Hello all,
I was very happy to find out this online discussions you are holding about TMJ as I am quite in the dark about the issue and very worried. I hope my following message is not very long and I hope some people in UK will read it..
I have been having TMJ problems for around 4 years now
but did not undergo any treatment except eating soft foods. Recently I started feeling that my bite was weird (and I also felt random very short-duration dislocations of the jaw). I also have constant mild irritation around the ear. I am now in London and saw an (expensive)TMJ specialist who says that I should immediately get a splint, keep it for around 9 months ro relax the muscles so that I can then undergo surgery-he says my situation is very bad (I took an MRI scan to him for his diagnosis) and the problem can only be fixed with surgery (the third stage he suggested for after the surgery is orthodontic treatment). Given that surgery is best to be avoided I am very reluctant to undergo the treatment he suggests (at the cost of around 10,000 english pounds i.e. around 18000 dollars!!!). Does anybody of you know a good specialist in LOndon or around areas that could do it cheaper or did anybody or you got a successful treatment through NHS instead of the private exuberantly expensive option?Thank you all.
I'm in London, one of the few people (only 2 others that I know of) from GB on this board. I recently got my diagnosis and am being treated at The Eastman Dental Hospital in Kings Cross. It is an NHS hospital and I am recieving free treatment. It has an excellent reputation BUT they only believe in ultra conservative reversible treatment - my problem is muscular, not joint related, but I believe even if it was joint related, they would only treat with a splint to stop clenching and grinding and drugs to relax the muscles. I am on a waiting list for a splint through them. I am also going to recieve physio for postural problems that may be contributing to the problem.
There is a lot of discussion on this board about anterior repositioning splints - these actually move your jaw joints if you have a problem with them. It seems a lot of dentist use this treatment in the USA but, like you, I looked in to TMJD dentists in London, and could find hardly any. I think I know of the dentist you are talking about. I phoned his practice, the receptionist mentioned surgery within the first five minutes and also his prices, I never called back.
You could try getting a referral to The Eastman, (I think your dentist will have to refer you - this is how I got to see them) even if you are unhappy with the treatment they offer you, at least you will get a second opinion/diagnosis from a source that isn't set to make money off you. From everything I have read on this board, surgery is only ever recommended after every other option (splint therapy, massage, physiotherapy etc) has been exhausted.
Hello, thank you very much for your replies.
I have seen the name of Patrick Grossman in the email by nirmal. This is exactly the private person I had seen for a consultation. He charged 200 pounds for one hour consultation (and he seemed not to have more time when I tried to ask more questions however) but if I am to follow the treatment he says I have to pay around 10000 pounds!Does anybody of you been to patrick grossman for therapy and if so was it successful? Is it OK to ask his secretary to put me in contact with other patients to ask whether they are satisfied or not? (His secretary told me she has undergone the surgery herself and it was successful)
I also obtained a referral to my local nhs hospital and I am to see their specialist in a few days (3rd of June-after waiting a long time). Should I discuss with him what Patrick Grossman suggested? I imagine NHS goes for the conservative, no-surgery option but how I am supposed to know whether the person I am going to see has a good track record for curing his/her patients?
Sorry for the long email,
thanks a lot again.
My advice for what it's worth - find out what the NHS consultant has to say. He will have nothing to gain (i.e money) from giving you his diagnosis - and will be able to tell you whether he thinks your problem is as severe as Patrick Grossman says it is. I would ask him what approach he would take, (I'm sure you're right and it will be very conservative) ask his opinion on surgery for tmjd in general, and especially in your case. There's no harm in saying you have seen someone else who suggested it, as long as you're tactful and don't offend the consultant you're seeing, you want to make sure he is sympathetic towards you. You could simply say you saw Mr Grossman out of desperation as the NHS waiting lists are so long (he can't really argue with that.) It is my understanding that people should only have surgery if they have REALLY EXHAUSTED ever other option. You haven't yet even tried a splint for clenching/grinding - you have recieved no splint treatment yet at all - (there are different types of splints which you can find out about by reading lots of info on this board) the fact that Grossman wants to start off with a splint only to move towards surgery seems (in my opinion, I'm no dentist/doctor) extreme. From everything I've read, surgery is a LAST STEP not a first step, and there are risks involved. Also if he isn't prepared to answer all your questions now - I wonder how much time he would have for you if the surgery went wrong.
I am interested in what he says your problem with your jaw is, why does he think surgery is the only option? The NHS may only offer conservative treatment, but this strikes me as the other extreme. If I were you I would write another topic which is directly entitled 'surgery, please give advice,' or something like that. Say what Patrick Grossman has said your problem is with your jaw, what type of surgery he wants to do, what is it called, and ask for people's opinions on this board. Explain that as yet you have had NO treatment at all. People often don't respond to posts that mention the UK, as there are very few UK people on the board so they feel they can't give advice about where to seek treatment. They can, however, give advice on surgery, there are many people far more informed about this than me.
It is difficult to get treatment in England, but check out what the NHS consultant has to say then assess your options. Even if it is hard to find people who use different types of splints in England, it would be worth checking out every other option, even travelling abroad for treatment if you feel that's necessary, before you go with someone who wants to perform surgery on you. Also, read a lot of posts on this board, put 'surgery' in to a search engine and see what comes up. Check out all the different type of splint options, there is much information on the board, read, read and read some more.
Hope this helps, let us know what the NHS consultant says.
Well I am going to make a suggestion I make to everyone - especially in the UK - because I know it works.
The NHS is a course you should continue to take. But many people on here will tell you, and I would agree, that surgery is absolutelynot to be considered until it is a last resort.
The basic truth as I can see it from talking to many many people and studying the conditin is that tmj can manifest itself as a very severe problem symptomatically whilst being a relatively minor inherent problem.
My advice is a) see the NHS guy because you have nothing to lose. Hear what he has to say and examine that and if necessary get on his waiting list for treatment. b) in the meantime, go and see a cranial-osteopath who knows more about that joint that any surgeon you are likely to see. And who will be very gentle and very conservative. They are not too expensive either..about £40 per session. I have seen remarkable results from the work they do. Let me know where you are in the UK.
I need to make clear that I am NOT talking about cranial-sacral therapists.
Hello hbep, Nirmal and Michael,
thanks a lot for your emails, they are very helpful.
hbep, I would like to ask you: you mention Eastman Dental Hospital and a waiting list for splint. How much is this waiting? Do you if it far longer than what you would experience in the private sector? Also you ask me what is the problem with my jaw: well, Patrick Grossman saw my MRI (I did not have one before him but he told me he would not give me a consultation without it). He looked at it and he told me that my right disk is totally displaced and that i also have an artritic condition on the lower bone involved in the TMJ bone (I do not know how much sense this description makes). He wants to perform surgery to bring the disk back to its place but he admits that he does not know exactly what will exactly happen with my arthritic condition and he says the success is around 80% whereas only with a splint less than 50%.
Nirmal, you suggest that I should see an orthodontist: wouldn't they have to use splints as well to treat me? Is TMJ specialisation something additional to orthodontic specialisation? And how do you know about Patric GROSSMAN? Were you ever a patient with me or know what kind of reputation he has? I am a bit puzzled at the moment because I emailed some other dentistsa round that country that do TMJ: one of them told me that she does children TMJ and she suggested three other people that do adult TMJ but Patric Grossman was not in the list. Should I think something of this?
Also one general question: I have already arranged to see a specialist at my local NHS hospital would he accept to refer me to the Eastman Dental Hospital?
Sorry about the delay in response, i got suspended by the welcome moderator for posting a link
Basically i found patrick grossmans site through my research for tmj specialists within the uk.
However i did find an article where there was a nhs dentist describing splint therapy, and the warious appliances. The repositioning splint the Gelb appliance, it said that this person was with birmingham dental hospital, this is purely nhs
I am going to try and get a reffereal there to see if they do proper splint therapy
Unfortuneately i lost the url of the article which listed the name of the dentist, which is a real kick in the teeth.
who are these dentists u r refferring to who treat tmj
Sorry about the delay in response, i got suspended by the welcome moderator for posting a link
Basically i found patrick grossmans site through my research for tmj specialists within the uk.
However i did find an article where there was a nhs dentist describing splint therapy, and the warious appliances. The repositioning splint the Gelb appliance, it said that this person was with birmingham dental hospital, this is purely nhs
I am going to try and get a reffereal there to see if they do proper splint therapy
Unfortuneately i lost the url of the article which listed the name of the dentist, which is a real kick in the teeth.
who are these dentists u r refferring to who treat tmj
I would like to ask something the USA people.
I recently went to see a TMJ doctor in London and he told me that he closely collaborates with Dr Brendan Stack in the USA. Did anybody in this forum get treated by Dr Stack and if so what would you say?
I am particularly interested in listening to experiences of the surgical procedure to put their displaced TMJ disk back to place (meniscoplasty).
Just wanted to say as people in the U.S obviously don't know much about treatment in the UK they tend not to look at posts with topic headers that specifically refer to UK treatment. To get as many answers as possible to this question I would put it under a new topic header that refers to Dr Stack and not to the UK. This way they will see that they may be able to be helpful to you.
I have to admit that from what I remember you have not received any tmjd treatment so far. For this reason warning bells go off bit time when you mention surgery. There are people who are happy with the surgery they've had done, but they generally have tried every which way to get help with splint therapy first. Surgery is a last resort not a first, and there are risks involved.I would also advise putting a separate topic for the surgery question you have. Many people on here are v. knowledgeable about surgery and I would strongly advise consulting with people who have had experiences of surgery both good and dreadful before even thinking about it.
You mentioned a cranial-osteopath for 40pounds/session and was also apparently quite good. Is this person in London? If so, could you possibly be so kind as to let me know who it is?
Thanks, Mark
[Edited to remove request for "off-board contact information". Please review the guidelines. It is not permitted. "Naming doctors/cities/states is OK", but no more detailed information beyond that. Thanks.]
[This message has been edited by Well-come (edited 08-28-2003).]
I've had TMJ problems for about 3.5 years and have pretty much done the rounds in terms of UK practitioners. In summary, Colin Hopper (UCH MaxFax), Nigel Evens (Eastman) and all the other NHS specialists I've seen will recommend conservative (ie alternative and/or spint) therapy, most of which I've managed to claim back from BUPA (although not without arguments). Alternative therapies (Physio, ultrasound, acupuncture, cranial osteopathy) apparently work for some people but I find they promise far more than they deliver. Splints (I'm on my forth) do reduce symptoms in my experience, although as you know they are hard to live with. I've done lots of research on Partrick Grossman and am still not convinced - I've spoken to about 4 of his former patients who recommend him but these are the ones that he directed me to so I'm cynical. Basically I think he's too quick to recommend surgery as a "one size fits all" strategy and I have problems with the amount of money he charges. Any questions or ideas, I'd been keen to chat
Just curious, when you say you've tried splints - what type do you mean? Simply splints to suppress clenching and/or grinding, or repositioning splints - of the type used in functional jaw orthopedics or neuromuscular dentistry. As you will have seen above, I've been treated at the Eastman - they gave me a bog standard splint to suppress clenching - rubbish - made me clench more. Ditched it really fast, and am not going to bother with them anymore. I have been using an NTI splint for 4 months (not from the Eastman) and am finally seeing results, although when I'm feeling a bit wealthier I intend to seek an opinion in the UK from someone who practices either of the above type of splint therapies. One dentist told me the Eastman is about 20 yrs behind when it comes to tmj treatment, I tend to agree. Are you familiar with the British Society of Occlusal Studies and the Cranio group?
Anyway, let me know the type of splints you've tried. I share you reservations about Patrick Grossman, never met him, but when I talked to his receptionist I was worried by a couple of things she said.
I have the Gelb pivotal splint whic is apparently what Patric Grossman uses. I am very interested in the various types of splint myself.
People say that splints are really uncomfortable, I am interested why they say so-for me it is uncomfortable because the surface of the splint is flat so it does not fit to my upper teeth and I cannot eat properly-I wonder if for longterm this flatness also bad for the teeth surfaces-there must be areason that we are construced with upper and lower ideally fitting teeth.
Last, about eastman. I was hoping to get a referral from them from my NhS dentist but it seems if they are "behind by 20 years" it would not worth it. Hbep can you be a bit more specific? Also what is an NTI splint by the way?
thank you.
[Edited to remove website with advertising. This is not permitted.]
[This message has been edited by Well-come (edited 09-26-2003).]
My jaw+neck was bothering me especially today and I happened upon this website. Im 22 uni student and from London. I was referred to the Eastman Dental Hospital when i was 15 with almost as severe tmj as i have now. They found nothing and gave me a bit of paper with jaw exercises that only exacerbated my symptoms which i tried for about a year. When 17 new dentist gave me a mouthguard that didnt work, talking a about muscles hyper activating - which i know is whats happening. I have since seen a tmj specialist on NHS and privately. both say tmj common blah blah, put a hot water bottle on the affected muscles. That was it - no more help! I tried 3 osteopaths for related posutral problems to no avail. I have had remedial massage too. Over the years I have been told that the tmj is exacerbated by stress and study. I have it worse when I study and it blurs my vision - (my glasses are correct). The best thing to relieve symptoms (hemifascial pain, headache and tightness/stiffness) is to stretch my neck muscle(sternocleidomastoid)on the affected side like 3 to 4 times a day or under heavy study. It also helps to stretch the upper and lower trapezius in the back as this muscle hunches during stress and is associated with tmj. When I do this, it feels pressure is taken off a nerve or something and muscles in the neck jaw and temple balance better and aren't tight or as tight (for a while). When i say stretch I mean the gentlest of stretches, cos overdoing the stretch makes pain worse.
I have been using these stretches for a couple months now and they are the most effective means of reducing the escalation of symptoms into the 'ahhhhh what the £$%^ am I supposed to do' phase of my day. I used to just lie down if the pain got too bad- which, in the middle of the day, is a bit inconvenient. I found the strectches on [website deleted] - it describes a theory of why muscles become painful, and what to do. Quite interesting. As I understand it, the conventional medics like those in NHS have no diagnostic test for muscle pain. I think this is so ****ty. I believe in this conspiracy theory that some huge multinational pharmaceuticals company is paying for research into the subject to be destroyed - there is no other reason for an understanding ot the mechanics of muscular pain (and its effects in tmj) to be coming along so slowly....
...long email. night.
[Edited to remove website. Website with advertising are not allowed.]
[This message has been edited by Well-come (edited 10-14-2003).]
TMJ Treatment in UK-Advice! 
