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Crowning My Teeth For a Headache?

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I mentioned to my dentist I’d been having pretty bad headaches. He instantly started moving my jaw around and declared that I have TMJ disorder. He wants to crown all my teeth. He says it will solve my headaches but at quite a cost! I’m not sure the $30K is worth it. Is there no other solution? I see that you treat TMJ as well, but seem to have other treatments.

Kimberly

Dear Kimberly,

Illustration of how TMJ is affected by neuromuscular issues

There are many causes and solutions for TMJ Disorder

 

I am glad you wrote. What your dentist is suggesting is known as a full-mouth reconstruction. Not only is it reserved for the most serious of TMJ cases, but it also is an immensely advanced procedure. If you were in need of that, you would not have had to tell him about your headaches. He would have noticed your bite was off. If he didn’t, then he is not the one to do the procedure even if it was necessary.

Before you do anything, I would like you to see a dentist who has significant post-doctoral training in TMJ Disorder. In order to give you some idea of the type of dentist you would need, I would like you to look at Dr. Hadgis’ TMJ Specialist page.  The best dentists will begin with the most conservative treatment. Only if those show no signs of helping would he or she delve into more invasive treatments.  Your dentist is suggesting one of the most invasive treatments from the very beginning.

If it turns out you do need a full-mouth reconstruction, which I highly doubt, I want you to make sure that your dentist not only has the same LVI training that Dr. Hadgis does, but that (also like Dr. Hadgis) he is AACD accredited. These are the top cosmetic dentists in the world. This way, not only will you have the correct bite, but a beautiful smile to go right along with it.

This blog is brought to you by Grosse Pointe Woods Dentist Dr. Theodore Hadgis.

Dentists Are Exacerbatting her TMJ Disorder and It’s Serious

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I have had massive problems after seeing two dentists. Each time, rather than helping me they’ve made the situation worse. I am now to the point where I am not sure who to trust and how to fix this. I grind my teeth. They ended up ground down to nubs so my dentist placed a crown on every tooth. That is when things started going downhill. He didn’t do it right and my jaw ended up crooked and slanted, with one side higher than the other. I started having serious pain every day and massive headaches. I went to see another dentist and he told me I’d developed TMJ Disorder. He gave me an orthotic device to wear and ended up opening my bite up too much. He didn’t address the slant in my jaw and now my crowns are ground down the way my teeth were. Is there any hope to getting this fixed?  Someone told me to see a prosthodontist, but I heard they don’t know how to make their crowns pretty. Is it too much to ask to have a pain-free functioning smile that also looks great?

Penelope

Dear Penelope,

Woman holding her jaw with TMJ pain

You certainly haven’t had the best dentists in this situation. You’d think they would at least not make it worse. As you can tell, not all dentists invest in the post-doctoral training necessary to handle advanced classes such as yours. When all your teeth are ground down to nubs, the solution is to crown them, a procedure known as a full-mouth reconstruction. While he knew what procedure to do, he obviously didn’t have the expertise to do it.

You are now dealing with serious TMJ Disorder and will need a dentist who knows how to reconstruct your bite to its proper position. While there isn’t a recognized specialty in TMJ, there are some post-doctoral institutions who have great training programs in learning to skillfully diagnose and treat this problem.

I would look for a dentist who has invested in training with one or more of the following:

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

Dr. Hadgis not only has training from the Las Vegas Institute for Advanced Dental Studies, but he is also now a Fellow, which requires extra training and skill. This is the type of advanced TMJ dentist you need to help you with your full mouth reconstruction.

Getting a Functional AND Beautiful Smile

You don’t need to choose between form and function. Though a tall order, it is possible to find a dentist with TMJ and cosmetic dentistry training. My suggestion would be to look for an AACD accredited dentist then look to see what their training is in reconstructive dentistry.

This blog is brought to you by Grosse Pointe Woods Cosmetic Dentist Dr. Theodore Hadgis.

Full-Mouth Reconstruction Problems

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I am having some problems with the procedure my dentist is doing. My teeth are down to tiny nubs. I’ve also had lots of pain in my jaw because of some trauma and it pops whenever I open it. My dentist said he’d need to open up my bite, which would require placing dental crowns on every tooth. At first, it went well. The temporaries fit fine and everything looks good. But, now that both the upper and lowers are placed, I am in tremendous pain. The right uppers don’t meet, but the left uppers meet too quickly and hurt like crazy. They’re permanently bonded on. Is there a way for him to shave down the ones that are hitting too soon?

Carrie

Dear Carrie,

Woman holding her jaw with TMJ pain

What your dentist is trying to do is called a full-mouth reconstruction. This is a very advanced procedure and takes a significant amount of training AFTER dental school to understand all the mechanics behind it. Three very good post-doctoral training centers for this are:

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

However, even with advanced training, this type of procedure has to be done carefully and methodically. It’s important to work from provisionals only until the case is successful at that point. By successful, I mean every occludes properly, your bite is so comfortable you don’t notice it, and you speak without any issues. Only when all that is accomplished are the permanent crowns even to be made.

From there, your dentist would seat the dental crowns, along with any bridgework, temporarily making sure they are completely comfortable and any bite adjustments necessary are made. Only after that would he permanently bond them on. It doesn’t sound like your dentist did this.

In cases such as yours, where there are already have symptoms of underlying TMJ Disorder issues, such as popping in your jaw, it’s even more important. You don’t want the procedure to throw off your bite even further, thereby exacerbating your TMJ problems.

While technically he could do some grinding on the crowns to get them to meet your teeth at the same time as the opposite side, based on what you said there would be too much grinding necessary for this to be a realistic functioning solution. At this point, my recommendation is you get a second opinion from a dentist who attended one of the schools I mentioned above. They can give you some guidance from there.

This blog is brought to you by Grosse Pointe Woods Dentist Dr. Theodore Hadgis.

The Problem of a Collapsed Bite

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I have great difficulty in speaking certain letters, plus my smile is embarrassing. It is almost impossible to see my teeth, even when I smile. You can’t see them at all when my mouth is in repose. I don’t know what is causing it but I want to fix it. I also have tremendous jaw pain. The only time I get any relief is when I wear my nightguard. It is also the closest I come to having “teeth” you can see. Is there anything I can do to fix my smile? Will porcelain veneers be a good solution?

Carl

Dear Carl,

Man grabbing the side of his jaw in obvious pain and in need of a dentist

I’m glad I’m getting to deal with this question now instead of after a dentist had a chance to play around with this and cause severe problems. It sounds like what you’re dealing with is a collapsed bite along with some pretty severe TMJ Disorder complications. Porcelain veneers will be too thin to build up your bite. What you need is a full-mouth reconstruction with dental crowns which can build up the bite, done by a dentist who has had extensive TMJ training as well as expertise in cosmetic dentistry to make it look beautiful as well.

The best postdoctoral schools for this type of training are:

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

I’m going to highly suggest you find a dentist who has thoroughly studied at one of these institutions. Generally, an AACD accredited dentist will have the qualifications you need.

Additionally, the dentist want to build up the reconstruction reversibly. What I mean by that is your dentist will need to do it first using nothing but temporary restorations. It will need to continue that way until you are certain things are correctly done. That means your restorations are occluding well, they feel completely comfortable, you can speak properly, and the teeth are visible when you smile.

Once that is achieved, they can make the permanent restorations out of the temporary ones.

This blog is brought to you by Grosse Pointe Dentist Dr. Theodore Hadgis.

If My Bite is Off Do I Have to Have Crowns?

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I was at my dentist for a regular checkup. He told me my bite was off and wants to crown every tooth. I know I needed some fillings after my braces were taken off, but a crown on every tooth seems extreme. Plus, my braces have only been gone for a few years. How off could my bite really be?

Amanda

Dear Amanda,

Diagram of TMJ

In extreme TMJ cases a full-mouth recontruction is necessary

Something seems fishy to me here. Crowning every tooth is called a full-mouth reconstruction. There are times when a full-mouth reconstruction is necessary, but that is generally reserved for extreme cases of TMJ Disorder. I don’t think that’s what you have. How can I say that without examining you?

Your dentist gave no specifics and said your bite is “off”? What does that mean? Everyone’s bite is off to one degree or another. That doesn’t mean they have severe problems or even any problems. If your bite was off enough to require such a drastic treatment, the complaint would come from the patient, not the dentist.

I’m going to recommend you get a second opinion from a dentist who’s invested a lot of time and training for TMJ Disorder. Look for a dentist who has studied at the Las Vegas Institute of Advanced Dental Studies or the Pankey Institute. These institutions are well known for their TMJ training.

If Your Bite Does Require a Full-Mouth Reconstruction

Let’s say the second opinion dentist tells you your dentist was right and does need this invasive of a treatment. In that case, I want you to look for two qualifications in the dentist who actually performs the procedure. The first, we’ve already discussed. They need significant TMJ training.

However, getting the bite correct isn’t enough. Your smile is the first thing people notice about you. You’ll want your first impression to be one of a beautiful smile. Because of that, it will require an artistic cosmetic dentist. Ideally, you’ll want a dentist who is accredited by the American Academy of Cosmetic Dentistry. AACD accredited dentists are the best cosmetic dentists in the country and can make you a stunning smile.

Though it’s a tall order to find a dentist with both of those qualifications, I wouldn’t settle for anything less if you really do need to get a dental crown on every tooth.

This blog is brought to you by Grosse Pointe Woods Dentist Dr. Theodore Hadgis.

Do I Have TMJ?

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Lately, I’ve been having some pretty bad pain in my jaw and it is sometimes popping when I chew. I’m worried I have TMJ. Is there a way to know or is there something else wrong? If I do have TMJ, what’s the solution?

Kathy

Dear Kathy,

Jaw pain can be a sign of TMJ

It does sound like you have a symptom of TMJ Disorder. I’m going to list out some more symptoms because all of these different signs put together can help the dentist know what is the underlying cause of your TMJ disorder in able to find the most conservative solution for you.

Symptoms of TMJ Disorder

  • popping when chewing
  • Your jaw locks up
  • migraines, especially in the morning
  • pain in your jaw

Often, people develop TMJ from teeth grinding or clenching. They don’t even realize they are doing it because it more often happens at night while they are sleeping.

Some evidence if you are doing this is tooth pain (unrelated to decay) and worn down teeth. If you see a dentist regularly, they should be warning you if they see your teeth showing signs of wear.

Other times TMJ disorder is caused by a misaligned bite which has to be repaired by orthodontics, such as Invisalign.

Finding a TMJ Dentist

There isn’t a recognized specialty in TMJ so any general dentist can call themselves a TMJ Dentist. However, you want to make sure they have the necessary training to diagnose and treat you correctly. It does take an investment in post-doctoral training. There isn’t enough training for it in general dental school.

For instance, if you look at Dr. Hadgis’ TMJ Specialist page, you can see he did extensive training with the Las Vegas Institute of Advanced Dental Studies (LVI). There are other good schools as well, such as The Dawson Academy and the Kois Center.

It’s imperative they have invested in this. We’ve seen too many horror stories where dentists who didn’t have the requisite training, ended up destroying someone’s bite, causing them to need a full-mouth reconstruction.

This blog is brought to you by Grosse Pointe Dentist Dr. Theodore Hadgis.

TMJ Cure Hoax?

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My dentist is always promoting different cosmetic treatments. Every year he asks me if I want to whiten my teeth. I finally told him he was giving me a complex. I’ve always been happy with my teeth, but somehow he always makes me feel insecure. Yesterday when I was in there he asked how I was doing. I simply said, “Fine, except for a headache.” He instantly starts moving my jaw around and tells me I have TMJ Disorder and need a full mouth construction. He said his office will send me some information. This morning, I get an email, but the information consisted of nothing but a cost estimate. It’s actually more than I make in a year. I’m feeling like this has to be a hoax. Maybe he’s trying to raise money for some new equipment or something. Is this for real?

Meghan

Dear Meghan,

Illustration of how TMJ is affected by neuromuscular issues
There are many causes and solutions for TMJ Disorder

While TMJ Disorder is very real and some of the more severe cases require a full-mouth reconstruction, I feel like maybe your dentist can slow down a bit at do a more careful examination before prescribing one of the more invasive procedures.

Diagnosing TMJ takes a lot more than just moving someone’s jaw around. Because there are so many different things which can lead to this issue, dentists trained in TMJ will take the time to find the root cause and not just jump to a treatment option.

A full-mouth reconstruction requires putting a crown on every tooth in order to completely re-position your bite. Not only is this extremely invasive, it requires advanced training. It’s not something taught in dental school. I’m going to recommend you get a second opinion by a highly trained TMJ dentist.

Finding a TMJ Dentist

It’s imperative they’ve taken a significant amount of post-doctoral education. You’ll also want it to be TMJ specific training. One of the top schools for this type of education is the renowned “Las Vegas Institute for Advanced Dental Studies” (LVI). Dr. Hadgis has not only extensively studied there, he’s an LVI Fellow.

This is the type of dentist you want to look at your jaw. He or she will take the proper amount of time to diagnose the cause or causes of any TMJ symptoms you are suffering and then work up a reasonable treatment plan for your TMJ, which varies based on the cause.

Most dentists will start with the most conservative treatment unless there is a very good reason not to. For instance, one TMJ treatment option is just wearing an overnight splint device until the temporomandibular joint is in proper alignment.

This blog is brought to you by Grosse Pointe Woods Dentist Dr. Theodore Hadgis.

A Dentist for Face Pain?

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I’ve been to my doctor recently for headaches and pain to my face. It’s usually in my cheeks. I think my doctor has just given up because he told me to visit my dentist. I don’t want to waste money. Is this something you’d typically see a dentist about?

Laura

Dear Laura,

Diagram of TMJ

So, when you refer to face pain in your cheeks, are you talking specifically around the area of the side of your jaw where it opens and closes? If so, that could mean you are having TMJ problems and it would make total sense to see a dentist in that case. Persistent headaches can also be a symptom of TMJ Disorder.

I don’t think your doctor has given up as much as trying to determine if this is actually the problem instead of other medical problems. If he’s eliminated most of the common reasons for what is happening to you, the next steps would be very expensive neurological nerve exams and MRIs. He’s likely reaching for something less expensive to test.

Finding a TMJ Dentist

You want to find a dentist who is sort of a TMJ Specialist. While that isn’t a recognized specialty, there are dentists who have invested a great deal of time studying the causes and treatments of TMJ Disorder. They’ll be more qualified to help you and will be more likely to find solutions using the least invasive treatments available.

One thing I’d do is look for a dentist who specifically considers himself a TMJ Dentist or TMJ Specialist. They’ll often list they treat TMJ on their website (as Dr. Hadgis does), so you’d start by doing an internet search for those terms. It should pull up some dentists in your area.

Next, you’ll want to ask them where they did their TMJ Training. It should be a post-graduate school, not a general dental school. Three very reputable ones are:

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

There are others, but these are some of the top TMJ institutes in the country.

This blog is brought to you by Grosse Pointe Woods Dentist Dr. Theodore Hadgis.

Can I Change My Mind about Full-Mouth Reconstruction?

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I went to a dentist about jaw pain. He said I have TMJ and ordered a full-mouth reconstruction. He’s given me the temporaries, but nothing feels right. Is it too late to change my mind?

Annabelle

Dear Annabelle,

Jaw pain can be a sign of TMJ

I cringed after reading your question. I hate when I hear things like this. I’m curious as to why your dentist went straight to a full-mouth reconstruction. There are much more conservative treatments which should be tried first. The exception being that your case was extraordinarily bad. Based on your description above that didn’t seem to be the case.

If you’ve already received your temporaries that means your teeth have already been ground down. The only thing which can be placed on your teeth now are porcelain crowns. It’s too late to switch the procedure, but not too late to switch your dentist. In fact, if your temporaries aren’t fitting properly it might be prudent to find a more experienced TMJ dentist. A poorly done full mouth reconstruction can make your TMJ much worse.

Finding the Right TMJ Dentist to Fix This

I’d like you to get a consultation with a well trained TMJ specialist. Don’t confuse me saying specialist with a recognized specialty. There is not a TMJ specialty. However, there are dentists who invest a great deal of time in training in TMJ.

Do NOT hesitate to ask a dentist where they received their TMJ training. Dental school is not enough. There needs to be post-doctoral training involved. Here are some reputable institutes. He or she should list at least one of these:

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

They are the type of dentists who can give you a properly functioning smile.

You have another issue to consider. Obviously, functionality is of primary importance; however, we’re also talking about your smile here. It’s the first thing people notice about us and, right or wrong, we’re often judged by the condition of our teeth.

You’ll want an experienced and artistic cosmetic dentist. In your place, I’d want an AACD accredited dentist. These are the top cosmetic dentists in the country. They can guarantee you a gorgeous, natural looking smile.

I know it’s no short order to find an expert in TMJ who is also an accredited cosmetic dentist, but they do exist. Dr. Hadgis is one of them. You didn’t mention what area you’re from but you can look at the American Academy of Cosmetic Dentistry website to find them in your area.

This blog is brought to you by Grosse Pointe Woods Dentist Dr. Theodore Hadgis.

How Do You Find a Good Dentist?

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I’ve always had the same dentist. It’s the same dentist I had as a child. Now, he’s retired. I thought all dentists were like him, but I really can’t stand the new guy. Is there any practical procedure to follow in order to find a good dentist?

Betsy

Dear Betsy,

A woman giving a thumbs up from a dental chair

It’s hard losing a trusted caregiver. I think I can give you some direction here, but I want you to set your sites a little higher. I don’t want you to just get a good dentist. I want you to have the best dentist for your particular needs.

Finding the Best Dentist

The first thing you’ll want to ask is what type of services do you need. For instance, are you strictly a bread and butter patient, just needing the minimal general dental work, or are you someone who also likes to have cosmetic dental work done?

If you’re strictly looking for a nice general dentist who knows his job, then I’d simply look at some reviews of local dentists in your area. Google Reviews and Yelp! often have a large number of reviews. What you’re looking for is a flavor for their office. Are people happy with the service they received? Enough to write good reviews? Are they just complementing the hygienist and not also the dentist? Make sure both are pleasant.

If You Want a Cosmetic Dentist

In the case of a cosmetic dentist, there’s more to it. This is an art form. You want to make sure they’ve been vetted for their skill and their artistry. The easiest way to do that is to look at the American Academy of Cosmetic Dentistry’s site (aacd.com). Do a search for dentists in your area, but check that you want an accredited dentist. These are the top cosmetic dentists in the country.

They’ve been given stringent oral and written exams on their technical knowledge as well as demonstrated their artistry with a large number of cases.

If You Have Special Needs

Sometimes, you have a particular issue that you deal with regularly, such as TMJ disorder. In that case, you’ll also want to make sure the dentist you’re considering has the training necessary in that area as well.

This blog is brought to you by Grosse Pointe Woods Dentist Dr. Theodore Hadgis.