PS The guy I am seeing is supposed to be one of the best (here) and deals with some difficult cases of tmj-so- how is a person supposed to decipher if a person TRULY is great and the right one for them- how many people do you check out? and HOW do you tell if they are for real, etc?
Frustration! Thanks for listening-tired of it all- esp my mouth and diet!!!!!!! Yuck!
Yogi, I am so sorry you are going through this very difficult time with your TMJ. Like the others, I strongly recommend you get a second opinion. It sounds like your jaw is in a state of trauma. I also have a hard splint. I could not make it through the night without wearing it. And on days when my jaw is throbbing or in a spasm I can hardly wait to put it in, sometimes wearing it 24 because it settles and relieves pain. My jaw has gone into spasms and I have had that liquid dry ice sprayed on my face to relieve the spasms and stop the quivering. It is frightening when you jaw is out of control. If things get completely out of control maybe you should go to the ER. Did he recommend ice paks or heat? I am so sorry . . . it is so darn difficult . .
Yes, the Functional Jaw orthodontics is the other piece of credentials that someone should have, IMO, with NM. They are kind of hard to find...so you need to call, and do some homework. It's worth your time. Just by the symptoms you are having, it sounds like your mandible is way unstable....it sounds like you would be better off in an orthodic that "holds" your jaw in place...not a flat plane splint that does nothing to stabilize jaw position. This will allow the tissues in your joints to heal better, and to have more range of motion eventually. LIke I said, oral surgeons don't do NM dentistry, I've never come across one that does. If they do, someone fill me in please. Go with your gut feeling about this, putting the costs aside...what do you feel is the suitable course of action? IF you feel that you want to get a second opinion, consults are usually around 100dollars in my area from that type of dentist. Some don't charge a fee at all, it just depends. Good luck! Jill
I notice you said you had braces in the past. That can cause TMD, (it was probably the cause of mine), as the repositioning of the teeth can force the jaw into an unnatural position, and force the discs within the TMJ out of position. It might therefore sound rather confusing, but a different type of orthodontics called functional orthodontics is used to correct the TMD and is very different from the standard orthodontics. These functional orthodontists move teeth so that the jaw is in the right position to allow room for the discs. They start with a splint worn 24/7 to reposition the jaw, to allow the joint to heal, and to allow room for the discs to move more freely within the joint. Then functional orthodontics is used to reposition teeth so that the splint can be removed, and the new position of the teeth can hold the jaw in a better position.
This is no quick fix, as while wearing the splint, your jaw needs to heal, jaw muscles need to adapt, and any inflammation caused by the previous dysfunction takes time to reduce as the jaw starts to function better.
The principle of having the jaw positioned correctly is they key to all of this. If it’s not correctly positioned by the correct splint worn 24/7, then no surgery will help the situation either. For example cleaning out the joint to remove inflammation, wouldn’t be of any use if the jaw is still poorly positioned, as the jaw still won’t function and the inflammation will return. Also surgery to reposition the displaced discs wouldn’t last more than 5 minutes, if you don’t have a correct 24/7 splint as well to hold the jaw correctly. The issue with this neuromuscular splint and functional orthodontic method is that it isn’t accepted as a mainstream method of treating the TMJ.
There are dentists and surgeons who consider themselves to be TMJ specialists, but they are only using the mainstream methods -Which are some form of splint therapy, muscle relaxants, and surgery when things get desperate. But they are paying no consideration to the position of the jaw, and how this is determined by the position of your teeth. Your current specialist could well be one of those, which is why it’s always a good idea to seek a second opinion from someone who you are certain is a neuromuscular dentist and functional orthodontist.
The splint which I wear 24/7 took a while to get used to. It did make my mouth sore to begin with, and caused jaw pains and muscular pains which were worse than before I had the splint, but takes around a couple of weeks to settle down.
Thanks A LOT "guys"
My jaw seems to be pretty stuck in a 10mm or so place-except when it was getting WORSE and this guy did the lavage etc which obviously did not do much for opening long term-Another thing I have noticed with all the splints I have worn is that they seem to sort of prop my mouth open when I sleep- which makes it VERY difficult to sleep well and is causing more issues with dryness and mouth sores, lips so chapped they hurt all the time and it feels like my jaw structure is being modified-is it supposed to be?!I can't believe this mess!!!! I look so longingly on just months ago when I was "normal" and painfree- anyway- do your splints have any of these effects and are you able to sleep with them in comfortably?
Do you think the therabite machine would help me or not?
I have used both heat and ice for months to answer your question- right now he is saying heat on the muscles and cold for sharp pain- I am supposed to get an antinflammatory to take too- which I don't like to do and wonder if they will help at this point.
I am going to keep looking for the nm it is difficult! I found one near me and have to see if he does the functional orthodontics. I just keep wondering-CAN anyone or anything open my mouth further?!!! and how long will this take?
My current person said I would feel good poss. in Sept- that seems way to far away!
How messed up is my jaw at this pt?
My livelihood depends on my mouth and I LOVE to talk!!! let alone eat normally again-Also- my bite is different then before- when I chew I chew my cheek on left side and I have way more popping on right side-
Amanda- I think my symptoms started when I opened my mouth wide a lot during sinus virus and then it got to this sort of stuck pt- until it started getting worse!
sorry- this is a bad day!
Thanks for listening and have a good day,
further responses appreciated,
I can sleep quite comfortably with my lower splint, but mine was made by taking a cast of my teeth. But since you cannot open your jaw more than 10mm I doubt they are currenly able to take casts of your teeth, so perhaps you have a temporary type of splint to start with until you can open your mouth wider.
Is this NM dentist who you says is fairly near to you a member of the ICCMO? Are they a member of the AACFP - American Academy of CranioFacial Pain? And which country are you in?
I can understand that it must be frustrating not being able to talk easily, when it's your main function in your job, and can make the situation seem even more stressful to deal with.
The reason therabites are typically prescribed is to stretch the jaw. My doctor told me to keep using it 5 times a day (with 10 stretches) because it helps to strengthen the muscles. My jaw was continually closing, making a smaller opening. Without the therabite and other treatments I am doing, I would have lost much of the opening I have. Stretching exercises are critical to treatment, and the therabite is a way in which to do that.
I am in USA. I am not sure about his credentials- I will have to call.
My guard was also made from a mold of my teeth but the top is flat- he put me out and did manipulations in order to do splints.
I just wish it felt like it was making my jaw relax or whatever it is supposed to do- because it more so makes everything feel tighter.
thanks for your reply
I also have tmj disorder and have had issues with it for the past 3 years now. The dentist I am currently seeing is supposed to be a specialist in this area, but I just don't know how much I trust him. He has had me wearing a hard splint that was created from a mold of my teeth for the past 3 months. So far, this has not helped whatsoever. In fact, my symptoms seem to have gotten worse. My teeth have changed and no longer line up right. There has been no decrease in pain, muscle spasms, or popping. He insists that muscle relaxers will not help this. However, after a visit to my doctor a few weeks back, he prescribed a muscle relaxer because he noticed a great deal of tension along my neck and jaw. I was having horrible headaches at the time. These help for awhile but the spasms always come back. I cannot smile on the left side of my face due to the twitching. I cannot open my mouth very wide. I have noticed that this has decreased as I've been wearing this splint. He now thinks that I will need arthroscopic surgery to remove built up scar tissue, but I have heard that this can often cause more problems. I don't know what to do. My doctor advised against it. Instead, he believes that this was caused from my shorter leg. It's 2 inches shorter than the other. I believe that this is probably correct as I have read that this often causes tmj along with other issues. I just hope that this splint, which was a whopping 1000 dollars, has not made matters worse. I return to the dentist in 2 weeks and I'm thinking that this may be my last visit since I have had no improvement since I started seeing him last October, and he also mentioned that if it has not improved by this visit, he is suggesting an mri and surgery, which I cannot afford. This disorder is so horrible and as a teacher I need my jaw to function as I talk all day long. So frustrating..
Hi Morbidly----I hear your frustration....and dealt with the same thing as well. I"m on my second tmj specialist, and doing very well. I opted to leave my last dentist because his splint was not designed correctly, and caused massive pain that continued to get worse, not better. His splint also caused ligament and disc damage unfortunately. I opted to go the Neuromuscular route, with someone who specializes in tmd, and sleep apnea, and Functional Jaw Orthodontics. After much research, this was my decision because I believe that these guys understand the jaw/teeth/muscle relationship, and don't just slap a splint in your mouth with hardly any diagnostic testing whatsoever. The tests that my specialist does to fabricate the orthodic are: tomographic x-rays, panoramic x-ray, EMG testing, before and after the orthodic is made, CMS, K-7 unit testing, and more tomograms with the orthodic in place to check condyle position is correct. If these tests were not done for you, I would highly consider switching doctors. My pain levels have dropped from an off the charts level, to about a 5 within months of getting my orthodic. Also, just because this dentist is telling you that your opening is poor, and that your muscles are highly inflamed, etc., DOES NOT mean that you need surgery. I can't stress this enough. IMO, you need to consult with a new doctor. Hang in there....I feel for what you are going through. THat was my life last spring, and it wasn't fun at all. Take care, J.
Thanks for your reply. I will definitely start looking to see if we have a doctor that specializes in the neuromuscular route around my area. Unfortunately, I live in a small town and highly doubt we have a specialist like this. I have had no tests done whatsoever. On my first visit with him back in October, I was expecting to at least have an x-ray done but he did nothing. Only checked the opening of my mouth and looked at the alignment of my teeth, listened to and felt the popping and that's about it. he then proceeded to make me this stupid worthless splint. What a waste of time and money.
The experience you had is unfortunately so typical...Some dentists claim that they can treat tmd, but haven't a clue how to treat it successfully. Merely putting a generic splint in someone's mouth without the proper diagnostic testing, or x-rays will do nothing to change symptoms. The only thing it does is protect the teeth, that's all. I get crazy when I hear about these types of dentists and the money that they are charging patients for their incompetency....drives me nuts. The dentists that are neuromuscular, and Functional Jaw Orthodontists are the ones that usually do all these types of tests. There absolutely cannot be any guesswork in fabricating an orthodic for a tmd patient. There is too much at stake, and to be honest, the patient's life is on the line. For the people out there who have severe tmd, and myofascial pain, they know what I'm talking about.. Sorry to sound dramatic, but it's the truth..lol. I will move up an old post for you from last summer about what questions to ask a tmj specialist...these list the tests that my doctor did for me, and it will give you a better idea about what goes on in the first phase. It's under Silverwings post back from June of 09' . Take care, J.
I found your post you mentioned. Those questions will come in quite handy. I saved them and will print them out. Fortunately, I did come across a doctor who practices nearby who claims to be a neuromuscular dentist. I will be giving him a call soon to make an appointment. Your information has been very helpful. Hopefully I can get this straightened out, as I am only 24 years old and need my jaw to function properly since my job requires me to speak all day long. Thank you!
I am starting to reevaluate my situation- I have been so anti-surgery the last 2 years regarding my closed lock....but I have started to notice that I am one of the only closed lock patients STILL in a lock on these boards...there are no re-occuring posts from others who have have sudden-onset closed lock. Unfortunately those who have said that they have a closed lock, do only a couple of posts about their condition and then never return.
I saw a few neuromuscular dentists and they have said that my case cannot be helped unless I have either arthrocentises (which is only helpful for initial locks) or arthroscopy. This makes sense as I have Displaced discs WITHOUT reduction, meaning they NEVER have moved back to their correct position for 2 years.
One neuromuscular dentists (trained at LVI) suggested that the discs could be recaptured, but how??? If the disc is literally stuck to the fossa (due to adhesions, debris,thickened fluid), how can a splint that pulls the jaw down and forward do anything when the environment within the joint wont allow the disc to move?
I am at the stage where it would be difficult for a splint to be made at a 1cm opening, so I'm thinking I literally have no choice but to do surgical.
Im thinking at this stage an arthroscopy would be preferrable as I have been locked so long and it would be better for the surgeon to see inside the joint & not only flush it out, but also remove adhesions etc. Arthrocentises from what i understand is best used for locks that have just happened, where 'flushing' lubricant would be enough to get the jaw moving again.
I know the surgery alone wont be the solution, im hoping if i can get my jaw moving again after the arthroscopy I can then consult a neuromuscular dentist to help me with my bruxism/sleep apnea & look into the position of my jaw so hopefully this closed lock doesnt happen again.....