Reasons to Smile

This week brought two new patients that have locked jaws. Their “TMJ joints” either have been displaced or they are having muscle spams. There was a significant differences in age as well as both sexes.

So what do we do? First, I always start with a full exam. This includes history of the injury or event along with full dental exam. I check muscles and all the related supporting structures to get an idea of the extent of the problem.

A word about x-rays: I recommend a complete set of x-rays as well as additional x-rays of the TMJ. For the x-rays of the TMJ, there is a single cone x-ray called an I-Cat. The I-Cat gives a great hard tissue view of the bone. If I need additional information after I see the I-Cat, I may request an MRI. This kind of X-ray will fill in the blanks of soft tissue information that the I-Cat will not have.

With the combination of the exam, history and supporting documentation can give me a great idea as to the health of the TMJ and a prognosis. Having an accurate diagnosis is what dictates treatment and projected outcome. Based upon this information, I design and make a TMJ splint. A well designed TMJ splint is essnetial for TMJ treatment as well as for aiding in the diagnosis.

Locked jaws are nothing to waste about time about. One of hte most important factors determining recover is the time lapse between the event and a visit to your dentist. Time is critical. The sooner care is started the better the chance of complete recovery. I am pleased to say that I expect these two patients from last week to make good recoveries.

This is a true story told to me by a new patient named Stacey.

Stacey is originally from the East Coast and was given my name by a dentist who attended the Pankey Institute, an entity that teaches a sophisticated way to repair mouths.

Anyway back to my story. Stacey asked me how long a veneer should last. The answer is usually a long time. Some of the first ones I placed almost 25 years ago are still in the mouth and functioning well. Stacey, on the other hand, has had three replacements of her veneer in the last three years. This is obviously far too frequent, especially since she had had to pay each time. To make matters worse, these three replacements did not include the multiple times she had to have them re-cemented them. When I met Stacey today, she was missing her right front tooth. Obviously this was not a pretty sight and she was not happy. I asked her if she wanted to find out WHY and, to her credit, she decided to let us discover the problem and plan the cure.

So this is what we did…

I started with a complete exam. This told me Stacey’s mouth has three problems:

1. She has been grinding her teeth!
2. The way her bite hit was causing all the force of the bite to come down right on the veneers which caused them to break the cement junction!
3. Her teeth are significantly worn down. This changes the the forces and dynamics of her mouth accentuating the harmful forces.

After completing the exam, I placed a temporary bonding on the front teeth. Stacey was ecstatic and I thought, “not bad if I did not say so myself.”

I also made some molds of her teeth to make her a TMJ splint called a MAGO. This appliance is used to help diagnose the true jaw position called CR (Centric Occlusion) and then we can find true, neutral position. Finally, after discovering the CR and the neutral positions, we are ready for the full diagnosis and we can develop the PLAN.

In the meantime, I think the temporary bonding will last through this time, giving Stacey a temporary beautiful smile while we work to give her her permanent, stable one. I will keep you posted.

Dr. S