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!
Thanks SOOO much for the encouraging words- right now I am under the gun having to tell my boss whether I think
I can do my job for the next several weeks til it ends for summer. I am SOO scared!!
I have an appt thurs and I AM supposed to get therabite for 500$$
Hope to hear from you soon I will check messages manana am
Thanks again!!! for your reply and support!
Oh my goodness Yogi, $500??? My doctor said he charged me exactly what it cost, even with the shipping. It sounds like your surgeon is overcharging you. That is not right at all.
I wish I could tell you whether or not to continue working. You are the only one who knows your pain well and your ability to work. I am a pastor and talking for a living has been one of my greatest challenges with TMD. I've had days where i've wondered how in the world I could make it another five minutes, let alone the wait till surgery (May 20th).
I find TMD to be like a rollercoaster ride. While I don't have any of the real calms, there are days where things get just a little bit calmer and then..wham! I'm shot down with a huge dip.
I have found pain management to be helpful through this time of waiting. I am currently taking vicodin as needed, 800mg motrin x3 a day, Skelaxin 800mg 2x a day, Soma at night, and neurontin 200mg x3 a day (just started a few weeks ago, still increasing dosage). This plus PT and my splint makes it so I can function somewhat. Like you describe, I live paycheck to paycheck. I cannot afford to be out of work right now. With my doctors help, I have found a pharmaceutical regimen that works for me. I do however, look forward to being off so many meds. Thanks be to God surgery is only a few weeks away!
So really, I don't have any clear cut answers for you. All I can say is do what you can, and trust that the rest will take care of itself. I will say however, that it may be in your best interest to get a second opinion. The fact this doctor is charging you $500 for a therabite bothers me a great deal. I would tell him you know it costs less than that and share with him what I paid through my Hopkins doctor. It sounds as though he is putting a surcharge of $200 on it to make a profit. That is so dishonest!
I don't know what your beliefs are, but know i'm praying for you. This journey is so hard for all of us and these decisions regarding treatment are incredibly difficult to make. I don't know if I shared this with you, but I was recommended for surgery back in 2002. It took me 8 years to make the decision to go forward with surgery. Financially and medically, I felt it was in my best interest to go with as many conservative treatments as possible. I'm grateful I did it. While more damage was done to my joints, the peace of mind that came with it was worth it for me. I now can say I did what I could and surgery is the best next step in my journey.
Take the time you need Yogi, and if you don't feel you can do your job right now, then give your jaw the rest it needs. Nothing is worth putting yourself in excruciating pain for. If you need to keep working, however, I would talk with your surgeon about proper pain control.
Continue to keep us posted, and never hesitate to ask questions. I know from experience how helpful it can be!
Hi Jill 227,
I'm not sure if you can share the name of your dentist, but I am very interested in doing some research on the neuromuscular orthodic splint that he/she designs. I have been in a 'flat' splint for 20 yrs and looking for some new alternatives. My MRI shows severe degenerative jaw joints. I am getting a second opinion and therefore interested in your dentist. Thanks so much
Hi Sorbil, I think that if I'm approached with someone asking me his name directly, I can post it....so here goes... Dr. Paul Insolera, Middleton, Wi....He has been doing tmd for over 20yrs., and has studied with some of the top tmd doctors. He is a Functional Jaw Orthodontist, as well as a Neuromuscular dentist, who is a TMD specialist and Sleep Apnea doctor.......whew..
Laura, Thank you so much for the info on Dr. D. B. I will pursue. I have an appoint with a Dr. I, in San Francisco and want another opinion. I have read your responses to Yogi and she is fortunate to have you supporting her with 'conservative' ideas/suggestions. TMD is NOT to be taken experimentally or frivolously. Thanks again.
You are so welcome! Dr. B is a wonderful surgeon and human being. Please tell him Laura Lynn sent you his way if you choose to see him. I have found that he is not one to rush into anything, and is very well educated in the field of TMD. He actually has been a guest speaker on the subject a number of times, according to my "googling"! He also does a great deal of reconstructive jaw surgery, including patients whose jaws were shattered in accidents. He has been a great answer to prayer for me; I feel fortunate to have found him.
Hope everything goes well for you. Please keep us posted on how you are doing, and if you ever have any questions for me, i'd be happy to share what I know. My surgery will be on May 20th. I cannot share my personal blog on here, but if you google "my life with tmd" you should find me. I keep it fairly well updated on my experience. I hope I didn't break any rules by sharing how to find it.
Awww, thanks Cyndee! I feel that way with all I have connected with via this gift of the internet. Having a severe case of TMD can be quite isolating. I know of no one else in person who has shared this journey. Connecting with others through these forums has been a great opportunity to share the ups and downs with those who know what it is like. I am so grateful to have this support. Unless you've walked this road yourself, it is impossible to understand.
Hi Laura, Jill and all,
I just visited my tmj guy yesterday and he did some more jaw mobilization on me to try and keep my jaw open he says- I asked him if he was sure that this is good for the jaw and he said it's what you need to do to keep it open- he used ultrasound and some spray stuff that is supposed to keep the muscles relaxed and from guarding. My opening is still quite small and he's got me in a small thin plastic splint new yesterday for the top- that I found slipped and slid all night and a bottom splint that is acrylic and I wear all day. I feel like one side rests on my tooth and I'm not sure if it really allows my jaw to rest or whatever it is supposed to do- but wearing them both at night causes my mouth to be open and my lips and throat are so dry now- I wonder if this is right? Everyone says I need to stick with it for a while and trust that it will work- he says that I won't really feel good til Aug or Sept. Do these things seem in line with splint therapy you have tried? Also, he is encouraging me to try chewing softer foods- does that seem ok? Could it hurt me if my jaw isn't ready for that or do I just stop it if it doesn't feel good? Thoughts???? Much appreciated.
can these things make it worse? I am also doing tongue depressor therapy with trying to keep the jaw opening. I am supposed to call the therabite place today to check into that.
What confuses me is that people say to rest the jaw- but doesn't the therabite work the jaw? Do you think that could bring me improvement?
Also- I am supposed to ease my way back into talking- which is what I do for a living- and I just don't know what to believe. I just want my jaw to get back to working and not cause things to be worse or take longer due to more mistakes on my part. Do I stick with this for awhile then if I don't see improvement try the nueromuscular route?
Will it be too late by then? My funds are definitely limited and I am unable to perform my job right now AND I nee to get better in a few months, or at least show progress so I will be ready to go for my job by then.
Thanks for your reply and support.
I am checking your blog also.
HI Yoga gal,
I am concerned with what he has you wearing...was there any diagnostic testing done to fabricate the lower acrylic splint? is it flat, or is it indexed to "hold' your jaw into a new position? Please get a second opinion from someone that has the credentials I posted earlier on this thread if you can....a consult is worth the $$... REst your jaw....eat soft foods...if any of the splints hurt you or make things worse....it may not be the right route to take. Appliances need to be measured carefully, with lots of diagnostic testing before handing them to the patient to wear. Flat plane splints let your jaw slide all over....causing IMO more problems....I hope that helps a bit...
I agree with Jill, you NEED a second opinion. Whether it is with a neuromuscular dentist or a more highly trained oral surgeon, I really think you need to see someone else. Splints are not meant to hurt. My jaw was a bit tired after I began wearing this splint, but it was very minimal and lasted only like a day. I find the splint to be comfortable, and it holds my jaw in the correct position. What you are doing sounds detrimental to your recovery. Plus, he sounds like he is contradicting himself, saying to exercise your jaw with the popsicle stick therapy and therabite, but then to rest from talking. He just doesn't sound like he is cutting it.
My recommendation is get a second opinion, and make sure that person has a great deal of training and practice, plus is known to have great success.
I'm so sorry your going through this. I hope you find someone who is on track and can help!
hi Jill and Laura,
THANKS for the replies!
Yes, I am soooo confused and have spent all my $$$ on this guy. The splint is acrylic with flat edge and I feel like it is affecting my bite,etc oddly because my right side hurts more and it feels weird when I move my jaw like my jaw is deviating more now when I push it forward like in an exercise he has me doing- and my right side feels soo tight- it doesn't seem restful to be having my jaw sit like this-do your splints hurt the insides of your mouth? I don't like having my mouth open while I sleep either- I am also wondering about the jaw mobilizations-they open my jaw temporarily but don't seem "restful"
I am having trouble finding any nueromuscular person in my area-right now it has to be in my area due to work and $$ (i found one nm dds that supposedly does a lot of tmj cases and has the lvi training- he trains people too I guess- how do I know how good he is? Is the other credential the orthodontic piece?
I don't even know how I would pay for it
Do you think I should get the therabite? I had one other opinion that said just do nothing but relax and slacken your jaw- that wasn't working and that guy is a top guy in my area for tmj also- do I go back to him? Neither of these was an oral surgeon-(my jaw just jumped!on one side) Also- would I know if I had an infection or reaction from the procedure? Do I just assume that I am ok because nobody really checked me and I do feel like I have some hearing damage on one side who would I verify or check that out with? I just feel so totally damaged right now
I keep searching on the internet for a nm specialist- is there any really good , quick way to do this?
What do I do in the meantime- everyone (my other friends) tells me to keep doing this guys therapy for awhile to see if things improve- my next appt is in 2 weeks- do I keep wearing these splints til then? HELP!!!!!!
Where can I get my expert opinion that I can trust?!
Thanks for listening and your knowledge and support.
The Tmj dentist I am having treatment with is not a member of the group of Neuromuscular dentists trained by the LVI. He is a member of the AACFP is the American Academy of CranioFacial Pain - perhaps you could find a dentist near you who belongs to this group.
If the dentist who did your arthroscopy has instructed you to wear the splints, then I think you ought to keep wearing them as you were advised, until you seek out a second opinion. I have a flat plane splint myself which i wear 24/7, although I don't have such a restricted mouth opening. The flat plane splint enables jaw to sit in any position, and not forced into the position set by your teeth.
I will try that.
I am supposed to wear my bottom splint 24/7 too.
Did your mouth get sore from these things at first?
Now, suddenly my lips are so chapped and cracking too I wonder if that is from sleeping with my mouth open?
Anyway- thanks all,
trying to relax- but stressed out