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30K Cosmetic Dentistry Disaster

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Can you help me find a different dentist. I just had a total smile makeover that included both dental crowns and porcelain veneers. This was done to fix both the damage done from my teeth grinding as well as cover my tetracycline stains. They look really opaque, which does give them a fake appearance. However, the thing I’m worried about is my jaw has been hurting. It didn’t hurt like this before the crowns and veneers were placed. I did have some low level aching because of the teeth grinding. However, now my jaw really hurts all the time. So much so that it is distracting. My dentist insists not only does everything look great but that he has passed all the check marks for proper placement. I’m at my wits end and have already spent $30,000 on this.

Laurie

Dear Laurie,

Woman Holding her jaw in pain

Under normal circumstances, it would be very hard for you to get this repaired without paying for the whole thing all over again. If the only problem is the appearance it is nearly impossible for you to get a refund. You’d think that wouldn’t be the case when you are talking about cosmetic work, but that is currently where it stands. However, you seem to be dealing with some functional issues. I don’t know how he thinks the markers for proper placement would not include your patient not being in pain.

It sounds like your bite may be thrown off a bit, which could be leading to complicating issues such as TMJ Disorder. This can work in your favor because it means that the case isn’t truly functional. We’ll go over how to get this diagnosed in a moment. First, I want to go over the difference between a general dentist and a true cosmetic dentist. Even though there is not a recognized specialty in cosmetic dentistry, there are some distinct differences.

One of those differences is the amount of training they get. Smile makeovers are not taught in dental school. In order for a dentist to truly learn the techniques and artistry required, they would need post doctoral training. Another important difference is how they treat the patient. A true cosmetic dentist would not be satisfied with the work if you weren’t. They would first do a temporary try in and allow you to look at it in several different lights and make sure you are completely thrilled with the results. Even a little hesitation would cause them to ask, “What do you wish was different?” and it would go back to the lab to make the changes.

The easiest way for you to find one of these dentists would be to go to the American Academy of Cosmetic Dentistry’s (AACD) website. They have a “find a cosmetic dentist” link. Make sure you check the box that says you want an Accredited Cosmetic Dentist. These are among the top 1% of cosmetic dentist’s in the country. Have one of them examine your case. It will be helpful if they also have TMJ training. They can tell you if your current dentist’s work threw off your bite. If that is the case, then they can help you secure a refund so you can get this done properly by a qualified dentist.

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

Tanda Pearl Ionic Teeth Whitening System

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I recently read an advertisement about a Tanda Pearl Ionic Teeth Whitening System. It said I could whiten my teeth in just 5 minutes a day.  I like that idea because the system I am using now aches my jaw and is aggravating my TMJ Disorder. Do you know if the advertisements about this system are accurate?

Laurie

Dear Laurie,

teeth whitening trays

I am glad you wrote because I think I can help you.  I looked up this system. It functions on the basic system that other professional teeth whitening systems use. It uses a peroxide gel that is placed in a bleaching tray. In that aspect it is fine. However, there are some differences you need to be aware of that could cause some issues.

First, the tray. This system uses just one tray that you bite down to form to your teeth. Here are my concerns about that. When you have trays made by a dentist, they are form-fitted to your specific bite. This keeps the gel from leaking out and saliva from leaking into the tray. Both of those things weaken the effectiveness of the teeth whitening. This means you will have to get more whitening gel than you normally would in order to get the same results.

However, there is another difference with the tray that will be a bigger problem for you. Custom-fitted trays can be worn anywhere and are more comfortable than most. With the Tanda Pearl System, there are not really trays as much as a single tray you have to bite down on the entire time to keep it in place.  Even for just five minutes, that is going to cause serious problems with your TMJ Disorder. Because of that, I would not recommend this system for you.

You did not mention what you were currently using, but if it isn’t a system through your dentist, that may be why you are experiencing the aching. Talk to your dentist about what is going on and have him make you trays that won’t ache your jaw when you wear them.

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

Bonding Color is Wrong

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I have these exposed places at the top of my teeth that are very sensitive. Other than that, my teeth were attractive. They showed me their plan and I knew immediately the color would need to be whiter. I pointed that out and they agreed. Then, they put in the new “whiter” color. It still doesn’t match my teeth. Plus, it looks opaque and is rougher looking than my natural tooth structure. I feel like what was an attractive smile has been made less attractive in order to prevent the sensitivity I was feeling. Is there a fix for this?

Callie

Dear Callie,

abfraction lesionWhen done well, dental bonding should blend seamlessly with the remainder of the tooth. I’m especially sorry for what you are going through because what your dentist is trying to do is even easier than when you have to repair a chip. If I understand your description correctly, you are dealing with what is known as an abfraction lesion (pictured left).

We used to think these were caused by brushing too hard. We now think it has more to do with clenching and grinding of your teeth. This flexes the tooth right at your gumline, adding stress. That repeated movement wears away the gumline. One thing you will want to do after this is repaired is to have a night guard made. This is a custom fit mouthpiece, similar to a sports mouthguard that you will wear while you are sleeping. Nighttime is when most grinding and clenching takes place. Usually, until their teeth are worn down, the patient has no idea it is taking place. Over time, this can lead to TMJ Disorder as well as wearing your teeth down to numbs.

Repairing Your Dental Bonding

before and after dental bonding to repair a chipped tooth

Pictured directly above, you will see a case of dental bonding done well. You can’t tell where the bonding ends and the natural tooth structure begins. Your teeth can look this way too. Unfortunately, the only way to fix this is to have it done over again.

Being blunt, I think this is beyond the scope of your dentist’s abilities. You will need to have a dentist with more cosmetic training step in and repair this. Ask your current dentist for a refund. Then, look for an AACD accredited dentist in your area. They can give you the results you are looking for.

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.

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.

TMJ and Dental Crowns

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I have TMJ. It’s been under control for a while, ever since I had a night guard made. However, recently, the pain has returned in force. I think it is because of how tall this crown is, but my dentist says it isn’t. This crown hits the upper teeth before all my other teeth. He’s adjusted it three times and told me that is as good as it gets. He said this happens to many first time crown wearers and I will get used to how it feels. Fine, but what about the TMJ pain? Should I get a second opinion?

Misty

Dear Misty,

Woman in pain with TMJ
Poorly place dental crowns can cause serious damage

On the contrary of needing a second opinion, I think you need a new dentist. This one is not serving you. In fact, he’s either ignorant or deceptive.

The way your teeth meet both adjacently and with their opposing teeth is extremely important. It’s obvious he hasn’t put much time in studying this, which will lead to disaster for his patients.

Normally, your biting force is spread out over all of your teeth. However, when a dental crown is seated to high, it takes on the full force of your bite. Not only does this cause pain on biting, but you also are causing problems to the rest of your bite.

If you have TMJ Disorder, this will exacerbate it. If you don’t have TMJ disorder, it can lead to it.

Finding a TMJ Dentist

As you look for your new dentist, and I strongly suggest you get one, I want you to look for one who specifically has TMJ training. For instance, Dr. Weiss studied at the renowned Dawson Academy known for its TMJ training.

Additionally, he’s been treating TMJ successfully since the 1990s and has a very high success rate. His advanced TMJ training combined with his cosmetic training and expertise in smile makeovers makes him uniquely qualified for the toughest TMJ treatment, reserved for the most advanced cases, a full-mouth reconstruction.

That’s the type of dentist you want to look for in your area so you can make sure you don’t face exacerbated TMJ problem again.

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.