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IndyGirl1 09-18-2012 02:06 PM

Trying to determine the cause...
Hello fellow tmj sufferers,

I am really trying to figure out what the cause of my tmj pain is. If I can't figure out the cause then I may pick the wrong treatment.

I am leaning towards the problem being a bite misalignment due to the fact I was hit in the face and my right disc was injured. My lower jaw and teeth have slid to the right, and when I look at the center of my teeth..the line in the middle of the front two teeth on top and on bottom are not even..the bottom middle line is about a half inch to the right. I hope that makes sense to everyone. My bottom teeth also slant, the right side is higher than the left side. Its almost like my bad right disc is pulling my right side up to the right and back into the joint space.

Here is the issue, the couple of doctors I have seen seem to believe it is a clenching issue. I just can't figure out if clenching is part of my problem. I try to pay attention when I wake up but it is difficult. One thing I have noticed that is odd is that I keep having dreams of either my teeth all falling out or breaking braces and or retainers and having all of the metal break off in my mouth. I feel like this could be my body telling me I am clenching in my sleep.
Do any of you have these dreams?

I feel best in the morning, and as the day goes on my jaw becomes more and more sore. The left side of my neck gets so tight and I can feel all of those muscles pulling down on my jaw.

My muscle tightness in my neck also switches sides depending on how much exertion I use with that arm. For instance if I do too much repetitive motion with my right arm the next day the neck tightness will shift to that side and that side of my jaw will ache. This makes no sense and is driving me absolutely crazy. I guess atleast I can choose which side I want to ache the next day. lol

So what do I do? Do I get a repositioning splint that doesn't do much for clenching or do I try to focus on keeping my back teeth apart and address the clenching. I am just not sure at all where to go from here, and do NOT at all trust these so called "tmj doctors"

I would love some thoughts...any thoughts.


pipdog 09-19-2012 03:21 AM

Re: Trying to determine the cause...
Hi weird I had those dreams too, dreaming that all my teeth were splintering and falling out. I was also waking up with the taste of blood in my mouth fom all the intense griding/clenching action which was rocking the teeth in the gums and I guess causing bleeding.

Sounds like you have a crossbite if your lower midline is so off to one side and a cant to the occlusal plane. The doctors who say its a clenching issue have cause and effect mixed up, the clenching is your bodies way to attempt to even out the misaligned bite, I say this because once my mandible was repositioned with an appliance I stopped the grinding, my teeth no longer hurt every morning when I woke up. You need orthodontics to correct your issues and give you a level balanced bite, the guys who know their stuff are called functional jaw orthodontist, i.e. not looking at the teeth in isolation but in how the bite interacts with healthy jaw/muscle function

IndyGirl1 09-19-2012 06:33 AM

Re: Trying to determine the cause...
Hi Pipdog,

I'm so happy you responded. It is great to hear other's thoughts on my issues. I feel like you are on the right track as to what is happening. I guess my question is would a bite splint be able to correct the cant and the crossbite? I have already had braces before my injury, and can't imagine having them again with how painful my jaw already feels. Have you had braces or just a splint?

I would be interested to hear about your story and what symptoms you were having, and also what treatment worked for you. I am also considering going to see a myofacial release therapist to see if I can get my muscles more relaxed. The entire left side of my neck feels tight and rock hard. I also have issues with the muscles irritating my occipital nerves which is so unbelievably painful.

Did your symptoms switch sides? I have read many posts on these boards and that issue doesn't seem to come up very often. It seems most people just have issues on one side.. boy I wish! ;)

pipdog 09-20-2012 04:40 AM

Re: Trying to determine the cause...
Bite splints can be higher on one side to artificially level out the cant. Also they can be 'indexed', made with cusps and grooves so you will be closing into a fixed position to centre the way your lower jaw functions.

I am wearing upper and lower ALF appliances to widen my arches and will soon go into Damons for the final phase. I had earlier extraction orthodontics and ended up with multiple issues caused by what they call a 'distally trapped mandible', my lower jaw was forced to close too far back because my upper jaw had been retracted. Symptoms were multiple; killer headaches, breathing problems, dizzyness, neck pain on on it went. I had absolutley no idea the effect of extraction retraction orthodontics would have. Treatment now is walking me back to class 1 occlusion and getting the extracted premolars replaced either with implants of bridges. My posture has improved so much I stand taller no more forward head posture which I think was causing all the tension in my neck and shoulder - the head is heavy and needs to be centred over the spine to properly distribute it's weight. There is some interaction between lower jaw position and this balancing I can't quite explain it but there are studies showing the link.

Symptoms were mainly left sided which I was told is for some reason the most common.

IndyGirl1 09-20-2012 07:18 AM

Re: Trying to determine the cause...
Good Morning Pipdog,

It is amazing to hear how many things they can do with bite plates. I didn't know it was possible to adjust the cant. Is that what an aqualizer is designed to do? I read about it and it uses water to level out the bite. Maybe you have heard of it?

It sounds like you have/had a very extensive problem with your jaw. I am very sorry to hear that. It seems many people undergo orthodontics and then later develop all of these jaw problems. I was fortunate and had a wonderful orthodontist who did a great job and gave me a beautiful smile. Too bad I got injured and ruined it. haha

I have a rather different question to ask you. It has been bugging me for quite some time now and I have been doing research to try and find out why this seems to be different from the classic tmj cases. My jaw has never popped when I open my jaw wide..straight up and straight down and when I chew and so forth. I can't open my mouth very wide but that is because of the muscle tightness. I can only pop my jaw in and out of place from moving my jaw sideways. Isn't that crazy? It simply just does not pop when I open my mouth to talk or chew or yawn. I know how to pop it in and out as I used to pop it all the time before I became symptomatic as it felt good to do. Now I have trained myself to not pop it in that manner, but I can't figure out why everyone else's pops when they open too far and mine only pops when I move it a certain way to the side. NoOne has an answer so I thought possibly you may have an idea. If not, that is ok I will just have to keep asking dentists and doctors about it lol.

It sounds as if for the most part your headaches have subsided, is that the case? I sure hope so! Have you tried any other treatments possibly prior to starting with your current dentist? I am trying to make a list of other treatments that I could try that are conservative that have helped other tmj sufferers with some of their never ending symptoms.

I hope I have not asked you too many questions. Have a WONDERFUL day Pipdog, and thank you again for being so helpful and kind to me.


Liquidplasma 09-20-2012 07:52 AM

Re: Trying to determine the cause...
Indygirl is your lower jaw crooked when biting or just when your mouth is open naturally?i ask because my tmj doctor which I'm starting to doubt, says my bite is fine .yet when I just open my mouth naturally I can see my lower jaw slants to one side like you. I them question is it my tight muscles causing this or are the tight because of this.

IndyGirl1 09-20-2012 08:14 AM

Re: Trying to determine the cause...
Hello There LiquidPlasma,

I am going to try to make this as clear as possible but it is very hard to explain. I have injured my right disc and it is out of place and is obviously causing muscle tightness in the right joint area. My jaw shifts slightly to the right and is like that all day every day. If you were to draw a line from my nose down to my jaw you can clearly see my jaw sits to the right slightly. However when I talk about the slant I am referring to my teeth and the way they look. My bottom row of teeth are not even, the right side pull up slightly. When I relax my jaw I can see they rise higher on the right and when I close my jaw you can still see that side is higher. I attribute this to the jaw joint being out of place and sitting in a more awkward, less level state.

If you have had an mri that shows a disc displacement on one or both sides then it is probably a combination of the joint being in an incorrect position in addition to your muscles being tight. If you have had an mri that shows both discs are in place and working properly then you have an easier to correct muscle dysfunction. I am sure tight muscles can cause a slant to some extent as well.

I hope I have not confused you. Maybe you could tell me more of your story when you have time? Have a wonderful day.


Liquidplasma 09-20-2012 04:30 PM

Re: Trying to determine the cause...
Thanks for the reply.I thought we had the same thing but in my case the jaw on the sides is even. I have a slight slant to the left when my jaw is relaxed but very minor. My muscles are tight because of a horrible posture problem I'm working on however this is a long process. I'm just trying to figure out if I need an adjustment splint although the myofacial clinic says I do not given my bite is aligned. I doubt this but I'm no expert either :( I wish specialists on tmj existed in Montreal

IndyGirl1 09-24-2012 01:58 PM

Re: Trying to determine the cause...

I hope you're having a good day today. It sounds as if yours may truly be muscular in nature. Posture can have a huge effect on the entire body. Have you looked at your hips and shoulders? Is one side higher than the other? Many muscles can tighten/shorten and pull on the jaw. The sternocleidomastoid is just one of those muscles that can pull on the jaw and cause pain.

Unless you are noticing a difference in your bite or clicking and popping within the joint on one or both sides then it is probably muscular in nature for you. I would work to address your posture. In addition to your posture it wouldn't hurt to address any stress you may be having. Stress can cause clenching which can also hurt the muscles of the jaw. If clenching is found to be an issue for you, a splint can be used to help try and stop that from happening at night but it would be best to address the cause of the clenching. Certain medications have been known to cause clenching so be sure to make sure nothing like that could be happening in your case.

Are you making sure to give your jaw a break? Make sure to eat soft foods and use moist heat on the joint area and muscles when you have a chance.


Bellamq 09-29-2012 08:29 PM

Re: Trying to determine the cause...
It is very difficult to determine the cause of TMJ. It is different for everyone. If your bite is off, then that's the problem, and if not corrected, it can get worse. I went to 2 orthos and a head & neck surgeon when I first got TMJ and they all told me that the problem wasn't my bite. It was muscular and I was clenching/bruxing unconsciously at night. So... I took muscle relaxants, bought hot pads for my jaw, did acupuncture, did physical therapy, got botox injections, did massage therapy, and wore a hard acrylic splint at night, all in the hopes that my masseter muscles would eventually relax... They did not.

My bite has gotten progressively worse with time, and now the orthos are saying it's my bite. Oh... and my facial pain switches sides as well. Botox works for the pain. The pain you have is caused by the tightness of your muscles. Botox essentially causes your muscles to atrophy (relaxes them). But it is just for the pain. If your problem is truly muscular, 2 rounds of botox should do it. But, if it is in fact your bite, no amount of pain pills, tranquilizers or botox will take care of the problem permanently... only orthotics.

IndyGirl1 10-01-2012 07:05 AM

Re: Trying to determine the cause...
Hi There Bellamq,

Thank you for responding! I am happy to hear the botox has worked well for calming your symptoms down. I decided against trying it as I had heard it works well the first time and then later treatments lose effectiveness very quickly.

If you don't mind me asking, how did your symptoms present? What does your bite look like now?

It is very unsettling to hear that you tried all of those conservative therapies and got absolutely no relief. What type of appliance do you wear now and are all of your symptoms improving?

I did try accupuncture for two visits but perhaps I didn't give it long enough? I am looking into myofascial release now. I'm hoping that might help out with the muscle tightness in my sternocleidomastoid and trap muscles.

Did you find that you felt best in the morning? Mine progresses as the day goes on, but I feel relatively well for the first couple hours of the day. That makes me feel like it is not a clenching problem. If I was clenching my teeth all night I feel like my symptoms would be way worse in the morning upon waking but it is the opposite.

Looks like I will be looking for a functional orthodontist to visit here soon. Darn, I hate doctors. :(


Bellamq 10-03-2012 01:40 PM

Re: Trying to determine the cause...
Hi IndyGirl1,

I tried botox 3 times before it actually worked. Each time, the doctor upped the dosage. It wasn't until he gave me 100 units of botox (which is a lot) in my left (problem) masseter that I felt relief.

My symptoms started with what I thought was a toothache. The back 4 teeth of my lower left side were throbbing and I thought it was due to an abscessed tooth or something. In the beginning, my bite was just fine.

I had an unnecessary root canal done which only made the problem worse. After the root canal, the pain began switching sides of my mouth and more symptoms popped up (ear pain, headaches and noticeable jaw muscle pain).

About 2 weeks later, I noticed that my bite was slightly off. That's when I went to all the orthos and doctors who said that the problem wasn't my bite.

Today, I have a significant open bite. Only 4 of my teeth touch when I clench them, and now, I have to get it corrected with an orthotic splint, then braces.

I don't wear an appliance now (because they weren't helping -a bite guard will protect your teeth, but won't prevent clenching), but I do take medication before bed and during the day. I take 50mg of Nortriptyline and 1 mg of Clonazepam before bed each night, and it definitely helps.

I also take .5 mg of Clonazepam in the morning because like you, my pain progressively gets worse throughout the day. I usually feel fine in the morning, but around 5:00pm, the pain is much worse. Don't automatically assume that if you feel better in the morining, you aren't clenching, because I thought the same thing, but, after nearly cracking through my hard acrylic splint, I realized that I was in fact grinding/clenching.

Acupuncture didn't help me at all. I went to 10 sessions, and experienced no real pain relief. Myofacial release will help with the pain, but it won't solve the problem. You have to find the root of the problem and correct it.

Hope this helps :)

IndyGirl1 10-04-2012 07:03 AM

Re: Trying to determine the cause...

When your symptoms all started, back when your rear teeth started to hurt on that one side, were you under any significant stress? The reason I ask is because when all of my symptoms cropped up I was really stressed out. Maybe I really am clenching a little when I sleep. It never occurred to me that it could be possible without feeling worse in the morning... strange.

I've heard that once you start clenching it is hard to train yourself to stop, even after your stress that caused you to begin clenching in the first place is gone, you still are left with the clenching. I wonder if a hypnotherapist could help? Sorry if you think I'm crazy, but I just really don't like taking medicine. I know at some point I will have to. I was in incredible occipital nerve pain for 10 months and only took a couple advil to make it through the day. It's funny though, I had a drawer full of different meds that doctors gave me and I didn't touch any of them.

Thank you so much for your response. It has given me much to think about. I am so happy I found a clencher that doesn't feel worse in the morning. I hope you have a great day!


Liquidplasma 10-04-2012 04:36 PM

Re: Trying to determine the cause...
Well after seeing another tmj expert I'm good on and disk or structure problems . I bought two books on tmj and am doing the exercises for the tongue, mouth, neck snd jaw muscle relaxing techniques. Wow what a difference my jaw feels relaxed much more so these exercises truely work!

Bellamq 10-08-2012 07:11 PM

Re: Trying to determine the cause...
Hi Indygirl1,

Yes. when my symptoms first popped up, I was under a tremendous amount of stress. And you are absolutely right. Once your body gets into the habit of clenching, it is difficult to stop, even after the stressful period is over.

All I know is that my bite has gotten progressively worse since this all began about 2 years ago. And now, the orthos are saying that I will never stop clenching until my bite is corrected. Info I could have used 2 years ago. Anyways, please also know that a lot of doctors don't know what the hell they are talking about when it comes to TMD/TMJ. It is not a condition that has been thoroughly studied or understood. I hope you find a good doctor who knows more about it = ) and I would try hypnotism, what could it hurt?

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