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dentistry

Will Porcelain Veneers Solve My Problem?

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I have never liked my smile and I am finally in a position to do something about it. Here are the issues:

  • It’s extraordinarily difficult to show my upper teeth.
  • When my mouth is at rest you cannot see them at all.
  • I have pretty constant jaw pain, except for when I wear my nightguard at night for my teeth grinding.

What I’d like is to be able to see my teeth and maybe even improve my appearance. I’d also like my jaw to hurt less, like the way it does when I’m wearing my nightguard. Would porcelain veneers be my best solution?

Laurie

Dear Laurie,

woman holding her her jaw in pain

While porcelain veneers are the go-to procedure for a smile makeover, your situation is a little more complicated. It sounds like you are facing a collapsed bite along with TMJ Disorder. This requires a different approach. You will need to open your bite. This is typically done as full-mouth reconstruction with dental crowns. However, I want you to proceed with caution.

Only a small percentage of dentists are able to do this procedure correctly. When it isn’t properly done, it ends up making things much worse. Here is the way I’d recommend a dentist proceed.

You want whoever does your full-mouth reconstruction to start by using provisional crowns to open your bite. This way it is reversible. When you are completely out of pain and love the appearance of your smile, that is the time to move forward and the dentist can make the permanent crowns.

What Qualifications Do You Want in Your TMJ Dentist

It’s important whatever dentist you choose has extensive post-doctoral training in TMJ Disorder. For instance, Dr. Weiss did his TMJ training with the renowned Dawson Academy. Other reputable institutions would be the Kois Center and the Las Vegas Institute for Advanced Dental Studies.

You also want to ask them what experience they have in full-mouth reconstruction. You definitely don’t want to be their first case.

Cosmetic Considerations with Your New Bite

While you are opening your bite, you are also getting a smile makeover. Because of that, it is important you find a dentist who is a top of the line cosmetic dentist. Ideally, you’d want an AACD accredited dentist. The good news is finding such a dentist will likely take care of both sets of qualifications.

This blog is brought to you by Philadelphia Cosmetic Dentist Dr. Michael Weiss.

Form and Function with TMJ Disorder

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I am a mess. I had been grinding my teeth for years. Apparently, my dentist knew this and never mentioned it until my teeth were down to nubs. He crowned the worn teeth, but now I am in constant pain. Plus, I’ve worn those down as well. I don’t know how to stop doing that because I didn’t realize I was doing it to begin with. I went to get specialist help but learned there isn’t a specialist in this. It has been suggested I see a prosthodontist, but I’m worried the teeth won’t look good. Do I have to choose between functioning pain-free teeth and a pretty smile?

Amelia

Dear Amelia,

woman holding her her jaw in pain

I’m sorry you’ve been put through this. Plus, I hope you don’t mind saying I think you need to find a better dentist. This one doesn’t seem to have your best interests at heart. He knew you were grinding your teeth and never provided you with the simple tool to protect your teeth to keep from wearing them down.

Then he let you do it again with your dental crowns. I’m sorry, but that is like standing there watching a blind person walk off a cliff, charge them for the hospital bill and repairs, then watching them do it again. How were you supposed to know you were grinding your teeth, let alone what would help? He’s the professional.

Yes, a prosthodontist will typically have more training in treating TMJ Disorders than your average dentist, but as you mentioned not many of them are artistic. They are passionate about the technical aspects and don’t really care about appearance-related issues.

What you need is a dentist who is passionate about form and function; one who has invested in both TMJ training as well as cosmetic training. I promise they exist. They’re not as much of a unicorn as it might seem at the moment.

Finding a Great TMJ Dentist Who Can Create Beautiful Smiles

You’ll need to begin with the TMJ training. It will not matter how beautiful your smile is if you are in too much pain to share it. Here are some institutions which have great TMJ training. You’ll want to find a dentist who has trained with one of them.

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

From there, you’ll look to see if any of them have great cosmetic skills. The best are AACD accredited. These are hard to find. Dr. Weiss is one of six accredited dentists in the whole of Pennsylvania. If you can’t find one, that doesn’t mean it’s hopeless. Many great cosmetic dentists are on their way toward accreditation. I would look at their smile galleries to see what type of results they get. Just makes sure it is images of their actual work and not just stock photos.

One other thing. You need to get a nightguard. This is like a sport’s mouthguard, but is custom-fitted to your bite. It will protect your teeth from the grinding you are doing while you sleep.

This blog is brought to you by Philadelphia Cosmetic Dentist Dr. Micahel Weiss.

Her Dentist Seems Negligent

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I’ve never had a cavity so I don’t know what to expect. I do grind my teeth in my sleep, but I had a check-up just two months ago and everything was fine, so I don’t know what is causing this. Recently, I feel like someone is pulling on my back teeth for a second and then releasing. It’s happening on both sides of my back teeth. Is this a cavity or something else?

Candy

Dear Candy,

woman holding her her jaw in pain

I’m concerned about what I’m hearing. You said everything was declared fine at your last appointment, but if you have been grinding your teeth than it most certainly isn’t alright. When you grind your teeth, it can lead to serious problems such as TMJ Disorder. Not to mention you can grind your teeth down to nubs. This will require you to need dental crowns on all your teeth. This type of full-mouth reconstruction is expensive.

Your dentist should have discussed this with you and warned you of the repercussions. This is especially true because the solution is to simply wear a nightguard.

It’s possible your dentist is just one of those bread and butter dentist who only looks at things like cavities and doesn’t check on other important issues such as bruxism and gum disease.

Your issue doesn’t seem like a cavity. However, bear in mind with anything I am telling you that I haven’t exactly examined you. Your situation sounds more like what would happen if you had gum disease. Though, for it to get to the point you have pain would be rather serious. You would be to the point of bone loss, which means you could start losing teeth.

Because you have just started feeling the pain, I tend to think it might be that you are experiencing pain because of your teeth grinding.

I’m going to recommend you see another dentist to get a thorough examination. At the very least you are going to need a nightguard. But, I’d like your gums checked as well.

This blog is brought to you by Philadelphia Dentist Dr. Michael Weiss.

Jaw Pain from Dental Appointment

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I had my teeth prepared for both crowns and porcelain veneers on my upper arch. I’m almost a week out and my jaw is still in massive pain. I ache constantly. My dentist suggested taking Ibuprofen, which I have been, but I feel like I’m living on the pills. Could my dentist have caused a TMJ problem? He’s going to be gone for a week. Do I need to see another dentist or can I wait until he gets back?

Missy

Dear Missy,

woman holding her her jaw in pain

This sounds pretty normal for what you’ve been through. Your mouth had to be propped open for quite a while. Soreness in your jaw is to be expected. It may even go on for another week or so. In addition to the pain medicine, you can do hot and cold compresses to help give you some relief.

If your dentist is gone for a week, he should have made arrangements with another dentist to care for his patients in the case of a dental emergency. I don’t think this is one, but if things get worse you can call your office and there should be a number on their answering machine for the dentist he’s made arrangements with.

Symptoms of TMJ Disorder

While jaw pain is a symptom of TMJ, that in isolation isn’t usually a sign. There are generally other things which accompany jaw pain. Some examples would be:

  • Popping or clicking of your jaw
  • Migraines, especially in the morning
  • A change in your bite
  • Neck pain

If any of these symptoms develop, that would be when you should talk to a dentist about TMJ disorder. There are tests a dentist can run to help determine if this is an issue for you.

Don’t go to any dentist about this, though. You want a dentist who has invested time in TMJ training after dental school. You’ve had what sounds like a full-mouth reconstruction. When this is done properly, it can actually treat TMJ disorder. But, if it is done improperly it can make things worse. That’s why you should keep an eye on those other symptoms.

This blog is brought to you by Philadelphia Cosmetic Dentist Dr. Michael Weiss.

Should I Get a Second Opinion from a TMJ Specialist?

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I mentioned to my dentist that I wish my teeth were whiter. He mentioned because I have two crowns, I’d need to get those re-done first to match. He also looked closer at all my teeth and said my bite is off which means I have TMJ and need to get all the teeth crowned to fix it. This seems a bit excessive to me. Plus, it really surprised me to hear my bite was off. I had braces in my middle school years and didn’t feel like anything had changed since then. I’m thinking I should get a second opinion. What do you think?

Carla

Dear Carla,

Woman in pain with TMJ

I’m a little concerned with what I’m hearing. Let’s start with the teeth whitening. You don’t crown teeth to whiten them. Yes, you have a couple of crowns and they will have to be re-done to match but that will be AFTER your teeth are whitened. Not before. Otherwise, how will he know what shade of white to make them?

Now, about this crowning every tooth. This is called a full-mouth reconstruction and is usually reserved for more severe TMJ Cases. You haven’t mentioned any symptoms of TMJ Disorder. Without that, you should have serious doubts about this recommendation.

TMJ Symptoms

  • Jaw Pain
  • Popping in Your Jaw
  • Clicking in Your Jaw
  • Migraines, especially in the morning
  • Teeth Grinding or clenching

See a TMJ Dentist

I agree you need a second opinion. There isn’t a recognized specialty in TMJ Disorder. As such, there aren’t really any TMJ “Specialists”. However, there are dentists who have invested a great deal of time in studying TMJ Disorder and the different treatment options. Treatment is determined by first finding the underlying cause.

You want a dentist who has studied TMJ and occlusion at one of the reputable post-doctoral schools, such as The Dawson Academy, the Las Vegas Institute of Advanced Dental Studies, and The Kois Center.

Dentists who’ve studied at one of these schools are qualified to help diagnose your problem and come up with a good treatment. Most dentists prefer to start with the most conservative treatments first to see if that solves it before delving into something as invasive (and expensive) as a full-mouth reconstruction.

This blog is brought to you by Philadelphia Cosmetic Dentist Dr. Michael Weiss.

Thinking about Leaving Your TMJ Untreated? 5 Risks that Will Make Your Jaw Drop

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The temporomandibular joint is like a sliding hinge that connects your lower jaw to your temporal bone (on the side of your head). Joint disorder or dysfunction is commonly referred to as TMJ.

Why Some People Choose Not to Treat TMJ

Some people who think they have TMJ ignore the signs and symptoms. They don’t necessarily think the issue will go away, but they might choose to handle it on their own without seeking medical or dental advice. Why? The reasons vary, but some of them are below.

  • Too busy – Like many medical or dental appointments, you might feel that your schedule is too busy. What if you need follow-up appointments? What if you’re prescribed therapy? A busy schedule can cause you to delay or avoid seeking professional advice.
  • The cost – The cost of a co-pay, coinsurance, or out-of-pocket expenses can cause you to delay or avoid treatment.
  • DIY works for you – A common way to relieve most types of pain and discomfort is with over-the-counter pain reliever, so you might choose to take ibuprofen when symptoms become intense and skip a dental visit altogether.
  • Afraid of the dentist – If you have dental anxiety, it can keep you out of the office. Period. Your fear of the dentist might be greater than fear of what can happen if your TMJ signs and symptoms are left untreated.

What Are the Risks?

Diagram of the temporomandibular joint with the mandibular condyle resting in the articular fossa of the skull and the disk and the ligament between are attached to the muscle; for information on dentists in Philadelphia treating TMJ disorder.
Temporomandibular joint moves whenever your jaw does

Experts agree that TMJ symptoms should be treated conservatively. At-home care often provides relief and can include resting the joint, applying heat and cold packs to your jaw, and doing gentle jaw exercises.

But if you ignore the signs and symptoms and decide to do nothing, what are the risks? Five of them are reviewed below.

  1. Chronic pain – Untreated TMJ can get worse. As your jaw joint becomes increasingly stressed, headaches, earaches, jaw pain, and neck pain will also increase. Your quality of life can eventually become affected by chronic pain.
  2. Tinnitus – Tinnitus (ringing in the ear) can result from TMJ dysfunction. Tinnitus can be stressful and disturb your sleep.
  3. Dizziness – A poorly aligned jaw can put pressure on the sensors in your inner ear that are responsible for balance and make you feel dizzy.
  4. Sleep disturbances – The pain and discomfort from TMJ can disturb your sleep. Insufficient sleep can result in anxiety, depression, lack of concentration, impaired memory, and a variety of medical conditions.
  5. Misaligned bite – Joint dysfunction can cause your bite (the way your upper and lower teeth fit together) to be misaligned. A misaligned bite can create painful and costly orthodontic issues that, if left untreated, will last a lifetime.

What Should You Do?

Schedule an appointment with a dentist who has advanced, post-graduate training in occlusion, bite, and TMJ therapy. If you have dental anxiety, let the receptionist know it when you schedule your appointment. Accommodations will be made to ensure you are comfortable.

An examination will be needed to determine if your symptoms are related to TMJ disorder. You’ll learn about conservative treatment options that will give you relief.

This post is sponsored by Philadelphia, PA dentist Dr. Michael Weiss.