Patient with "TMJ Clicking" Needs to Simplify His Complaint - From PatientBabble Lost Archives

Questioner: Eli
Subject: Clicking feeling
Date Asked: 2012-08-28 15:46:16
Date Answered: 2012-08-29 07:27:48

Question:
Hi~
Please excuse my English. I'm now learning it.

I have lots of questions to ask you, I hope you understand..
please...

Please help me!
You said that after your wisdom teeth extraction, you felt your bite is not normal. I'm going through that problem. 

About 7 weeks ago, I got two of my right wisdom teeth extracted.
The lower one was partially impacted, so I got it surgically removed. 
But after that, I feel like so many things are being changed in my mouth.

1. First of all, I used to have clicking sound in my jaw when I open my mouth, since 'before' my wisdom teeth extraction. But it became worse after the extraction. And sometimes when I tense my jaw muscle unconsciously, I feel like my teeth at the back hurts (temporarily). Is it possible that tension from TMJ makes me feel like my teeth are sensitive? (With my teeth having no problem according to my dentist.)

2. And most importantly!
I've been wearing hard acrylic nightguard (only for my upper teeth) for a year because of grinding habit.
But, lately, sometimes when I take off my nightguard in the morning, I feel like my upper premolars are wobbly and when I touch them with my tongue, I feel like they are clicking inside my gum!!!!
But sometimes the feeling exists in my upper left premolars only, and sometimes my upper right premolars only. (rarely both.)
Then usually a few hours later, or 2~3 days later (maximum), the clicking disappears!
I don't think the nightguard doesn't fit me because it is a cumtomer-made product, and the symptom doesn't always exists.

When I first bought my nightguard from dental hospital, I was told that it can cause me some weird feeling (feeling like my teeth are sensitive, and my bite is off.) until I get used to it. By then, it was just fine but, as I mentioned, after the extraction, sometimes it causes me wobbly feeling!!!!

★I have no idea whether it is normal or not. Do I have to worry about this? Can I just leave it alone? Do you think I should get a new one?

If I sometimes grind my teeth too heavily, even if I'm wearing a nightguard, can my teeth be damaged or traumatized?
(My dentist took an x-ray film of my teeth a month ago, and told me nothing about gum or bone problem, so I don't think I have some kind of chronic gum disease or a bone loss.)

PLEASE Help me!! I'm almost scared to death. Because, usually, even if there was a clicking feeling inside my gum, I couldn't feel it shifting with my finger. But!!! Today, the feeling of clicking is sooo vivid that when I try to wiggle it with my finger, I can feel it shifting and clicking! (Only my upper left 2nd premolar). 
But I can't see it moving through the mirror as it doesn't move That much!

I have a crossbite that my lower front teeth are slightly covering my upper front teeth. My dentist used to recommend me having braces saying that my premolars and molars are receiving much pressure from biting. 
But my biting problem has existed for 18 years!(as I'm 18 years old.) Why did the feeling of clicking suddenly appear?

If the teeth is loose for some kind of bone loss or an occlusal trauma, I think my dentist would probably have seen it in my x-ray film. But I'm starting to feel anxious. If my dentist only took a glance at my x-ray film, could he have missed it all the time?

★Will the clicking possibly go away by its own, completely? (Usually it comes and goes but today it is too severe..so I'm so worried.) Is it temporary? 
What's bothering me the most is the anxiety of my teeth coming out!!

And, this is another question,
Is every 'visible line' in my teeth 'which I can feel with my finger nail' all cracks? (not craze lines?)
Because if it is so, it means almost all of my premolars and molars are cracked. (Then I'll be scared to death. I'm only 18 years old now!) 
I've had vivid lines in my molars for years and I've been visiting my dentist at least twice a year, (the latest one was a month ago) but my dentist never told me about it and it causes me no pain at all. (My dentist once has even looked into that tooth very carefully to check whether it had been ground because of my grinding habit.)
Do I really have to fret about all the visible lines in my teeth?

Of course, I know it would be the best to ask all these questions to my dentist.
But! in my country,(I'm a Korean.) dentists seldom explains much to their patients. They are always busy with so many patients, and even if I make an appointment, I always have to wait. They usually explains, but there are no time to ask many additional questions. The atmosphere doesn't allow it! (And only few people have regular check up. They visit dental hospital only when they have pain.)

And, When I visit my dentist, a woman who receives a bill at the dental clinic (She is not a dentist, just a client.) always tries to persuade me all day long to have braces threatening me that if I don't have braces, my gums and bones are going to recede all the way that I should pull out all my teeth. 
(But My dentist told me that my crossbite has been caused because of my huge bottom jaw bone. So if I am to fix it, with having braces, I should also have 'my jaw bone surgically CUT.' (OH MY GOD!!!!!) Then does it mean that, if I don't cut my jaw bone, I have to extract all my teeth?!!
Is it possible for a human being to be born in that state?)
I doubt if it will help, but I'm just attaching a simple photo of my teeth to make it more understandable.

So I really don't want to go back to my dentist since my latest check up was only a month ago!!

I tend to worry toooo much about my teeth these days. My mother says even normal teeth would start to feel strange if someone pays toooo much attention to them. I strongly agree!! and now I think I really want/have to stop this, but new concerns always come up!!
If I tell my mom I want to have my teeth checked again (I'm still a minor in my country), since I've been worrying toooo much about my teeth these days, my mother will send me to mental hospital right away thinking that my worrying disease became worse.:) .(If I were her, I would have done it also.) But the feeling of shifting and clicking is real!! 
If I visit my dentist once or twice a year regularly, will my teeth be just fine?

I'm so sorry that I've written so long,
pleeeease understand.....
and Thank you sooooooo much for reading all this,
You will be blessed!!!! :)

Have a nice day!

Answer:
Eli,

Wow!!  Yes, your question was certainly very long!!

It does sound like you have been spooked by the feeling of clicking and maybe a few teeth as well that may be a little loose.  As a result of this, you keep mulling over what could be the cause, problem or whatever inside your mouth.  It becomes sort of like a vicious cycle.  Your teeth bother you, so then you think about what the problem is, then the more you focus on your teeth, the more other little things bother you.

Your mother, friends and god knows who else can see all the worrying, analyzing and obsessing you are doing about your teeth, so they are likely discounting what could be a very real problem.   You may have lost credibility with your mom and others because they are assuming these problems are being created by your obsessing....instead of seeing it the opposite way.....you have a problem, therefore you are obsessing.

First the good news.  I believe you.  It is very common to feel like nobody can see or understand what the problem is with their mouth, and the clicking that you are experiencing.

I am going to give you some helpful suggestions.

First.....If your visit to the dentist sounds anything like your letter to me, you will have lost the battle even before you have begun.  You can't just walk into a dentist and spew out all this stuff.  There is just too much information here and it is very likely that your audience will politely listen to you and tune out after about 5 minutes....that is, if they even have the time.  Most dentists are very busy.

Second.....All dentists are familiar with the TMJ Condition, most of them will claim they can fix it......but in my opinion....and I will say this delicately.....not all dentists can fix it.  What you need to find is a dentist who spends the majority of their time working on TMJ Cases.  Not somebody who cleans teeth one minute, fills a cavity the next, then about once a month has a patient who has a TMJ complaint.  You need to find a specialist who has handled many TMJ cases.  And I would go back to a dentist again, instead of waiting, if you have not seen a person who specializes in TMJ.

Third....When you go to the dentist, try and condense your thoughts into maybe 3 or 4 short talking points.  Example:  1. Clicking   2. Crossbite  3. Teeth Wiggling and 4. Can you look at my bite plate and see if it fits correctly?  Now you can elaborate by one or two sentences on each one of these, but maintain your focus.

Four....You mentioned that you got an x-ray.  Talk with your dentist about the type of x-ray you received.  If he/she determines your problem is serious enough they may want to do an MRI which shows much more detail then just a plain vanilla x-ray.

Five.....I've never heard of the term, "dental hospital."  When you got your night guard from the dental hospital....was it a custom made appliance?  Custom made appliances are more expensive, but a properly fitted one can be more effective.  Be sure to bring whatever it is you are wearing with you to your appointment.

Six....Cutting your jaw bone should be a last resort.  I would not let anyone cut it and you should be looked at by an oral surgeon before even considering that.

Seven.....Whether you are wearing your appliance or not.....say this to yourself....."Lips together, teeth apart."  You need to keep reminding yourself all the time....Lips together, teeth apart.  Your uppers and lowers should not be touching.

Good luck to you and your next dentist appointment!

Regards,
Jonathan
Patient Point of View

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