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Old 06-17-2009, 05:24 PM   #1
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Merricat HB User
New to TMJ - Is arthrocentesis a good first step?

Hi All,
I am 24 years old and have been grinding my teeth at night for about 5 or 6 years that I am aware of. Last year, I got a customized bite guard from my dentist and have been wearing it every night since. About six weeks ago, I began to get an intense feeling of pain/pressure on the sides of my face, extending up into my head and causing extreme side headaches. I also noticed that the muscles in my neck and shoulders were quite painful. Initially, it was periodic, but after a few days, it became constant. Since it has been constant, I have developed a locked jaw (28mm max opening), significant popping/crunching/snapping noises, ringing in my ears, and sinus pressure.

I went to see a neuromuscular dentist in Massachusetts (I live in New Hampshire) who recommended a $6,000 course of treatment that would include almost weekly trips to his office, a lower splint, and numerous splint adjustments. Unfortunately, my health insurance won't cover any of this treatment, so my dentist referred me to an oral surgeon, who recommended arthrocentesis.

I am very hesitant to consent to this procedure without first exploring non-invasive options such as physical therapy. Am I correct in this belief, or is arthrocentesis really such a common and/or useful procedure that it makes a good first choice?

Any ideas you have would be much appreciated - all I can think about right now is having these symptoms for the rest of my life, probably getting worse, and am feeling pretty hopeless.

Belle

 
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Old 06-17-2009, 05:30 PM   #2
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Re: New to TMJ - Is arthrocentesis a good first step?

I should also add that I am considering a trip to the Craniofacial Pain Center at Tufts in Boston. I have been reading through posts and noticed that a couple of members have been treated there, but have not been able to find any posts indicating whether or not their treatments were successful. Once again, any information or suggestions would be much appreciated!

 
Old 06-17-2009, 06:00 PM   #3
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Re: New to TMJ - Is arthrocentesis a good first step?

You poor thing...One comment on the mouth guards. I have never really understood the purpose. Let me tell you why. I, too, am a grinder/ clencher. The only purpose a mouth guard does it protect the teeth. It does not *stop* your from grinding/clenching. I was still walking up with headaches...from grinding the blasted mouthguard.

I hope you get help soon. I know this is terrible....

 
Old 06-17-2009, 06:18 PM   #4
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Thelma-Louise HB UserThelma-Louise HB UserThelma-Louise HB User
Re: New to TMJ - Is arthrocentesis a good first step?

This is just my opinion but I wouldn't do anything invasive just yet - its never a bad idea to try all non-invasive conservative treamtents first. If you injured your knee would you go right into arthrocentesis of the knee joint? - most medical drs would try cortizone shots and a knee brace and anti-inflamatory medication and suggest PT (stretching, exercise, warm compresses), etc before surgery.

I'm surprised your medical insurance won't cover the splint/orthotic and tens unit treatment - most do now - its the bite adjustments and office visits they generally won't cover. Did you verify this or the drs office did it for you? If they don't cover tmj - do they cover myofacial pain syndrome - that is more readily recognized as a medical condition and is more commonly covered and the treatment is the same as that of tmj.

 
Old 06-17-2009, 06:54 PM   #5
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Re: New to TMJ - Is arthrocentesis a good first step?

Hi,
You are correct, Thelma-Louise, I am definitely interested in pursuing any and every non-invasive method of treatment before I report to other options. Unfortunately, I contacted my health insurance company directly and they do not cover any non-surgical treatments for TMJ or myofacial pain, after reading a previous post that recommended asking about both. They will pay for physical therapy, but not for any medicial devices related to it (TENS unit, etc.) I have come to the conclusion that my only hope for some relief is to pay out of pocket to visit a specialist. I have been thinking about purchasing an additional, individual health insurance plan if I can find one that will cover a broader range of TMD treatments, but have not had any luck finding one as of yet.

Madnmas - I agree with you! Half the time I think I am just munching away on my mouthguard. Unfortunately, I have experienced significant damage to my teeth (fractures, gum recession) as a result of the clenching and grinding, which is why I am not afraid to not use a night guard. I really wish there was some way of actually preventing me from doing those things (short of mega-doses of muscle relaxants, if in fact that would help.)

Thank you both for taking the time to respond to my post!

 
Old 06-17-2009, 07:33 PM   #6
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Re: New to TMJ - Is arthrocentesis a good first step?

Yes - i guess I was lucky at the time that my private insurance did cover my orthotics (under medical devices, as you mentoned) and non-dental treatments & therapies for tmj/tmd - many states have laws or regulations which mandate what insurance co's doing business in the state must cover and many nat'l tmj orgs have been lobbying for some time now to make tmj/tmd a nation wide recognized, and therefore covered, medical condtion. Although supplemental or secondary private insurance may be the route to take - sometimes even if you find them the premiums come with such a hefty price tag you might be better off not purchasing it and instead setting aside the premium amt you would pay into a a savings acct to pay for the treatment - or consider the credit cards offered for medical & dental expenses - these often have zero percent financing for 12 mos if you have a good credit rating.


PS You may want to see if your insurance covers cranial mandibular cervical disorder or cranial disorders in general as they often require the same treatment too.

Good luck...

 
Old 01-08-2011, 11:41 PM   #7
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Re: New to TMJ - Is arthrocentesis a good first step?

Hi merricat, I also developed a lock jaw in Jan 09- started at about 26mm opening, now down to about 18mm. Came on suddenly, never had any problems before with TMJ. I have done nothing for mine except Physiotherapy, with no results. they really couldnt do much as my jaw literally won't go any further- its like a locked hinge. I also do have a splint (which just protects the teeths surface, nothing else). But i think i bite/grind more due to it but continue to wear it due to my enamel badly being worn away.
The only other conservative treatment i know of for a locked jaw is an orthotic, however over this time I have not found a dr who can help me- all just refer me to surgery. People always say dont have surgery, but in teh case of a locked jaw, there's not many options left.

How are you going now? Have you seen any improvement and what options did you try?

 
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