Tooth Loss and TMJ Disorders: Key Insights and Solutions

Tooth loss and temporomandibular joint (TMJ) disorders?

Hello Dr.
Huang Ting-Fang, I have a few dental questions I would like to ask, and I hope you can take the time to clarify and provide medical advice.
Thank you very much.
1.
I have a problem with temporomandibular joint (TMJ) disorder and inflammation, which fluctuates in severity.
I have been receiving treatment with an occlusal splint from a TMJ specialist.
For the past few years, I have noticed a strange phenomenon: after meals, the first molars on my right side feel slightly elevated.
I have confirmed that there is nothing stuck between my teeth.
After resting for about half an hour post-meal, the sensation gradually returns to normal.
If I have dental cleanings or fillings that require me to keep my mouth open for more than ten minutes, this sensation can persist for several days before returning to normal.
When I return to the dentist for an occlusion paper test, they say there is no occlusal wear and suggest resting for a few days.
I suspect that the inflammation around the TMJ and the masticatory muscles may swell during eating or when opening my mouth, causing the feeling of increased height in my bite.
Is this a possibility?
2.
I have been missing my lower left first molar for over ten years, and the upper molar has been growing downwards (it has undergone root canal treatment but has not been restored with a crown).
The dentist mentioned that if the upper first molar is not addressed, it will "be written off." I am unclear about what "written off" means.
Does it imply that if left untreated, the upper molar will continue to grow downwards until the entire tooth, including the root, falls out? Currently, it seems to have reached a certain length and has not grown further, being about 0.5 cm away from the lower gum.
Will it continue to grow longer each year?
3.
Following up on the previous two points, I primarily chew on the right side, but recently I have experienced some sharp pain around the upper left first molar.
Chewing causes intermittent soreness, and the pain is localized to the left side.
Could this be related to a dental (gum) issue, or is it possibly pain caused by the TMJ?

Baiduren, 30~39 year old female. Ask Date: 2017/10/02

Dr. Huang Tingfang reply Dentistry

Dear Ferryman,
Hello!
1.
Based on what you described, your occlusal function is not very good.

2.
The missing lower teeth will cause the upper teeth to grow downwards until they make contact with the lower teeth, at which point they will stop.

3.
You may experience some throbbing pain around the upper left first molar when chewing; this could be due to exposed tooth roots, which can be sensitive and painful.

Please communicate more with your dentist! Thank you! Wishing you safety!

Reply Date: 2017/10/02

More Info

Dear Patient,
Thank you for your detailed inquiry regarding your dental issues and concerns related to temporomandibular joint (TMJ) disorders. Your symptoms and experiences reflect a complex interplay between dental health and TMJ function, which can indeed be challenging to navigate. Let’s break down your questions and provide some insights and recommendations.

1. TMJ Disorder and Perceived Changes in Tooth Height: Your observation that your upper and lower first molars on the right side feel "higher" after chewing could be attributed to several factors. TMJ disorders often lead to inflammation in the joint and surrounding muscles, which can cause swelling. This swelling may create a sensation of altered occlusion (bite), especially after prolonged mouth opening, such as during dental treatments. It’s also possible that muscle fatigue or tension from chewing could contribute to this feeling. If your dentist has ruled out any significant occlusal discrepancies, it may be beneficial to continue with your TMJ management strategies, such as the use of a splint or physical therapy, to alleviate muscle tension and inflammation.

2. Implications of Tooth Loss and Overeruption: The term "報銷" (which translates to "write-off" or "depreciation") in this context likely refers to the potential loss of the opposing tooth due to its overeruption. When a tooth is missing, the opposing tooth can continue to grow downwards (or upwards) into the space, which can lead to complications. If the upper first molar has been growing for years without any intervention, it may eventually reach a point where it could compromise its own stability or health. While it may not continue to grow indefinitely, it can lead to issues such as root resorption or periodontal problems if not addressed. Regular dental check-ups are crucial to monitor this situation, and your dentist may recommend a prosthetic solution, such as a dental implant or bridge, to restore function and prevent further complications.

3. Pain in the Left Upper First Molar: The discomfort you are experiencing in the left upper first molar could stem from either dental issues or TMJ-related problems. Given that you have a history of TMJ disorder, it’s possible that the pain could be referred pain from the joint or associated muscles. However, it’s also essential to consider that the tooth itself may have underlying issues, such as decay, gum disease, or even a cracked tooth, especially since you mentioned discomfort during chewing. A thorough examination, including X-rays, may be necessary to determine the exact cause of the pain.

In conclusion, it is crucial to maintain open communication with your dental care providers. Given the complexity of your situation, a multidisciplinary approach may be beneficial. This could involve consultations with both a dentist specializing in restorative dentistry and a TMJ specialist. Additionally, consider discussing your symptoms in detail during your next appointment, as this will help your dentist tailor a treatment plan that addresses both your dental health and TMJ disorder effectively.

Remember, managing TMJ disorders often requires patience and a combination of treatments, including lifestyle modifications, physical therapy, and possibly dental interventions. Regular follow-ups and monitoring will be key to achieving the best outcomes for your oral health.

Wishing you the best in your dental journey.

Sincerely,
Doctor Q&A Teams

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