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.