Managing Dental Issues: Prioritizing Treatment for Oral Health Concerns

Oral issues

Doctor, may I ask in what order I should address my oral condition? For the past six months, the two lower left teeth have been intermittently itchy and slightly painful.
In the last two months, the two upper left teeth have also started to experience occasional mild pain, which is not sharp or severe like an open wound but rather a dull, tight sensation.
The only difference in pain intensity is that it can be slightly more painful at times, but it never reaches the level of severe decay.
Yesterday, I underwent numerous tests at the hospital, and everything came back normal.
The suspected cause of the pain is muscle-related.
An X-ray previously indicated that the cartilage in my temporomandibular joint (TMJ) is severely worn down, almost to the point of being completely gone, which is unusual for my age.
Additionally, I have malocclusion, where my upper and lower teeth do not align properly; the upper teeth protrude to the northwest while the lower teeth retract to the southeast.
The doctor mentioned that this could also be a contributing factor to the pain, along with my severe nighttime bruxism.
Previously, I would alternate chewing on both sides, but since I had a dental implant placed on the lower right second molar two years ago, I have been primarily chewing on the left side.
Recently, due to the poor condition of the left side, I have started using the right side again.
I have been diligent about dental hygiene, using dental floss and brushing my teeth twice daily.
The four upper front teeth have significant decay from 20 years ago, and I had root canals done but did not get crowns, so they are mostly filled.
The hospital advised me to first address the four upper front teeth, then create an occlusal splint or get crowns for occlusal correction before consulting an oral and maxillofacial surgeon to evaluate how to manage the TMJ cartilage.
Both the hospital and the dental clinic indicated that X-rays of the four upper front teeth show that the nerves were not completely cleaned out during the root canal treatment, and the fillings were not done properly.
However, I only experience occasional sensitivity to hot and cold, which subsides quickly.
Currently, the fillings have almost completely discolored, and I can visually see cracks.
Both the hospital and the clinic mentioned that if I need to get crowns, all four teeth would require redoing the root canals and placing posts.
I suspect that my bruxism, possibly due to stress, is causing the pain, and I am unsure what material to choose for the posts, as I worry that a softer material may compromise the stability of the crowns.
I am also concerned that if the material is too hard, it could damage the tooth roots, leading to extractions.
The reason I have not addressed the front teeth is that the amount of filling is significant, and I fear that if I start drilling, they may all fracture and require extraction.
If I lose all four teeth, I am unsure how to manage that situation.
A friend of mine expressed concern about why I should prioritize the four upper front teeth, which have been problematic for a long time, suggesting that I should first address the severe wear of the TMJ cartilage.
I sincerely ask you, doctor, what should I do now? What should I prioritize first, second, and last, and how should I approach these treatments? Additionally, what materials would be most suitable for the posts and crowns? I have no budget constraints and ample time to manage this.
Thank you very much, doctor, and I apologize for the numerous questions.

Li Qiuqiu, 30~39 year old female. Ask Date: 2020/09/05

Dr. Qiu Qiongyao reply Dentistry

Dear Ms.
Li Qiuqiu,
Regarding your inquiries, please find the responses below:
1.
Trust the recommendations of the attending physician regarding the treatment plan.
2.
Your oral issues are complex and cannot be resolved in a short period.
3.
It is advisable to visit a medical center with a temporomandibular joint (TMJ) treatment clinic; Taipei Medical University Hospital has such a facility, and you may inquire there.
4.
The sequence of treatment will be planned by the attending physician, and you should follow their instructions to complete the process in order.
Wishing you a smooth and safe medical experience.
Sincerely,
Hualien Hospital, Ministry of Health and Welfare

Reply Date: 2020/09/05

More Info

Managing dental issues can be a complex process, especially when multiple concerns arise simultaneously. Based on your description, it seems you are dealing with a combination of dental pain, potential issues with your bite, and concerns regarding the health of your teeth and gums. Here’s a structured approach to prioritize and manage your oral health concerns effectively.

Step 1: Comprehensive Assessment
Before any treatment begins, it’s crucial to have a thorough assessment of your dental health. This includes:
- Dental X-rays: To evaluate the condition of your teeth, roots, and bone structure.

- Clinical Examination: A dentist should examine your teeth for cavities, gum disease, and any signs of wear or damage.

- Bite Analysis: Given your concerns about misalignment and jaw issues, a bite analysis can help determine how your teeth come together and identify any discrepancies.

Step 2: Addressing Immediate Pain
Since you are experiencing discomfort, it’s essential to address the most pressing issues first:
- Pain Management: If you have persistent pain, your dentist may recommend pain relief options, such as over-the-counter medications or topical treatments.

- Temporary Solutions: If certain teeth are causing significant discomfort, your dentist might suggest temporary fillings or crowns to alleviate pain while planning further treatment.

Step 3: Treating the Teeth
Once immediate pain is managed, focus on your teeth:
- Front Teeth Restoration: Given that your front teeth have undergone significant treatment and show signs of wear, it may be wise to prioritize their restoration. This could involve:
- Root Canal Treatment: If any of the teeth have not been adequately treated, a root canal may be necessary to prevent further complications.

- Crowns or Veneers: Depending on the extent of damage, crowns or veneers can restore function and aesthetics.

Step 4: Addressing Bite and Jaw Issues
After treating the front teeth, the next step is to address your bite and jaw concerns:
- Orthodontic Evaluation: Consult with an orthodontist to evaluate your bite and determine if braces or other orthodontic treatments are necessary to correct misalignment.

- Splint or Night Guard: Given your history of bruxism (teeth grinding), a custom night guard can help protect your teeth from further wear and alleviate pressure on your jaw joints.

Step 5: Long-term Maintenance and Monitoring
Once the immediate issues are addressed, it’s crucial to establish a long-term plan:
- Regular Dental Check-ups: Schedule routine visits every six months to monitor your dental health and catch any issues early.

- Oral Hygiene Practices: Maintain a rigorous oral hygiene routine, including brushing twice a day, flossing daily, and using mouthwash to prevent gum disease and cavities.

Material Considerations for Dental Work
Regarding the materials for dental work, here are some recommendations:
- Dental Crowns: Porcelain-fused-to-metal crowns offer durability and aesthetics, while all-ceramic crowns provide a more natural look but may not be as strong.

- Dental Implants: If any teeth need to be extracted, titanium implants are the gold standard due to their strength and biocompatibility.

- Root Canal Posts: Stainless steel or titanium posts are commonly used, with titanium being more biocompatible and less likely to cause allergic reactions.

Conclusion
Navigating dental issues requires a systematic approach to ensure all concerns are addressed effectively. Start with a comprehensive assessment, manage immediate pain, restore damaged teeth, correct bite issues, and establish a long-term maintenance plan. Always communicate openly with your dental care team about your concerns and preferences, as they can tailor a treatment plan that suits your needs. Remember, prioritizing your oral health will not only alleviate discomfort but also enhance your overall well-being.

Similar Q&A

Managing Recurring Periodontal Disease: What You Need to Know

Hello, doctor: I underwent periodontal treatment two years ago and have been getting dental cleanings every six months since then. It was stable for a while, but recently I have noticed several teeth becoming loose, and the situation is quite severe. I am considering orthodontic ...

Dr. Zeng Guanghui reply Dentistry
The above situation indicates signs of periodontal disease. Periodontal disease is associated not only with dental plaque in the oral cavity but also with systemic conditions such as diabetes or bone metabolism disorders, which can affect the health of periodontal tissues. It is ...

Assessing Your Dental Health: A Guide for Patients Facing Challenges

Hello Dr. Huang, I had orthodontic treatment when I was younger, but due to inadequate maintenance and various factors, my dentures have deteriorated, and my upper teeth can hardly occlude. Recently, I visited a hospital for a consultation, where I had a dental cleaning, and th...

Dr. Huang Tingfang reply Dentistry
Dear Mr. Chuang, Hello! Welcome to our hospital. Based on your description, it may be severe periodontal disease. Please make sure to brush your teeth thoroughly! Take care! Wishing you peace and smooth recovery! Sincerely, Dr. Huang Ting-Fang, Dentistry

Essential Considerations for Orthodontics and Dentures: A Comprehensive Guide

1. Is it necessary to be free of periodontal disease in order to undergo orthodontic treatment (Invisalign)? 2. Should cavities be filled and a periodontal treatment plan completed before starting orthodontic treatment? 3. Can unhealthy last molars be extracted and bone anchors p...

Dr. Zeng Guanghui reply Dentistry
1. It is essential to complete the treatment of periodontal disease before orthodontic treatment. 2. Prior to orthodontic treatment, any cavities should be filled, and periodontal disease treatment must be completed. 3. It is advisable to consult an orthodontist regarding the...

Managing Gum Health: Dental Care Tips for Busy Lives

In the past year, whenever I stay up late or experience high stress, I develop abscesses on my gums. However, after adjusting my schedule and brushing my teeth properly, they usually heal gradually. My mother believes that I have excessive heat in my body and that I don't ne...

Dr. Huang Tingfang reply Dentistry
Dear Ms. Yun, Hello! 1. Using dental floss or mouthwash can help reduce tartar buildup. 2. Please have your teeth cleaned every six months and communicate more with your dentist! Thank you! Wishing you safety! Sincerely, Dr. Huang Ting-Fang, Dentistry