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  • Am I ready for Phase 2 ???

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    Old 02-03-2017, 01:33 PM   #1
    tmjineedamiracl
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    Am I ready for Phase 2 ???

    Everyone suffering from TMJ, my thoughts and prayers go out to you.

    I began Phase 1 treatment for my TMJ back in December of 2016. I was referred to my doctor by a coworker back in November of 2016. I am a 31 year old high school history teacher and athletics coach of seven years. I noticed over that over the last couple years of teaching, that my jaw was quickly getting tired from talking and my face was becoming more and more fatigued feeling. In addition, I noticed that my ear seemed clogged and they would itch deep in my ear. In addition, i always felt slightly off balanced like i had vertigo. I was getting head aches and neck aches as well. I was eating lunch one day when I could barely open my mouth to eat a subsandwich for lunch, and I started complaining about the way I felt, and my coworker told me that I sounded just like him a year ago. He said that he had tmj problems and he recommended that I see his doctor. I went to his doctor (hes actually a dentist), and he quickly diagnosed me with TMJ and wanted to begin splint therapy immediately. I got fitted with a splint in December, and got all my MRIs done, and I have been in the splint ever since. I was told to wear it 24/7 and come in once a month for adjustments.

    I am now ready for Phase 2 according to the doctors timeline. However, I am deathly afraid I am not ready for it. And here is why....

    I have not been wearing my splint 24/7, I probably clock in about 15-18 hours a day in it. I would periodically take it out in order to teach, because I was insecure about having it in my mouth while I am trying to teach a room full of high schoolers (they can be vicious). I would take it out while I taught and then put it back in after I was done. I could feel my face tighten back up, the headaches would come back, and then I would be done and I would put the splint back in and within a half hour my symptoms would go away. The splint seemed to work.

    Now I am at the end of treatment of Phase 1. My co-worker wore his splint 24/7 all year and he said that all of his symptoms went away and now he doesn't wear the splint during the day, only at night. He told me he became symptom free. What is crazy is that he decided to skip phase 2 altogether. He just wears his splint at nite now and thats it.

    Back to me now...for the first 6 months, I would say the simple act of wearing my splint would take 100% of my symptoms away. Now 12 months later, I would say my splint takes about 80% of my symptoms away. My doctor said that my splint is worn out (I have deep molar grooves in my splint - I am a clencher) and that is causing some of my symptoms to return.

    My dentist says that he wants to begin equilibriate my bite on feb 8th. He will alter some of my back teeth permanently on feb 8th to achieve the correct horizontal bite and then I go back a week later for more work to equilibriate the forwards and backwards (or some other part of my bite, I cant remember). He says that when he is done, my bite will feel as if I have the splint in when I really don't. This would be a literal miracle if he can actually do this.

    Even now, after 12 months of being in my splint (although I haven't worn it exactly 24 hours a day), when I take my splint out I feel terrible (my face tenses up, and my jaw feels unsupported and unhinged) but when I put it in I do feel alot better.

    Do any of you think I should proceed with phase 2, or do you think I need more time in a splint (like another 6 months). If I get phase 2 done and my symptoms come back, can I get refitted for a splint again and go back to phase one for another period of time, and try it all again? Did I fail at recapturing the disc (pseudo disc)? If a splint fails to recapture the disc, can you just wait longer and get the psuedo disc to form or try again? Or am I screwed....


    If this doesnt get fixed I am afraid that I won't be able to teach, and that I am going to be in constant pain...I dont know how I could perform my job as a teacher in this kind of head and facial pain.

    I dont mind staying in the splint longer or paying the extra money (I cant put a price on my health), I just desperately need this to work.

    Last edited by tmjineedamiracl; 02-06-2017 at 06:19 AM.

     
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    Old 02-05-2017, 06:13 PM   #2
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    Re: Am I ready for Phase 2 ???

    There are multiple factors to consider.

    It is important to consider both the physical bite issues and the muscular issues in the TMJD treatment.

    Everyone is different. The muscular part took me much longer than the time frame you are on. The muscles tighten/spasm in the face and neck in response to the TMJD since they try to compensate for the issues. I did a lot of therapy on my face/neck/shoulders and body alignment to get those muscles out of spasm enough to even consider the Phase II.

    Do you know your bite issue? Will adjusting teeth really help it? Are you out of spasm enough that you even know if you are ready for tooth adjustments or will they cause more problems because your bite isn't quite in position because of the muscles?

    Did your dentist talk over multiple options with you for Phase II? I had 4 main options that my dentist covered with me. Lots of discussion on pros and cons. None of them involved filing down teeth. From what I have read on the internet, not many people actually have success with the teeth filing. Many end up in more pain. You are putting a lot of trust in your dentist. Make sure you are ready and not being rushed.

    What training does your dentist have? Does he specialize in orofacial pain?

    I wore my splint 24/7 for a long time, even when eating which was a pain. The 24/7 was important in the muscular piece. If you aren't wearing yours consistently, your muscles won't establish the 'relaxed' state as easily since when your take the splint out you are undoing some of what you worked on wearing the splint.

    If you are asking if you are ready, I think chances are you may not be. Seriously look at where you were, where you are now, and what you want to accomplish long-term.
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    Old 02-06-2017, 06:55 AM   #3
    tmjineedamiracl
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    Re: Am I ready for Phase 2 ???

    MountainReader, I really appreciate that you took the time to post a reply to my message.

    My bite position has slowly been moving due to splint therapy. We can tell because when I close my jaw and put my teeth together, and then clench, my jaw and teeth slide a little bit to the left where they used to go before I began splint therapy. And I definitely go thru periods where I feel like the muscles in my face and neck spasm and and feel tight, and then there are times where they feel relaxed. So, I am assuming they are not completely relaxed yet due to these periodic spasms.

    My long term plan is to do what ever I can to try and become pain free. I will wear my splint for years if I must, in order to get rid of the dizzy vertigo feelings, facial muscle fatigue and pain, the constant feeling of being run down and tired, and head and neck aches. Oh, and the worst of it is the startling crunching and cracking and grinding noises when I chew and talk!

    Like I said, the splint takes most of this pain and symptoms away (it used to take all of them away), however now they seem to be reappearing even with the splint in. THis is why I believe I may need a new splint - I think my back molars dug in to deep into my splint causing it to be off a little.

    Last edited by Administrator; 07-06-2017 at 01:18 PM.

     
    Old 03-02-2017, 08:46 AM   #4
    tmjineedamiracl
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    Re: Am I ready for Phase 2 ???

    Here is an update for my TMJ progress (or lack there of)....Please post any comments or advice for me, I would greatly appreciate anyone elses experiences with what I am going through, and how you were effected.

    After a year of splint therapy with my original TMJ Specialist, I have decided to find a new tmj specialist. During this year of splint therapy, I was wearing my splint between 16-24 hours a day, and at the end of my first year of treatment, I don't feel like I progressed that much. Perhaps I should have worn the splint 24 hours a day, but my dr. gave me the impression that if I wore it at least 16 hours a day I would heal, as well as being able to take it out to brush my teeth and eat. Over this time, I think my symptoms seem to have gotten worse if not just stayed the same.

    I am seeing a new specialist whose examination of me seemed very thorough. He used the TENS machine on my face and neck/shoulders for roughly 45 min, with the idea that my muscles would relax enough to then use EMG (I think its called EMG) technology to take readings on my muscles in my face and where they are at the most relaxed. We went through a series of readings in which I opened and closed my mouth, clentched and released, slid my teeth forwards and sideways etc. And the whole time, the EMG's that were hooked up to my face were taking readings. He then put the putty around my lower teeth in order to make the mold for my splint. Before the putty dried, he would tell me to slightly move my jaw in very subtle directions to get my jaw to be in the most optimal position, and then we waited for the putty to dry. We went through this three times, because the first two times he thought the mold did not dry in the exact spot he wanted it to dry in.

    I guess the new splint he is making me will be very similar to the old one, expect that it will be hopefully more precise and based on EMG readings instead of just the doctor using his hands to position my jaw in the right spot. Also, he wants to see me once a week for the first several weeks to TENS me and make adjustments. In addition, this doctor was very adamant that I will need to wear the splint 24 hours a day (even when eating! Although he said I coud take it out to brush my teeth, but that I have to keep my mouth open and jaw seperated) in order for it to work properly. No more cheating for me.

    I have been taking IB prophen (800mg) three times a day, which helps a bit. Plus I began taking Zoloft (Sertraline)to help with anxiety. This combination has helped alot, especially because my neck and shoulders were so tense it was causing me head aches and neck aches that were debilitating, and I was getting extremely anxious due to the pain I was in and the prospect of having to wear the splint 24 hours a day. However, these medications have definitely alleviated a lot of the tension I was accumulating in my neck and shoulders - however they do make me sort of tired and a little difficult to concentrate.

    I get the new splint on the March 9th....and so begins my new round of treatment with the new splint and new doctor and new plan to use TENS, EMGs, and wearing the splint 24 hours a day for several months....this wasnt cheap by the way ($4,300).

    Last edited by Administrator; 07-06-2017 at 01:19 PM.

     
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    Old 04-04-2017, 10:25 AM   #5
    tmjineedamiracl
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    Re: Am I ready for Phase 2 ???

    Update:

    I have been in the new splint for about a month now. The new splint is the same exact type as the old one, only it feels a little thinner especially in the little hump right behind the bottom front teeth where the tip of the tongue touches. This little difference makes it so much easier and clearer to speak with. I have been wearing this new splint 24/7 for the past month, and I have actually been eating without a problem with it in (I just have to rinse or brush my teeth and splint when I am done eating), and I have been teaching/lecturing with the new splint in and my students hardly know I have it in. I did mention to them that I had to wear it and explained to them why in really brief terms. They were all very interested and sympathetic and a number of kids actually thought it was cool because they had invisiline braces or traditional braces or orthodontic retainers in. This was a very relieving conversation to have becuase it made me feel much more comfortable and confident.

    The first week of wearing this new splint, I felt perfect. All of my symptoms went away. However, after a week and a half the light and constant muscle tingling and fatigued feelings in my face returned - just not as bad as before. Plus, the muscles in my neck began to tighten up again as well. these symptoms have persisted for the past 3-4 weeks. They haven't gotten worse, but they havent gotten better either. Now, I am thankful that my symptoms haven't gotten worse, but I really want all of these to go away completely. That is what I am praying for...


    I do feel clicks/pops still when I yawn, so I try to not open my mouth wide when I yawn.

    I also have been seeing a chiropractor for the past 2-3 weeks or so. It really hasn't been helping or producing any results in my symptoms though....

    Last edited by tmjineedamiracl; 04-05-2017 at 05:57 PM. Reason: I didn't finish my post

     
    Old 04-06-2017, 09:04 PM   #6
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    Re: Am I ready for Phase 2 ???

    I wore my splint 24/7 for about 1.5 years. I had oral PT to work on loosening the muscles in my jaw, in addition to manual work on my shoulders and neck throughout the treatment. I also worked on my body alignment. The jaw really is influenced by it.

    You are taking the 2 steps that I find extremely important in getting TMJ symptoms under control by addressing the physical bite in addition to the muscle spasms.
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    Old 04-07-2017, 06:41 AM   #7
    tmjineedamiracl
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    Re: Am I ready for Phase 2 ???

    Thanks MoutainReader for telling me about the types of treatments you went through. It gives me some more confidence in the 2-step treatment plan that I am following.

    I went in to my TMJ specialist again yesterday for my routine check ups, and he made some adjustments to my splint. He stated that my jaw was trying to move forward (which is what we want to happen) however, my teeth were getting stuck in certain parts of the splint preventing my jaw to move freely. He made some adjustments to the splint (shaving down the splint in a few places). These adjustments should allow my jaw to now move freely forward, and hopefully some of my neck and facial aches and tingling will be reduced now that these adjustments have been made.

    Last edited by Administrator; 07-06-2017 at 01:22 PM.

     
    Old 04-07-2017, 07:06 PM   #8
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    Re: Am I ready for Phase 2 ???

    I had frequent adjustments to my splint in the beginning, sometimes more than once a week. Those minor changes in how things hit when the jaw starts coming forward (or side to side as the case may be) can result in a lot of irritation in daily living. Chewing, pain, etc... My Orthodontist was over an hour from my work and I used up a lot of leave during that period. Well worth it in my opinion.

    Another thing my orthodontist promoted was proper nutrition to help the body heal. Something to think about. He said lots of spinach. I told him that there was no way I could chew it with the splint. He said lots of smoothies.
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    Last edited by Administrator; 03-19-2018 at 01:37 PM.

     
    Old 04-13-2017, 10:25 AM   #9
    tmjineedamiracl
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    Re: Am I ready for Phase 2 ???

    I had my adjustment on Thursday, and I improved dramatically throughout Friday through Sunday and on Monday I damn near felt perfect. It felt like a miracle...My neck loosened up completely, no more headaches, no more facial tingling, no more fatigue in jaw...Then starting around Tuesday and Wednesday, my symptoms started to come back slightly again... not as bad as before, but it definitely has me down a little bit.

    I emailed my dentist to report to him how I improved and how I my symptoms kind of came back, and I suggested that maybe I should come in sooner for another adjustment. He told me to wait and let me jaw settle in and get used to the new position before we make any more adjustments. So I will be meeting with him on April 20th for the next adjustment.

     
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    Old 06-24-2017, 10:25 AM   #10
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    Re: Am I ready for Phase 2 ???

    I had my repositioning splint on my lower teeth as prescribed by my new TMJ Neuromuscular dentist specialist since about March 9th.

    Around mid-May my dentist was starting to talk about weaning me off of my repositioning splint. He hooked me up to the EMG machine and determined that over the two and half months, my jaw had moved to the most relaxed position it should be in. He advised me that now that my jaw is in position we need to try and wean me off of the splint by taking it out for an hour each day for three days in a row. Then, if I felt good enough, I would then up it to 2 hours a day for three days in a row. Then, if that felt good, I would up it to 3 hours a day for three days in a row etc....

    Here is where my case is a little tricky, even though the EMG indicated my jaw had moved into a new position and that it showed my jaw and muscles were in the most relaxed state, I still feel muscle fatigue, tightness, and aches in my cheeks lips and near my joints even when I have the splint in all day...I can't pinpoint the exact location or determine exactly what is causing this, but I think its like the base of my masseter muscles on jaws and my pterygoid muscles feel achy.....I don't know why this is happening, or if I am even correct but I have convinced myself that what I am feeling is emanating from my masseter and pterygoid muscles..

    I don't know how the EMGs show that my muscles are in the most relaxed position, yet I still feel fatigue and achyness on the sides of my face...Its like an anomaly.

    I am now up to taking the splint out for 4 hours a day. I during those 4 hours I am just sitting and relaxing watching tv, then all I feel is a little tightness sensations, but I actually feel pretty decent. However, if I am talking and laughing and eating and being social then I feel pretty good for the first 2 or so hours but then my sides of my face begin hurting (to me it feels like my masters and pterygoid muscles begin aching and tightening)...when I put the splint back in after 4 hours, it usually takes about an hour or so for my face to relax again and then a lot of my symptoms go away. However, after several hours of having the splint in, it seems like my muscles tighten up again and get achy. It kind of seems like I am damned if I have it in and I am damned if I take it out at this point.

    I am thinking that the splint did indeed move and reposition my jaw just like my dentist said. I even believe that my jaw was moved to the most technically relaxed position according to the EMGs. However, I believe that moving my jaw to this position is causing my muscles and other soft tissues to be stretched or strained temporarily, and that is why I am feeling aches and fatigue even though my dentist and the EMG readings show my jaw is in the relaxed position.

    I am also guessing that over the 2 1/2 to 3 month period of wearing the splint 24/7 that my joints may have healed and condyles centered (I base this on the idea that a broken arm or other injury to bones and ligaments would be healed in 3 months, so why would the joints in the face take significantly longer...) and now I am dealing with my muscles adjusting to this new position, which is why muscles ache even when my splint is in (this is assuming that it is indeed my muscles and not something else causing this uncomfortable feeling).

    I am also guessing that when I take the splint out, I feel good for the first two hours because my jaw is in the relaxed new position, however after two hours my muscles in my cheeks, neck, and head begin to wobble and ache because they don't have the support of the splint. I can't go longer than 4 hours with the splint out when I am eating, talking, and smiling/laughing before it begins aching...

    I don't know if my conclusions are correct or not. I know that I am not at all back to normal yet....I guess if I can't wean myself off the splint for an entire day and just wear it as a nightguard, then I will have to wear braces or invisiline to adjust my teeth in the correct position to permanently hold my jaw in the new position, or I would have to go with crowns - all of which cost a lot of money....However, I am not even certain this would solve my problem

    Last edited by Administrator; 07-06-2017 at 01:25 PM.

     
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