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TMJ treatment - looking for other people's experiences

  • 14-06-2009 3:34pm
    #1
    Registered Users Posts: 1,170 ✭✭✭


    I'm looking for some feedback from people with bad TMJ who've had it successully treated. I've had TMJ for years, finally met a dentist who's referred me on to a specialist. I've had splints, physio, osteopathic treatment, cranio-sacral treatment (actually found that good but way too expensive) and I've been given completely different advice from various dentists along the way. One guy (who another dentist told me wasn't fully qualified for what he was planning to do) wanted me to wear a contraption involving steel rods attached to braces in my mouth for 2 years 24 hours a day to pull my upper jaw forward, followed by a few years of orthodontic work, and another has told me I need to have an operation to break and re-set my jaw, followed by a few years of orthodontic work.

    Before I meet the specialist I'd like to hear from people who have had the jaw re-setting done, or who have experienced successful pain relief in any other way. I can't take anti-inflammatories, I've had valium prescribed a few times because I end up with my neck muscles getting so tight from the TMJ that I can't move it, but obviously that isn't a long term, or daytime solution! I'm experiencing a lot of pain at the moment and I've never felt that my jaw muscles were this tight before (I've been diagnosed for over 12 years), I just really want to get something practical done now.

    Thanks in advance for any feedback/advice/stories!


Comments

  • Registered Users Posts: 698 ✭✭✭vishal


    reading your story, i doubt it that those steel rods were to bring your upper jaw forward but rather to bring your lower jaw forward. it's actually called a Herbst appliance.
    it is used seemingly quite a lot in Germany to recapture a lost disc in Adults but it's use in UK/Ireland on Adults is quite controversial.

    Surgically advancing the lower jaw will leave your disc is the same place, so I doubt this treatment will solve your TMJ pain if the problem is that your disc is displaced.

    What you really need is a diagnosis.

    orthodontics and surgery will improve your appearance but probably may not give you relief from jaw pain, unless it is related to deep bite or crossbite, so keep this is mind. surgery has it's own risks so don't take the decision thinking it will fix your jaw pain, rather if you are gonna do it, think about in a way that it will improve your appearance.


  • Moderators Posts: 1,589 ✭✭✭Big_G


    TMJ is a notoriously difficult thing to treat. I agree mostly with what vishal has said, but would like to add that orthodontic treatment can exacerbate TMJ issues as during treatment, the relationship between the teeth is an unstable one.


  • Registered Users Posts: 1,170 ✭✭✭E.T.


    Vishal - the appliance was definitely to bring my upper jaw forward - it's my lower jaw that's already protruding. It was the only time I'd ever heard it suggested that my upper jaw be brought forward - I've since heard that the treatment is very experimental and controversial, so I'm glad I turned it down point blank, despite a few scare tactics from the person involved. Cosmetically I really don't care about crooked teeth or the jawline, but painwise I'm getting fed up at the moment!


  • Registered Users Posts: 698 ✭✭✭vishal


    never heard of any appliance to bring your upper jaw forward except a facemask or a tandem appliance, but as far as i am aware they are not used to treated TMJ and also only used to treat children. http://www.johnsdental.com/pdfiles/orthopdfs/Tandem.pdf
    http://www.orthotechnology.com/new_products/images/facemask.jpg

    This is what I thought you were talking about http://www.braces.com/6022.html?*session*id*key*=*session*id*val*
    Commonly used on growing children in Germany and United States


  • Registered Users Posts: 698 ✭✭✭vishal


    Big G is right.
    TMJ is notoriously difficult to treat and unfortunately no consensus exists among dentist on how to treat.
    Some people recommend soft splints, others say it can make the problem worse over time. Other recommend hard splints, full coverage flat plane splints, Michigan Splints, NTI splints, Anteriorly repositioning Splints. The list goes on and on, many of these can cause problems over time.

    The role of orthodontics in TMJ is also very controversial and can cause other problems or may relapse or may do nothing at all to relieve pain.
    The general consensus is it does temporarily reduce TMJ pain because the pain of having all that extra stuff in your mouth and the discomfort involved in moving teeth will distract you from your TMJ pain.
    That is why I said, if you are gonna get ortho and jaw surgery you would really only want to do if you want to improve your appearance rather than expect relief of TMJ pain permanently. If you get relief permanently it's a bonus.

    Dentist can only control the teeth but probably the biggest factor in TMJ is stress.


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  • Registered Users Posts: 1,170 ✭✭✭E.T.


    Vishal - the facemask picture you left a link to is similar to what was recommended for me, but your one is far more attractive! When I said there was no way I could wear it 24 hours a day for 2 years the dentist said well imagine how much pain you'll be in when you're 60! I actually cried when I got home that day, and it takes a lot to get me that upset! As far as I can remember it was 2 metal rods on either side of my face with a black band around the top of my head, attached to braces in my mouth and with a matching black chinstrap. I'd have literally scared small children walking down the street.
    Saying no to that scenario aside, my appearance doesn't bother me, so there's no way on earth I'd have any kind of surgery on cosmetic grounds. Cosmetically I've been told my teeth aren't too bad, but orthodontically they're extremely complicated.

    Are there any medications available to treat TMJ pain? I'm using over the counter painkillers at the moment (I can't take anti-inflammatories), but I know this isn't a great solution. Wearing a splint/biteguard during the day isn't an option as I'm a teacher so I need to be able to speak clearly, I've never found that they made a huge difference anyway. I just want to have some questions ready to ask the TMJ specialist I'm going to see, and to hear what other people are using/finding helpful.


  • Registered Users Posts: 42 nettlesoup


    E.T. if you don't mind could you PM me the TMJ specialist's name and location. I hope you have some success with them.

    I have TMJ for about 4 years now, no pain just clicking/popping on the left hand side of my face.


  • Closed Accounts Posts: 7 splanc


    Have you tried to use the simple TMJ Appliance - Myofunctional Research Co. Australia

    I did and it help my TMJ condition.
    For want of a better work it is a sdimple device pretty much like a gum shield


  • Registered Users Posts: 4 Murph05


    The general recommendations re TMJ management / treatment is first 'do no harm'. Therefore TMJ surgery, orthodontics and jaw splints that change the bite or the jaw position permanently are not recommended. If the problem is chronic, it is best to get the opinion of a dentist with advanced training in this field. There are a varying number of conditions that require management and it is not a 'one treatment fits all' programme. Beware if somebody suggests carrying out irreversible treatments - it is not clinically or scientifically. Most patients get better with time and conservative management. TMJ problems are not associated with bite problems, it is therefore unnceessary to change ones bite with orthodontics. The key to getting better it trying to figure out what is perpetuating the problem (pain, clicking, locking etc), eliminating this and unloading the TMjs.


  • Registered Users Posts: 436 ✭✭Kila


    I'd recommend maybe heading to www.archwired.com for some opinions also. There are a number of people there having various orthodontic procedures for TMJ including braces, other fixed and/or removable appliance, surgery, etc.

    You may get some decent info over there from people in the same situation as you, and from people who've tried many different ways to fix it.


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  • Registered Users Posts: 4 Murph05


    there is no indication for orthodontic therapy for the vast vast majority of tmj problems. the rules thay govern decision making in dentistry clearly state this- the scientific literature will back this up also. if sombody is having orthodontic treatment for a tmj problem - they are being misguided - a very good resource is tmj.org - go then to the FAQ section and all your answers should be answered honestly. dentistry is a business ullimately and ortho is an expensive treatment plan......


  • Moderators Posts: 1,589 ✭✭✭Big_G


    I think we need to differentiate here between certain painful conditions of the face. TMJ and myofascial pain possibly have two different aetiologies. The symptoms are similar and can often overlap.

    I have seen cases of crossbite that are clearly causing the patient myofascial and odontogenic pain. I suspect that if these positional issues were corrected that the pain may go away.

    That is not to say that ortho can fix TMJ which is likely a different animal entirely. Nor is it to say that myofascial pain can be counterintuitive in its aetiology. Admittedly to me, the whole thing can be very confusing.

    However, I find Jim Boyd to be an enlightening speaker on this issue. But there are umpteen schools of thought on this and very little consensus. I've heard of people spending thousands of euro on neuromuscular dentistry and it seems to be very well respected, but I also know of a dentist in the UK who has gotten into trouble for using the same treatment philosophy because it is considered unproven. The famous LVI and Bill Dickerson have built their careers and business around it.

    Ultimately, what works for some may not work for others because of the complex nature of the disease and the possibility of the contribution of top down mediation. Dentists are not neurologists, and neurologists not dentists...


  • Registered Users Posts: 12 girlingalway


    Dr Dermot Canavan in the Galway Clinic treats alot of patients with TMDJ Disorders. He is suitably qualified and it would be worth making an appointment to get his opinion. I've referred a few patients to him who were pleased with his treatment. He also works some where in Dublin.


  • Registered Users Posts: 4 Murph05


    A number of good points are made and as such this is a public forum it is reasonable to summarise for those afflicted with the condition -
    As already stated 'TMJ' is not a single disorder but consists of a myriad of conditions. It can be a muscular problem or indeed it can be strictly related to the jaw joint (tmj). It may be entirely a pain problem or some people may complain of issues such as clicking, locking and difficulty opening.

    The mode of treatment varies depending on who you speak to. The evidence clearly states that patients should be treated conservatively - in other words nothing irreversible should be done. Therefore orthodontics and surgery are not first line treatment options. Treatment is generally based around specific jaw exercies, correcting jaw posture, eliminating bad jaw habits, or wearing a splint at night if one grinds there teeth.

    Most jaw / tmj problems get better by adhering to these guidelines. A lot of tmj problems get better without treatment - just simple advise. The singlemost important step taken is getting advise from a dentsit with training in this field if the problem is not resolving. The diagnosis is the most important step - once this has been establised the patient will play a key role in getting themselves better


  • Closed Accounts Posts: 33 ILOC


    Hi
    I have had Tmj since April this year. It started after the dentist filled my wisdom tooth and had my mouth opened for at least 40-45 mins.When the numbness wore off I was left with this horrible excrutiating pain. I went back to the dentist who I feel fobbed me off with a mouth guard for teeth grinding and I have been using that every night since with little or no release. The constant pain since April is starting to ruin my life. I have researched alot online and found a person who suffered with this problem but he had a misalignment in his shoulders( one was lower than the other) this prompted me to check my shoulders and they were also misaligned. So I started seeing a spinologist who is charging me 50euro per visit and I will have my fifth visit this weekend. I am on the dole and am having to resort to asking my parents for help to pay for treatment. My question for anyone out there is: Has anyone ever been treated for TMJ by a spineologist and if so could they share their experiences? Just so I know that it will eventually work or if I am wasting my parents money. Its just that right now all it seems to have done is make it worse The pain used to be just below my right ear but now it is behind my eye in my shoulder my neck my face under my eye it has spread to al these places since I started the spinologist treatment. I have also stopped talking, laughing, yawning and chewing anything other than soup or mash potatoe or yogurts so as it will have time to rest but nothing has worked. Plus I am really really terrified this is just something that I am going to have to learn to live with because there doesn't seem to be a cure for it. I usually have a very high pain threshold but right now this second the pain in my jaw has me in tears as I write this. Anyone with even the smallest bit of information that may be of help I would be so grateful if you could reply. This pain is ruining my life and I am only 25.


  • Registered Users Posts: 4 Murph05


    Hi There

    i have a lot of experience with TMJ problems over the years and thankfully it is now stable.

    I was a bit like you initially and did not know where to turn. The most important thing for you at this stage is to get the correct diagnosis. If you have TMJ you should be treated by a dentist with specialist training in this field.

    You may also be treated by a spinologist but ultimately they will not get to the bottom of the problem. I was treated by several dentists, physios and a chiropractor before I attended a dentist with advanced training in Cork. If you want further info send me a PM.


  • Registered Users Posts: 436 ✭✭Kila


    I'd recommend that you stop seeing a spinologist (because it's a made up profession with no certifying body that has been widely discredited) and see another dentist or other certified medical professional.

    Ignoring the problem, or treating it with unproven alternative medicine, could leave you with chronic pain issues long term.


  • Closed Accounts Posts: 1 pollyrodgers


    <snip> Please read the charter.


  • Closed Accounts Posts: 33 ILOC


    Hi Murph05 Thanks so much for gettin back to me.. Honestly I have no idea how to pm on here but I am so interested in that doctor. Any details like how much he charges and how to contact him would be brilliant. Maybe if you could pm me. That'd be fantastic. Thanks again. Also you said that your TMJ was now stable. How did you get it to that point and do you ever get pain now. Thank you so much.

    To Kila.. I had no idea spinology had been discredited. Thanks for the heads up :)


  • Registered Users Posts: 436 ✭✭Kila


    It's a fairly suspect profession because there's no certification or anything like it. Technically I could set myself up as one tomorrow. If you're getting relief from something, and it's not damaging you further, then it's working for you. I would just be wary of you being damaged further by someone who has had nothing but a pseudo-science course in bone manipulation.

    If you do a bit of googling on Spinology you'll find plenty of resources, and I recommend reading books such as Bad Science, Suckers, and Trick or Treatment for information on various alternative therapies.

    Hope that what I said helped, and also I'll again refer anyone with TMJ pain to visit http://www.archwired.com as many members there suffer from it and are in various stages of different treatments for it.


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  • Closed Accounts Posts: 909 ✭✭✭marti8


    OP, you asked for other peoples experiences so here's mine. About 3 months ago I went to a dentist for a simple checkup and an xray (what's called a panoramic xray) Anyway, the moment I opened my mouth he said whoa! Somethings up here, you have TMJ. Funnily, other dentists I had seen just a couple of weeks earlier hadn't mentioned TMJ at all? I went on to explain to him that I've had tinnitus for months - non-stop. I'm also in reciept of a disability payment for depression (not a total suicide case mind you) so having this sure doesn't help. As I'm a medical card patient that dentist wrote to the local HSE dental section who have referred me in turn to a specialist at the Cork Dental Hospital. catch is I could be waiting upto 18 months to even see the specialist. Got back onto the HSE and they've also referred me to a specialist who visits their clinic once a month who hopefully I'll see within a few months, ha, hopefully.

    I'm on Ponstan and Amitriptyline at present to deal with the pain and try to reduce the tinnitus - goodluck with that me thinks! Amitriptyline was developed as an anti-depressant but has secondary off label uses. Constant tinnitus is a ****.

    I also have problems with two molars which need root canal done. Having one root canal done this coming week. A typical dentist will charge say €600 - €700 for a 3 root canal but at the Cork Dental Hospital a student supervised (better be!) by a trained dentist does it for €150 (€50 per root) Makes a difference when your only income is social welfare. So while I'm in pain it is a mix between roots and TMJ. Roots will be sorted soon and any pain that's left will be all TMJ I'd expect. From what I've heard many have TMJ but no pain. I've jawpain, a kinda dull face pain, a kind of "tension" in my head/face, earache sometimes, pain in my left temple and head sometimes (had a brain CAT scan a week a go for that - just incase - while I was having a CAT scan for my sinuses for a totally different issue that I'm seeing an ENT specialist about) and of course the bloody tinnitus- non stop. The only time it stops is when I sleep. Must have been like that for 6 or 8 months or so now.

    The original dentist I saw recommended a splint, a soft one. I had thought hard ones were better however? But they are also more expensive as far as I know. He'll charge between €130 and €150 for a consultation and soft splint moulded on my teeth - it doesn't just cover a few teeth as I've seen some splints do but rather the full row inc.molars. Not sure if it's both up and down, hopefully it is. But it'll be free if I wait to see the specialist who the HSE have referred me to. I've also heard of biofeedback devices etc to deal with TMJ but on't know anything much about them.

    Having TMJ is a mess really, you kind of fall between dentistry and medicine it seems. And if you are a medical card holder the services offered for dentistry are very limited, more option sthrough medicine. When I told my doc I had TMJ she didn't even check my jaw or anything just accepted what the dentist had said - but then primarily TMJ would be a dental issue yet it does cross into maxillofacial and neurological areas from what I understand. Hope things are going ok for you anyway.


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