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  • Optimal lower jaw position?

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    Old 04-17-2003, 06:33 AM   #1
    Al4
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    Post Optimal lower jaw position?

    I have read posts concerning the optimal healthy position of the lower jaw relative to the upper jaw. It seems that the goal to be achieved by using a splint or an orthotic device is to bring the lower jaw down and forward. I have just started seeing a second TMJ doctor who has given me a new lower splint (used an upper splint by a previous TMJ dr. before that created problems) which seems to bring my lower jaw back instead of forward! When the doctor was working on adjusting the splint, he was pushing my lower jaw back and up. At one time when he was pushing it back I felt very dizzy (like the start of vertigo). When I got home from the doctor's office, I had brief severe vertigo attack and fell on the kitchen floor. I wonder if bringing the lower jaw back and up is the right thing to do, or is the doctor a quack? To splint users, is it supposed to bring your lower jaw forward. I have read at the website of Dr. Brock Rondeau, Canada (the dr. that Marlene mentioned in her posts and helped her with her TMJ I believe) that his orthotic device brings the lower jaw down and forward. What is you take on the jaw position issue? Marlene, what do you think? Thanks to all.

     
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    Old 04-17-2003, 07:09 AM   #2
    autumn83175
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    Al4,

    I am no doctor, but this is what I have seen in my research.

    Your positioning is correct when your teeth meet properly without overlap. When you smile, your teeth should touch each other, mainly the back ones. Sometimes for cosmetic reasons, such as crooked or buck teeth, your front may not meet perfectly, but they should be close.

    If when you smile, your lower teeth are behind the uppers, that is a sign of a problem with lower jaw position. If when you smile, your upper teeth are behind the lowers, that is a sign of a problem with upper jaw position. Sometimes this is just the way you grew, plenty of people with this problem do not have TMJ. Sometimes this is the result of joint damage.

    X-rays can usually determine if your jaw is sitting in the correct position if it is not obvious. I would ask your doctor to show you what he believes your positioning is, why, and have him explain better why he thinks that particular splint is for you.

    Hope this helps some. Good Luck with your treatment.

    Autumn

     
    Old 04-17-2003, 07:43 AM   #3
    Cymy Sue
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    Hi Al,

    My condition is different than most, but the splint I'm using is to let the muscles relax, unclench, lengthen;
    This has happened to some degree already (4 Mo.)because the right-sided pull and deviation is gone. (The muscles on the right were shorter & weaker)

    My jaw has elongated and my face is longer and straighter. I can't tell if it has gone forward any, but it has dropped down and this is why so many symtoms have been alleviated. This is what was supposed to happen.

    I got a little lost? The new Doc. is pushing up & back. That doesn't sound right to me. Marlene & some of the others will know more, but I can't imagine a Dr. pushing back & up, putting pressure on your joints.

    My Dentist says, new theories in splint therapy are to let the muscles relax and reposition without disturbing the joint, for most conditions. I guess that's his opinion, but it's working for his patients.

    I know this was not any help, but I want to check back and see what the others say.

    Take Care,

    Cymy Sue

    [This message has been edited by Cymy Sue (edited 04-17-2003).]

     
    Old 04-17-2003, 07:56 AM   #4
    GJA
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    --my problem has been vertigo from 24 hour clenching, then more of dizziness from not clenching. my jaw
    suddenly went to a very forward position, with my lower teeth almost infront of my upper. I am wearing a lower splint during the day and an upper splint at night.

    --g

     
    Old 04-17-2003, 09:15 AM   #5
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    Hi Al: My splint brings my lower jaw forward. I've just been wearing this one for a short time and it's already improved my bite and ahsn't caused any pain or dizziness. It seems odd to me that your were given a splint that pulls your jaw back, but then I'm hardly a TMJ expert. I agree that you should get your DDS to explain the situation to you and maybe get another opinion if necessary? Sorry I don't know more about splints, but I hope things work out for you. Sue

     
    Old 04-17-2003, 09:47 AM   #6
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    Hello,

    Just wanted to ask, for those who have splints which bring their lower jaw forward, is this simply to take the pressure off the muscles, temporarily, or will it permanently change the position of your bite? Will you, afterwards, require a stage 2 which involves orthodontal work to line up your new bite? I know Cymy Sue said she has a muscular repositional splint, i.e. simply takes the load off the muscles. Is this what other people are talking about when they mention an anterior repositional splint?

    I am very interested in this as were someone to attempt to put my lower teeth in line with my top teeth (which are in front of them) it is obvious even to me looking at them, that the orthodontal work required afterwards would be extensive. Very big gap btwn the bite to fill, and no doubt lengthy and expensive, so am hoping this isn't the way I will have to go.

    [This message has been edited by hbep (edited 04-17-2003).]
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    Old 04-17-2003, 09:53 AM   #7
    GenDen
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    The key to a correct jaw position is the condyles and how they fit in the fossa. There should be a 3mm space between the head of the condyle and the fossa. If that space does not exist, the condyle head pushes on the sensitive nerves, blood vessels, and tissues of the fossa and that causes pain. It also causes the muscles around the joint to contract to protect the joint, then there is muscle pain. The condyle head space in the fossa can be viewed with a tomogram which is a form of catscan and also with a transcranial x-ray. The tomogram is more specific because it provides a dimensional view. The transcranial x-ray is a flat view. The MRI images the tissues rather than the bones. Often, to get the best information for a diagnosis, all the tests are necessary.

     
    Old 04-17-2003, 10:27 AM   #8
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    hbep,

    To answer part of your question - I wear an anterior repositional splint which has brought my lower jaw forward and given me an "end to end" bite. This means that my front teeth line up when I close my mouth. And yes, when/if my symptoms are alleviated I will require Phase II treatment which usually entails orthodontics. Again, Marlene may be able to better answer you question as she has gone through Phase I and Phase II treatment with success.

    Just a note - I see the dentist who treated Marlene(Dr. Rondeau), and so far have had very little success. I'm not trying to be negative, I just want to remind people that every case is different.

    Take care.
    Crystal

     
    Old 04-17-2003, 09:12 PM   #9
    Marlene
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    Hi Al4,

    That's a new one!!! If you had an episode of dizziness with the dentist adjusting your splint back and up, it sounds to me that he doesn't really know what he's doing!? I would think it's supposed to be adjusted down and forward. I would DEFINITELY ask him to explain what he intends to accomplish by his adjustments!

    Marlene

     
    Old 04-18-2003, 01:06 AM   #10
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    Hey Crystal,

    Thanks so much for your answer, I'm still getting to grips with all the terms.

    Remembered after I wrote my post yesterday, that even if they were to bring my jaw forward to line up my bite, I have, if I remember correctly, what's called a cross bite, lower teeth sit outside top teeth when I bite. I've been told twice, once when young and once now by the NTI dentist, that the only way my teeth could ever fit together properly would be to crack my top jaw to widen it - yuck. For all sort of obvious reasons, LOL, that isn't appealing or something I'd want. Guess I'll just have to wait and see what the dental hospital say.
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    Old 04-18-2003, 08:23 AM   #11
    autumn83175
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    hbep,

    I believe the surgery for your upper jaw is a saggital split osteotomy. There is alot of information on the web about it. It is actually much more common than TMJ surgeries and I believe much safer with a high success rate. I had mine done on 3/27, upper and lower. I am not trying to pursuade you to get it, I just thought you may want to look into it a little further. I don't know how old you are or your situation, so you would obviously have to decide what you would want to do. I just wanted to arm you with a little knowledge.

    Autumn

     
    Old 04-18-2003, 11:03 AM   #12
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    Hi autumn,

    Thanks so much for your reply, I will do a bit of research. As trying to get help for tmjd is either an expensive or slow process in England, so far all I've tried is an NTI brace, so will be trying other splint therapies first, but it's always fantastic to have this information should I need to weigh up the options further down the line. So thank you again.
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    Old 04-18-2003, 11:25 AM   #13
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    Anyone who is thinking about having jaw surgery to move the lower jaw (mandible) needs to understand that complications can and do happen which can have devastating effects upon the use of the mandible and the integrity of the jaw joints.

    If you're considering orthognathic surgery to change the way your upper and lower jaws come together (the bite), your surgeon must explain to you how it is possible that your jaw joints could be damaged or how it is your lower jaw may not function normally after surgery. If the surgeon is operating on the lower jaw and says that this is not possible ... run! If the surgeon says it could happen but it is rare ... so rare that he's never seen it happen .... ask yourself why it is possible that such a thing could not possibly happen to you if it happens to other people.

    If you don't think this happens ... just because it happens rarely ... who do you think those rare people are? It it happens in 2% of the cases operated, that is two out of one-hundred. Who are those unlucky two?

    I'm one of the 2% (an estimate by surgeons) walking the planet. And I have two artificial jaw joints because of it.



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    Old 04-18-2003, 01:20 PM   #14
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    Hi Webby,

    Thanks to the excellent debate on surgery that both you and others contributed to, I am very aware of the issues. For me, surgery is not a consideration at the moment as my current situation is not severe enough to warrant it. Although I am very grateful to both you and Autumm for for your input, information from all different perspectives is massively helpful when it comes to seeking treatment.
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    Old 04-18-2003, 09:34 PM   #15
    Al4
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    Sorry if this is too long. I thank all of you very much for your very helpful responses. I think my new DDS was not helping by pushing my jaw back and up. It caused the vertigo attacks and my tinnitus has increased tremendously. The tinnitus and echo have never been this bad in my left ear; the side from where I felt the vertigo coming when he pushed my jaw back. I hope it will improve to the previous lower level, because I am having an extremely difficult time relaxing. GenDenís explanation is very plausible. I believe the dentist pushed the condyle against the fossa and may have disturbed the blood vessels and nerves in the fossa, which caused vertigo and now the increase in tinnitus. From the responses, it sounds that the most helpful lower jaw position for TMJ symptoms is down and forward, which brings lower front teeth in line with upper front teeth. My lower front teeth are slightly behind my upper front teeth. I wore the splint the new doc gave me for a few minutes and I felt that it was trying to create a bigger gap between my upper and lower front teeth by pushing my lower jaw back instead of bringing it forward. It was harder on my jaw muscles to open my mouth with the splint. I am waiting for the DDS to call me back so I can find out about his logic behind pushing my jaw back and the type of splint he prescribed.

    My problem now is that I canít find competent trustworthy TMJ doctors in my state. The first doc I saw had thirteen complaints with the dental board. Needless to say, I did not have any jaw symptoms before seeing him, and all the joint problems have occurred in the few months that I saw him. Incredibly, I also found out today that this new DDS I was referred to has his dental license in a stay of suspension, until he completes conditions set by the dental board. Yet, I was referred to both of them by other dentists because they treated many TMJ cases in my state. I must now find a trustworthy and competent out of state TMJ DDS, and will have to travel for the visits. Cymy sue, who is your TMJ dentist? I would appreciate the names of other TMJ dentists that others may have found very helpful in treating them. Thank you again.
    Al

     
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