Splint Therapy -- Upper vs. Lower - TMJ Disorder -TemporoMandibular Joint Message Board

delilah1963 · 11-21-2003, 02:18 PM

I went through splint therapy with no success. In fact, my symptoms and pain seemed to morph even more. The doctor was a prosthodontist and charged me a flippin' fortune for the splint. $1,000 and I paid it (insurance did not cover).

He claims my jaw now operates properly (ta-da!) yet I'm still in pain, even after physical therapy, chiro, drugs, etc.

My splint was an UPPER one. A friend of mine mentioned hers was a LOWER one and while she's not "cured" she manages better.

What's the difference in the appliances, besides the obvious placement of it. I mean, is an upper used for a certain type of condition and lower for another, or is it just a doctor preference? If anyone out there has any experiences or information that could help me understand, that would be great.

D.

Arleen · 11-22-2003, 12:25 AM

Hi Delilah:

Welcome to the board. I've talked with a number of dentists and while there may be some logical reason why some use uppers and others lowers, I've never been able to find out, apart from being told that the dentist has been very successful with one or the other.

What I found unusual in your post was that a prosthedontist is treating you for TMJD. Most of the people here are being treated by general dentists, neuromuscular or orthodontists. I was under the impression, based on first hand experience and reading the board, that prosthos mostly do reconstructive work, crowns, that sort of thing. Do you know what percentage of your dentist's practice is TMJD related, and how long has he been treating it?

If you're not having luck with him, you might want to go for a second opinion with someone who been focused on TMD for a long time, as each case is very different. Also, with someone who's been trained under a number of approaches, as the problem is complex, and requires a lot of understanding of the joints, muscles and occlusion.

Do not let him start filing away at your teeth. I'm not trying to be pushy or anything, but I came very close myself. I've since learned that with TMJD, you want to stabilize the joints first and get pain free before you start messing with the teeth.

Good luck, and take care,
Arleen

mrsumer · 11-23-2003, 07:14 AM

Hi delilah1963,
I too have been going to a wonderful prosthodontist, he has had training in TMJD. My splint cost more than yours and is an 'upper' splint. My DMD chose the upper splint because of his ability to diagnos which I needed for the best treatment. Be aware that TMJD is a very, very, slow healing process ( I am in my 2nd year of recovery)...the splint actually lifts the jaw off of the joints to let them heal and places the jaw in a more 'natural' / proper postion. (The DMD told me that I may need to have reconstructive work down, such as: crowns etc. after splint therapy, it just depends on how the jaw places itself back after the splint has been eliminated. If you are still having pain talk to your dentist, adjustments were made on every visit for my splint. (The splint should never produce pain, its objective is to eliminate or reduce pain). I was prescribed 2 types of pain meds, which eventually gave me relief. I also am experiencing tinnitus, the dreaded 'ring in the ear'. I am going to give you a list of what I had to do to help the healing process, bare in mind you should not follow this treatment, everyone's is different and you should follow the advice of your doctor, if you feel you are not getting the best treatment get a second opinion, my regular MD and my ENT told me that I had to 'deal' with the tinnitus, which came before my pain (jaw), I left them both and found a great MD in my area, when he first saw me told me that my jaw was out of alignment and recommended me to the DMD that I see now....
1. no hard foods, especially gum chewing.
2 vitamins, daily.
3. hot/cold compresses on the TMJ areas (20 mins on 20 mins off).
4. while in the shower let the hot water (as tolerable as possible) run over the TMJ joints, do not let water run in the ear canals.
5. music on at all times in the background, even at night ( this is for the tinnitus).
6. I had to wear my splint, at first, 24/7 except when I ate, some splints need to be worn even when eating, follow your docs advice.
7. For the tinnitus, music at all times, not loud, but enough to 'drown' out the sound of the tinnitus ring, buzz.
8. Chiro treatments, which included altrasound physical therapy ( on the TMJ joint and Sternocleidomastoid, which runs from behing the ear down the side of the neck and splints in 2 directions at the throat area.
9. My GP put me on klonopin and nortripalene (sp) (anti*depressants known to help tinnitus) which I have been on for about 2 weeks now and have had remarkable success...I finally have no more 'buzz' in my head, I believe the splint, helped with relieving the ring in the ear, but I soon developed a buzz in my head.
Just remember, healing is slow! like I said, I am in my 2nd year of recovery and am doing fairly well...but have hope, best of luck on your recovery....