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TMJ Disorder -TemporoMandibular Joint Message Board

Vertical Dimension and Muscular TMJ

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Old 08-10-2009, 05:47 PM   #1
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loudawg HB User
Vertical Dimension and Muscular TMJ

Hey all,
I went to the University of Pacific's Orofacial Pain Clinic in San Francisco last Friday and wanted to give an update and ask a couple questions.

During the appointment the dentist reviewed my MRI, pano and other xrays and listened to my story. He poked around in all the typical places and had me do the typical things to evaluate my bite. He was pretty personable and spent lots of time talking to me about my situation while doing a light examination.

At the end of it all, he said that he feels the dentists that I've seen up to this point haven't done anything to hurt me. He said that my current orthotic puts my bite in the correct position in regards to left / right and foward / backwards position. However, he thinks that the vertical dimension needs to be increased. He thinks that my mandible and maxilla have been too close together all my life and that is causing my muscle problems. He arrived at this in part from evaluating my "swallow bite". He had me bite down and swallow w/ the splint and also just swallow naturally. When I bite down and swallow - he noticed it is more labored than it should be. He also noticed that when I swallow by itself my teeth do not touch. According to him, this isn't normal - the teeth should meet when swallowing.

His treatment plan is to come in for the electromyography to measure the "correct" position of the jaw. Add vertical dimension to my current splint to be in accordance to this position. He said that after this point it would be good to continue to work w/ my osteo and NUCCA chiro to make sure the relationship w/ the neck stays correct also. In all it would cost me about $1500 for him to do the EMG and modify my existing splint. He also told me to get x-rays of my teeth because from the pano, it seems my teeth my be recessing into the gums in response to all the grinding I did (or do).

Does this sound familiar to anyone? My main hesitance is that I'm not convinced about more vertical dimension helping me. My current TMJ dentist added a lot more vertical on my splint than previous splints and I thought it might have caused an uptick in my symptoms if anything.

Has increased vertical dimension significantly helped anyone's symptoms?

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Old 08-10-2009, 07:19 PM   #2
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Location: Rockland County, NY
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Thelma-Louise HB UserThelma-Louise HB UserThelma-Louise HB User
Re: Vertical Dimension and Muscular TMJ

I can't say for sure - as I am still in the process of determining the correct vertical for my mouth - but from someone who suffers with a total decrease in vertical dimension I know it definitely does affect the swallowing function and tongue movement. At my last appt my dentist increased the height on the orthotic we are using to try and determine the correct vertical and I immediately noticed the back of my neck relax as well as my throat and my lower jaw pushed forward naturally on its own. He suspected it might be too much vertical but it seemed good to me but hard to say as I only had it that way for a few mins at which point we ran out of time so I go back in a few weeks. The point being though I think you will know if its correct or too high pretty quickly. Also I believe he is right - my back teeth used to touch lightly when I swallowed before my bite was altered (and the onset of tmj symptoms) and now they do not - I know they also used to slightly touch doing anything strenuous - like bending to pick up something, exercising, running, etc - it seems to affect upper body strength as well.

Its really not as hit or miss though as it sounds - usually once the vertical is increased tomos are taken to check the joints and temporal plane - this coupled with the change in symptoms - either better or worse - generally helps the dr figure out the correct height.

My suggestion though would be that instead of using your current splint that he try and replicate it or make something similar and play with that - otherwise you run the risk of possibly permanently altering or damaging the splint you are using now and if this does not work you will not have your current splint to go back to "as it is today" and as we all know - once its changed, no matter what they do to restore it - it seldom feels exactly the same.

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