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Hiya Jonathan.

I'm Charlotte, 26 years old and I am wondering if you could give me a bit of advice.

I believe I have TMJ (perhaps a very mild form) although I've never actually been diagnosed with it. The reason I believe I may have it is that the jaw on my right hand side (so left hand side if you were to be looking at me) becomes stiff and seems to 'lock' so that I have to scrap my teeth and click my jaw until it 'unlocks' it feels stiff and uncomfortable until I do click! This can happen several times a day!

The very back tooth on that side has fallen out, but only the middle part of the tooth, the outside of the tooth is still there! The middle of it is now just a dark bump! Another tooth on that side seems to have a cavity in the middle! Just recently all of the teeth on that side have become sensitive - they are not painful to eat on or to touch, but they ache (it's probably the gum). It's not constantly painful, it's usually a dull ache but last night was absolutely excruciating! To point it actually made me cry from pain and frustration! When I woke up this morning I was pain free again, but through out the day the dull aching has returned! I also suffer from mild headaches sometimes, could that be related?

The tooth with the hole in the middle isn't really painful and it's been that way since about March/April of this year.

Is there any advice at all on how to stop this? I am 26 and have not been to the dentist for many years! I would rather not go if it can be helped, partly because I find it very overwhelming and daunting, but also affording may be difficult!

Is there any massive danger in not going to the dentist? I have read some horror stories of infected teeth spreading to other parts of the body, and that possibility terrifies me!

Thank you for reading, any help would be great.

Thanks again,

Hi Charlotte,

I think deep inside you know what to do.  You know that you should see a dentist and you are scared.  You are also worried that this could be an expensive undertaking.  But I can assure you, the longer you wait to see a dentist, the more you will end up paying for it in the end.

There are several red flags here.  When teeth start falling out of your head.....that's not good....and I am saying that with a little added sarcasm.  Does teeth falling out of your mouth seem like a normal event?  Of course not.  Not unless you are seven years old maybe.

And you also mentioned that you are aware of the stories about infections and how dangerous that is.  Yes, it is something to be addressed sooner than later.

You also touched on one of my other favorite topics....TMJ.  Temporal Mandibular Joint Disorder or TMJ as it is most commonly referred to as, is sort of a catch all category for all kinds of things that people experience with their jaw.  When something does not feel quite right in your mouth, such as locking, clicking, malocclusion of your bite, challenges with speech.....any of these things could fall into the TMJ category.  Anything that impedes the normal motion of your jaw could be construed as TMJ.  From your description, it does sound to me like you have TMJ.  I have definitely had people with TMJ describe that locking or clicking feeling.

I am concerned about you.  You are definitely doing the right thing by beginning the process of seeking help.  You are also lucky that you sent your question to me because I can relate to the patient experience, better than anyone else I know.

First, do not let the financing of this problem discourage you from seeking the help you need.  Sometimes dental insurance or even medical insurance can cover at least part of the costs. Some things you may want to try to attempt is to get pre-approval from the insurance company.  Also, many dentist offices are used to dealing with insurance companies due to the high costs. There is usually a "benefits person" in a dentist's office who knows how to file these claims with the insurance companies.  You can also talk with your dentist about spreading the costs into 18 or 24 month payments.  So if you need to skip the iPad this holiday, than do so.  You will be glad you did.

Second, visit a good board certified dentist right away.  Try and find one that also deals with a lot of TMJ cases.  All dentists will claim they are familiar with TMJ, but I want you to find a dentist that deals with TMJ issues every week and constantly. TMJ treatment frequently involves a dentist making and fitting an night guard appliance for you.  Dentists that have dealt with a lot of TMJ cases have had a lot of practice in making and fitting night guards.  So the question is not can a dentist just put a piece of plastic in your mouth, but rather, can they make and fit a properly balanced night guard for you.  It really does take practice, even for the best dentists.

Third, write down your list of questions before going to the dentist, so that you hit on the most important points.  One line of questioning I would ask about is that you may also want to see an oral surgeon that also has an MD.  It sounds like you do have some serious issues with teeth falling out, jaw clicking, etc, so I like the idea of an oral surgeon looking at you.  Please ask them about getting an MRI for you.  An MRI is usually something that they like to do because it can reveal a lot more about your problem, then just a traditional x-ray at the doctors office.

Charlotte, this should give you a good head start with some important tips.  But don't wait.  Your condition could get worse by ignoring the warning signs.

Good luck and please check back in at and let us know how you are progressing!

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Jonathan at PatientBabble


My area of expertise from the patients point of view would be TMJ plus the speech challenges that these jaw and bite problems sometimes represent. Over the years I have seen a multitude of dentists, orthodontists, oral surgeons, speech therapists, neurologists and other health professionals who all had an opinion about my bite problem. I am not a doctor, but would purely be a patients point of view type person. I "get it" when people say they tried to explain to their dentist what their bite problem is and that they are misunderstood. I can listen to people's trials and tribulations and there is a good chance I have been down that road before. I can make suggestions as to what people can do at home, or what questions to ask their doctor or dentist when they visit. ////// I come from a family of dentists. My first house growing up was one of those residential/dentist combination homes and I was around the dental practice all the time. My teeth had always been perfect, and in many respects they still are. I have never had a cavity and my teeth are straight. About 25 years ago, I had my wisdom teeth out and since then my bite has never felt "normal." I have learned a lot over the years as I tried to figure out my problem from the Dentists, Speech Pathologists and assorted doctors that I have visited. I will try and recall information or experiences that may be helpful to you.


Twenty-Five years ago after my wisdom teeth were removed, my bite did not feel right and then had trouble speaking. For whatever reason, the first sensation I remember was not that my bite was off.....but rather that my normal tongue and speech patterns had been impeded. The years of searching for proper treatment has underscored the importance of understanding the relationship between dental and speech methodologies.///// To this end, and to further my research, I recently attended the American Speech-Language-Hearing Association Convention (ASHA) in Atlanta. At ASHA I learned about a specialty within Speech Pathology termed “Orofacial Myology”. In laymen's terms Orofacial Myology Disorder (OMD) deals with the establishment of correct functional activities of the tongue, lips and jaw. OMD is a motor speech disorder that impacts the normal flow of speech, chewing or swallowing.///// If you believe that your struggles with your teeth also present speech, chewing or swallowing challenges, you may want to seek out a licensed Speech Language Pathologist.....preferably one that has training with Orofacial Myology Disorder.

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Abridged Version of a Letter I Sent to a Health Care Professional (3/14/13): "..In my early 20's I had my wisdom teeth out. Almost immediately within a few days, something did not feel right in my mouth. I had trouble speaking. When I raised my tongue to try and touch my palate, I felt mostly just teeth. It is very cumbersome to talk and my bite also became a little bit off. If feels almost as if someone put a fork in my mouth and said "now try and speak." Very difficult. My articulation is fine, so to an observer I sound normal. But it takes a monumental effort, so I hate situations like talking on the phone or when somebody asks me to "tell them a story." ..I spent years going to different dentists, who lumped me into their generic version of what they knew about TMJ. They just automatically gravitate to what they have heard about TMJ and assume I am either stressed, or just imagining it. Years later, I look back at all those dentists and doctors and I am amazed at how little they really knew about my condition. I have seen the best dentists, including my dad who is a Orthodontist in New York, to TMJ Dentists in Atlanta and Florida. No one ever suggested that Speech Pathology may be a direction I should explore. ..And I was frustrated by the fact that several MRI's over the years, showed nothing. How could the MRI’s show nothing, and at the same time, I know something does not feel right? I do wear a night guard to sleep in, but it does not fix the trouble that I have when I try to talk. ..I went with a Speech Pathologist friend of mine to the American Speech Language Hearing (ASHA) Convention last October in Atlanta...There was a Speech Pathologist at ASHA who was saying that sometimes when you have your Wisdom Teeth taken out "late" that it could possibly cause damage to the Trigeminal Nerve and surrounding muscles.” POSTSCRIPT: At ASHA, I discovered OROFACIAL MYOLOGY (OMD) which is a specialty in Speech Pathology that addresses Oral Muscular Issues.

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