I have several questions about treatment for TMJ.
I know all Physical Therapists do not treat TMJ. What should I be looking
for in a PT? What type of training should they have? Is it as simple as
if they treat a lot of cases, or specialized training?
Also, what type of night splint (custom made by dentist) is best?
Can a regular dentist make it correctly, or do I need a head and neck
doctor to make it?
Full mouth or just bottom teeth? Hard plastic splint or soft splint?
Any help is very much appreciated.
I have a lot to say to answer you, but I've been crazy busy and I'm way tired tonight. I'll give you a few quick answers, but try to get back to you more in-depth later this weekend.
PT is really helpful. If you can find one who is trained to do orofacial trigger point work, that is best in my opinion. I had one who worked my neck, shoulders and who did the trigger point work inside my mouth. That is really hard to find though. Outside of that, I would call around and ask if they are trained to treat TMJD. Many aren't.
If you are treating TMJD, you need to see a dentist with extra training in treating TMJ issues. There really isn't a "tmj" speciality and any dentist can treat it, but most don't have the training to provide proper treatment. In fact, some dental splints can actually make the tmjd issues worse.
Based on my research and experience, a good functional orthodontist with additional training in tmjd treatment would be good to consider. Functional orthodontists are trained to treat the bite in addition to the teeth. Mine has additional training in treating orofacial pain. There are also some good neuromuscular orthodontists who treat tmjd as well.
You want a custom fit hard splint if you are treating tmjd, not soft ones. There are multiple types of splints out there depending on the dentist you go to. For sleep, I've found the upper splints helpful. For daily tmjd treatment, I had a lower mandibular repositioning splint. I've tried the NTI's twice and they are awful. I wouldn't recommend them to anyone.
Thank you for the informative reply. In spite of being busy, you answered
my questions, and I really appreicate it.
Based on what you suggested, I found and have made an appointment with
a clinic that specializes in head and neck pain. The provider is a dentist
with TMJ training. He teaches others about TMJ. They also do Physical
Therapy at this place. I will find out what kind when I go. My appointment
is in about 3 weeks.
Apparently, they usually take a panaromic xray, and then some kind of a CT scan
of the joint. It sounds like the right place, I sure hope so.
I don't know what your symptoms were to start with. Did you see a lot of
different providers and did it take awhile to diagnose your condition? My doctor
wanted me to see and ENT also because of my ear pain.
I am very grateful you are willing to share your experiences with me.
I will look forward to any other information if you have time to tell me.
I will keep you posted of my findings.
My first symptom was a "stuffy" ear that wouldn't pop. It stayed that way for over a year before I found treatment and it gradually got better. A few months after the stuffiness started, I developed ear pain that felt like a bad ear infection. I also had some tinnitus and eventually developed some "numbness" in my ear lobes as well. I went to my ENT a few times. He is an excellent doctor and has helped me with other issues for many years. He did examinations, scopes and even a brain MRI and everything kept coming back normal. Eventually, he offered to try a tube in my ear to help, but I decided to seek out other options first. I also went to a couple Audiologists. Physically, they couldn't find any problems with my ear. Unfortunately, I'd developed some significant hearing loss. I get tested regularly because I already had hearing problems from birth and my "above normal" ear lost a lot of hearing in just a year. After all those months of issues, I came across something on the internet that lead me to search TMJ. That was when I suspected I had TMJD.
I went to my dentist. He said maybe and recommended me to a TMJ dentist who had a 100% TMJ practice and taught at a local large university. I spent over $1000 for testing with him and a couple visits only to have him offer me no support. It took me many months to save more $. In the meantime, I did a lot more research and found another dentist (functional orthodontist) to try. I knew from my first visits with him that he would be able to help me. He was much more thorough and I could tell he had a lot more training in this area.
Tests he did included:
-Thorough medical and dental history
-Range of motion assessment
-MRI of the jaw by a specific radiology place. Evidently it takes a special hand to do good tmj MRI's.
-3D Cone Beam CT Scan
-joint vibration analysis
-computerized jaw tracking
-nasal airway assessment
I started treatment with Phase I splint therapy. After about 3 months with the splints, my ear pain was significantly better and my stuffiness was better. PT also helped with the constant muscle spasms I hadn't realized I'd been having. When my ears hurt the most, my ENT helped me out be giving me a couple weeks of low dose muscle relaxers.
Sounds like you found a good dentist to try. I wish you luck at your appointment.
There is a great book that came out about 1 1/2 years ago that you may find helpful. It came out after I'd gone through all my initial stuff and I would have saved tons of money at specialists if I'd read it first. It is called The TMJ Healing Plan by Cynthia Peterson, PT. I highly recommend it to help you through your journey. It can help you a lot in your discussions with your dentists, doctors and therapists.
I didnt have the confidence to go to a doctor as I felt I was going to be going down a rabbit hole of appointments and specialists that would be never ending.
After some experimentation and research I ended up with a process which works for me as most of my problems were related due to muscle tension and jaw misalignment.
I now have no problems but I need to make sure I always maintain my regime to keep my body balanced and to prevent my jaw from clicking or popping.
I use a mix of stretching and massage on scalp, face, cheeks and neck to keep muscles relaxed and make sure I dont have any more issues. If I do feel some tenderness I will increase stretching and exercises which bings things under control.
I wish you the best and hope your treatment works out well.
Thank you both for responding to my questions about TMJ.
I already went to the library, and obtained a copy of TMJ Healing Pain.
There looks to be like tons of good information, I have only read a bit
of it, but picked up a few things to do or not do already.
I have the two appointments coming up, one to rule out any ear problem,
and the other with the head and neck clinic. I can fully understand
people going through all sorts of things to try to figure out what is
wrong with them. This is a very expensive disorder to have. But
I am reading all the advice I have been given here on this board.
It is so much apprecaited.
I will post again after my appointments and let you know what I
have found out. I really believe it is TMJ, at least that is a step in
the right direction to figure out what it is.
The following user gives a hug of support to Tracey248: MountainReader (02-03-2013)
Tracey and others: I have spent a lot of money on splints over the last 10 years, only to find that a short-term splint that I was provided did the trick and helped me understand the nature of my problem. Your dentist may not have heard of the TMJ QuickSplint, but it is more comfortable than the NTI and after I tried it for 2 months both the dentist and I knew better what I needed. I am now wearing a Somnadent splint for sleep apnea, but it is adjustable in such a way that my back teeth do not clench at night. You should look into the TMJ QuickSplint however because any dentist can make it on a same day basis, and it would not cost over $250 (my understanding.)
Alot of physio's don't have specialized training TMJ though I think there are specialized courses they can take - but they also need to see a lot of patients. Best thing to do is ask. I wouldn't do physio until you understand and have a diagnosis as to what the problem is.
With respect to splints - that will really depend upon the recommendaion of your dentist and what problem it is trying to address. Some splints try to reposition the jaw, other's don't. I have a custom night gaurd to help reduce the impact of clenching - its thin and fairly firm (and my dentist would have done a thicker one but she think my jaw could tolerate it - I have very limited opening). I understand there are various degrees of thinness and thickness and flexiblity and some cover the top of your teeth; some the bottom; some are partials etc.
Unfortunately, it may take a number of diagnostic tests to determine what your TMJ issue is, because it is usually a complex issue with a number of factors coming into play. It also depends upon how severe your symptoms are.
Its a good idea to see an ENT just to rule out an ear issues, but ear problems are a common sympton of a TMJ disorder.
As for me, when my problem first developed I went to my family doctor who said medical doctors don't treat TMJ, you should see your dentist. So I went to my regular dentist and he said this out of his speciality and referred me to a dentist who specialized in oral and ofacial pain. She subsequently referred me to an oral surgeon when I failed to improve with conservative treatment.