Does anyone have thoughts on this situation? I had a several new crowns placed 10 months ago and all was well until a dentist noticed cross bite interference and took down 3 teeth like a carpenter. I immediately developed plugged ears & facial spasms. I know my issue is occlusion. My lips are now uneven and tip to the left where the teeth were taken down. Only I can see this as I use a lip liner and I know where they used to be. The back of my mouth, left side feels "gummy" since I don't have the proper tooth height to support it. And, often times at rest the upper right lip will elevate like Billy Idol since the teeth are lower on the other side. I was diagnosed with the garden variety TMJ and went forward with splint therapy which lasted only 3 months and was a failure. I wore the splint at night only and my lower teeth were developing gaps within days and my lower arch was collapsing in addition to the other issues. I was turned loose and told to find an ortho. I don't know if there is an accurate way to measure imbalance or find the correct occlusion. Also, I have an impression that was taken before this adjustment was done. I don't know if this can be used to find the correct position. It's been a downhill decline since then and things are gradually worsening. I can no longer move my mouth to speak or eat and my facial muscles are overworked. I realize that I would have to relax the muscles before dental work can be done but I'm hesitant to try the splint therapy again. One ortho wanted to put a stabilizer bar on the lower teeth to hold them in and another wanted to let them flare during splint therapy and push them back in later. ???? I'm seeing several top dr's in the next few weeks who will try to sort this out. Has anyone walked this path before?
Hi lilypad. I believe that we have a similar situation! What do you mean by garden variety of TMJ? Here is my story...My Dentist replaced a silver fillling with a white composite filling than NEVER felt right. HAd it adjusted several time to no avail. Then he determined that I had an interference going in left lateral what ever that means. He grinded down an upper tooth (the one with the new filling way too much)Well guess what... since that procedure everything in my mouth changed. Teeth not fitting properly swollen gums. Then it got HORRIBLE. started to expierence eye twitching, difficulty swallowing, neck back and shoulder pain. I think my TMD is occlusal too! Our discs are out of postion because the brain tells the teeth what is a comfortable position and the jaws move to accomadate the new teeth position----which leads to TMD! I believe this is what happened to me and you. I now have both left and right discs anteriorly displaced and the left one is also LATERALY displaced. (remember what the dentist did! He filed too much tooth filling down becasue of the interference) Sounds like you got too much grinded down too. It sends everything off balance. PLEASE tell me the difference between an occlusal guard and a splint. MY tmj doc made me a night guard--- is this a splint, I think I need something to move my jaw back in place so the discs can recapture. MY tmj doc says I clench too. I think you need to have those crowns built up or redone. I hoped all this made sense...What are your symptons now? You say you can't move your mouth! Do you have pain in your jaw, back or neck too? I really hope I helped in some way. Take care, Allison
This is how my tmj started as well - a few white fillings that felt too low and then replacment of a few crowns on both lower sides with one side feeling lower and 2 front bridges that felt large or bulky and I started getting facial fatigue, then tooth sensitivity, then jaw pain. I noticed my upper lip on one side kept pulling upward near the canine yet my lower lip directly below it pulled downward and I would occasionally feel like I was drooling there. Then I noticed when I laid down the last teeth on the left side could not touch as they once did and I started sleeping with my head turned toward that side quite a bit. What finally was the straw on the camels back was I went to the dentist complaining of all these things as always (this was going on for 3 yrs) - he adjusted the lower front bridge to give my tongue more room, did bonding on the teeth that had become extremely sensitive and did another filling on the last upper right molar (again a white one that was too low) and within a week my neck stiffened and I had my first facial spasm and quickly spiraled out of control from there.
Unfortunately every dr I went to see insisted my pain was due to large older fillings in my molars and I can't believe I actually let myself be talked into having them crowned b/c it made things so much worse - none of my teeth met correctly afterwards and it felt like my upper and lower jaws were both misplaced. Even my palate felt lopsided and titled down towards the left and my tongue could no longer function since the new crowns were too short - I often felt like I could not open my mouth.
I, too had models previously taken before the tmj developed and 2 dentists tried using them as a guideline to try and retore my bite in addition to splint therapy but it failed miserably. My current tmj dentist tried using my pre-tmj models as well but something seems to happen during the process where the teeth or their position change since they did not fit in my mouth - I mean I literally could not get my front lips to close together and bite adjustments to them just thrust me further into a totally unbalanced bite. So he removed everything and he sent me to a cranial chiro saying that the impressions he was taking must be picking up cranial derangement that occurred with previous dentists. After 7 months now we are getting ready to try new teeth again - and again I have the same concerns.
My feeling is that b/c a dental model is taken basically by putting impression material over the teeth - when the model is hardened it is already slightly larger that the teeth beneath it. To make another model from that model only adds to the dimension of the 2nd model. So no matter what the model is slightly larger than your natural teeth - although my dentist tells me there are ways of accounting for this excess and removing it - I have not yet seen this happen. In theory - I am told this should work - however, if teeth have already shifted during the onset of the occlusional tmj - chances are those teeth need to be repositioned.
Supposedly there is a way to measure bite and jaw imblance and occlusion but there are different approaches or theories on this too depending on what type of dr you go to. One dr I saw specialized in bio-aethetics and made me temp teeth (crowns) using a model he made from my pre-tmj models - they weren't too bad until he started doing bite adjustments to them by basically putting me in the chair so low that my legs and feet were slightly higher than my head - when this failed I literally pulled them off one night I could not stand the pain no longer. The next dr (neuromuscular dentist) told me doing bite adjustments lying down was not good for someone who is used to all teeth meeting - so he tried to do the same thing in making the teeth only he used the tens unit to try and do bite adjustments with me standing - but the same darn thing happened - I could not get my lips together and one side ended up lower than the other side. When I smiled all my teeth looked like they were on one side of my face. My face became very distorted with one cheekbone, ear and eyebrow higher than the other and one cheek was rounded and puffy and the other hollow and pulled inward.
For occlusional problems a splint is supposed help balance the jaw by providing a flat plane for the teeth to glide over with no resistance. I know there is a difference of opinon in terms of whether to do an upper or lower splint - each dentist I went to had their own preference - my feeling is it should be done on the jaw where the problem resides - in that if you feel you lost vertical dimension from upper teeth - the splint should be done on upper teeth - but if you feel you lost height on lower teeth then the splint should be done there. Some dentists think both upper and lower should both be used simultaneously - and this I think would work as well if the imblance occurred on both upper and lower teeth due to multiple bite adjustments.
For displacement problems a respositioning splint is generally used to push the jaw down and foward so the discs can be recaptured. Usually there are indentations or contacts on the splint which help the jaw reposition itself.
Night guards are generally used to provide protection to the teeth from clenching and grinding while sleeping. They may also help keep the jaw in a relaxed position by providing more secure contact between teeth. Some guards are designed though to remove pressure from the back teeth and vice versa. It is thought in doing this the facial muscles will then relax. I doubt a night guard will help the discs be recaptured but maybe it can - I am not certain.
Sorry I have no anwers for either of you - just thought I would share my experience in the hopes it will somehow help.
Allison - you are right when you said "Our discs are out of postion because the brain tells the teeth what is a comfortable position and the jaws move to accomadate the new teeth position----which leads to TMD" - this is basically what happens when our innate bite pattern and vertical dimension is altered and does not match our muscular skeletal structure.
Thanks for your great post Thelma-Louise. I can see you've had quite the journey.
Allison, I experience facial fatigue when I eat or speak. I also have a huge lump on the right side of my face due to the muscle being overworked. Eye ticks, yes, often times, difficulty swallowing, yes, all on the left side. Creaks in my neck and shoulder blade pain, yes.
I don't know if this is related to the TMJ but when this whole thing began I had a lower crown replaced #18 and within 2 weeks developed jaw pain along with submandible swelling on the left side. This was BEFORE the occlusal adjustment so I may have two things going on, both of which I've been unable to figure out. I feel pressure with an itchy feeling from the tissure swelling. The gummy area behind #18 seems to be the "hot spot." It has gotten worse over a 1 year period. Lymph glands often times are enlarged indicating possible infection. Do you notice this? My dentist has documented swollen glands inside my mouth (left) & along the jawline (left). My dentist and others are advising me that nothing can be done i.e., dentistry or ortho for permanent correction of occlusion with the swelling as it presently exists. To make matters worse the tooth that MAY be the problem is #19 which is the stabilizer for the entire left side. If the swelling is not due to this tooth and we extract it an implant cannot be done and I'll be in a position with an imbalance and no way of replacing teeth or permanently fixing the TMJ. #19 is now percussion sensitive following a root canal 7 months ago that has never settled down. The tooth behind it, #18 now has a temp crown and needs replacing within the next couple months. (we were looking for cracks as to the source of the pain, but none were found) It just doesn't make sense to me that following placement of a permanent crown on #18 the tooth in front #19 begins to hurt. ???? Although I WAS coming down hard on tooth #19 I wouldn't think in 2 weeks it could cause so much discomfort. This is why I'm hesitant to extract #19 even though I've been directed to by some oral surgeons. It may just be tissue inflammation. To further complicate this issue when I had a novicane block I still experienced jaw pain & was told it wasn't related to the teeth??? I really don't know which way to turn. I'm presently in the process of regrouping. I'll be seen at Mayo Clinic this week and UCLA in 2 weeks. Also, will see another highly regarded ortho in SoCal. I'll keep you both posted. Where are you both now in your stage of treatment? Are you looking for or working with anyone? Also, another question for Thelma-Louise. Do we have any recourse with the dentists that got us into this situation?
An afterthought.....at the beginning of this journey when #18 and #19 were deliberately taken out of occlusion I had an imbalance at the canine level on one side ( Billy Idol) as you did Thelma-Louise. The left side was too low and the right lip would raise. When I had the crowns (#18 & #19) re-done and increased in height, the lip line was once again normal and balanced. Now with the cross bite interferrence adjustment I am back to square one.
Allison, when I refer to garden variety TMJ I find dr's all want to proceed with splint therapy with very little regard for the individuality of the different cases. It's also a huge money maker for them so we are all on the same path as lemmings to the sea. TMJ is different things to different people. Some folks with TMJ don't have major issues with occlusion but in my case if 3 teeth were aggressively modified & symptoms started within 24 hours than we need to look at the dental aspects of the situation. My last dr claims teeth are never implicated in TMJ that there is always an underlining condition. Another dr claimed occlusion is always implicated. In my case I believe I had a delicate bite (end to end) which was disrupted. Not everyone is textbook and there is no perfect bite. It's what's perfect for you. This is the reason I believe folks often develop TMJ following ortho. They've been restored to textbook perfect but it wasn't perfect for them.
Hi again, I don't see how doctors can say that teeth aren't related to the tmd onset. Like you, I had at least 3 teeth "polished", or "grinded" down to accomadate one bothersome filling. After that procedure teeth felt misaligned. NEck and back pain eye tiwitching, pretty standard tmd pains. I gather that most TMD doctors treat tmd with splint therapy. I mean what else is there besides surgery? ( which doctor #2 advised to me)- he wanted to do open joint surgery on both sides. I opted for Doctor # 3- lower appliance to pull jaw forward. He took all kinds of test. Joint vibration, scans x-ray tomograph(sp) and a mri. My discs are anterioly displaced with the left one trying to go medial. He states that if disc goes medial and falls sideways it is impossible to recapture. My condoyles(right more than left) are quite small and are jagged on some parts, he says that did not happen in just a few weeks he says more like 20 plus years. I am 37. He claims I have had underlying tmd but with no problems or symptons until (the straw that broke the camels back) ie: the new filling. I am praying that the lower appliance works to get my jaw joints in the correct position. He says after jaw is in place I may or may not need braces, bite adjusted or maybe even nothing done to my teeth. My jaw only needs to come forward about 2mm. (not sure about that number) something like that. Lily pad, I WOULD not have #19 removed! When you were coming down hard on #19 it causes the gums around it to be swollen and very tender (as I am sure you know) HAs any doctor put you on any antibiotics (like take it for several weeks to rid infection. )I mean if your lymph nodes are swollen you have an infection some where in your body. It would make sense to me that your gum tissue is infected and it pushes your teeth all around. Also, Your bite is off so your jaw joints have moved to accomadate a comfortable postion for your teeth (I use the word comfort loosely) That is why your jaw hurts. YOu do have a lot going on, but it sounds like that you are on it. Mayo is great place to be! I hope you could take something from this post. Ask about antibiotics...Take care.
Thelma-Louise, you have been through so much that I can't even believe it! It is horrendous all the mistakes that were made. Has any doctor wanted to do open joint surgery to your tm joints? Where are the discs? Are they forward, back or medial? The Doctor that wanted to do open joint surgery on me said that teeth would be adjusted to fit the post surgical joint postion. I thought to myself...I will not have surgery unless I am on my death bed, or going out of my mind from this tmd monster. Has anyone brought up jaw joint surgery to you? You might have mentioned this before but I have not read all your posts, and am fairly new here. Read post to lilypad and that is my latest news. Take care...
Allison - based on MRI's, CT scans and tomograms - my discs are supposedly fine and the condyles are OK although the left one has an irregualr shape which the dr thinks is primarily b/c this has been going on for several years now. I do have arthitis on the lower left near the joint as well but nothing that could account for the facial spasms, pain and other symptoms. The 2nd tmj dr I went to thought I needed to have my lower jaw surgically pulled forward due to a constricted airway visible on all tests but he sent me to 4 other specialists to get a 2nd opinion or consensus on his diagnosis and all 4 had different recommendations so I obviously would not have the surgery done - at that time, had another dr agreed with him I might have done it. My current tmj dr (my 4th) just recently suggested we do another ICAT (dental CT scan) in a few weeks as we are getting ready to start to try and restore my bite again - I had taken a hiatus from any further dental treatment for the tmj (occlusional/muscular type) for several months now as the tmj dr sent me to a cranial chiro since he felt I was just too "torqued " and needed to have that corrected first.
To be honest at times I have wished something was displaced or damaged that could be surgically repaired b/c I have been dealing with this - where its all msucular in nature, going on for 4 years now. But I have read on several occasions that lots of people live with displaced discs with no symptoms so I doubt surgery is the answer.
I did do some searches on open joint surgery and found there are various forms of it depending on the problem - but what you describe sounds more like jaw surgical respostioning followed by ortho or braces to move the teeth based on the jaws new position, but that is often referred to as orthognathic surgery not open joint.
LilyPad - my lymph glands were swollen for a full year before the tmj started. I had them check several times and had various blood test done by my PCP looking for underlying infection. Then at one point my lower left jaw swelled near the joint & I was sent to an OS as the periodontist I went to (I thought maybe a molar was infected back there) thought it was a salivary gland infection but again nothing was found. Personally I just think my muscles were becoming so inflamed from strain that the glands just reacted to it although sometimes I wonder if they now just seem large and hard b/c my jaw may be further back then it should be so they are just more pronounced. But I am still tender in the throat areaas well.
I have had problems with novacaine blockers not working too!!! I was told I had "messed up nerve pathways" that were very intertwined.
I wouldn't extract number 19 just yet either. My current tmj dentist asked me why the dentist who did my restorations did not just remove the crowns for several weeks and let things settle down. He felt that even though a problem with a crown or bridge is not visible pain alone was symptom enough to warrant the dental work to be removed. I tend to agree with what Allison said that it is reacting to the tooth next to it. Hopefully it has not been damaged. As it turned out my upper left canine was infringed upon or pushed by the replacement bridge next to it and now has a "torn" ligament - whether its salvageable at this point I am not sure - my current dentist seems to think once my bite and occlusion are restored it may improve and heal on its own (I am ready to yank the darn thing too since I am still getting a lot of pain there and up the side of my nose).
It has been mentioned to me by several drs that I should sue or at least file a complaint for negligence with the dentist that did my dental restorations and the first tmj dentist that did the crowns on my back molars - one actually put it in writing and sent me a letter recommending it - but I did not pursue it for a few reasons - the first being I was and still am in too much pain to be bothered - I just want to get passed this somehow and get my life back and lawsuits (finding a lawyer, meeting with them, etc) takes time and stamina and requires a lot of talking, etc. Secondly - since other drs messed with my bite by doing the crowns I think it would be hard to prove who did what. Thirdly, I was concerned that if other drs found out I had filed a lawsuit against another dr they would not want to treat me.
My feeling is, however, if you can prove all of this is due to some negligence by your dentist - even if its just based on what another dentist is now telling you - at the very least file a complaint with the dental ward in your county or state and they will investigate it - and yes, there are lawyers that handle dental malpractice cases - I have come across several in some of my research on tmj.
I wish you both well and hope things improve for you soon.
Thanks Thelma, Thanks Allison. For an update. My bone scan came back negative. My dr. did find a very small isolated high spot on #19. The constant slamming on this point could be the cause of the pain and swelling. I've been keeping a small piece of TP on #18 to help redistribute the load and I can almost feel the muscles beginning to relax. To think that this has been the best solution to date. I met with a new doc this week who works with many reconstructive TMJ patients. My problems go much deeper. Apparently, my upper arch is positioned to the right and the lower arch to the left so when I close my mouth I have a major misalignment. I hit on a cusp when I close and with force the upper jaw slides over and snaps into place. Muscular in nature. This new DDS would be involved in the TMJ therapy and will be my dentist who will do the final work. I may get sent to an ortho. In your opinion what would be better. An ortho who does TMJ therapy who would send you to a dentist for final reconstruction or a dentist who does TMJ therapy who would send you to an ortho? Assuming all speak with each other and work closely as a team. Any thoughts on this new development? Thanks again for your great responses. I'll keep you posted.