[leesal]

I've had TMJ and a severe over bite for quite some time.

My previous Dentist added bonding to the the bottom teeth creating my upper teeth# 7-10 to have become scooped out. Those 4 teeth have veneers on them.

I switched Dentists last year since the previous Dentist did some bad dental bridges causing me to loose more teeth. This new Dentist said the only way to fix the problem is to put crowns and veneers on all of my upper teeth to lengthen them for my teeth to come together. I asked him if he could take the bonding off the bottom teeth and he said no, since he cant tell where it was added and could do damage to the lower teeth.

I have 5 missing lower teeth hoping to possibly do some bone grafting again in the future to get dental implants. Bryanna, you probable remember my bone grafting nightmare.

This Dentist gave me a quote of $32,900.00 to fix the upper teeth which I think is outrageous. My question is how do I know this will fix my problem? Isn't it pretty invasive to take healthy teeth and crown them? In the past any time I've gotten crowns, those teeth eventually needed root canals.

Bryanna, how should I proceed?

[leesal]

Bryanna, any thoughts on how to proceed?

Thanks!

[Bryanna]

Hi leesal,

Based on all that you have shared with us on this forum.... you have extensive jaw alignment and teeth problems. To my recollection, you did not mention how your dental problems originated whether it was due to severe decay, trauma, dental neglect, health problems, medications.... etc. But over a short period of time you ended up with many, many invasive dental procedures which seem to have only exacerbated your dental and jaw problems.

Building up the occlusion to open the bite is risky especially in someone who has TMJ problems and severe jaw bone loss in the lower arch. If I remember correctly, the lower grafts did not take because your lower jaw bone is not adequate enough to hold the grafts because the teeth were missing for a long time which results in deterioration of the level, width and height of the bone. So after what you have gone through with the surgeries, infections, and failed bone grafting, I thought you understood that dental implants on your lower arch was not a possibility?

Is this new dentist proposing to restore just your upper teeth with veneers and crowns? What is his suggestion for the lower arch?

[leesal]

Originally Posted by Bryanna

Hi leesal,

Based on all that you have shared with us on this forum.... you have extensive jaw alignment and teeth problems. To my recollection, you did not mention how your dental problems originated whether it was due to severe decay, trauma, dental neglect, health problems, medications.... etc. But over a short period of time you ended up with many, many invasive dental procedures which seem to have only exacerbated your dental and jaw problems.

Building up the occlusion to open the bite is risky especially in someone who has TMJ problems and severe jaw bone loss in the lower arch. If I remember correctly, the lower grafts did not take because your lower jaw bone is not adequate enough to hold the grafts because the teeth were missing for a long time which results in deterioration of the level, width and height of the bone. So after what you have gone through with the surgeries, infections, and failed bone grafting, I thought you understood that dental implants on your lower arch was not a possibility?

Is this new dentist proposing to restore just your upper teeth with veneers and crowns? What is his suggestion for the lower arch?

I lost three teeth after an accident many years ago. I was diagnosed with TMJ around the same time as the accident. At that time my Dentist did fixed bridges on both sides. When I moved to a new state, the new dentist added bonding to 5 lower teeth to help the TMJ which really screwed me up. He was a biological dentist and honestly his hygienist and him were both not competent. He redid my original bridges. The new bridge failed within one year of him completing it which is why I had more teeth extracted due to decay and an improper fitting bridge.

I switched to a new dentist and he wants to restore the upper teeth with veneers and crowns to lengthen the bite. He also is proposing that I try bone grafting again if he can find the right person. He said if that didn't work, he would do some sort of permanent denture. This is the dentist that wants to charge me $33,000.

[Bryanna]

Leesal,

The teeth that were lost in an accident years ago have resulted in severe bone loss in at least those areas of your jaw and most likely to some degree in areas surrounding those missing teeth. It is a natural process that the jaw losses bone when there is no longer a tooth to help maintain the structure of the bone. Over time as the bone deteriorates, bone grafting will not be successful in those areas which means dental implants will fail. You need to have adequate bone level, height and width to hold bone graft material. The graft material does not replace real bone, it stimulates and encourages new bone to grow into it providing that it is placed in healthy, bloody bone. As in your case when the grafting was done, the graft just sat on top of the bone because the bone was too flat to hold it so no integration took place.

The bonding and other dentistry that the other dentist did was to help open your bite and relieve some pressure off of the TMJ and hopefully give you a new bite. Obviously this did not work which is often the case. The decay that occurred in that short period of time could have been caused by poor oral hygiene and ill fitting dentistry. It also sounds to me like the TMJ was injured int the accident, yes? If so, what is the status of the injury or damage to the TMJ at this point?

I am surprised that you would consider bone grafting again given the trauma you have had to your jaw with the accident, the rampant decay, the extractions, the failed oral surgery for bone grafting and implants along with the severity of the infections. That is a lot to put yourself through one time never mind again.

I would suggest that you ask your dentist what he means by a permanent denture and discuss that option with him thoroughly.

[leesal]

Bryanna,

The TMJ was the result of my accident.

When my dentist says a permanent solution if implants don't work he means using what I believe is caused a flipper with metal clasps. I have one now that has plastic clasps which I do not like.

My TMJ is bothering me which is why the Dentist is proposing that he lengthen my bite. My question to you is what do you think about the Dentist proposing to lengthen the teeth, add veneers and crowns? I think $33,000.00 is outrageous.

How do I find a new Dentist?

[Bryanna]

Hi leesal,

What do you mean by this? .... "The TMJ was the result of my accident". What happened to your TMJ? Did you have surgery on the TMJ? Do you have arthritis or crepitus of the TMJ? Did you have a fractured jaw, if so were you wired shut? If you do not have a clear diagnosis of the problems with your TMJ, then any dentistry you do to re align your bite may not work and may put you into a worse occlusion resulting in muscles spasms, etc.

A flipper or partial denture with clasps is not a permanent restoration. It is a removable one. A permanent restoration is one that is glued in place, like a bridge or a crown and not removable by the patient.

You asked for my opinion... I am not in favor of lengthening or opening the bite due to TMJ issues or any other restorative dental work to re align the bite until the TMJ is properly evaluated and the problems are diagnosed. Aggressive dentistry like crowns, veneers, bridges.... are irreversible restorations and not without risks of infection, injury and possible tooth loss. So irrelevant of the cost, although it is SO outrageously expensive, you just need to be so careful about putting yourself through all the work and trauma and with no guarantee that the outcome will be beneficial.

Unfortunately it can be difficult to find someone really competent in treating TMJ. Some dentists call themselves TMJ experts but really aren't and their idea of treatment is to build up the bite.

Most of the time, non invasive treatment for TMJ disorders have better outcomes. In your case you have dental issues along with the TMJ so you may find that you have to treat the two issues with 2 different practitioners. A dentist who treats you conservatively and someone else who physically works with the TMJ and other muscles. Both of these people would need to be in communication with each other so neither messes up what the other one is doing.

Here is one link that offers good information on TMJ. Perhaps you can contact them about locating a practitioner and/or a dentist in your area.... http://www.tmj.org/

[leesal]

He didn't offer any of those solutions.

I have two teeth missing on the bottom right and three teeth in a row on the left. The reason I'm in this mess is because the teeth under my bridges decayed.

What kind of solutions could I have with my situation and how can I find a reputable Dentist that isn't trying to charge me thousands of dollars and wanting to change my bite?

[Bryanna]

Leesal,

Dentists are in the business of restoring teeth and offering esthetic smiles most of which is done without much if any thought to the physical or systemic health consequences caused by the dental work. So they treatment plan their patients from a tooth restorative perspective, not necessarily a healthy perspective. This is why in cases like yours you will most likely get similar restorative suggestions from different dentists because they all want to build up your teeth and your bite for better functionality. In the long run and as you have experienced twice already, the work does not hold up and the TMJ gets worse.

Those 5 teeth missing on the lower arch, does that include your wisdom teeth? Or are the wisdom teeth still present?

Dentists are either going to be reluctant to treat you because of all the complexities of your case, including all the surgical trauma and infection which puts their work in a higher risk for failure or they are going to want to do extensive heroic work to try and create a new bite. The TMJ issues need to be addressed as well as the dentistry because one needs to be stable just as much as the other.

Did you take a look at the TMJ website or have you looked into help for the TMJ problems? I have a feeling that you may think the TMJ is just tooth or bite related, it's not. Read the info on that site I gave you. It explains exactly what is involved in TMJ disorders. You may have to get some help for the TMJ first and then find a dentist to incorporate non invasive restorative dentistry into your TMJ therapy.

Some practitioners who deal with TMJ are physical therapists, chiropractors, and massage therapists.

[leesal]

Thank you Bryanna.

I've been treated for TMJ over the last 20 years with not much success. I've tried Chiropractors, physical therapy, acupuncture and massage. I also went to an oral facial mycologist many years ago. I just cant seem to get the TMJ under control for a long period of time.

I did go to the website and understand TMJ. Since I have 5 lower teeth that bonding was added to, could it be removed, would this help my situation? Is my Dentist correct when he said it's hard to tell where bonding was added and he can't remove it? Secondly, how do I find a Dentist that is willing to do non invasive restoration?

In regards to my missing lower teeth which doesn't include wisdom teeth, what options do I have? The current Dentist seems to think a flipper is the only option since I have 3 teeth missing in a row.