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TMJ Treatment: Form AND Function

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I have a teeth grinding problem. My dentist said my teeth were too worn down and I needed crowns. Now, I’ve worn those down too. The problem I have is while my last crowns felt okay, they looked awful. I’ve been told you need a TMJ dentist to do the crowns, which is fine but is it possible to get crowns which also look beautiful?

Karyn

Dear Karyn,

Illustration of how TMJ is affected by neuromuscular issues

You haven’t been given adequate treatment. If your teeth grinding hasn’t been addressed, that means you will grind down these new crowns as well. It’s also why you’ve ground down the ones you have. A simple night guard would have protected both your teeth and your crowns, saving you a small fortune. While you will need new crowns, make sure you get a mouth guard as soon as they’re completed. You likely won’t need to replace your crowns for a long time with protection.

You don’t have to choose between a pain-free life with TMJ and having an attractive smile. However, it will require you finding the right dentist.

Finding a TMJ Dentist Who Can Do a Functional and Beautiful Smile

The first thing you need to find is a qualified TMJ Dentist. What you’re looking at is a full-mouth reconstruction with porcelain crowns. This requires advanced training and experience. For instance, Dr. Hadgis has done extensive post-graduate studies at the Las Vegas Institute for Advanced Dental Studies (LVI), including studies on full-mouth reconstruction.

That is the type of dentist you want. Don’t hesitate to ask for their qualifications. When this is done improperly, it can ruin your bite, leaving you in tremendous pain and costing tens of thousands of dollars to fix.

In addition to the technical know-how for the reconstruction, you’ll want an AACD accredited dentist. You’re talking about completely remaking your smile. The really great news about that is you can end up with a gorgeous smile. Expert cosmetic dentists can create any type of smile you want. So, while you’re researching your dentists, look at different smiles and see what is attractive to you. The dentist can help you with this too because he’ll know what will most compliment your facial shape.

Whatever you do, don’t go back to the dentist who did your last case. He or she has cost you unbelievable amounts of money and time unnecessarily.

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

Free Dental Sedation in 2019?

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I was told the law is changing in 2019 for dental sedation to be covered by insurance. If I have a tooth that’s bothering me, is it okay to wait until the sedation will be covered by insurance?

Kelly A.

Dear Kelly,

Woman asleep in dental chair from dental sedation

You should know each state has their own laws regarding dentistry and sedation. There is a change in the law regarding dental sedation on the books in California that is proposed. If it passes, it’s slated to take effect in 2019. However, it’s a long way from passing at the moment.

Currently in California anesthesia is only covered when the patient is in the hospital. A lot of patients who prefer to use anesthesia for treatment don’t really need a hospital (which naturally has a higher cost). The proposal re-words it to cover anesthesia in certain other medical settings as well. This could be a great help for patients with dental anxiety.

Don’t Wait on the Dental Sedation Law for Treatment

Woman grabbing her jaw with pain

It’s dangerous for you to hold off on dental care when you have a tooth in pain. Pain, in the dental sphere, usually represents an infection. If you put it off too long, you’ll have a dental emergency on your hands. Wait longer and you will have a life-threatening emergency on your hands.

Most people don’t realize how dangerous a dental infection can be. Your jaw is very close to both your heart and brain. If the infection reaches those areas, you can die. In fact, several people died just this last year due to waiting too long to deal with their teeth.

In other cases, the decay can become so invasive that you can’t save the tooth. That means a tooth extraction and expensive tooth replacements, such as dental implants.

Most dentists are compassionate. If you have dental issues that need addressing and don’t have the money, it usually only takes the willingness to talk to them about it. Often, they’ll offer payment plans. If for some reason you have a dentist who’s unwilling to work with you, you can either try another dentist or apply for Care Credit.

It’s a medical credit card which has low and even no-interest payments depending on your credit. There’s also no penalty for early payoff.

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

One Porcelain Veneer is Dull

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I had porcelain veneers done by a cosmetic dentist. I did like them but one of them had some kind of defect. I tried to live with it but finally admitted to my dentist it was bugging me and ruining the whole smile in my mind. He was very nice about it and said, “We can’t have that now, can we?” He told me to come on in and he’d fix it. He did something with a tool to buff it off. I was happy at first, but now it looks dull like the glaze is gone. Am I being too picky?

Brianne

Dear Brianne,

A porcelain veneers being placed on a tooth

You are NOT being too picky. And, even if you were, you paid to have a beautiful smile you love. If you don’t have that, then you’re not getting your money’s worth. I know you called your dentist a cosmetic dentist, but not everyone who bears the name also owns the skills. I’m starting to think your dentist is one that lacks the real skill he needs to do the job well.

First, he should never have been satisfied with a defective porcelain veneer. I don’t know why he thought that was a good idea. At least he was honest about it though. I also appreciate the fact that he tried to fix it for you. That shows integrity.

Unfortunately, what he is lacking is knowledge of what would actually repair that type of problem.

Polishing a Porcelain Veneer

You’ll want to fix this. If left as it is, it will begin to pick up stains rather quickly. Stains that teeth whitening can’t fix because it’s not natural tooth structure. The dull look means the glaze was taken off during his buffing. I don’t know what he used. What I’ll do is tell you how it should be fixed and you can show your dentist.

I’d like to suggest he use Brasseler’s Dialite porcelain polishing system. Using diamond polishing instruments and polishing paste it should help. He’ll need to finish the job with an ultra-fine diamond polishing paste.

If he does this you should have a beautiful porcelain veneer again in no time.

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

Can I Be Forced to Get TMJ Surgery?

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I’ve been having some significant pain in my jaw. I’ve done some research online (I know, don’t groan) and it looks like I have TMJ Disorder. From what I can tell, my choices for healing are jaw surgery or complete bite reconstruction. If I went to the doctor and it turns out I have TMJ can he force me to get surgery? I’m only 25 and don’t think I want that. I just want some medicine to help with the pain.

Madison

Dear Madison,

Illustration of how TMJ is affected by neuromuscular issues

I’m sorry you’re having jaw pain. Before anything else, I want to make sure you understand that while other countries, with national health care plans, can force you to have certain treatments or deny them if they so choose, we live in a country where a doctor can’t force you to get a certain procedure done without your consent. That would be illegal. You are a sentient human being with control over your body. Don’t be afraid to see a dentist to have your jaw pain examined.

Next, I want to assure you that there are many solutions to TMJ disorder. You’ve named the two most invasive. Let me assure you there are many other simple solutions to TMJ. The key is going to a dentist with the right TMJ training who can properly diagnose and treat you.

Finding a TMJ Dentist

There isn’t such a thing as a TMJ specialty. While some dentists call themselves TMJ Specialists, they should make it clear it’s not a recognized specialty from the American Dental Association. They really just mean that they’ve made additional effort to train and treat TMJ. So how do you know who is qualified?

Taking a look at Dr. Hadgis’ TMJ Specialist page should give you an idea of what type of training you want in a dentist who treats you for TMJ. This will protect you from some disastrous treatments. In many cases, TMJ can be treated simply. After you Google some TMJ dentists, check their training credentials against Dr. Hadgis’. If they don’t list any, don’t hesitate to call their office and ask. If they have a problem with the question, they’re not the practice for you.

If their training checks out, I’d go one step further and give a peek to their reviews. You want to make sure there treatment protocol is effective and they’re good with patients.

If it’s a TMJ Worst Case Scenario

If for some reason you do need a full mouth reconstruction, which should only be resorted to after all other less-invasive treatments have been exhausted, you want to make sure your dentist has an additional skill. On top of the reconstructive skill necessary to do such an advanced procedure, you also want to make sure they’re a skilled, artistic cosmetic dentist. These are usually done with porcelain crowns. You want your smile to be beautiful.

Ideally, you’ll want a dentist who’s reached accreditation level with the American Academy of Cosmetic Dentistry. AACD accredited dentists are the top cosmetic dentists in the world. It would be worth it to drive to another city to get one. If you can’t find one in a reasonable distance, check with the mynewsmile.com website. They have a “find a cosmetic dentist” link. You input your zip code and how far you’re willing to travel and they’ll recommend artistic cosmetic dentists that can give you a beautiful smile. In fact, all of them should have some form of a beautiful smile guarantee.

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

Unapproved Work While Under Sedation

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It took a lot for me to go see a dentist. I’ve had dental anxiety for a long time. But, I tried to put all that aside to get some work done. I opted for sedation because I thought it would make things go smoother, but while I was “under” my dentist did some work we hadn’t agreed to. Is he allowed to do that? I know the work needed to be done at some point, but shouldn’t he have my permission? I wasn’t planning on that big of a bill my first time back. One of the things he did was extract a tooth that I wanted to think about my options first.

Serenity.

Dear Serenity,

An image of someone's eye closed, maybe from sedation dentistry

Let me apologize on behalf of a colleague. That should never have happened. In fact, he can get in serious trouble for this. Dentists are never allowed to do work without getting express permission from the patient ahead of time. Here’s what I suggest you do:

First, call your dentist’s office and tell them you’ve consulted with another dentist and they informed you what he did was unethical. Either they give you the unapproved procedures free of charge or you go to the dental board.

Second, I don’t want you to allow this to scare you away from any further dental work. It was very brave of you to take the steps necessary to get your oral health care on track. Most sedation dentists are honest, compassionate people who use this as a means of helping patients with dental anxiety.

Obviously, for any further work, I don’t want you to go to this dentist. He can’t be trusted. However, you’re in the tough position of needing to have a tooth replaced as soon as possible. You didn’t mention where the tooth was he extracted or if he put in any type of temporary replacement.

Options for Replacing a Single Tooth

If your missing tooth is in a visible place when you smile, he should have at the least provided you with a dental flipper. This is an easy, temporary fake tooth so you won’t feel self-conscious about your missing tooth while you decide how to proceed.

Dental Implant
The top of the line replacement is a dental implant. This puts a prosthetic root into your jawbone then places a dental crown on the top. It’s like having a healthy, natural tooth in its place, but it does require surgery.

Dental Bridge
The next best option is a dental bridge. This is a false tooth suspended between two crowns. It makes more sense if the adjacent teeth already need work. Then, it’s like getting two procedures knocked out at once.

Best of luck to you.
This blog is brought to you by Dr. Theodore Hadgis.

Porcelain Versus Press-On Veneers

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I really wanted to get porcelain veneers but when I found out the cost I almost had a stroke. There’s no way I can afford that. But, I don’t want to live my life with stained teeth and a chip on my front tooth. I did some research and learned about something called Press-on Veneers. The company says they’re only a little over $1000. Is that a good alternative for people in my situation?

Lana C.

Dear Lana,

A porcelain veneers being placed on a tooth

It’s always disappointing when we’re looking forward to something we feel will improve our lives only to discover it’s out of reach. However, I wouldn’t use press-on veneers as a consolation procedure. You won’t be happy with the results. These are a bit like that procedure called Snap-on Smile, which fits over your teeth. Most people find them to be bulky looking.

When you have porcelain veneers done, you go to a dentist who’s invested a great deal of money and time into learning the artistry involved in creating stunning smiles. First, they’ll usually go over with you the type of smile you want. Do you want to look more youthful? More authoritative? Sporty? All of those require different design strategies. Plus, there’s your facial structure and skin tone to factor into the design. They’re custom designed for you then permanently bonded on.

With Press-on Veneers, you take the impression of your teeth and send it in. It often takes dental assistants years to get the proper technique of impressions correct. If yours are off even a tiny bit, it will affect how your press-on Veneers turn out. Plus, they’re removable and don’t last very long.

Great Alternatives for you to Porcelain Veneers

I have good news for you. You can fix those areas of your smile, and for a fraction of the cost of the press-on veneers. Porcelain veneers are phenomenal if you want a total smile makeover, that includes changing even the shape and size of your teeth, not just their color. Because you’re talking about staining and a chipped tooth, two affordable procedures will give you much better and natural looking results than the press-on Veneers.

  • Teeth Whitening—This is the most affordable way to remake your smile and will take years off of your appearance.
  • Dental Bonding—This is the standard solution for a chipped tooth. It uses a composite resin which the dentist sculpts onto your tooth.

This will save you money and give you a much more permanent solution to your smile.

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

Lumineers for Collapsed Bite? No!

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I told my dentist that I was embarrassed by my smile. You can never see my upper teeth. It’s even difficult to see them when I smile. I also have trouble talking in cold weather. He said I have a collapsed bite and that he just got certified in Lumineers and could fix my smile. I was wondering if I should be concerned about the bite as well as the appearance? What do you think? A “second opinion” never hurts, right?

Amy L.

Dear Amy,

A chart illustrating the relation of muscles, joints, and teeth with TMJ Disorder

I am so glad you wrote for a second opinion. Do not go further with this treatment! Your dentist means well but doesn’t know what he’s talking about in this case. An open bite is very complicated and usually requires a full-mouth reconstruction with dental crowns. Even then, it has to be done by a dentist with significant TMJ Disorder Training.

I sincerely doubt your dentist has this based on his treatment suggestion. Also, so you know, getting certified to place Lumineers does not make someone an expert cosmetic dentist. They’re marketed to inexperienced cosmetic dentists and only have to participate in a short seminar to become certified.

Treating Severe TMJ with a Full-Mouth Reconstruction

The first huge issue is finding the right TMJ dentist. You need a dentist with advanced training. Look for someone who’s completed training at one of the following:

  • L.D. Pankey Institute in Florida
  • The Dawson Academy in Florida
  • The Las Vegas Institute for Advanced Dental Studies in Nevada

There are some others, but these are very reputable and give superb training in restorative dentistry. There are too many horror stories of patients whose bites have been completely destroyed by dentists without the right training.

Next, make sure they do a provisional reconstruction first. When that’s perfect, then they can copy what they did for a provisional. By perfect, I mean that you love the appearance, your speech comes easily and naturally, and you can see your upper teeth as you would with a normal bite.

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

Did My New Sedation Dentist Do Something Wrong?

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I’m a little concerned I was given something dangerous and don’t know what to do. I have a highly visible career and take great care of my teeth. I have had to have a few dental procedures that required dental sedation over they have always gone fine. I received a promotion that required a transfer which meant switching dentists. I needed another procedure which required sedation again. I wasn’t worried because it has always been a breeze before. This time, when I got home a couple of things happened which really scared me. The procedure itself went fine, but when I got home I became nauseated. I was trying to get to the couch when I had what I only guess what is a panic attack. My heart started racing. I started shaking all over. I had to lay on the floor I thought I was going to pass out. Eventually, it passed but I had no idea what to do. Should I have called 911 or just let it pass as I did? Do you know what went wrong? I’ve never had that happen.

Name Withheld

Dear Anonymous,

An image of someone's eye closed, maybe from sedation dentistry

My first concern is that you seem to have been alone after your sedation procedure. Generally, a dentist will make sure you have someone to drive you home and stay with you throughout the day. That’s mostly because it makes you loopy and a tad unsteady on your feet. Your dentist will want to be certain you’re not in danger of taking a tumble by being on your own.

The next thing to do is figure out what was different this time. You said it’s a different dentist than you’ve seen in the past. One thing to consider is he uses a different sedation medication that your last dentist used. This could be why your body reacted differently. It may be that this isn’t the best medicine for you. Have your new dentist call your old dentist to see if what medicine he used that you did fine with. If it’s different than what your new dentist used, he should definitely be willing to switch to the medication you don’t have a negative reaction to.

If it’s the same medication, which I doubt, you’ll want to double check to see if there is any new medication you’ve started since your last sedation dental procedure that you may have taken this time around. Even over-the-counter medication can affect how your sedation works.

What to do When Something Goes Wrong

I don’t think what happened was a panic attack. Dental sedation is an anti-anxiety medication. It has the opposite effect. Sedation is generally very safe. However, our bodies are still mysteries in many ways. We don’t know why reactions happen. If this were to happen again you need to have whoever is staying with you call 911 right away. Then they need to call your dentist.

Never just try to wait it out. If you’d have stopped breathing and lost consciousness you could have died. Or maybe you ended up in cardiac arrest.

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

Why Is One Veneer Darker than the Others?

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I got four porcelain veneers. They’re okay. They’re not quite as “Wow!” as I was expecting and they seem to look in all the pictures of them. I’ve got a few things bugging me and making me embarrassed about smiling. First, they don’t match my teeth. I didn’t want them to look exactly like my teeth otherwise what’s the point of porcelain veneers anyway. But, my regular teeth show on either side of them, so I wish they blended better. Next, one of them is darker than the rest of them. That means I now have three different colored teeth. What do I do? Do you know why this one veneer is darker?

Lindsey K.

Dear Lindsey,

A porcelain veneers being placed on a tooth

Based on what you’ve described above, I think the biggest hurdle you’re facing is the dentist you’ve chosen to place them. Many people, out of a mistaken sense of loyalty, think they have to go to their family dentist for their cosmetic work too. Not only is that not necessary, it’s usually a disaster unless their family dentist has invested a lot of time training in cosmetic procedures. Your dentist hasn’t. Here’s how I know that.

1. He only placed four porcelain veneers on your teeth. Even the tiniest of smiles is wider than four teeth. Normally, you’d place double that. For wide smiles, you’d place even more.

2. At the very least, he should have whitened your entire smile, before placing only four veneers, so there’d be at least a chance of them blending with your natural, yet still visible, teeth.

3. The darkening of the single veneer. That’s probably a sign that he didn’t bond the veneer on properly, which allows food and other things to get between the veneer and your tooth. This makes the veneer appear darker.

Unfortunately, the only way to fix this is to have the case re-done. In your place, I’d ask for a refund from your dentist. You’re obviously unsatisfied with the quality of the work and a lot of it was done improperly.

Then, when you go to have it re-done, make sure you get a skilled and artistic cosmetic dentist. The easiest way to find one of those is to look for a dentist who’s reached accreditation level with the American Academy of Cosmetic Dentistry (AACD). An AACD accredited dentist can give you a stunning smile.

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

TMJ Scam?

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I’ve been having horrible jaw pain in the mornings, along with headaches. I looked up some of my symptoms and it sounds like the problem could be TMJ related. I mentioned it to my sister-in-law. She thinks the whole thing is a scam made up by dentists and that a simple whole foods diet will take care of my problem. She’s really big on the whole foods thing anyway, so I’m not sure how much I buy into her idea. I noticed you treat TMJ. What type of success do you have in helping patients with it?

Laurie M.

Dear Laurie,

Woman grabbing her jaw with pain

Many things can be fixed by a whole foods diet, but TMJ isn’t one of them. In fact, it can exacerbate the problem. Consider you’re having jaw pain, then you start chomping down on a carrot. It will likely make the pain worse from the strain.

Sometimes TMJ can be tricky to solve, but it can be solved. It’s a matter of figuring out the source of the problem, not merely treating symptoms. You mentioned that your jaw pain is worse in the morning and you have headaches. That is usually a symptom of TMJ.

In fact, it sounds like you probably grind your teeth at night. You wouldn’t realize you were doing it because it happens in your sleep. But, an astute dentist would be on the lookout for that and inform you that your teeth are ground down.

A simple mouth guard can be custom designed for you by your dentist. Make sure he’s done extensive TMJ studies as a post-graduate. If not, you may be better served to visit another dentist just for this issue.

Depending on how ground down your teeth are, you may find you need some crowns, but if you’re catching it early enough, you could be fine.

Let untreated, this can lead not only to severe migraines but lockjaw and broken teeth, which you’ll need to completely replace.

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