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Her Dentist is Doing This Wrong

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I had a root canal treatment done several years ago that had recently started hurting again. I went to see my dentist who did an x-ray and realized it was reinfected. He did another root canal treatment and sent me home with some pain meds and an antibiotic. The tooth started to feel better after a few days, but now it is hurting again. I called the dental office and they spoke with the dentist who said some people take longer to heal than others. The pain seems to be getting worse but he wants me to give it three more weeks. I am now out of pain meds and in agony. I don’t think I can last that long. Should I be worried about this or is he right and it just needs more time?

Andrea

Dear Andrea,

Female patient in need of emergency dentist

 

No, I don’t want you to wait. Something isn’t right here, especially if you started to feel better but then it began to hurt again. This means the infection is back to being active. Your dentist should have recognized that. The fact that he did not tells me that he does not understand root canal treatments very well. When a root canal treatment fails, the successive treatments have less of a chance of succeeding.

I think you need to see a root canal specialist to give yourself the best chance. They are called endodontists. When you call, tell them everything you told me. I think they will consider it a dental emergency and get you in sooner. I still have hope that with a specialist you can save your tooth. If it turns out you cannot, then it will have to be extracted. If that happens you will want to replace it so the adjacent teeth don’t shift or tip into the empty space. This can throw off your bite and lead to TMJ Disorder.

The best tooth replacement is a dental implant. However, that is an advanced procedure. I would make sure your dentist has post-doctoral training in dental implants. If he doesn’t, go to another dentist who does for your replacement.

This blog is brought to you by Grosse Pointe Woods Dentist Dr. Patel.

Tanda Pearl Ionic Teeth Whitening System

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I’ve recently read some reviews of the Tanda Pearl Ionic whitening system. This allows you to whiten your teeth in just 5 minutes a day. People are saying it’s working. I’ve been using the tray my dentist provided for me, but I’ve noticed when I use it, it aggravates my TMJ. I wondered if the Tanda system is a better option for me because it works so much more quickly. Do you know if this option is safe?

Kathryn

Dear Kathryn,

teeth whitening trays

The type of whitening that Tanda Pearl uses is similar to how most teeth whitening works. It uses a peroxide gel. The light they use isn’t special, but my guess is that it is just there for psychological reasons. If they had a light that made whitening work that quickly in reality, they’d make a total fortune selling that to dental offices. The fact that they’re not even trying tells me they know it doesn’t really do much.

However, there is a MAJOR difference between the trays your dentist likely provided you and the whitening tray available through Tanda Pearl. Your dentist should have made a custom-fit tray for each arch of your teeth. The Tanda Pearl system has one tray that you have to bite down on in order to keep it in your mouth. Even for just five minutes, that will cause your TMJ pain to be significantly worse. You don’t want to have to clench your jaw for any period of time.

In your place, I would do two things. First, tell your dentist that the trays are aggravating your TMJ Disorder. Maybe there is something off about their fit. If he doesn’t have significant TMJ training, you may want to see a dentist who does. It’s not something that is taught in dental school. A dentist has to invest in post-doctoral training in order to properly treat TMJ Disorder.

If the trays are fine, then just cut back on the amount of time you’re wearing them. If the idea of five minutes appealed to you, wear them for five minutes. The amount of time the gel is worn only affects how quickly the teeth whiten. They’ll still whiten. As you’ve already paid for the trays, I wouldn’t bother wasting money on something else.

This blog is brought to you by Grosse Pointe Woods Dentist Dr. Theodore Hadgis.

If My Bite is Off Do I Have to Have Crowns?

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I was at my dentist for a regular checkup. He told me my bite was off and wants to crown every tooth. I know I needed some fillings after my braces were taken off, but a crown on every tooth seems extreme. Plus, my braces have only been gone for a few years. How off could my bite really be?

Amanda

Dear Amanda,

Diagram of TMJ

In extreme TMJ cases a full-mouth recontruction is necessary

Something seems fishy to me here. Crowning every tooth is called a full-mouth reconstruction. There are times when a full-mouth reconstruction is necessary, but that is generally reserved for extreme cases of TMJ Disorder. I don’t think that’s what you have. How can I say that without examining you?

Your dentist gave no specifics and said your bite is “off”? What does that mean? Everyone’s bite is off to one degree or another. That doesn’t mean they have severe problems or even any problems. If your bite was off enough to require such a drastic treatment, the complaint would come from the patient, not the dentist.

I’m going to recommend you get a second opinion from a dentist who’s invested a lot of time and training for TMJ Disorder. Look for a dentist who has studied at the Las Vegas Institute of Advanced Dental Studies or the Pankey Institute. These institutions are well known for their TMJ training.

If Your Bite Does Require a Full-Mouth Reconstruction

Let’s say the second opinion dentist tells you your dentist was right and does need this invasive of a treatment. In that case, I want you to look for two qualifications in the dentist who actually performs the procedure. The first, we’ve already discussed. They need significant TMJ training.

However, getting the bite correct isn’t enough. Your smile is the first thing people notice about you. You’ll want your first impression to be one of a beautiful smile. Because of that, it will require an artistic cosmetic dentist. Ideally, you’ll want a dentist who is accredited by the American Academy of Cosmetic Dentistry. AACD accredited dentists are the best cosmetic dentists in the country and can make you a stunning smile.

Though it’s a tall order to find a dentist with both of those qualifications, I wouldn’t settle for anything less if you really do need to get a dental crown on every tooth.

This blog is brought to you by Grosse Pointe Woods Dentist Dr. Theodore Hadgis.

Why Can’t I Have Porcelain Veneers With My Tongue Pierced?

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I’m getting married. I wanted to get porcelain veneers so I’d have a pretty smile. But, the cosmetic dentist I went to said he’d only do it if I got rid of my tongue ring.  My tongue ring is part of who I am. Why do I have to get rid of it?

Tabitha – Brooklyn

Tabitha,

Great question. After all, no one wants to change who they are for a makeover. They want it to express their personality. I can tell you the likely reason this dentist doesn’t want you to wear it, though. Tongue rings do a real number on your teeth.  I wouldn’t be surprised if you’ve got some chipped teeth right now.

Another common problem for teeth with tongue rings is knocking your bite out of alignment, which can lead to TMJ Disorder. Many people who wear them subconsciously suck on them, which will push some of your teeth out of whack.

However, if getting porcelain veneers means that much to you, you’ll certainly be able to find more than one dentist willing. Just be certain you’re willing to spend that much money on something that is likely to be damaged.

This blog is brought to you by Dr. Theodore Hadgis.

Fitting Crowns together

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I’ve had crowns in the past without any problems. Recently, my dentist put two more crowns on. I’m to the permanent crowns so there is not more dental work to be done on them. The problem is the new crowns are not touching the teeth opposite on the lower jaw. These teeth are also crowned.  They’re at least 2mm from touching. I used a new dentist do to moving states. I wonder if it is just differences in preference and style that makes these crowns seem different from my previous ones, or if this new dentist made a mistake. It seems to me they should touch the other teeth. It bothers me because my mouth feels funny. What should I do?

Kimberly A. from Denver

Kimberly,

You have good instincts. Your dental crowns should touch their opposing teeth. How this works is called occlusion. There are textbooks and many post-graduate courses designed to teach the complexities of how it all functions.

One of the leading causes of TMJ disorder is improper alignment of your teeth. If your jaw is properly aligned, you should be able to clench together and all your teeth will meet at the same time. Also,there are two acceptable patterns of occlusion when you slide your teeth side-to-side. One is called canine-protected occlusion. In that type, when you grind your teeth to the side, only your canine teeth touch. These teeth have long, strong roots and are equipped to take this sideways stress. The second acceptable pattern is called group function. In group function, all of the posterior teeth have the same slope and when you grind your teeth to the side, they all touch evenly.

Over time, your teeth may drift together and touch, but there is a strong chance that they won’t touch properly, which throws your bite out of alignment. I’d speak with your new dentist about fixing this. Although, if he or she isn’t qualified in the study of occlusion, you may just want to ask for a refund and go to a different dentist to have your crowns done. You might look for someone who has done some post-graduate study at LVI.

This blog is brought to you by Grosse Pointe Woods Cosmetic Dentist Dr. Theodore Hadgis.

Teeth not lining up with implants

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I just had four dental implants placed, but now my teeth aren’t lining up when I bite down. Is this normal?

Kathy- Tallahassee, FL

Kathy,

No, this is not normal. Your teeth should line up together when you bite. I’d get this looked to right away, because if it isn’t fixed it could lead to TMJ disorder.

There are a couple of possibilities for what went wrong with your dental implants:

  1. The more likely scenario is that the surgeon placed the implants in the wrong position.
  2. The other possibility is that the implants weren’t restored properly.

Implant dentistry is not a recognized specialty and fairly unregulated. It is important to go to a dentist that has a lot of post graduate implant credentials, such as at LVI. It’s even more helpful if you can find a dentist that is also knowledgeable in neuromuscular dentistry, like Dr. Hadgis is. Although it is challenging to find that combination.

This blog is brought to you by Grosse Pointe Woods Cosmetic dentist Dr. Theodore Hadgis.

What is a neuromuscular dentist?

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I am writing because I am a natural born skeptic, and some advice I recently received sounds a little dicey to me. I’ve been suffering for quite some time with headaches and dizziness. I’ve seen three different doctors in the practice I go to, and they’ve each tried something different, and nothing has worked. Now the newest and youngest member of the practice says that I should talk to a neuromuscular dentist.

I don’t even know what that is! He was in such a hurry, and rattled it off really fast, like I should know. I was too embarrassed to ask him to repeat it. Good thing he wrote it on the paperwork. Iwent home and looked it up on the Internet, and all I found was a bunch of letters from people that talked about how badly dentists claiming they did neuromuscular dentistry messed them up! My doctor made this recommendation after he found out that I had lost a tooth shortly before my troubles started.

Is this a reputable field? I don’t even know how to find a neuromuscular dentist. Any help you can offer would be greatly appreciated.

Thanks,

Veronica in Chicago, IL

Dear Veronica,

It is good that you are approaching this with some caution. Neuromuscular dentistry is a legitimate field, but it is not yet recognized as a speciality by the American Dental Association. For this reason, anyone can SAY they do neuromuscular dentistry, whether they have the training or not.

Neuromuscular dentistry is used to treat disorders of the temporomandibular joint, also called TMD or TMJ. This field of study looks at not just the teeth, but the related muscles and functionality of the joints.

It sounds as if your most recent doctor thinks you may be suffering from TMJ. TMJ symptoms include the headaches and dizziness that you are suffering from, and can also include facial and jaw pain, muscle tension in the neck or shoulders, numbness in the fingers or arms, locking or clicking of the jaw, and tinnitus (ringing in the ears).

It is a shame your doctor did not take more time to explain his recommendation and the reasons for it. If you feel comfortable, ask your doctor’s office for a referral to a reputable neuromuscular dentist for TMJ treatment. If you would rather find one on your own, make very sure you check their credentials closely. Look for extensive training in reputable programs, and beware of any that want to offer some kind of quick fix.

This blog post sponsored by Grosse Pointe Woods cosmetic dentist Dr. Hadgis.

Serious TMJ Disorder

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I found this blog because I was looking for information about TMJ. I could really use some expert advice, and unlike some of the dentists I have dealt with in the past, your credentials seem impeccable.

Even though I am only in my early thirties, my teeth are a mess. I have a long-standing teeth grinding habit that forced me to get porcelain crowns on all my teeth 10 years ago. I’ve come to understand that the crowns were not well done. They are ugly and fake-looking, and my bite is completely screwed up. My jaw is crooked, and even my gums are messed up from poor placement of the crowns.

I need help, but my past experience has me really nervous about choosing a professional to work with. From what I can tell, I think I have to choose a cosmetic dentist or a prosthodontist. Now I read about this “neuromuscular dentistry” through your website. Your page says that is not a specialty, but should I look for someone like that to help me with my alignment issues?

I’ve spoken with an orthodontist, and he said that since my case is so complicated I should talk to a prosthodontist. I don’t know what to do at all.

Calvin in Grand Ledge

Dear Calvin,

As you have discovered, there is not a legally distinct speciality in neuromuscular dentistry, and this means that anyone can say that they provide this type of treatment, regardless of their training. You are on the right path, making sure you are checking into details of training and experience. This is the only way to establish whether or not a dentist can provide this type of treatment, which is in fact what will probably help you most.

And you don’t have to choose between the way your teeth look and the way they function – with the help of the right professional, you can have a beautiful smile that works beautifully, too. The key will be to find a dentist that is experienced and educated in both cosmetic dentistry and in TMJ treatment.

Grosse Pointe Woods cosmetic dentist Dr. Hadgis supports this blog as a courtesy service.