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Another person with open bite, TMJ and perio, need advice pls

Hi, yesterday I visited one of the "Top3" dentists, which I understand are the top dentists in the country. Anyway, I have developed an open bite over the past few months from night clenching... which also was identified as the main cause of a recent diagnosis of periodontitis. I was treated for TMJ years ago, and thought it had resolved itself, so ditched the splint after chewing through several. Anyway, the recommended treatment is a full mouth restoration with some type of properly aligned crowns on  ALL my teeth. The estimated "discounted" price for all this work is $70k... give or take a few thou. I am 45 and have two kids in college and two foster children, so there is really no way I can afford this sum.
Although I have a few old fillings/crowns that need replacing, I think crowning ALL my teeth is a bit much. Yet, the dentist claimed this was a conservative treatment!? With generalized pockets of 5-8mm on the majority of my molars, and no pocketing on front teeth, I really do not view this as a conservative treatment. It seems to me that the gum inflammation caused my back teeth to "rise", creating this 'new bite'. I do have a couple of slightly loose teeth #16 and 15 that were classified as having class 1 mobility. I am trying to be proactive and sought out perioscopic cleaning and had emdogain applied to all root surfaces. My Periotherapist saw nothing wrong with my wisdom teeth, yet the reconstruction includes yanking them. I am frantically trying to find an alternate solution. I frankly abhor these manufactured smiles and think spending this amount of money on a "shaky" foundation is really not the best way to address this problem. Yet, the high-pressure tactics of the dentist remind me of used-car salesmen. They suggested my husband come with me for the treatment plan, and basically suggested that if he loved me, he would find the financing to get this done.
The 2mm open bite is not objectionable to me, however, the TMJ is now returning after being stable for the past 10 years. What else can be done in this situation? I am seeking a second opinion, but, I read these boards and believe the pros here dispense some great advice. I'm thinking that the rear teeth may recede once the perio inflammation calms down... or, that the rear molars could be filed down a bit.
Another specialist in occlusion had suggested an upper and lower orthotic might be the answer. However, this individual is across the country from me, so they referred me to the dentist that is suggesting the above course of action. Their main specialty is cosmetics which concerns me. I am not prepared to go into hawk for one of these manufactured smiles that look like dentures to me! The dentist in question said this was the ONLY solution, but I think grinding my teeth down to nubs, with the possibility that I could end up losing them to perio is a fairly risky gamble. As much as it pains me to think about it, I am considering dentures. I just think there has to be another solution, and that my rear molars may settle down once the perio is more stable. Other than dentures, any suggestions of what else I might consider?...
4 Responses
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782045 tn?1238193325
MEDICAL PROFESSIONAL
Dear LysaJane
I am not here to tell which philosophy is right and which is wrong. I am a NM dentist and have treated many patients who had TMD problems and so did many other dentists on this forum and one thing we can say it works and there is a lot scientific proof for it and it is documented.
And there is plenty of research how to treat it effectively and to prevent it once diagnosed and treated. But when it comes to prevention from the onset, it isn't like preventing getting a cavity by stop consuming candies. TMD has many contributing factors and that is something hard to control since we all are different in how we function and live.
As far as which approach a patient takes for treatment is a personal choice. As a health provider we only can make suggestions based on our training and education. Our patients are the ultimate decision makers.
Why is TMD so common? That is a question you can't just respond with one answer. It influenced by growth, genetics, society, diet, race, etc. And to answer your next question is it also common in folks who never had fillings or ortho, yes it is.
Neuromuscular dentistry is a proven science, and research is being done to find better answers and results each day just like any other medical field.
You have to understand the human body is very unique and it works in mysterious ways and responds to any stimulus and action it is placed under.
Like any other medical field we do not have all the answers, but based on millions of patients who have been treated with a neuromuscular approach it has shown definitive results and there are many patients who have had successful treatment after dealing with a lifelong debilitating disease.  
As far as cost effective......as long as the insurance companies rule and make decision on how to properly render treatment for our patients there will never be a cost effective way.
Sincerely
Dr. Mehregan
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Avatar universal
I so much appreciate the well written and well informed letter from whimzy63.    I am especially concerned that there seems to be little consensus within the dental profession as far as which approach is best when reconstructing the occlusion. I am thinking of prosthodontics, LVI, Bioesthetics and I believe Pankey.  Some believe that it is important that the condyles of the temporal mandibular joint are placed in a forward position, others say that the condyles should be placed upwards and back when the "bite" is reconstructed.  Some insist on imagery and special x-rays, and others seem not to need it. Even though there appears not to be a lot of scientific papers on these issues, or direction from the dental societies or dental schools, the one thing that they do  have in common is the enormous cost. Even if the cost was an attainable one, it would be difficult to proceed based on the inability to predict the success of the procedure. Can someone tell me why  temporal mandibular pain is so common?  Is it present amongst those people who  have never had fillings or orthodontic work? Is anybody doing the studies? Do we know how to prevent it? Where do we go for direction before placing our life savings at risk for help with this disabling condition.?  Since TMD appears to be so widespread, we need cost effective ways to correct the condition and research initiated on how to prevent it from occuring.  This is a serious health issue.
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Avatar universal
Yes, the splint was a thin, acrylic, orthotic device that was adjusted until my bite was in a stable position. My bite is an anterior open bite of approx. 2mm. The dentist who claimed the solution of the crowns is a cosmetic dentist with a subspecialty in neuromuscular. They are also an instructor at LVI. The sales tactics were very high pressure and the whole situation with the post-evaluation consultation was really uncomfortable.... with a whole bunch of staff basically tag-teaming my husband and I and telling us blatant lies about discounts and financing, (they kept contradicting themselves which made me start investigating their claims as it seemed odd.) I have no doubt the man does good work, however, to start out blatantly lying about silly things like how they are able to offer financing through Capital-one but they have to pay a fee in order to offer it to me was a bit much. If one is to lie about something so inane, what else will they lie about? The dental community at large is really starting to make me a bit paranoid about finding proper care. I need a dentist I can trust!
Thanks so much for your reply
Helpful - 0
782045 tn?1238193325
MEDICAL PROFESSIONAL
Dear patient,
I am sorry for your disappointment from the experience you had at one of the top3dentists. And yes I am also part of the top3dentists and not all of us are mainly specialized in cosmetics. Some of us do have other options available, such as orthodontics.
My first concern would be eliminating your TMJ issues, which you said you had few splints fabricated over the past and have worn through them. The question I have where those splints fabricated based on a physiological position of your lower jaw? Which means was the position determined after relaxation of your jaw muscles?
There are splints and there are splints. A conventional "nightguard" will only protect your teeth and yes after time you will grind through them, because it is only an arbitrary position determined by the lab technician and not a through physiologic position. A Neuromuscular approach is far more difficult to explain on this forum. But is does stop grinding if done properly and also alleviate TMJ symptoms.
The other aspect I am confused in is the open bite??? Is it in the front or the back of your teeth. Now the location is important because it could mean many things and also determine the final outcome of treatment.
The first action of your treatment is to treat your TMJ and perio problems. After that once and only once your TMJ problems have been eliminated you can move into the next phase of treatment, if you choose to do so. And by the way a full mouth reconstruction and grinding teeth down to knobs is not always the only solution and not always the best either.
I recommend to find a neuromuscular dentist at top3dentist who also performs orthodontics and consult him or her for a second opinion.
Good luck to you
Dr. Mehregan
Helpful - 0
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