A Collapsed Bite & TMJ

I have a problem with my smile that has gotten worse over the years. It is always hard to see my teeth, even when I smile. When I don’t smile it looks like inside my mouth is just a black hole. In recent months my jaw has started hurting. I do wear a nightguard because of some clenching and grinding I do. When I am wearing it, my jaw feels a bit better and you can see my smile. I spoke to my dentist about this and he said that he could provide me with porcelain veneers to improve the appearance of my smile. I just wanted to make sure this was my best option before moving forward.

Marilyn

Dear Marilyn,

It sounds to me like you are dealing with a combination of a collapsed bite along with TMJ Disorder. I am glad you are writing now instead of after you spent a fortune on a procedure which does not help. Your dentist may be well intentioned, but porcelain veneers will not solvoe your problem.

This will require advanced TMJ training so a dentist can build your bite back up properly with dental crowns. Make sure he or she does it first with provisional crowns. These are temporary and can be changed as necessary to get the crowns correct. Take that to mean they are comfortable, you like how they look, you can see your smile properly, and you have no trouble with speech as a result. Once the provisionals are correct, then your dentist can make the permanent crowns.

The dentist you choose will need advanced training in TMJ. There is not a TMJ specialty, so you’ll have to do some homework. Look at Dr. Goebel’s TMJ Credentials in order to get an idea of what you want from the dentist in that regard. Some other good training institutions, in addition to what Dr. Goebel has done are the Dawson Academy or the Las Vegas Institute for Advanced Dental Studies.

This blog is brought to you by Moline Dentist Dr. Thomas Goebel.

Do I REALLY Need to Replace This Dental Bridge?

I have a dental bridge on my lower right to replace a lost tooth. I initially thought about getting a dental implant but my dentist suggested the bridge would be less expensive. Now he is saying the one of the teeth holding the bridge is broken and I need to replace the entire unit. If I have no pain and no symptoms, do I really need to replace this? Is there another option?

Jeremy

Dear Jeremy,

You’ve brought up one of the many benefits of dental implants over a dental bridge. If an adjacent tooth to the replacement is damaged it has no impact on the dental implant. With a bridge, that is not the case. The only reason I can think of that he steered you toward a bridge instead is that he doesn’t have dental implant training and did not want you going somewhere else.

That being said, I am a bit sceptical of your dentist’s diagnosis here. You have no pain. If a tooth was broken, you would be very likely to have some pain, especially when you bite down. Generally, the solution to a broken or fractured tooth that can be saved is a dental crown, so why is this one suddenly damaged when it already has that protection. Plus, replacing the bridge would only be necessary if the tooth had to be extracted, which means you would now need a longer bridge. That is another crown on a healthy tooth, with even more strain on it.

I would not consider this a dental emergency especially since you do not have any symptoms. My recommendation is for you to get a second opinion before following through with this. Don’t tell Dentist B who Dentist A is or what he said. They may know each other and you don’t want Dentist B feeling pressured to not contradict his pal. Instead, just go and say, I am seeking a second opinion on the lower right side of my mouth. If he asks you what the previous diagnosis was or who the dentist was, just explain you don’t want to prejudice his diagnosis in any way and just want a blind second opinion. He or she should not have a problem with that.

This blog is brought to you by Moline Dentist Dr. Thomas Goebel.