeth. You can do better. I’m going to highly recommend you get a second opinion on this tooth.

Don’t Wait before Getting a Dental Implant

If, after getting a second opinion, it turns out the tooth cannot be saved, I wouldn’t recommend waiting more than a week or two (at the most) with that space empty. The teeth around it will start to drift or tip into the space, making a replacement difficult.

In fact, it can lead to serious bite problems, which can cause TMJ Disorder. Just like cleaning out the tooth properly with a root canal treatment before getting your original dental crown would have saved you the problems you are facing now, making sure that space is kept open will save you a lot of pain down the road.

I’d recommend something simple and inexpensive, such as a dental flipper, to hold the space for you until your insurance will cover your dental implant. Truthfully, even if you received the implant today you’d need a temporary tooth anyway. The site where the implant is placed needs both time to heal and for the bone to integrate around the implant before it can support an implant crown anyway, so this isn’t an unnecessary step.

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.

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.

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.

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.

Dental Double Cross

I’ve kind of had it. I had a dental crown placed on a back tooth. It didn’t feel right from the beginning. The dentist adjusted it, then it fell out. He put it back. It felt worse. He adjusted it again, but nothing got better. He told me I’m just not used to crowns and I’d become accustomed to it. I was frustrated, but what could I do? Now, a piece of it broke off at dinner. I’d had it with the dentist that placed it. Instead, I went to see an emergency dentist. All I needed him to do is reattach the broken piece, but he’s insisting the entire crown needs to be re-done. Now, I have to pay for an entirely new crown. Can’t he just fix it? I’m willing to live with the pain at this point. I just need a dentist who’s not going to do a double cross.

Karen

Dear Karen,

A Dental Crown being Placed

I don’t blame you for your frustration. It doesn’t sound like your dentist has done his job. Nor does it sound like he’s shown any interest in the fact you’re in pain. I have to say, in most cases the “You’ll get used to it line…” is code for I don’t know what I’m doing or how to make it right.

As for the emergency dentist, I don’t think he was trying to cheat you. It’s very likely that the crown broke in a way where a true repair is impossible.

What Caused Your Emergency Dental Visit

There are a couple of things which can cause pain on biting with a crown. The first is a lingering infection. I don’t know if your crown was due to large decay or a root canal treatment. If it was a root canal for an infection, it’s possible there is still an infection there causing pain. There are canals in the tooth which can be quite adept at hiding. It’s possible your dentist missed one.

The second thing which can cause pain is when a crown is seated too high. I tend to lean toward this because of the fact that it broke when you bit down. Generally, our biting force, which is quite substantial, is spread out as our teeth meet together. However, if a crown is seated too high it absorbs all the force. This could lead to it breaking.

Crowns on molars are a little trickier because you have to factor in the occlusion with the other teeth. It’s very likely your dentist could do a fine crown on other teeth, but a molar is a bit beyond his skill set. The fact that his bonding didn’t hold makes me question his skill set already. But, occlusion requires the kind of extra training you would see with dentists who take an interest in treating TMJ Disorder.

Your Options

Option One: You could ask your original dentist to make you a new crown (free of charge). His didn’t meet even the minimum standard of longevity. I don’t know that you’ll get any better results the second time with him, but you’re certainly able to try.

Option Two: You could ask for a refund and allow the emergency dentist to make a new crown for you. The refund would keep you from having to pay for two crowns and you may have better luck with this dentist.

Option Three: As it didn’t sound like you were thrilled with either dentist, you could take the refund and find a completely different dentist altogether.

I hate that you’re having to go through all of this trouble for a crown.

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