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does tmj mean surgery?

I’m 27 years old and have been dealing with a significant amount of jaw pain. I did some research online and it sounds like I may have TMJ. Everything I read says the treatments for this are jaw reconstruction or having all your teeth re-made. That sounds terrifying to me. In fact, I’m a little too scared to see a dentist about it in case they say that is what I need. Are there any other options? What happens if I just don’t treat it and just deal with the pain with medications?

Morgan

Dear Morgan,

close up of temporomadibular joint
TMJ disorder has various causes and solutions

Before you panic, let me assure you there are many causes and solutions for TMJ Disorder. As you can see from the image above, your TMJ joint is similar to your knee joint. It has movable parts and a disc which serves as a buffer. There are also lots of muscles that help with the various movements requisite to good jaw function. This is known as the temporomandibular joint (hence the TMJ).

Treatments like full-mouth reconstruction or jaw surgery are for the most severe cases, usually after years of going without treatment or a tragic accident. It doesn’t sound like that is what you’re dealing with.

The first step to any treatment is a diagnosis of what is causing the problem in the first place.

Two Causes for TMJ Disorder

One common cause for this is pressure you’ve put on the jaw joint. This is done through clenching your jaw or grinding your teeth. This often happens without a patient even realizing it because they do it in their sleep.

If you get treatment for this early on, before too much damage is done, there is no invasive treatment. It can often be handled simply by wearing a night guard to protect your teeth and add some cushion to assist with the pressure on your jaw.

Another cause is misalignment of your bite. Our teeth shift over time. It could be that yours have shifted in a way that has caused pressure on your jaw.

In some cases, this can be fixed with orthodontics such as Invisalign. Other, more severe cases, will require a full-mouth reconstruction. This latter treatment can also happen if you don’t get teeth grinding under control and your teeth get worn down to nubs.

Full-Mouth Reconstruction

With this procedure a dentist has to crown all of your teeth. This is either because they are too worn down from grinding or your bite is so far out of alignment this is necessary to repair it.

This is quite an advanced procedure and would require a dentist with significant training in TMJ Disorders as well as cosmetic dentistry.

Look for a dentist who trained at one of the following:

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

This will take care of their TMJ qualifications. To find out if they’re also a great cosmetic dentist, go to the mynewsmile.com website to see if they’re recommended . They pre-screen cosmetic dentists for both their technical skill and artistry.

This blog is brought to you by New Orleans Dentist Dr. Duane Delaune.

teeth darkening under porcelain veneers

I’m really worried something is seriously wrong with my teeth. I had porcelain veneers placed about six years ago. I moved shortly after that. Two of the veneers fell off. A dentist placed them back for a small fee, that after a receiving a letter on an attorney’s letterhead my original dentist finally reimbursed me for. Now it looks like the teeth under the veneers are darker. So much so that the porcelain veneers are no longer white. Even my friends with natural teeth have a whiter color now. What do I do?

Mark

Dear Mark,

A woman getting a porcelain veneer placed on her teeth

I’m afraid neither of your dentists have done you a great service. I’m sure it is obvious to you the first dentist wasn’t a skilled cosmetic dentist by the fact they would just fall off.

The problem you are facing is they weren’t bonded on correctly to begin with and things are getting underneath them, including bacteria. This can lead to serous decay.

It sounds like the second dentist didn’t have enough expertise to recognize the problem or to rebond them on. Truthfully, very few dentists know how to properly re-bond.

Re-Bonding Porcelain Veneers

One of the problems you will run into is very few dentists have the skill and equipment to do this properly. Using sand-blasting equipment, the old bonding material would first need to be completely cleaned off. After that, they’d have to etch the inside surface of the porcelain with hydrofluoric acid. The final step is to prime the porcelain veneer. Only then could it be bonded on again.

Now, if your porcelain veneers can be removed without them breaking, you can likely find an expert cosmetic dentist to do this properly.

Unfortunately, I’m worried the second dentist bonded them on strongly, without fixing the problem. This may mean they’ll break when the dentist tries to get them off.

If that happens, you will have to have them completely re-done. You may be able to get a refund as your porcelain veneers weren’t placed on properly and have put your teeth in danger.

Finding an Expert Cosmetic Dentist

To find a cosmetic dentist skilled enough to do either of these correctly, I recommend you go to the mynewsmile.com website. They have a link to help readers find a cosmetic dentist.

The biggest benefit to this website’s list is they prescreen every cosmetic dentist who wishes to be listed. They have to prove both their technical knowledge as well as their artistry to ensure that anyone they recommend has the expertise and artistic eye to give patients a stunning smile.

This blog is brought to you by New Orleans Dentist Dr. Duane Delaune.

Is My Dentist Too Old School?

I’ve been going to my dentist for over 15 years. I really like him, but I’m wondering if he’s losing his touch. I don’t think he always keeps up with his field anymore. I asked him to remove one of my dental fillings because of the amalgam content and he said it’s not safe to do that and I should just leave it in. Can you please explain to me if it is not safe to remove because I’ll ingest some mercury, why it is supposedly safe to have it in my mouth at all?

Carrie

Dear Carrie,

Image left of silver amalgam fillings loaded with mercury. Image right: mercury-free composite fillings
Mercury-Free Dentists Know How to Do Sanitary Amalgam Removals

You asked a great question. Why should a patient feel safe having mercury in their filling if it is considered unsafe to remove it? Your dentist should be asking the same question. The truth is, you can have this filling removed safely if that is what you want. However, you’ll have to go to a different dentist to have it done.

You’ll want a dentist who knows how to do a sanitary amalgam removal. You could do an internet search for a “mercury-free dentist” online. They’ll know the proper method for preventing you from inhaling any mercury vapors or swallowing any bits. You shouldn’t have much trouble finding one unless you live in a very isolated area.

That leads me to the other issue you brought up. Your dentist not keeping up with the advancements in his field. This is actually a big issue. While most states have a minimum amount of continuing education dentists must take every year, some dentists do just that—the bare minimum.

You want a dentist who is passionate about his work. Science changes all the time. That’s because we learn more as we go along. I once looked at an old magazine which had an advertisement promoting the superiority of lead paint. Now we know it is toxic. This is why you want a medical professional to keep up. It’s a lot of work doing that, which is why a passion for your field makes it easier to keep up. It’s likely time for you to find a dentist who still has that passion.

This blog is brought to you by New Orleans Dentist Dr. Duane Delaune.

why didn’t zoom whitening help?

My daughter had braces. When they were removed, there was an uneven color on her teeth. Some of the teeth had white spots. We talked to our dentist about it and he suggested we use Zoom Whitening. We did. Although her teeth are whiter they are still quite uneven. What went wrong?

Natasha

Dear Natasha,

Patient using Zoom Whitening light
Whitening your teeth in one appointment is easy with Zoom

The biggest thing which went wrong is your dentist doesn’t know anything about cosmetic dentistry. while Zoom Whitening is an extraordinarily effective treatment for whitening stained teeth, it is not the correct treatment for uneven teeth.

When it comes to white spots, any type of teeth whitening procedure will actually make the situation worse.

Dealing with White Spots After Braces

When a patient has white spots after braces, it is usually caused by decalcification. Cleaning your teeth with braces on is very challenging. It takes a lot of effort to get in all the nooks and crannies. That’s one reason many dentists are recommending Invisalign for orthodontics whenever possible. It makes it much easier to clean your teeth.

Tooth Mousse is a product designed for this type of situation. It helps to remineralize the decalcified spots.

Another option is to have dental bonding placed in order to cover the uneven spots on your teeth. Don’t go to your family dentist for this. It requires a great cosmetic dentist to do this well.

How to Find a Great Cosmetic Dentist

I’m going to suggest you go to the mynewsmile.com website. They pre-screen cosmetic dentists for both technical skill and artistry. Anyone listed on their site will give your daughter a beautiful smile.

This blog is brought to you by New Orleans Dentist Dr. Duane Delaune.

lumineers for white spots

I just finished my braces and my teeth have white spots on them. It’s pretty embarrassing and my friends have pointed it out to me, so I know it is noticeable. Getting braces was pretty expensive. I want to cover the white spots, but I don’t want to ask my mom about it if it is going to be way too expensive for her. She’s a single mom and works super hard but we don’t have a lot of money.

Becky

Dear Becky,

Advertisement with Lumineers including a woman smiling and a single veneer being held by a tool
Lumineers are just one brand of porcelain veneers

First, I just want to tell you how proud I am of how you are handling this. You aren’t running to your mom demanding anything. Instead, you are doing research to see if this is even a possibility.

You should know up front, that Lumineers are just one brand of porcelain veneers. Many of the best cosmetic dentists actually prefer to use a different brand, so don’t be surprised if you go to a dentist and they suggest another type.

As far as the cost, that often depends on the quality, skill, and philisopy of the dentist you’re going to, but I would expect it to cost between $800 to $1,600 per tooth.

This may be out of the budget of your mother if finances are a struggle. That doesn’t mean you can’t have a beautiful smile though.

White Spots After Braces

When your braces are removed and there are white spots, it is a sign that food and bacteria became caught around your braces while you were wearing them. The white spots are the pre-cursors to decay, so you’ll want to see your dentist fairly soon to shore up and weak spots before they become full blown cavities.

Repairing the white spots cosmetically can be done with dental bonding. A dentist could hand sculpt the composite bonding onto your teeth and it will cover the white spots perfectly.

In your place, instead of suggesting a procedure to your mother, I would just let her know what’s going on and ask if the two of you can talk to the dentist about affordable solutions.

Best of luck to you!

This blog is brought to you by New Orleans Dentist Dr. Duane Delaune.

Can I bleach my non-veneered teeth?

I had four porcelain veneers done several years ago. They look fine, but the teeth next to them have stained a bit and it looks weird having white teeth and not white teeth when I smile. I was thinking of getting Crest Whitestrips but don’t want to hurt the veneers. Would it be safe?

Mia

Dear Mia,

custom-fitted teeth whitening trays

Crest Whitestrips are safe for your teeth and they will whiten them some, but very slowly. They only cover a few teeth so to get the teeth you need whitened, you’ll need to cut them and try to fit them on those teeth.

I wouldn’t use other over-the-counter products. They’re not as safe. Some have citric acid and some have things which will etch the teeth to make the look whiter. Unfortunately, they also cause micro scratches on your teeth which will cause them to pick up stains.

Consider Professional Teeth Whitening

If you want to whiten them faster, you may want to consider professional teeth whitening with a dentist. They can get all the teeth you want without any damage to your porcelain veneers.

Another option would be to add porcelain veneers to the teeth which are exposed when you smile. This way you wouldn’t have to constantly worry about the discrepancy in color.

In fact, originally, your cosmetic dentist should have suggested to cover all your teeth visible when you smile. For most smiles, that would mean 6-8 veneers. Some wide smiles require up to ten.

This blog is brought to you by New Orleans Dentist Dr. Duane Delaune.

dentist said no to porcelain veneers

I had dental bonding done on my front four teeth. The bonding has since worn out. I decided I wanted to upgrade a bit and get porcelain veneers. My dentist said I’m not a candidate for that because of the bonding. Instead, he wants to do crowns. I’m not crazy about that option. Do you have a recommendation?

Laurie

Dear Laurie,

A woman getting a porcelain veneer placed on her teeth

My first recommendation is you see another dentist. Under no circumstances should you let your dentist put dental crowns on your front teeth. This will grind them down to nubs. If this were necessary that would be one thing, but it is completely unnecessary.

You can have porcelain veneers placed after dental bonding. The only reason your dentist is saying you can’t is likely because he doesn’t know how to place them.

In dental school, we’re taught to always be confident with patients. Without that confidence, patients will grow anxious. So, instead of saying, “i’m not comfortable doing porcelain veneers” or “I haven’t done many porcelain veneers”, which could make you (understandably) uncomfortable, he says you’re not a candidate and avoids the issue altogether by suggesting a procedure he does know.

Find a Great Cosmetic Dentist

Cosmetic dentistry isn’t taught in dental school. A dentist has to make an effort to invest in cosmetic training after they graduate.

Even if you needed crowns, I would suggest a different dentist. To get a beautiful smile, you need an expert cosmetic dentist. Otherwise, the results would be disappointing.

In your case, I’d go to the mynewsmile.com website. They have a “Find a Cosmetic Dentist” link. You’ll input your zipcode and how far you are willing to travel to see a cosmetic dentist.

The key to this site is they have pre-screened each dentist who wants to be listed. They can’t just pay to get on the site. Instead, they have to show their technical knowledge and skill, as well as demonstrate their artistry in their work.

Anyone they recommend can give you a beautiful smile.

This blog is brought to you by New Orleans Cosmetic Dentist Dr. Duane Delaune.

help avoiding dental implant failure

I’m looking at dental implants. One dentist is insisting on a CT scan but he uses a brand of implants I’ve heard a lot of good things about called Straumann. The other dentist says the CT scan isn’t necessary, but he uses a brand I can’t find much about called Southern Venturi. I like the idea of saving money on the CT scan, but want to make sure the brand is okay first. Do you have an opinion on that brand?

Keith

Dear Keith,

dental implant diagram

CT Scans and Dental Implants

I’m glad you are asking these questions. Both have important implications for a successful dental implant case. Let’s start with the CT scan. I would spend the money on that. The big reason is getting dental implants is a 3-Dimentional procedure. In order to get the right placement, it helps to have 3-Dimentional scans.

A lot of dentists are willing to place the dental implants without the scan but here’s what concerns me about that. If you’re talking about a an implant for a front tooth, without the scan the dentist risks it perforating your sinuses. Some dentists try to circumvent that issue by using a small implant, but they aren’t always able to retain the tooth in the long-term.

Another important piece of information is the depth and thickness of the bone. You only get that with the CT. This one additional step can prevent a host of problems.

The Brand of Dental Implants

The first brand you mentioned, Straumann, is one of the brands the top implant dentists prefer. Other good ones are Nobel Biocare, BioHorizons, Zimmer, and Astrotech.

The second brand you mentioned has me a tad concerned. I don’t know any of the top dentists who use this brand. It may be a cheaper brand which saves the dentist money, but you have to be very careful with “cheap” implant fixtures.

Often, it goes fine at the procedure but fails later and the patient has no idea it’s because the dentist used a cheap implant fixture. You also have no real recourse if that happens. It’s much better to pay a little more and get a proven fixture.

The Importance of a Skilled Implant Dentist

Another huge factor in the prevention of dental implant failure is the skill of the dentist. You want a dentist with extensive dental implant training. You can look at some of Dr. Delaune’s credentials to get an idea of what you are looking for in a dentist.

Don’t hesitate to ask where they received their dental implant training. Dental school isn’t enough. They must have post-graduate training.

You also want to make sure they do a significant amount of cases and have a lot of experience. Additionally, ask about their success rate. I’d want someone with a 98% success rate.

I hope this helps you. This blog is brought to you by New Orleans Dentist Dr. Duane Delaune.

Custom mouthpiece for grinding because of meds?

My dentist is trying to convince me to get this custom-fitted device to sleep with. He says I’m grinding my teeth because of the medicine I take. First, wouldn’t I know if I happened to be grinding my teeth and second, can medicines really make you do that? Does it even matter?

Clark

Dear Clark,

custom-fitted trays
Custome-fitted mouthpiece’s will protect your teeth.

I promise your dentist isn’t trying to pull one over on you. Everything he said is based in fact. Most patients doen’t realize they are grinding their teeth, because it happens at night while they’re sleeping.

The Consequences of Grinding and Clenching

Griding and clenching your teeth is known as bruxism. When you do that habitually, whether intentionally or not, your teeth begin to wear down. In some cases, I’ve seen them worn down to nubs and the patient had to have all their teeth crowned. This is known as a full-mouth reconstruction and is very costly.

In addition to wearing down the teeth, you can also end up chipping or even cracking them . Cracked teeth will also have to be crowned in order to save them.

A nightguard protects your teeth from the force of these motions. Even though you likely won’t be able to stop doing them, your teeth won’t bear the consequences.

Be on the Lookout for TMJ Disorder

With constant motion of your jaw in grinding, you’re in danger of another kind of problem. You could wear down your temporomandibular joint, leading to TMJ disorder.

Here are some symptoms to look out for:

  • Jaw Pain
  • Clicking in the Jaw
  • Migraines, especially in the morning

If any of these pick up, you’ll want to see a dentist who has some special training in TMJ.

This blog is brought to you by New Orleans Dentist Dr. Duane Delaune.

Are Lumineers the best?

I am planning on a smile makeover. I want to get the best one possible. I keep hearing good things about Lumineers. Are they as good as their advertisements say?

Georgiana

Dear Georgiana,

Advertisement with Lumineers including a woman smiling and a single veneer being held by a tool

You are right that Lumineers are heavily advertised. They happen to be one of only brands known by name because of that. While they are okay, you can do better. Plus, there is a much more important consideration than the brand.

More Important than the Brand

While some brands are better than others, you can use the absolute best brand and the results would totally depend on the skill of the cosmetic dentist using that brand.

The skill of the dentist is the number one determining factor in whether or not your smile makeover ends up stunning or sad.

Finding an Expert Cosmetic Dentist

You want a dentist who has invested a lot of post-doctoral time in cosmetic training. Smile makeovers aren’t taught in dental school. Instead, a dentist has to intentionally take the time to study its theory and practice.

Just like not all painters have the same skill level, neither do cosmetic dentists. One dentist will have a more artistic eye than another. So, how do you know if you’re getting a Michelangelo or a Mickey Mouse?

One way is to look at their smile galleries. This should be a brag book of sorts showcasing their best work. You’ll want to make sure it is their actual work and not just stock photos they are posting.

However, you’ll likely be safer looking on the mynewsmile.com website. This site examines both the technical skill and artistry of dentists who wish to be listed. They can’t pay to get on. They have to have the requisite skill.

Don’t Be Surprised if they Don’t Suggest Lumineers

An expert cosmetic dentist will know the strengths and weaknesses of each brand of porcelain veneers. Unfortunately, Lumineers has more weaknesses than strengths. Their biggest weakness is the company which owns the brand insists dentists have to use their lab. It’s not known for beautiful work.

Find the right dentist and trust them to pick the right brand of porcelain veneers for your smile makeover goals.

This blog is brought to you by New Orleans Dentist Dr. Duane Delaune.