TMJ / TMD News

I’m am about to lose a front tooth because an old broken crown can’t be fixed anymore.  What are my options?

This is a question we get fairly often.  Many times patients have teeth that become un-restorable.  It may be due to bone loss, fractured teeth, old posts that won’t stay in anymore, etc.  The answer to the question depends on a bunch of different factors including where it is, bone levels, the teeth next to the missing tooth, whether the patient smokes, and many more.

Option #1: Do nothing.

This is the cheapest option in the short term, but it may actually become the most expensive in the long run.  Over time, the teeth next to the space shift towards the space and can cause problems with the gums, bone and the bite.  It may require braces or other procedures to correct this down the road.  Also, when the missing tooth is in the front, aesthetics becomes a big concern.  This may make this choice not so good.

Option #2: A removable Partial Denture

This is where you have an appliance made with metal or acrylic. It stays in by clasping onto other teeth in the mouth.  A portion of the appliance fills the missing tooth area with a plastic tooth.  This option can work very well for some, but for others, food getting caught under the partial, taking the partial in and out, and aesthetics make this not a good option.

Option #3: A fixed Bridge

This option is a good option for many people.  It is where crowns are done on the teeth next to the space.  The framework of the bridge spans across the space over to the other crown.  The lab then creates a piece that looks like three teeth.  The bridge is cemented in and is not removable.  It can look very good, be very comfortable, easy to clean, etc.  There are factors that we need to think about when deciding that a bridge is right for the patient.  Are there fillings on the teeth next to the space?   How stable are those teeth?  What does the gum look like?  How big does the patient smile? What materials will work well?  A bridge is a great option for many, but what if the teeth next to the space have bone loss or crowns with very little natural tooth left?  Will they be strong enough in the long run to support all this?  Maybe,  maybe not.

Option #4: An implant

This option is a great option for many people.  An implant is made of Titanium and placed into the space of the missing tooth.  Once the bone around the implant grabs onto the implant (integrates), the implant is ready to restore.  This integration takes about 3 months.  During this time, a temporary of some sort is used.  There are many factors that go into making an implant successful, but they are typically very long lasting, comfortable, aesthetic, and conservative.  With an implant you don’t have to do any restorations on the surrounding teeth.  This “keeps a one tooth problem, a one tooth solution”.  If you were to ever have a problem, it is only limited to that area.  I like to think of it as having a new tooth put in.  There are factors that make an implant more difficult, such as uneven gum levels, active gum disease, tooth width, and smoking.  Many of these issues can be overcome, but it does require some pre-planning.

As you can see, there is a lot to think about.  It is best to talk over you options with your dentist before finalizing your choice.

Please send any questions that you would like answered in future issues or comments to me at: The Journal at PO Box 432 Colts Neck, NJ 07722 or email them to me at Mike@DrBixby.com. Your name will not be used in the article. This article is meant for informational purposes only. Please contact your dentist or our office, if you desire dental advice.

Michael J. Bixby, DMD, FAGD is a General, Cosmetic and Neuromuscular/TMJ Dentist, practicing at 250 Maple Ave. Red Bank, NJ  He can be reached at: 732-224-1160, Mike@DrBixby.com or www.drbixby.com.

What do the following questions have in common?

1)  “Doc, my dentist fixed this chip on my front tooth, but it keeps coming off.  Is it the Glue?”

2)  “I get headaches around my temples and neck every day.  Can you help?”

3)  “My teeth are getting smaller as I get older.  I am afraid they are going to wear to nothing.  What can I do?”

The answer to all three of these questions may be your bite.  The Jaw is a complicated joint that has muscles, bones, discs and is kept in balance by the position of your teeth.  A healthy joint requires a balance between all of these parts.  Think of it as a battle between the muscles of the face and your teeth.  Ideally the muscles and joint are happy and the teeth mesh nicely as you close.  The problem for many people is where the teeth mesh is not where the muscles and joints are happy.  Posture, breathing, worn out fillings and missing teeth all have an effect on your bite.

In the battle for a healthy joint, there will be a winner and a loser.  If the muscles win, you will chip teeth, break fillings, or wear down your teeth as in questions 1 and 3. The teeth are in the way, so they try to get them out of the way.  If the teeth win, your muscles have to work really hard to get your teeth to meet or they may not be able to find a comfortable spot.    This can lead to pain, headaches, neck aches, or jaw pain as is question 2.  The muscles are working really hard to go where they want, but they can’t.  This leads to tired and sore muscles.

What can we do about this?  Neuromuscular dentistry looks at all of these things and tries to get you in balance.  When you’re in balance, your teeth are no longer in the way, so your muscles don’t have to work very hard.  Your muscles don’t have to get teeth out of the way, because the teeth fit where the muscles and jaw are most happy.

If you find yourself asking these questions about your teeth, it may be your bite.

If you don’t have a dental home, you are welcome to call our office (732-224-1160) and schedule an appointment so we can discuss your unique situation.

Please send any questions that you would like answered in future issues or comments to me at: The Journal at PO Box 432 Colts Neck, NJ 07722 or email them to me at Mike@DrBixby.com. Your name will not be used in the article. This article is meant for informational purposes only. Please contact your dentist or our office, if you desire dental advice.

Michael J. Bixby, DMD, FAGD is a General, Cosmetic and Neuromuscular/TMJ Dentist, practicing at the Wikoff Building in Red Bank  He can be reached at: 732-224-1160, Mike@DrBixby.com or www.drbixby.com.

What do the following questions have in common?

1)  “Doc, my dentist fixed this chip on my front tooth, but it keeps coming off.  Is it the Glue?”

2)  “I get headaches around my temples and neck every day.  Can you help?”

3)  “My teeth are getting smaller as I get older.  I am afraid they are going to wear to nothing.  What can I do?”

The answer to all three of these questions may be your bite.  The Jaw is a complicated joint that has muscles, bones, discs and is kept in balance by the position of your teeth.  A healthy joint requires a balance between all of these parts.  Think of it as a battle between the muscles of the face and your teeth.  Ideally the muscles and joint are happy and the teeth mesh nicely as you close.  The problem for many people is where the teeth mesh is not where the muscles and joints are happy.  Posture, breathing, worn out fillings and missing teeth all have an effect on your bite.

In the battle for a healthy joint, there will be a winner and a loser.  If the muscles win, you will chip teeth, break fillings, or wear down your teeth as in questions 1 and 3. The teeth are in the way, so they try to get them out of the way.  If the teeth win, your muscles have to work really hard to get your teeth to meet or they may not be able to find a comfortable spot. This can lead to pain, headaches, neck aches, or jaw pain as is question 2.  The muscles are working really hard to go where they want, but they can’t.  This leads to tired and sore muscles.
What can we do about this?  Neuromuscular dentistry looks at all of these things and tries to get you in balance.  When you’re in balance, your teeth are no longer in the way, so your muscles don’t have to work very hard.  Your muscles don’t have to get teeth out of the way, because the teeth fit where the muscles and jaw are most happy.

If you find yourself asking these questions about your teeth, it may be your bite.

If you don’t have a dental home, you are welcome to call our office (732-224-1160) and schedule an appointment so we can discuss your unique situation.

Please send any questions that you would like answered in future issues or comments to me at: The Journal at PO Box 432 Colts Neck, NJ 07722 or email them to me at Mike@DrBixby.com. Your name will not be used in the article. This article is meant for informational purposes only. Please contact your dentist or our office, if you desire dental advice.