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TMJ Disorder -TemporoMandibular Joint Message Board
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Old 06-22-2013, 06:59 AM   #1
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girlygirl1234 HB User
Treatment plan - Please give me your opinion

I have recently seen a surgeon and I'm not sure if I entirely agree with his treatment plan and would like to hear a few opinions.

I have had tmj dysfunction on my right side for 6 years and it has become worse over time.
I have full range when opening my mouth but it does lock and I have to move my jaw from side to side to unlock it and be able to close my mouth. This happens every single time without fail when I open my mouth fully. I get the typical symptoms such as clicking, crackling/popping in my ear when I chew, my jaw hurts/gets tired after eating foods that require a lot of chewing such as steak, I get pain directly at the joint area which spreads to the ears and part of face and I also get headaches which are a result of the joint being sore.

To date the treatments I have tried have been wisdom teeth removal, wearing a splint, physiotherapy, steroid injections into the joint, massage, soft food diet, and at home jaw exercises. The injections did give me significant relief but once they wore off after a few months I was just back to square one with the pain. The pain gets so bad that it impacts on my day to day life. I take valium, oxycontin, and anti-inflammatory tablets which do help a little bit but nothing really gets rid of the pain. I just end up having to ride it out and wait for it to ease but it's always just a matter of time before the pain strikes again. If I open my jaw repeatedly that's all it takes to bring on the pain.

I've found that the splint didn't help and it actually seemed as though it was making the pain worse. My dentist said that it sometimes does actually make tmj worse and that if I found it wasn't helping that I didn't need to bother wearing it. He also said that it would never actually put my jaw back into alignment and wouldn't fix the clicking. I stopped seeing the physio because he said had tried everything and he didn't have any further treatment options that could help me.

I saw a private billing surgeon (I'm in Australia) and he said that lavage flush out (forget the actual name of it) surgery was needed seeing as nothing else had fixed my jaw. He said that I was quite a severe case and that it appears that the disc is out of place and also mentioned something about the muscles on the inside of my mouth. I then decided to go through the public health system which is free here. The surgeon said that he only performs tmj surgery in 1% of cases and that the other 99% of cases are fixed by wearing a splint. He then told me to go back to the dentist to check that the splint is fitting correctly and also to go back to the physio for more treatment. I feel like he just brushed me off and didn't really listen to what I had to say. He looked at xrays and he can see that my jaw isn't sitting correctly. He said that I don't have any arthritis in the joint. No MRI of CT scan has been performed as he feels that I do not need to have those tests.

Do you agree with his view on only 1% of cases needing surgery? Have you had success with a splint and if so, how many months did it take? Did if fully cure your tmj?
I just don't see how repeating the same treatment will fix it when it didn't work the first time. It's not as if I want to have surgery but I feel like I have done the right thing in terms of exploring all of my non surgical options. I just want the pain to stop and if surgery will do that then it's worth it. I just don't know what else to do and I'm so sick of being in pain :-(

 
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Old 06-23-2013, 10:37 AM   #2
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Re: Treatment plan - Please give me your opinion

I think you definitely should have a CT scan and MRI before deciding whether or not to have the surgery. Otherwise how you will you have an accurate idea of what's wrong with the joint? You say there may be a muscular component, I would explore this idea first before having any joint surgery. I would try getting a massage from someone that specializes in TMJ/head pain. I tried rolfing and it did help temporarily. If it gets a lot better from having a massage, then there is a muscular problem, so just getting surgery on the joint isn't going to fix it.

I would be cautious with the surgery as it has the potential to make things worse. In my case, I have all muscular pain and no joint pain. You having joint pain, that seems like surgery could be a possibility, but I would only look at that as a last resort. I wouldn't make any decisions at all before exhausting every other option and also getting the MRI and CT scans to see exactly what's going on in there.

 
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Old 06-27-2013, 07:42 AM   #3
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Re: Treatment plan - Please give me your opinion

I would echo Mountain Readers comments - you need an CT scan and an MRI of the joint to properly diagnos what is going on with your joint before committing to surgery and to any kind of treatment.

Also what is the purpose of the splint - is it a repositioning splint? Or is it simply a splint to wear at night to reduce the impact of clenching or grinding? If its painful you need to understand why its causing pain - is the pain due to repositioning? or is it simply not fitting well?

I had arthoscopic surgery on my right TMJ (I think its called arthocentisis) which is the surgery I think your surgeon is describing. Basically the surgeon makes 2 tiny holes in front of your ear then using microscopic instruments they wash out the joint which reduces inflamation, they will also remove any adhesions (scar tissue) that can form which can cause the disk to "stick" and not move well; and they will typically stretch or manipulate your jaw while under anesthetic. It is day surgery though you are wrapped up in compression bandage and the stitches come out in a week. I didn't find the surgery to be that bad although the nerve to my right eye got irritated which meant I couldn't blink or shut my eye for the weekend following surgery but it then resolved - this is a common side affect.

There are scientific studies to show that this type of surgery can be very helpful in treating internal disc derangements where more conservative therapy has failed. (Unfortunately it didn't help me though it was subsequently discovered I have other issues). And this is also the most conservative surgical treatment option. Though all surgery has risks.

I would get a second opinion from another dentist who specializes in oral and facial pain. I would also get a second opinion from another oral surgeon.

In terms of surgery, I think you need to understand how much improvement the surgeon exepects to achieve in terms of pain reduction and function, verus the risks of surgery, versus how your symptons are currently affecting your quality of life.

Take care.

 
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Old 06-27-2013, 07:49 AM   #4
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Re: Treatment plan - Please give me your opinion

Meant to refer to TMJhelp001's comments not Mountain Readers! Sorry.

Also after rereading your post again I wouldn't trust any surgeon who says an MRI or CT Scan is not necessary.

Lastly, based on my own personal experiences, talking with my surgeon and dentist who is treating me as well as reading other comments on this message board, there really isn't any "cure" for TMJ. Usually it is a lifetime issue that you have to learn to manage - I'm not saying things can't get better but its not like getting your appendix out because you have appendicitis and everything is all better.

 
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