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TMJ Disorder -TemporoMandibular Joint Message Board
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Old 09-08-2011, 11:18 AM   #1
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Lower jaw moved forward but now a different problem

Hi everyone,

This is my first post. I've found a lot of very useful information on this forum, and I'm relieved to see that I'm not the only one...

I'm currently undergoing treatment for my TMJ disorder. My symptoms are different than many in that I don't suffer the traditional pain in the joint. For some reason one day my jaw joint sort of snapped and felt wonky. I think it happened during an anxiety attack, but I suppose the reason doesn't matter. The fact is that it happened. A dentist put me in a generic overnight splint, and one morning I woke up and couldn't open my mouth like I always had. I forced it, and my jaw seemed to settle into place. It was painful. It almost felt at the time as if my bones were crunching together. After it settled my lower jaw was lodged behind the disc so that my front teeth could no longer make contact to the extent that I could easily push my tongue out while biting. (I hope that makes sense.) That wasn't the entire problem unfortunately because, in addition to being displaced, my jaw was unstable. The position seemed to be constantly changing whereby sometimes there'd be a clearly defined click when articulating and other times a squishy sound. Other times my jaw would slip around such than, when trying to open my mouth, it would be jammed temporarily.

I went from dentist to orthodontist to oral surgeon, etc., etc., etc., all of whom told me that the problem would likely heal itself over time. Two years later it still hadn't. I finally found a dentist who specialises in TMJ disorders, and I'm so grateful for him in that he has stabilized my jaw joint. The clicking and such were annoying, but the instability of my jaw was ever present and a constant source of distress.

He said the problem was that the lower jaw was lodged behind the disc and that the jaw was in actuality permanently displaced, albeit unstably so. His strategy was to slowly open up the jaw joint so that my lower jaw could be measured slowly forward so that it wasn't lodged behind the disc. Over the course of about a year I wore a splint full-time which placed my jaw into position. The treatment has been successful in that I no longer have a wonky jaw slipping around. All clicking, squishy sounds are gone. The articulation is even without any sliding to the left or right.

There's a problem unfortunately, and I'm wondering if anyone out there has undergone a similar treatment and had the same thing happen. The dentist had intended to follow-up the treatment with orthodontics after the jaw was moved forward and stabilized. I hope I'm able to describe this well enough for people to understand because I have a difficult time understanding it myself. The way I understand it, though, is that the dentist was hoping that, when the joint was opened up, my lower jaw would roll forward in such a way that the upper and lower teeth would meet more evenly. In my case what has happened is that my lower jaw has rolled forward but in such a way that only the very back teeth meet. My front teeth don't even come close to making contact. The result is that I can't naturally close my mouth without pursing my lips. The best way I can describe it is that my lips don't seem big enough to meet. Asthetically the lower half of my face is slightly longer than it was before treatment.

Before treatment began the dentist had anticipated that some orthodontics would be necessary to some extent in that a bit of height would have to be shaved off the bottom back teeth in order for the front ones to be able to make contact. However, he didn't anticipate the extent of which this would be necessary. He said that he'd have to shave off so much that my teeth would be ultra-sensitive and would require veneers to protect them. However, he said that the veneers would have to be thin enough to not interfere by making the height of the tooth too much, which would defeat the purpose of shaving the tooth in the first place. Therefore, the veneer would have to be extremely thin, which would make porcelain veneers impractical. He said he'd have to use golden veneers. He said that, even *if* that were successful, odds are that my teeth would still be sensitive.

I'm shattered that all this work has been done to treat the TMJ disorder only to be stuck at this stage. His recommendation is not to do the orthodontics and to just leave things as they are by continuing to wear the splint at night and while I eat. I'm grateful that my jaw is stable again, and I don't want to discount the important of that. However, obviously it's not ideal to leave things as they are either as I'm really limited in ability to close my mouth and make facial expressions the way I use to. Asthetically I'd prefer the shape of my face be what it was, but that's secondary really to limited functionality.

Sorry for the very long post and thank you if you've read this far. I'm wondering if anyone else out there has had problems similar to mine? And I'm also curious as to what solutions anyone else found or treatments that seemed to work?

Thanks in advance for any feedback!

Last edited by SourMug; 09-08-2011 at 01:18 PM.

 
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Old 09-08-2011, 02:47 PM   #2
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Re: Lower jaw moved forward but now a different problem

Hi SourMug,
I am also in the UK and have also been having splint and orthodontic treatment with a dentist who specialises in treating the TMJ. I have not had the problem which you describe, and my splint and orthodontics started all at the same time. It could be worth getting a second opinion with another dentist who does both splints and orthodontics for the TMJ. I would certainly avoid having back molars reduced in height, as it could end up moving your condyles too high up within the joint, and make the problem worse.

 
Old 09-08-2011, 04:31 PM   #3
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Re: Lower jaw moved forward but now a different problem

While sometimes adding material to the teeth is advised, shaving us rarely advised.
Sounds to me like you have an anterior open bite. I would seek a second opinion.

 
Old 09-08-2011, 04:52 PM   #4
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Re: Lower jaw moved forward but now a different problem

Thank you for the replies Amanda & Salty --

Yes, what I have is an anterior open bite. I'm not crazy about the idea of shaving off anything from my teeth or removing molars. The idea scares me silly. I agree that a second opinion is the what is needed at this point. The problem is that, although my disc is apparently positioned where it needs to be now, the way my bite is now doesn't allow my lips to close naturally. It seems to me that the solution somehow needs to involve reducing height in the front without shaving anything off the back teeth. It's frustrating knowing that for almost all of my life everything was 'configured' so that my bite and everything else was normal. I wish there were a snapshot of that because then maybe the dentist could see how things should ideally be put back together again (assuming it's remotely possible).

Amanda, do you know of any good consultants in the London area? My current dentist is excellent and has lots of experience with TMJD. I just think my case might be more complicated than most and might be stretching the boundaries of his comfort zone.

 
Old 09-08-2011, 05:01 PM   #5
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Re: Lower jaw moved forward but now a different problem

Hi SourMug,
Do you mean you wish you had a snapshot of your bite just before you started wearing your current 24/7 splint. Did you have molds taken of your upper and lower teeth before you started? Did you have any XRays taken?
The only dentist I really know of is the one I am having treatment with, who is Andre Hedger in Surrey.

 
Old 09-08-2011, 06:40 PM   #6
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Re: Lower jaw moved forward but now a different problem

Hi Amanda,

I mean that I wish I had a snapshot of my bite before everything went wrong. All my life my bite was normal, and I had no symptoms or any problems. One day something literally seemed to snap like a rubber band, and that's when my jaw became unstable, lower jaw was wedged behind the disc meaning my bottom front teeth were too far back to meet the top front teeth, and the clicking began. The dentist treating me at the moment took a mold two years after the problems with the jaw started, and the mold shockingly shows just how bad the problem was. Now my jaw is forward. However, the front teeth still can't touch because now I have a front anterior bite.

I've heard of Andre Hedger. Are you happy with his treatment?

Last edited by SourMug; 09-08-2011 at 06:41 PM.

 
Old 09-08-2011, 06:56 PM   #7
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Re: Lower jaw moved forward but now a different problem

Hi SourMug,
I'm happy with what has been done so far. He does Functional Orthodontics. Which dentist are you currently seeing?

 
Old 09-11-2011, 09:03 AM   #8
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Re: Lower jaw moved forward but now a different problem

Hi Amanda,

Just curious - is Dr. Hedger widening your palette? I'm wondering if that is part of the solution for me as, based on what I've read on the forum, that seems to be one of the measures other dentists incorporate in their treatment.

Last edited by moderator2; 09-11-2011 at 09:30 AM.

 
Old 09-11-2011, 09:27 AM   #9
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Re: Lower jaw moved forward but now a different problem

Hi SourMug,
Yes, I had my upper arch widened with something called an ALF appliance, and while wearing a lower splint 24/7. Then I had the ALF removed and fixed braces fitted. The whole treatment is enabling my lower jaw to reposition more foward than it was.
It seems to me that for every dentist you see about the TMJ, even with the ones that say they are experienced in treating the TMJ, you get can get different treatment, different methods, different splints, different order. Some don't start orthodontics until the TMJ is functioning normally, and is stable. My orthodontics started after I had worn my splint for only one month, and before my TMJ was stable.

Last edited by moderator2; 09-11-2011 at 09:29 AM.

 
Old 09-11-2011, 09:40 AM   #10
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Re: Lower jaw moved forward but now a different problem

Yes, I know what you mean. I have received so many different opinions. It's dizzying because it doesn't seem at times as if the medical profession has even decided who should be treating the condition in the first place -- dentists, ENT doctors, oral surgeons... The worst was when I was told for two years that I was worrying too much and that it would correct itself.

I think a second opinion from someone who uses the ALF device or an equivalent is what I need as my current dentist has never mentioned it in his treatment strategy. He took the first approach you described in that he wanted to first get the TMJ functioning normally and then focus on the orthodontics. I appreciated that at first because it gave me the option of either following that with the orthodontics or sticking with a splint part-time. I want the orthodontics but not so sure I do if it means having my molars shaven down so drastically.

 
Old 09-11-2011, 09:53 AM   #11
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Re: Lower jaw moved forward but now a different problem

You definately shouldn't have your molars shaved down, you would loose all the natural tooth shaped surface if they do that, and the natural height of the molars, which wouldn't grow back. It wouldn't be fixing the root cause of the problem, but just patching over things. I have seen more than one dentist for opinions, you have to really until you find one who can provide a treatment plan which makes the most sense.
What is your 24/7 splint like? Is it covering over your molars? and is it also covering you front teeth? Mine is just covering my molars, and not my 6 front teeth, and it is a flat plane splint. I have read that NTI splints which are used for wearing at night can cause an anterior open bite, if used for too long.

 
Old 09-13-2011, 03:59 PM   #12
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Re: Lower jaw moved forward but now a different problem

I looked up NTI splint since I wasn't sure what it was. It doesn't look like that's what I have. Mine covers all of the molars but doesn't cover the 6 front teeth. It basically runs behind the back teeth. The bit that covers the molars has been designed with grooves that match the upper molars. The dentist has made adjustments to it over time by adding height the part covering the molars and then also to slowly force the jaw forward. It's a bulky appliance, but honestly I was so desperate to get my jaw stabilized that it was worth the trouble. And I'd still feel that way if I thought the end goal of a normal bite were on the horizon.

Last edited by moderator2; 09-13-2011 at 04:01 PM.

 
Old 09-14-2011, 11:03 AM   #13
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Re: Lower jaw moved forward but now a different problem

Hi SourMug,
Your splint sounds like it has some similarities to mine, only mine doesn't have any grooves to match the upper molars, and I haven't had any height added since wearing it. My understanding of my treatment that the height of the splint between the molars is necessary to keep the lower jaw in the correct position, and the orthodontic phase will errupt the molars so they will then be at the same height as the splint. That way the lower jaw will remain in the same position as it was with the splint, when the splint is finally removed. Yet your proposed treatment plan is to make the height of your molars smaller, so your lower jaw would no longer be in the same position as it is currently in? Do you mean that your front teeth don't meet while you have the splint in place due the increased vertical height, or do they no longer meet when you bite without the splint? My front teeth don't currently meet with my splint in, as they are a few mms apart, and i'm not sure yet what the dentist plans to do about that.

Last edited by Amanda6; 09-14-2011 at 11:04 AM.

 
Old 09-14-2011, 12:49 PM   #14
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Re: Lower jaw moved forward but now a different problem

Hi Amanda,

The part you described about the molars erupting has never been mentioned by my dentist. I seem to have the opposite problem now in that height needs to be reduced, but why everything worked previously is a mystery than no one can answer. When my jaw dislocated, the lower jaw was wedged too far backwards behind the discs. My previously normal bite became an anterior open bite at the same time the jaw dislocated. My understanding was that my dentist added height to the splint gradually to open up the joint so that the jaw could then move down and out from behind the discs, and afterwards forward. All that happened. I think what my dentist had hoped was that my lower jaw would somehow rotate at the same time so that the open anterior bite would close up. When I take out my splint and the height of the splint is gone, only my back molars make contact so that my anterior open bite that was there before treatment is still there. That's why I understand my dentist's reasoning when he says the height of the molars must be reduced in order to close the anterior open bite. I just don't understand why the whole thing can't be restored to the way it was before my jaw dislocated. My bite was perfect, and the dentists were pleased. I didn't even know what TMJD was until suddenly one day things snapped. Ugh.

 
Old 09-14-2011, 01:31 PM   #15
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Re: Lower jaw moved forward but now a different problem

Hi SourMug,
Is the dentist you had this splint treatment with a Functional Orthodontist?
There is a group of dentists in the UK who treat the TMJ, called the British Society for the Study of Cranio Mandibular Disorders, (BSSCMD). Is your dentist a member of this group?

 
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