A Full-Mouth Reconstruction Causing Problems

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I am in the middle of a full-mouth reconstruction, and things are not going well. It’s a bit of a mixed bag with two dental implants and the rest are crowns and bridges. I am a bit worried, because the first round went well and I thought I would be good to go. Unfortunately, that has not been the case. Once the permanent ones were bonded on things went really wonka-donk. The teeth are not meeting together the way I had always considered normal. I thought at first maybe it felt different because I was used to it the wrong way. But, now I’m having trouble chewing both because of the way the teeth are meeting (some of them don’t even touch) and the fact that my jaw isn’t moving properly. I don’t think this is because it is unfamiliar to me. Do you have any advice? I’m in quite a bit of pain.

Sandy

Dear Sandy,

An image of a woman holding her jaw while in pain.

Bear in mind that I have not examined you. However, if I am getting an accurate understanding of your description, there is a real problem here. First, for those who are not aware of what a full-mouth reconstruction is, it is when a dentist uses crowns, in some form, on every tooth. In this case, there is a mixture of dental implants, along with crowns and bridges.

Doing a full-mouth reconstruction is a very advanced procedure which very few dentists are actually qualified to do. It takes significant post-doctoral training. Based on your description, the way this was done is a serious problem and it sounds like it has completely thrown off your bite and you are now dealing with both poor occlusion of your teeth as well as TMJ Disorder. If that is the case it needs to be fixed as soon as possible.

One thing that puzzles me is the fact that you said the temporary placements were fine. Your permanent crowns and bridges should have been modeled after your temporaries. Also, your dentist should have used a temporary try-in paste and made sure everything still lined up properly. It does not sound like he did that.

I want you to get a second opinion by a dentist with significant TMJ training. Look for someone who has post-doctoral training in TMJ Disorder. Look for training at one of the following institutions, which are known for their great TMJ instruction:

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

One word of advice. When you do get your second opinion, make sure it is a blind appointment. That means that you do not tell your dentist who did your full-mouth reconstruction. If they ask, just tell them you want an unbiased opinion and would prefer he or she gave their thoughts without knowing who the dentist is.

This blog is brought to you by East Cobb Dentist Dr. Cristi Cheek.

Veneers for a Collapsed Bite? Nope

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I have a really hard time with my smile. First, when my mouth is relaxed you can’t even see my teeth. Even when I smile it has to be pretty forced in order for you to actually see my teeth. My jaw aches a lot. I do wear a night guard because I grind my teeth. You can see my smile a little better when I do. My dentist is suggesting porcelain veneers to fix this issue. That is quite a big expense. Before I invest in that, can you tell me if porcelain veneers are my best option?

Alana

Dear Alana,

A chart showing the connection between muscles, jaw joints, and teeth

I am very glad you wrote before going forward with any treatment. Bear in mind that I haven’t examined you, but what you have described sounds like you have a collapsed bite, along with some TMJ issues that have resulted from it. Porcelain veneers alone is not the right treatment for this. You would need to open up your bite. This is done with dental crowns. However, before you do this, don’t just go to your dentist and say, “let’s do this with dental crowns instead.”

This is one of the most advanced procedures a dentist can do and if it is not done carefully and methodically, it can leave you in massive pain for the rest of your life. Right now you have TMJ symptoms. If this is done incorrectly, you’ll have severe TMJ disorder.

In a situation such as yours, it would need to be done provisionally, working reversibly. Whatever dentist you have do this needs to start by getting the provisional crowns successful first. For you, success should look like the following:

  • You are completely out of pain
  • Your teeth meet together properly
  • Your upper teeth should show normally
  • There should be no difficulties speaking
  • You should love how they look

This may seem like an impossible order. However, there are dentists with the right training to do this. Look for someone who has been to one of the following post-doctoral training institutions:

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

I cannot stress how important it will be that you find the right dentist for this. Do not feel guilty about using a different dentist for this than your general care. That is a common, and necessary, practice.

This blog is brought to you by East Cobb Dentist Dr. Cristi Cheek.

My Smile Is Disappearing

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I would love some advice. It is almost impossible to see my teeth, even when I smile. I don’t know what is causing this but I am so embarrassed by my smile. My dentist said that porcelain veneers might help. That is a pretty expensive procedure to get a might. Here is some more information and maybe you can tell me if that maybe leans more toward a yes or no. When my lips are in repose, you cannot see my teeth at all. When I force my smile as big as possible, you can see a bit of my teeth. I have jaw pain and wear my night guard. When the night guard is in, you can see my teeth a bit better. What do you think?

Caroline

Dear Caroline,

A chart showing the connection between muscles, jaw joints, and teeth

I am going to right off the bat tell you that porcelain veneers are NOT the solution for this. In fact, it is so much not the solution to this that I think when you get the actually procedures you need, it will be important to find another dentist to do it. While porcelain veneers might help your appearance, if he is a skilled cosmetic dentist, it could potentially make your pain significantly worse.

Based on your description, it sounds like you have ground your teeth down, which has caused them to be overclosed. That kind of positioning could lead to TMJ Disorder. The fact that you’ve been having jaw pain makes me think this is what is happening. I’m glad you have a nightguard because that could help prevent further damage. However, the damage already done needs to be dealt with. This will require a dentist who has training and understands TMJ Disorder and the different type of treatments.

I believe you are going to need a full mouth reconstruction which means crowning each of the ground down teeth. It needs someone with training far above what most general dentists have.

I would suggest doing an internet search for “TMJ Dentist.” Then, check that they have post-doctoral training in TMJ. It’s not a recognized specialty, but general dental school is not enough. Ideally, they would have gained additional training at one of these institutions:

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

Then, take the additional precaution of checking out their smile gallery to see if they have some artistic skill with cosmetic dentistry and can create beautiful smiles. You do not have to choose between form and function. Find a dentist who can do both.

This blog is brought to you by East Cobb Dentist Dr. Cristi Cheek.

TMJ Dentist Disasters

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I’ve been to two different TMJ Dentists and both times my situation ended up worse. The first time I was with my dentist and mentioned headaches. He told me it is probably because I grind my teeth and the situation is to crown all my teeth. It wasn’t done correctly, and my bite ended up at a slant. I managed to grind those down too and was in more pain than ever. I went to see another dentist who called himself a TMJ specialist. He placed me in some kind of bite splint for two years. Now my bite is too far forward on my lower jaw. The pain is unbearable. I don’t know who to turn to at this point. What do you recommend?

Katherine L.

Dear Katherine,

Woman holding her jaw in pain from TMJ disorder

Treating TMJ properly requires training.

One of the problems you are facing is that being a TMJ Dentist is not really a specialty. Any dentist can call themselves a TMJ dentist, regardless of the amount of post-doctoral training they have. It seems you have been seen by two dentists who did procedures that were over their heads. The first dentist botched your full-mouth reconstruction. This is one of the most advanced procedures in dental work and does require a great deal of post-doctoral training. Then, when your procedure was done, knowing you were a teeth grinder he should have provided you with a mouthguard. For that matter, why didn’t he provide you with a mouth guard to begin with? Why wait until your teeth were ground down and you needed them to be crowned? He was not serving your best interest.The second dentist left you in the orthotic way too long. These are meant to be temporary.

So, where do you go from here? They have left you with a serious case of TMJ Disorder at this point. You need a dentist with the training to give you proper treatment. I would look for someone who trained at the Dawson Academy, the Las Vegas Institute for Advanced Dental Studies, or the Kois Center. All of these have excellent TMJ Training Programs.

One other bit of advice. Do not think you have to choose between form and function. Whatever crowns your new dentist places, the first thing you need to make certain of is that your crowns fit comfortably. They should feel perfectly natural and your bite come together naturally. In addition to that, you want them to look beautiful. When they are placed, make sure the dentist does it with a temporary try-in paste. You should get a chance to look at the aesthetics of the bite in several different lightings. If you are not happy with how they look, then you need to have the dentist send them back and redo them until you are. A patient deserves a healthy, natural bite that looks beautiful as well.

This blog is brought to you by East Cobb Dentist Dr. Cristi Cheek.

Do You Have to Choose Between Form over Function?

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I have a horrible tooth grinding habit. Six or so years ago, my dentist crowned all my teeth because they were ground down to nubs. Unfortunately, the crowns were not placed correctly. My bite was a bit slanted and now I’ve worn them out again and my bite is even worse. I’m in a lot of pain. Something I haven’t mentioned is how ugly the crowns were. I just don’t know what to do. Is it possible to have a correct bite and it look good? Where do I find a dentist who can fix this correctly? It has already cost me a fortune.

Jane

Dear Jane,

Woman holding her jaw in pain from TMJ disorder

 

One thing you may have figured out already is that there is not a recognized specialty for TMJ dentists. It is up to the dentist whether or not they get training. It is obvious your dentist did not have the training necessary to do this correctly. He’s caused more problems than he solved. Additionally, knowing that you had a tooth grinding habit he did nothing to protect your new dental crowns from the grinding, which were equally at risk as your natural teeth were. A simple nightguard would have solved the issue. That of course, would only be a great solution if you’d have had this repaired correctly.

To answer your question, you do not have to choose between form and function. However, it will take doing some research. First, you want to make a list of dentists in your area who have TMJ Training. Then, go down your list looking for one who also has great cosmetic skills. You should look at their smile galleries to get an idea of what type of results they get.

A smile gallery is a page on their website that shows before and after photos of cosmetic procedures. If they don’t have a smile gallery on their site, you can be fairly certain they do not do great cosmetic work. For those who do have beautiful before and after images, you want to make certain they are actual cases the dentist has done and not just stock photos.

Finally, whenever you have any type of cosmetic work done, make certain the dentist only does a temporary try-in at first. You should be allowed to look at the work in your mouth BEFORE  it is permanently bonded, then if you don’t love the work they should be willing to send it back to the lab making the changes you want. If the dentist doesn’t agree to that, don’t let him work on you. They should be confident in their ability to get it right.

This blog is brought to you by Marietta Dentist Dr. Christi Cheek.
Click here to learn more about our Free Virtual Smile Consult.

 

Her Dentist Said Everything Is Fine, But it’s NOT!

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I’m hoping you can give me some guidance. I’ve never had a cavity before so I don’t know what a cavity feels like but am wondering if I’ve developed my first one. I had a check-up just a month ago and my dentist said everything looked fine, so it would have to be pretty new. It is a bit hard to describe but feels a bit like someone is pulling my back teeth and then letting go. It only lasts a short time, but it is distracting and I don’t want to ignore if anything is wrong. My husband says I grind my teeth when I’m sleeping. Could that be it? Or is this what a cavity feels like?

Miranda

Dear Miranda,

a woman holding her jaw from TMJ pain

I know you said everything was fine at your last check-up, but if you are a tooth grinder, everything is not fine. I’m worried you are not getting adequate care. Some discount clinics only focus on cavities and don’t pay attention to important issues such as gum disease, bruxism (teeth grinding and clenching) or other occlusion issues such as TMJ Disorder. Overlooking these things can cause serious long-term problems.

I haven’t examined you and wish I had an x-ray to look at, but what you are describing does not sound like decay to me. The two possibilities that come to mind immediately are gum disease or damage from the grinding. Either one of these would need to be dealt with and the sooner the better.

If You Are Grinding Your TEeth

Grinding your teeth is an urgent matter, especially if you’ve been doing it for a while. You can end up cracking your teeth or grinding them down to nubs. This will cause you to need a full mouth reconstruction which requires placing a porcelain crown on every tooth.

There is a simple fix for this which can save your teeth. Your dentist can make a custom-fitted night guard. This will protect your teeth from the grinding as well as pressure if you clench. It’s much better to get a night guard than to leave your teeth unprotected and end up having to spend tens of thousands of dollars crowning every tooth.

If You Have Gum Disease

Gum disease is also serious. If left untreated, your teeth will eventually fall out. Then you’ll need expensive tooth replacement options, such as dental implants.

As I said earlier, I’m not sure you’re getting adequate care from your current dentist. I’d like you to see another one, sooner rather than later.

This blog is brought to you by East Cobb Dentist Dr. Cristi Cheek.

Treatment for TMJ Disorder

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My doctor has been unable to find a cause for my headaches. They are debilitating, especially in the morning. It’s kept me from being the mom I want to be. At my last visit, my doc suggested I see a dentist and ask about TMJ Disorder. He called it a “Hail Mary”, because he doesn’t know what else to do for me. I did see my dentist and mentioned what my doc said. He told me if I have headaches in the morning it is because of TMJ and I’ll need to have a full-mouth reconstruction. He had the business office write me up an estimate. It will cost me a fortune. Before I invest in this, I just want to make sure this is the correct course of action. Should I move forward or get a second opinion first?

Ellen

Dear Ellen,

An illustration with a close up of a TMJ Joint

There are many causes and solutions to TMJ Disorder

While a full-mouth reconstruction is a legitimate treatment for certain cases of TMJ Disorder, there are other treatments. Treatments which are much less invasive. Which treatment is used, depends on what the underlying cause is. You need the right treatment for the right cause. If that is the right treatment, it requires a dentist with exceptional training in both restorative and neuromuscular dentistry that is not gained in dental school. Because of that, I am going to suggest you get a second opinion by someone with the right training.

Sometimes, those headaches in the morning are caused by your clenching or grinding your teeth. Many patients don’t even realize they are doing it because they only do it at night. It is hard to know what you are doing in your sleep. A full-mouth reconstruction wouldn’t even help that issue. Instead, all you would need for this is to wear a night guard while you slept. It’s a simple and comfortable mouthpiece that is worn over your teeth.

Finding a Qualified Dentist to Evaluate Your TMJ

What you want is a dentist who invested time in post-graduate training. There are several schools which have great TMJ training. Here are a few of the best:

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

A dentist who has studied at one of these institutes will be qualified to both diagnose and treat you. It may be something simple, such as I mentioned earlier. If it turns out that you do need a full-mouth reconstruction and it requires putting a dental crown on every tooth, you will need a dentist with an additional qualification. Because this treatment is a combination of fixing your bite and creating a new one, you’ll need someone who is also skilled in cosmetic dentistry. I’d look for someone who has reached accreditation with the American Academy of Cosmetic Dentistry.

This blog is brought to you by Hilton Head Cosmetic Dentist Dr. Bonnie Rothwell.

TMJ Problem or Cavity

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I’ve never had a cavity before so I don’t know what they feel like. Lately, I’ve been having pain at the back of my mouth with a couple of my molars. It comes and goes. I thought it might be a cavity but I was asking a friend about it and she said that hers was that way because of TMJ problems from grinding her teeth. I know I do that because my dentist said I do. So, how do I know if my problem is a cavity or TMJ?

Alana

Dear Alana,

An illustration with a close up of a TMJ Joint
The Temporomandibular Join

I will say first I am more than a little concerned your dentist told you that you were grinding your teeth but didn’t explain the importance of it being dealt with or suggest a treatment.

The grinding of your teeth will wear them down to little nubs until you’ll either need them crowned or they will begin to crack. Additionally, it will begin to wear down your the joint that is the center of TMJ Disorder.

He should have suggested you wear a nightguard. This is such a simple fix. He custom fits a special nightguard for you to wear while you sleep. Most people who grind their teeth, do so at night and don’t realize it is happening. Wearing the guard protects your teeth from the grinding motion.

Leaving TMJ Causes Untreated

If you don’t get a nightguard, eventually you will need what is known as a full-mouth reconstruction. This means every tooth will have to be crowned. It is a very expensive procedure and only a handful of dentists have the training necessary to do it right.

Simple prevention now will save you a fortune.

Cavity or TMJ

As to your original question. The only real way to know if you have a cavity is to go in and have it checked. Your dentist will do x-rays as well as a physical examination.

The earlier you catch a cavity the better. A filling is better than a crown. A crown is better than an extraction and tooth replacement.

My recommendation is you go in to see your dentist and eliminate a cavity. From there find a TMJ dentist who will give you the proper solution for your grinding.

This blog is brought to you by East Cobb Dentist Dr. Cristi Cheek.

Store Bought TMJ Device

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I’m in the middle of cancer treatments, which comes with thousands of dollars in medical bills. I think it’s the stress but I suspect I’ve started grinding my teeth again because my TMJ is acting up. When I first had it, the dentist made me this device. I no longer have the device but noticed the stores have something similar that’s a one size fits all. Could I just get that? I don’t have a lot of money right now and I need to deal with this jaw pain.

Harriet

Dear Harriet,

a woman holding her jaw from TMJ pain

First, let me say I’m sorry for what you’re going through. I know several people with cancer and it’s not an easy treatment plan to deal with. You’re in our thoughts. Second, I understand the cost issue. Here’s what I’m going to suggest.

If the absolute only thing you can afford is the store bought mouthguard, get that. It’s better than nothing and will at least protect your teeth from the grinding. However, because of its poor quality, you will grind through it and need to purchase them multiple times until you stop grinding.

However, TMJ devices are a tad different than just a mouth guard. While a mouth guard protects you from grinding, the TMJ device will reposition your jaw to a healthy position if it’s out of alignment. The store-bought device will not do that.

See your dentist to find out if the jaw pain is from the grinding or something to do with alignment. If it’s grinding and you want to stick with the store bought device, go ahead. If it’s alignment, you’ll need professional treatment.

There are insurance policies that will at least cover it partially. If your insurance won’t cover it, you can try Care Credit. It’s a medical credit card that allows you to get the treatment and then pay off the cost in low-interest payments. No-interest plans are also available.

Dental Care and Cancer

Most doctors will let you know this, but it is extremely important you keep up your regular dental care during your cancer treatments. Chemo and radiation play havoc on teeth. You’ll have unexpected cavities, even if you’ve never had any before if you don’t get regular treatment.

A small bit of prevention will protect you from needing dental crowns or worse.

This blog is brought to you by East Cobb Dentist Dr. Cristi Cheek.