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Old 06-26-2013, 04:30 AM   #1
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2nd Neuro dentist appointment this week...

Hello,

I'm new here. I visited a neurological dentist a week and a half ago, and I suspect they will be recommending a mouth guard for my bruxing and what I suspect is some level of tmjd (he said he felt my jaw open uneven when I opened my mou, plus noticed my c1 was off, both of which a massage specialist previously told me, as well as a chiropractor confirmed the c1). They took a mold of my teeth last time, and hooked me up to a device that measured my jaw muscles, and will be making a recommendation for treatment tomorrow.

My chief issue for the last three years has been Eustachian tube dysfunction. I found out 7 months ago that I've had silent herd and LPR reflux. Both this dentist and my regular dentist confirmed that I have a good deal of brushing symptoms too. I've been noticing that a lot of these symptoms seem to overlap with people.

Can anyone give me some good suggestions on what kind of questions I should ask the neuro dentist about whatever he suggests? I am not experienced in the area and am admittedly a little nervous.

I just want the Eustachian tube symptoms to go away (ringing and fullness and related hearing loss). Can these symptoms be from a bad bite or from grinding? Or is it any more likelier that this issue resulted from my gerd? Where does bruxing fit in? I'm determined to figure this out and would adore any and all insight. Thank you so, so much!

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Old 06-26-2013, 08:59 PM   #2
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Re: 2nd Neurotic dentist appointment this week...

Welcome to Healthboards.

My journey started with similar symptoms. I had a 'stuffy' ear for over a year. When seeking answers for that, I came to realize I'd developed a borderline moderate hearing loss in my left ear. (My right was already hard of hearing.) It took me lots of different doctor/dental appointments to find out I it was tmjd. Turns out my discs had slipped which resulted in my lower jaw being pushed back towards my ear. As you've probably learned, the jaw and ear are only mm apart. Over time, I also developed severe ear pain and ringing. I also learned I had muscle issues in my face, neck and shoulder from this.

I had bruxism and acid reflux for years before these symptoms developed.

With the ear issues, my primary goal was to bring my lower jaw back into a more forward position. I had different treatment options from a couple different tmj specialists. I chose to go with a lower repositioning splint for 3 months. It was fitted well and within that 3 months, with supportive PT/trigger point releases, my ear finally became unstuffy and my other symptoms subsided. After that, I had various options based upon what my ultimate goal was. I could have weaned off the the splint. That would have been the most natural option. I ended up choosing to stay in the splint for a while before deciding to get braces to help re-align my bite so I wouldn't have to worry about the ear issues again.

Honestly, the pain was bad, but the hearing loss was very scary. That impacted my choices.

In the short term and on an on-going basis, good pt/myofascial work and orofacial trigger point work can be extremely helpful.

GERD and bruxism can both be sleep related. My orthodontist created me an incredible sleep splint. I would wear my repositioning splint during the day and the sleep splint at night. This night splint was upper and had a wedge that came down behind my lower teeth. It kept my lower jaw forward when I slept. I had a sleep study done while I was wearing it and it went well. (I'm out of the splint now with the change in my treatment and I really really miss it.) Is your neuromuscular dentist trained in sleep dentistry?

Make sure at your appointment that you thoroughly understand what the dentist is explaining, ask pros and cons of the treatment options he/she presents and make sure the decision you make is the right one for you. Ask about short term and long-term options.

Personally, if they discuss using an NTI type divice, I'd run the other way. I've tried them twice now and they were EXTREMELY painful for me. My ears have never hurt that bad. While the splints were fitted well, they were very wrong for me during my treatment.

There is a very informational book that I recommend. It is called The TMJ Healing Plan by Cynthia Peterson. It answers a lot of the questions you may have and gives a lot of recommendations for questions for you to ask.

Good luck tomorrow.
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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 06-27-2013, 06:07 AM   #3
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Re: 2nd Neurotic dentist appointment this week...

Thank you so much for your post. Your reaching out to me is overwhelming and greatly appreciated.

So you realized that your issues traced back to a slipped disc? Was it in your neck?

And the lower splint truly fixed this for you? That would be a dream come true. It's been a long, dark 3 years, but I'm so completely ready to get better. I am hopeful that I could be so fortunate. But, if the jaw issue resulted from a slipped disc, were you able to have your disc corrected too to prevent this from occurring again, or is that something not easily corrected?

And what is PTwork? I read many people citing this. Is it self massage? Or is it like an acupuncture treatment administered by someone else?

Hmm sleep dentistry? I'm not too familiar with it. I will have to look into that. I'm certainly not sure if my neuro dentist is.

I'm going to bring a pen and pad of paper and take many many notes. I am slightly nervous because since I don't know enough about the subject, I don't want to be snowballed into signing up for something too quickly, though the desperate part of me would love to jump on board with any suggestion the dentist is optimistic about. I am keeping fingers crossed. I will report back with what I am told.

Thanks again for taking the time to respond in such detail, mountain reader. I hope to one day be in the position to help others once I find my way.

One more thing, are you pretty much all better now? Also, do you still have gerd and bruxism? I have seen at least one other detailed post on this site where someone said that a TMJ splint treatment plan stopped their long term gerd. Is that even possible? One theory I have is that, perhaps in the same way chewing gum sends signals to our stomach to produce acid because our body believes we are eating, could tense jaw muscles and grinding be signaling the same thing because our body things we are often chewing?

 
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Old 06-27-2013, 08:15 AM   #4
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Re: 2nd Neuro dentist appointment this week...

I think you should be getting MRIs and CT scans of your joint - that is the only way you can really tell what is going on. Personally, I think it is inexcusable for any dentist not to order these tests before proposing a treatment plan.

My understand is that neuromuscular dentisty is not universally accepted for treating TMJ within the dental community. That being said, I believe some people on this forum have found it be helpful, but I would proceed very carefully with any treatment plan and I would get a second opinion from a dentist who specializes in oral and facial pain or an oral surgeon who has experience with TMJ disorders.

Bruxing and clenching are both sleep related and it puts a lot of stress on your jaw and jaw muscles. A night gaurd can help reduce the impact of clenching/bruxing but it won't make it go away. But ask whether its a flat night gaurd or a gaurd that attempts to reposition your jaw.

 
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Old 06-27-2013, 08:40 PM   #5
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Re: 2nd Neurotic dentist appointment this week...

When I was referencing the slipped disc, I was talking about the articular disc. It slides over the condyle bone in your tmj area. Every time you open and close your mout, it moves back and forth. Many people with tmjd problems have discs that don't move properly or have slipped out of place all together. This is usually the problem when people have jaws that lock up and they can't open very wide.

My discs aren't fully displaced, but they have slipped far enough out of position that it resulted in my jaw being 'pushed' back towards my ear.

For people with more serious tmjd symptoms, I don't think there really is a 'fix'. That said, my symptoms are pretty much under control right now. I just need to continually remember to watch for signs symptoms are returning so I can step up my treatments again before they get bad.

That said, right now there are many days I forget about my tmjd. That is quite an accomplishment considering how my symptoms were incredibly bad for a very long time.

Because testing revealed that I my jaw was pushed back towards my ear and I was having such severe ear problems, the lower mandibular repositioning splint was a very good option for me. It took a while, but my most of my ear problems gradually subsided so that I didn't have my ear symptoms after about 3-6 months. My hearing loss was permenant though. I give tons of credit to the splint, but the splint therapy wouldn't have been nearly as effective with out the PT and trigger point work in conjunction.

My teeth were really worn from the bruxism in the years prior which were a problem in re-establishing my 'old' proper bite. After my splint therapy allowed my tmj muscles to be 'happy' again, I chose to go with braces. They have re-aligned my bite and I've been able to 'erupt' my worn down molars to a better height. I'm 22 months into my braces treatment and not currently having much problem with my tmjd. Mostly, it has just been orthodontic adjustment issues lately. When I get my braces off, my retainer for night will be customized to act as a sleep device as well. I don't advocate bite changes for most tmjd patients. I do think it was a good choice for me because of the type and severity of my symptoms.

PT work: I see a physical therapist who does a lot of manual physical therapy on me. It involves a lot of gentle working and stretching of the muscles in my neck and face. It also involves working on my whole body alignment since when the jaw is off it can impact the entire body. In addition to the gentle manual manipulation, she also does trigger point work. Trigger points are 'knots' of muscles. With TMJD, muscles are frequently in spasm causing many of the symptoms. You can get knots in your face, jaw, neck, shoulders, back, etc... I found tremendous relief the trigger point work on all areas. In particular, orofacial trigger point work which is done inside the mouth. There are trigger points in the masseter and pterygoid areas. Getting 'releases' of those knots hurts like crazy, but you will feel a lot of relief afterwards. Each treatment loosens the area more and more until it really isn't needed very frequently anymore. That book I recommended was recommended was written by a PT who specializes in TMJD.

My description of sleep Dentistry: Sleep dentistry usually involves use of oral appliances to help manage sleep related breathing disorders/sleep apnea. For those with mild-moderate problems, it may be an option. Typical appliances are designed to hold the tongue or jaw forward to keep airways open when sleeping. It also involves use of oral appliances to help address bruxism as well. Usually the dentist will work in conjunction with your doctor. Mine required a sleep study to help confirm my sleep issues first. He communicates with my Pulmonologist. There are a couple of professsional sleep dentistry organizations: the American Academy of Dental Sleep Medicine and the American Academy of Sleep Medicine. Your NM could very well be trained in sleep dentistry.

You asked how I'm doing. My TMJD is significantly better. I don't brux much at this point except for when I'm adjusting to new orthodontic changes. I do wear elastics to hold my jaw forward while I sleep though. The acid reflux is another story though. The severity of my symptoms cycles. I have extremely severe (way beyond normal) gerd/lpr issues that result in breathing problems for me. Treatment has helped a bit, but in conjunction with several other approaches as well. I think those with more mild issues might have much more reflux symptoms relief from the sleep dentistry than I do.
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Old 06-27-2013, 09:41 PM   #6
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Re: 2nd Neurotic dentist appointment this week...

Mountain eager, describe you hearing loss to me. What I am experiencing fit now is high frequency loss. My hearing tests concluded that it was a conductive loss and not damaged nerves, which sounded promising. Do you attribute your ears getting better to correcting your TMJ, or to your correcting your gerd? I'm not sure if my Eustachian tube dysfunction-related loss and ear fullness is from a bad bite occlusion or from a reaction to my silent gerd. Anyway, I just wondering if you experience ear fullness too, as maybe you Eustachian tubes could be balloon dilated, which is a promising new procedure that is gaining traction.

Thanks again for the very detailed response!!

So about today's vist . . .
The dentist sat me down and showed me a PowerPoint he put together to show me all of my computer readings as well as slides that helped him to illustrate anatomy (it was much more thorough than just explaining things to me!). He showed how my jaw muscles had a weak bite force, but were always in a tense stae (especially the left side). He recommended a bottom orthotic splint be worn, 24 hours a day, for 3 months. What he said and showed me made good sense.

What REALLY impressed me and made me realize that he was concerned about my well being and not his business's bottom line, was when I mentioned the relationship between sleep disturbances and bruxing in addition to my dropping the bomb on him at I have silent gerd. He immediately changed his tune and pushed he demo splint and presentation to the side. He strongly recommended a sleep study be done as he explained the effects of negative pressure and sleep apnea (I snore) and bruxism. His practice has a take home kit for a lite sleep study, but he said I should go to a full blown, proper facility with the symptoms I have. I was impressed that he insisted I do the study first, even after going through the entire presentation with me! So many health professionals stick to focusing on their area of expertise--I really appreciated the endorsement. It still seemed like the splint would be a good idea, but he seemed to think that the gerd was a more dangerous, potential root to the problem. So it is off to a sleep study I will go! I'm feeling hopeful with these new leads! Any sleep study advice for me?

Thanks again for the terrific replies! I am seeing light at the end of is long tunnel!!

 
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Old 06-27-2013, 11:20 PM   #7
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Re: 2nd Neurotic dentist appointment this week...

My hearing loss is mixed. I've had conversations with audiologists and it is my understanding that the conductive loss would be more in line with the tmjd stuff. I had my eustachain tubes scoped several times. Every time, my ENT said he didn't see any problems. He did offer to put a tube in my right ear when I was having the constant 'stuffiness' that lasted for over a year, but I decided against it since the rest of his exams kept coming back 'normal'. I'm not sure if I mentioned it, but I even had brain MRI's to see if the stuffiness was neurological in nature. (I had numbness in my ears too around that time.) Once my ear cleared of stuffiness over 2 years ago, I was great. Since I've continued my tmjd treatment, the stuffiness hasn't returned.

My hearing loss includes the high frequencies. I'm borderline mild/moderate in classification in my left ear. I lost the hearing in less than a year. My right ear has never been able to hear speech. (I was a preemie.) I fully attribute my ears getting better to my tmjd treatment. The relief of the stuffiness was right along with my tmj treatment timeline.

I'm not sure if I mentioned it, but my orthodontist believes that it was the surgery I had for my acid reflux that actually triggered my tmjd. I started with the symptoms not long after surgery. My orthodontist said that intubation is a classic trigger for tmjd. I'm hypermobile and a bruxer so I was predisposed to the tmjd already. It would have been easier for things to be damaged during the intubation though. I didn't realize the hypermobility until later on though when I started having other joint problems. Anyway, my acid reflux significantly improved post surgery, before my symptoms got bad. That is why I said I really believe it was fully the tmjd treatment that helped my ears.

I attribute my sinus problems getting significantly better to my reflux treatment though. After my reflux surgery, I hardly have any sinus problems and before it was a chronic problem.

It sounds like you are on-track with your dentist. It actually sounds a lot like my experience. Instead of a power point though, he had 3 huge touch screen computer screens with lots of test results and pictures that he moved around (3D) and in and out. He also had some physical models handy too to show 'normal' against what I was seeing on my results.

The imbalance you describe in your muscles is part of what I've been refering to as the muscles being in constant spasm. They have to compensate for being out of whack with the tmjd. Just my laymans definition. Ironically, my muscle and ear issues were intensly bad on the right side. My testing showed right side problems, but that my left side was much much worse. I had no idea.

My orthodontist did a consultation visit where he thoroughly went over my health history (pages and pages) before deciding what testing I needed. He to recommended a sleep study due to my history of GERD/bruxism/hypertension. Ironically, I was already scheduled for one by my Pulmonologist before I had this appointment. By the time my apointment rolled around I was in a new sleep splint though so I think it helped with my results which came back with a slight problem but 'ok'. My pulmonologist had me do the at-home test first. It is basically wearing an oximeter overnight. The lab test is much different. I'm going back in for a sleep test before I get my braces off so my orthodontist knows what kind of rainer I will need.

The 24/7 lower splint for 3 months is pretty typical. It gives time for those muscles to become 'happier'. Because of my issues with my jaw being pushed back into my ear, my dentist and I decided to use a combination of splints (atypical for treatment). I wore the lower mandibular repositioning splint in the day. At night, I had an upper appliance with a wedge that came down behind my lower teeth. It held my jaw in a forward position while I slept. The night splint also had a 'beak' in the front that kept my bite at the exact height as my daytime splint so as to be complementary to my daytime treatment. I LOVED that sleep splint too. I almost cried when I had to give it up.

It sounds like your dentist is very thorough. It is important that you have that confidence in him if your treatment is to go well.

As for the sleep study, I didn't find it too bad. Lots of wires stuck all over you literally from head to toe. Wear comfy pj's/sweats/t-shirt. They may let you bring your own pillow if that helps you sleep better. I found the room to be pretty cold and they didn't have any extra blankets. I wish I'd brought socks. I would have been more comfortable.

Are you having a split sleep study? If so, they will fit you with a sleep apnea mask before the test. If they see results indicating there may be a concern during your first half of the test, they will come in and wake you and put the mask on to test how well you respond during the second half of the night.
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Old 06-28-2013, 07:37 PM   #8
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Re: 2nd Neurotic dentist appointment this week...

Your story is amazing. I have to admit, I mostly see posts from people on these boards who have the problems and much less from people who have made it clear to the other side. Thank you for sharing your wisdom to those who are still feeling lost.

What do you attribute making the ear fullness and stuffiness going away? was it the tmj splint treatment? I've tried so many things before this without success that I am predisposed to almost expecting lackluster results from my next attempt. This is so encouraging!

The dentist said that my actual TMJ bone structure looked pretty good on the x-ray, but that my muscles are out of whack.

Wat do you mean when you say that you are "hyper mobile"?

The 3d presentation you received sounds pretty cool!

I don't understand--why did you have to give up your night time splint? At a certain point in the treatment, do they tell you to stop using it after your bite is better?

A split sleepy study? I have no idea! I have to call the sleep study specialist the dentist referred me to on Monday. That gives me the weekend to research and try to figure out what I need to tell the sleep study place. I am game for them to wake me up as much as they want to try different things out! Do you have any suggestions of what I should ask the sleep study place when I call the, to I quite about an appointment? As of right now, all I know is that I will tell them who referred me due to bruxism and acid reflux, and at I have a deviated septum and a family history of a degree of sleep apnea. I'm hoping they know the best course of action to take! Haha

Thanks again for your great, informative posts, mountainreader!

 
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