Is all three phases the normal recommendation? (long) - TMJ Disorder -TemporoMandibular Joint Message Board

Soupdejour · 11-04-2005, 12:18 PM

Hi,

This board is a lifeline, everyone here is so helpful!

Am new to TMD and wanted to ask if the following is the normal diagnosis/recommendation -

I am a 40 yo woman who was diagnosed w/TMD a couple of mos ago and went to a very well known TMJ specialist in Northern VA whose been recommended on this great doc thread as a good local TMJ specialist.

Have had clicking/crunching/grinding noises in my jaw, and getting harder to bite or chew hard/crunchy foods (which am avoiding now). Up until this last week, there's no pain (yet) or headaches, other than a slight fatigue/jaw ache if am talking for long periods of time (the last few days have noticed more soreness starting earlier in the day, the condition may be worsening).

The doctor did MRIs and said that I needed to go thru all of the Phases:
a) Six mos of 24/7 bite splints then b) surgery, and healing for 6 mos. and then c) orthodontics. All phases, no ifs, ands or buts.

just wanted to know if this is completely normal to get a three phase diagnosis/treatment all at once like this, it sounds like many times doctors will work w/you on one phase at a time, then evaluate the next step, is that true? There are so many routes of treatment am confused and am terrified will spend too much time and money going in the wrong direction

I understand the doc I saw is respected and don't mean to counter what he says at all.but it's altogether it's huge $$$, 3-5 years of treatment right out the gate and not sure what to do. (Guess I was hoping that there would be recommendations at this point to start one or two phases, but kind of amazed w/all three at once.)

Should I take go ahead take his word and commit? if not, does anyone have recommendations for TMJ specialists for second opinions in the DC metro area (also has anyone heard of a Dr. Carrion/Baltimore here, his website says he's certified as a TMJ oral surgeon/specialist?)..and thank you to the person who recommended Dr. Schwartz in Rockville, however he's booked solid for 2 1/2 mos, and for another recommendation for Dr. Zussman in NoVa - his office says he's no longer taking new TMJ patients.

Has anyone been to Dr. Bonacchi in Vienna?

PS..here's MRI results, in case anyone might be familair w/results and could comment more:

"In closed mouth position the discs of both TMJ joints are both anteriorly and medially displaced. In open mouth position there is no evidence of reduction of the displaced discs. There is a deformity of the mandular condyles bilaterally. Cortical erosions are also present. There is normal range of motion in noth TM joints. No joint effusion is noted on either side."
He also said there was also arthritis in the joints.

After reading the posts on this board all of you are heros to be going thru what you are and still going out of your way in offering your time and energy to helping others here. Thank you very much.

TiffanyAnn · 11-04-2005, 03:20 PM

Quote:

Originally Posted by Soupdejour

Hi,

This board is a lifeline, everyone here is so helpful!

Am new to TMD and wanted to ask if the following is the normal diagnosis/recommendation -

I am a 40 yo woman who was diagnosed w/TMD a couple of mos ago and went to a very well known TMJ specialist in Northern VA whose been recommended on this great doc thread as a good local TMJ specialist.

Have had clicking/crunching/grinding noises in my jaw, and getting harder to bite or chew hard/crunchy foods (which am avoiding now). Up until this last week, there's no pain (yet) or headaches, other than a slight fatigue/jaw ache if am talking for long periods of time (the last few days have noticed more soreness starting earlier in the day, the condition may be worsening).

The doctor did MRIs and said that I needed to go thru all of the Phases:
a) Six mos of 24/7 bite splints then b) surgery, and healing for 6 mos. and then c) orthodontics. All phases, no ifs, ands or buts.

just wanted to know if this is completely normal to get a three phase diagnosis/treatment all at once like this, it sounds like many times doctors will work w/you on one phase at a time, then evaluate the next step, is that true? There are so many routes of treatment am confused and am terrified will spend too much time and money going in the wrong direction

I understand the doc I saw is respected and don't mean to counter what he says at all.but it's altogether it's huge $$$, 3-5 years of treatment right out the gate and not sure what to do. (Guess I was hoping that there would be recommendations at this point to start one or two phases, but kind of amazed w/all three at once.)

Should I take go ahead take his word and commit? if not, does anyone have recommendations for TMJ specialists for second opinions in the DC metro area (also has anyone heard of a Dr. Carrion/Baltimore here, his website says he's certified as a TMJ oral surgeon/specialist?)..and thank you to the person who recommended Dr. Schwartz in Rockville, however he's booked solid for 2 1/2 mos, and for another recommendation for Dr. Zussman in NoVa - his office says he's no longer taking new TMJ patients.

Has anyone been to Dr. Bonacchi in Vienna?

PS..here's MRI results, in case anyone might be familair w/results and could comment more:

"In closed mouth position the discs of both TMJ joints are both anteriorly and medially displaced. In open mouth position there is no evidence of reduction of the displaced discs. There is a deformity of the mandular condyles bilaterally. Cortical erosions are also present. There is normal range of motion in noth TM joints. No joint effusion is noted on either side."
He also said there was also arthritis in the joints.

After reading the posts on this board all of you are heros to be going thru what you are and still going out of your way in offering your time and energy to helping others here. Thank you very much.

Hi and welcome to the board

In treatment of TMJ is there usually only phase l and phase ll. Phase l consists of treatment such as splint, PT, massage therapy etc.. Once the patient is out of pain and comfortable for at least 6 months they move onto phase ll which usually consists of either braces, equilibration, crowns/restorations or a combination of these treatments. Surgery is not a phase of normal treatment. I would caution you to PLEASE avoid surgery. A good majority of people who have had TMJ surgery end up in worse condition than they started in. And most who have surgery have continual surgeries. It's one of those cases where one almost ALWAYS leads to further surgeries. Many ending up have total joint replacements and sometimes end up having their discs removed. It's a horrible propositon. TMJ surgery is a very delicate surgery and should NEVER been used unless absolutely necessary. Far too many patients with TMJ are being operated on and ending up more miserable, in more pain and much worse off than they started with. You can do a search on this site and read all the horror stories of those who have had surgery. The failure rate of TMJ surgeries is extremely high, for all types of TMJ surgery. Please get more opinions before agreeing to this doctors treatment plan. I would hate to see you end up in worse shape than you started in.
Tiffany

VA-GAL · 11-04-2005, 06:21 PM

I have to echo what Tiffany said. Surgery is NOT a normal part of treatment. Surgery is for the most extreme cases and reserved for people who are in alot of pain that nothing else will help with. Even then, I would try and avoid it. I have unfortunately gone down that road 4 times and one lead to another and another and another and eventually open joint surgery that has left me in unending pain and nerve damage. My current doc, who is a pain management DMD says I most likely will spend the rest of my life with some amount of pain and will end up with a total joint replacement at some point in the future. It is just a matter of time. So please avoid surgery, get a second opinion. Good luck to you.

VA-GAL

Soupdejour · 11-09-2005, 12:07 PM

Thank you so much for replying, I am soo sorry for all the pain and horribleness this monster TMD causes in everyone's lives, who would have known that our lives would start revolving around this disorder..everytime I eat or talk it's obsessing me now.

Thank you for the warnings about surgery. have scheduled two appts w/local TMJ doctors and will be seeking more advice. I also had a doctor friend who showed the MRI's to a head radiologist and he said there is displacement but thought there were a lot less degenerative problems than the first diagnosis.

One of the things w/this is there is no set treatments, to compound matter every medical professional has another opinion about what to do. I had posted on a dentist site a question about TMJ and got immediately got email pitches for orthodontist work from non-TMJ related ortho offices, and it makes you even more leery- it's like there are people trying to make a buck off you w/this diagnosis and you have to worry about that too. imagine there are folks out there who could look at TMD patient work as a never ending cash cow.

If you break your arm for instance any doc you'd see would probably give close to the same treatment, examine, xray, treat, cast. there's no such normal protocol here w/TMD, some docs say splints then maybe surgery and braces..its almost like a lot of guesswork and pieces of a puzzle.

anways sorry to vent , thanks all for your advice and good health to all.

laskalady · 11-09-2005, 12:29 PM

You're so right! I've been seeing more and more clearly how this works. The tmd is taking control of our lives, and its distressing at times. Docs know this, and some of them are just trying to make a buck or 2 off of tmd sufferers. I get the impression that they go to these seminars and get certified, but lack true experience and knowledge in this complex field. I'm on my way to the 4th tmj doctor on Friday. AT least you've got an mri. I have gotten no diagnosis or mri concerning the condition of my tmj. I'm hoping this doc really knows what he's doing and can help me. Hang in there!