Q.

Hi, I’m looking for a dental practitioner/consultant who can treat my bruxism/tmj by botox injection. After 32 years of problems with firstly, misaligned teeth from a bad dentist, causing me to grind my teeth which caused problems which my then dentist tried over time to regain my bite with a little success but did solve the problem. Over the past 10 years the problem has achieved epic proportons despite ‘appliances’ supplied by Manchester dental hospital, no treatment by North Staffs hospital, told joints are not ‘bad enought’ to operate on, did not ask them to operate on them but that is the only treatment they provide for TMJ. Have now graduated to TMJ and Bruixism, and teeth are suffering despite a bio feedback device and mouth guards/splints. I need to stabilise my condition in order to both receive pain relief and in order that my teeth may be repaired before I have a chance to break them. The only way I can see forward is to paralyse the muscles to some extent so that repair work may be carried out to stabilise my teeth, which whilst unattractive do at least allow me to eat. So any idea who in this country or in Europe is both qualified to carry out this treatment and is prepared to do it?

Q.

I grind my teeth at night and have for about 25 years. Normally, I wear a mouth guard. I also have migraine headaches and other types of headaches. I think that there is an association between my grinding, ear issues, and neck pain. Is there any way to stop the grinding? Most of the night guards I have had recently, last few years, have not been helpful. They do not take the inclusion into consideration. My teeth have vertical lines in them from the grinding and my gums have recessed (I think there are other reasons for this, but hygeine is not one of them, FYI). What suggestions do you have for the grinding and for a mouth guard that is not expensive but works? Do the vertical lines in my teeth make it difficult for me to not have my teeth whitened adequately? (a dentist recently mentioned this and it did not sound realistic to me). Thank you!

Q.

Last march i noticed a small lump and pain in my upper right gum, had xray done at dentist to reveal upper impacked wisdom tooth, I was 34 years old. Went to the maxillofacial hospital and was told that it didnt look like it would cause any problems and that most of the pain was TMJD and not from the tooth, alothough I tend to disagree, so its been a year now and not a painfree week has gone by. The wisdom tooth has now cut through the gum and my dentist can now see the cusp of the wisdom tooth and the shape through my gum, the pain is unbelievable at times and hurts in my nose and face, my two back teeth feel sore and feel like there is pressure on them, im now awaiting another appointment at the hospital to have it looked at again, but im afraid he will try to blame the pain on TMJ!, do you thing all this pain is from my tooth? I never had this pain before the lump in my gum was discovered. I really want it removed.

Q.

Dear Dr Justin,

I have suffered with TMJ for over 4 jears now. I get terrible tension headaches that just won’t go away, neck pains, ear ache, stiff hands. I’ve gone through 1 wash out of the joint surgery, volarol painkillers which caused my stomach to bleed and caused an infection, valium which I’ve refused to take after it changed my personality, 3 botox injections (after two my smile got paralysed). Now I’m taking 150mg – 175 mg of Nortryptyline and also undergoing accupuncture which doesn’t seem to help much. I would love to find a longterm solution for my problem as I really can’t stand taking so many drugs for the rest of my life and my headaches are back and whole face feel tense. I am looking for help that will cure my problems once and for all. Can you help? Have you had many succesful stories of people with the same problem? I just don’t want to undergo another surgery and find out that it doesn’t really help to cure my pain.

Regards, 

Q.

i have jaw problem i have went to the otho and i have slight tmj well i got a nite guard and it made it worse so mow my bite is off and my bottom teeth are pushing on my upper teeth so they are starting to point out the denstist said i need braces to fix my bite but my otho said i dont but i think he is wrong becuse my bottom them are crouded and are crooded no to crooked but noticable and my upper teeth are pushing out will braces help this and what do you remomend me doing

Q.

Can your teeth/ jaw mis-allignment lead to other problems in the body? Phsical/ Neurological?

Q.

I have had braces since September 2010 due correctdion of an open bite. I have only recently suffered with an open bite, the last 2 years, I am now 40 years of age. My Maxillofacial surgeon and Orthodontist are working towards me have surgery to resolve my open bite, whereby a part of my upper jaw bone is removed each side. I have had various tests to find the cause of this but have found nothing. Is the jaw surgery necessary or could my problem be related to my jaw joints not fitting together any longer and that’s where the problem has occurred?

Thanks

Q.

Dear Dr. Hughes, I have TMJD for the past 3 years from getting my 1st crown put on and it took over 2 hours. My jaws from a CT scan look good no damage. The dentist I see now and have been seeing ever since the last dentist did my crown work suggests that I try Invisalign braces. He has made me a mouth guard but I have a hard time using it at night as it creates a suction with my cheeks and causes them to be sore with white lines. I am in pain and swelling everyday. He said that my bite if off. My teeth hit my left side of the tongue a lot causing more swelling in the mouth. Also in one place my upper teeth are hitting the lower teeth, a high bite, causing terrible pain and he has to file down the teeth to correct it. I have this done now about every 4 months because my bite is off. I clench my teeth during stressful times without me knowing it. I tighten up my jaw/facial muscles when I am stress which happens to be a lot due to the pain. At night I clench. My jaw jerks sideways sometimes especially when I am nervous. That makes my teeth slam into each other causing more pain. I am a light sleeper and I wake up with a jerk and my jaw jerks violently sideways or clamps down very hard. My dentist thinks fixing the bite with Invisalign braces will correct the bite which in turn will correct these other problems. I can have any metal in my mouth due to allergy to the metal. I do not want the Invisalign braces to make my TMJ worse. Do you know if they can help like in my case. He also said the Invisalign braces acts like a mouth guard too which is good for me. He is very nice and gentle with me. What would your advice be for my situation. Most of my teeth are straigth except I have a over bite, my 2 upper front teeth cross over a little from me sucking my thumb when I was little, and a little crowding on the upper and lower teeth. I have only 1 crown on the left upper back side. My TMJD is only on the left side after my crown was put in. All my silver fillings have been replace with white fillings due to allergy to metal now. No gum disease or bleeding. Pretty healthy mouth except for the bite being off. My tongue gets bite a lot and so it is swollen a lot too with pain. I hope you will be able to email me back as I see him next week for the start of the braces.

Q.

Hi, I’ve always been very self-conscious about my crooked front teeth. So I decided to have braces. The orthodontist told me that I will need 4 bicuspid tooth extraction. My parents were against it but agree to let me make my own decision. But unfortunately, just a few days ago, I found out that I might have TMJ disorders so I went on asking about it and found it was true. I have TMJ. And some even said that bicuspid extraction will actually cause TMJ to severe. So in the end I had decided not to have braces. But right now I’m still feeling very upset about my teeth. How can I straighten it a little? Braces is definitely out of the question. I just want to make it look better a little, is there anything I can do?

Q.
Hi there, i am a 17 year old looking into getting my teeth straightened something that should have been done when i was about 14 but i was never taken back to a dentist then. I recently went back and registered at a dentist where i was told my teeth were very healthy but I cannot get braces on the NHS anymore. Could the reason be because it’s purely cosmetic? I am looking into six month smiles and i have recently been told i have TMJ i am wondering if undergoing this treat ment will agrivate it? Thirdly (sorry) i have naturally discoloured teeth would a whitening help this or would something like veneers be my only option? Thanks ,