I Think I Have TMJ

Question: I have prided myself on reaching my fifties with all my teeth except one wisdom tooth. I’ll explain in a minute. Up through my forties, I didn’t give my teeth much thought. I saw the hygienist kind of regularly but not religiously. My family has good teeth and every time I went, though I wasn’t diligent, I got a “good check-up, no cavities.” I thought, “Great,” then I’d let a year and a half go by, then two years, before going back.

A number of years after doing this, I did have a couple of cavities – big ones, so I got root canals. Then a year or so later, I began to have pain on the opposite side that ran over the side of my face, back of my head, and into my upper back. I saw a dentist and because my wisdom tooth seemed a bit tender, we put it down to that so I had that wisdom tooth pulled. I expected relief but it didn’t come and that has been several years. The pain is not debilitating but it really gets my attention and takes my focus from more important things. I’ve looked into it but can’t seem to find answers.

Recently, I saw a dentist who asked a bunch of questions and took a lot of x-rays and moulds of my teeth. After all the information gathering, I’m to go back and get a diagnosis but something interesting happened as I was about to leave. He said, “You have a deep overbite,” (something I knew). He said, “Because the pain is regional, over a large area, that is a good thing; proper treatment will relieve the pain.” That made me feel hopeful. What did he mean?

Answer: TMJ, or temporomandibular joint, is a shortened, almost acronym, of non-dental personnel to describe a painful aching or sharp pain that can affect the head, neck, back, and sometimes centres itself over the joint. This is a big topic so let’s keep it to your symptoms.

When pain is regional, it most often is a muscular response – lactic acid build-up and over exertion.

Though the root causes are multifaceted, clenching and retro pressure on the joint structure can set this off. It is exacerbated every time you swallow.

A deep overbite can often be found to be the mechanical cause. In other words, when you bring your teeth together, your lower jaw is forced backward because as the front teeth and bite come together, the final squeezing together of the teeth “levers” the jaw and joints rearward. This backward force stimulates muscle reactivity, meaning muscles that close the mouth and muscles that open the mouth are activated at the same time. Muscles that are supposed to be complementary become antagonistic as a result. This hyperactivity leads to muscle fatigue, lactic acid build-up, and pain.

Palliative and definitive treatment of muscular facial pain is available. It sounds like you are on the right track.

Am I Doing the Right Thing?

Question: I lost my wife several years ago and things are not the same. I don’t make decisions well without her. I tend to leave personal needs and attention to detail until the last hour and then only when circumstance, or pain of one kind or another, forces me into action. I haven’t cared for my teeth as I should and now I get pain all too frequently. I’ve got broken teeth, loose teeth, missing teeth, and abscesses or the like that keeps my gums swollen most of the time.

I was told I’ve got some good teeth too – I mean ones that aren’t rotten and held together with fillings, so I’m wondering what to do. A family member said get them yanked and get dentures, then your problems are over, no more pain, don’t have to worry about needles (I do have a needle phobia), no drills or smells or sterile clinics and wondering what’s coming next. His argument went on in a tirade and was sounding pretty good. As I thought about it, parents and grandparents came to mind. They hated their lower dentures and they did have to go back many times for fittings and relining so that seemed more of the same.

I’m sure there are pros and cons to any decision but the person I trust the most is gone. She always seemed to come up with the best answers. Anyway, I’ve heard about implants but they sound expensive and painful. That’s another thing, pain and expense, the two things that drive me crazy. So what is best – that’s the question my wife would have asked. I was and am always the penny pincher, so I need to know what the best thing is.

Answer: Dentures still serve some of the population of seniors, some have adapted and say that their dentures work for them, others find them difficult, and some say, “My dentures are in a drawer and I take them out only for social occasions.”

In the past twenty years, implants – especially for those whose teeth are ‘gone’ and need removing – have provided the most transformative, comfortable, attractive option and can be done comfortably in one seating. When I first heard of this procedure over sixteen years ago, I couldn’t believe it. It seemed to be contrary to what I knew, i.e. dental implants need time for the bone to heal tightly before a crown or denture was attached.

In an engineering principle called Cross Arch Stabilization, these implants act as one, allowing for increased, unified strength to support function immediately. In thirteen years of using this cross arch stabilization of implants, I’ve seen nothing like it. The bone stays intact around the implants better than in any other application.

In dozens upon dozens – several hundred restorations of this type, in fact – this has been the best result for teeth supported by implants I’ve seen. On top of that, one may go from unsightly non-functional teeth to beautiful, strong, functioning teeth in one dental appointment. Seeing it, doing it, has made me a real believer. If your teeth are unrestorable, yes, this is the right thing to do.