Are Crowns a Good Treatment Plan for TMJ Disorder?
I’ve been wearing a splint for TMJ Disorder and it has been helping. The symptoms have eased a bit when I wear them. Now my dentist is suggesting that he crown several of my back teeth. He says that it could completely alleviate my TMJ symptoms. Is this a normal treatment for TMJ? It sounds a bit over the top for me. There’s nothing physically wrong with those teeth. No decay or infections.
Amanda
Dear Amanda.
Yes, while it may sound extreme. it is a very legitimate way to treat TMJ Disorder. Your teeth don’t have to have decay or have an infection in order to throw off your temporomandibular joint, which is the one that leads to TMJ problems. Having crowns placed correctly, can reposition your bite properly so that you no longer have TMJ pain. In some cases, when a bite is off severely, a dentist will actually crown all of the teeth. This is known as a full-mouth reconstruction.
While it is a legitimate treatment, you have to be careful who does it. There is not a recognized specialty in treating TMJ. Yet, in order to do it correctly, a dentist will need significant post-doctoral training in order to treat it properly. While it sounds like your dentist has some experience with treating TMJ based on the splint, I would still double check the training.
You’d want someone who has training from one of these institutions for post-doctoral training:
- Spear Education in Scottsdale, Arizona
- The Pankey Institute in Key Biscayne, Florida
- The Dawson Academy, with headquarters in Florida but training centers in various states
- The Las Vegas Institute for Advanced Dental Studies in Las Vegas, Nevada
- Piper Education and Research Center in Tampa, Florida
If they have training from one of these institutions, you will be in good hands.
This blog is brought to you by an understanding dentist in Moline, Dr. Thomas Goebel.
Porcelain Veneers Led to Root Canal Treatments
I had a smile makeover done with veneer crowns. Ten teeth on top and ten on the bottom. After the permanent veneer crowns were put on, I started having some problems. In the first four weeks, I’ve had three teeth have sharp pains. He tried adjusting them, but that didn’t help. He did some x-rays and told me that I have nerve damage and will need root canals. First, he never told me that nerve damage was a possibility. I asked him about that and he said that it is rare and I’m just one of the “unlucky” ones. Now, I’ve had two more teeth start to bother me. I’ve already paid for all of this and now I’m having to pay for root canals too. Should he offer to pay for some of this?
Angie
Dear Angie,
I am sorry that you’ve had this experience. I want to start by clearing up some terms to make sure we are talking about the same thing. You keep saying veneer crowns. There are porcelain veneers and there are porcelain crowns, but there are not veneer crowns. The big difference between the two is the amount of tooth preparation that has to be done.
With porcelain veneers, hardly any tooth structure needs to be removed. In part, that is why nerve damage would be extremely rare. I’m thinking with the amount of damage and root canals you ended up needing, I suspect you were given dental crowns. With dental crowns, much more of your tooth structure is removed as you can see in the image above. This would have a greater risk for nerve damage. However, even then it would take some aggressive shaving of the tooth to do the kind of damage you are talking about.
The fact that he gave you crowns also concerns me. The standard procedure for a smile makeover is porcelain veneers. Do you know why your dentist gave you crowns? Did your teeth already have crowns? Unless you needed crowns, doing them for a smile makeover is an overtreatment. Though, sometimes, dentists who don’t really do a lot of cosmetic work, will suggest them simply because they don’t know how to do veneers.
I would ask him to pay for the root canal treatments. You wouldn’t have nerve damage without his procedure unless there is something else you didn’t mention that would reflect on this situation.
This blog is brought to you by Moline Dentist Dr. Thomas Goebel.
Dentist Lied to Me About Porcelain Veneers
I went to a dentist to get porcelain veneers. It’s not my normal dentist who said he doesn’t do a lot of cosmetic dentistry and I’d be better off with someone else for this procedure. I appreciated his honesty. If only all dentists were as honest. The dentist I went to told me he was giving me porcelain veneers. I have texts and emails to that effect. I should have been suspicious when he ground down my teeth and gave me temporary “veneers.” Unfortunately, I continued to trust him. I had two teeth that had already had root canals. One of them ended up getting infected after my procedure. It started bothering me a few days after it was placed, which the dentist assured me was normal and would rectify itself. The pain became so intense that I ended up in the hospital and they had to extract the tooth in order to save my life. The infection had spread and was close to my brain. The hospital also told me that I did not have veneers but crowns. I looked at my texts again. They definitely said veneers. I also looked at their website, which does explain the difference between crowns and veneers. I went to see another dentist after this and he said they are definitely crowns and that the dentist over prepared my teeth, which is why I’m having problems. I feel so angry. Is there any way to get my money back on this so I can get veneers?
Catherine
Dear Catherine,
I am sorry this happened to you. Unfortunately, now that you have had crowns placed on your teeth, there is no way to unring that bell and get veneers. The tooth structure cannot be regrown. As you can see from the difference in tooth preparation, porcelain crowns require much more tooth preparation. Based on your description, it sounds like the dentist you went to was even more aggressive.
While you cannot get porcelain veneers, you can get your money back. In fact, I think you have a decent case for a lawsuit, but that is a lot of time and trouble. A basic tenant of dentistry is informed consent. You gave consent for porcelain veneers. He gave you a completely different procedure altogether. I would start by just asking the dentist for a refund. Let him know that you understand the strength of your position and are willing to go to court, but wanted to give him the chance to do the right thing.
The fact that his website shows that he knows the difference between the two procedures works in your favor.
This blog is brought to you by Moline Dentist Dr. Thomas Goebel.
Same Day Crowns on Front Teeth
I broke a front tooth and was hoping to get one of those same day CEREC crowns. My dentist said that it is a bad idea and wants me to do a traditional crown. Should I get a referral to a dentist who would do the CEREC crown for me or stick with the traditional?
Emily
Dear Emily,
CEREC crowns are wonderful ways to get a dental crown in just one appointment. However, I would not recommend them for a front tooth. Teeth have a variety of opacities throughout their structure. Parts of them will be more translucent. Same day crowns are milled from a single block of porcelain, which means the crown will be uniform throughout. When dealing with a tooth that is not on a front tooth, it will look fine. However, front teeth are a different story. They are exposed directly to the light, which means it will be obvious you have a single block of porcelain.
If you instead had it done with a traditional porcelain crown, the ceramist could use a variety of porcelains which would mimic the variety of the tooth structure. Even then, your dentist will likely have to do several try ins before he gets it to match the adjacent teeth. This would be a normal procedure for front teeth. Make sure your dentist uses a temporary try-in paste and will redo the porcelain crown until it matches perfectly.
It sounds to me that your dentist is trying to protect you from a disappointing result. I’d go with his recommendation.
This blog is brought to you by Moline Dentist Dr. Thomas Goebel.
Mouthwash for Porcelain Veneers
I have some porcelain veneers that I really love. I want to take the best care of them that I can. I’ve made a homemade mouth wash and just want to make sure there is nothing in it that can hurt the veneers.
My recipe is essentially equal parts of filtered water and hydrogen peroxide and some sea salt. As an example, last night I mixed:
4 oz. filtered water
4 oz. 3% hydrogen peroxide
1 T. sea salt
Will this work for me?
Karen
Dear Karen,
I am glad you love your porcelain veneers. There are many patients that end up with a cosmetic dentistry horror story because their dentist did not have the artistic ability to create a beautiful smile. Thankfully, yours did. It is also commendable that you are tying your best to take care of them. Though, I wish your dentist would have given you a list of instructions to do this.
The only problem with your DIY mouthwash is the peroxide. While peroxide is great at killing bacteria, it does not distinguish between good and bad bacteria. The good news is that your mouthwash will not damage your porcelain veneers. Unfortunately, what it will do is create an environment to that will breed candida albicans, a type of yeast. As a result, you will end up with some nasty thrush.
If you really want to use a mouthwash, there are some good over-the-counter mouthwashes. The one thing that you want to avoid is a mouthwash that contains alcohol. This is because it will eventually wear out the bonding that holds your porcelain veneers in place.
While we are on the topic of taking care of your porcelain veneers, I want to suggest you use Supersmile toothpaste. This is specifically designed to safely care for cosmetic dental work and keep them stain free. This includes things like porcelain crowns and dental bonding.
This blog is brought to you by Moline Dentist Dr. Thomas Goebel.
Rules for Touching Up Teeth Whitening
I’m looking to touch up my smile ahead of my upcoming dental crown placement. However, I’m having trouble getting information from my dentist on how to go about this. My specific questions are mostly in regard to how long I have to whiten, such as how many hours per day and how many days/weeks to plan.
Fannie
Dear Fannie,
I’m a bit concerned that your dentist cannot answer these questions. These are pretty basic cosmetic questions. Much more basic that making a dental crown blend in naturally to the adjacent teeth.
While there isn’t an definitive number of hours and days I can give you, there are general principles. The first of which being that the longer you wear the teeth whitening gel each day, the faster your teeth will whiten. For example, if you wear them for five hours a day, your teeth will whiten much faster than if you just whitened for 30 minutes a day.
If you are in a hurry, the most effective way to do it would be to wear the teeth whitening trays over night. This is not only because the gel will be on your teeth longer, but also because we produce less saliva at night. If that is not possible for you, then just wear them for as long as you can tolerate throughout the day. Another speedy option is Zoom Whitening. It is an in-office teeth whitening procedure that will whiten your teeth in just one appointment.
The one definitive is something you did not ask. That is how long you need to wait between the time you finish your whitening and when you can get your dental crown made. Your teeth will continue whitening for up to two weeks after you complete your procedure. After that, you will be safe to have your dental crown done.
This blog is brought to you by Moline Dentist Dr. Thomas Goebel.
How to Get a Refund Because of a Dental Mistake
I had a crown put on one of my teeth because it was a slightly slanted tooth. A few weeks after the crown was placed, I noticed that I started having sensitivity to hot and cold. I called the dentist’s office and he said that those sensitivities are normal the first few weeks. I was a bit confused about that because it had not happened before that, but decided to trust him. A few months later, it was hurting so much that I went to the E.R. They told me I needed to see a dentist. The next morning my cheek was completely swelled. I called a dentist who could see me the very next day. This dentist told me the tooth was severely infected and I needed to have a root canal treatment done. I was shocked and asked how it got infected with a dental crown on it and she told me the margins were open and showed it to me on the x-ray. When I called the original dentist, thinking that they should pay for my root canal treatment, they blamed me for not taking care of the crown. Is there any way I can get my money back from this dentist because I’m obviously going to have to pay for this root canal treatment?
Brooke
Dear Brooke,
I am sorry that this happened to you. Your dentist violated the standard of care and that led to you having a dental emergency. Even worse, they refuse to take responsibility. A dentist is supposed to run an explorer around the margins of the dental crown to make sure it is fitted correctly. Otherwise, they risk what happened to you.
The good news is that you have another dentist telling you that your crown was done incorrectly and has x-ray proof to help with that. Unfortunately, the amount you would get generally isn’t worth the expense of a malpractice suit. That being said, there are some things you can do that will increase your chances of a dental refund.
First, I would threaten to complain to the dental board. I don’t know a dentist who would be thrilled at that prospect, especially when you have documentation. Second, threaten to call your insurance company and tell them about the shoddy work. A third option is to ask the dentist who helped you during your dental emergency to speak to your dentist. Sometimes, they are more willing to give a refund so as to not look bad in front of their peers. Finally, you could ask a lawyer to write a threatening letter on official letterhead. It will not cost you as much as a court case and can produce results because the dentist thinks you are willing to go to court.
This blog is brought to you by Moline Dentist Dr. Thomas Goebel.
Can Teeth Be Too Bleached for Dental Work?
I whiten my teeth every other year because I like a very white smile. This year, I was in an accident that damaged a tooth and now I need a dental crown. My dentist cannot seem to find a crown shade white enough to match my teeth. He told me he is using the whitest color, but it is markedly darker than the rest of my teeth. What do I do?
Candice
Dear Candice,
I have some good news for you. It is definitely possible for you to get a porcelain crown that matches your white teeth. However, you may have to do it with a different dentist. Here is why.
Dentists use a shade guide to match dental work to your teeth. Above was the standard shade guide for many years. I’m willing to bet your dentist is still working from this shade guide. This served dentists very well until about the 1990s, when teeth whitening exploded in popularity.
Once people started whitening their teeth, the shade guide no longer had shades white enough for these patients. Dentists who did a lot of cosmetic work recognized this was an issue that needed to be addressed. As a result, the shade guides developed an extention for dentists who did cosmetic work. Here is an image of that below:
As you can see, this has much whiter options. I’m also willing to bet your dentist does not do a lot of cosmetic work in his office. He probably does not have this shade guide. I think you will be better served if you went to a dentist who has the tools required to give you a natural looking result. This is especially true with a tooth that is visible when you smile. A flat shade, is not going to be enough. In order to have the variance of translucency that a natural tooth has, your dentist will have to provide a color map with various creams and tints to truly mimic your other teeth. I don’t think your current dentist will know how to do this.
Look for a dentist who does regular cosmetic work and you should be able to get the dental crown you need.
This blog is brought to you by Moline Dentist Dr. Thomas Goebel.
Her porcelain veneers keep falling off, but are they really veneers?
Last December, my dentist ground down my upper front teeth for porcelain veneers. Although I’ve had this dentist since 2008, I regret trusting him for the work. And after researching online, he probably should not have recommended veneers for the issues with my teeth. Two teeth had slight chips, and one tooth was shorter than the other. I also wanted whiter teeth.
After my dentist reduced my teeth to stumps, I wore temporary veneers for almost three weeks. Then he bonded on the permanent veneers. In less than a month, a veneer popped off. My dentist is so kind that he asked me to come into the office the same day that I called, and he bonded the veneer on again. But again, in less than a month, another veneer popped off. My dentist says that he doesn’t know why the veneers are coming off. He asked me if I wear my night guard every night because grinding my teeth could be weakening the veneers. Of course, I wear my night guard, and I don’t believe that this issue is my fault. I noticed that when I slide my tongue across the backside of some of the veneers, I feel a ledge on them. Those veneers seem to come off more frequently.
Two weeks ago, a dental assistant called from my dentist’s office and said that my dentist wants me to come in so he can try something else to keep my veneers on. It sounds like he is guessing about the problem. I can tell that another veneer is loose and will come off soon, but I am nervous about returning to my dentist. Although he is kind, I know that kindness cannot correct this issue. Before I agreed to veneers, he told me that veneers would last 15 to 20 years, but if I must return to the dental office every month for the next 20 years, it is not worth it.
Why can’t my dentist figure out why the veneers are popping off? Will another dentist eventually need to remove them and give me crowns instead? Thank you. Tanya from Springfield, MO
Tanya,
Thank you for asking us about your cosmetic dentistry nightmare. We are sorry to hear about the anxiety and frustration your dentist is causing. Although Dr. Goebel would have needed to examine your teeth before your dentist ground them down, it is possible that teeth whitening and composite bonding would have revived your smile.
Based on your description, your dentist might be liable for malpractice. We have several concerns.
You Received Porcelain Crowns, Not Veneers
Unfortunately, some dentists tell their patients that they are receiving porcelain veneers, but the dentist gives them crowns instead. If your dentist ground your teeth down to stumps, that form of tooth preparation says that you received porcelain crowns—not veneers. Please consider these facts:
- A dentist removes only a half-millimeter or less of tooth enamel to prepare teeth for porcelain veneers, but your teeth are now stumps.
- Porcelain veneers are bonded to the front of your teeth only, and they will not adhere to teeth that a dentist reduces to stumps.
- You will not feel a ledge on the backside of a veneer, because the back of it is bonded to your tooth.
- You may feel a ledge on a dental crown’s backside if there is a problem with it.
Unfortunately, the facts show that you received dental crowns, but they are problematic because they keep popping off.
Why Do Porcelain Veneers and Crowns Keep Coming Off?
Porcelain veneers and crowns can come off due to over-preparation and incorrect bonding techniques.
- Over-preparation for veneers – Only a fraction of a millimeter of tooth enamel must be removed to ensure veneers fit well on the tooth and at the gumline. Too much preparation causes loose veneers that fall off.
- Over-preparation for crowns – Although your teeth must be shaved on all sides for a crown to fit over it, aggressive preparation results in a short, stubby tooth. And the crown is left with minimal tooth structure to adhere to (retention form), so it will loosen and come off.
- Bonding techniques – A dentist must apply enough bonding material for a secure attachment and remove any excess bonding material between your tooth and the restoration. And the composite bonding must be cured properly for porcelain veneers.
When Your Dentist Did the Wrong Dental Treatment
If your dentist does the wrong dental treatment, they are responsible for correcting it or compensating you to have another dentist fix it. You agreed to porcelain veneers, but your dentist gave you crowns. The results from your crowns make it clear that your dentist does not have the skill to do either veneers or crowns.
- Proper restoration – We believe that your dentist is responsible for paying to have your teeth restored correctly by an advanced cosmetic dentist who knows what they are doing.
- Future problems – Your dentist should also be willing to compensate you for issues you can experience in the future from excessive tooth preparation.
How to Get a Refund from Your Dentist
You can get a refund from your dentist by explaining that you did not receive the agreed-upon cosmetic treatment. If your dentist resists, you can inform him that you will report the issue to the state dental board. And follow through.
But first, we recommend that you find a dentist with advanced cosmetic dentistry training and experience. You can schedule consultations with two dentists to examine your teeth and discuss your options. After you select a cosmetic dentist, you can talk to your current dentist and ask for compensation. And your new cosmetic dentist may be willing to provide documentation and help you request a refund.
Dentists have malpractice insurance, so hopefully, your current dentist will agree to pay for your dental care. If you need to hire an attorney, the judge or arbitrator will likely grant you a substantial award.
Unfortunately, your dentist prepared your teeth so aggressively that you will still need dental crowns. Porcelain veneers will not stay on teeth that a dentist ground down to tiny stumps. But a skilled cosmetic dentist can recreate your smile with dental crowns and make it look beautiful and natural.
Best wishes.
Dr. Thomas J. Goebel, a cosmetic dentist in Moline, IL, sponsors this post.