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Dentist Wants to Treat My TMJ Disorder with Crowns

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Can you give me some advice? I grind my teeth and have worn them down. As a result, I have TMJ Disorder. I’ve been seeing a specialist, who has me wearing a nightguard. They are so worn down that they can no longer get fillings. Through my specialist’s care, my migraines and jaw pain have improved when I am wearing the mouthguard. However, now she is suggesting that if she put crowns and onlays on several of my bottom teeth, she could fix my bite permanently to treat my TMJ Disorder. Is this a legitimate treatment? I’m starting to panic that it might be a mistake. My treatment is scheduled for next week. Should I go through with this?

Sandy

Dear Sandy,

Illustation of TMJ problems

Using crowns to rebuild a bite, especially one that a grinding habit has shortened the teeth to nubs is a legitimate way to treat TMJ Disorder. In fact, in some of the more severe cases of TMJ, a dentist will do what is called a full mouth reconstruction, which consists of crowning every tooth.

One thing I would caution you about is your dentist calling herself a TMJ Specialist. You should know that there is not a recognized specialty in TMJ, though I wish there was. Maybe she explained that to you already. TMJ is a complex disorder. In order for a dentist to understand how to treat it correctly, they would need post-doctoral training. It’s possible your dentist has that training. But, if she doesn’t I would get this procedure done by someone else. Otherwise, you could end up with a lifetime of pain.

Here is a list of some of the best post-doctoral institutions that train dentists in TMJ disorder:

  • The Pankey Institute in Key Biscayne, Florida
  • The Dawson Academy. Their headquarters are in Florida, but they have training centers in several different states
  • Spear Education in Scottsdale, Arizona
  • The Las Vegas Institute for Advanced Dental Studies in Las Vegas, Nevada
  • Piper Education and Research Center in Tampa, Florida

Find out if your dentist studied TMJ at one of the places listed above. If so, you should be perfectly safe. If not, go elsewhere for the treatment.

This blog is brought to you by Hoffman Estates Dentist Dr. William Becker.

TMJ Disorder Caused by Dental Tourism

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I need some advice. I went to Costa Rica to have some dental work done cheaper than I can here because I needed about seven dental crowns. Before you lecture me, I learned my lesson. I just need to know what to do from here because I’m in bad shape and have limited funds. The problems actually started at the appointment when Dr. [name withheld, publicly] broke one of my teeth that didn’t need a crown so I ended up with an extra root canal and dental crown because of that. Once I returned, everything went downhill. The crowns feel uneven, and don’t all hit the opposing teeth. I was in pain and then one of the crowns popped off. In frustration, I went to a local dentist here in the U.S. He told me that all of the crowns had open margins and needed to be repaired. He also said they were not occluding with my teeth, which is why I was in so much pain. I contacted the Costa Rican dentist and he refused to take responsibility. I hired an attorney and we did get a Costa Rican Dentist to agree that the work was negligent. However, because I complained publicly about the dentist, which is apparently a felony there, they considered ME in violation of the law. It didn’t matter that I made the complaints from my computer in the U.S.. I ended up having to flee the country to keep from being arrested. I tried to get criminal charges filed against the dentist but was told he’d just bribe the officials so there was no point.

Carolyn

Dear Carolyn,

Woman covering her mouth

I am very sorry this happened to you, and don’t worry, you will not be lectured. What you’ve been through is not only expensive, but terrifying. Sometimes, as Americans, we don’t realize how great we have it. Having to flee the country must have been a dreadful experience. For the benefit of others, I am going post some red flags that may help someone else.

First, this dentist (whose name I have but she couldn’t share publicly for reasons stated above) has a minor in prosthodontics listed in his dental school degree. We don’t have minors in dental school. Second, he listed the DaVinci Institute as one of his places for post doctoral studies. This is a think tank, not a dental program. People may confuse it with a dental program because of DaVinci Dental Studio in California, which is a lab (again, not a school). Third, his practice seems to have changed names recently. This is a common practice from dodgy practitioners looking to escape some damage to their reputation. There do not seem to be any reviews for him either, at least not under this new name.

As for what you need to do, I have bad news for you. I know you are in a pickle financially, but there are two really big reasons for you to have these crowns redone. You will want to do it as soon as possible, too. First, is the open margins. You are going to have food and other bacteria get caught in there, which will lead to decay as well as gum disease. Second, the fact that your teeth are not occluding together is serious. If not repaired soon, you are going to end up with painful TMJ Disorder.

Because of the damage done, you are going to need to see someone with real expertise in TMJ Disorder. While this is not a recognized specialty, there are dentists who have some expertise in this area and that is what you will need. Look for someone who has trained at one of the following post-doctoral institutes:

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

If anyone reading this is considering dental tourism, please look at Carolyn’s story as a warning and remember that cheap dentistry rarely ends up being affordable dentistry.

This blog is brought to you by Hoffman Estates Dentist Dr. William Becker.

A Full Mouth Reconstruction Going Badly

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I was having a full mouth reconstruction done mostly of crowns but there were a couple of dental implants as well. When he did the temporaries, I felt pretty good about things. However, once the permanent ones were placed things felt off. I asked him not to bond them because of that but he said they are exactly the same as the temporaries that I already approved. I know I approved the others, but I am certain these are different. Many of the teeth, especially on the left side no longer touch each other and I’m having trouble with some of my jaw movements. The only thing he will do is grind down some of the crowns, which has only served to make things worse. I did go to see another dentist to get a second opinion. He seemed to be on my side until he asked me who the dentist was and then his tune changed. Now I feel like he is protecting his colleague instead of giving an honest assessment of the work. I’m left in pain and unable to eat properly.

Stu

Dear Stu,

Illustation of TMJ problems

The way teeth come together is called occlusion. It takes advanced training to do this well. Your dentist appears to be in over his head. Also, when you expressed concern and asked him not to bond them on, your dentist should have stopped then and there. You did not give consent. I don’t  know why there was a difference between the provisionals and the permanent ones, but there was and he should have investigated that instead of putting your bite at risk.

The fact that you are having trouble with your jaw movements and several of your teeth are no longer occluding, tells me there is a serious problem. If it is not addressed, you are likely to end up with TMJ Disorder.

Getting a TRUE Second Opinion

I am not surprised that your second opinion dentist changed his tune once he heard the name of your dentist. The dental world is a small world and it is likely that they are friends. He likely felt he was in an awkward position and didn’t want to denigrate his friend’s work. To get a true unbiased opinion, you will need to make it a blind second opinion. Even if they ask you who did the work, be honest with them and say that you don’t want that to influence their diagnosis of the situation. You’d like a blind second opinion. However, I don’t want you to go just any dentist.

Instead, I would like you to look at a dentist with advanced TMJ training. There are three post-doctoral schools I would like you to look for in their training. Any one of these and they’ll be in a good position to diagnose your issue. You can generally find this type of training listed in their bio.

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

I’m sorry this happened to you. When you get the second opinion in your favor, don’t ask for a refund. Ask for them to pay for the repairs with the dentist of your choosing and then go to the dentist with the advanced training.

This blog is brought to you by Hoffman Estates Dentist Dr. William Becker.

 

Should I Finish My Full-Mouth Reconstruction?

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I had a problem with grinding my teeth. I did not realize it was a problem until I switched to a new dentist. She showed me how much tooth structure I had lost and asked if I’d been having any jawpain or headache. I had and she explained that having my bite so far off could be leading to TMJ disorder. Her suggestion was that we crown the teeth that have been ground down. I went ahead with that and not sure I want to finish. My jaw is not hurting as much as it used to. I was really emotional about how perfect the bottom teeth were. I miss the quirky nature of my original smile. Can I just stick with my upper teeth as they are? I am a bit embarrassed that the upper teeth will be darker than the bottom teeth, but maybe I can whiten those. Yet, that causes problems of its own because I used zoom once and my teeth were super sensitive. Help!

Stacey

Dear Stacey,

Woman covering her mouth

A smile makeover should last for years.

While you can just stop with your bottom teeth, I want to make sure you understand all the things that come with that. First, your dentist likely designed your full-mouth reconstruction to include both arches. Doing just one, limits its effectiveness. However, the thing that worries me most is the impact on your upper teeth. The ceramics on the bottom teeth will be tougher on your upper teeth than natural tooth structure. If they are already damaged from grinding, this will damage them further and could acerbate your TMJ Disorder issues.

Your main concern seems to be the appearance of the bottom teeth being too perfect. If you are seeing a great cosmetic dentist the teeth can include that quirkiness you are missing. In fact, most cosmetic dentists would jump at the chance to do something other than a Hollywood smile! Communication with your dentist is key.

If you still do not want to complete the upper arch, that is totally within your right and your dentist should respect that. You’ll be more comfortable with your smile if you do go ahead with teeth whitening. Zoom is a pretty strong way of doing that. If you had sensitivity last time, I would go with a different option. There are plenty of take home, yet professional strength, options that are more gentle but will still give you a white smile.

Hopefully, your dentist has already done this but if you’re not wearing a night guard, you really need to. It will protect your teeth from your grinding.

This blog is brought to you by Hoffman Estates Dentist Dr. William Becker.

Fixing a Collapsed Bite

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I have a smile that has always embarrassed me. When my mouth is relaxed, you can’t see my teeth at all. It’s like a big black gap. I often have trouble saying certain letters and have jaw pain almost all the time. The only break I get from it is when I am wearing my mouthguard. You can see my teeth a little better too then. A friend of mine thought that porcelain veneers might be helpful. I just want to make sure that is the right path before I move forward.

Lisa

Dear Lisa,

Woman in pain from TMJ

I am very glad you wrote. This can be fixed, but you have to do it very carefully. The dentist you choose will be the most important thing. Bear in mind that I have not examined you, but based on your description, it sounds like you have two issues going on. The first is a collapsed bite. The second is some TMJ complications.

Fixing this will require more than just porcelain veneers. The solution is to open up your bite with a full mouth reconstruction. It is usually done with dental crowns and possibly some porcelain veneers combined. It is extremely complicated and advanced. It requires a dentist who has advanced post-doctoral training.

Three of the top institutions that offer the training necessary for a dentist to perform this treatment are:

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

If you have a dentist who is not qualified to do this, then you could end up with a disastrous result. There have been patients whose bites were so thrown off by this that they ended up in pain for years. I don’t want that to happen to you. There is nothing wrong with asking a dentist about their qualifications. Start by looking online for dentists who consider themselves TMJ Dentists. Then make sure they have studied at least one of the three institutes I listed above.

This blog is brought to you by Hoffman Estates Dentist Dr. William Becker.

 

Head Butt by a Horse. Can I Get TMJ From This?

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I’ve been giving riding lessons for the past ten years. I always wear my helmet and observe all safety rules around horses. Two weeks ago, however, my six-year-old Paint gelding hit me with his head while shaking off flies. He’s usually very gentle; I know he wasn’t trying to be aggressive at all. The left side of my face took most of the blow, and since my teeth and nose weren’t injured or bloody I thought I was okay and nothing had happened. Besides a small bruise that took about a week to go away, I was fine. I figured that was that. Now I’m beginning to develop a lot of soreness and stiffness in my jaw joints, mainly the left side. It’s more pronounced when I first wake up in the morning, or after eating something chewy. My husband says I should see a dentist to make sure I haven’t permanently ruined my jaw joint, but I keep thinking it’ll go away on its own. Is this related to the injury from my horse? Should I listen to him and come in? 

Many thanks,

Dee

Dear Dee, 

A woman grabbing her jaw in pain from TMJ

 

First, kudos to you for your attention to safety! Horses are large, powerful animals and people often underestimate their strength. It’s good to see that you observe and model helmet use and other safety parameters for yourself and your clients. Second, you may want to listen to your husband. He’s correct in urging you to be seen. There may be complications that time alone cannot handle and these would be best addressed by professional care. Even if no visible damage is done, there may be issues that might not be immediately apparent as trauma can be one of the primary causes of TMJ Disorder. Let’s expand upon this:

The Sooner The Better

With any joint damage, getting seen sooner is always the better. Your chances of successful, as well as shorter, healing times are much greater if you are seen within the week, so you may not want to delay any further. 

What To Do Initially

Directly following an injury to the face or jaw, it’s best to apply ice to the area to control swelling and call your doctor or dentist. Hold the ice packs against your face for no more than 10 minutes at a time, with 10-minute intervals in between, to allow the skin to rest and warm up again. You may also wish to gently wrap a bandage around the face to minimize movement while you wait to be seen. 

There May Be A Fracture

The affected area should be x-rayed as soon as possible to assess for damage to the teeth/root systems as well as dislocation or fractures of the jaw, even if your teeth themselves feel fine. Severe fractures likely require surgery, while minor ones may at times heal without intervention. Some indicators of a break in the jaw are: a numb sensation, swelling, pain and/or stiffness especially when eating/chewing, and bruising. 

It May Be Sprained

Another possibility is a sprain and/or strain to the muscles and ligaments surrounding the joint. These may take a fair amount of time to heal and there are various options available to you in the treatment of this condition. You may be prescribed pain relievers, muscle relaxers, and an anti-inflammatory. Sometimes an appliance is prescribed or physical therapy unique to the jaw.

Come For A Complete Examination

Your examination will shed light on the unique complexities of your condition and the best treatment going forward and get you  “back in the saddle” once more! Until then, enjoy your equine buddy and give him an extra apple or two. 

This blog is brought to you by Hoffman Estates Dentist Dr. William Becker.

My Mouth is Collapsing

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I need some advice. My smile has changed quite a bit. I don’t know if it has to do with my lips, teeth, or jaws, but in order to see my upper teeth when I smile, I have to force the smile to be higher than normal. It’s uncomfortable to smile that way. When my mouth is at rest, you can’t see the upper teeth at all. I do wear a mouthguard at night, which does help with both giving the appearance of visible teeth as well as relieving some of the aches I feel in my jaw. My dentist is suggesting I get porcelain veneers. Will that be the best option for my situation?

Lana

Dear Lana,

Illustation of TMJ problems

TMJ Disorder Can Come From a Mixture of Sources

 

Bear in mind that I have not examined you. That being said, it sounds like you have worn your teeth down. This can happen because of teeth grinding. Your mouthguard will help prevent further damage to your teeth but will not repair any damage already done. Worn down teeth can cause your jaw to overclose, which is likely leading to the aches you are feeling. This is a symptom of TMJ Disorder.

I am concerned that your dentist is suggesting you get porcelain veneers as the solution to this. While it could help with the appearance of your smile, depending on the artistic skill of your dentist,  it will not deal with the root of the problem, which does need to be dealt with. You need a dentist who has training in TMJ Disorder. I don’t think your dentist does if he is suggesting porcelain veneers.

Look for a dentist who has trained in one of the following post-doctoral institutions:

  • The Pankey Institute in Florida
  • The Dawson Academy, also in Florida
  • The Las Vegas Institute for Advanced Dental Studies

Depending on the extent of damage you are dealing with, you may need a full mouth reconstruction, which boils down to placing dental crowns on almost all your teeth. The training I mentioned will be extremely important in these types of cases.

This blog is brought to you by Hoffman Estates Dentist Dr. William Becker.

Need Advice About Jaw Pain

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I have a teeth grinding habit. To fix it, my dentist crowned all my teeth, but somehow they weren’t done quite right. My bite is slanted and I ended up grinding those down as well. My jaw hurt so much that I went to another dentist who called himself a TMJ dentist. I thought he could help because of the pain in my jaw. He put me in an orthotic device for a little over two years but that seems to have had the result of opening up my jaw too much. I am in agony and everyone I see has the tendency to make it worse. What do I do?

Zoe

Dear Zoe,

TMJ illustration

You have had a rough go of things. One of the things you are up against is the fact that TMJ is not a recognized specialty. Any general dentist can claim to be a TMJ dentist even if they have not invested the time and money in the additional training necessary. This, however, rarely serves their patients well. Your first dentist tried what is known as a full-mouth reconstruction. This is one of the most advanced procedures in dentistry. It does not sound like your dentist has the training necessary to do this, which is why your bite ended up worse.  You should also know that just crowning the teeth won’t keep you from grinding them. The best way to protect your teeth from grinding, once they are repaired is with a nighttime mouthguard.

The second dentist kept you in an orthotic too long, which is what opened up your bite past its natural position. What you have now is a serious case of TMJ disorder. You need a dentist who has the advanced training to give you proper treatment. Three of the best post-doctoral institutions for TMJ Training are:

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

Find a dentist who has training at one of these institutions and you will be in good hands and on the road to getting your bite corrected properly.

This blog is brought to you by Hoffman Estates Dentist Dr. William Becker.

 

 

 

Can Diabetes Lead to TMJ?

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I was initially diagnosed as having TMJ by my dentist about five months ago, but I was in pain for quite some time before that. He did the evaluation and suggested a nightguard to help with my grinding. He made me one of those and sent me away with a bunch of other tips about how I should be using compresses and taking ibuprofen to reduce inflammation. None of it has helped. I went back in and he said that it must be that my bite is off, so I let him do a bunch of work like shaving down some teeth and building others up. Weeks and a small fortune later, I was still in pain.

At this point, I’m out thousands of dollars because insurance isn’t paying for any of this and I’ve had no relief. I went back in again yesterday and the dentist basically says my TMJ is related to my diabetes and that there’s nothing that can be done about it. I just have to live with it.

I’m no wimp, but I can’t function anymore. It hurts all the time. I can’t sleep. I can’t eat. I can’t focus at work. And all the stress makes me clench my jaw a lot, which makes it even worse.

I feel like this is a total copout on his part at this point. He’s taken the money, done nothing for me, and is now saying that my diabetes is to blame. Is there even a grain of truth to what he’s saying? And, if so, is there really no hope?

-Jordyn

Dear Jordyn,

Woman in pain grabbing

That sounds terrible. Sorry to hear you’ve been dealing with all this. First things first, if you’re Type 2 diabetic, ibuprofen is contraindicated. Although it’s the standard go-to for these kinds of issues, NSAIDs aren’t recommended for diabetics. Talk to your doctor so you can be on pain medicine which doesn’t put you at a greater risk.

Night Guard and TMJ Issues

If you’re grinding at night, it’s going to contribute to the issues, along with wearing down your teeth. Even if it isn’t the only thing contributing to your TMJ disorder it needs to be dealt with. That’s arguably the easiest thing to fix and the treatment is non-invasive—a nightguard like you received. It was a good first step. Bite adjustments are another logical thing to address.

Diabetic Neuropathy and Your Jaw

About half of all people with Type 2 diabetes and 20% with Type 1 diabetes will develop diabetic neuropathy. Of these, just .05% of people will develop craniofacial neuropathy. It’s fairly rare and wouldn’t be the first thing a doctor looks for. He’d rule out the obvious and easy causes first.

Where to go from Here

Your dentist saying your TMD is caused by diabetes and then doing nothing is a copout. That’s not an acceptable answer. If that’s really all he did, then he dropped the ball in a big way. While there isn’t an officially recognized specialty in TMJ, there are dentists who have completed significant training in that area who are the equivalent of a specialist.

It requires significant post-doctoral training because there isn’t enough coverage of the topic in general dental school. Look for a dentist who has invested in TMJ specific training. For instance, Dr. Becker has done extensive training with some very prestigious institutes, like:

  • The Dawson Academy
  • The Pankey Institute
  • U.S. Dental Institute

This is the type of dentist you want to diagnose the cause of your TMJ disorder. There are lots of potential treatments, and it may take some time to work through them to find the one that’s right for you, but don’t accept defeat on this. Work with someone who’s going to keep investigating and find a solution.

This blog is sponsored by Hoffman Estates Dentist Dr. William Becker.

Gorilla Bite or Bad Crown?

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I have had a dental crown for three months. Today it broke of, including the post. Is there a recommended fix for this? Should the dentist cover some of the cost? I was told a crown can last for years.

Preston

Dear Preston,

A woman grabbing her jaw in pain from TMJ

A poorly fitted crown can lead to TMJ problems

Bear in mind with everything I’m telling you here that I haven’t seen your dental crown or examined you. This is speculation. It is educated speculation, but still not an official diagnostic. Based on what you’ve said, it sounds like the tooth and post broke at the base. If that is the case, then the tooth cannot be saved.

It’s very possible the tooth was so far gone it couldn’t be saved anyway. That is not saying your dentist did anything wrong. It’s admirable any time a dentist tries to save a tooth. If it was a matter of the post being weak, it may be able to be re-done. If, however, the tooth can’t be saved you will need to replace it. The best tooth replacement option is dental implants.

Without a replacement, the teeth adjacent to the open space will shift or tip into it. Bite problems like that can lead to TMJ Disorder, which is painful.

Gorilla Bite

In some cases, there are patients with a bite so forceful it is known as gorilla bite. This can break a crown. Once you get a certain age, it will start to break your teeth down. One way to know if you have this issue is to look at the profile. If the bottom of the lower jaw is parallel to the upper jaw, that is evidence of gorilla bite.

If that is the case, you will need to get a nightguard or your natural teeth will start to break. This simple precaution will save you a fortune.

As to who pays for the crown; Without evidence of any fault on your dentist’s part, he won’t be required to pay for it. However, with a failed procedure, he may be willing to credit you for the cost of the procedure. That is completely up to him, though.

This blog is brought to you by Hoffman Estates Dentist Dr. William Becker.