flow24er
01-15-2004, 06:22 PM
Hi all,
I am just back from seeing a TMJ specialist. He is a very nice man and listened to what I had to say and I had done my research so I was really able to question him properly.
He told me that I probably did have an internal derangement in my left TMJ but that a tomogram would cost me $1000 to confirm it. He reckoned that my lower jaw needs to be brought forward a bit but again it would cost loads and he just thought that as I am in no pain whatsoever that I should perhaps go back to get an NTI made for my top teeth to wear at night. However I told him I would get back to him as I have a few reservations about the NTI. I have read that they can give you an open bite, does anyone have experience with the NTI , good or bad ?
I also feel like I have been given an incomplete diagnosis. Is it true that tomograms cost $1000 ? I am not in pain but I am in constant discomfort with the majority of symtoms listed for TMJ apart from the headaches. I also get that my teeth clatter together when I am talking.
To add to my problem I suspect that one of my wisdom teeth is causing a problem with my chewing. It is preventing me from chewing properly or even closing my mouth properly. But the specialist said that he could file this tooth down a bit but could not guarantee that it wouldn't make my problem worse. I didn't feel that he was guiding me in a diagnosis. I felt that I was guiding him !
Does anyone have any thoughts or answers to my questions ?
The fact remaons that I am in some discomfort with this and am worried that it is going to get worse. Think I will need to see another specialist...........god this is so expensive and I don't have a job !
Emma
I am just back from seeing a TMJ specialist. He is a very nice man and listened to what I had to say and I had done my research so I was really able to question him properly.
He told me that I probably did have an internal derangement in my left TMJ but that a tomogram would cost me $1000 to confirm it. He reckoned that my lower jaw needs to be brought forward a bit but again it would cost loads and he just thought that as I am in no pain whatsoever that I should perhaps go back to get an NTI made for my top teeth to wear at night. However I told him I would get back to him as I have a few reservations about the NTI. I have read that they can give you an open bite, does anyone have experience with the NTI , good or bad ?
I also feel like I have been given an incomplete diagnosis. Is it true that tomograms cost $1000 ? I am not in pain but I am in constant discomfort with the majority of symtoms listed for TMJ apart from the headaches. I also get that my teeth clatter together when I am talking.
To add to my problem I suspect that one of my wisdom teeth is causing a problem with my chewing. It is preventing me from chewing properly or even closing my mouth properly. But the specialist said that he could file this tooth down a bit but could not guarantee that it wouldn't make my problem worse. I didn't feel that he was guiding me in a diagnosis. I felt that I was guiding him !
Does anyone have any thoughts or answers to my questions ?
The fact remaons that I am in some discomfort with this and am worried that it is going to get worse. Think I will need to see another specialist...........god this is so expensive and I don't have a job !
Emma
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saaraah
01-15-2004, 06:59 PM
i had a bad experience with an NTI. i wore mine for only 3 weeks, and i developed an openbite, which has not gone away even tho i havent worn the NTI for almost 4 years. it also did not alleviate any of my symptoms when i did wear it. also, if you have displaced discs, a NTI is a bad idea. it's only for people who clench, but dont have displacement.
i have an underdeveloped mandible, and not enough space between the condyle and fossa in my TMJs. right now, im wearing an anterior repositioning splint, which is moving my mandible down and forward. it has helped my symptoms a lot in the past 3.5 months that i've been wearing it. the splint cost $1200 including adjustments each month.
i think that $1000 just for tomograms is outrageous. i got about 9 different xrays including tomos [and a few other diagnostic tests] done for $650 CDN.
good luck and take care,
- saaraah.
i have an underdeveloped mandible, and not enough space between the condyle and fossa in my TMJs. right now, im wearing an anterior repositioning splint, which is moving my mandible down and forward. it has helped my symptoms a lot in the past 3.5 months that i've been wearing it. the splint cost $1200 including adjustments each month.
i think that $1000 just for tomograms is outrageous. i got about 9 different xrays including tomos [and a few other diagnostic tests] done for $650 CDN.
good luck and take care,
- saaraah.
Cymy Sue
01-15-2004, 07:04 PM
Emma,
I think you're right. Sounds like you were doing the guiding and this person is not very experienced with TMJ problems. Many experienced Dentist can tell if the disc is displaced or displacing by examination. They can feel it or see it when you open and close. If this is suspected then tests are in order to confirm and to see how bad. An MRI is normally used to look at the disc and a Tomogram to look at the entire joint structure. Different Doctors/Dentists prefer different methods. Some like to do both plus panarex X-rays to get a complete picture of your condition.
Filing down teeth many times causes incredible problems. It can be done, but has to be done with extreme precision and a person with a great deal of experience. I would be concerned with his statement of it possibly causing further problems. Most Dentists of Specialist who would do this, would only grind off a very, very, slight amount and would be very confident that it would be helpful.
Many Dentist and others in this field list as TMJ Specialists and they do not have the experience to treat. You have to be very careful.
I don't remember the cost of my last tomogram, it's been several years. I think some other members have had them done recently and could help you with that information.
NTI's are helpful for many people and are the least expensive route in most cases. There are reports of them causing open bites and sometimes they just do not work for some people. I think many times, they're made too thick and this may be some of the problem. Some dentists are making them a little thinner now, than when they were first introduced and this may be better.
I do think another opinion would be a good idea. I know it does get expensive.
If you're not in major pain, maybe you could look around for a while and find someone more quailified to help you, so at least your money will be well spent.
If you live near a teaching hospital, a University-Hospital type complex, you might could go to the Dental School, get the tests you need and the expense would be far less. You wouldn't have to stay with them for treatment if you didn't feel comfortable, but you would have a diagnosis and information to take to someone experienced to help you.
Cymy Sue
I think you're right. Sounds like you were doing the guiding and this person is not very experienced with TMJ problems. Many experienced Dentist can tell if the disc is displaced or displacing by examination. They can feel it or see it when you open and close. If this is suspected then tests are in order to confirm and to see how bad. An MRI is normally used to look at the disc and a Tomogram to look at the entire joint structure. Different Doctors/Dentists prefer different methods. Some like to do both plus panarex X-rays to get a complete picture of your condition.
Filing down teeth many times causes incredible problems. It can be done, but has to be done with extreme precision and a person with a great deal of experience. I would be concerned with his statement of it possibly causing further problems. Most Dentists of Specialist who would do this, would only grind off a very, very, slight amount and would be very confident that it would be helpful.
Many Dentist and others in this field list as TMJ Specialists and they do not have the experience to treat. You have to be very careful.
I don't remember the cost of my last tomogram, it's been several years. I think some other members have had them done recently and could help you with that information.
NTI's are helpful for many people and are the least expensive route in most cases. There are reports of them causing open bites and sometimes they just do not work for some people. I think many times, they're made too thick and this may be some of the problem. Some dentists are making them a little thinner now, than when they were first introduced and this may be better.
I do think another opinion would be a good idea. I know it does get expensive.
If you're not in major pain, maybe you could look around for a while and find someone more quailified to help you, so at least your money will be well spent.
If you live near a teaching hospital, a University-Hospital type complex, you might could go to the Dental School, get the tests you need and the expense would be far less. You wouldn't have to stay with them for treatment if you didn't feel comfortable, but you would have a diagnosis and information to take to someone experienced to help you.
Cymy Sue
flow24er
01-15-2004, 07:58 PM
Thanks CymySue and Saarah,
I did mention to this dentist that I had read that the NTI can cause an open bite but he disputed this fact. Perhaps, as you say CymySue, open bites are caused by the NTI being made too thick. It is so confusing. It would be so fantastic to find a specialist who really knew what he was talking about and to feel confident that u were being treated correctly.
Believe it or not this was a dental school specialist ! I have ruled him out now and will be moving onto my next 'specialist'. The thing for me is that I am not actually in pain which is something I am very grateful for, however the musle tension and sheer exhaustion caused by normal human interaction such as talking and laughing really gets me down however I am going to search for a solution until I am blue in the face!
I have read Shankland's book on TMJ and he sounds really knowledgeable....perhaps I will travel across the US to see him. Does anyone have any experience with him ? R we not allowed to talk about actual doctors on this site ? I think it would be such an excellent resource to be able to look up a list of tmj 'specialists' and view patients' comments on their receieved treatments. Perhaps I should set this site up ! Would it help do you think ?
The thing with my wisdom tooth is that it really does have a sharp pointy bit on one corner that is definately preventing me from closing my mouth properly. My thinking is that I didn't have this tooth for the first twenty years of my life and my jaw was fine so surely if it was shaved down then my mouth might get back to functioning how it should...anyway I will be seeking another opinion.
Saarah thanks for the info on the NTI. R u finding some relief with alternative treatment now ?
CymySue, you are an inspiration to us all and your knowledge on this board is invaluable !
Emma
I did mention to this dentist that I had read that the NTI can cause an open bite but he disputed this fact. Perhaps, as you say CymySue, open bites are caused by the NTI being made too thick. It is so confusing. It would be so fantastic to find a specialist who really knew what he was talking about and to feel confident that u were being treated correctly.
Believe it or not this was a dental school specialist ! I have ruled him out now and will be moving onto my next 'specialist'. The thing for me is that I am not actually in pain which is something I am very grateful for, however the musle tension and sheer exhaustion caused by normal human interaction such as talking and laughing really gets me down however I am going to search for a solution until I am blue in the face!
I have read Shankland's book on TMJ and he sounds really knowledgeable....perhaps I will travel across the US to see him. Does anyone have any experience with him ? R we not allowed to talk about actual doctors on this site ? I think it would be such an excellent resource to be able to look up a list of tmj 'specialists' and view patients' comments on their receieved treatments. Perhaps I should set this site up ! Would it help do you think ?
The thing with my wisdom tooth is that it really does have a sharp pointy bit on one corner that is definately preventing me from closing my mouth properly. My thinking is that I didn't have this tooth for the first twenty years of my life and my jaw was fine so surely if it was shaved down then my mouth might get back to functioning how it should...anyway I will be seeking another opinion.
Saarah thanks for the info on the NTI. R u finding some relief with alternative treatment now ?
CymySue, you are an inspiration to us all and your knowledge on this board is invaluable !
Emma
flow24er
01-15-2004, 08:04 PM
i have an underdeveloped mandible, and not enough space between the condyle and fossa in my TMJs. right now, im wearing an anterior repositioning splint, which is moving my mandible down and forward. it has helped my symptoms a lot in the past 3.5 months that i've been wearing it. the splint cost $1200 including adjustments each month.
Saaraah I am glad that this splint is helping your symptoms. Is this something that you wear all the time 24/7 ? Is it an irreversible treatment ?
Thanks,
Emma
Saaraah I am glad that this splint is helping your symptoms. Is this something that you wear all the time 24/7 ? Is it an irreversible treatment ?
Thanks,
Emma
Arleen
01-15-2004, 08:14 PM
Hi Flow24er:
I agree with Saaraah. $1,000 for a tomogram is outrageous! I've had them done by 3 different dentists. The first time was at a lab and they took 5 or 6 with total cost of $155 Cdn. The last bunch I had done was done with a bunch of testing which totaled $560, but the xrays themselves probably amounted to $400 tops (which included a number of tomos and some ceph xrays (skull/neck/spine) too.
Normally, treatment should be done first to stabilize your jaw. Once you've been stabilized for a few months, and painfree, THEN if you need bite adjustments that's usually when it's done. Many dentists can call themselves TMJ specialists, but there seem to be very few who actually know what they're doing. I would definitely get a second opinion. This guy is WAY overcharging you and doesn't appear to have a good grasp of TMJ. I'd also be concerned about wearing an NTI indefinitely, as like Saaraah can attest, many people develop open bites.
Good luck,
I agree with Saaraah. $1,000 for a tomogram is outrageous! I've had them done by 3 different dentists. The first time was at a lab and they took 5 or 6 with total cost of $155 Cdn. The last bunch I had done was done with a bunch of testing which totaled $560, but the xrays themselves probably amounted to $400 tops (which included a number of tomos and some ceph xrays (skull/neck/spine) too.
Normally, treatment should be done first to stabilize your jaw. Once you've been stabilized for a few months, and painfree, THEN if you need bite adjustments that's usually when it's done. Many dentists can call themselves TMJ specialists, but there seem to be very few who actually know what they're doing. I would definitely get a second opinion. This guy is WAY overcharging you and doesn't appear to have a good grasp of TMJ. I'd also be concerned about wearing an NTI indefinitely, as like Saaraah can attest, many people develop open bites.
Good luck,
flow24er
01-15-2004, 08:24 PM
Hi Flow24er:
I agree with Saaraah. $1,000 for a tomogram is outrageous! I've had them done by 3 different dentists. The first time was at a lab and they took 5 or 6 with total cost of $155 Cdn. The last bunch I had done was done with a bunch of testing which totaled $560, but the xrays themselves probably amounted to $400 tops (which included a number of tomos and some ceph xrays (skull/neck/spine) too.
Normally, treatment should be done first to stabilize your jaw. Once you've been stabilized for a few months, and painfree, THEN if you need bite adjustments that's usually when it's done. Many dentists can call themselves TMJ specialists, but there seem to be very few who actually know what they're doing. I would definitely get a second opinion. This guy is WAY overcharging you and doesn't appear to have a good grasp of TMJ. I'd also be concerned about wearing an NTI indefinitely, as like Saaraah can attest, many people develop open bites.
Good luck,
Thanks Arleen. I will definately be going elsewhere ! I can't believe he quoted me so much for a tomogram when yours were much less.
I will be holding off on the NTI as well until I have done more research into alternatives and seen someone else !
Thanks a lot,
Emma
I agree with Saaraah. $1,000 for a tomogram is outrageous! I've had them done by 3 different dentists. The first time was at a lab and they took 5 or 6 with total cost of $155 Cdn. The last bunch I had done was done with a bunch of testing which totaled $560, but the xrays themselves probably amounted to $400 tops (which included a number of tomos and some ceph xrays (skull/neck/spine) too.
Normally, treatment should be done first to stabilize your jaw. Once you've been stabilized for a few months, and painfree, THEN if you need bite adjustments that's usually when it's done. Many dentists can call themselves TMJ specialists, but there seem to be very few who actually know what they're doing. I would definitely get a second opinion. This guy is WAY overcharging you and doesn't appear to have a good grasp of TMJ. I'd also be concerned about wearing an NTI indefinitely, as like Saaraah can attest, many people develop open bites.
Good luck,
Thanks Arleen. I will definately be going elsewhere ! I can't believe he quoted me so much for a tomogram when yours were much less.
I will be holding off on the NTI as well until I have done more research into alternatives and seen someone else !
Thanks a lot,
Emma
beth99
01-15-2004, 08:36 PM
I am for the first time going to be treated by a TMJ specialist (27 years exp and sounds like he'll be treating me like what many of you describe as proper splint therapy) so this is all new to me. What is an NTI? I have just a straight splint that a dentist (not specialist) made for me a few years ago that I'm wearing at night now because I'm locked on one side and it seems that the ache is less if I wear it. I showed it to my new dentist and he said that it makes sense that it would help because it keeps me opened a bit. I hope this isn't bad??
Also, I had a bunch of Xrays done (I think 19) and a test to determine facial muscle strength, swallow test, and a test to determine how noisy my TMJs were. Luckily my insurance is covering the majority of my treatment, but I think the tech said that all the tests were around $1300. My friends said it sounded high and now from reading the posts maybe it was? Does this sound normal?
Beth
Also, I had a bunch of Xrays done (I think 19) and a test to determine facial muscle strength, swallow test, and a test to determine how noisy my TMJs were. Luckily my insurance is covering the majority of my treatment, but I think the tech said that all the tests were around $1300. My friends said it sounded high and now from reading the posts maybe it was? Does this sound normal?
Beth
flow24er
01-15-2004, 08:47 PM
I am for the first time going to be treated by a TMJ specialist (27 years exp and sounds like he'll be treating me like what many of you describe as proper splint therapy) so this is all new to me. What is an NTI? I have just a straight splint that a dentist (not specialist) made for me a few years ago that I'm wearing at night now because I'm locked on one side and it seems that the ache is less if I wear it. I showed it to my new dentist and he said that it makes sense that it would help because it keeps me opened a bit. I hope this isn't bad??
Also, I had a bunch of Xrays done (I think 19) and a test to determine facial muscle strength, swallow test, and a test to determine how noisy my TMJs were. Luckily my insurance is covering the majority of my treatment, but I think the tech said that all the tests were around $1300. My friends said it sounded high and now from reading the posts maybe it was? Does this sound normal?
Beth
Hi Beth,
I don't really have an answer to your questions about splints as I am a newbie here and in initial stages of trying to find a decent specialist ! But it sounds like u have been given a really thorough examination which is a good start ! Hopefully some of the more experienced members can answer your questions though
good luck
Also, I had a bunch of Xrays done (I think 19) and a test to determine facial muscle strength, swallow test, and a test to determine how noisy my TMJs were. Luckily my insurance is covering the majority of my treatment, but I think the tech said that all the tests were around $1300. My friends said it sounded high and now from reading the posts maybe it was? Does this sound normal?
Beth
Hi Beth,
I don't really have an answer to your questions about splints as I am a newbie here and in initial stages of trying to find a decent specialist ! But it sounds like u have been given a really thorough examination which is a good start ! Hopefully some of the more experienced members can answer your questions though
good luck
saaraah
01-15-2004, 10:05 PM
flow24er: my splint is for my lower teeth, and i wear it 24/7 even while eating.
it is not supposed to be irreversible because the theory is that if i stopped wearing the splint, my bite would go back to 'normal'. all that's changed are my muscles. however, i must admit i have my doubts about how conservative this treatment is, since some sites online say that repositioning splints are considered irreversible because of the bite changes.
i do have an option of going onto phase II, which would include onlays, crowns, and/or orthodontics, but i am not interested in doing anything *that* irreversible at this time in my life.
- saaraah.
it is not supposed to be irreversible because the theory is that if i stopped wearing the splint, my bite would go back to 'normal'. all that's changed are my muscles. however, i must admit i have my doubts about how conservative this treatment is, since some sites online say that repositioning splints are considered irreversible because of the bite changes.
i do have an option of going onto phase II, which would include onlays, crowns, and/or orthodontics, but i am not interested in doing anything *that* irreversible at this time in my life.
- saaraah.
Michelle99
01-15-2004, 10:08 PM
Hi Emma,
NTI has helped me greatly. It wasn't an easy road though. My dentist was new at using it, and for some time, I was feeling worse. It took many visits to my dentist and a daytime version of the NTI, before I really felt better. It's really important to have good communication with your dentist and for the dentist to be willing to do what it takes to achieve success. I can't say that I am 100% symptom free, but I am happy with the results.
Some people find that the relationship between their upper and lower teeth changes, so yes, it is definitely possible to develop an open bite while using NTI. I know that I certainly did. It can happen because as the muscles become less tense, the condyles are able to seat in a more stable position. One thing to remember though is that the bite relationship can change with other types of splints as well. Doctors who use repositioning splints intentionally change the bite relationship, and their patients often go through equilibration, orthodontics, or restorative dentistry in order to get their teeth work better with the new jaw position. The same types of treatments can also be used with NTI.
The change in the occlusal relationship can be unexpected though. With some treatments, the doctor decides where the jaw should be, but with NTI the body "decides" for itself. I like that aspect of NTI, but it does make it harder when you don't know what to expect. I wish my bite hadn't changed as much as it did. However, I believe I am better positioned now, because my joint sounds have decreased. When the muscles relax, sometimes the discs can move to a better place too.
NTI can also be useful as a diagnostic device. If the symptoms don't change, it's a good sign you're not dealing with a muscular problem.
One important note, the NTI is very small, so it is important to check it each night to see if it fits correctly. You shouldn't wear it if it is loose.
I am very enthusiastic about NTI, but I believe anyone who uses should be aware of the possible consequences. If you are not willing to accept the chance that your bite relationship may change, it may not be the best option for you.
I hope this information is useful to you. I wish you all the best with whatever you decide.
Hi all,
I am just back from seeing a TMJ specialist. He is a very nice man and listened to what I had to say and I had done my research so I was really able to question him properly.
He told me that I probably did have an internal derangement in my left TMJ but that a tomogram would cost me $1000 to confirm it. He reckoned that my lower jaw needs to be brought forward a bit but again it would cost loads and he just thought that as I am in no pain whatsoever that I should perhaps go back to get an NTI made for my top teeth to wear at night. However I told him I would get back to him as I have a few reservations about the NTI. I have read that they can give you an open bite, does anyone have experience with the NTI , good or bad ?
I also feel like I have been given an incomplete diagnosis. Is it true that tomograms cost $1000 ? I am not in pain but I am in constant discomfort with the majority of symtoms listed for TMJ apart from the headaches. I also get that my teeth clatter together when I am talking.
To add to my problem I suspect that one of my wisdom teeth is causing a problem with my chewing. It is preventing me from chewing properly or even closing my mouth properly. But the specialist said that he could file this tooth down a bit but could not guarantee that it wouldn't make my problem worse. I didn't feel that he was guiding me in a diagnosis. I felt that I was guiding him !
Does anyone have any thoughts or answers to my questions ?
The fact remaons that I am in some discomfort with this and am worried that it is going to get worse. Think I will need to see another specialist...........god this is so expensive and I don't have a job !
Emma
NTI has helped me greatly. It wasn't an easy road though. My dentist was new at using it, and for some time, I was feeling worse. It took many visits to my dentist and a daytime version of the NTI, before I really felt better. It's really important to have good communication with your dentist and for the dentist to be willing to do what it takes to achieve success. I can't say that I am 100% symptom free, but I am happy with the results.
Some people find that the relationship between their upper and lower teeth changes, so yes, it is definitely possible to develop an open bite while using NTI. I know that I certainly did. It can happen because as the muscles become less tense, the condyles are able to seat in a more stable position. One thing to remember though is that the bite relationship can change with other types of splints as well. Doctors who use repositioning splints intentionally change the bite relationship, and their patients often go through equilibration, orthodontics, or restorative dentistry in order to get their teeth work better with the new jaw position. The same types of treatments can also be used with NTI.
The change in the occlusal relationship can be unexpected though. With some treatments, the doctor decides where the jaw should be, but with NTI the body "decides" for itself. I like that aspect of NTI, but it does make it harder when you don't know what to expect. I wish my bite hadn't changed as much as it did. However, I believe I am better positioned now, because my joint sounds have decreased. When the muscles relax, sometimes the discs can move to a better place too.
NTI can also be useful as a diagnostic device. If the symptoms don't change, it's a good sign you're not dealing with a muscular problem.
One important note, the NTI is very small, so it is important to check it each night to see if it fits correctly. You shouldn't wear it if it is loose.
I am very enthusiastic about NTI, but I believe anyone who uses should be aware of the possible consequences. If you are not willing to accept the chance that your bite relationship may change, it may not be the best option for you.
I hope this information is useful to you. I wish you all the best with whatever you decide.
Hi all,
I am just back from seeing a TMJ specialist. He is a very nice man and listened to what I had to say and I had done my research so I was really able to question him properly.
He told me that I probably did have an internal derangement in my left TMJ but that a tomogram would cost me $1000 to confirm it. He reckoned that my lower jaw needs to be brought forward a bit but again it would cost loads and he just thought that as I am in no pain whatsoever that I should perhaps go back to get an NTI made for my top teeth to wear at night. However I told him I would get back to him as I have a few reservations about the NTI. I have read that they can give you an open bite, does anyone have experience with the NTI , good or bad ?
I also feel like I have been given an incomplete diagnosis. Is it true that tomograms cost $1000 ? I am not in pain but I am in constant discomfort with the majority of symtoms listed for TMJ apart from the headaches. I also get that my teeth clatter together when I am talking.
To add to my problem I suspect that one of my wisdom teeth is causing a problem with my chewing. It is preventing me from chewing properly or even closing my mouth properly. But the specialist said that he could file this tooth down a bit but could not guarantee that it wouldn't make my problem worse. I didn't feel that he was guiding me in a diagnosis. I felt that I was guiding him !
Does anyone have any thoughts or answers to my questions ?
The fact remaons that I am in some discomfort with this and am worried that it is going to get worse. Think I will need to see another specialist...........god this is so expensive and I don't have a job !
Emma
flow24er
01-16-2004, 01:20 PM
Thanks very much Michelle I am a lot clearer now on the NTI and splints in general. I obviously have a lot to think about but I will see another specialist and see what he says first.
Take care and I hope that you r well today,
Emma
Take care and I hope that you r well today,
Emma