You need to arm yourself with good baseline information about what your actual problem is. First get MRI scans of your mouth in open and closed positions, these will show the position of the disc. Then get them reported by somebody you can trust. There is a radiologist in London called Kevin Lotzof who only looks at TMJs, he's even written papers on the subject. If you do have a displaced disc you will probably be advised to wear a Gelb appliance which will bring your mandible down and forward and allow space in the glenoid fossa for the disc to recapture. Grossmann in London is the man for this kind of work.
X-rays don't show soft tissue so won't help except to show position of the condyle in the glenoid fossa which can be diagnostic as well. Most people with TMD have condyles which are too far up and back, caused by our bites becoming overclosed over time.
However if the MRI shows no pathology in the TMJs but you have all the classic TMD symptoms then you could take it that the cause of the problem is spasming muscles. This is around 90% of cases.
Because men have stronger facial muscles I was told we destroy our teeth first so look in your mouth:
- Is there dentin exposed along the tops of the lower incisors?
- Do you have notches at the gum line of the incisors?
- Are there any fracture lines running down the teeth?
These are all signs of serious grinding and need immediate treatment even it this is only a bruxing guard to wear at night. Otherwise you will loose the teeth. I lost one, it started with the notches at the gum line which got bigger over time, destabilized the tooth and then it just started to splinter away.
The jury seems to be out on the question of why people grind, the most common explanation is stress but another theory is that grinding is our sub-conscious way of trying to find the correct bite. I'd be inclined to believe the latter because children grind and they don't suffer from stress the way adults do and their bites are in development.
For the muscular form of TMD you could try a neuromuscular dentist. If you read their theories and methods they make a convincing case. They record objective data on joint sound, jaw tracking and muscles activity.
When I had my work up it was illuminating to see the pathologies on the screen, i.e. I have pain on the left side and thats the side where my temporalis and masseter are in a state of total fatigue trying all the time to maintain a badly positioned mandible (too far back and with a distinct yaw). Also they put a magnet on your lower teeth and track the opening and closing route you take. It should be a smooth slightly curving line. Just before closing mine suddenly makes a big detour back to get under the top teeth.
Once you get information on the exact nature of your problem it will be easier for you to make a treatment decision. Its like a jigsaw puzzle, at the beginning you will have only little pieces of information but gradually a better picture will emerge and you will know what is right for you.