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TMJ Disorder -TemporoMandibular Joint Message Board
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Old 08-06-2012, 05:32 AM   #1
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Splint Making Things Worse

Hi All,

I've been in TMJD treatment since April of this year. My TMJ specialist has had me wearing an anterior repositioning splint that goes over all of my upper teeth. I was having a very difficult time adjusting to it as I couldn't talk very well with it in and I kept taking it out especially at work. Sometimes I fell asleep without it and so had some nights where I didn't have it in either. The past 3-4 weeks or so, I've made a concerted effort to wear it more and found my symptoms worsening. My ear pain and pressure became unbearable and is now in both ears instead of just the one. I didn't used to have a lot of jaw/facial pain, but now I'm having it daily.
When I told my NM dentist that I felt the splint was making my symptoms worse, he seemed very concerned and said that he was going to change the splint. He said if my pain was worsening, it was telling him that we were doing something wrong. He took the splint and made it a lot smaller and removed the slope that sat behind the front teeth. It's basically almost smooth now like a flat plane splint. He told me to wear it for two more weeks and see how it goes. He said if my pain gets worse to stop wearing it and to call him immediately. He said if this doesn't change things, that he's going to switch me to an NTI splint to prevent bruxing. When I told him that I read that NTI splints don't work, he seemed surprised and asked where I read that?
I'm confused as to what is going on. He put me in the original repositioning splint because he said that we needed to recapture the disk and also said that my TMJ's are pushed too far back and they need to come down. Now that he is ditching the repositioning splint, I have no idea where we are going from here. I paid over $3000 for this TMJ treatment and wonder what I'm getting for it. If we go back to just a splint to prevent bruxing, I could have gotten one of those splints for a whole lot less. In fact, an oral surgeon made me a soft splint you wear on the bottom teeth to wear at night when this whole nightmare started over 2 1/2 years ago.
I have no idea what to do. This is like my seventh dentist and going to another will just put me more in debt and I don't have that kind of money.

Right now, the ear pressure and pain is so bad I can't sleep at night. I'm eating a soft diet and using hot/cold compresses, but nothing is helping. Any advice would be greatly appreciated.

 
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Old 08-06-2012, 07:16 PM   #2
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Re: Splint Making Things Worse

I know from my personal experience that a splint with an incorrect bite can make things worse. I wore a custom occlusal guard for years at night that my current TMJ dentist says probably contributed to my TMJD.

If your dentist removed your slope almost completely, how is it working to help reposition your jaw? I'm not able to picture that. It sounds to me more like my old occlusal splint that was more for protecting teeth from bruxing.

You should have seen progress by now.

I wish I could help you more. My TMJD splint therapy has been with the use of a lower mandibular repositioning splint for day and a customized upper splint at night to hold my jaw in a forward position when I sleep.

It did take a while to adjust to my lower splint and I went in for multiple "adjustments" to the bite on it before we got it exactly "right". I also had regular appointments with a PT who worked on my Cervicalgia and Myofascial pain (face, neck and shoulder muscles that were in spasm). She also did orofacial trigger point releases. When my ear hurt that bad, releases on the Pterygoid and Masseter trigger points hurt like crazy but they really really really helped me get those spasming muscles to loosen. I also got a prescription from my ENT when I was at my worst for ear pain, and even now as I'm adjusting from splint to braces, for a muscle relaxer to give me a bit of relief from the intense ear pain. I didn't take them long, but it helped me get some much needed sleep.

If the splint isn't right for you, it might be worth trying another type. I'm not sure on how much difference there is in the effectiveness of the lower repositioning splints vs. the upper repositioning splints. Have you talked to him about trying a lower repositioning splint? I know the lower one worked over time for me during the day. I ended up wearing it for 26 months and was mostly ear pain free after the first couple months. I've never seen one on the internet like the upper one I wore at night. It had a "beak" out the front to help me maintain the distance of my bite and a "wedge" that fell behind my lower teeth to keep my lower jaw from falling back when I was lying down. NTI's are pretty common, but I had pretty bad experiences with them (2 tries) personally. I tried one most recently when I got my upper braces and could no longer wear my beloved upper splint. It was HORRIBLE. I was in major pain and didn't make it past two weeks. My dentist seemed surprised in how badly it worked for me, but after my good experiences with his other 2 splints, I refused to wear that NTI any longer since none of adjustments to it helped at all. We had to find another solution.

I think I've recommended it before. Have you read the book The TMJ Healing Plan by Cynthia Peterson, PT? It gives information on TMJ treatment strategies, trigger point muscle info, information on proper posture and sleeping positions, information on proper use of facial muscles when breathing, speaking, eating, etc, facial exercise and relaxation information, muscle and ligament info, etc... It may have strategies that make sense to you and that you could try on your own. Much of what is in the book, I learned the hard way before the book was published.

If nothing else, try finding someone who can do good facial massages to help you with loosening those muscles while you go through this.
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Asthma, Allergies, severe LPR/GERD, TMJD, Hearing Loss, Ulnar Impaction Syndrome, Shoulder Impingement, Plantar Fasciitis, DeQuervains, Hypermobility, possible Ehlers Danlos Syndrome

 
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Old 08-09-2012, 01:13 AM   #3
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Re: Splint Making Things Worse

The National Institute of Health has a web page for their National Dental and Craniofacial Research that pretty much says try to avoid bite changing treatments since they are not proven to help.

Over the years, I have tried pretty much every adjustable orthotic splint, NTI, treatment and surgery except replacement, since my TMJoints are wrecked and I get disabling pain. I had 2 severe dislocations in accidents, lots of problems after dental procedures, etc. Lots of TMJD specialists (one of whom worked on getting the Dental and Craniofacial subspecialty approved). They gave me various treatments and physical therapies, based on topos, scans, MRI's, Cat Scans, cone and generally every kind of analysis of my joints and bite possible. Everything is wrong with my bite and TMJoints.

Some of the treatments gave me temporary relief (the cruelest kind of hope), and some of them made me worse. I could buy more than one house, with the money I spent. I love sacral cranial massage, and once pretty much passed out from one, due to sheer relief. But nothing helped more than temporarily. And now that we know that Botoxing your masseters will give only temporary relief from bruxism, and cause long term jaw bone loss, I've added that to my list of things I wish I hadn't spent money on.

Although I knew I was a bruxer (a silent clencher whose spouse NEVER noticed), I could not tolerate anything more than the thinnest mouthguard, which IS a good way to protect your teeth and dental work from chronic bruxing. Anything else just leveraged more pressure onto my poor TMJoints. I can't open wide without dislocating (sometimes I needed a doctor's help to unlock), I can't open or close my mouth straight, since my jaw seasaws around until I get it closed.

Then I found out you can rent an ipod sized EMG sleep study unit for diagnosing or ruling out bruxism, from a dentist. I think ruling out chronic bruxism as the cause of TMJoint related pain is the first thing to do, and home EMG sleep studies for bruxism the only effective diagnostic, and the only effective way to monitor if a treatment is working for bruxism.

Anyways, when I got EMG sleep studies, I found that I had been clenching with all my might hundreds of times a night. And when I used the non-invasive biofeedback option, I stopped the bruxism, got off the muscle relaxants and pain killers and grams of neurontin a day, and started having some quality of life again. My jaw is wrecked, but I am not disabled, no longer in a daily stupor, in a bed or daybed, dying any more. I can function, so I'm pretty ecstatic.

Luckily, more and more dentists are renting out ipod sized EMG units for sleep studies for bruxism, with dentists in more states every time I look at the list. It's not as profitable as 5 or 10 year invasive plans, but I think bruxism is something people should at least rule out before starting down the road of these expensive, unproven, invasive treatments, which the National Institute of Health reccommends that you avoid.

And any dentist who doesn't want to FIRST use home EMG sleep studies to rule out bruxism, or monitor the effectiveness of a treatment to stop it? They get a big, "Why?" from me. EMG is mature, proven, non-invasive techology, and callibrating it for bruxism makes it a very useful tool. If you are not a chronic bruxer, my experience won't help you at all. But it's worth ruling out, especially if you are more of a silent clencher, like me, whose spouse will never even notice.

To give you an analogy, a huge, double blind study of back scans was done a few years ago, of thousands of people. Abnormalities like slipped discs pressing on nerves, nerves looking pinched by discs or bone (stenosis), etc. were found in half of adult backs. Half of adults have structural abnormalities and damage sufficient to justify back surgery! Because it was a good, double blind study, only later did they match the scans to the patient histories. Half of the people who looked like they needed surgery had NO back problems/pain at all! Half! That is why doctors do a whole lot less back surgery nowadays. I wouldn't be surprised that when they repeat a similar study of TMJoints, the results will be similar.

So I no longer listen to any TMJ specialist who does not consider using home EMG sleep studies to rule out or diagnose chronic bruxism. And if you have chronic bruxism, uses it to monitor whether a treatment is actually stopping the bruxism, or merely temporarily interrupting it. I still have a lot of chronic pain. But I don't bleed from the ear and nose any more, nor chew the inside of my mouth to hamburger, nor need sacral cranial massage. I can even relax my neck and shoulders sometimes, and don't get constipation, just from the spastic colon response, to overwhelming muscle spasms, which were themselves a response to pain. And all the nasal surgeries and oroplasties for my ears, and arthroscopic TMJoint surgeries were a total waste of my time and money, because my problem was chronic TMD bruxism. Calming down the bruxism calmed everything else down. I don't sing with a band anymore, or do anything stupid like chew gum (I would be a chronic daytime clencher if I weren't mindful!). But I have good days now, after having been completely disabled for years.

I find it irritating that the NIDCR has decided to defer a study to see how much of TMJ related pain may be due to chronic bruxism. Instead they did the Opera study, and are looking into possible relationships between TMJ related pain and fibromyalgia, and TMJ related pain and genetic susceptibility. Europe is pretty much doing the work on the possibiliies that are less profitable, as usual, so far. Anyways, my advice is to rule out chronic bruxism, or diagnose and stop it, before you start assuming diagnoses by trying on various expensive treatments based on structural analyses, and hoping that one treatment will work, thus confirming the initially assumed diagnosis. There are conditions where you have no choice but to diagnose by treatment, like migraine preventatives. But chronic bruxism is no longer something to skip past - home sleep studies using EMG are effective for diagnosis of chronic bruxism, and for monitoring if a treatment is working or not.

Last edited by moderator2; 08-09-2012 at 06:34 AM.

 
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