Neuromuscular Splint - What is Required? Please Help Me Out
I'm a new TMJ sufferer. I've only had symptoms for about 6 months or so, but they seem to be progressing rapidly. I know I need help because every day is now a bad day with symptoms.
My worst problems are: muscle spasm in the neck, scalp, and head, jaw clicking and popping, sticky eustachian tubes that don't want to open and close right, pain in head, face, neck, and jaw, tinnitus and hyperacusis very bad.
I have a big overbite and I clench and grind at night.
I'm wondering if there is any consensus here about the best place to start. It seems there are all different approaches out there: night guards, neuromuscular splints, repositional splints, etc.
I'm so confused as to what to do. I do have an appointment with an orthodontist in a couple of weeks, and I know he makes the night splints. But I hope this isn't a dead end.
Is it better to go for the repositional splints right off the bat? If so, are neuromuscular dentists the best place to go? What tests are required in order to get a splint made?
Oh, I am intimidated, as it sure seems like everybody else here knows a lot more about all this stuff than I do. I don't even know where to begin. The neuro-dentist I spoke with said the night guards aren't enough to help with the TMJ and the orthos say that they don't like to fool around with repositioning the jaw and the muscles, etc. What is a person to think?
I feel the sam way you do!!! for right now I am just focusing on the pain. But at some point I will have to look at getting a splint made since I cant have and decided against having the surgery my OS wants me to have.
I am also having a lymph node removed soon to be biopsied so Im also focusing on that now.
Good luck to you and I will say a prayer that things get easier in your quest and you find the right provider that works well with you.
I'm struggling with this too, some of my symptoms are similar to yours, muscle spasms in face and neck, apparant tinnitus and hyperacusis, incredible stiffness of neck. The first ENT I saw said get a nightguard as did the dentist, so I did that, though I've hardly worn it so far, I'm so scared it will worsen something. Anyway, it comprises a plastic mould with acrylic on it, shaped to my top teeth. The dentist told me it should 'train' my jaw not to grind and clench as it makes my bite a little higher than normal (I have bad malocclusion as well), after a few months, he said, my jaw will stop grinding without the guard as it will instinctively be expecting the teeth to touch at a higher point (i.e. the point the guard itself meets the lower teeth). This doesn't quite sound convincing to me.
The maxillo facial surgeon I saw told me something different, he said the guard should correct my bite (he worked on the guard too himself to reshape it a bit after the dentist made it), the acrylic and plastic filling in the spaces and making the bite equal on both sides and slightly higher. This achieved, he opined, my jaw will hopefully no longer feel it has to grind as grinding is frequently caused by some irregularity in the bite (higher teeth, badly aligned teeth heightwise), the jaw won't be attempting to flatten out some higher tooth point or whatever but will rest more comfortably and when it moves in my sleep it will remain relaxed, not grinding.
This sounds theoretically ok, but I'm afraid the guard is still allowing, or encouraging, grinding on one side as it is slightly lower there so the teeth seem to move instinctively to grind there when I'm asleep.
Does anyone have any opinion on either of the above theories?
I saw the NTI on the web, I'm interested to hear it doesn't really work, but how does it cause an open bite?
Looney, anyway I'm impressed by your thoroughness, you're not cutting corners and are rationally exploring the different professionals and confusing treatment options out there who could help TMJ, I feel you know more, at least than I do (!), and hope you find answers you need. I just took the advice of the first (and only so far) ENT I saw (about a month ago) and now I feel that he just prescribed 'fit all' solutions, with no real examinaton of what my history is or even what all of my symptoms are.
[This message has been edited by Isobelj (edited 09-22-2003).]
Hi, I'm new to this forum. I am a neuromuscular dentist in Indiana. I would recommend that you find a neuromuscular dentist in your area to be treated by. There are several methods of treating TMJ, it is a hotly debated topic in dentistry. In my opinion Neuromuscular Denistry is the most comprehensive, and therefore the best way of treating TMJ. Unfortunally NM dentists are in the minority (for now). It is my prediction that in 10 years NM will be the standard of care. If anyone needs help in finding a neuromuscular dentist, feel let me know. I would be happy to refer you to someone in your area.
[Edited to remove email address. This is not permitted.]
[This message has been edited by Well-come (edited 09-22-2003).]
Hello Dr. Strickland,
I know that Neuromuscular dentistry worked for me. It is a very heavily debated issue right now within the NIH/NIDCR/ADA. I only know that it put me back on this planet. :-)
I do read that many people are helped with the NM techniques.
Many are not. Many of us have been helped by Dentist who incorporate Dr. Jankelson's theories, plus many others into their practice and provide treatment that does not rely on one technique or theory alone.
I respectfully disagree with your prediction of treatment for TMJD in 10 years or so. I believe that there will be "TMJD Dental Specialist" trained in every theory, every technique, have the experience of the failures and successes of past and current treatments and ongoing research that will allow for "Totally Individualized Treatment" for each person. I see this evolving, slowly, as we "Speak".
Experience teaches that "Assembly Line Treatment" does not work for everyone.
For future generations, I was told a few years ago, by a very wise individual, that in possibly 25 to 30 years or less, Dentistry as we know it, will be obsolete. Research is already underway to develope techniques to correct any joint or facial abnormalities and/or Dental problems, in-vitro.
Embryonic intervention for diseases and abnormalities is relatively new, but is advancing rapidly. The "worst" and "most" life threatening problems are being researched and some intervention is already being done.
In 25 years, I would think it is reasonable to think that Facial, TM joint and Dental abnormalities/ problems could be stopped, before they start.
This "Old Dentist" was right. I now find information on research in this area. We are possibly pre-disposed to have Cranial-Mandibular and Articular Disc malformations or deformities that progress as we age and present as what we now call TMJD.
This leads me to believe that after the process has started, it's very hard to correct, completely. I believe the "Good Guys" already know this and do what they can to help, without causing more damage.
It appears that a lot of current research is directed in how to prevent, rather than how to treat.
Hope for the Future,
I do believe many more of the "Good Guys" "WILL APPEAR" who will be able to provide better treatment for those of us who need help now.
[This message has been edited by Cymy Sue (edited 09-23-2003).]
Good morning Cymy Sue -
Boy, your words are so perfect. It is NOT about one discipline, but about many, and for the dentist that gets "stuck" with treating TMD with only one discipline, will only see endless cases of patients walking away with no relief or even feeling worse.
I suppose I should have clarified in my previous post to Dr. Strickland that my dentist uses many techniques to relieve each patient of their TMD symptoms. He hangs his shingle under NM dentistry, but is so beyond just that technique. Dare I say, had I gone to a NM dentist, that only practiced that one technique, that one splint, I would still be in pain and syptoms.
That is why I have stated in my previous posts, it is vital to ask, ask, ask, ask. Just because a dentist hangs out a shingle that says "neuromuscular dentist", does NOT mean they can help you. Each case is so different, requiring a true TMD dentist to have several "tools of the trade" up their sleeves to help their patients get relief.
My dentist told me my TMD was genetics, which breaks my heart, I have let my neice and nephew know they must get checked so they do not go through what I went through in years to come. I went from bein subclinical (no symptoms)for 46 years to full blown TMD with a bad filling that through my bite off.
Education, education, education. It is a must when it comes to a dentist properly treating TMD, years and years of education.
Take care Cymy Sue, I hope your mother is feeling better and your kitty cats are doing okay. I have one purring away in my lap as I type and oh, does he have a purrrrrr.
'A prediction of in 10 years NM will be the standard of care'?? God, I sure hope not, my young Son's Neuromuscular dentist is referring him elsewhere in another week if no improvement is seen with his splint by then. He's said that NM dentistry is NOT for everyone.....what kind of life would my young Son look forward to if NM dentists became the standard of care??????
I'm glad I wasn't the only one to see that statement as a little "worrisome". (is that a word)
I truly believe it will get better. Prevention and better all around care & treatment.
I don't understand all of the hype about NM Dentistry.
I agree with you Cheryl, If one splint is it, they need to expand on their education. More like Diane's. The theories of the neuromuscular aspect of TMJ problems is sound and has been around a very long time.
I think what they fail to see is they have to understand "it", before they can treat "it" with any method.
Diane and I both seem to have Dentists who have learned a great deal about TMJ problems and use all of the knowledge they have accumulated. We're close to the same age, but our TMJD is very different.
Hers, very bad all of a sudden, mine, most of my life, plus the "Surgical Mess".
We both have seen incredible results with our splint therapy.
(I don't believe a Dentist who adhere's completely to the Neuromuscular Theories or any one method, would have had clue as to what to do with me. I'm sure there are many more who need the kind of attention, knowledge, time and thought that I had, to get the Right Splint and Treatment.)
Again, I believe the future "Standard of Care" will be Dentists who know every discipline, theory, method, and technique of treating TMJD.
Well, I know that my TMJ Specialist at the Head and Neck Pain Clinic I go to isn't helping me. 4 months later I still have a lot of pain and don't know how to control it or what is causing it. (He prescribed a night splint which is acrylic and covers the bottom teeth--I also see a physical therapist there and do stretches for my jaw 2x day).
I would LOVE to try seeing a neuromuscular dentist. I'm not seeing any improvement and would love to have a pain free moment again...RDentist, could you see if you can find a nueromuscular dentist in Minneapolis? THANK YOU!