I have TMJ and Must Have Things Done dentally. Halp?

June 6, 2022 4:51 PM

My very back molar gave up (broke, etc.) the crown. It was many years previously root canaled, at which time my jaw spasmed and there was general misery. Any tips to avoid that again?

My TMJ is better than when the rooot canal happened and my jaw locked up - and that's how we determined I had TMJ. Now I sleep with a night guard and I have less overall discomfort, but yeah, TMJ is still a thing.

Now I'm once again staring down 2+ hours of dental work at a go (not just a new crown but a whole bunch o' work), at the very back, with my sad jaw. Any tips on how to preemptively make this suck less?

posted by Ink-stained wretch to Health & Fitness (11 answers total)

Best answer: Did they use a bite block last time? If not, they probably should. It will prop your mouth open so you won't have to use your jaw muscles to keep it open, which means your jaw muscles will remain more relaxed.

"A mouth prop (also bite block) is a wedge-shaped implement used in dentistry for dentists working with children and other patients who have difficulty keeping their mouths open wide and steady during a procedure."
posted by SageTrail at 5:02 PM on June 6, 2022 [3 favorites]

You sound like me. Crazy clenching, broken teeth/crowns and dental work despite night guard. My very back molar was ready to go (“significant vertical crack”) so after talking with my dentist, I decided to stop fucking around with expensive, painful work and just had it removed. Went to the oral surgeon, they put me under, 20 mins later the tooth was gone via surgical extraction. Can’t tell/see, cost me about $250 with insurance. Gum was sore/irritated for about a week. Not sure if this is an option for you, but I definitely don’t regret the choice.
posted by HonoriaGlossop at 5:06 PM on June 6, 2022

You say the very back molar - is it one of your wisdom teeth? Even if it's the tooth in front of that last one, your dentist's verdict may be, extraction. Too hard to work on those last teeth (and it's sounding more like you'd need an implant, if it's already had a root canal, and is now broken). Your TMJ adds complications beyond my experience, however; first, get your dentist's assessment.
posted by Rash at 5:20 PM on June 6, 2022

Response by poster: Thanks, all. It's not my wisdom tooth, it is a back molar. What broke was the metal rod inside the canaled tooth. So that will need to be removed and replaced.
posted by Ink-stained wretch at 6:10 PM on June 6, 2022

It is both okay and normal to ask your dentist to prescribe you drugs before your appointment. Maybe this is a single dose of a muscle relaxer or a Valium or something. It will help you, it will help your jaw, it will make the process marginally less shitty. Go into the thing with an assist from pharmaceuticals.
posted by phunniemee at 7:03 PM on June 6, 2022 [2 favorites]

IANYD but I would, all things considered, have a long talk with your dentist about the prognosis for this tooth before re-doing a failed post/crown. Extraction and implant is almost always the preferred treatment these days. Chasing a failed post just doesn't offer the long-term success that an implant offers.
You can go a long way by stretching those muscles beforehand, and yes, use a bite block if you can. It's less likely that you'll send those muscles into spasm if they are biting than if they are stretching.
Muscle relaxers are an option, but arrange transportation if you go that route.
Another obvious alternative is to break the work into multiple visits. One hour twice might be more comfortable than 2 hrs once.
posted by OHenryPacey at 7:47 PM on June 6, 2022 [1 favorite]

Not too familiar with TMJ, but very familiar with long dental visits working on those back molars. Can you get some light sedation (ativan, halcion) for the procedure so that you’re more relaxed during the ordeal? My theory is that the more relaxed you are, the less likely the muscles will tighten up. It’ll also make the two hours go by super quick, and youll be less worried during the time that something will happen. You’ll need a ride home however.
posted by cgg at 9:24 PM on June 6, 2022

Oh, and as an extra data point - after trying and failing to save my back molar after my 20 year old root canal failed, i too just had the tooth removed. A week later everything feels a million times better. I can get an implant later if i want, but meh. Even the oral surgeon who did the extraction said not to bother.
posted by cgg at 9:28 PM on June 6, 2022

Note: You don't need to bite down on a bite block to keep it in place - it's essentially a car jack, but for your mouth. So no muscle action needs to be involved.
posted by SageTrail at 5:59 AM on June 7, 2022

Note: You don't need to bite down on a bite block to keep it in place - it's essentially a car jack, but for your mouth. So no muscle action needs to be involved.

This is rarely true in a general dentist's office. The car jack kind are mostly used by surgeons when the patient is under general anesthesia.
posted by OHenryPacey at 7:23 AM on June 7, 2022

Best answer: Xanax about a half hour before, and a bite block. Bite blocks are life-changing!
posted by mmf at 8:53 AM on June 7, 2022