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    how to proceed - so many issues
    alladdsup posted:
    Recently I was given a dental treatment plan including extractions and a partial; due to several loose teeth. I've had gingivitis and did not keep up with treatments. I have had many dental procedures over many years (I'm now 57); and have seen several dentists. After a few days of internet research, it seems that everything is related: a bad bite and grinding teeth, TMJD (not painful yet), sleep apnea and dry mouth, gingivitis .... Wish I had done this research years ago!
    Each time I had a crown or filling, I never knew if my bite was correct and always thought that it was okay as long as it was not uncomfortable. (I thought the dentist could tell if it was appropriate for my bite) Seems that I had a proper bite on the left or right, but not both. Now I have some loose teeth, some have shifted, I don't know how to bite correctly. My jaw does get "stuck" and makes noise frequently. I get dry mouth when I'm sleeping. I need to know how to proceed. If I get the extractions and a partial, will my bite be corrected and possibly relieve the TMJD? Would the Perio-Protect treatment be a good choice? (My current dentist does not offer that treatment.) Also I have an old crown that has already had a root canal that now has an abcess- it's also a bit loose and on the schedule for extraction. By the way, I've started taking much better care of myself! (brushing, flossing, rinses, biotene spray, improved nutritional supplements) My finances are limited, my only coverage is through a dental plan.
    Thanks for any advice. Hopefully this will also help others with similar issues.
    Zev Kaufman, DDS responded:
    Dear alladdsup:

    I am sorry to hear that you have these issues. However, it is good that you are finally taking responsibility and want to do something about it.

    The best way to proceed is to locate a Prosthodontic department in a local dental school. Go in for a proper consultation and get a proper treatment plan.

    The dental plan coverage is usually very limited, and since they pay the dentist a very little amount, it is very difficult for the dentist to spend the required time with you to come up with a proper treatment plan. Most treatment ends up haphazard, and the result is what you have already.

    There are ways to finance dental treatment and I am sure that the dental school will be able to help you with that as well.

    Best of luck,
    Dr. Zev Kaufman
    alladdsup replied to Zev Kaufman, DDS's response:
    Thanks for your reply, and I will find some way to finance my treatment. I have been responsibly taking care of my dental needs for decades; mostly covered by dental insurance.
    I trusted the dentists, and the dental work always seemed to be done properly and I was comfortable and satisfied.

    The point is that even with quality dental care; the problem of TMJD can cause further dental problems and other health problems. Many dentists are trained to treat only the teeth that have damage and do not recognize the cause of the damage may be a problem with the jaw. TMJD is a general term; there can be a variety of causes, symptoms and treatments. Little research has been done. Treatments that I have been able to review include exercise, acupuncture, massage therapy, using a mouth guard appliance either all day or only at night, or surgery. There seems to be research and discussion about hormones or other types of injections. Many insurance plans, medical or dental, do not cover treatments due to the lack of research.

    No matter where I go (or what I pay) for dental work, it may be a waste of time and money if I don't find a way to relieve the TMJD. My frustration is in determining which treatment plan is appropriate for me, and which professional should be trusted.

    TMJD, malocclusion, bruxism, sleep apnea and dry mouth are all related to each other, and can cause or contribute to gingivitis and loosened teeth. Following the treatment plan of frequent deep cleaning, brushing and flossing should improve the condition of the gums but will not treat or change the other contributing factors. The dentist will continue to take money for the treatment, and continue to make the patient feel guilty about their lack of proper hygiene. In my opinion, patients should not expect their general dentist or specialist to identify or treat TMJD. Also, some dental procedures can make the TMJD worse.

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