Cosmetic Partial

Dorothy, in need of replacing her old partial wanted a cosmetic make-over. Implants were considered, but she decided against them. Crowns were placed on the remaining lower teeth with special metal rings added to them. The new lower partial had nylon snaps placed on the under side that will engage with the metal rings. This allowed a very secure and optimum aesthetic end result.




Frequently Asked Questions (FAQs)

Before reading through our FAQ's. Why not explore the SITE MAP page for the topic that interests you?


TOOTH WHITENING

Q -I'm interested in your whitening services, and I found your website extremely informative. I have a crown on a upper front tooth, so I understand I would need to have this replaced or modified so the color would match. How would you handle a procedure like this? Would you be able to replace the crown at the same time as the whitening, or how long would I have to walk around with the darker crown before the color of my bleached teeth has stabilized enough so you could match and replace the crown?

A - We do either tray or ZOOM whitening. That is the patient chooses either the tray type or in office ZOOM system. The end result can be the same from either system. ZOOM is a one hour process compared to the multi-weeks for the tray systems. There is no way to modify the color of a crown therefore it will require replacement. Depending on how the tooth was initially prepared, we will most likely use an all porcelain crown. This is made with new "space-age" materials that are VERY strong. The plus side is that there is no grey edge to the crown and light and color pass through it as natural teeth. When I do these, we have the person go directly to the lab for "custom color matching" there is no additional fee - but the match is much better. The hardest crown to do is ONE front tooth - so we really take our time with them. The sequence is to whiten, let the color mature for a couple weeks, then redo the crown. We speed this up by preparing the crown right after the whitening and let the color mature while the lab begins creating the crown (this usually takes them 2 or so weeks).


BRUXISM (Night grinding/clenching)

Q - I have been grinding my teeth for quite some time.  My previous dentist had made a plastic guard for me and I have worn it off and on for the past few years--he didn't tell me how severe my grinding and damage to my teeth were.  I just recently changed dentists and now I'm scared.  My new dentist told me that I have worn most of the enamel off of my teeth and wants to make the acrylic night guard.  This is not a cost covered by my insurance; therefore, I will have to pay ~800.00 to have this done.  I am exploring all of my options and am really unsure what to do.  I care very much for my teeth and I don't want to loose them. I suffer from jaw pain sometimes, and I don't know if there is a connection but I suffer from migraine headaches.  Some advice would be very much appreciated.  I am a Type A person so stress could certainly be a factor--what have you recommended for this?  Some other specific questions that I have is if I get the mouth guard how long do they typically last?  I know it varies, but a guess would help. If I have another mouth guard made would I have to redo molds, and everything equaling the cost of ~800.00 again.  Please help me.  Thanks.

A - What you have to understand is that a nightguard is only a BANDAID. What I mean by that is the best nightguard on the planet will not solve ANYTHING. A nightguard is only worn of course at "night". I can assure you that during the 16 hours in the day that you are not wearing the nightguard you (and anyone) will still clench and "micro grind". So the problem you discuss will unfortunately continue to occur. Your dentist (and most others) will most likely disagree with me concerning this point.....but.....none-the-less is is true. So the question is not whether or not you should have a nightguard (most are made incorrectly) .......but......you should have someone who understands the things about what CAUSE the bruxing NOT a "bandaid" known as a nightguard. The length of service of a nightguard varies from individual to individual and the fees are something I can not comment on.

Q - I experience headaches and soreness in the jaw area every morning. My dentist tells me that this is due to grinding my teeth while I sleep. If I do not resolve the bruxism with a night guard, what medical problems can result from this?

A - You can NOT "resolve the bruxism" with a night guard. A properly made night guard (no matter who makes it) will ONLY slow down the process.....I refer to them as a "band-aid". People (all people) micro-grind and clench during the day - and the night guard is not in during the day. There are many "possible" problems that can occur due to bruxing.....much to many to discuss here. See my site under "bruxism" for a review of the most frequent consequences.

Q - I am 20 years old and live in Austin. I have a few concerns about bruxism, and I'm afraid I may be suffering from it. My roommate has complained about hearing me grind my teeth every night. Well last night she recorded it and played it for me this morning. It sounded HORRIBLE. It makes me sick to listen to the loud grinds and pops. I've noticed over the past year or so that I have developed 3 small chips on the bottoms of 3 of my front teeth. Also, at my last cleaning and check-up, the assistant asked me if I ground my teeth. At the time I didn't know I was doing it at night and told her no. I am interested in speaking with you about the night guard I read about on your web-site and having you take a look at my teeth for me. What is the process of getting it?

A - Isn't it amazing what a noise it makes?? I find it rather interesting that she recorded your noises.....now there's a way to prove your point! A night guard is definitely something to talk about and generally look at your teeth as well....call my office for a "consult" - complimentary -  and we'll discuss it all. Let me warn you that about 96%+  of night guards are not made correctly - so be sure you have one made correctly. To see the process....CLICK HERE.

Q - My siblings complain about the grinding noise I make at night & I do wake up with a sore jaw sometimes. Does that make me a bruxer? How do you actually tell someone is a bruxer if the symptoms can take decades to manifest? Thanks for your time!

A -You are a text book description of a bruxer. BUT....everyone bruxes some. It's just that some people more than others.

Q -  I have been told by my dentist that I grind my teeth at night. I also suffer from severe lower back (L5, S1) pain - especially the first few hours after I wake up. Is it possible there is a connection with my back pain and night grinding?

A - Yes, there "could" be. I had a case worst than yours that I treated some few years ago. It is unusual but there is a way to investigate whether the grinding (bruxing) is the culprit or not.

Q - When I was young, I had ground my teeth down. I am in my thirties now and every time I eat something sweet or even apples and plums, my molars feel as if I'm eating on exposed nerves or something. It is very painful. My dentist says there is nothing I can do about it. I would think it would get worse as I get older. Isn't there something that modern dentistry can do?

A - Everyone grinds their teeth at night while they sleep. Most don't even know that they do it. Since EVERYONE does grind at night, the real question is how hard they do this. Some folks barely grind, some grind violently. This nighttime grinding is termed - BRUXING.
With severe bruxers, all the enamel may be removed from the teeth. Once the enamel is all gone, the wear can proceed more quickly. Your dentist may be correct - there may not be anything that can be done. On the other hand - sometimes at least a 2nd opinion may be a good idea. If your teeth are that worn - it may be time to explore the options that will be best to protect your teeth.

Q -  I was to the dentist 7 months ago and had no cavities and my gums were healthy. However, just lately, I have noticed a swelling in the very back left cheek and gum, as if I had bitten my cheek at night, and in fact it feels like a small canker sore. But my gum there is also swollen and has been for for about a week. My jaw clicks when I eat and it has never bothered me, but it bothers my family. My husband thinks I am grinding my teeth at night. Could this be what is causing the swelling? Please let me know.

A - The swelling you describe can be associated with bruxing (night grinding). In fact I have seen it so much that I am in the process of adding information about this phenomenon in my web site under the already existing info on bruxing. The jaw joint noise can be a result of bruxing as well. Look in my site under "TMJ Therapy" for the cause/effect.

Q - My 3-year-old son grinds his teeth excessively in his sleep. What can I do for him???

A - Quite a few children do this (bruxing). This can be due to a number of subtle reasons. The bottom line is that they'll wear on the teeth excessively. But the good news, is that they'll lose these teeth eventually. A mouth guard is not a solution because it would only fit for a short while since he/she is growing so rapidly.

Q - I am considering an implant. I am a bruxer and am wondering what effect that may have on the life of an implant.

A - You ask a VERY good question. The one place implants can fail is when someone is a heavy bruxer. If you are replacing a molar, then you might want to be sure that either you have a better bite created or limit the way the crown on the implant functions in the bite. Front teeth are not as much a problem (less PSI on them) but at the same time, I'd limit excessive contacts to the crown.

Q - Hi! I just viewed your website. I went to the dentist this week and they said my teeth are very damaged from grinding (I am a teen) and I need to start wearing a night guard. I was wondering, do I only have to wear it at night and if you have any more pictures of what they look like. Thank you!

A- No I have no more pictures than what you found.
Hate to tell you but a night guard is NOT going to solve your problem because the 16 waking hours a day you're not wearing it......you will (I guarantee) still "micro" grind and clench (even if you don't notice it).
It takes a correction of your bite (too hard to describe in an email) to really stop the damage.

Q - On your website you discuss night guards and how they are not a solution. I completely agree with this as I have been wearing one for years. What do you recommend as a solution? Can realigning teeth really solve the problem? Are there any other remedies you would recommend? Thanks for your help.

A - This is a multifaceted problem.
I find that almost all (I said "almost") all bruxers will stop with a very correct bite.
So...........yes...........the best solution is having a correct bite.
Then use a night guard as well.


COSMETIC  DENTISTRY

Q - I am a 35 year old female, and as a child I was given tetracycline which discolored my teeth. I have never had a cavity, and my teeth are very strong. My dentist is recommending that I have my teeth crowned. I have read that crowns are most beneficial for problematic teeth, i.e. decayed, missing, root canals, etc. However, because my teeth are in such great shape I feel veneers would be a better alternative. What would you recommend as a cosmetic remedy?

A - Covering tetracycline stains can be done with veneers.......but.....there is more to the story than that simple statement.
Tetracycline stains come in different ways.
1. There are different shades in different people.
2. Some are MUCH more dark than others.
I have as a matter of fact seen moderate tetracycline stains done away with with office whitening. Granted the patient had to whiten for months not the usual weeks. But the teeth were darn near perfect at the end. Now this is not the usual case but it demonstrates that not all tetra stains are the same. I most often do veneers........but (another "but")....I tell patients that their veneers may not be as translucent as most because it takes opaquers to mask the darkness and opaquers (in the porcelain) are sometimes required. I often recommend extensive whitening before doing either veneers or crowns. This leads me to one last question.....what type of crowns are planned? Crowns with metal under them or all porcelain?? There are a whole set of advantages - disadvantages with both of these methods.

Q - My dentist wants to put caps on my front upper teeth which are not straight, for cosmetics reasons. However these teeth are perfectly healthy. Should I let him do this or is there a better solution to my problem, such as veneers or braces?

A - My first question is......who wants the caps? You or your dentist?? I mean, do you want straight teeth?? If so, and they are perfectly healthy, I would ALWAYS opt for orthodontics where possible. Now with InVisalign (clear trays instead of metal braces) why would anyone consider altering healthy teeth? Veneers are usually the 2nd choice when orthodontics are ruled out. Last are full crowns. Remember, if you live long enough, you'll have to replace any crowns or veneers placed now. So if possible, go with the orthodontics.

Q - I am extremely interested in finding out more information on porcelain veneers, bleaching, etc., actually anything dealing with cosmetic dentistry.
I have severe flourosis due to the water where I live in New Mexico. My two front teeth are very yellow, but my bottom teeth are extremely white. I will be bleaching my teeth, eventually placing veneers on them. Will this work with my severe case of discoloration?


A - Severe discolorations can be handled but do present a challenge at times. Remember veneers are translucent (light passes through them) and are only 1/2 to 1 millimeter thick. The patient must be aware of certain limitations and be willing to live with small imperfections. At times one must use opaquers (porcelain shades to mask severe discolorations). There are different methods to mask etc. Each case can be slightly different.

Q - I live in WA state and recently had my four front teeth done with porcelain veneers. From what I have seen from before and after pictures, the teeth look like the size doesn't change much. I naturally have pretty small teeth, but now, after my veneers, they look almost too big. Is there anything they could do like file them down? Also, do veneers tend to stick out a little further than your natural teeth? I almost feel like I have an overbite. Is this a common complaint?

A - Porcelain veneers can be "tricky" to do correctly. Your new veneers may very well be perfect, I have not personally examined you and therefore any of the things I mention must be understood in this light.
First, I have seen over bulked veneers. These are usually the result of either the teeth being underprepared or the porcelain made too thick.
Second, veneers can be adjusted after they are placed. Length is about the only thing that can be altered successfully.


ORTHODONTICS

Q - What is the best age to start braces or retainers on my child ? She is eight years old and will definitely need them. thanks.

A - There is no "best" age to begin orthodontics. There are many factors that determine when to begin therapy. At age eight it would be wise to at least have an orthodontist examine and evaluate the possible need for early (2 stage) therapy. I would refer you to my web page and specifically to the ORTHODONTIC area where the topic of "EARLY TREATMENT" is covered.


PERIODONTAL DISEASE (Gum Disease)

Q - My mom has a severe periodontal disease problem, does this automatically mean that I'll lose my teeth as well?

A - No, not at all. Periodontal disease can not be directly inherited, you may inherit a heavier than usual tartar buildup etc. All the more reason to have regular checkups performed.

Q - If a patient has serious gum recession, does the gum tissue grow back, or it always stay that way until it gets bad enough to have to go through gum surgery to correct it?

A - Recession often (almost always) does NOT come from gum disease. This may surprise you - but it's true. The real culprit is bruxism (night-grinding) which causes the notching and receding you see. Often times it is first noticed on the upper cuspids (third from the front) on either one or both sides. Look at my web site under "BRUXISM" and you'll read and see more. Yes, gum procedures can help cover some of these areas.


WISDOM TEETH

Q - I recently had my wisdom teeth out and a side effect was that the left side of my tongue is tingly/numb and sore. Could you tell me more about this please?

A - What you have is a paresthesia (false numbing).
The needle tip touched a major nerve while administering the local anesthesia. The reason you feel tingly on the tongue is because this nerve (trigeminal nerve) has been mildly irritated and will take time to recover. The trigeminal nerve supplies feeling to both the lower teeth (one side) and half the tongue as well. Paresthesia can happen ANYTIME local anesthesia is administered for dental therapy to the lower jaw (mandible). This is not an area that can be visualized, it is an anatomical position for proper lower anesthesia.
These things are of short duration and the nerve irritation heals on its own.
All should be fine with time.

Q - Is there a posiblilty that you can have only one or two wisdom teeth or do you usually get all four?

A - Wisdom teeth are also the 3rd molars. I am one of three children in my family. One of my sisters had all four wisdom teeth, the other had no wisdom teeth and I had only the two upper ones. A generation later my 17 year old daughter has upper 4th molars! Now 4th molars are very rare but they do occur. So you can see, any and all combinations are possible.


PORCELAIN  CROWNS

Q - What are the complications, if any, in replacing a deficiently made porcelain fused to metal crown with an all porcelain crowns? This regards an upper front tooth.

A - There are NO complications in replacing a crown like that. It will look MUCH better and be just as strong if done properly.


ROOT CANALS

Q - What type of anesthesia is used during a root canal?

A - Local anesthesia (what is commonly referred to as "novocaine") is used. Novocaine has not actually been used in dentistry for decades of time. Now there are much better "caines" available. Some of the most common are lidocaine, carbocaine, marcaine and others.

Q - My root canal was completed two weeks ago, however there is still pain, especially when I try to run or train. Is this normal and if so, how long normally before the healing is complete?

A -  Root canals can at times take a while to "settle down" after being completed, usually any soreness lasts only a few days to a few weeks (rare cases can be several months). The most usual cause of the pain you feel is inflammation. Inflammation is a very normal part of healing. Whenever you hurt yourself (such as a cut, or sprained ankle) one of the first things that happens is the inflammatory response to injury. When there is inflammation - there is swelling. In the case of a root canal this swelling is at the very apex (or tip of the root). Swelling in this area sometimes takes a while to diminish. Time will take care of this, but you can speed things up by taking anti-inflammatory medications. Steroids are the strongest type but, you can't get them without a prescription and are most likely overkill for what you are experiencing. A good alternative is non-steroidal anti-inflammatory drugs - my favorite is an over-the-counter medication - ALEVE
Another thing to watch out for is that you are not hitting on the tooth too hard. This will cause increased soreness - if you are, have your dentist check it out. I would have your dentist check it out irregardless if this persists much longer.


TMJ  THERAPY / Splint Therapy

Q - I am a 20 yr old college student and began having pain in my left jaw at the age of 18.  It has since progressed to my right jaw as well. The pain is now so severe that I had to move back home and take a semester off of school. I'm very confused because I don't know how to go about fixing this. At first, I was told that many people have TMJ pains and basically just to "deal with it." My latest oral surgeon has discovered that my lower jaw has not grown to the size of my upper jaw, and has said that I will probably need braces and orthognathic surgery to correct this problem. However, he wants to try and get my pain under control first. I have had two rounds of botox injections, trigger point injections, and arthrocentesis so far. None of it helped. I have heard so many awful outcomes from joint surgery, and I just don't want to go down that road. If my problem is malocclusion, can orthodontics and jaw surgery correct my TMJ pain? Is there any  reason that I should consider joint surgeries? Thank you for help!

A - What I have to tell you is just my PERSONAL opinion (which would NOT be shared by practically all oral surgeons). I have oral surgeon friends and I respect their knowledge and skills - for sure. BUT (big "but") in general they are not trained to treat the causes of TMJ but rather the symptoms. As an example of that the three things you mention (botox, trigger point injections and arthrocentesis) are all attempts to treat the "symptoms" - NOT the cause. The cause (if you truly have a TMD disorder) is that the occlusion (bite) is not in a balance with your jaw joints - this discrepancy can cause muscular, joint and/or teeth related symptoms. Now if you print this email out and let your surgeon read it - he/she will most likely tell you that I am GREATLY misguided in my approach. All I can say is that they should read the emails I get (some of which you should read in my "FAQ" area of my website) and see some of the post surgical patients I see.
If you came to my office for therapy..........
I would put you into a correctly made splint full time for a few months and during that time  monitor and adjust the splint  to see if your symptoms are relieved or not. If they are then it can be assumed that the CAUSE of your problem is like I mentioned earlier and is related to your occlusion(bite). Then and only then I would determine what the solution is to make your bite VERY correct for the jaw joints and proceed with whatever that may be so that you may discontinue the use of the splint and be comfortable with your natural teeth. If the solution was orthognathic surgery I would BE VERY VERY careful about who the orthodontist is and the surgeon. I have seen orthognathic surgeries that were planned incorrectly and had to be redone.
By the way you have already had joint surgery if you had an arthrocentesis procedure performed.
I hope this lengthy answer is some help and not too confusing.

Q - I am 27 and had bilateral arthroscopic TMJ surgery almost 4 years ago, for a slipped disk due to clenching. The surgeon said that both disks were severely damaged and sutured them in place. I still suffer from chronic pain. I am taking zoloft, ibuprofen, and glucosamine chondroitin sulfate. I have been going through splint therapy since the surgery. My current dentist is taking off the points of my teeth to make them mesh better. Do you have any other suggestions? Is my jaw just going to get worse as I get older? Thank You.

A - I am not a fan of the surgery you had done. That is not to say you did not require it.....it is just that I see many joints that are operated on that do not require it. Not all splint therapy is the same....I sure wish that it was. I have not any advice except to say if you question any therapy you should get a second opinion. I urge my patients to get 2nd opinions on more difficult therapies if they feel more secure.

Q - After sustaining a line drive softball to the face 5 years ago I now wear a bridge in the front and have had multiple root canals. I've been diagnosed by 4 TMJ specialists to have TMJ and have undergone treatment from 2 different dentists. The first dentist's splint broke within 2 weeks and he wouldn't replace it. Some physical therapy seemed to relieve my headaches - a major complaint for the last 5 years (now all traced to my teeth/jaw). After unsatisfactory treatment I sought out another doctor. The 2nd dentist made me a lower splint thicker than first but the headaches have not decreased like before. Now they want to put me on high potent drugs to decrease headaches - 'Neurotin'. I'm a former college division 1 athlete and I really don't like taking medicine if it's not the last resort. I was also told that since the splint isn't helping the headaches I should only wear it at night - was using it 24hrs a day eating with it also. Since I've stopped wearing it, pain in the right ear/joint has started.  Supposedly I don't have much cartilage left in the joint -  never had an MRI ( been talk of one). Very confused and tired of everything but I need the pain to stop?
Suggestions would be greatly appreciated


A - I get a surprising amount of emails with situations like yours......
I have a TMJ problem.
I have seen multiple doctors.
It seems they all have a different diagnosis/treatment philosophy.
Result is.... I AM CONFUSED....
I sure wish I could help you. Since I have not examined you myself, nor seen the splint/and other therapy provided to you it is IMPOSSIBLE to say anything with absolute certainty. I can tell you for a fact that quite a few "TMJ specialists" are off base in their treatments. I would tell you to continue to seek out further opinions (hopefully from dentists that know what they're doing). But this is difficult for someone like yourself - how do you tell if they know what they're doing? An MRI would be a help - but to be honest with you, I rarely have them made. I DO though have tomographs taken (regular x-rays of the jaw joint) to check out the condition of the bony components of the joint.

Q - My son has had a severe constant headache all the time for 13 years! He has been told he doesn't have TMJ but got the splints anyway and thought they helped some. His jaw clicks and he has ear pain and vertigo in addition to the pain in the center of his forehead. Unfortunately, he broke the splints biting down hard I suppose. I just found your site. We are wondering how to know whether new splints are made correctly.

A - The REAL problem is finding someone who knows how to make a guard that is physiologically correct. Of the night guards/splints/bruxism guards/bite guards/etc, etc that are brought to my office - a VERY small percentage of them are made correctly. 
After receiving numerous emails about this I have now added a section to my webpage......CLICK HERE.

Q - I have been clinching & grinding my teeth together day & night for many years now . I am a 46 year old female .I have been to the dentist who fixed me up with a night guard & I have been wearing it every night for over a year & have been back to the dentist 3-4 times for adjustments because its not working . I have bad jaw pain everyday and it's difficult to open my mouth all the way or yawn. The dentist says it will get better if I wear the night guard but I just keep going back & he keeps adjusting it but it doesn't seem to help. I know its stress . I am a business owner & its very difficult to stay away from the stress. I never have had pain like this before in my right jaw. Guess I am older & can't take it like I used to.  Sure hope you can offer some ideas . I am ready to get some kind of mind altering drugs to see if that would help . But the dentist says that's not a cure just something to help for a little while you can't take drugs like that forever. Thanks

A - I  must remind you that I have NOT examined you myself and therefore the following assumptions could be very incorrect. Bearing that in mind....it sounds as if wearing a night guard alone is not enough for your situation. Let me try to explain it this way...
A night guard (if made correctly- see my site) allows the jaw joint to remain in socket when it is in place. "In place" with a night guard is 8 hours a day. When someone wears a "splint" (made EXACTLY the same way) they have it in 24 hours a day. When left in full time - the jaw joint is allowed to "relax" all the time and this then can make a SIGNIFICANT difference in how the patient responds. This is called "REPOSITIONING THERAPY" and the reason for this is that the jaw joint will most often "reposition" itself to its most correct and comfortable position. After wearing the full time splint for a number of months - the patient ALWAYS finds that the teeth do not fit together correctly without the splint in place. This is NOT because the teeth have moved but rather because the bite changes as a result of the jaw joint "repositioning" itself. The "trick" then is transitioning off of the splint to a tooth to tooth bite/occlusion that will be in the same very correct position as the splint was in. Thus the bite and jaw joint are correctly positioned.

Q - Can sleep apnea cause bruxism to appear ? Bruxism developed around the same time that I was prescribed anti-depressant medication. I suspect that the bruxism is triggered by stress. I wonder if the sleeping disorder has anything to do with the bruxism condition, i.e lack of sleep, general fatigue, stress. I have recently seen a orthodontist and he has indicated that I should consider surgery to move  the lower jaw forward. The opinion is that this will correct the apnea and place the teeth in the optimum position. I am currently using a CPAP device, tried a mouthguard for six months, had surgery to remove some of the soft tissue at back of throat. The surgery did not help, I was considering going back to get more tissue removed, the dentist indicated that this might not work ( i.e he was advocating radical surgery). 
Any help or comments would be appreciated.
P.S My dentist did not make any adjustments as you have outlined on site. My guard is worn down, does this mean that it was designed wrong to begin with ?


A - Boy the sleep apnea/brux relationship is one that is VERY tricky to answer. Listen...everyone bruxes....so you can count on the fact that you do as well. Stress on the other hand increases the intensity of bruxing BIG TIME! There are MANY studies done looking at bruxing and when it occurs during sleep. It seems to occur more in the REM (rapid eye movement) part of sleep. Why??? Who knows. But possible tie in here is that as you have more interrupted sleep- the more REM cycles you go through. This PURE conjecture on my part - you may not take that to the bank!!
Be careful on the orthognathic surgery...I have not seen this be successful for sleep (maybe your surgeon is better than mine). There are several sleep apnea appliances on the market that position the jaw forward during sleep. Have you had one of these made??
As far as the night guard being correct.....well I have not seen yours....all I can say is that  90% of the splints/guards/bite guards/etc that are brought into my office are not correctly made.

Q - I am a 23 year old beautician and have had TMJ since 13. I have undergone two surgeries the last was reconstructive and my mouth was wired shut. My headaches and pain are so bad I don't want to leave the house. I have alot of stress on me that I can't make go away and am on Lunox and Chlonopin to help with the stress and anxiety. Talking sometimes makes me feel better and I am considering a chiropractor to help the pain. The new doctor I have (oral surgeon) wants me to have surgery again but I just can't go through the pain. I am in such bad shape and have been going to doctors for years. I'm so confused and have spent alot of money. Can you give me some advice.

A - Unfortunately, after multiple surgeries, the joints are not stable. There is not much I can do for you

Q - Is it possible to start having TMJ problems from cervical traction therapy? After a few sessions of cervical traction for a cervical herniated disc, my right jaw and ear became very swollen. That was 2 months ago. The swelling is gone but my jaw/ear area hurt.

A - I am not totally convinced that cervical traction can actually cause TMJ problems. Most often it can aggravate an already existing condition.

Q - I really enjoyed your article about TMJ. It was really enlightening! Anyway my question is what and how does the arthrocentisis procedure work, are there any side effects. My dentist (TMJ Specialist) has suggested this procedure for me! Please email me with any information you have.

A - Arthrocentesis is a procedure where two large gauge needles are placed (one in the top joint space, one in the lower joint space). Into one needle, saline (salt) solution is injected and it comes out of the other needle. The supposed purpose of this is to break up adhesions in the joint. As a side effect, it does remove all the natural lubricating solution in the joint as well. The problem with this procedure (and the grand majority of other TMJ surgery) is that it treats the symptom, not the cause. I have seen little long-term success from ANY joint surgery. By the way, don't let anyone tell you this is not surgery, it IS.

Q - Almost a year ago I started getting bad ear aches and a lot of pressure in the ear and jaw area. My doc sent me to my dentist said I probably have tmj. They did notice on my right side I have a disc out of place. He made a splint for me several months ago, and no change! What's my next step? again it's not all pain, it's sometimes just a lot of pressure.

A - I wish I could tell you that the splint did not help you but the truth is that most splints are made incorrectly. I do not know who you have seen and I am NOT trying to have you doubt your doctor....but be sure that the splint was made correctly and adjusted correctly before you proceed with any irreversible therapy.

Q - My name is ----- and I wanted to let you know that I found your website to be very informative. I have been dealing with TMJ for about 4 or 5 years and wear a bruxing splint to bed. The reason I am sending this e-mail is because I am concerned about my mother. She had been having horrible headaches, earaches, and dizziness for a long time and could not firgure out the cause. The doctor gave her different drugs for cures, but nothing seemed to work. She finally went to the dentist, thinking she might have what I have. He diagnosed it as TMJ and gave her a sliding " splint"? It didn't seem to help her at all. It was a device that went over her two front teeth. I want to know if you could tell me why they would give a person that instead of the full thing that I have that covers my upper teeth. I really want to try to help her so if you know of anything that I could do or anyone that I should talk to, please let me know. I appreciate your time.

A - The device you mention over the front two teeth is not something new (although I have recently seen it claimed as such). It goes by a few names although the most common in dentistry is....the "Lucia jig". They are used most commonly as a very quick start to TMJ therapy when someone comes in with really advanced pain and needs immediate help. The jig is made in a few minutes and then a splint can be made over the next week or so and delivered as a follow up. To get a little further into this.....you see the main objective of the jig is to not let the back teeth touch and therefore stop the stimulus to "fire" the muscles that are painful and cramping. The biggest danger is that if someone wore a jig like this 24/7 for months then the back teeth not in contact will erupt and begin to really make for bad problems.
So, it is a great short term initial therapy. 

Q - I have had severe problems with TMJ for the past year and a half. I have had physical therapy, arthrocentesis twice, two different bite splints, a myriad of pain pills and muscle relaxers, soft food diet....trying to avoid surgery. Still, no real relief. Is there anything else I am missing. I open at about 22mm now - an improvement from 12mm. Thanks for your help.

A - I'll tell you I get emails like yours monthly and they are always so difficult to answer because I can't be very specific since I have not examined you myself. You may not truly have "TMJ" but it is likely that you do based on your information.
But none-the-less here goes.............
1. I can tell you that not all splints are made correctly (I wish they were for a lot of reasons). Therefore, the question is whether or not your splints were       physiologically correct.
2. How was the splint used? Full time? Part time? Night time? These all make a difference.
3. At 22mm maximum opening that is not clearing up there is a good chance that you will require a surgical procedure to get an appropriate opening (this in NOT arthrocentesis). It consists of simply releasing the disk so as to "unblock" the full range of motion of the jaw.
4. Pain pills, arthrocentesis, soft food, muscle relaxers (especially) are all.........treatment of symptoms NOT treatment of the cause of your problem.

Q - First of all, let me say thanks for your very informative website. However, I have a situation in which I urgently need your help/advise. On Jan. 11, 2000 I was involved in a side-impact car accident in which I was a passenger in the rear seat, when an oncoming car hit us and the right side of my jaw/face broke through the window. I was immediately transported to the hospital where x-rays were taken and although there were no broken bones, I had sustained significant trauma to my head, side of face and neck. There was much bruising and swelling and treatment was primarily anti-inflammatory and pain meds. After a couple of weeks there was still in so much pain that I went to a chiropractor. I could barely turn my head, felt very off balanced, severe headaches and pain in my right jaw/ear. I treated with chiropractic for approximately 7 months and did get much relief. However the pain/pressure in my ear stayed and I actually had loss of hearing in my right ear during this time. I also developed clicking/popping noises in my jaw. For two and a half years my main problem has been ear pain/pressure, muscle spasms in neck radiating to shoulder and continued constant clicking. But, this past summer, I went to my dentist for a routine exam/cleaning and she noticed some swelling/tenderness on the right side of my jaw as well as detecting a shift in my bite. She noticed audible clicking and I was having a very difficult time keeping my mouth open wide enough for her to work on. She referred me to a TMJ specialist  He examined me and my MRI. His recommendation was to try an oral splint for 8-12 weeks and see if I got any relief. He said in my case, that a splint will never repair/solve the problem but it might give me relief. He said that the odds were very slim that this would work because my problem had been going on for so long and that the ligaments were probably stretched/torn during the accident and unable to hold my discs in proper position for my jaw to function as it should. He felt certain that in all probability I would need surgery to recapture disc and pin them into position. (He claims a 90 % success rate with this surgery.) I am scheduled for bilateral TMJ arthroplasty, then physical therapy and (only 1 week after surgery) an oral splint. (Orthodontist says this will be extremely long & painful so soon after surgery and prefers to do the fitting prior to surgery but no time.) This is so scary to me, I am opposed to the surgery if there is any other way to help me with my problem. The chiropractor I see said that although he is willing to continue with jaw adjustments, he feels that I have no stability in my jaw, it usually shifts to the left, or pulls back to give me almost a bucktooth look, one side locks or lately both locking and at this time I can only open two fingers width. I have very bad ear pain/pressure and neck pain, but I do get relief on my weekly chiropractic visits but it is short lived. Realistically, I can't live at my chiropractor all my life and am not sure that the oral splint is a long term total solution either. Can you please advise me, I don't know what to do. My gut feeling is to cancel the surgery because I know that once you operate you are never the same and maybe much worse with all that scar tissue and permanent titanium pins in your bone. I'm afraid I will have complications/pain all my life. I urgently need your help/information as soon as possible. Have you ever seen a very successful operation of this kind that was not helped any other way. I read some true horror stories about this surgery. Seems like once they go in, the keep having to go back in for repeated surgeries. Dr. Hafernik, I thank you for your concern and patience in taking the time to read all this. Praying for a miracle.

A - All that I say is based solely on my experience and those whom I respect VERY much in this line of therapy. We are as a group VERY, very opposed to TMJ surgery. This is NOT to say your doctor is not correct and it is not to say that surgery is never required. In my humble opinion surgeries like that which you describe for yourself do not succeed for more than at most a few years. There is a very slow move away from surgery in these cases.....I hear more and more doctors/therapists say so.
So............You are very correct to be afraid of this surgery. I really would like to know how your doctor claims a 90% success rate (what is his specific criteria to be determined "successful"?)......since I see a 99% failure rate (people 3 - 5 years post surgery still have anterior displaced discs .....with a lot more pain......that I can't help because surgery is irreversible).
My opinion.............well...........I would not advise the surgery until a full-time splint is used for not 8 - 12 weeks, but rather for at least 6 months. I would also advise good physical therapy so that a good range of motion could be established. If you still had pain, limited opening, etc after some months then it may be time to consider surgery.
READ THIS CAREFULLY......Here is one VERY important fact that you may not be aware of.............millions and millions of people have anterior displaced discs/menisci and they are just fine (most don't even know they have this). What forms over the top of the condyle over time is a sort of scar tissue referred to as a "pseudodisc" and this pseudodisc can function just fine if given the chance to do so.
Now, onto the "splint"....why are you not in one full-time now?
Just what does the splint do?
What are the plans of your doctor once the 8-12 weeks of splint therapy is complete?
These are very important questions and the correct answers lie within my website.
I have other questions about your case but let me rather describe a current case of mine.........
The patient had a long dental appointment (elsewhere) and after that she began to have joint popping and locking. She then became locked (able to open only a short distance) and was not able to unlock at all (this is referred to as "closed lock"). I placed her into a full-time splint and sent her to a physical therapist for multiple sessions. She has a left side anterior displaced disc...........she will forever have a left side anterior displaced disc...............now a couple of months later, she can open 90% of normal and is (I am certain) forming a "pseudodisc" that will be just fine. After 6 - 9 months on the full -time splint, I will alter her bite/occlusion to support the TMJ's in the proper position. You see, the problem with this patient (as it is with ALL TMJ patients) is that her bite did not match the proper jaw joint position for the TMJ's to be comfortable and healthy. Now I realize that your accident triggered your problem, but I would not approach it any differently than any other patient I see.

Q - I recently got a splint to reposition my jaw. My question is how do I know that it is fitting correctly since my bite was off anyway? I feel like I have to slide my upper jaw to the right to make my teeth fit in the grooves. Should I have to make such an effort to make it fit properly or should it fit naturally? Is the sliding part of the treatment? If it doesn't fit correctly can it do more damage? Thanks!

A - First.....the splint does NOT reposition the jaw.........it allows the jaw to reposition itself into the best position. I realize this is a subtle difference but if you think about it.......you'll see the difference. Another way of putting it is that the jaw cannot be forced to a healthy position............but given the best splint.....the jaw will assume its best position over time.
There are different types of splints.
There are only 2 that I (and others like myself use).
1. Usually referred to as a "anterior repositioning splint". This might have some slight "grooves".
This type is very very rarely used and only in special circumstances.
2. Typical TMJ splint (sometimes referred to in dentistry as a centric relation splint).
This is the type used 98% of the time.
There should be no "grooves". A correct splint is virtually flat on the biting surface.
There should be no "slide" in the bite provided by the splint.
The splint should feel very "natural" when adjusted properly.
Did you see where in my site I show via photos a correct splint being made and delivered?
By the way, you cannot slide the upper jaw.......only the lower jaw moves left, right, forward.


CRACKED  TEETH

Q - I have an upper molar that has a crack in it, my dentist has advised me to put a cap on it. I understand as well that if I do not put a cap on my tooth, the only other option is to have it pulled. If a person has one tooth cracked, are the rest at a higher risk? Should I worry about the other teeth or can this be an isolated case? I don't think taking calcium will hurt seeing that it is a bone strengthener and the teeth are bone. Thank you for your input. I was just surprised when I found out that in this day and age of technology, there are no other alternatives to cracked teeth. That's why I started searching on the web.

A - Cracked teeth are usually a result of larger fillings and bruxism (grinding your teeth at night). This puts pressures on the teeth and they micro-flex over the years until they visibly have cracks in them. Eventually the cracks result in failures. You can take a bath in calcium and it won't matter. Your teeth are "bone" but they are fully formed. Nothing you ingest can effect them whatsoever. Example, fluoride in the water - does you absolutely no good. Only children (whose teeth are still forming under the gums) can benefit from fluoride in the water - and calcium swallowed. As far as alternatives to cracked teeth - yes there is an alternative in this day and age........a well made crown (I have 18 of them). Teeth shift, bites change, teeth wear down prematurely, etc etc .....don't remove it.

Jokes

One of the favorite things that I (we) like to do is gather jokes from the friends that we see in our office. My staff starts groaning when I start the same joke for the 343rd time. But, I feel a personal responsibility to pass the better ones on. Unfortunately, we must avoid those many jokes that are "TOTALLY TASTELESS".

So here's a collection (that will surely grow) of our favorites.

A U.S. Congressman dies and goes to the pearly gates. St. Peter meets him and says, "Well congressman, would you rather go to heaven or to hell?". The congressman was surprised and said, "To heaven...... for sure!" St. Peter told him, "well, you get to visit each and see which one you like best". So off he goes to hell and he finds some of his friends there. They play a round of golf and then Satan fixes a gourmet meal. Then the congressman went back to the pearly gates. St. Peter said, "What did you think of that?". The congressman told him he was amazed how nice it was there. The next day, the congressman went to visit heaven and it was truly magnificent and wonderful. The congressman then returned to the pearly gates and St. Peter asked him, "Congressman, what's your decision?"

The congressman told him, "I can't believe this is actually a difficult decision, but I think I'll pick hell". So off he went and when he got there, it was a burning inferno. The congressman fought his way through the flames and spotted Satan. He asked Satan, "Hey I was here a couple of days ago and it was a country club. What's the deal?". Satan looked at him, smiled and said, "Congressman, two days ago we were campaigning!"

 

What do you call a cow without legs?      Ground beef.

 

What do you call a boomerang that doesn't come back?     A stick.

 

A man went into to see his physician with a banana in one ear, a carrot in the other, a bean in one nostril and a pea in the other. He said he didn't feel well. The doctor looked at him and said, "It's obvious you're not eating right".

 

Dyslexic Aggies thought that the UT-A&M football game that ended at 51-15 was a tie.

 

Two ocean-going tanker ships, one filled with red paint and the other filled with blue collided at sea. All the sailors were marooned.

 

A guy came home and found his dog lifeless on the floor. The dog still felt warm so he hurriedly took him to the vet. Once at the vet's office he asked if he could tell him if his dog was dead or not. The vet put the dog on the floor and first let a Labrador retriever out of a cage to sniff the dog. Then he took a cat out of a cage and placed it on the floor. The cat ran around the dog about 15 times and was placed back in its cage. The doctor told the man that his dog was definitely dead. The man thanked the vet and asked him how much he owed him. The vet said, "$450". "What!" said the man. "Could you itemize that for me?" The vet said, "Sure, it's $50 for the consultation, $100 the the 'lab' tests and $300 for the CAT scan".

 

Four men were playing golf on a hole that ran right next to the highway. Just down the road was a church and when they looked up a funeral procession was just pulling out and heading down the road. One of the golfers turned to the procession, took off his hat and stood motionless until the last car passed by. The other 3 golfers were surprised and told him that they didn't realize he was such a religious man. He said, "I know. But, she was the greatest wife a guy could have".

 

What did the snail say when it jumped on the back of the turtle? "YEE HAWWW"

 

A guy goes into a bar and orders 3 beers. The bartender thinks it is odd, but doesn't say anything. The next week, the same guy comes in and orders 3 whiskeys. This time the bartender asks him what the deal is about 3 drinks. "Well, my brothers live far away and when we were young, we swore we'd always drink together", said the fellow. This then went on for a few months until one day the guy comes in and orders 2 scotch and waters. The bartender feeling bad, asked the guy what happened to one of his brothers. He answered, "Oh, they're fine.....I gave up drinking for lent."

 

What do you call a frog in a NO PARKING ZONE ? Towed.

 

A cowboy, politician and attorney died on the same day and all wound up in front of St. Peter at the Pearly Gates. St. Peter told them he had to ask them each one question. If they answered it correctly, they could enter heaven. He turned first to the cowboy and asked him, "There was a large luxury liner that sunk during its maiden voyage when it struck an iceberg. What was the name of that ship?" The cowboy excitedly said, "The Titanic!" St. Peter opened the gates an let him in. Then turning to the politician, he asked, "How many people died that night?" The politician nervously said, "I saw that movie........let me think........1,500 people !" St. Peter agreed that was correct and let him in as well. Turning last to the attorney, he said, "Name them."

 

A man is eating in a fancy restaurant and there is a gorgeous blonde eating at the next table. He has been checking her out all night, but lacks the nerve to go talk to her. Suddenly she sneezes and her glass eye comes flying out of her socket towards the man. He reflexively grabs and snatches it out of the air.

"Oh my goodness, I am sooo sorry," the woman says, as she pops her eye back in place. "Let me buy you dinner to make it up to you."
They enjoy a wonderful dinner together and afterwards the woman invites him to the theater followed by drinks. After paying for everything, she asks him if he would like to come to breakfast the next morning. When he arrives the next morning, she  has cooked a gourmet meal with all the trimmings. The guy is amazed!

"You know, you are the perfect woman. Are you this nice to every guy you meet?"

"No," she replies,

"YOU JUST HAPPENED TO CATCH MY EYE."

 

What do you call a line of rabbits hopping backwards?  A receding hare line.

 

What do you call 32 people from Tennessee in a room? A full set of teeth.

Halitosis (Bad Breath)

Halitosis can be very misunderstood. Is it a result of oral conditions such as periodontal (gum) disease, lack of tongue cleaning or is it more than these things? The answer can be complicated for some people. The following table is an attempt to describe the major types of halitosis most often found:

Types of halitosis (bad breath)

 
A. Genuine Halitosis  
1. Physiologic halitosis
  • Obvious bad odor
  • No specific disease cause nor pathologic condition that could cause halitosis is present.
  • The main cause is bacteria on the mid to back of tongue.
2. Pathologic halitosis
  • Bad odor caused by disease or pathologic condition.
    • Originates from nasal or throat area.
    • Originates from lungs
    • Originates from digestive tract.
    • Originates from disorders anywhere in body - odor is blood borne and emitted via the lungs.
B. False-halitosis
  • Obvious bad breath is not perceived by others even though person is certain exists.
C. Halitophobia
(fear of having bad breath)
  • After receiving treatment for halitosis the person persists in believing it is still present.


Examination for presence of genuine halitosis is most accurately performed using  a gas chromatography (GC) unit - only a few halitosis clinics have these devices). When being tested, a person usually closes their mouth, breathes through their nose for one minute, and then exhales into the GC tube. Some clinics also make use of a 'odor judge' - a person trained to smell and then score the amount of malodor present in the breath. A GC unit measures for volatile sulfur compounds (VSCs), such as hydrogen sulfide, methyl mercaptan and dimethyl sulfide which are the  main components of oral bad breath.

Treatment of Halitosis

  1. Tongue cleaning is the very most important aspect when treating 'genuine halitosis'. The tongue harbors bacteria that produce the VSCs mentioned above. Most people when asked say that the tongue has a light color  - actually a tongue when cleaned properly has a dark rose color to it. Although a toothbrush is most commonly used to clean the tongue, there are devices specifically designed for this purpose. These devices do a better job of getting to the back of the tongue without triggering the gag reflex as well as 'scrape' the tongue clean. To best achieve getting to the back of the tongue a person should stick the tongue out as far as possible and hold their breath to minimize gagging.

  2. Mouth rinses are most often only effective for a short time in reducing malodors. Most often they only mask the odor and do not effectively deal with the VSCs that cause them. There are mouth rinses containing zinc and chlorine compounds that can significantly reduce the  VSCs present in the mouth.

  3. Proper attention to home oral hygiene

  4. Regular thorough professional cleaning appointments are also a great aid in treating halitosis.

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Dr. Maury Hafernik
11645 Angus Road, Suite 10
Austin, Texas 78759
P: (512) 345-5552

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