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Need advice: Disagree with my dentist about treatment


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Old 01-16-2009, 05:56 PM   #1
jra83
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Exclamation Need advice: Disagree with my dentist about treatment

Hi everyone. I'm new to these boards and thought maybe I could get some advice from some of you since I need an outside opinion. I've recently developed TMJ in the past 4 months and it's gotten bad pretty quickly.

I finally got to see my dentist last month and, as in most other TMJ cases I guess, my bite is off. More specifically, my back left teeth touch together before my right teeth, and there is little to no contact on my front teeth. I've had braces many years ago and although my teeth look great there is definitely a problem somewhere. Now I still have both my top wisdom teeth and coincidentally, my top left wisdom tooth is considerably more developed than the right one and my dentist thinks it's the cause of my problem.

To get some other opinions, I've also seen a different dentist and an orthodontist. After speaking with each other, they've come to conclude that my left wisdom tooth has to come out, and I should wear a splint afterwards. Since I've been reading a lot about TMJ disorder lately, most websites I've come across suggest doing conservative treatments first before doing anything permanent to the teeth. I've expressed this to my dentist and he seems to disagree with me, and really wants me to get the tooth pulled out over anything else.

Have any of you ever had teeth extracted to fix your TMJ? If so, how did it work out for you? Am I in the wrong here for thinking maybe I should be wearing a splint or doing something more conservative before I start getting some teeth pulled out? Any advice you could give me would be extremely helpful. Thanks!

 
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Old 01-16-2009, 06:45 PM   #2
StillHope
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Re: Need advice: Disagree with my dentist about treatment

Don't rush with the extraction! From the dental posts which I read many problems are caused exactly by this! Last teeth are very essential and they keep the VDO- vertical dimension of the bite. Once the last tooth is extracted the VDO will get lower and this might cause a big bunch of other problems. The solution then might be only a full mouth reconstruction which is not that easy to say the least.
Absolutely, don't do anything irreversible until you will be comfortable and the dentist and you will be totally sure what the problem is and what is helping.

Your bite is not balanced and it might be open as well (if no front teeth touch), maybe due to the braces. An open and uneven bite causes the jaw to move out of its functional position and causes the tmj symptoms.

I'd suggest to find a dentist specializing in occlusion and tmj together, and better get few opinions as well. From what I heard from dentists, Pankey Institute and KOIS center teach it all as a system, maybe there are similar dental schools in CA too.
Hope this helps.

 
Old 01-16-2009, 07:28 PM   #3
jra83
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Re: Need advice: Disagree with my dentist about treatment

Thanks for your reply StillHope! I am also very skeptical about the usefulness of an extraction like this. As much as I'd like to get some more opinions before doing anything, I don't think there are really any TMJ specialists or anything in my region (I live in a fairly small town) and I have no means of getting around much. I guess my alternative at this time is to try talking to my dentist again to see if he would be willing to make me a splint instead and forget about the extraction. Anything else at this point would cause permanent changes to my teeth, and most other methods of treatment are out of my reach financially (I currently don't have any dental insurance). All I know is I'm really paranoid about getting a tooth pulled out.

 
Old 01-16-2009, 07:34 PM   #4
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Re: Need advice: Disagree with my dentist about treatment

I am glad that your intuition is working well for you! Listen to it.

Hope a splint will help. If you'd just have to live with what you have try to keep your teeth apart as much as you can (sometimes the tongue does it), and focus on keeping your neck, shoulders and hips relaxed, and maintain a good posture during all your activities.

 
Old 01-16-2009, 09:37 PM   #5
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Re: Need advice: Disagree with my dentist about treatment

Yours is an interesting post - I have read a few other posts abut wisdom teeth in general causing tmj issues. I myself have only one wisdom tooth left on the upper left side - the other were extracted when I was younger - the one wisdom tooth was Kept b/c the molar in front of it had to be removed and the dentist said it would shift into the former molars position and it did. It however was also not as developed as the corresponding molar on my upper right - it even angled out a bit - and some drs have told me this may be part of my problem. Upper wisdom teeth are generally much higher up in the arch and there are a few studies on the net - and some discussion here - about their role in tmj. Interestingly before the tmj pain started I too noticed I was not making contact on the left side where the wisdom tooth was - but instead the contact was made on my central molars on that side. Have your canines rotated or changed postion?

I would agree that you not remove anything as of yet but ask about having a splint made that would take the wisdom teeth out of the equation in your bite to see if this does indeed help with your symptoms.

 
Old 01-16-2009, 10:28 PM   #6
AnnD
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Re: Need advice: Disagree with my dentist about treatment

It is odd that dentists feel the need to pull someone's tooth. I don't think I would want my second opinion DDS to be talking it over with anyone one else that has seen me...that's the point of a second independent opinion. Since there have been no real science done to know exactly what to do with TMJ every dentist has their own ideas of how to correct it. No one even knows how to treat it and it is rare that insurance will even pay for any treatments. Both sides of my jaws pop in and out when i chew but it otherwise doesn't cause me any other problems that I can't live with so I wouldn't allow anyone to touch me and certainly not to pull a healthy tooth...it is all a guess anyway it may not change a thing. Good luck.

 
Old 01-17-2009, 08:08 AM   #7
jra83
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Re: Need advice: Disagree with my dentist about treatment

Ah, there's something I left out in my original post. Before I got my braces, my dentist pulled out two permanent premolars and said this would make room for my top wisdom teeth to grow and shift in place, which they did. So basically, I'm missing the same amount of teeth as someone who would have gotten all their wisdom teeth extracted. That is partially why I don't want to have my tooth extracted, I feel like I'd have less than the ''minimum'' amount of teeth most adults have. I don't want a huge gap in the back of my mouth.

Is it possible the tooth grew a bit making my bite uneven? I'm only 25 yrs old but I don't know if wisdom teeth can still grow at my age. Maybe it just needs to be evened out a bit.

 
Old 01-17-2009, 09:16 AM   #8
StillHope
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Re: Need advice: Disagree with my dentist about treatment

Teeth grow and move at any age. They only grow when they need to have more contact trying to reach the opposite tooth. If your wisdom tooth grew higher (which is moved higher, not actually "grew" in size) it needed this for stability, maybe in fact for VDO since your premolars were removed.
Sorry to say they could have been important!

This only confirms my suggestion not to remove any more teeth. I was gradually loosing VDO from dental work and it went from no TMJ symptoms, to mild symptoms and then to sever symptoms. We need the VDO! Unfortunately, all that dentists can do w/o a lab work is lowering the height of occlusion since they can only grind down and remove teeth. They can't put back the VDO since it involves generally all the teeth.
Please, be careful not to have irreversible changes until you will be comfy!
It CAN get worse easily from any minor adjustment of the teeth not to mention an extraction!

 
Old 01-17-2009, 07:55 PM   #9
jra83
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Re: Need advice: Disagree with my dentist about treatment

Alright then, I guess I'll go with my instincts and tell my dentist I won't be having any teeth extracted yet. I'll just ask for a splint. Thanks for the replies everyone!

 
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