It appears you have not yet Signed Up with our community. To Sign Up for free, please click here....



TMJ Disorder -TemporoMandibular Joint Message Board
Post New Thread   Reply Reply
LinkBack Thread Tools
Old 06-04-2012, 11:29 AM   #1
Newbie
(female)
 
Join Date: Feb 2012
Location: USA
Posts: 7
nc711 HB User
New to TMJD - can someone point me in the right direction?

Hello. I'm a 23 year old female. About a year ago, my primary care physician ordered an MRI of my TMJ due to clicking/popping noises when I opened my mouth, some discomfort, and a small lump in front of my right ear. This is what the report said:

Right TMJ meniscus anterior dislocation in closed mouth position but recapture and anatomic positioning wit mouth opening. Accompanying small joint effusion. Left TMJ grossly normal. Each TMJ meniscus normal size and no abnormal degenerative attenuation. No imagining signs of arthropathy at either joint. Normal configuration mandible condyles and normal marrow intensity. Both joints have normal condyle translation in open mouth positions.

She explained to me that when my jaw is closed, it is misaligned, but when it is open, it is aligned as it should be. The first oral surgeon I saw did not specialize in treating TMJD cases such as this, but he recommended a night guard and said that if my jaw stopped shifting to find a comfortable position, the ligaments would strengthen and pull things into place as they should be. He said that that I developed this issue due to not having braces as a child. We switched insurance companies and he was no longer in network, so I went to another oral surgeon.

The second oral surgeon didn't really answer my questions. He just said my only chance to regain normal function was to do arthrocentisis in his office that day, with a local block (no anesthesia). He told me I would be fine to go to work later that day (I'm a vet tech) and restrain animals. I didn't feel comfortable having the procedure done and then going to work, so I left. I felt rushed and pressured into doing the procedure without being 100% comfortable with it, so I never returned.

I had a dental cleaning a few weeks ago and the dentist who checked my teeth afterwards said that I developed my jaw issues because I am a "thruster" and my tongue is not where it should be when I swallow. Because of this, my upper teeth are aligned poorly with my bottom teeth. She seemed to know a lot about TMJD and recommended a splint, but unfortunately, she is not a participating provider.

I have had consults with two orthodontists who said they have seen positive results by treating TMJ with braces. I'm definitely willing to do that, but they said that orthodontists usually work with another doctor who actually treats the TMJD and together they will develop a treatment plan.

Since the appointment with the 2nd oral surgeon, it's been a struggle to find an oral surgeon who treats TMJD and is in network. The closest oral surgeons who do treat TMJD are over 80 miles away, and I'm going to set up an appointment with one of them. My other option is to go to partner of the 2nd oral surgeon, who is only 10 miles away, but I just felt so uncomfortable the last time I was there, I just don't want to have the same experience. I just want to have a doctor that I can trust throughout the treatment. I feel kind of silly for seeing all these doctors and getting different opinions, but I don't want to risk making things worse. Is it necessary to have an oral surgeon, or can my dentist and orthodontist develop a treatment plan together? Does the general dentist usually develop the splint, and if symptoms improve, then the orthodontist puts braces on?

Any similar TMJD stories or advice as to where to go from here would be appreciated.

 
Reply With Quote
The following 2 users give hugs of support to: nc711
judye (06-04-2012), MountainReader (06-12-2012)
Sponsors Lightbulb
   
Old 06-04-2012, 12:06 PM   #2
Inactive
(female)
 
Join Date: Jun 2011
Posts: 59
judye HB Userjudye HB Userjudye HB Userjudye HB Userjudye HB User
Re: New to TMJD - can someone point me in the right direction?

Hi Nc711,

It's great that you are doing some research and not being rushed into a procedure prematurely. The wrong treatment for your issues can cause years or even a lifetime of discomfort - all you have to do is spend some time on this site to see so many examples of this.

TMJ is particular tricky to find the right treatment. There are different camps of NM dentists - tradition and modern - and they'll give you totally different treatment options. There are no agreed upon best practices in the field of TMJ as yet - there is actually tons of disagreement! Even modern NM dentists may offer differing treatments. I went a couple years mired in pain because I didn't see an excellent NM dentist and didn't get an effective treatment. Once I researched the best in my area and got a treatment to help me, I finally started to recover. I have a misaligned bite, bottom jaw is too far back and too low - it's trapped in this position by the top teeth. After a few months in a lower, permanent repositional splint, I started to finally get relief from extreme pain and symptoms. I'm now into my 2nd month in braces and things are continuing to go well.

I'd like to share a few things I've learned with you in the hopes that it might be useful. The first is that surgery does not usually help with TMJ issues and is an absolute last resort because of it's very low success rate. (The literature demonstrates low success and so do people's experience that I've read about). Sadly, many people resort to surgery because it's the only treatment that's covered by medical in both Canada and the US! None of the effective treatments (such as repositional splint/orthodontics) are covered. Surgeons will tell you that surgery is the only answer - they totally reject modern NM dentistry, as do traditional NM dentists. Most of the people who have been helped on this site have gone the modern NM dentistry route. Boy I wish I knew all this at the beginning - it was a much longer and painful road for me because I didn't.

Many people also run into trouble because they don't see a highly qualified modern NM dentist. This tricky treatment takes great expertise and a great deal of post-grad education - it shouldn't be done by a regular dentist. Also, functional orthodontics (braces) should not be performed by a regular orthodontist - you really need a well-reputed and experienced NM dentist who specializes in functional orthodontics for TMJD. Also, you shouldn't be rushed straight into orthodontics. The repositional orthotic (splint) is an important first step. Through the splint, on optimal position for your bite is found. Once your jaw is able to relax, you should feel a reduction in symptoms and muscles start to relax. After finding this optimal position, braces are used to permantly set it in place.

Night guards often seem to cause more problems than not, (for me and many others on this site) so I'd be careful about this.

My suggestion is to research the absolute best NM dentist in your state or city and travel to see them if necessary. Get at least one opinion from a modern NM dentist that specializes in TMJ issues - one that has cured many others from TMJD...I wouldn't do anything before then.

Hope you find relief soon and wish you the best in your recovery! Let us know how you make out

 
Reply With Quote
The Following User Says Thank You to judye For This Useful Post:
pipdog (06-15-2012)
Old 06-11-2012, 06:46 PM   #3
Newbie
(female)
 
Join Date: Feb 2012
Location: USA
Posts: 7
nc711 HB User
Re: New to TMJD - can someone point me in the right direction?

Thank you so much for the great advice! I'm glad your treatment is working

I've looked up NM dentists in my state and surrounding states and unfortunately, there are only two doctors and neither of them are in network. There are new doctors added to my network every month, so I could continue to look for someone who has extensive training with treating TMJD. In the meantime, I've made an appointment with a dentist who treats TMJD and is a board certified oral and maxillofacial surgeon. I could always use another opinion. Although, now I'm kind of anxious that due to my insurance, the dentist who may end up treating me is under-qualified.

Are there any questions I should be sure to ask the doctor at the first visit? I plan to ask him if/how he's treated other patients with similar problems and if the treatment had a positive outcome. I usually get so anxious at appointments that I forget to ask all the questions I had thought about beforehand.

You suggested I visit a modern NM dentist. This might sound silly, but how do I know if the dentist I am seeing is considered modern?

Thanks so much for the advice. I've talked to everyone I know, and not many people have experience with TMJD, so your advice really helped!

 
Reply With Quote
The following user gives a hug of support to nc711:
MissyJ (06-11-2012)
Old 06-12-2012, 10:55 AM   #4
Inactive
(female)
 
Join Date: Jun 2011
Posts: 59
judye HB Userjudye HB Userjudye HB Userjudye HB Userjudye HB User
Re: New to TMJD - can someone point me in the right direction?

Hi again NC711,

You are wise to gather some information about TMJ and think things through carefully before going into treatment.

I’m going to try to answer all your questions and give you as much information as I possibly can so I apologize in advance if my post is a little lengthy. If I don’t manage to answer all your questions or you have more, don’t hesitate to let me know.

I want to start by saying that I think things are looking pretty good for you. I reread the MRI results you posted and your TMJ situation is pretty good – no degeneration as yet, so it’s great you can catch all this before it worsens. I hate to say it, but you should know that with TMJ issues, things tend to worsen; they rarely go away or stay the same. The important thing now is to get the proper treatment for this so things don’t get more serious (from the condition itself or from a mis-treatment). Finding your way to the right TMJ treatment is so much harder than it should be…so many of us are in pain for longer than need be or have seriously worsened situations from the wrong treatments.

Your questions about how to know what kind of dentist you are seeing is not silly at all - the whole divide in neuromuscular dentistry is hidden under the covers. There's not really any way to find out about it and there’s no real language in the industry that speaks to this divide (the terms “traditional” and “modern” are more descriptive than anything. I’ll try to give you the lowdown on the limited amount that I’ve found out.

In North America (I'm not sure about other parts of the world) the two different types of neuromuscular dentists, modern and traditional, offer totally different kinds of treatment as they believe the causes of TMJD to be different. Traditional NM dentists believe TMJD can only be caused by muscle or joint issues while modern NM dentists include causes such as malocclusion/bite issues. Therefore, depending on which of NM dentist you see, you may or may not find the right treatment for you. I’ll use my experience as an example. I spent an extra year in pain because I started off with a traditional NM dentist and spent a ton of money on treatments (least invasive/safest first) and nightguards that only worsened my situation. Because the cause of my TMJ was a bite issue, and traditional NM dentists refuse to acknowledge this as a real issue, he was no help. He was one of the finest in my city (a big one at that) and he claimed there was absolutely nothing left for me to try, save botox, which I wasn’t willing to try as it is no long term solution and has many complications down the line. I had no idea that there were other types of dentists offering other types of treatments. My desperation finally drove me to research the most highly reputed NM dentist I could in my part of Canada or in the neighbouring US (if you PM me, I’ll tell you specifically how I found them – maybe you can try that as well). I was seriously considering going to LVI - the biggest post-grad training centre for modern neurmuscular dentistry in the US - where they also see patients. Finally I decided on a dentist who had LVI training, but did even more post-grad work than that. He could see my bite issue immediately and I soon went into reposition splint/orthodontics. I’m one year into treatment and almost pain free for the first time in years.

Now, on the other hand, if someone with a muscle-based issue (say they were a stress clencher with no bite problems) went to modern NM dentist and was mis-treated by being fit with a repositional splint (maybe the dentist is incompetent or looking for $), this person would spend tons of money on the wrong treatment and possibly end up in more pain and/or a bad bite.

So this is why I advocate trying to sort out what the cause of your TMJ is – as they are varied. However, this is no easy task!

As an aside, the divide I speak of is very contentious and dentists tend to avoid direct discussion about it. If you ask a traditional NM dentist about functional orthodontics, he/she will likely say something along the lines that The National Health Institute (NHI) doesn’t approve of contested and unproven treatments. But can we really trust the National Institute of Health? Do they only have our best interest at heart? I did some investigating to get some clarity for myself before moving forward with modern treatments and discovered some interesting things.

You might consider this: The NIH been telling us for years (and still claim) that aspartame is safe (although it’s been proven otherwise). If you follow this NIH advice, you risk getting sick from carcinogenic sweeteners! There is a clear conflict of interest here as the NIH government scientists and officials are in the pockets of the food & drug companies whose studies they are conducting. It’s hard for me to trust the NIH when they take large “consulting fees” from such companies – the NIH will have a vested interest in those studies being successful. Using corporate and federal records, the Los Angeles Times, exposed hundreds of NIH officials who took “consulting fees” from drug companies. The drug companies are also making a lot of money off of those whose TMJD remains untreated as they stay in pain and require drugs if no successful treatment is found. This represents a serious conflict of interest as NHI / government scientists are taking in huge consulting fees from the very drug companies that are getting rich off our pain and suffering. This state of affairs is apparently not uncommon. My husband was reading the biography of a prominent aids researcher who claims that there are 3 or 4 possible research areas that could very likely lead to a cure but they are not being pursued because, with drugs, people can live a full life span with AIDS and there is so much money to be made off these drugs. How sad for the folks in Africa how can’t access them. How sad for the folks here that they have to live a drug-addled existence rather than be cured.

Also, significant institutional change is very threatening to the establishment in question (traditional side) and takes time to implement. Imagine once the traditionalists finally include such issues as malocclusion as possible causes of TMJD, they will need to change undergraduate dental education, get more post-graduate work, buy new equipment...the list goes on. I believe it’s only a matter of time until the modern NM treatments are accepted as status quo but until then, we remain in a state of confusion and often without coverage for the treatments we need.

I’m thinking about your issues and it sounds like a case of misalignment/malocclusion. Interesting though that this only occurs with your mouth closed. I think the first oral surgeon you saw was on the right track…once your jaw finds a comfortable position, the muscles do relax and the pain/discomfort goes away. I guess the question is whether or not there is malocclusion. Did the dentist who diagnosed the thrusting see evidence of thrusting & malocclusion– was she certain and how did she know? Also, is the tongue thrusting causing the problem or a reaction to it? Apparently we swallow up to 2,000 times a day with about 4 pounds of pressure per thrust – this can easily push the teeth out of alignment if you thrust when you swallow. If you are thrusting as a response to issues in your mouth, the thrusting should go away with treatment. If your thrusting is a separate issue, it’s possible you could get treatment, straighten your teeth to fix your bit and then thrusting may push them back out of alignment. It may help to do some investigation about this.

Many TMJ people are bruxers and there is a lot of debate over the clenching/grinding issue. It’s sort of a chicken-egg scenario as TMJ can cause bruxing (usually because the jaw is desperately seeking a comfortable position at night) and bruxing can also cause TMJ. I wonder if it’s the same with thrusting.

Being a Canadian, I’m not familiar with the American medical plan system. What is a network exactly and why do you only have access to certain doctors? Can you contest this?

If you are unable to see the best modern NM dentist because they aren’t in your network, I would pay out of pocket if necessary to get the right professional and the right treatment. Sadly, there is often not coverage for the best TMJD treatments, but don't let this be the cause of your issues getting worse, not seeing the right specialist or getting the wrong treatment. It's too easy for TMJ issues to get really debilitating and your health is the most valuable thing you've got!

Once you go to an appointment, don’t be shy to take a page with questions and/or a support person who also knows the questions (and won’t let you leave without them being asked). I would often be in too much pain or anxiety to be fully present during such visits and so this is what I did. I also brought along a tiny tape recorder so I could capture the information correctly. Sometimes it’s easy to miss parts because there’s a lot going on physically or emotionally and sometimes the docs talk medicalese – too confusing to understand. Ask them to clarify simply. A support person can also act as another backup for information retrieval so I highly recommend it.

I guess some questions I would want to ask might include:

How long has the specialist been doing this treatment and how many people with TMJ has he/she treated with it?

What is the success rate like? What are the possible complications?

What kind of post-grad education/training has this specialist had in performing the treatment?

Can you be referred to another client they’ve treated to ask some questions about the treatment?

What precisely is the cause of your TMJ issues? How does the specialist know this to be true? Are there any other possible factors that could be the cause?

Could your thrusting undo the good work of the treatment after it’s done? If so, how can this be addressed?

Does anyone else have any ideas about important questions I’ve missed?

If you find out that you need functional orthotic/orthodontic treatment, there is likely a whole other set of questions to ask. This might be great as a separate post in itself because it could be useful to many people.

Well this is possibly my longest post to date…I hope you find some of this helpful!

I’m pulling for you! Let me know how things go and don’t hesitate to ask if you have any more questions

Last edited by judye; 06-12-2012 at 02:16 PM.

 
Reply With Quote
Old 06-13-2012, 06:59 AM   #5
Junior Member
(female)
 
Join Date: Mar 2012
Location: Huntsville, Alabama
Posts: 45
gretel07 HB Usergretel07 HB User
Re: New to TMJD - can someone point me in the right direction?

Just giving my 2 cents. I am 6 weeks into my TMJD treatment. I have a displaced disc on my left side (been that way since Jan). Prior to that I had a lot of popping... which I ignored because I had no pain and my dentist told me it was not a problem. (A very costly misdiagnosis!!!)

I have chosen not to go the NM route and found my dentist through the American Academy of Craniofacial Pain. You can go to their website and do a provider search. I drive two hours to see my specialist, and he is an out of network provider. Yes, it sucks and expensive and by the time it is all said and done I will have several trips to Europe in my mouth! BUT - my dentist does offer a payment plan and I am slowly seeing progress.

I am currently in a repositioning splint and my disc has been partially recaptured. My pain levels are down (certainly not gone but they are getting better), and my opening is getting larger (up to 43mm from 29mm). My advice, even though it is hard to swallow, is not to worry about the money and find a competent dentist/TMJ specialist. There are many people who claim to be able to treat you, but if you have a maloclussion problem, a stabilization splint is not going to help and could even make things worse. And certainly steer away from surgery if you don't have to do it. One thing I have learned is that surgeons will recommend surgery because that is what they do! Insurance companies are a pain, and often times will not cover a dime. But - for me - I would rather pay a few thousand bucks out of pocket then be looking at a series of jaw surgeries. Good luck to you!

 
Reply With Quote
Old 06-16-2012, 06:01 PM   #6
Newbie
(female)
 
Join Date: Feb 2012
Location: USA
Posts: 7
nc711 HB User
Re: New to TMJD - can someone point me in the right direction?

Thank you again for the reply! And thanks for explaining the difference between the two types of dentists are. I did schedule an appointment with a D.M.D with an M.S. degree at a TMJ & Orofacial Pain Treatment Center, instead of the dentist I was researching before. I'm always open to finding new doctors, though, especially a modern NM dentist. I live in a suburb of a big city so I'm surprised there are not more specialists available in the area. I will PM you as well. I'm interested in a NM dentist, especially after reading all the information you wrote regarding the NIH. Edit: I just tried to PM you and it said the administrator has turned off private messages.

As far as the thrusting goes, I've been swallowing this way for as long as I can remember. Also, when I was about seven years old, I went to speech therapy for a slight speech impediment - I couldn't pronounce words with S correctly. In fact, I still can't do it perfectly. The dentist that told me about the thrusting was only checking my teeth after the dental cleaning, so it was a very brief consult. She made it sound like the thrusting is what caused the problem. She said that the tongue dictates the upper jaw, and due to the thrusting (and probably the way I pronounce the letter S), my bottom jaw had to move to attempt to fit with the upper jaw. I'm guessing it's a combination of the thrusting and not having braces that caused my problem. My childhood dentist said "we have to give you a dental implant and make a splint for you when you're a little older - we can't do it now until your face has matured" or something along those lines. I can't remember exactly what he said, I was probably about 14 years old. So, he must have seen something early on that was an indication of TMJD.

The orthodontists that I saw said that my face is slightly unsymmetrical. If I remember correctly, they said that my nose lines up with the center of my top center incisors, and my chin lines up with the center of the bottom center incisors. The orthodontist said that when my treatment is finished and my top/bottom incisors line up correctly, that my chin will be offset a little. I remember this because he was concerned I was going to have a fit about my chin being off a little, but I couldn't even tell a difference when he positioned my jaw differently and I looked in a mirror.

As far as bruxism goes, I use to grind my teeth so loud that it would wake my parents up in the room next to mine. This only happened in times of stress. I don't think I grind my teeth any more, but I have a feeling that I clench a lot during the night. My jaw/neck muscles are always stiff when I first wake up.

To answer your question about a doctor being out of network, you were on the right track. If they are out of network, I pay for everything out of pocket. I pay monthly to an insurance company to have insurance, and doctors only accept certain insurances. If a doctor doesn't accept my insurance, then they are out of network, and I pay for everything myself. If they are in network, then my insurance company will help pay for the costs.

I have talked to my employer's insurance rep and he tried to make it so I could see a specialist who is out of network, but they denied my request because there is a specialist who is nearby and in network who I just refuse to see (the second doctor I saw who wanted to do arthrocentisis and made me feel really uncomfortable). I think I will meet with as many in network doctors as I can first, and if there's still no one with the proper training required to treat my problem, then I will go out of network.

Thanks so much for the list of questions. I think a recording device and paper and pen will come in handy. I've read really good reviews about the doctor I am going to see. It's important that I see a doctor who will slow things down and take time to explain everything to me.

Thanks for replying, gretchen07. Good to hear that your treatment is working. That website is helpful, I'll have to double check to see if any of the doctors are in my network. I just have a question though. A lot of the dentists on the site are DDS. If learning about treatment of TMJD is taught in post grad training, shouldn't most of the dentists who treat TMJD have titles other than DDS?

If I can't find a good doctor in my network and I read good reviews on a really great doctor (out of network) and had a consult and trusted their treatment plan, I would probably end just dealing with the money and paying for it out of pocket. You can't put a price on a reliable and competent doctor.

Thank you again for the help. My appointment is on July 3rd, so I will keep everyone posted

Last edited by nc711; 06-16-2012 at 06:02 PM.

 
Reply With Quote
Old 06-18-2012, 07:01 AM   #7
Junior Member
(female)
 
Join Date: Mar 2012
Location: Huntsville, Alabama
Posts: 45
gretel07 HB Usergretel07 HB User
Re: New to TMJD - can someone point me in the right direction?

I don't know about the DDS versus DMD designation. I didn't focus so much on the medical degree, more on the experience and percentage of patients that the doctor treats with TMJ. I also looked for doctors that had been actively doing research in treatment plans. My current specialist is a DDS, but 80% of his practice is TMJ and he has been doing this for 25 years. He also has done a lot of research in treating TMJ, so that's why I went with him. I also talked to patients of his in the waiting room to see how their treatment was going.

I looked into one NM dentist closer to my city and only 30% of his work was on TMJ - not good enough for me. Another NM specialist, a little bit further from me but well known, seemed too "flashy" for me. Like he was trying to sell cars or something, you know?

Look for someone who is rational and to the point. They should tell you there is no way to cure this problem, but there is a way to manage it. Good luck to you and keep us posted!

 
Reply With Quote
Old 07-03-2012, 03:01 PM   #8
Newbie
(female)
 
Join Date: Feb 2012
Location: USA
Posts: 7
nc711 HB User
Re: New to TMJD - can someone point me in the right direction?

I went for a consult today with the DMD I mentioned earlier and I thought I'd post an update. The nurse and doctor were both really polite and helpful. I gave the doctor a disk with my MRI images on it and he printed them out and doodled on them to show me what the problem was and what needed to be fixed. He also did an exam (although it was kind of brief) but he sat down and took the time to explain things to me and answer my questions. He said that there is no joint effusion and there isn't any permanent damage, but things will get worse if I don't start treatment.

The MRI report from last year says the right TMJ meniscus is dislocated but the left TMJ is grossly normal. I told him how I've been on a soft diet and I've been "babying" the joint as much as possible. He said that by doing so, the muscles in the right TMJ have strengthened and the joint became lubricated so it's easier to recapture, and that's why I don't have a loud popping noise anymore. The left TMJ now has clicking and he was concerned about the condition of the left TMJ. He recommends I start treatment as soon as possible. He wants me to go to physical therapy one to two times a week to start, and he wants to fit me for an orthopedic splint. He said I will have to wear the splint at night for the rest of my life and wear it during the day while driving, watching TV, etc. He said the day splint wonít be necessary for the rest of my life, but by wearing it now itíll relax the muscle and make recapturing easier.

I was expecting him to tell me I would need braces once my jaw was in a comfortable position, but he didnít. I asked about it and he said it wasnít necessary but it could be done later down the road if I wanted, but he wanted to focus primarily on relaxing my jaw and braces was not part of the treatment plan. I told him how my bite was not comfortable and how all my teeth touch at an awkward position when I close my mouth. He said when the jaw is relaxed with the splint, my teeth will have a slight space between them when I close my mouth and it will be more comfortable. I asked if my bite would change once my jaw was treated and he said it could a little, but not much. He said itís hard to pinpoint what caused my TMJ issues but I guess straightening my bite isnít vital to the treatment. I was kind of surprised by that after reading everyoneís posts about braces being part of their treatment. I also asked about the thrusting and wasnít concerned about. He told me to keep swallowing and eating and talking the way I always have.

When I asked if the treatment plan had a high success rate, he said that he typically sees good results and rarely needs to perform surgery. He also has TMJD and his treatment is splint therapy at night for the rest of his life. I really like and trust the doctor, Iím just apprehensive about starting treatment because Iíve read that splints can make pain so much worse, and right now I donít even have pain!

Is it common to have just splint therapy and not splint therapy as part of a two phase plan with braces? Iím comfortable with this doctor and I already have more questions to ask at the next appointment. Does anyone have any input, thoughts, opinions, or can think of further questions to ask the doctor?

 
Reply With Quote
Old 07-03-2012, 06:23 PM   #9
Inactive
(female)
 
Join Date: Jun 2011
Posts: 59
judye HB Userjudye HB Userjudye HB Userjudye HB Userjudye HB User
Re: New to TMJD - can someone point me in the right direction?

Hi NC711,

It's a good question about whether or not braces are necessary for permanently and successfully recapturing disks. My braces were for bite issues, so I'm unclear on this.

If you don't hear back on this question from others on this site, you may find a lot of information by searching through old posts - I've located a lot of very specific helpful things through doing this.

My thoughts are that your bite may be damaged (years of thrusting/grinding) and this might need sorting out as well. I also guess that this doctor is not trained in treating misalignmed bite and functional orthodontics and this is why is is not offering this as a treatment option. I'm also guessing that his "permanent" solution is wearing the splint for life but this may not be your only option. It's possible that orthodontics permanently fix the solution so you won't have to wear a splint for life but perhaps this doctor isn't trained to do it.

My understanding is that the splint works to relax the muscles and find the optimal position for your jaw to fix the problems. Once that optimal position is found (you know because symptoms begin to abate), the jaw then needs to be permanently kept in that position. Most people do this through braces. When I talked to my dentist about other options, he explained that you can keep a removable splint on for life instead of braces but they are quite bulky and not super comfortable. He also felt this was not the best for the health of the teeth and that I wouldn't get as close to eliminating my symptoms as I would with braces. He was willing to do the permanent orthotic if I wanted it but he strongly felt that braces were the best choice for optimal symptom reduction, comfort and oral health.

I'd really recommend getting a second opinion before starting with this doctor. I'm impressed by how much time he took to explain things to you and by how kind he is - this can be hard to come by. However, if he isn't offering (potentially) the best treatment option for you in the long run, kindness may not be enough to go with. I know it's a ton of work, but TMJ goes so easily wrong with the wrong treatment...it's worth the extra effort to make absolutely certain you have the best treatment for your situation. If you're interested in getting a second opinion, let me know - I'll try messaging you so I can let you know about how I found my great dentist.

Another question I'd have for any dentist I was thinking of getting into treatment with would be the effect of thrusting in this whole equation. If the disk issues are due to thrusting, does the splint address this issue? Does it impede thrusting? If thrusting is the cause, then I have to wonder if a splint on its own will help. You may have to address the thrusting issue (and grinding if that's still in play).

It's a real chicken/egg scenario with these types of issues though because thrusting/grinding/clenching can be the cause of the jaw issues but it can also be caused by them!

Well that just one girl's opinion - hope it's helpful in some way. It's a tricky road to navigate, that's for sure. But it sounds like you are going about things very carefully, which is good!

All the best

Last edited by Administrator; 07-14-2012 at 03:37 AM.

 
Reply With Quote
Old 07-05-2012, 05:03 PM   #10
Member
(male)
 
Join Date: Mar 2011
Location: Austin
Posts: 97
PatientZero HB UserPatientZero HB UserPatientZero HB User
Re: New to TMJD - can someone point me in the right direction?

Another doctor to consider is Dr. Piper in St. Pete FL. He is one of the best TMJ surgeons in the world and extremely honest. His consultations are the most complete diagnostics you will ever get. And unlike most oral surgeons and NM dentists he is honest about his treatment. He only recommends surgery if it is REALLY necessary. Always remember... 90% of TMJ disorder is muscle related, and 10% is joint related. People with muscle related TMJ disorder should never be operated on.

~~~
Tom

 
Reply With Quote
Old 07-12-2012, 11:00 AM   #11
Newbie
(female)
 
Join Date: Feb 2012
Location: USA
Posts: 7
nc711 HB User
Re: New to TMJD - can someone point me in the right direction?

Hi there,

I've come up with a ton of additional questions to ask the doctor and I'm wondering if he'd be willing to discuss them with me over the phone rather than another appointment. My next appointment is suppose to be when they take impressions, so I don't know if I have an opportunity to talk with him before they take the molds. I'm just starting to feel really anxious about the treatment because I have a crossbite and if my jaw relaxs and moves into the correct position, I feel like my bite will move the jaw out of position if I ever stop wearing the splint. Kind of like the splint being a bandaid - it's a fix and will keep the jaw where it needs to be and it will "fix" the crossbite, but it's not actually fixing the source of the problem, if that makes sense. I also seem to get cavities a lot, even though I brush and floss religiously. I'm concerned the splint would trap bacteria and make the condition of my teeth much worse. The doctor did say that once my jaw is in the correct position that I could get braces, but it's not necessary. I'm guessing you're right - he isn't trained in orthodontics, but I could always go to another doctor for that.

I guess what I'm thinking is, I would get a splint either way at the start of treatment, whether I went with the current doctor or if I went with a doctor who recommened phase I and phase 2. They would both aim to do the same thing - to position the jaw the correct way, but they would have different long term treatment plans.

I will keep researching new doctors and reading around on this message board, but my head is starting to spin! I feel pressured to decide what to do soon because I'm starting school in a month and I just hate feeling like a sitting duck - like I'm not doing anything to get treatment done. I'm a very indecisive person as it is (with anything) so I feel like I've procrastinated a lot. I know it's really important to be comfortable with your treatment plan (if you want it to be successful you have to feel confident and at ease) but I'm never a relaxed person and I feel like my expectations of finding the perfect doctor and treatment are too high. Maybe I'm just having a mild panic attack because I've had a pretty busy week, lol.

I have a dentist appointment next week (new regular DDS) and I will ask him for some advice as well. I know I need some crowns on past root canals. I'm curious to know if the teeth will hold up through splint treatment, or if the crowns need to be put on sooner rather than later.

I came across a website a while back where you could post your symptoms on a message board and a TMJ doctor would respond with suggestions. I wish I could remember the name of it. It'd be nice to get an experts opinion without having to travel 10 states away!

Thanks again for all the advice everyone has offered, and for listening to my small rant! This board has really made me feel better and everyone here has been so helpful!

 
Reply With Quote
Old 07-12-2012, 12:13 PM   #12
Inactive
(female)
 
Join Date: Jun 2011
Posts: 59
judye HB Userjudye HB Userjudye HB Userjudye HB Userjudye HB User
Re: New to TMJD - can someone point me in the right direction?

As I've previously posted, I really wouldn't recommend going into treatment with someone who doesn't do functional orthodontics. What this says to me is that they don't have the most updated and necessary training to provide modern nm treatment.

I've given you the names of two dentists in your area who have such training. The names were given to me by the same modern nm dentist who referred me to mine and mine is excellent. I didn't hear back from you after sending you those names, please let me know if you did not receive them for some reason.

Not all splints are created equal. I wouldn't assume that a splint meant to be used for life would be the equivalent to a functional splint that is meant to precede functional orthodontics.

Hope everything works out for you. Good luck!

Last edited by Administrator; 07-14-2012 at 03:38 AM.

 
Reply With Quote
Old 07-18-2012, 08:08 PM   #13
Newbie
(female)
 
Join Date: Feb 2012
Location: USA
Posts: 7
nc711 HB User
Re: New to TMJD - can someone point me in the right direction?

Hello. I thought I replied to your message when I got it, but I guess there was an error. I tried replying just now but messages are disabled. I did get the names, thank you SO much! I will keep this thread updated as I see doctors and start treatment. Thanks again!

 
Reply With Quote
Reply Reply




Thread Tools

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is Off
HTML code is Off
Trackbacks are Off
Pingbacks are Off
Refbacks are Off




Join Our Newsletter

Stay healthy through tips curated by our health experts.

Whoops,

There was a problem adding your email Try again

Thank You

Your email has been added




Top 10 Drugs Discussed on this Board.
(Go to DrugTalk.com for complete list)
Botox
Flexeril
Ibuprofen
Klonopin Motrin
  Neurontin
Tylenol
Valium
Vioxx
Xanax




TOP THANKED CONTRIBUTORS



MountainReader (78), Canuck65 (36), Shirlett (26), TMJ82 (22), Jill 227 (17), judye (16), Marlene (13), navymid (10), clencher1 (9), saltyk9 (8)

Site Wide Totals

teteri66 (1180), MSJayhawk (1004), Apollo123 (905), Titchou (848), janewhite1 (823), Gabriel (759), ladybud (754), midwest1 (669), sammy64 (668), BlueSkies14 (610)



All times are GMT -7. The time now is 11:59 PM.



Site owned and operated by HealthBoards.comô
Terms of Use © 1998-2014 HealthBoards.comô All rights reserved.
Do not copy or redistribute in any form!