Archive for December, 2009

TMJ Problems

Monday, December 28th, 2009

Due to a teeth grinding habit, I’ve already got crowns on all of my teeth. (placed about 10 yrs ago). I’m only 32. They were not placed correctly and I grinded them down too eventually and now suffer pain and clicking. Now my jaw is crooked, I have a posterior crossbite, my gums are in bad shape due to the crown placements – not to mention they’re just plain ugly, dark and “chiclet looking”. Because of my jaw pain, out of desperation, and at the time, 7 months pregnant, I found myself in the hands of a “neuromuscular dentist”. At the time I had no idea this was not a specialty. I personally feel quite sickened by the whole experience believe that I’ve been taken advantage by charlatans. Now after 2 yrs in an orthotic that essentially opened my bite too much and moved my lower jaw forward (which didn’t work), I feel like my situation is even worse. Now, with this orthotic off, I have an open bite and my crowns are further grinded down – no anatomy. Obviously I need some restorations, but I’m torn between a prosthodontist and a cosmetic dentist. Do I have to choose between function and appearance? I’m worried that the complicated nature of my case – also, how does a dentist know where my natural bite in order to place the crowns? I did consult an orthodontist and he told me my case is complicated (clearly)and that I should see a prosthodontist. Any information is greatly appreciated. I am so incredibly skeptical of dentists after my experiences. I don’t know who to believe. Thank you so much.
- Rachel in Pittsburgh

Rachel,
You were on the right track with the “neuromuscular dentist.” The problem, as you seemed to be able to perceive it, is that this isn’t a legally distinct specialty in dentistry, and your dentist doesn’t appear to have had the needed expertise for your problem.

And if the appearance of your teeth is important to you, you’re in a particularly difficult spot. While prosthodontists have strong academic credentials, they tend to be indifferent to appearance-related issues, which is reinforced by their extra time in dental school.

It is tricky to find where your natural bite is supposed to be, but it can be found by a dentist who has true expertise in TMJ problems. That’s your key – finding the right dentist who knows what they are doing and also cares how your end result is going to look. They aren’t exclusive goals – you don’t have to sacrifice appearance to have a balanced occlusion. You just have to find a dentist with the proper expertise who actually cares enough about the appearance, too.

Look for a dentist who has been trained at the L.D. Pankey Institute. The Pankey Institute is a center of postgraduate dental education located here in Florida that teaches dentists excellence in dentistry in general, and the treatment of TMJ disorders in particular. This is where Dr. Kagan received his training in TMJ disorders, and they are recognized as a worldwide leader in this field. And then look for a strong interest in appearance-related dentistry. Cosmetic dentistry is partly a skill but partly a passion, and the big issue is how much a dentist cares about the appearance of his or her work.

Other links:
Read more about dental crowns.

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A bunch of old ugly dental work.

Monday, December 21st, 2009

I have a high-maintenance mouth (genetics, mostly, because I try to take care of my teeth) and now at 50, I find myself wanting a beautiful white smile but not knowing if I can have one without spending tens of thousands of dollars. The problem is I have many crowns and bridges and metal fillings, so bleaching won’t work. I’ve become very self-conscious about opening my mouth real wide becasue I don’t want people to see all the dark fillings and the empty space where I’m missing a tooth. What I want to know is, is there some cosmetic dental procedure that I can get that wouldn’t require pulling out all my teeth, wouldn’t bankrupt me, but would look natural and beautiful? Thank you for your time,
- Lisa from Georgia

Lisa,
When you have existing dental work that makes your mouth look ugly, there are those who may try to entice you to do shortcut “cover-up” procedures, but I wouldn’t recommend them because you’ll end up spending more in the end and could do real damage to your teeth.

For example, the company that makes Lumineers promotes them for use in covering over old crowns and bridges. The problem is that the coverup looks good for only a year or two, it hides possible existing problems under the old crowns and bridges, and it costs almost as much as replacing the crowns and bridges.

My advice for keeping this within budget is to phase it in over a period of years and do it right. Just reconcile yourself to the idea that you need to be patient, but you’ll end up with a beautiful smile, and find an excellent cosmetic dentist who will walk through this with you and replace all the old work over a period of years. First decide the color you’ll want your teeth to be, and then work toward getting your entire smile in that degree of whiteness.

PS - There are a lot of people who feet that they have inherited bad teeth, but it may be that they have merely inherited eating habits. And very few people seem to understand what really provokes aggressive decay. There is an excellent page on tooth decay – you may want to check it out, paying particular attention to point #5.

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How soon should I replace my missing tooth?

Friday, December 11th, 2009

I just had an extraction on #3. How soon after an extraction is it recommended to have some kind of replacement? I’m concerned about the surrounding teeth shifting or any other issues that arise from a missing tooth.
- Melissa from Texas

Melissa,
Once a tooth is extracted, I would get SOMETHING in the space right away, even if it’s a temporary “flipper” removable partial. The teeth can start moving significantly within a week or so.

Yes, you’re right that the missing tooth can cause problems. You had an upper first molar extracted. This is a key tooth. When it is missing, the second molar tends to tip forward, the tooth in front will tend to tip backward, and the opposing molar on the lower will drift upward into the space. A missing first molar can completely disrupt your bite and lead to TMJ disorder, or gum disease.

With a single missing tooth, your reasonable choices would be to replace it with a three-tooth dental bridge, or to place a single dental implant in the space.

Click here to read our page about the pros and cons of a dental implant vs a dental bridge.

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I’m 30, scared of the dentist, but don’t want to lose my teeth.

Friday, December 4th, 2009

I am 30 years old and I am terrified of going to the dentist. When I was younger I went every 6 months. When I was 18 years old I had a tumor growing on the right side of my mouth. A specialist had to do surgery and reconstructions as well. I’ve been a couple of times after but now I know that my teeth needs some work on them but I dont know how much it will cost and what exactly I would need done. I know for a fact that I have gum disease because I have all the symptoms that you describe on the website. Please help. I dont want to be 35 without any teeth. I thank you in advance for your response.
- Jean from Atlanta

Dear Jean,
You’re on the right track if you want to save your teeth as you say. That’s a healthy attitude, and once you have that, the other problems can all be resolved.

I see you’re near Atlanta. I would recommend that you find a dentist in Atlanta who does sedation dentistry or sleep dentistry. There are a number of them there. They should be able to help you with your fear of the dentist. If you need it, they can give you a  medication which will make it so you may not even remember your appointment.

Usually, people who have trouble with dental care have had some traumatic experience at the dentist, and that sounds like your situation. Dentists who become trained in sedation dentistry often do so because they are especially concerned about people who have dental fears, and they want to help them.

It’s nice that you’re catching this problem at age 30. If you go ahead and take action now, I think they will be able to solve all your problems. If you do indeed have gum disease, at age 30 it is much less complicated to treat. And if there are some teeth that can’t be saved, yes, dental implants can replace them. But there will probably be some less expensive options that would also work. I’d be sure to ask the dentist to explain all of your options, which should include trying to save the teeth, replacing missing teeth with removable partial dentures, using dental implants, or using bridgework. Look for a dentist who gives you various options and doesn’t seem to be trying to push the more expensive radical work on you. Expect him or her to give you pros and cons of various treatments and lets you decide. Then, once you have had your examination, if you have a bad feeling about the office, you have the right to have your records sent to another office and transfer to another dentist. Don’t be afraid to make that move, because there is a lot at stake here for you.

Good luck.

Posted in Dental Implants, Sedation Dentistry | Comments Off