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Old 06-14-2009, 06:49 AM   #1
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tmjruinsmyday HB User
New TMJ Sufferer - Looking for tips on treatment

Hi,

I'm a 23 year old male and I've been suffering from a crackling/popping jaw and pain next to my left ear for about two years now whenever I swallow, yawn, or open my jaw in any significant way in general. I also suffer from from significant sinus troubles (just had a deviated septum fixed), and I'm a bit unsure whether my headaches are caused by sinus problems or TMJ, as I understand both can cause them.

About three years back my dentist said there was evidence from my teeth that I was a bruxer, but two full-night sleep studies via a different doctor (for daytime-tiredness and sleep related problems) didn't show that I bruxed at all. Nonetheless, my gut tells me that I clench and/or brux at night. Whenever I clench my teeth, I start to feel pain in my neck, shoulders, and upper ribcage, particularly along the left side, where I have my TMJ issues. I've done my best to be cognizant of any clenching now and to relax my muscles, but this hasn't helped much.

I've pretty much had it with the pain, and I feel that the bruxing may be contributing to my sleep problems as well, so I've decided to finally seek treatment.

The only thing I've tried thus far is the Aqualizer, which I chewed through in one night (I had a dream I was searching for food and found a piece of pita bread and started chewing on it..then all of a sudden I hear a pop and wake up to notice the Aqualizer pouches had burst). I'm a bit unsure whether that was due to regular bruxing or just the odd sensation of having something in my mouth that night caused the dream and bruxing.

Browsing through these forums has definitely opened my eyes a bit and taught me to be very careful seeking treatment. I'd really like things to get better, but I'd even more like for things NOT to get worse.

- What kind of qualifications should I look for as I seek a TMJ doc/dentist?
- What kind of questions should I ask him about his philosophy, treatment plan, and potential side effects (to bite or anything else) before we start?
- What kind of diagnostic tests should I expect before we start a treatment plan?

I understand splints/nightguards are the usual first line of treatment..

- What kind of splint/nightguard should I expect? (are splints and nightguards the same thing or different btw?)
- I hear a lot about "bite". Is changing my bite a usual part of initial treatment or is it only for specific cases? Is it recommended to fix my bite or not?
- If there are different kinds of splint/nightguards that the doc may start out with, what are the pros/cons of each, and why would the doc choose one over the other?
- What should I know about using the splint, getting it adjusted, side effects or anything in general, in advance?
- Would you highly recommend getting a second opinion for something as "conservative" as a splint? (insurance/money is going to be a big issue for me and has kept me from seeking treatment thus far so I'd rather not if its not that important...but please give me your honest opinion regardless)

If you could also please let me know what you've personally tried thus far, and what has worked, and what hasn't, for how long, and any side effects or changes to bite, that'd be excellent. I'd really like to get things right the first time if possible.

Thanks for your help guys! Thank god for forums like this!

Last edited by tmjruinsmyday; 06-14-2009 at 07:09 AM.

 
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Old 06-14-2009, 08:12 AM   #2
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bassclari HB User
Re: New TMJ Sufferer - Looking for tips on treatment

I'm just beginning my TMJ treatment (getting my splints next week), so I'm definintely no expert, but my advice would be this: Find a dentist who specializes in TMJ disorder. Not a dentist who knows something about it, but a actual specialist. Check out the sticky at the beginning of this topic for great doctor suggestions. The doctor should give you a list of everything he uses in his treatment plan (I received a whole package to take home and look over before I made a decision). He also should give you a detailed quote for all the charges, and should explain to you what those charges are for.

That being said, my specialist does not think he is the be all and end all. He has made it very clear that there are other professionals that he works with to support the treatment plan, for example chiro, massage, CST, acupuncture, etc., as well as other doctors (for example family doctor, ENT, whoever). He does not give the splints and send you along your way, but he has a plan, with different treatments along the way to support the healing.

He also has made it clear that the treatments (in my case, lower splint for during the day, and upper for at night) are non-invasive and totally reversible. He also did not discourage me from searching out other diagnoses (though I saw the xrays and know there is a TMJ issue), but rather encouraged it (in case there are multiple issues aggravating each other).

I felt like I could have talked to him all day, he did not rush me, he did not pressure me into "signing on the dotted line", he listened to my symptoms and complaints - in fact my first appt was 3 hours with him! He was the first professional in this search who actually paid attention and didn't brush me off (I'm guessing this has been a battle for many years...10+).

I had several different types of xrays done, muscle testing, more xrays.

My understanding is that not all splints are made equally. My dentist wanted to give me a night splint, and the specialist said that I would have chewed through it in a few months, so I'm glad I didn't waste $500 with the family dentist! I have 2 of the aqualizers that I have been using at night, they are only meant for temporary (they will break eventually).

Definitely, get second opinions, and third or fourth until you find someone who makes you comfortable! If I hadn't, I would have had a $500 night splint from my dentist which would not have fixed the problem.

For now that is all I can offer. Good luck!

 
Old 06-14-2009, 08:55 AM   #3
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Thelma-Louise HB UserThelma-Louise HB UserThelma-Louise HB User
Re: New TMJ Sufferer - Looking for tips on treatment

You ask good questions - that is key and bassclari gave great sound advice - both are great posts.

Here are some more info to mull over and keep in mind in your search for the right treatment:

A good tmj dentist will not just rely on his examination of your teeth, bite and jaw mobility to determine the extent of your problem - he will want to see images of them on film - tomogram, MRI or some type of CT scan to check for displacement and the presence of abnormalities often indicative of some form of tmj dysfunction.

Do not let anyone do bite equiliration - the filing down of your teeth to remove contact interferences - until they have proved this is the problem by using a splint to non-invasively remove the interference first to see how you respond. A change in bite is not always warranted - it may depend on the nature or cause of the tmjd and one's dental state and history.

Although credentials are good sometime a dr can be booksmart and quite educated but his execution of his training is poor - some just attend seminars and pay the fee to remain members of certain orgs - so you can check out some of his credentials to see if he is active or not - but for the most part you are looking for someone who is a member of the myofacial pain syndrome, functional jaw orthotics, neuromuscular and oral orthopedics and various tmj organizations.

You may want to know what percentage of the drs practice is devoted to treating tmj - it shouldn't be too high and it shouldn't be too low.

Certainly ask about his philosophy and treatment plan - there are so many - you are looking for one which makes sense to you. The idea of one philosophy and therefore one type of treatment is going to limit the number of successes this type of dr will see.

Splints and nightguards are diff. Splints are primarily used to treat tmj - there are various types for different problems - so educate yourself on them - some web sites list them with pictures and describe their purpose and in what types of situations they work best in. Its very unlikely tmj treatment will not include some sort of splint or orthotic appliance.

Personally I have found tmj treatment is a trial and error type of process - there are just too many variables that cannot be controlled - various theories on what causes it and how to treat it, the training and experience of the dr treating it and the individuality of the patient (no 2 are the same) in terms of dental and medical history - its seldom one gets it all right the first time around.

Last edited by Thelma-Louise; 06-14-2009 at 08:57 AM.

 
Old 06-14-2009, 04:37 PM   #4
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Re: New TMJ Sufferer - Looking for tips on treatment

Quote:
Originally Posted by tmjruinsmyday View Post
Hi,

I'm a 23 year old male and I've been suffering from a crackling/popping jaw and pain next to my left ear for about two years now whenever I swallow, yawn, or open my jaw in any significant way in general. I also suffer from from significant sinus troubles (just had a deviated septum fixed), and I'm a bit unsure whether my headaches are caused by sinus problems or TMJ, as I understand both can cause them.

About three years back my dentist said there was evidence from my teeth that I was a bruxer, but two full-night sleep studies via a different doctor (for daytime-tiredness and sleep related problems) didn't show that I bruxed at all. Nonetheless, my gut tells me that I clench and/or brux at night. Whenever I clench my teeth, I start to feel pain in my neck, shoulders, and upper ribcage, particularly along the left side, where I have my TMJ issues. I've done my best to be cognizant of any clenching now and to relax my muscles, but this hasn't helped much.

I've pretty much had it with the pain, and I feel that the bruxing may be contributing to my sleep problems as well, so I've decided to finally seek treatment.

The only thing I've tried thus far is the Aqualizer, which I chewed through in one night (I had a dream I was searching for food and found a piece of pita bread and started chewing on it..then all of a sudden I hear a pop and wake up to notice the Aqualizer pouches had burst). I'm a bit unsure whether that was due to regular bruxing or just the odd sensation of having something in my mouth that night caused the dream and bruxing.

Browsing through these forums has definitely opened my eyes a bit and taught me to be very careful seeking treatment. I'd really like things to get better, but I'd even more like for things NOT to get worse.

- What kind of qualifications should I look for as I seek a TMJ doc/dentist?
- What kind of questions should I ask him about his philosophy, treatment plan, and potential side effects (to bite or anything else) before we start?
- What kind of diagnostic tests should I expect before we start a treatment plan?

I understand splints/nightguards are the usual first line of treatment..

- What kind of splint/nightguard should I expect? (are splints and nightguards the same thing or different btw?)
- I hear a lot about "bite". Is changing my bite a usual part of initial treatment or is it only for specific cases? Is it recommended to fix my bite or not?
- If there are different kinds of splint/nightguards that the doc may start out with, what are the pros/cons of each, and why would the doc choose one over the other?
- What should I know about using the splint, getting it adjusted, side effects or anything in general, in advance?
- Would you highly recommend getting a second opinion for something as "conservative" as a splint? (insurance/money is going to be a big issue for me and has kept me from seeking treatment thus far so I'd rather not if its not that important...but please give me your honest opinion regardless)

If you could also please let me know what you've personally tried thus far, and what has worked, and what hasn't, for how long, and any side effects or changes to bite, that'd be excellent. I'd really like to get things right the first time if possible.

Thanks for your help guys! Thank god for forums like this!
Hi--I'm going through the same thing as far as trying to find help, starting into splint therapy, etc. since feb. Look at my old posts and see what good advice i've gotten the last 3 mo. Keep reading , I've learned a heck of a lot here. Ask a million questions, be very cautious, and be careful with splint therapy. They can definitely make or break treatment. Each kind does something different. Have your dentist tell you in great detail his initial plan, and long range plan to help you. If he doesn't have one, run. A good dentist will need some type of x-ray to plan treatment, and you should begin chiropractic care, massage therapy w-tmj treatment. It helps a lot. Look into going to an atlas orthoganist chiro. --they don't do heavy cracking ..Good luck!!!!!!!!!!

 
Old 06-15-2009, 02:03 AM   #5
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Join Date: Jul 2008
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nessie01 HB User
Re: New TMJ Sufferer - Looking for tips on treatment

hi i have found success using a night splint and taking 10mg of amitripiline at night and antidepressent during the day.my shoulders no longer feel like bricks i am beginning to feel some softness in them again...........im not 100% better but i am feeling pretty good (with a few minor flares) and had one day last week where i felt almost normal lol.............i also sleep on my back mostly with a flatish pillow to rest the jaws ................i also do daliy stretches for the whole body and am going to start yoga tohelp relax.......i dont want to be on drugs for to long but they are helping so i will stick with them until i feel like the tmj is under control..............i may go to a tmj specilist in the future but at the mean time im going to see how i go...........i ahve only had my splint for two weeks and been on amitrip and antidepressent for just over a week.. i cant reccomend amitripiine enough it helps to sleep and relax the muscles and you only need a very small dose 10mg is more than enough
ness

Last edited by nessie01; 06-15-2009 at 02:07 AM.

 
Old 06-15-2009, 12:29 PM   #6
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Join Date: Jun 2009
Posts: 6
tmjruinsmyday HB User
Re: New TMJ Sufferer - Looking for tips on treatment

nessie: I'm glad you mentioned the amitryptyline (sp?). I meant to ask about that, but forgot to in my original post. I'm seeing my sleep doctor tomorrow so I'm going to see if he can prescribe that as a temporary help until I see a TMJ specialist.

I already take Ultram (an opiate-like painkiller) 75mg 2x/night for Restless Legs Syndrome (I have so many "syndromes"..) and it takes care of TMJ pain at night in addition to the RLS. However, I still feel a lot of stress/tension in my jaw when I sleep and wake up. OTC painkillers work OK for relieving the pain during the day, but the jaw cracking/popping is pretty bad and I'm worried things will get worse if I don't nip this in the bud.

Thanks to the rest of you guys for the tips as well. I'm definitely going to keep reading old posts.

Please keep the advice coming!

 
Old 06-22-2009, 01:50 PM   #7
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Join Date: May 2009
Location: Birmingham UK
Posts: 65
AndreaL HB User
Re: New TMJ Sufferer - Looking for tips on treatment

I just read your post, you do ask some great questions and even game me something to think about as I embark on my treatment.

I agree with what others have said here, that your dentist should be able to back up his talk with actual experience of treating people with tmjd, it's so easy for dr's and dentists to attend seminars and get the certificate, post it on their wall and think they have all the answers, so do your research on the dentist, google him and find out his career history.

I've had dentists look at me and talk over me to their colleagues rather than to me, never explaining anything to me, leaving me none the wiser but more worried and frustrated. I now see an osteopath who calls himself an ostedontic, having a specialist interest in dentistry with the tmj and how osteoathy can work together with ortodontics. He is a miracle worker in my mind lol he has helped relieve my shoulder aches and pains and reduce the amount of headaches I have and their intensity.

It's been my experience that it takes quite some time and a lot of research before you'll find a practitioner you feel you can trust. I wish you all the best! Make sure to keep posting and sharing your tmjd journey with this forum!

Last edited by AndreaL; 06-22-2009 at 01:52 PM.

 
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