Peter Hibberd, M.D., is a doctor whose advice is based on more than 28 years of hospital outpatient and inpatient experience. He is an experienced emergency medicine physician, surgeon, and consultant. Dr. Hibberd is certified by the American Board of Emergency Medicine. He is also a fellow and active member of the American Academy of Family Physicians, an active member of the American College of Emergency Physicians, and a member and fellow of the American Academy of Emergency Medicine. Dr. Hibberd has earned numerous national and international professional certifications, memberships, and awards.

Did My Crowns Cause TMJ?

Thursday, 08 July 2010 03:09 PM

Question: I have a bad case of Temporomandibular Joint Disorder after having crowns placed on teeth on both sides of my mouth, top and bottom. My teeth do not meet in the front as they used to. I have been told by the dentist, oral surgeon and doctor that it is arthritis, and that I need to take pain relievers until the pain becomes unbearable at which time I will have to have surgery. I have no arthritis anywhere else in my body. The crackling and pain at night are not fun. What is your take on this?

Dr. Hibberd's Answer:

My take on this is just what you already have alluded to. While long term malocclusion can lead to premature degenerative changes and eventual arthritis, I favor exploring your probable occlusion a little more.

If your symptoms started after the crowns were placed, the solution appears simple. We all know that minor changes in occlusion can generate TMJ-like symptoms. If your dentist is not willing to refer you for an alternate opinion, consider a consultation from an oral surgeon or an orthodontist to verify your hunch that this is related to malocclusion, and whether this has been exacerbated by the new crown placement. If this can be confirmed, redoing your crowns would be simple and quite effective. Sometimes dental labs do make minor errors with crowns, so discuss whether the lab would be willing to redo these crowns, or whether your dentist will customize them for you.

Be sure to discuss this with your dentist first, since he may be willing to modify your crowns at little or no expense, assuming he is willing to stand behind his own procedures. If you are at a loss for consultants, look for a nearby dental school, and request an opinion from one of their clinic faculty.

While arthritis sounds unlikely since no other joints are involved and the symptoms were strangely coincident with your crown placement, the crackling and pain at night suggests inflammation that may simply be from poor occlusion.
Your physician has many tests at his disposal to help you sort out whether arthritis or inflammation is present, so see your physician for help here. An MRI of your TMJ joints should settle any questions about a local cause of your pain not related to your occlusion.

Joint noises in the TMJ areas are often caused by inflammation and even degeneration of the cartilage disc within the TMJ joint. The may be successfully treated by removing the disc material surgically when more conservative measures fail.

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