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    Old 02-08-2020, 06:19 AM   #1
    zacharias
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    Appliance not helping

    Hi all,

    I have had clicking on one side of my jaw without pain for a couple of years ago, usually while chewing. When the clicking became more frequent and was accompanied by an occasional painful popping feeling, I sought help from a dentist who specializes in TMJ disorders. He made me a hard acrylic appliance for my bottom teeth, which he adjusts every 4 weeks as, supposedly, my jaw is moving forward. I have been wearing the appliance 24/7 for 5 months now. Usually the appliance keeps my jaw from clicking, but recently my jaw began clicking even with the appliance in.

    The dentist initially said the treatment would last 4-5 months. Now he is saying that when my jaw finishes moving forward (probably in two more months), I'll likely need an Inman brace for several months (and several more thousands of dollars). My insurance doesn't cover any of this, and it's costing a small fortune, as the dentist charges for each adjustment.

    I am beginning to wonder whether all of this is normal TMJ treatment or if this dentist is actually trying to make the treatment take as long as possible to keep the cash coming. What was supposed to be a 4-5 month treatment now looks like close to a year. Should I at least be experiencing a reduction in clicking after 5 months when I try eating without the appliance? I had never experienced clicking when eating with the appliance in place until recently. Help?

     
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    Old 03-10-2020, 10:42 PM   #2
    MountainReader
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    Re: Appliance not helping

    I was in a massive flare and going through TMJD treatment about 11 years ago. The clicking in and of itself isn't necessarily the best determination of how well your treatment is working, based upon what I have learned through my research and treatment process. There are multiple issues/questions that are involved in your question. It seems compounded by the fact that TMJD is typically not covered by medical or dental insurance. Mine wasn't. It made my treatment process much slower and extended over several years because of the expenses.

    The treatment does sound fairly typical. The training and skill of the dentist you are seeing is critical. I learned through experience, that not all splints are created equally. Some do more harm than good. I hope you have confidence in your dentist and their skills as you continue your treatment. There is no actual "TMJ" specialty and there are many dentists who say they treat TMJD, but only have a few hours of training.

    Did your dentist explain what the clicking is, based upon your exam and scans? For example, is your disc sliding back and forth appropriately? Is it displaced? is your jaw pushed back towards your ear causing the clicking to be ear related? Your treatment progress with regards to the clicking, will depend on what your dentist is trying to achieve with the treatment.

    The biggest thing I learned was that with TMJD you need to treat BOTH the bite and your muscles. I am assuming that your splint therapy is addressing your bite problems. Are you doing anything to treat your muscles? Most people, me included, have no idea how tight the muscles in your jaw/face/neck/ even shoulders, become when the jaw is out of place. The muscles are in spasm trying to compensate and hold the jaw in place. PT with manual therapy, oral trigger point releases of the masseter and pterygoids, and dry needling helped me significantly. Over time, the muscles start to loosen and the splint is able to do its job much better. While I had success with my TMJD treatment (splints and braces), still to this day, I head back to PT when I feel those muscles start tightening back up to keep from flaring again.

    Typically, they call the splint therapy like you are receiving Phase I. Once your jaw is into a correct position, you usually have a choice of your next steps. For me I had several options: 1. continue with splint therapy indefinitely. 2. wean myself off of the splint and hope for the best. 3. caps on some of my teeth to keep my re-established bite stable. 4. orthodontic braces. I chose 4 for several reasons. Mostly because the years of TMJD had resulted in grinding/bruxing at night and damage to my molars. I felt braces were more natural than crowns on so many teeth. I also wanted to look long term and braces seemed the best in establishing my bite permanently.

    Because of the expense of the treatment process, which was way over my budget, I took things slowly. I ended up wearing my lower mandibular repositioning splint for almost a year before moving to the braces. I just kept up with periodic PT during that time. Other than the inconvenience, it worked for me. I can't speak for the Iman brace. I had Damon braces and was happy with that choice. Those brackets were much easier, pressure wise, than traditional braces would have been on my TMJD. Just remember, the goal is a proper bite, not just a straightening of teeth.

    I know it has been a while since you posted. I haven't been on here in a while, but felt bad when I noticed nobody had responded. I hope you have success with your treatment.
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