Do I have to replace a missing tooth right away?

I just had to have one of my teeth extracted. What is the recommended timeline after a tooth is pulled to get some kind of replacement put into place? I am worried that everything will start moving around and start causing me more problems. My Dad had some teeth extracted, and he had nothing but trouble after that.

Thanks for your help on this,

Max in Oregon

Dear Max,

You are right to be concerned about getting at least something in place before too much time passes, even if it is just a temporary partial denture (also called a dental “flipper”). In as little as a week or two, your teeth could move significantly. I am a little surprised that your dentist did not give you some kind of appliance to wear while you decide on a more permanent solution.

Even just a single missing tooth can wreck havoc in your mouth. The teeth adjacent to the empty socket tend to “tip in” to the space, and the corresponding tooth in the opposing jaw will “super erupt” to try and meet a tooth that is no longer there. All of these movements can cause a misalignment in your bite, which can lead to TMJ problems including headaches and facial pain. You are also at increased risk for gum disease, which could threaten the health of all your remaining teeth.

Usually you have two options for replacing a single missing tooth. You can do a dental bridge, which is two crowns with a false tooth suspended between them, or you can do a dental implant.

Posted in Dental Implants, TMJ Disorders | Comments Off

A mouthguard to prevent my crowns from cracking from my epilepsy.

I have epilepsy, just partial seizures, and I also have a mouthguard, one of those that sticks out of my mouth, beyond my front teeth. I have crowns on my front teeth, the upper ones. I was wondering if this mouthguard is good for these crowns, or if it will crack them. If I didn’t have epilepsy and just had bruxism, will this mouthguard crack my crowns too? Also I was wondering if the mouthguards that are sold in stores, like the ones that you form to your upper teeth, are any good. Won’t these crack your crowns too? Thank you for your help on these subjects. Respectfully, Julie from Wisconsin. 

Dear Julie,
The mouthguard, if it is put in right, will protect your porcelain crowns from cracking during a seizure or from bruxism or other physical contact.

The mouthguards you can buy in the stores and then you heat them and apply them to your teeth, those usually work just fine, though I would have your dentist check the fit afterward to make sure they will give you adequate protection. Or you can have a custom mouthguard made by your dentist, and this will offer the surest protection but will be more expensive. For bruxism we usually make hard flat splits that snap on your teeth. For epilepsy it may be a softer material that will cushion better. But either one will work.

Other links:
Read about bulimia and teeth damage.

Posted in Porcelain Crowns, TMJ Disorders | No Comments »

Help for migraine headaches

I’ve had migraine headaches for years. Most of that time, I didn’t have insurance, so I just did the best I could with over the counter pain killers, and tried to just live with the pain. Through my new job I finally have insurance, and I’ve been working with a new doctor to try and get rid of these headaches. We’ve tried some different medications, but he wants me to talk to a dentist about something called “TMJ”. I looked it up, and understand that he is talking about the joints of my jaws, but I’ve never heard of a dentist treating headaches. Is my doctor just trying to pass the buck?
–Eddie in Sacramento

Dear Eddie,

It sounds like you have a doctor that is well up on current research, and progressively trying to find a solution for you that does not have to involve drugs. That is all good!

As you learned through your research, TMJstands for temporomandibular joint, which are the joints that join your jaw bones together. “TMJ” is a lay term used to refer to TMJ disorders or dysfunctions. Problems with the temporomandibular joints are dramatically under-diagnosed, and particular to your case, are very often a source of unexplained headaches and migraines. 

You’ll want to seek a dentist who has had training above and beyond normal dental school. Look for someone who has trained at the L.D. Pankey Institute, or the Las Vegas Institute for Advanced Dental Studies. There is no official “TMJ specialist” designation, so you may have to do a little bit of detective work to find a dentist that really has the training to help you. Your doctor may even be able to recommend someone.

A dentist trained in the treatment of TMJ disorders will try to locate the source of the problem, rather than trying to mask your symptoms with drugs. He or she may try a custom-made oral device or neuromuscular dentistry techniques that address the alignment and function of your jaws and teeth. The key is finding a dentist with the right training.

Good luck, and we hope you are pain-free soon.

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Does bonding come off when you chew hard substances?

Question:
Does bonding just fall off a tooth with chewing a hard substance?
- Mike in Georgia

Mike,
Dental bonding involves the application of a composite material to the tooth. It is different from porcelain veneers  in that it is made out of composite, not porcelain, and it is shaped on the spot by the dentist rather than baked in an oven by a dental laboratory and later bonded to the tooth. To read about veneers, see our Seattle porcelain veneers page.

The bond to the tooth is very strong, and ordinarily it doesn’t come off. But sometimes it does. It will come off if:

1. It hasn’t been bonded on properly.
2. It is abused. Normal chewing of hard substances wouldn’t be abuse. We mean things like playing a contact sport without mouth protection, biting on metal or rock or other very hard substances, or getting struck in the mouth.
3. You have a problem with grinding your teeth or other occlusal problems, including certain TMJ disorders that haven’t been addressed or taken into account by your dentist.

Or it could be a combination of the above factors that causes the bonding to fail. For example, if the bond is only moderately strong instead of its full strength, it will be more susceptible to lesser degrees of the bottom two problems.

If your bonding has come off because of normal chewing of a hard substance, I would suspect that there could be some improvement in how the bonding was placed. Sometimes dentists don’t fully analyze your chewing patterns so as to shape bonding to be able to withstand normal mouth function. That’s my guess about what has happened, but I could be wrong, since I haven’t examined you. 

Posted in Dental Bonding, TMJ Disorders | No Comments »