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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.

Bleeding Gums with Porcelain Veneers

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I got porcelain veneers for my birthday about 8 months ago. I was thrilled and like them. They’re way prettier than my regular teeth. I’m a little worried though. I just went in for my first check up since then and the hygienist said it looks like I’m developing gum disease. she said I need to kick up my oral hygiene. But, I don’t think that’s the problem. I’ve always been quite good with my brushing and flossing and never had a problem before. If anything, I’ve been even more diligent. I even purchased a special toothpaste I read about for porcelain veneers called Supersmile. Can porcelain veneers cause bleeding gums?

Katherine

Dear Katherine,

A single porcelain veneer being placed on a tooth

Porcelain veneers will not cause bleeding gums or gum disease. However, if you have a set of porcelain veneers which aren’t properly placed, that placement can contribute to gum issues.

Have you had your dentist look at their placement? It’s possible, if your dentist didn’t place them flush against your teeth, you have something termed “bulky margins”.

Bulky Margins with Porcelain Veneers

With bulky margins, it creates a tiny shelf on the top of the veneers. This traps food and other types of bacteria, leaving you quite vulnerable to decay.

Your dentist should be able to tell if that’s what is going on. If you suspect it is and your dentist is unwilling to admit it, then you can get a second opinion. Tell him or her what you’ve been experiencing with your gums and ask him to look at your veneers and give you his thoughts.

If it turns out you do have bulky margins, he can help you with your dentist. He either needs to repair them or re-do them. If he doesn’t, you will get gum disease, putting your teeth at risk.

In the meantime, get a water pick to help you get your veneers cleaned out as best you can.

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

Sleep Dentistry Versus Sedation Dentistry

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I’m looking at some type of help with my anxiety and dental appointments. I know what nitrous oxide does, but don’t think that will be enough in my particular situation. I’ve also read about sleep dentistry and sedation. What are some of the differences? Is one more effective than the other?

Cassidy

Dear Cassidy,

Woman asleep in dental chair from dental sedation
You can nap through your dental appointments with a sedation dentist

Sedation dentistry can refer to one of several different types of dental sedation, such as the Nitrous Oxide you mentioned above. Another specific type of sedation is Oral Conscious Sedation. This is sometimes dubbed sleep dentistry.

It is designed for patients just like you who need something stronger than nitrous. You will have a consultation with your dentist ahead of time. It’s important you bring all your medication to this appointment, even over-the-counter medication.

This is so your dentist knows what you are taking and doesn’t give you a sedation medication that will interfere with any of your current medications.

What to Expect with Sleep Dentistry

You’ll take a simple pill before your appointment. However, you’ll be so relaxed and drowsy you will need someone to drive you to and from your dental appointment.

You will likely sleep through your appointment, but you don’t have to if you don’t want to. When it’s over, your ride will drive you home. They’ll need to stay with you for at least a few hours after your appointment until the medicine wears off and you are more lucid and steady on your feet.

You can set up a little comfy area on your couch or bed and binge watch some of your favorite programs or just take an extended nap. Then, you’ll be good as new.

An additional benefit to this type of sedation is the amount of work your dentist is able to get done in each appointment. If you haven’t been to the dentist in a while, you may need more work than usual. This will allow you to consolidate your appointments., saving you time and money.

I hope this helps with your decision.

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

What Went Wrong with My Porcelain Veneers?

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I’m having a hard time with my smile “makeover”. I have always had short teeth which embarrassed me. I saw on Instagram that Kyle Richards (from Real Housewives of Beverly Hills) had a smile makeover done for the same problem. I did some checking and it turns out she had porcelain veneers done. I figured if it worked for her it would work for me too. It didn’t. Hers looks gorgeous. Mine looks weird. They’re super long and bulky. I’m even having problems speaking. I feel like I have donkey teeth. What went wrong? Can it be fixed?

Brianne

Dear Brianne,

A single porcelain veneer being placed on a tooth

Porcelain veneers are a great choice when you want to makeover your smile. When done well, you can get a stunning smile. For your particular problem, porcelain veneers will do wonders. They can lengthen, reshape, and whiten teeth simultaneously.

While the treatment you chose was spot on, it sounds like your choice of which dentist to do the procedure missed the mark a bit. That’s why her case resulted in a beautiful smile and yours did not.

Picking a Dentist for Porcelain Veneers

What many people don’t realize is that a smile makeover is an art form. Like any art, some will be more skilled than others in creating beautiful results. Smile makeovers aren’t taught in dental school. A dentist has to invest time and money in the training and practice of creating beautiful smiles after they graduate.

Because cosmetic dentistry isn’t a recognized specialty it’s quite difficult for patients to separate the skilled from the wannabes. Smile makeovers are a pricey procedure to take a risk on the dentist. That is one of the reasons the American Academy of Cosmetic Dentistry (AACD) began their accreditation program.

Dentists who wish to be accredited have to pass stringent oral and written exams. In addition, they have to provide visual evidence of a large number of cases they’ve recently done demonstrating their artistic ability. Those who reach accreditation are the best of the best.

For the dentist, this is a distinction. For the patient, it’s insurance. Getting a smile makeover from an AACD accredited cosmetic is a guaranteed beautiful smile.

Can Your Porcelain Veneers be Fixed?

Once veneers are bonded on it’s permanent. When you have a gorgeous result, that is a benefit. In your position, it makes things harder. The only way to “fix” this is to have it redone. You can tell your dentist that you don’t like the result and it’s so bulky you’re having trouble speaking. Ask for a refund. Then, go to an accredited dentist to get your smile redone properly.

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.

Another Porcelain Veneers Horror Story

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I had some misaligned teeth in the front when I smiled. It’s always been an embarrassment. I recently read that bad teeth can have a negative impact on your career. I decided it was time to invest in my smile and (hopefully) my career as well. I went to see a dentist who said he was a cosmetic dentist to get an idea of what to do. He suggested four porcelain veneers as they would take away the negative appearance but not require me to wear braces. Plus, it would be an instantaneous fix. It sounded great. So, I agreed. Unfortunately, it didn’t work out that way at all. The veneers seemed too small. All of them seemed to have a ridge at the top where I’m worried things will get trapped. On top of that, my teeth don’t match and everything still looks uneven. He also did some reshaping of bottom teeth which I didn’t ask for and charged me for it. I asked him what we needed to do to get the results he promised me and he said my teeth are in bad shape and need root canal treatments and crowns. I found this hard to believe so went to get a second opinion from another cosmetic dentist. He said the teeth are healthy and the only thing I need is to have the veneers re-done. What do I do now? I’m out A TON of money.

Ben

Dear Ben,

A single porcelain veneer being placed on a tooth

The first thing I’ll say is you should know that there isn’t a recognized specialty in cosmetic dentistry. That means any general dentist can call themselves a cosmetic dentist. To make matters worse, smile makeovers aren’t taught in dental school.

In order to be a skilled cosmetic dentist, the individual dentists need to seek out and invest in post-doctoral training in this skill. Plus, that doesn’t guarantee skill. Look at it this way. You can have 20 people taking an art course, but not all of them will do beautiful work. You want the dentist who is at the top of the class.

So, how is a patient to know? The American Academy of Cosmetic Dentistry (AACD) has an accreditation program for just this reason. If I were looking to improve my smile. I’d go to see an AACD accredited dentist.

When Your Porcelain Veneers are a Disaster

You have the right to a refund. I’d start by just outright asking the dentist. You have three things going for you in this:

  • He did work without your permission. This is a big no-no in the dental field and he can get in trouble. He is supposed to have your go ahead.
  • His work is faulty. With what you described the ridge on your teeth, it sounds like he gave you bulky margins by not getting the porcelain veneers flush. Your concern that things will get trapped there is valid. They will and it will lead to decay.
  • You have another dentist saying he lied to you and his work is subpar.

With these factors going for you, if he declines to give you a full refund I’d play hardball. However, be sure you get the other dentist to write out what’s wrong with your case and also that you did not need root canal treatments. Let the dentist know that if he doesn’t return your money you will be reporting him to the dental board as well as taking him to court. That should give him some pause.

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

4 Things to Consider Before Choosing a Sedation Dentist

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Someone mentions it’s time to go to the dentist. That’s when it starts. Your pulse quickens. Your palms sweat. All of a sudden you remember 1000 other things you can’t put off a day longer, so the dentist will have to wait. Sound familiar? If you rather do every chore you’ve put off for months than go to the dentist, then you likely suffer from dental anxiety.

person cowering behind a chair

There’s a Solution to Dental Anxiety

An easy solution for fearful dental patients is to see a sedation dentist. But, there are some considerations to make before choosing.

What Level of Dental Sedation is Right For You?

Most dentists do two different levels of sedation, though some will also add I.V. Sedation. The lower level, nitrous oxide is the easiest. It’s sometimes called laughing gas. It’s useful for those with mild anxiety. It puts them at ease and allows the anesthetic to do its job. The biggest benefit to this is once your procedure is done, they simply switch the gas to oxygen and you’re good to go home on your own.

Those with more extensive anxiety have better success with oral conscious sedation. This is a pill you’ll take before your appointment. It relaxes you so much that you’ll need someone to drive you to and from your appointment. You’ll feel a tad goofy, but you’ll certainly be happy. Some patients call this sleep dentistry because you’re able to sleep through your entire appointment.

Not every dentist offers oral conscious sedation, so if you have severe anxiety, you’ll need to make sure this is available to you.

Make Sure the Sedation Dentist has Specialized Training

Especially when it comes to things such as oral conscious sedation, your dentist needs to be trained in the administration of these medications and what emergency procedures to know. Ask about their sedation certification to make sure you’re in safe hands.

Your Sedation Dentist Must do a Consultation

Any legitimate sedation dentist will do a consultation with you ahead of time. Here they’ll go over your medical history. It’s important you tell them about all medications you’re taking, including over-the-counter. This way they can ensure you won’t receive anything that would interfere with what you’re currently using.

Check Their Expertise is in the Dental Area You Need

Each dentist has areas they excel at and treat. If you need a dentist who’s familiar with TMJ, make sure your sedation dentist has significant TMJ training. Alternately, if you’re after a smile makeover, be sure you’re dealing with an accredited cosmetic dentist. Otherwise. you could end up with a cosmetic dentistry horror story. There are many.

Follow these simple tips and you’ll have a lifetime of anxiety-free dental care.
This blog is brought to you by Grosse Pointe Woods Dentist Dr. Theodore Hadgis.

Dentist Refuses Porcelain Veneers for My Son

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I don’t understand why the dentist won’t let me get a porcelain veneer for my son. He fell and chipped his tooth. I don’t want to get a cheap solution because it’s his permanent tooth. My preference was to get a porcelain veneer because it would affect his tooth structureless. But, my doctor says that’s not a viable solution. Is that true? I really don’t want to get a crown on his tooth if I don’t have to because of how much healthy tooth he’ll lose. Do you know what the issue is?

Marion

Dear Marion,

A single porcelain veneer being placed on a tooth

Before we get into a viable solution I just want to make sure his dentist has seen him to check for nerve damage in his tooth. If that hasn’t been done, you’ll want to do it right away so appropriate steps have been taken. If, however, he’s been cleared and the main issue is the repair to the chip then great.

Porcelain Veneers for Chipped Teeth

It’s absolutely wonderful that you’re working to give your son the best treatment possible. It shows how much you care about him. While porcelain veneers can fix a chipped tooth, it’s not usually recommended for children. The bite and jaw are still growing and developing. This will require you to replace the veneers way more often than you’d want to, especially with how expensive they are.

While a crown can also “repair” a chipped tooth, you’re right, that is way too much healthy tooth structure to damage when there is a better option.

The Ideal Solution for a Chipped Tooth

Even in adults, we’d recommend dental bonding to replace the missing tooth structure. Yes, they could get porcelain veneers, but it’s generally considered an expensive overtreatment. The exception would be if they were already wanting a smile makeover. Then it would be killing two birds with one stone.

Tooth bonding is fairly simple for any skilled cosmetic dentist. The fact that your dentist didn’t bring it up tells me two things:

1. He’s not a skilled cosmetic dentist and probably doesn’t provide that procedure.
2. He’s not telling you all your options, which he is ethically obligated to do.

In your place, I’d simply look at mynewsmile.com to find a skilled cosmetic dentist in your area. The repair can be done in one procedure, freehand. Your son’s tooth will look perfectly natural. As he grows it can easily be replaced and is a fraction of the cost of other options.

This blog is brought to you by Dr. Theodore Hadgis.