My first encounter with a tmj specialist....what do you think?
Hi to everyone!
I wondered if you would all give your advice on this one. I had my appointment yesterday with a Dentist who has a subspecialization in tmj. He is actually an endodontist - but has taken various coursework in tmj.
Anyway... After a brief exam where he palpated various facial muscles, checked my bite, my neck, and watched my jaw do "acrobatics and perform a clunking symphony" when I openned/closed my mouth.... he told me my discs are displaced (anterior). Said because of this, my joint is compensating by moving "around" these out of place discs...causing stress and strain on the joint - the muscles etc.
Basically, he told me there is no way to get the discs back where they belong... and suggested pt and a splint (he would fabricate) - to help relax the muscles, and take strain off the joint. He told me I am a "clencher" - even though I was not aware I was. Said he could tell by the size of my muscles on palpation (huge for a petite woman like me?).
Well..you all know the rest - the splint will cost $750 - this one sits on all of the bottom teeth. It's to be worn 24 hours a day (except eating) - for a few weeks...and then gradually less time per day. He said weekly adjusments are necessariy at first --then monthly etc.
It wasn't a good day for the doctor..was short staffed and distracted - so my consultation was a bit disappointing. When I asked about films, mri etc - he said only after and if the splint/pt fails to help. Said the treatment is the same regardless of what the films show... and he can tell what's going on just by my clinical exam.
Ok...there's my report. Now - for those of you who have been through this journey --- I would really and truly appreciate your advice, insight - or thoughts.
I'm not sure if I should proceed --- or do some more opinions -- or maybe something else???
Thank your loads!!
[This message has been edited by RobynRose (edited 06-24-2003).]
Hmmm....does he have a magic ball or x-ray vision? How can he be so positive that your disks are displaced? Just because your jaw moves around, doesn't mean that your disks are permenantly out of place...it may mean that they are going in and out of place...you really have to have an MRI to be sure that's the problem....
A splint is conservative treatment to be sure, but if he hasn't seen what's really going on, he can't put you in the correct position to help the problem. He can keep you out of joint in the splint and the disks won't get damaged, but it won't necessarily fix the problem...
OK, to sum it up...second opinion! Don't lay down the cash for a splint for a guy that's only had a few courses on TMJ...go to a specialist. I was in a splint for three years, treated by a dentist that thought he was god. He had no idea how to treat me. He just kept me in the splint and charged me beaucoup bucks every month...I had to sue him to get out of my contract and go to a doctor that could really help me.
He may have a good "idea" of what's happening in your joint, by I personally wouldn't commit to splint therapy without the full course of diagnostic tests.
I'd go with the second opinion as well.
Thanks so much Jennifer and Crystal. I'm sort of perplexed at this point....trying to figure out how to find the right specialist. I don't think there are many docs who treat only TMJ --- are there?? Most seem to do it "on the side" - along with whatever specialty they may have been formally trained in. Jennifer... how did you finally come to find the Dentist that helped you?? Did he help you through splint therapy - or surgery?? I also thought that diagnostic films would be a good way to start - would be nice to know what is truly happening. Question... do the mris/or even xrays always tell the whole story?
I only wonder because obviously this is a problem that is functional - meaning happens when we put the joint into action (eating - yawning etc.). Since MRIs and xrays are still films... I wondered if they would capture the dysfunction completely. In any case...
I will certainy heed your advice....but how to find the right doctor - hmmm? There is a tmj specialist in my area (well within 2 hours) - who has a pretty comprehensive website - and seems to have published extensive research on the disorder (Dr. Barry Cooper).
Does anyone know of this doctor...or heard anything + or - about him?? Thanks again for all your insight!!
[This message has been edited by RobynRose (edited 06-24-2003).]
I found my guy by looking up OralMax. Surgeons on my insurance and then went through the list and called everyone...some had web pages, but I knew I needed a full service doctor...splints, surgery, whatever I might need.
I'd have to say the guy I'm with now, was a WONDERFUL surgeon, but his bedside manner leaves a lot to be desired. I couldn't care less about that though, I just wanted someone who could fix the problem.
It took me a lot longer to find the first doctor I had 13 years ago though...I went through bad 'expert' dentists who took classes and thought they knew everything, ENTs who completely missed the TMJ problem and was finally diagnosed by my younger brother who was in medical school! (It helped that he knew I had a history of grinding my teeth!) He sent me to my regular dentist to 'get my teeth cleaned' and I now realize that he set me up. When I got to the dentist, I couldn't open my mouth! TADA!
Anyway, my rule of thumb since I have moved around a lot is to go through my insurance and use their resources first...it's easier to get things approved that way!
Good luck! Hope this helped! Remember, you don't usually buy the 1st house you look at, so why do you go with the first doctor you go to? Shop around!
Thanks Jennifer... I think I need to do some more homework for sure. A complicating factor is that I have hypermobile ligments/joints in my spine (lumbar and cervical)...and I can feel when the back locks up..it yanks on the tmj. I wonder if a splint in my mouth would work for me with this tug of war going on??!! - any idea?? I do clunk and click in the jaw..but I do this also in my neck and sacrum... knees and feet etc. I sure hope there is hope....
Thanks much!!
[This message has been edited by RobynRose (edited 06-24-2003).]
Hi, Robyn Rose-
Next week, I'm going to the NYU dental school's TMJ clinic in NYC and I'll see what I can find out.... In the middle of May, I have an appt. with the director of the headache clinic (neuorolog) at Beth Israel Hospital in NYC. I wasn't feeling too well - I just had a root canal and periodontal surgery, and I'm in pain... (I just read your reply to my email from letter to Elaine around April 6, my physiatrist, who's out near the East End, Eric Shapiro, MD, realigned my pelvis, and he has a rehab clinic on premises, but he's not a TMJ doctor. At a family seder last night, my cousins get headaches - migraines and such. One cousin is prescribed Immotrix (phonetic spelling) and Vioxx (ditto), an antinflammatory, and she is able to tolerate the combination and it helps. The burning pain I am experiencing, (with my TMJ, root canal (2/3 completed), perio surgery (last week), cervical arthritis (just diagnosed by orthopedist), sinusitis (the Averex I took in Dec. fr it seemed to work better than the amoxicllian I was prescribed for the root canal), strabismus, allergies...all contributing to what I perceive to be an inflammatory process (see, Hans Selye, MD, general inflammatory syndrome for stress.) Working on a word processor (such as writing this email is difficult - that's why I haven't been on the websiste (from early in April until today). As for the splints and devices, I was told that's a slow process....
Hi, Robyn-
I know what works for the pain and dysfunction of TMJ and that's the massage therapy my chiropractor does with a gloved hand inside my mouth. The problem is that I will sometimes experience pain and dizziness between my weekly visits - e.g., after keeping my mouth open for a root canal. Furthermore, there is an interrelationship between my TMJ spasm and my cervical spasm (suboccipatal muscles in back of head and s.c.m. and other muscle groups in front of and around C2) that relate to my prior injuries. With your back injuries, too, your TMJ condition does not act up in a vacuum - -. Later this week, I will be going to the NYU Dental School TMJ Clinic. (My guess is that its director(s) is (are) high-level specialists, given that this is a specialized clinical training program. (I was told that it is staffed by honors students - under the supervision of their prof(s). Obviously, it's the professor-director whose guidance I will be seeking.) Likewise, with my planned visit to the neurology dept. headache clinic at Beth Israel, where my appointment is with the clinical director, which is set up for later (middle of May). Two nights ago, I had dinner with family, including a dentist (who's my aunt's cousin); he emphasized that dental adjustments for TMJ is a slow process... (Last night, I had dinner with my other aunt's sister, who has migraines, as do others in her family and in mine, which I wrote about in the reply preceding this one - I don't take anti-inflammatories, but I suspect that inflammation may be the driving engine of the muscle spasm that causes the pain and dysfunction of TMJ.... The massage therapy, however, by a gloved finger of a therapist (in my case, my chiropractor) does work. Even if my bite gets loose and sloppy, with clicking sounds, etc., relaxing the muscles, which cause the 'vise of pain' of set up, helps; because it is the extreme pain and dizziness that is disabiling and makes me irritable... As for the neck muscles, I will rub them out and try to strip the cramps, as often as needed. (Like now, in the middle of typing this.) But I can do this myself; (and I try to enlist a family member when one's around). What I didn't realize until recently, however, was that other dental problems, such as cavities lurking under deep fillings or crowns, and periodontal (gum) problems, can also act as triggers for TMJ spasms, as well as directly cause pain referral to the TMJ joint (from the molar areas). My vision blurring as the result of the TMJ spasm is the last straw - the eyes focus with 16 different muscle groups pulling in 16 different directions, and when I havw at least a low-grade infection (such as sinusitis) or my allergies acting up, coupled with my TMJ, the resultant fatigue of the musles (which feels like a tug of war) makes it difficult to read (even if I remember to wear my reading glasses, which I need now in my early 40s). As for the TMJ itself, if the spasm isn't so bad, I find I can gently massage out the (massater) muscles near the joints (external massage), so it doesn't act up at all. Nevertheless, it can be a viscous and unpredictable cycle ... what B.F. Skinner called 'variable intermittant punishment', which by its unpredictability can drive the sufferer off-the-wall. But the relief I get from massage therapy (or, indeed, from a hot shower, [which I ought to have taken today], works. Not all TMJ progresses to such deterioration of the joint capsule that surgery is indicated (or necessary). And, the splint that the oral surgery students made for me at the clinic at the local hospital (my income was low, and I paid $10 for it) is a reminder that bite guards and splints don't always work... I can't believe that a splint will reduce a spasm.... (Although a properly placed splint on a leg injury, for instance, will prevent much traumatic spasm from occuring, I can't see it's reducing spasm that has already occurred...there's no magic to it....) It's really amazing how in a national bulletin board like this the collective knowledge and experience of those communicating can be helpful and even awe-inspiring. Yours, Mark
Hi Mark,
Was sorry to hear you have been having such a rough time. I've also been struggling along here, trying to figure out where to turn next. It's interesting that you are goinng to NYU...seems the majority of practitioners who treat tmjd (Dental) - seem to have come from that program (in our area anyway). I hope it brings some good things for you.
I'm considering getting another opinion as well.... There is a Dr. Barry Cooper (who has a very extensive website - you may want to google search his name along with tmj). Seems this is all he does - and his credentials look phenomenal. He's lectured world-wide on the topic - and has published research in all the peer-reviewed journals. Also consults for the NIH. If you look at his site - do let me know what you think (same for others who may be reading).
I know what you mean about the neck muscles. My scm muscle is especially irritable...along with the scalenes etc. I can't figure out whether the neck brings about the tmj symptoms ... or somehow my lumbar problems gave birth to both the tmj stuff and the cervical. The self-massage techniques do sometimes bring me some relief as well...but never for more than a short while. I stand in that hot shower for hours sometimes!!
A chiro recently rid me of a horrific headache through specific massage of the scm muscle. I was pretty amazed. Nevertheless --- the pain and clunking/popping always returns. Do you see and hear the joint clunk also?? I wasn't sure.
As for the inflammation ... I do think this relates but not sure if it's the trigger or the outcome of disturbled muscles/ligaments/blood vessels. One rheumatologist tested my C-Reactive Protein (specific marker for actute inflammation) when I was in a massive headache attack and it was significatnly elevated. I've been taking advil daily now for a few months...along with MSM. Not sure if it's making a difference. Also - my neurologist has me on Neurontin for the headaches. This has defintiely helped some.
Well..keep in touch. It is really nice to chat with someone who is local - and understands. I hope your Passover was nice!
[This message has been edited by RobynRose (edited 06-24-2003).]
My first encounter with a tmj specialist....what do you think? 
