Hi, Laura, I am new to this site but not to TMJ. I have had it about 25 years. I am wondering if you could give me the doctor's name you are scheduled to have surgery with. I have seen a dr. in Dallas and he has diagnosed me with degenerative jaw joints and recommended surgery. I need a second or third opinion before I make a decision. I appreciate any names you might have. I am willing to travel. Please also explain what an ICCMO dr. is. Thanks so much.
A ICCMO doctor is one who specializes in cranio-mandibular orthopedics, such as a neuromuscular dentist. I have not seen one as my insurance does not cover it and I do not have $6,000 to spend on an alternative treatment. I have heard they can help wonderfully for some people though.
I am currently seeing an oral surgeon from Johns Hopkins. I have started seeing him at his private practice in Catonsville, MD. His name is Dr. David C. Bastacky. He has been awesome so far and likes to take things as conservatively as possible. I have had many people tell me he is one of the best and so far I agree.
Yogi gal----Since my appt. Mon. was very brief...I'm going to email him now, and post what he says about your case. I know for a fact that he would say NO surgery. Can you postpone the surgery til next week, til you have more time to think about it and get more feedback? I will post more asap. Take care, J.
YogaG.----Here's his opinion on your case....."I've never had a patient, that I've not been able to at least fit with a soft splint...(he's been doing tmd for 20yrs.)....How he would open your bite a bit first off would be: Ice, Heat, ptyerygoid massage, tens unit therapy, muscle relaxers if need be...No surgery. Also, if your mandible is in the incorrect position, any amount of surgery will not correct the fact that your condyle placement is not good...Hope this helped.....
Wish I had gotten that sooner. What if someone did an arthrocentesis? has anyone benefitted? How long would the positive results last? I am in splints now and must get back to work next week- but /i am SCARED because I have to do so much talking AND I HAVE to pay back all my health bills. Need to stay calm and looking for answers. Any thoughts/ideas?
Thanks for your quick reply.
Yoga Gal- I have been following your posts bc I to am scheduled for the surgery and am nervous as well. Did you have the arthroscopy or did you post pone? I was wondering if your better if you did have it?
Hope you are doing ok.
I would advise against it! I did not do it-but did something else I regret and think you should be very cautious! Get lots of expert opinions and chose surgeon carefully if you do decide to do it.
I have had arthrocentesis done. According to the Mayo Clinic and Hopkins, arthrocentesis has positive, long lasting results for most people (95% success rate). My surgeon said a lot of times that is all his patients need (if the splint doesn't work which most cases it does). It is extremely rare anyone ever needs intervention beyond a splint, let alone arthrocentesis.
I had it done along with cortisone injections. It only helped me minimally for a couple weeks. The reason this is, however, is the majority of my problem is structural and the result of a trauma. Like Jill has said, the only people who ever really need surgery are those who have had a trauma to the jaw. Mine was the result of a 2.5 story fall onto the gym floor, landing directly on my jaw. I was 7yrs old at the time.
I hope this helps you. The arthrocentesis was minimally invasive (just needles) and I went home about 10-15 minutes after I woke up. You do not have to be put under IV sedation but my doctor advised to do it since my opening is so small and he needed to move my jaw open/closed a lot. I was feeling fine after two days, though many people say they feel better the moment it is done. So it really is a person by person basis.
Yogi- Thanks for the advice. I have done quite of bit of research about my doctor, he does specialize in TMJ, and have read some of his patients results. He is a haughty doctor but he does know his stuff. I feel similar to you when you said you were worried that it would get worse if nothing was done. The doctor said this is best option to try and fix the issue. My right disc is stuck and i can't open fully nor move my jaw to the left side at all which he says shows more that the disc is in the wrong position. He says without the surgery and leaving disc in that spot could cause more damage.So right now I am scheduled for arthroscopy in June when he will go in move disc back and suture in place, He says the suture will fall away in a few months, so hopefully its the right thing to do. Im sorry to babble on, but its hard when your not sure if your starting to go down this road where there is no return. The only thing that gives me a little hope is that with my TMJ I didnt always have this problem, its only been like this for 3-4 months. So Im hoping seeming its still semi recent with the stuck disc it can be undone. Sry for not knowing alot of the proper words in regards to everything.
You said you were thinking arthrocentesis and I had that done about a month ago and for me it didnt work. the day of the procedure my opening had increased greatly but within a day it was just about back to where it was, stuck. I hope for you, yours works, everyones different.
Hi Laura and Chicklett,
Your responses have been very helpful.
I am sad about my situationas I think the arthocentesis was a mistake- I am wondering Laura, if you or Jill could address the next question- will splints work AFTER the procedure-as my tmj says they will and that is what his path for me is- my opening varies between almost two fingers to more toward one and since the proc.(which I regret but friend scared me into- different long story) so I am just wondering if things can STILL get better ? (I HOPE) or if I will go back to the tiny unlivable opening I had before? I am hoping I can at least maintain the somewhat larger opening. My person said I could should start to chew soft foods by now too.
I am just needing to tell my boss if I will return to work and I HAVE TOO!!!! Will I be able to talk a lot as I need too? Thoughts and wisdom ASAP very appreciated from Laura or Jill.THANKS!!! wish things were very different.
Have a great day- So Laura, I just read your last post- do you think there is still hope for me?!! Please be honest- in the mean time I am wearing splints and doing my pt. I have a follow up appt Thurs.
I feel your pain.
I hope you are very cautious and wish you the best! As Laura told me- follow your gut- unfortunately I did not-which cost me a lot- in many ways. Good luck and take care.
Hi Yogi....sorry to hear that your opening didn't get much better with the procedure. You 100% most definitely can go into a neuromuscular orthodic after having the procedure. My doctor takes on many many post surgical cases with great success. You need to get your jaw stabilized into a more functioning position. Just make sure that you get with the right doctor....Neuromuscular, and functional Jaw Orthodontist. It's the only treament IMO that can accurately measure jaw placement with the diagnostic testing like ----EMG, CMS, K-7, use of the tens, tomograms, etc. They can find the jaw placement within a 10th of a mm. It does work effectively, I'm living proof. good luck...J>
Is the orthotic you are talking about different than the splint I have?
I am somewhat bound to the dr/dds I got my splints from- but WOULD be willing to check out something diff if it would work better. Also- what is your thought on things going back to how bad they were before? Do you suppose I can stay at functioning level through the end of my job (8 wks) for the season?
Hope you are well- much appreciate you
Yogi----a Neuromuscular orthodic is made by measuring the jaw placement with EMG testing, tomograms, K-7 testing, and many more diagnostic tests. This is how it's fabricated, unlike a traditional flat plane splint that simply does nothing to correct bad mandible position, and function. There's a world of difference. The NM orthodic is "bumpy" to the feel, and holds your jaw into the correct position. Finding the proper vertical dimension when making the orthodic is also extremely important. This is why there can be no guess work in making the appliance. Diagnostic testing is crucial.
As far as you not seeing much results with your surgery, unfortunately, this can happen. You should at least be wearing a soft splint after surgery....did they fit you for a bottom soft splint? You need to get into treatment with someone who can properly assess your joints, muscles, and help with the opening problems...My doctor helps cases out all the time like yours, with people who only have a 5mm-10mm opening, he gets them out of pain with the orthodics, and increases their range of motion and openings to normal..45-50mm....You need to get with the right doctor for help. As far as commenting on if you can hold out 8 more weeks like you are....if it were me, I would not wait that long. I was in agony last spring after my old dentist totally screwed up my splint that I was wearing at the time, and I could barely eat, function, or sleep. IT was a total nightmare. Later, Jill
I'm so sorry to hear arthrocentesis didn't work for you. Did your doctor and/or PT begin opening exercises immediately? This has been crucial to at least maintaining my opening. I use what is called a therabite. My doctor normally only prescribes it after surgery but had me begin using it much earlier (arthrocentesis is not surgical by definition). It was expensive, $300, but very much worth it. I hate the thing as it is not fun stretching your jaw, but it is essential to keeping any progress made by procedures or surgery (or conservative treatment for that matter).
Arthrocentesis is not a road to beginning surgery. Please don't think this is the end of the road for you and you now must have surgery. Yes, when it fails many doctors will recommend surgery, but it is not an absolute. With proper strengthening exercises, tens, heat therapy, ultrasound, and of course, a proper splint, you can achieve progress. I got my latest splint after arthrocentesis. I cannot live without it. This splint has been a gift to me; I don't know what it is called but it is somewhat white, fits on my bottom teeth, and is properly molded to my top/bottom teeth. After my accident, my jaw shifted back and to the side. This splint corrects that and holds it in the proper position.
I still have tremendous pain due to the damage in my jaw and to my nerves, but these things have made a difference, even if minimal. Keep your chin up, Yogi, and know there are a variety of choices you can make. If you choose to continue in the therapy you are in, go for it! Give the conservative treatment time to show if it will work or not. If you have the money and access to a neuromuscular dentist, I say do it! Many people like Jill have had great success with it. If nothing is working and your doctor can demonstrate to you that there is true, structural damage, than surgery may be needed.
But please, don't do it just because someone says to. Do it because you feel it is the right choice for you. If you find it is, be confident going in. This is one thing I have learned along the journey is to have hope in what lies before you. I have great hope this surgery in May will bring about healing and freedom from pain. It will take time, my doctor will be seeing me nearly every week for two months...but the time for me is worth it. The structural damage is great because of my trauma. The fact I waited so long is more than likely the reason I am having so many problems. The damage is great and needs to be corrected. I hate that I have to have surgery but am incredibly grateful for the skilled hands of my surgeon. I know God has chosen him to help me heal. I hope you can find that peace in those treating you.
Hang in there Yogi, and know there are many of us rooting for you!