New to TMJ... Can missing a major molar cause this? - TMJ Disorder -TemporoMandibular Joint Message Board

Janette* · 05-08-2009, 04:35 PM

Hi everyone, I would love it if any of you can give me advice on my situation.

Just for a bit of background, about a year ago my dentist suspected that I had been grinding my teeth. I was grinding during sleep so I never noticed. He told my my teeth were out of alignment and that was why my jaw was subconsciously "searching" where to go. This made sense to me, because I had a permanent molar on the bottom row removed about 4 years ago and the tooth in front of it and tooth behind it have since shifted to fill the gap somewhat. My dentist thought so and suggested I see an orthodontist about correcting the affected teeth and replacing the removed tooth with a false one.

I put off seeing the ortho simply because I knew I could not afford it at the time and didn't see a bit of teeth grinding as a serious problem (I had been stressed out at work and thought that the grinding might have been temporary).

Fast forward about a year later. My jaw clicks and shifts as I chew and gets sore/tired after a simple meal. I can't say I experience what I would call pain, just that my jaw feels like it gets a huge workout by just opening and closing a few times. Opening my mouth wide is a chore. And I still grind my teeth while I sleep.

I realized these problems were only getting worse and that I needed to seek treatment, so I saw an ortho today and this is the part I would like advice on. Upon his first inspection, the orthodontist told me that I definitely have TMJ-like tendencies, and said that about 50% of the population experiences popping and shifting in their jaw and that it was normal. He also said that it's possible that my jaw would "correct itself." When I brought up the issue of my molar having been removed years ago and that the teeth surrounding it had been slowly shifting, he didn't seem to make a connection. His answer was "are you looking for full orthodontic treatment, or to correct your jaw issues?" when in my mind it made sense that the tooth being gone could have CAUSED the jaw problems. I am returning in a few days to talk about splint therapy. He advised me that just wearing a splint during the night (and most of the day) could improve the symptoms, and could lead us to a permanent resolution if I chose to have work done to mimic what the splint does. The "permanent solution" I assume would be full braces but I won't know until I see him next.

Would anyone mind commenting? I am considering seeing a different ortho, just because what he told me is leading me to believe that he doesn't really get it or otherwise doesn't know how to properly deal with this.

StillHope · 05-08-2009, 08:01 PM

Hi,
Clicking of the jaw is a sure sign of the TMD (tmj disease) so is the restriction on opening. Those are not good signs though that is true that many people live with it and it does not progress much. One never knows! The problem is that if the bite is unstable the tmj problems will likely worsen over time.

Restoring a "proper bite" would be the best thing to do to stop the TMD. BUT, as you can probably learn from this Board so many bite and tmj problems are caused exactly by dental work with the best intentions to "correct the bite". So there is theory and there is practice!!

I would not be in favor of full braces. From many posts, from some dentists and a cranio-sacral therapist I can say that braces often create problems not only with the bite but with the head bones as well.

I'd suggest to look for a bite specialist and not necessarily for an ortho.
Surely, one molar can change the bite enough to cause the TMJ problems. It could have shifted the bite to one side or could have lowered it. It's difficult to say what's the best until someone can evaluate your bite thoroughly. If you were OK before that dental work maybe restoring that missing tooth will help.

Any ear pains? Blurry vision? Did you smile became skewed to one side? Any headaches?

I'd suggest also to read as much about bites as you can and to try to evaluate for yourself what is going on with your bite and jaw. I mean where does it want to bite and whether it's comfy and where does the jaw shift from there and why. What teeth are hitting and what are not contacting at all, and so on.

Thelma-Louise · 05-08-2009, 08:59 PM

Why is it with dentists its either all or nothing? I would agree this sounds like a simple semi-orthodontic issue resulting in mild to moderate tmj symptoms. A missing tooth allowed other teeth to shift - which is to be expected and quite the norm - yet the ortho wants to know if you want full ortho treamtent?. Why can't it just be - Ok lets move these 2 teeth back to where they belong and do an implant or bridge and restore the normal balance of the bite? It kind of like making a mountain out of a molehill. Plus you do run the risk of causing other problem by having full orthodontic treatment - although sometime it is quite necessary to treat tmj this way

Before you do anything you may want to go for a few other consults - maybe look for a dentist that is trained in orthodontics and FJO (functinal jaw orthotics) and understands tmj as well. A neuromuscular dentist or a dentist trained in occlusion may be a good idea.

I kind of wonder what the ortho thinks the splint therapy will show - that you need another tooth on the side where one is missing? Hello - that's not really a AHA moment is it? I can understand how the slpint may help equalize the bite on the side you are missing the tooth and how this will then help eliminate your symptoms - but I still wonder what he will do or recommend then - full mouth orthodontic treatment? why?

Janette* · 05-14-2009, 11:40 AM

I appreciate your replies, thank you.

I went back to the ortho yesterday to hear what his recommended treatment was. He gave me a few options in order of optimal to less-involved. Number one on his list was surgery to actually move my jaw forward. His reason for this is that my jaw would need to move forward to have a "normal" bite, as it is slightly back in relation to my top teeth, and because of this my front teeth on top are inclined very vertically and perhaps slightly inward, and my bottom teeth are inclined slightly outward to meet the top teeth.

Number two (and if I were doing the surgery option, this would be in addition) is full braces. He wants to actually close the gap where my missing molar is on the bottom row which is what I, in addition to my dentist, personally suspect caused my TMJ symptoms. On my top row, I should first mention that I only have one canine tooth, and it is a baby tooth. So not only do I have an uneven number of teeth on top, but that one baby tooth is due to come out at any time. He would like to remove the tooth and start shifting all of my top teeth to center them.

Number 3 is a splint that I could use indefinitely, if it helps. So far, this logic makes absolutely 0 sense to me. In my mind, he is an orthodontist and trained to take an imperfect set of teeth and straighten them out to make them perfect and normal. He must have asked me 5 times during my two visits what my goals were; if I was here for full orthodontic treatment or if my jaw was my #1 concern. I told him each time that I'm not interested in ANY cosmetic procedures, I am only concerned with fixing my TMJ so that it does not continue to get worse as it has for about a year now. And so after I remind him of that, he suggests the splint and tells me that I can wear the splint indefinitely but the permanent procedure would be the braces treatment he had explained.

I flat out asked him if correcting the two teeth that had shifted since removing my permanent molar, and then implanting or bridging for the gap would help. He paused and just said "No."

I have been living almost 23 years with absolutely no bite problems or grinding or jaw problems until last year, in relative time to missing that one major tooth. I am thoroughly unconvinced that I need to completely reconfigure my bite as he is suggesting that I do. In the back of my mind I realize that it is just his thought process as an orthodontist, and perhaps he has his own agenda.

He has also mentioned several times that grinding is very common and probably wouldn't be fixed. When I showed concern that while I don't experience any significant pain or headaches or earaches, I know that others with TMJ do and I would avoid getting to that point if possible, he explained that it isn't a 1-2-3 process like that and I probably would not experience those things. That leads me to consider taking no action at all and just dealing with the popping and clicking and hope that my jaw can adjust on its own.

So, and the end of all of that I am not interested in any of his recommendations and I don't want to see him again. If I see another professional I will be looking for a dentist who I know is specialized for these areas.

Thelma-Louise · 05-14-2009, 03:08 PM

Good for you - trust your instincts and rely on what makes complete sense to you. While others do go the route of surgically moving the jaw forward and having the teeth moved accordingly and have a successful outcome - it is not for everyone. Definitely get more opinions if you are so inclined - eventually you will come across the right dentist with the right approach for you.