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Visit to the maxillo facial surgeon and, again, to the dentist

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Old 09-06-2003, 12:43 AM   #1
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Isobelj HB User
Post Visit to the maxillo facial surgeon and, again, to the dentist

Last Wednesday I made my first visit to the maxillo facial surgeon recommended by my dentist. He is actually in the same hospital down the same corridor so that was convenient at least. I learnt some things, and was reassured, but also am still apprehensive that my TMJ will not be so easily vanquished (so easily that is as the surgeon seemed to suggest). The surgeon listened to my symptoms (not so interested in detailed history though I managed to tell him what seemed relevant to me and he was attentive to that), and told me that TMJ frequently afflicts people for a short time and then goes away (I can't help but be sceptical, reading all the messages here), and that it is very hard to trace precise causes. I remain convinced I have it because of irregular-in-height fillings and onlays placed in January, and a cracked molar making me eat on one side only since January. I do have bruxism (have for years) and have often been stressed but never in my life have I had the ear problems and facial pains I have now so these simply have to be related to the bad bite and eating on one side for so long. Anyway, the surgeon felt my TMJ, asking me to open and close my mouth, he said the discs and joint seem to be in place, because of what he could feel with his fingers and because he couldn't hear clicking (I can hear some slight clicking in my right ear only, this is the side which is too low and which I've been biting on too in these months) and my jaw isn't locking, plus I can open my mouth normally wide. He said, as I understood it, that I have muscular inflammation all around the TMJ, this is causing the ear problems I have which bother me more than anything else. I also have some molar sensitivity, I kept thinking I had different things wrong with different teeth (the dentist and x-rays find nothing but bruxism can cause incredible tooth sensitivity), and it is almost a relief to find this is a TMJ symptom and maybe it will go if I can stop the night clenching. My symptoms; ear noise and vibration, tenderness in jaw and sides of face, pains in shoulders and arms, are always worse when I've just woken up.

The surgeon said finish the course of the muscle relaxant Naxodol I'm taking, I told him I hate to take medication and it is upsetting my stomach a bit and I feel as if it makes me feel fluey and tired, though I don't feel great without it either so it's hard to know if this is the medication or the TMJD itself. He prescribed a less strong muscle relaxant but said only take that if I still have pain after finishing the present Naxodol course, I appreciated it that he wasn't forcing meds on me. I told him I got a heating pad and he said it can work well to use 5 mins of heat, 5 mins of cold, then 5 mins of heat again, instead of just heat. And he said get the nightguard, which should hold my mouth in a relaxed position, so that even if I clench it is when the jaw is more relaxed. I asked if x-rays would help (I know an MRI shows MUCH more of relevance but can't afford one) and he said yes, he'd like to see an x-ray, but I haven't had that done yet.

It's hard to understand just how the nightguard does work (he was calling it a splint whilst the dentist calls it a nightguard - the two of them talked together and looked at the guard together so I know however they mean the same thing - and also good they are working together and the clinics are basically next door to each other), it is a plastic thing with acrylic on it filling in the spaces where my teeth should really be to have a good bite, so in effect it seems to me what it does is correct the bite for now, and make it slightly higher.

Fitting the nightguard correctly has been rather a problem. My dentist first took a mould of top and bottom jaws, then on the next appointment tried the plastic guard on my top teeth. He was going to file it a little but I asked him not to as now any filing down of anything worries me! He put acrylic on it and I understood he wanted me to clench down on the acrylic to shape it with all my teeth so I did this. Anyway, apparantly we had a communication problem because after he put the acrylic the fit was just like a heightened version of my present bite, higher on one side, too low on the other. The dentist tried again with more acrylic and filing of the guard but couldn't get it right, he said himself it was bad work (thank goodness for this too, I respect him for it, another dentist could just easily have said it was okay and sent me off with it), and so I went back the next day for them to make another one. This time my normal (general) dentist suggested I see a prosthodontist (sp?) in the same clinic as him for the new fitting attempt, I think because he wanted it done right and felt she could do it better. So, I went back to see the prosthodontist on Thursday. Her procedures re making the new night guard (the old one was discarded by the first dentist) were quite different, the first thing she did, rather amazingly, was show me how to find my natural jaw position again, which I've pretty much lost this year due to my teeth height changing so. I had been practicing on Wednesday night just relaxing my jaw (pressing my fingers to the place in front of the ears where you can feel what I think is the TMJ disc raising and clenching when you clench your teeth, and going flat, almost concave, when you relax your whole jaw), my normal dentist had told me to try just first relaxing then bringing my teeth together, stopping at the first contact, this being he said how I should hold them when the acrylic was shaped onto the plastic mould, not trying to make all teeth meet, or clenching). So I came to a position I felt right, going by how straight my chin looked and how relaxed my TMJ felt. But the prosthodontist somewhat threw all this out of the window. She told me to put my tongue tip right up so it touched the top of my mouth, and then to move the toungue tip backwards, curling the toungue right back. She took my chin and just pushed up (I was so confused!), and gently put my teeth together. This, she said was my natural bite. I was inclined to be suspicious, after my work on what my loose and relaxed bite should be this seemed all wrong, but after trying this tongue positioning a few times myself when she waited, and then later on last night and today repeatedly trying this I see she is right. The tongue acts rather like a hinge, placed right in the middle of a small door, it literally, as you push the tip backwards towards your throat, pulls up the jaw, and centres it exactly, so your teeth slot into place, I still don't feel my teeth are the right heights, they aren't, but my jaw is straight and my bite straight (on left and right) if I do this tongue thing, which is such a relief. My jaw had been moving so much to the left because of the too low right molars. If I curl my tongue back as shown, my closed lips are visibly symetrical too, both corners at the same height, and my teeth slot into each other in the right way, right that is to keep my jaw symmetrical. For months I've been fumbling with how to position my mouth, because the teeth distortion has made the lips slightly different in height on either side and asymetrical when my mouth is closed so I'm really pleased to discover this so simple way (but still it would never have occurred to me) to centre my bite and jaw again. And glad my general dentist got the nightguard wrong so that I had the chance to have the prosthodontist make it.

Ouf. So the next thing she did was put acrylic on the plastic, and ask me to bring my teeth together doing the tongue thing, now she is shaping the acrylic a bit and I will probably bring the guard finally home on Tuesday if all goes well. She did say if I am not happy with it after trying it for a week she will make another one free of charge, she could see how worried I was about the fit and that it works. Also on Tuesday she will use a machine which will measure my face in various ways and somehow assess my articulation, I am really not sure what this is, (I wondered if she meant a TENS machine but it is worked manually apparantly), this so she can assess what I can do to correct my teeth height now, as I want to redo the significant molars the terrible dentist worked on disastrously (size and heightwise) earlier this year.

So, I'm pleased my joints and disc still seem to be in place. And to find out how to get my jaw positioned rightly and natural bite back. But I still have all the horrible symptoms I have for now, and despite beginning to use the heating pad and the antiinflammatory I still have pain in my shoulders and ear noises and sensitivity (which bother me most of all, will I always have damaged hearing now?). It is sometimes incredibly noisy where I live, two buildings down they are drilling and hammering digging up the pavement, which is unbearable, and my neighbour plays very loud music continually, I am even wondering if I have ear damage related to loud noise rather than the TMJ. I also got a bit of a scare on the way home from the hospital yesterday, it's on the other side of the mountains outside the city and on the way home we took a different route which took us up to a higher altitude, in an instant I registered, shocked, that my hearing had decreased drastically and I was just mentioning it when I felt sudden pain in both ears, I told the friend who was giving me a lift and she realized it was the altitude and we turned around and drove down slowly whilst I tried swallowing, but that was pretty frightening, since I've had a new symptom which is clicking in my neck when I bend it forwards or turn my head from side to side, and my ears feel very full and more tender than before and the noises have increased. Bother. Plus this means I can't fly I realize, and I am supposed to be leaving taking a long haul flight in November or December, what if the inflammation doesn't go down? I couldn't risk having my eardrums burst and that seems very likely now. I've actually driven in that very same high altitude place many times before without any problem so my ear inflammation clearly caused the eardrum susceptibility to pressure change. So, if we have TMJD, we can't change altitudes? I should have thought of that, ironic that on my way home from a fairly positive visit to the hospital I inadvertantly worsen my ear situation.

Now, I am so concerned that anything I do is right, so that I can stop the TMJD worsening. Today I actually just feel tired and down, I don't know whether to take the Naxodol or not, I want to sleep but also don't want to because then I clench. Hopefully next week with the nightguard will be better .

[This message has been edited by Isobelj (edited 09-06-2003).]

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