Is Surgury My Only Option? - TMJ Disorder -TemporoMandibular Joint Message Board

Remanufactor · 11-27-2003, 08:45 AM

I've always thought there was something wrong with my jaw. It would never open correctly (deviates to the left, with pressure in the right side near my ear). I have this pressure feeling close to my ear which feels like it builds up until i am able to crack my jaw to relieve the pressure. Over the past couple of months the problem seemed to have gotten worse. I have jaw pain when opening my mouth on the right side and limited opening ability. By the looks of it i dont see how anything less than surugury could help. Im afriad of messing something up but things just look too out of place to fix without actually cutting me open and physically changing something.

Will splints work to help me?? What do they do?

I finally have a job with medical insurance but when I call the insurance company to find a doctor who treats TMJ...they are all Oral Surgeons. I have a feeling if i make an apointment to see one of them the first thing they are going to opt for is surgury. I live In NJ..Is there anyone in this state who is qualified and will give a permanent fix?

saaraah · 11-27-2003, 09:30 AM

i personally believe that there are always options other than surgery.

it *sounds* like your right disc is permanently displaced, since you have a deviation. btw, how large is your opening?

i had pretty much the same symptoms as you: deviation, permanently displaced right disc, and left displaced disc with reduction. i had clicking [left side], popping, migraines, headaches, and facial muscular pain. for 3.5 years, i lived in chronic pain, while, at the same time, tried countless treatments [i've actually been treated for TMJD for 10 years, but the pain really started 3.5 years ago].

now, i am wearing an anterior repositioning splint, which has drastically helped my symptoms. the short version of the idea behind it is that it pulls my mandible down and forward, which produces more room in the joint. because of the increased space, the discs have room to reduce.

ive been wearing this splint for 2 months: i dont deviate anymore and my right side has begun clicking, which is a good sign - the disc isnt permanently displaced anymore. as well, my left side doesnt click as much anymore. my pain has been reduced, too. by no means am i 100% better, but the pain is bearable.. and im sure i'll get better. oh, and my opening has increased from 42mm to 50mm.

anyway, i'd suggest seeing a dentist, not an oral surgeon, to begin. an oral surgeon, more than likely, is going to suggest surgery -- since that's their job. a dentist, however, will be more likely to go the conservative route. i'd recommend doing conservative and non-irreversible treatments to start [splint therapy, NSAIDs, massage, osteopathy, physical therapy, etc]. it'd be good to get tomograms of your condyles and possibly an MRI to see exactly what's going on in your joint. you need to get a proper diagnosis.

splint therapy may help you -- oh, if both of your discs are permanently displaced, a pivotal splint may help the discs start to reduce.

overall, you need to find a competent dentist who wont rush you into doing irreversible treatments [grinding down teeth, crowns, braces, etc] before your symptoms are under control. the dentist should do a wide array of diagnostic tests to see what's really going on in TMJs, head, neck, and muscles.

if you have any more questions, i'd be glad to answer :)

take care,

- saaraah.

Remanufactor · 11-27-2003, 10:06 AM

Thank you saarah.

How does a person use a splint? Is it soemthing you wear or is it implanted into your face somehow?

Other than the reasons you mentioned, surgury isnt the best option for me also because I just staryted a new job...One that requires me to talk. With a splint would my talking ability be severly hampered?

I plan on getting 2nd and 3rd opinions from Dr.'s, but it is so hard to book an appointment without having to wait a month between each.

If it is just a matter of displaced discs....would surgury help to just put it back in place and maybe sew it in position?

What Im more concerned with is degeneration of cartilage and bone requiring me to have a major reconstruction...

You say you now have clicking on the other sid...do you know if that is something you may have to live with? Thanks for the detailed responce.

saaraah · 11-27-2003, 12:21 PM

a splint is a removable appliance that fits on the teeth, and is usually made out of hard plastic [acrylic]. there are so many different kinds - some fit on the top teeth while others fit on the bottom. some have 'grooves' in them and others dont. i'd really recommend searching google for different pictures of splints [we're not allowed to post URLs at this forum].

it depends on the splint, but some are worn 24/7, others only while sleeping, some during the day, etc etc. it completely depends on the dentist you see and what type of splint he prescribes.

surprisingly enough, it's pretty easy to get used to a splint. personally, it took about 3 days for me to feel comfortable eating and talking with it. after that, i talked fairly normally - no one noticed it, anyway.

it's excellent that you're planning on getting extra opinions, btw. :)

I'm afraid that the TMJs are very complicated little things in our bodies, and it's not "just a matter of displaced discs". surgery for sewing the dics into place tend not to have the highest success rates. some people here have had that type of surgery, so they'd be able to answer you on that.

it's better to try splint therapy first before surgery, since, in most cases, the discs will reduce. surgery for the TMJs is usually only needed for about 5% of patients. it's really really really discouraged. as you can tell, im very anti-surgery; im paranoid about people getting worse and being in more pain.

have you had xrays/tomograms done of your condyles? did they show degeneration? i have DJD [degenerative joint disease] on both condyles, but my newest dentist said that my splint therapy should at least stop the progression of damage.

ideally, my TMJs should stop clicking - that is, if my discs become recaptured and the tendons heal during splint therapy. however, i really dont know if the clicking will go away permanently. time will tell, i guess. :)

- saaraah.

Remanufactor · 11-27-2003, 05:55 PM

Well best of luck to you...And thank you for all the help. I have alot of thinking to do actually. My dental insurance doesnt cover TMJ (Aetna) but my health insurance (Cigna) does. Go Figure! The problem I see with that is finding an actual dentist to help me rather than going directly to a surgeon.

I have had TMJ problems for a while....Maybe 8 years but the pain is something quite recent. Sometimes it bothers me..sometimes it doesnt. I would like to go with a splint in place of the surgury if possible...But I also want to have braces put on again...hopefully that wont affect anything.

9 years ago I had braces...I think they were taken off too soon and the doctor rushed me on to a retainer. The retainer never fit correctly because my teeth were stil in the process of shifting and i had to sometimes jam the retainer onto my bottom teeth. I remember pushing too hard one and thats when i first messed up my jaw. Was the summer of 94 or 95. Ever since then I've been out of alignment. The orthodontist told me it was just a ligament, dont worry and dont chew gum. For a while I had no idea it was an actual problem and was embarassed to bring it up because I figure it was so unheard of.