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Form AND Function with TMJ Treatment

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I had a serious problem with my bite when I started grinding my teeth. I’d ground them down to nubs. He put crowns on each of my teeth. However, I don’t think he did them right because now I have a slanted bite both upper and lower, plus a crossbite. I feel I’m in worse condition than I was before. I decided then to go to a neuromuscular specialist. He put me in an orthotic for a little over two years, which opened up my bite. Now my crowned teeth are ground completely down to nubs. Again, I am in worse condition than I started. I also learned that there isn’t a neuromuscular specialist, which makes me feel I’ve been swindled. I am out a fortune and in horrible pain. I didn’t even talk about how bad the crowns looked to begin with but both of them said I could have a healthy bite and a decent smile, but it would never be a Hollywood smile. I wasn’t asking for a Hollywood smile, but rather, I was looking for a natural-looking smile.  This one looks like beige-ish chicklets. Is the bite even fixable at this point? If so, can it look like a normal smile?

Madeline

Dear Madeline,

a woman holder her jaw from TMJ pain

You have been through a lot with dentists. Though you were thinking rightly in wanting a neuromuscular dentist, as you have discovered, there isn’t a recognized specialty in neuromuscular care, though it does actually take a significant amount of post-doctoral training in order to do it well. You are dealing with a serious case of TMJ Disorder at this point, even more so than when you started treatment.

I will say right off the bat, though you will need a tall order in a dentist, you will not have to choose between form and function. You will need a dentist with expert post-doctoral training in both TMJ Disorder and Cosmetic Dentistry. Both have to be post-doctoral because what is taught in general dental school isn’t enough for your situation.

Look on the mynewsmile.com website. These dentists are prescreened for their technical skill and artistry. They cannot pay to be listed on the site, they actually have to have the skills needed.  Once you have found all the dentists listed on that site within a reasonable driving distance to you, that is when I’d like you to look a their TMJ training AND experience

How to Find a Qualified TMJ Dentist

There are several schools that have great TMJ programs. Here are some of them:

  • Dawson Academy
  • Kois Center
  • Las Vegas Institute of Advanced Dental Studies
  • The Spear Insititute

While there are others, these are among the best schools.

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

 

 

Her Dentist seems negligent

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I wanted to get some advice. I had a check up not too long ago and everything was great. However, recently I’ve been having pain in my lower back teeth. It is hard to describe. It feels a bit like someone is pulling on the teeth and then letting go. I have never had a cavity before so I don’t know what that feels like. Could it be from that? I’m not grinding my teeth when it happens, so I don’t think it is from that. Have you heard of this before?

Olivia

Dear Olivia,

a woman holder her jaw from TMJ pain
Teeth grinding can lead to serious problems

My first concern is that your dentist doesn’t seem to have addressed your teeth grinding. This is quite serious. You can actually end up grinding your teeth down to nubs. In addition, it can lead to TMJ problems by throwing off your bite.

This is such a simple thing to fix I don’t understand why your dentist hasn’t dealt with it. Wearing a simple nightguard can save you tens of thousands of dollars. Once your teeth get ground down to nubs, you are looking at a $30,000 full-mouth reconstruction.

There are some dentists who will only look at things like cavities and ignore other issues. such as TMJ Disorder, gum disease, and occlusion. All off those are important.

I’m going to recommend you get a second opinion from a dentist who may be more thorough than your current one. As for the pain you are experiencing, bear in mind I haven’t examined you or seen any x-rays. I’m just going by your description.

It doesn’t sound like a cavity to me. Based on what you’ve said, two possibilities come to mind. The first is gum disease. That’s a big deal because by the time you start feeling pain, there is usually significant bone loss, which could lead to you losing your teeth. I want you to get that evaluated as soon as possible.

A second possibility is from the tooth grinding. You are likely doing it at night when you aren’t aware it is happening, but the pain you’ve described can happen even when you aren’t grinding your teeth. I mentioned earlier the nightguard. That would be another very important issue to deal with.

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

full mouth reconstruction disaster

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My dentist has been fixing my teeth because of my teeth grinding. He said I’ve been grinding them for years. Now they need to be repaired. He’s using crowns and bridges. When he did the temporaries they fit sort of okay. Some of the teeth weren’t fitting together okay but he said he would straighten that out with the permanent ones. The permanent ones are in, but it doesn’t feel right. Some of them aren’t touching each other and some are touching in some spots and not others. Is that normal? I know teeth vary. The problem is it hurts when I’m chewing and I’ve been getting pretty bad migraines. What do you recommend?

Joseph

Dear Joseph,

man grabbing the side of his jaw in pain

If I am understanding you correctly, the first thing I suggest you do is find another dentist. You said he told you that you’ve been grinding your teeth for years. In all that time, did he mention it to you or did he wait until they were down to nubs?

If he knew it and didn’t mention it, that is gross negligence. He could have saved your teeth from this procedure by providing a simple nightguard for you. This is a device you wear, similar to a sports mouthguard, which is custom-fitted to your bite and protects your teeth from the grinding, which mostly happens while you are asleep.

Because he didn’t do that, you are spending thousands of dollars on a full-mouth reconstruction, instead of what could have been a couple of hundred bucks.

Plus, you told me the temporaries weren’t occluding well either. He said he’d fix that with the permanents, but that isn’t how it works. The permanent crowns and bridges are patterned after the temporary ones. He had to fix those first.

You Need a TMJ Dentist

A full-mouth reconstruction is extremely advanced. It is something well beyond the skills of someone who simply graduated from dental school. It takes advanced TMJ training.

Some of the better schools are:

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

In your place, I would get a refund and then find a dentist who has studied at one of these institutions. You can find them by doing a search for a TMJ Dentist online, then look at their bios to see where they did their post-doctoral training.

Bonus points if they are also a mynewsmile.com recommended cosmetic dentist, then you’ll know they can also create a beautiful smile.

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

solving a collapsed bite

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I’m trying to find out what to do about my smile. I hate it. You can never see my teeth when my mouth is at rest. Actually, they’re almost impossible to see all the time. Even smiling my hardest you can barely see them. There is also almost constant jaw pain. When I wear a nightguard, it does help things feel more normal, but obviously I can’t wear that all the time. I want a smile I can be proud of. I was thinking of porcelain veneers but wanted to get all my options before deciding.

Margot

Dear Margot,

Woman covering her mouth with her hands

You don’t have to spend your life ashamed of your smile. I will say, though, I’m very glad you wrote before seeing a dentist. Too many would make things worse instead of better. It sounds like you’re dealing with a collapsed bite, along with complications from TMJ. Disorder This will take a dentist with advanced post-graduate training in a variety of skills.

Porcelain veneers aren’t the best option for you. You’ll need a procedure that will build up the teeth. This should be done with dental crowns, but it has to be done in a very specific way.

This should start with a provisional restoration. Once that is successful, the permanent restoration should be built from it. However, this isn’t easy. Successful will mean your teeth show under normal circumstances, your jaw doesn’t hurt, your speech is normal, and you love how they look.

You will need a dentist who has advanced training in restorative dentistry, neuromuscular dentistry, as well as cosmetic dentistry. That is a tall order.

See what dentists have advanced TMJ Training in your area, then check to see if they’re listed on the mynewsmile.com website. These dentists have the cosmetic training to create beautiful smiles. Combined, it will cover all the aspects you need.

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

tmj and sleep apnea

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A friend of mine told me I should talk to a TMJ dentist because I’ve been struggling with sleep apnea. I’m not sure how reliable the source is, but thinking back, I really think my jaw problems and sleep apnea did start around the same time.

Back then, I was told to get a nightguard. I got one and I wore it for a while, but I don’t remember there being any difference and I found it cumbersome to sleep with, so I stopped using it and don’t remember what I did with it. I never got diagnosed with sleep apnea officially—my ex said I had it and that I snored. I figured if the fix for that was a full-on mask, there was no point in doing the sleep study since I couldn’t even tolerate the night guard. But, now I’m wondering if I should make my way back into the TMJ dentist again, just to see if I can have a new guard made that will address both. How viable is this?

Thank you,

Oscar

Dear Oscar,

You’re asking some great questions and are sort of on the right track. Let’s break things down a bit.

Sleep Apnea Involves Breaks of Breathing While You Sleep

There are three main forms of sleep apnea.

  • Obstructive Sleep Apnea: With obstructive sleep apnea, the muscles of the throat relax and block airways. It’s more common with people who carry extra weight, have allergies, take certain medications, and those who drink alcohol, among other things.
  • Central Sleep Apnea: With central sleep apnea, the brain doesn’t send the right signals to the muscles which control breathing.
  • Complex Sleep Apnea: When someone has both obstructive and central sleep apnea, it’s referred to as complex sleep apnea.

All Forms of Sleep Apnea Must Be Treated

When you wake up repeatedly through the night, your body has trouble making it through the various sleep cycles, so you never get a full night of sleep, no matter how many hours you spend in bed. That can lead to things like being grouchy, groggy, tired, and listless. In severe cases, sleep deprivation produces symptoms that are worse than being drunk, which makes it unsafe to drive and engage in a number of activities.

TMJ Dentists Help with Jaw Disorders

Most people refer to the concept of jaw issues as “TMJ,” but the acronym is short for temporomandibular joint, which is your jaw joint. When something’s wrong with it, it’s referred to as a temporomandibular joint disorder or temporomandibular disorder (TMD).

TMD Has Many Known Causes

In most cases, it’s the muscles which support the joint that become problematic. For example, a traumatic injury, like from a car accident, can cause TMD. Grinding, clenching, stress, and arthritis can all result in TMD too.

All Forms of TMD Must Be Treated

People who don’t treat TMD wind up with pain and tenderness, popping and clicking sounds as they open and close their mouths, difficulty opening, trouble chewing, and so forth. When grinding and clenching are involved, teeth issues also set in. Teeth may wear down or become loose. Dental work may wear out or break. The symptoms become worse over time if nothing is done.

If Malalignment is Contributing to Your Sleep Apnea, a TMJ Dentist Can Help

Research shows a huge correlation between sleep apnea and TMD. People who have one usually have the other. That’s not surprising, because if your jaw is not aligned properly, it will cause undue stress to your temporomandibular joint and the muscles which support it, plus cause your tongue to lay in an unnatural way. A doctor who performs a physical exam and takes x-rays may be able to give you a definitive answer, but ultimately, you need treatment for both. Go visit the TMJ dentist for treatment and see if that helps your sleep apnea. If not, then you’ll still want to follow through with your sleep apnea treatment.

This blog is sponsored by New Orleans Dentist Dr. Duane DeLaune.

Crown hurts

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I don’t know what’s going on. My crown hurts whenever I bite. It feels like the crown is bigger than the teeth next to it. I’m thinking bigger like taller. Could this be why it’s hurting. My dentist said it’s just a matter of me getting used to it but it has been about two months and it still hurts. Will I get used to it or is something else going on?

Kevin

Dear Kevin,

A woman holding her jaw from TMJ pain

When a crown is done properly, you shouldn’t even notice it is there. Your dentist saying, “You’ll get used to it.” is generally dental speak for “I’m not sure how to fix this.”

Normally, a basic step would be for a dentist to check that the crown isn’t seated to high. To do that, they’d have you bite on registration paper. This leaves marks where the crown hits prematurely. They will grind down those places.

I’m going on the assumption your dentist has already done this. If he hasn’t, you should definitely get a new dentist. If he has done this, there is something more challenging wrong and it’s out of his depth so he’s just saying you’ll “get used to it”.

This Can Lead to TMJ Disorder

If you don’t get this resolved, there is a possibility you will develop TMJ disorder.

I don’t think I’m confident your current dentist can fix this. Because of that, I’d like you to see a dentist who has experience with TMJ. They can properly place your crown so that you don’t have to worry about developing TMJ.

Making the Most of a Bad Situation

I’m a big believer in finding the good in a tough situation. If it turns out your crown was made improperly for your bite in a way which can be fixed, two good things can result.

First, you’ll be able to get a refund from your first dentist which will help you pay to get it done right. Second, this is a chance to improve your smile.

The color your crown is made is permanent. If you’re going to have it redone, I’d suggest getting your teeth whitened, so your second crown can be made to match a much lighter color to match your new, more youthful looking smile.

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

Custom mouthpiece for grinding because of meds?

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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.

Is It TMJ or an Ear Infection?

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Does your ear hurt and feel full and you think it might be related to TMJ? How can you determine the real cause of your symptoms?

What Is TMJ?

TMJ has is an acronym that is commonly used to describe dysfunction with the temporomandibular joint, which connects your lower jaw (mandible) to the bone on the side of your head (temporal).

close up of temporomadibular joint
TMJ disorder can cause ear pain

There are many signs and symptoms associated with TMJ. And you don’t have to experience them all to have a TMJ disorder. You might be experiencing one or more of the following signs or symptoms:

  • Pain in or around your ear
  • Chronic headaches
  • Chronic earaches
  • Tinnitus (ringing in your ears)
  • Chronic neck pain
  • Difficulty opening and closing your mouth
  • Clicking or popping noises when you open your mouth
  • Jaw clenching
  • Jaw pain or soreness that is worse in the morning or late afternoon
  • Jaw pain when you chew, bite or yawn
  • Tender jaw muscles
  • Sensitivity in your teeth
  • Bruxism (grinding your teeth)

What Are the Signs and Symptoms of an Ear Infection?

Although you may not be experiencing all of them, common signs and symptoms of an ear infection in adults include:

  • Ear pain
  • Fluid draining from the ear
  • Impaired hearing
  • Fullness in the ear
  • Nausea
  • Dizziness
  • In severe cases, a stiff neck and/or fever

If you think you have TMJ, schedule an appointment with a dentist who has advanced training in the disorder. He or she will examine your teeth, jaw, and bite to make the determination.

How Will It Be Treated?

  • If you have TMJ, a customized mouthguard will be recommended for you to wear while you sleep. It will relax your jaw and prevent bruxism, which is often related to TMJ.
  • Relaxation and jaw exercises might be recommended to help relax the muscles.
  • It can also help to alternately apply hot and cold packs to the side of your face where the muscles are sore.

What If Your Symptoms Don’t Match TMJ?

Even if you don’t think you have TMJ, chronic ear pain should not be ignored. An untreated infection can spread and permanently affect your hearing and balance. You should schedule an appointment with your primary care doctor. If necessary he or she will refer you to a specialist.

This post is sponsored by Dr. Duane Delaune of Delaune Dental in New Orleans.

Do I Have tmj or tmd?

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I’m a little confused about which problem I have. I’ve been having problems with severe headaches and pain in my jaw. Someone said they think I have TMJ . I went home to look that up and there seems to be two things. One is called TMJ and one is called TMD. How do I know which one I have?

Carol

Dear Carol,

close up of temporomadibular joint

There’s a good reason you are confused about this. Even though they have two different technical meanings, people (especially patients) use them synonymously.

TMJ refers to the temporomadibular joint. I’ve placed a picture of it above so you can see a close up of it. TMD refers to the disorder of the temporomandibular joint.

Generally, when people say TMJ they mean TMJ disorder (or TMD).

If You Have TMJ Disorder

The symptoms you’ve described above do relate to TMJ Disorder.
There are many possible reasons for developing jaw problems. Your next step would be to see a dentist with expertise in TMJ problems, so he can properly diagnose the cause.

You want a dentist who’ has invested in significant post-doctoral training in TMJ diagnosis and treatment. For instance, Dr. Delaune has done extensive training with the world renown Dawson Academy.

There is not a recognized TMJ Specialty so any general dentist can call themselves a TMJ dentist. That makes it especially important you know that the dentist you’re dealing with is actually qualified.

Treatments vary depending on the cause. It can range from a simple orthotic device up to a full-mouth reconstruction. Good dentists start with the most conservative treatment except for the most rare, devastating cases.

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

My Husband Says My Migraines are From TMJ

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I take medicine for migraines every day. My husband, who is not a big believer in medications, thinks I’m probably getting the migraines from TMJ disorder and the medicine is not necessary. How do I know if he’s right?

Adeline

Dear Adeline,

close up of temporomadibular joint

Migraines can be the result of TMJ disorder, but there are normally other signs which accompany it. Here are some of the more common symptoms.

  • Painful jaw muscles
  • Popping or clicking of jaw joints
  • Worn teeth
  • Ear pain

There are others as well, but these are some generalized indicators. Though a self-diagnosis will do you little good. Your best bet is to see a dentist who treats TMJ. They can give you a thorough exam and narrow down the cause of your particular TMJ.

For instance, worn teeth are usually a sign you grind or clench your teeth. Not only can this lead to TMJ, but it also wears your teeth down to nubs, requiring them to need dental crowns in order to function properly. Yet, a simple night guard worn at night can completely protect your teeth and ease up the pressure to your jaw.

In other cases, it’s a matter of your bite being thrown off by poor alignment. There can be several solutions for this depending on the severity of the problem.

Who Should Treat Your TMJ?

There isn’t a recognized specialty in TMJ, therefore any dentist can technically claim to treat it. However, the way the muscles, joints, and teeth line up is a complicated matter and requires some post-doctoral training in order to be effective. It’s imperative you see a dentist who’s invested time in learning how to properly treat it at a reputable institution.

Here are some well-qualified places a dentist may go to get trained in TMJ Disorder:

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

Any of these places offers extensive instruction on the diagnosis and treatment of TMJ Disorder. You should be in safe hands with a dentist who’s studied at one of them.

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