Tag Archives: TMJ training

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.

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.

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.

General Dentist or TMJ Specialist?

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

Norma

Dear Norma,

Woman holding her jaw in pain from TMJ

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

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

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

Finding a Qualified Dentist to Treat TMJ

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

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

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

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

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

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

New Crown hurts

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

Cammi

Dear Cammi,

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

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

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

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

What Type of Dentist Can Treat TMJ?

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

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

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

Do I Really Need to Destroy Healthy Teeth to Fix TMJ?

I’ve been having horrible jaw pain and merciless migraines. Sometimes it’s so bad I can’t even eat and have to drink my dinner of broth through a straw. I went to several doctors and two different dentists before I was diagnosed with TMU. But, he says the only way to fix it is to crown all my teeth to fix my bite. That would mean not only a fortune in dental bills, but destroying healthy tooth structure as well. Is that really the way to go?

Sydney C.

Dear Sydney,

Sometimes a full-mouth reconstruction is the only option, but it’s usually used as a last resort. There are several other treatments which should be tried before that. Additionally, it takes a significant amount of reconstructive and TMJ training to do a full mouth reconstruction. Done incorrectly, it can cause even more pain then what you’re currently in now.

Also, if you do need it, you may find a dentist who uses the composite resin, like you get for white fillings to adjust the bite instead of porcelain crowns. However, don’t push a dentist to use one type of treatment or another. It’s best they use the materials they’re most comfortable with.

In your place, I’d like to see you get at least two more opinions from dentists with lots of TMJ expertise. For instance, Dr. Burba studied at both the Dawson Academy and Spear Institute. Both of these give advanced training in TMJ. There’s never any harm in asking a dentist what type of training and success they’ve had in specific procedures, especially when you’re talking about such a huge, invasive procedure.

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

Are Numb Fingers Related to TMJ?

If I have known TMJ problems, could my numb fingers be related or is that a separate issue altogether?

Mark A.

Mark,

Yes, numb finger can be an issue with TMJ. The muscles in your jaw connect with other muscles further down in your shoulders, arms, and hands. Plus the misalignment can cause it to impinge on a nerve, which will also contribute to tingling or numbness.

This is not a diagnosis. I am just saying it CAN be related; not that it is. My recommendation is that you follow up with a TMJ dentist. If you’re not already getting treatment, I would make that an priority. It will only get worse. Look on Dr. Burba’s TMJ page to know what kind of training you’ll want a dentist to have who’ s going to treat you.

There are other issues that can cause numbness as well, some as simple as needing a chiropracter. But, because you know TMJ is an issue for you, that would be my starting place.

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

Could an accident cause TMJ problems?

I was in a acr accident the other day and got knocked around quite a bit.  Now  I have a lot of jaw pain and my jaw keeps making a popping sound whenever I chew. Could I have developed TMJ from this? Someone told me that’s what the popping is.

Brenna L. – New Mexico

Brenna,

Popping is a symptom of TMJ and it is possible to get it from a car accident, if your jaw was knocked out of alignmet. The only way to know for sure is to see a dentist who treats TMJ.

Do not hesitate to ask about their TMJ training credentials. There is not a recognized  TMJ specialty. That means any dentist can call themselves a TMJ dentist even without additional training.

Some training qualifications will be Spear, Dawson Academy, The Kois Center, LVI (Las Vegas Institute for Advanced Dental Studies). Those are good qualifications and you can feel assured the dentist will have a valuable understanding of TMJ and how to properly treat it.

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

Numbness in my fingers

I’ve been having muscle spasms in my neck and shoulders. I thought it was stress, but now my fingers are going numb. I’ve been doing some research and wondered if all my problems could be from TMJ, even  the numb fingers?

Elinor D. – Maryland

Elinor,

Yes, you’re likely on the right track. The muscles spasms could be caused from TMJ. These in turn can impinge on your nerves. Those nerves lead down your extremities.  That could be causing the numbness in your fingers.

You’ll need to see a dentist with experience treating TMJ. They can do some diagnostic work in order to determine if TMJ is really your problem.

Sometimes, it is a simple fix that can bring you immense relief.  Just be sure whatever dentist you go to has specific training in neuromuscular dentistry. The Dawson Academy and Spear Institute  are two good institutions for training, as well as LVI. Don’t be hesitant to ask what training they have.

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