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Old 09-05-2012, 07:17 PM   #1
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Wearing soft TMJ appliance (one size fits all) with braces during Phase II tx

So I'm in my phase 2 treatment- braces on upper and lower teeth to let the teeth grow to touch each other and to make them fit into a new bite that i had with previous appliance. But the problem is, while the teeth are growing, i'm without a splint - so my bite has relapsed a bit and now I'm in a lot of jaw pain AGAIN. My dr gave me one of those one size fits all soft plastic TMJ appliance thing - which is REALLY uncomfortable, and doesn't even stay ON because of braces - so I have to basically clench into it to hold it in place. The worst part is I have to wear it at night. I've been neglecting it for a month because I couldn't wear it but my pains been getting worse and today my dr told me i have relapsed a bit. . ..

What do I do?? I tried wearing the appliance for an hour and now my teeth are all so sore from clenching into the appliance...

 
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Old 09-05-2012, 09:06 PM   #2
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Re: Wearing soft TMJ appliance (one size fits all) with braces during Phase II tx

I've had the same struggles. I had a bit of an adjustment period, but it there is still a huge gap while the teeth get into proper positioning. I'm not even close to that yet.

I wore my upper braces and lower repositioning splint for 11 months prior to getting my lower braces. That put me in my repositioning splint for 26 months total so when I had to give it up it was a difficult thing. During those 11 months, my upper arch developed significantly and my lower splint was cut back a molar at a time. When I had my #7 molars exposed, they put on a bracket and I wore nighttime elastics in a V shape to help erupt the molars. Eventually they cut back to expose my #6's and I wore the same V configuration to work to erupt them some so I had a few teeth that touched without the splint. My left molars were much slower to erupt which left me in the splint longer than I wanted. They still don't touch. When I finally got my lower braces 5 weeks ago, my TMJ muscles went into spasm because I didn't have the height of the splint anymore and the guidance for my bite positioning. My orthodontist tried to be creative to help me bridge this gap time until the teeth and arch are in position. At night, I wear elastics from my lower back molars to my upper canines. This helps hold my lower jaw in a forward position when I sleep, keeping it from falling back as happen naturally when you are in prone position. I notice a huge difference with this treatment. Still, I had some bad days initially and I had some pretty major headaches. I was already on prescription NSAIDS for another issue and they really didn't help much. I ended up calling my primary care doc and he prescribed a couple weeks of muscle relaxers. I didn't need them for very long, but they did help on some of my early days of adjustment.

I'm still having difficulty adjusting to my lower braces, but that is because of wire issues... like my wire likes to slip and slide. Think we found a solution for that problem yesterday, but I'm dealing with some tmj pain and a major headache after dealing with the problems. It is frustrating, but I know I'll get through this.

Does this soft splint help hold your jaw in correct position or does it just protect your teeth from clenching? Has your orthodontist discussed its specific purpose with you. Are you wearing any elastics yet to help get your teeth to touch sooner? I know it really restricts your diet when you have to be careful about what you need to chew. Have you gotten any massage or PT for this? It can really help. I know it really helped me. Unfortunately my terrific PT left the practice and I haven't been able to find someone else as well trained as her to help me yet.

I stopped wearing my V's for tooth eruption until my TMJ gets happier with the lower braces on. My orthodontist is also focusing on my nutrition absorption for a while as well as part of my treatment.
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Old 09-06-2012, 11:23 AM   #3
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Re: Wearing soft TMJ appliance (one size fits all) with braces during Phase II tx

THank you for your reply, i REALLY appreciate it.

Unlike you, I removed my splint all at once (no cutting for each molar), and just got braces. Initially i had bottom splint --> bottom braces + upper splint --> bottom braces+ upper braces+ NO splint + plastic one size fits all splint (that is impossible to wear)

And It's supposed to hold my jaw in a relaxed position as well as secure my teeth/bite - there's no room for grinding. If i open my mouth, it's supposed to fall off. However, if i relax, it still falls off(i don't think thats supposed to happen). I can't obviously eat or talk.

I tried wearing it last night - after 30 minutes, i had to take it off - my teeth(which have braces) were SO sore!!! It felt like i got newly fitted braces, it was SO sore - i think the soft splint squishes my teeth against the bracket and tightens it, hence the sore pain. and with it, i drool and it's just really uncomfortable.

but of course, when you lie down, it's when your jaw falls back due to gravity, hence the relapse--> pain. So this morning i had pain naturally and i've been doing plenty of neck/back exercises to at least make it 10% better... but everytime i eat, drink, swallow, talk, use tongue to take food out of braces --> pain comes back and i think my jaw is relapsing.

i called my dr and emailed him yesterday telling him about my situation - he said there's no other option than to just wear this stupid soft appliance which apparently only fits 95% of adults. i have a smaller jaw even though i'm 22 and i really don't think this fits me. I emailed him if i can get a customized size with enough room so my teeth can still move/grow - no reply yet.

I'm really desperate, I feel like I'm in this dark hole that's invisible to everyone else. Nobody I know have TMJ and they look at me like I'm talking about Atlantis when I tell them about it. Especially on days when I don't want to speak because my jaw is sore- i just come off as a grouchy mean person.

I don't know what to do.. I'm just really, really depressed. I cried for 2 hours last night.

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Old 09-06-2012, 06:49 PM   #4
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Re: Wearing soft TMJ appliance (one size fits all) with braces during Phase II tx

I feel your pain. I'd question whether or not the splints are really intended to be worn with braces. I'm not too impressed comparing that to other options I've researched.

In my opinion, any splint that makes the TMJ symptoms that much worse and relies on having to deliberately clench to keep it in place isn't an appropriate treatment option for that patient. I think it is normal for the tmjd symptoms to get worse at first because you ahve to adjust, but it shouldn't hurt that intensly.

I tried an NTI devise a couple times and the pain was so bad, even after adjustments, that my dentist easily offered to find another solution.

Can you ask about trying elastics to help compensate for the TMJ issues? I know the elastics have really helped me.... both with the bruxism issues and the jaw positioning.

I highly recommend seeking out some massage or PT to help with your muscle spasming pain.

My lower wire popped out yet again this morning. I just made my 6th visit to my orthodontist in the last couple weeks. (long story) That lower wire just doesn't seem to like me very much. My TMJD pain has gotten almost as bad as before I started treatment. I know what works to help me feel better, but it takes time and I hate having to deal with the intense pain in the meantime. Know that you aren't alone.

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Old 09-06-2012, 06:56 PM   #5
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Re: Wearing soft TMJ appliance (one size fits all) with braces during Phase II tx

My dr said I'm not ready for elastics yet..

TMJ is such a disorder - it's invisible and relatively unknown to ordinary people and it really knows how to destroy your life. I simply wish I could just sit with friends and chat for hours without having to feel pain.

 
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Old 09-07-2012, 04:29 PM   #6
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Re: Wearing soft TMJ appliance (one size fits all) with braces during Phase II tx

I completely agree with wanting a break from the TMJ pain for a bit... well to have it go away, but a short break is always welcome.

I may not be explaining my elastic usage well. For the tmjd sleep issues, I'm not wearing elastics as part of my orthodontic treatment. When I use the nighttime elastics, they are only for the purpose of holding my jaw forward while I sleep. Actually, I don't have an overbite so I don't want the elastics to "work" to change my bite. That is why my dentist limits me to wearing them for just 8 hours at a time while I sleep. This strategy helped with my tmjd and sleep issues.

I had my elastics for molar eruption added later.

I wish your dentist would be open to trying to find another solution for you. Your treatment shouldn't be making your pain so much worse.

Take care,
MR
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