Create a Beautiful Smile, Resolve TMJ Issues with a Holistic Dentist


by Carey O’Rielly, DDS

The holistic approach to dentistry, by definition, encompasses every aspect of care because ‘holistic’ in essence means the ‘whole’ picture. Bio-compatible materials and procedures practiced in a supportive, non-toxic environment can be applicable to any type of dental care, including cosmetic dentistry.

Cosmetic dentistry is extremely satisfying work because the results can so dramatically alter a person’s overall sense of well-being, as well as their appearance.  This, too, falls under the category of ‘wholism’ or holistic dental health. Certainly the mind/body/spirit/connection is clearly expressed in a beautiful smile that represents an authentic, confident state of well-being.

Appropriate smile enhancement, from the standpoint of holistic care, involves the proper sequencing of structural evaluation, gum care and bio-friendly materials.  Diet may even come into play in certain instances.

The following cosmetic case illustrates how these holistic dentistry principles come into play:

The patient presented with ill-fitting, poorly made crowns that caused unsightly black triangles between her teeth.
In addition, the poor fit of her crowns and irritation from the materials they were fabricated from had caused her gums to become sore and inflamed.

The patient’s bite was evaluated and the microscope was used to determine necessary treatment, in-office treatment of gums and appropriate home care.  Next was laser treatment and shaping of the gums for gum health and cosmetic results.
The treatment took place over a period of five months.  The crowns were finished using the services of a meticulous dental lab.  The results, as seen in these pictures, are natural looking and beautiful.

By the time many adults have advanced in years, there may be structural issues and other stressors that have compromised the beauty of their smile. As in the case of the previous patient, poorly made, ill-fitting dental restorations can cause cosmetic, structural and/or inflammatory issues. Life’s daily stress can also bring about clenching and grinding, which can wear away the attachments between gums and teeth, and can wear away the teeth as well.

Recently I have seen a resurgence of stress-related joint problems in my practice. This is usually caused by:
Malocclusion (bite problems) – teeth and jaw interferences and imbalances that transfer pressure and stress to the patient’s jaw joint

Inflammation and pressure caused by clenching and grinding

In my experience, poor dental work can be yet another stressor.  I have seen cosmetic dentistry that created bite problems, resulting not only in pain, but also in balance problems that required the patient to use a cane in order to walk.

Another stressor can be prior orthodontic work. As practiced in the 50’s ‘60’s and even more recently, certain orthodontic procedures have created conditions that are now causing problems for many of the patients I see. For example, it has been standard practice to extract the bicuspid or canine teeth in order to create more room to straighten crowded teeth.

While this treatment did accomplish that purpose, it also created narrow jaws and some bite collapse. This sometimes results in headaches along with soreness and pain in the jaws, also known as TMJ Disorder.

This comes about because the position of the jaw or condyle in the temporal mandibular joint is changed, usually pushed back and upward toward the ear. In this position, it is out of alignment and can be considered a strain, or even dislocation, of the joint. Bone that is pushed out of its healthy position or socket, impinging on more delicate tissue and nerves, can be painful and sometimes debilitating.

The jaw joint is especially vulnerable because so much pressure is exerted on that joint by chewing.
TMJ Disorder needs to be taken very seriously, not only because it can cause pain and headaches, but because it will not get better by itself in most cases.

One common treatment for bite problems associated with TMJ is a night guard appliance or splint that keeps the mandible (lower jaw) from compressing and closing too far back and up into the cranium.

Approaching bite issues correctly is an aspect of doing cosmetic work properly. Multiple front teeth are usually being worked on at the same time, and the bite relationship is extremely important when it comes to your front teeth – more so than most people realize. If the bite relationship is not respected or the teeth are made too long, it can cause a restriction or deep bite that can change the joint position and cause pain from TMJ dysfunction.

Cosmetic dentists can restore the damage to teeth caused by clenching and grinding by placing crowns and veneers.
But sometimes clenching and grinding is a result of deeper cranial instability.  Cosmetic restorations may crack and chip eventually as the natural teeth did before them, since the cranial/jaw position has not been corrected effectively. The cosmetic patient is often given a splint to reduce the damage but, as discussed previously, this may not work.

How bio-mechanical issues can be resolved with holistic dentistry

Bio-mechanical structural problems in the cranium (skull) and mandible (lower jaw) that cause neurological, muscular, and physiological symptoms all over the body may be corrected by ALF Appliance Therapy.

This non-invasive approach utilizes very light, springy forces that are active 24/7, making this therapy extremely dynamic and responsive to the self-adjusting mechanisms of the body.

It may also be useful in establishing case stability during cosmetic dental treatments, which relies on the teeth (as well as the bones) being their ideal sizes, shapes, and in the correct position.

ALF appliances and the paradigm that created them have begun to change the way joint pain and facial bone imbalances are approached, and how orthodontic treatment can integrate with cosmetic dental care.  Underdeveloped or crowded teeth, bite problems, TMJ dysfunctions, and airway obstruction may be corrected in a comprehensive, positive, and effective manner.

This, in turn, offers another option for comprehensive, holistic-based cosmetic dentistry

Dr. Carey O’Rielly is a holistic dentist practicing in Encinitas, CA.  He offers Cosmetic and general dental care, Biological dentistry and Bio-Friendly Orthodontics for adults and children.  Visit his web site at

Mike Bundrant
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