TMJ Archives - Philadelphia Cosmetic Dentist

Full Mouth Reconstruction Going Badly

Posted on August 21, 2023 by writeradmin.

I needed a full-mouth reconstruction because of how bad my smile looked. My dentist provided crowns on all my teeth, with the exception of one tooth which he extracted and placed a dental implant. When he did the temporaries for the crowns, everything seemed fine to me. However, now that the permanent ones are in things are off. Some of my teeth are not lining up properly. Because of this, it hurts when I eat. When I spoke to my dentist he said he met all the checkpoints and just to give it time. I went to get a second opinion and the other dentist said, “Oh, Dr. —- [name withdrawn] is a great dentist.” I got the feeling that he didn’t want to disagree with this dentist because they must know each other. In the meantime, I am stuck with this bite that is killing me. Is there any advice you can give me?

Laurie

Dear Laurie,

I want to make sure I understand that your dentist gave you a full mouth reconstruction simply for cosmetic reasons. Is that right? If so, that is a massive overtreatment. A smile makeover is typically done with porcelain veneers and even then you would not put them on each and every tooth. You would only place them on the teeth that are visible when you smile. Generally, that is the eight to ten upper teeth, depending on the smile.

A full mouth reconstruction is for much more serious conditions and removes a LOT of your tooth structure. A couple of reasons for a reconstruction would be serious TMJ Disorder which does not respond to less invasive treatments; or to cover teeth that are worn down to nubs by bruxism (teeth grinding). Without a clinical reason for crowning all your teeth I would say this was unnecessary. Now, there may have been a good reason that just didn’t get mentioned because it was not relevant to your question. I just wanted to make sure.

Not that it is funny, but I chuckled a little at your dentist’s comment that he met all the checkpoints and you just need to get used to it. That is often dental speak for, “I want you to leave me alone. This is hard and I don’t know how to fix it.” Plus, I’m pretty sure any dentist should consider “My patient is not in pain” as a checkpoint. Just saying…

Occlusion, the term for how your teeth meet together, is an advanced subject. It takes post-doctoral training to understand this properly. It is very possible that your dentist does not have enough training in this area.

Getting a Real Second Opinion

I’m not surprised you didn’t have much luck with your second opinion. One of the cardinal rules in getting an unbiased second opinion is to not tell them who your dentist is. Just ask them about the way the crowns are meeting together and explain you’re in pain. If they ask before giving you their diagnosis, tell them you want an unbiased opinion so don’t want to tell them. They should understand that. When you get that second opinion, make sure you go to a dentist with the training you need. Unfortunately, there is not a recognized specialty in this type of work so you will just need to look for the right training. Two great post-doctoral institutes that instruct on TMJ and occlusion are the Dawson Academy and the Pankey Institute. Any dentist who has studied there, will be able to give you a truly educated diagnosis.

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

Do I Need to See My Dentist After Getting Head Butted by a Horse?

Posted on March 23, 2023 by writeradmin.

I was at my horse riding lesson when I got head-butted by a horse. It was not the fault of the school. I was standing too close to his head on the side without holding his bridle. Chestnut shook his head to try to get something off his ear and his head hit me on the left side of my face. I was wearing my helmet, so that was good. I thought I was fine. I just had a small bruise on the side of my face, which healed well. The last two days, however, my jaw has really been hurting and sore. It’s hard to open my mouth all the way. A friend of mine told me that trauma to the jaw can cause TMJ Disorder. Do you think I should see a dentist or should I just give it some more time?

Alley

Dear Alley,

Wow! Horse riding lessons sound fun…well, except for that head-butting thing. I’m sorry for your injury. Your friend is correct. You do need to get this checked out. While time heals bruises, it doesn’t do much for joint damage, which is what TMJ Disorder is. The trauma for the horse could have knocked your temporomandibular joint out of alignment. This can lead to pain in your jaw, difficulty opening your mouth, clicking sounds, and even migraines.

There are also the possibilities of a sprain or fracture of your jaw. Because of that, I think you should get this area imaged as soon as possible. Even if you don’t have any symptoms, it is important to have an injury imaged.

Be Careful About the Dentist

There is not currently a recognized specialty in TMJ. Because of that, you want to be careful at who you have do your evaluation and treatment, if that becomes necessary. You will want a dentist who has invested in post-doctoral TMJ training. Take a look at Dr. Weiss’s bio to get an idea of what you want in a dentist with regard to an understand of how TMJ disorder works. There are many horror stories of patients whose jaws were destroyed by dentists who didn’t know what they were doing. I don’t want you to be one of them.

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

Should I Finish My Full Mouth Reconstruction?

Posted on September 14, 2022 by writeradmin.

I am in the middle of a full-mouth reconstruction and I am not sure if I want to complete it. The lower teeth were done first. They look beautiful because I hired an AACD-accredited dentist. I know it sounds weird but that is what is bothering me. They look so perfect. I had a quirky smile and this just looks like your typical celebrity smile. I feel stupid but I miss the quirkiness of my smile. The reason for the reconstruction to begin with is that I had been grinding my teeth down. My dentist didn’t mention it until they were ground down and then he told me that I needed a full-mouth reconstruction. I was a little annoyed, which is how I started doing research about what it means and who should do it. That led me to getting an accredited dentist. Will I have to get the uppers done? Can I just whiten the uppers so they don’t look so perfect as the bottoms?

Callie

Dear Callie,

First, I want to tell you that your original dentist could and should have told you about the grinding to begin with. That would have saved you this expense and hassle. All you would have needed was a simple mouthguard and your teeth would have been protected even with the grinding. I’m going to suggest you find a different dentist who is more interested in protecting your teeth. Though, that doesn’t help with your present predicament.

If you are worried about the smile looking too perfect, I would say take full advantage of the skill an AACD accredited dentist has. What I mean by that is they are tasked with making Hollywood smiles all day long. I think they would jump with glee at the chance to make a quirky smile. You could literally get whatever you wanted and make a dentist and ceramist’s day with your desire for it not to be perfect.

As for just not completing it and just whitening, I haven’t seen your case, so couldn’t tell you with definitely. While you can definitely whiten, what I can tell you is that if the damage isn’t too bad, you can just get a mouthguard to protect them for further grinding. This will be important because the crowns on your lower teeth will be a bit more abrasive on the uppers than your natural teeth are. If the damage is bad, you will want to complete the case. Having a collapsed bite can lead to pain and serious TMJ Disorder.

Just remember, you can get quirky.

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

Dental Work in Costa Rica

Posted on March 5, 2022 by writeradmin.

I need twelve dental crowns done. After doing some calling around, I learned I can get this done for just $6000 in Costa Rica. I would have to stay two weeks, but that’s like a vacation and it is still cheaper than what I can do in the states. My sister is freaking out saying this is a huge mistake. She asked me to at least call my dentist and get his opinion on this plan, but of course he’s going to say don’t do it because then he gets my money. I came across your website. You are across the country from me and have no chance of getting my money, so what do you think of my plan?

Mason

Dear Mason,

Should you get dental work done in Costa Rica?

I’m glad you wrote. I think I can save you a lot of grief. The dental industry is a real risk in Costa Rica. Because of the way their legal system is set up you have no recourse if something goes wrong. And let me tell you, a LOT can go wrong. Here are just a handful that come to mind:

A tooth can be broken off or lost
Overdrilling could take place causing nerve or root damage
You could end up needing a root canal treatment
Your bite can get thrown off leading to painful TMJ Disorder
Once you return home, the crowns can fall off
The crowns could look terrible, pasty, fake, and the wrong color
Poor placement of the crowns can impact your speech

Believe me, I am not exaggerating here. I recently read a case that you can read about in total here, but I will sum it up. A woman went to Costa Rica to save money on her dental care. The job was so badly done that she was in terrible pain. A dentist in the states called it criminal negligence and it would cost her around $35,000 to get the needed repairs done. Of course, she didn’t have that kind of money. She tried to get her money back from the Costa Rican dentist, even hiring a lawyer from the area, who was on her side. However, the law in that area is very corrupt and she ended up getting in trouble for complaining about a Costa Rican dentist publicly who had not been convicted of any crime and they put a warrant out for her arrest. She ended up having to flee the country.

You are at particular risk because of the number of dental crowns you need. There is a lot that could go wrong with that type of bite placement. My advice is to find a dentist here in the states with good qualifications and let him or her do the work. You may even be able to work out payment arrangements. Leave the Costa Rica trip for a true vacation, where you are not putting yourself at risk.

This blog is brought to you by Philadelphia Cosmetic Dentist Dr. Michael Weiss, an AACD accredited dentist.

How Long Does TMJ Last?

Posted on September 29, 2020 by AllSmiles.

Since late April, my TMJ pain has increased. Whenever I eat or open my mouth too wide, the pain is intense, and my jaw clicks. My ears are clogged most of the day. Although I take ibuprofen, I know it’s not a permanent solution. My dentist told me to give it some time, but I’m not feeling any real relief yet. Will the pain eventually go away? – Thanks. Kenji

Kenji – TMJ (temporomandibular joint) pain and discomfort can be treated in a variety of ways, including:

TMJ exercises
Alternately applying heat and cold packs to the side of your face where you are feeling symptoms
Taking over-the-counter anti-inflammatory medication

But self-care isn’t always the solution.

How Long Will Your TMJ Symptoms Last?

TMJ symptoms can last a few days or a few weeks. If left untreated, your symptoms might not go away at all. At-home care can provide temporary relief for a few days. Depending on the cause and complexity of your symptoms, a long-term solution might be needed.

What Will a TMJ Dentist Do?

Examination

A dentist who is trained in diagnosing and treating TMJ issues will first examine your teeth and jaw joint. The exam will help determine if your symptoms are TMJ related.

Diagnosis

Your dentist will let you know if the problem is related to your temporomandibular joint (TMJ), your bite (the way your teeth fit together), or another issue.

Treatment

Night guard – A night guard might be prescribed for you to wear while you’re asleep. The appliance repositions your lower jaw and helps prevent teeth grinding (bruxism), which can contribute to TMJ symptoms.
Orthodontic treatment – At times, orthodontic treatment is needed to correctly align your teeth and prevent pain and discomfort associated with a misaligned bite.
Therapy – Your dentist might recommend at-home exercises or physical therapy to relieve your pain and discomfort. Treatment can include learning how to correctly position your tongue, teeth, and jaw when at rest because some postures increase discomfort.

Schedule an appointment with a dentist who has advanced training and experience in treating TMJ disorders. After an examination, he or she will let you know your treatment options.

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

Collapsing Mouth

Posted on September 23, 2020 by writeradmin.

I have an almost non-existent smile. Over the years, it seems my teeth have become less and less visible. It’s almost impossible to see my teeth, even when I smile. My jaw also aches all the time. I’ve noticed I feel the most comfortable at night when I’m wearing my night guard. When I talked to my dentist about my concerns, he suggested I get porcelain veneers. Before moving forward, I just wanted to get a second opinion.

Melanie

Dear Melanie,

I haven’t examined you so bear in mind I am only going based on your description. It sounds like you may be someone who struggles with either teeth grinding or clenching. This may be why your dentist has a night guard. The grinding can wear down your teeth to little nubs. It sounds like you’ve worn down your teeth to the point your mouth has become over closed.

Three things you mentioned lend credence to this. First, your teeth are less visible; second, your jaw aches; and third, you feel best when wearing the night guard.

What porcelain veneers will do is improve the appearance of your teeth. They will not solve the root issue of your mouth being over closed or the jaw pain.

My suggestion is for you to see a TMJ Dentist. This is a potentially serious issue that may need a totally different solution using dental crowns to build your bite back up.

One of the problems you will face is there isn’t a recognized TMJ Specialty, so any dentist can call themselves a TMJ Dentist. To make sure you are seeing a dentist who has the right training to help you, look for one who has done post-doctoral training at one of the following institutes:

The Pankey Institute
The Dawson Academy
The Las Vegas Institute for Advanced Dental Studies

A dentist with training from one of these reputable schools will be able to help.

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

My Dental Crown Doesn’t Feel Right

Posted on March 31, 2020 by writeradmin.

I just had a dental crown placed on a severely damaged tooth. It hasn’t felt right since I got it a week ago. I think it’s too big and bumping into the opposing tooth when I bite down. My dentist said it is just because I’m not used to a crown and to give it time. If I’m not used to it by the time the quarantine is up he’ll take another look. Is this normal?

Selwyn

Dear Selwyn,

I would laugh at your dentist’s comment that it’s just because you haven’t had a crown before and you’ll get used to it, if it weren’t such a dangerous attitude. The way your teeth should come together is very specific and in dental circles is known as occlusion. The best dentists, who want to seriously treat TMJ Disorder or do things like a full-mouth reconstruction, will attend post-doctoral schools to learn the skills they need to properly treat their patients in every aspect. Unfortunately, some bread and butter dentists think they’re only going to do single crowns and therefore don’t bother to get the extra training.

In general, they get by. They will have the odd patient here and there, like you, who will complain about something feeling off. But, the dentist tells them they’ll adjust and either they do or they’re too embarrassed to keep complaining.

He said you’re not used to having a crown. The truth is you shouldn’t notice a difference. It should fit exactly like your natural tooth. The fact that you’re not used to it means he didn’t fit it properly.

To me, it doesn’t even sound like he took the very basic step of using bite registration paper. He should have asked you to bite down on this paper which would show were the bite is not coming together properly. Then the dentist can carefully adjust that area. He hasn’t even bothered doing that.

You can continue this dentist, but I think you can do better. Plus, if you don’t get this adjusted, you can end up with bone loss or TMJ Disorder. This requires attention, even during COVID-19.

My suggestion is you find a dentist who has studied at one of the following post-doctoral institutes:

Texas Center for Occlusal Studies
The Pankey Institute
The Las Vegas Institute for Advanced Dental Studies
The Dawson Academy

Have them fix the crown.

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

Will Porcelain Veneers Solve My Problem?

Posted on January 1, 2020 by writeradmin.

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,

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

Posted on December 2, 2019 by writeradmin.

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,

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

Posted on September 14, 2019 by writeradmin.

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,

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.