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Should She Go Through With This Full-Mouth Reconstruction

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I had been grinding my teeth for years without noticing or having a dentist tell me. I recently moved and my new dentist was very concerned about the condition of my teeth. Some of them in the back were tiny nubs. She asked me some questions and believes I have TMJ Disorder. It made sense as she talked about the symptoms and would explain a lot about things I am going through. She suggested a full-mouth reconstruction. The bottom is done. It was a highly emotional experience for me and one I am not sure I want to go through again for the top arch. I chose a color that was darker than my dentist suggested, but now that it is done, I feel it is still too dark. I also miss the unique defects in my smile that I felt made me…me. These bottom teeth are just oo perfect. Do I have to finish the full mouth reconstruction? My dentist thinks it will do more damage to my bite if I don’t and she thinks the upper teeth being so much smaller and darker than the lower teeth will look odd. She is leaving it up to me and said, she’s given her thoughts and will not pressure me to conform to them. I’m paralyzed with the fear I’ll make the wrong decision. Do you have a recommendation?

Carol

Dear Carol,

I am sorry this has been so difficult for you. Up front, I want to make sure you understand that because I haven’t examined you or seen any of the diagnostics, anything I tell you will be based soley on what you said.

it sounds like the things that concerned you were 1. The color wasn’t what you were hoping for. 2. The teeth were too perfect looking and lost its quirks.

The color would be hard to change unless you had the dentist do them again, but if it is the color you picked you’d have to pay for them again. As for the quirkiness. You can get that easily…as long as you get the right dentist. Expert cosmetic dentists would likely trample over one another for an opportunity to design a smile with some character. Most patients just want the perfect Hollywood smile. Your request would put them in heaven.

While you could leave things as they are I have some concerns. You do not want to leave a full mouth reconstruction half done without a good reason. This is expecially true when you are already dealing with TMJ Disorder. Plus, the ceramics on the bottom teeth will damagae natural tooth structure as they butt up against on another. My suggestion is to complete the reconstruction but do it with a dentist who has the skills to create the look you want. They will need expert cosmetic training as well as advanced restonstructive training. It’s a tall order, but they do exist.

This blog is brought to you by Duluth, GA Dentist Dr. David Marion.

Dentist Wants to Crown Every Tooth Because My Bite Is Off

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I had braces in my younger years and always thought my bite was fine. I’m now a 40+ year old professional and my dentist said my bite is “off” and he wants to fix it by crowning all of my teeth. I am not too keen on the idea of capping a bunch of healthy teeth. Are there other options?

Adrian

Dear Adrian,

TMJ Diagram of joint

I am very glad you wrote. I’m concerned about your dentist’s diagnosis and treatment recommendation. Did you go in because you were in serious pain or did he just say your bite was off without you asking about it? The thing is, everyone’s bite is off to some extent or another.

A full mouth reconstruction, which is what crowning all of your teeth is called, is a major reconstruction. The only reason to do that is if you were dealing with major functional problems. You didn’t mention that. In fact, you started by saying you thought your bite was fine. A full-mouth reconstruction will cost you upwards of $30,000 or more. Not to mention the danger of your dentist doing it wrong and causing serious problems.

A serious bite problem can lead to TMJ disorder and this is my concern here. You don’t seem to have any reason to need this treatment. Yet, your dentist is suggesting it. It’s quite invasive and takes very advanced training. Going to dental school is not enough to do this properly. I would only allow a dentist with a significant amount of post-doctoral training in TMJ and Occlusion to do this procedure.

Before you step into this, I would suggest getting a second opinion from a dentist with this training. Look for someone who has studied at the Pankey Institute or the Las Vegas Institute of Advanced Dental Studies. Then, if you do need it, you will have a dentist who can do it without completely destroying your bite.

To be honest, I don’t think you are going to need this at all. Let’s say you are developing a TMJ issue. There are much less invasive options before you have to jump to the reconstruction option.

This blog is brought to you by Duluth, GA Dentist Dr. David Marion.

Can Diabetes Cause TMJ Disorder?

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I’d been having jaw pain for a while and went to see my dentist. He felt it was TMJ and we were working on solutions. First, he gave me a nightguard. That didn’t stop the pain. Next, he adjusted my bite, shaving some teeth and building up others. That cost me quite a bit of money. Again, no change in the pain. He told me to give it time. I gave it a couple of months and still no change in the pain so I went back. Now he saying that my TMJ Disorder is a result of my diabetes and there is nothing that can be done about it. The best I can do is take ibuprofen to manage the pain. Here are my questions. First, can diabetes even cause this problem? Second, if he knew that, why did he cost me all that money with treatments that he knew would not work?

Caroline

Dear Caroline,

Woman holding her jaw from TMJ pain

This sounds very frustrating. Before we get into this in more detail, you should know that ibuprofen is a contraindication for diabetes. While most people can take them, NSAIDs are not a good idea for people in your situation. I don’t want you getting into danger with your health.

Let’s answer your first question first. Is it possible for diabetes to cause this problem? Technically, yes, though it is rare. While about 20% of diabetics develop general neuropathy, only .05% will develop craniofacial neuropathy.

As for the treatments he did thus far, he did start with the least invasive treatment. That was good. However, even if your cause is the diabetes, saying there is nothing more he can do is really dropping the ball. What you need is someone with real TMJ training. Someone not in over his head, which is what I suspect your current dentist is. There are quite a few options left in getting you some relief.

Find a dentist with extensive post-doctoral TMJ training and let him examine you and give you the options. You will be able to get out of pain.

This blog is brought to you by Duluth, GA Dentist Dr. David Marion.

A Collapsed Bite

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I wonder if you can advise me. I am very self conscious about my smile. When my mouth is at rest, but not completely closed, there is just a black cavern. You cannot see my teeth at all. My jaw also hurts from years of grinding my teeth, which I just found out recently was an issue. My dentist made a night guard for me to wear at night. When I wear that, my jaw hurts less and it gives the slight appearance of my teeth being visible. This makes me think I need to add something to my teeth to make them “show up”, plus it may help with the jaw pain. I asked my dentist about it and he suggested porcelain veneers. Before I make such a big investment, I want to make sure it is the right choice. Have you seen patients in my situation? If so, what worked for them?

Caroline

Dear Caroline,

woman holding her jaw in pain

I am glad that you wrote. I think I know what has happened here and if it is not done right it can completely mess up your bite and leave you in a lifetime of pain. As for porcelain veneers, while if you see an excellent cosmetic dentist it would help with the appearance related issues, it would not solve the root of your problem or the jaw pain, which is like TMJ Disorder as the result of the grinding.

Based on what you have described, it sounds like your teeth grinding has led to a collapsed bite. I wish a dentist would have intervened sooner and protected you from this. However, that is water under the bridge and you need a solution. When your teeth are that ground down, the only real solution is a full mouth reconstruction. This is done by crowning the ground down teeth in order to get your bite in proper alignment and occlusion. However, this is one of the most advanced procedures in dentistry and has to be done very carefully.

A dentist would have to do this starting with provisionals to make sure everything lines up perfectly. It takes years of post-doctoral study to be able to do this well. Look at Dr. Marion’s bio to get an idea of the type of training a dentist would need to work on your case.

This blog is brought to you by Duluth, GA Dentist Dr. David Marion.

Full-Mouth Reconstruction Gone Bad

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I wanted to get a smile makeover and cover my six front teeth. My dentist said I would need to open my bite up more for that to work. In order to do that, he’d have to crown all of the teeth, top and bottom. My husband and I thought about this long and hard because we don’t have a ton of money but decided to go ahead with it. The whole thing has been a bit of a disaster. My mouth feels crooked now. The teeth on the right side of my mouth hit together way sooner than the teeth on the left side of my mouth. It’s causing a lot of pain. They look fine but it hurts to eat. Can the right side be ground down some to make them even? Or is there something else I can do?

Maggie

Dear Maggie,

woman holding her jaw in pain

When a dentist crowns all your teeth that is called a full-mouth reconstruction. This is one of the most advanced procedures a dentist can do. It is not taught in dental school. In order for a dentist to know how to do it well, they would need a significant amount of post-doctoral training. When it is done badly, it leads to significant problems, one of which you are experiencing.

He’s thrown off your bite completely. This can lead to not just the pain you are experiencing but can also throw you into a TMJ disorder situation. I don’t think just grinding down the side that is hitting first will solve your problem. First, you don’t know how far you’d have to grind. It could be you’d have to grind down too far. Second, knowing your dentist threw off this issue, there could be other things wrong with this case. What you need is someone with real expertise to look at this and evaluate the best way to fix it. With a dentist who has expertise in reconstructive dentistry on your side, you should be able to get a refund and then get this done properly.

So, how do you find this expert in full-mouth reconstructions? I would look for a dentist who has post-doctoral training in one of the following institutions:

  • Pankey Institute, located in Florida
  • Dawson Center for Advanced Dental Study, located in Florida
  • The Las Vegas Institute for Advanced Dental Studies

This blog is brought to you by Duluth, GA Dentist Dr. David P. Marion.

Mouth Collapsing

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It seems that the older I get the less I like my smile. When my mouth is at rest, you can’t see any of my teeth, just empty darkness. Even when I am smiling, I have to force my teeth to show. I don’t know if this is connected, but my jaw hurts all the time, except when I’m wearing my mouthguard, which I got not too long ago when my son told me he noticed I was grinding my teeth. My dentist suggested Lumineers might help, but I wanted to get another opinion before moving forward.

Melanie

Dear Melanie,

woman covering her mouth

I’m glad you wrote. Your dentist is going about this the wrong way. In fact, it is very likely to make things worse. Based on what you’ve described it sounds like your teeth are worn down to the point of being over closed. This can result in serious TMJ Disorder, if it hasn’t already.

Lumineers is a brand of porcelain veneers. This particular brand of veneers is often marketed to inexperienced cosmetic dentists. The fact that he’s even suggesting this as a solution backs up my suspicion that he doesn’t know what he’s doing in this case.

The solution for this is a full-mouth reconstruction. This is a very advanced procedure that has to be done very carefully. It usually involves crowning every tooth. It is beyond the ability of most dentists. Just getting the function of your bite correct is a tall enough order for this however, you will want more than function. You’ll want an attractive smile too.

I want you to look at Dr. Marion’s credentials. This would be the kind of dentist you are looking for when it comes to something like this. Also, if a dentist went to one of the following post-doctoral training centers, they will be qualified as well:

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

Do be careful with who does this for you.
This blog is brought to you by Duluth, GA Dentist Dr. David Marion.