E.T. Registered User

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!

vishal Registered User

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.

Big_G Moderator

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.

E.T. Registered User

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!

vishal Registered User

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

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

vishal Registered User

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.

E.T. Registered User

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.

nettlesoup Registered User

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.

splanc Banned

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

Murph05 Registered User

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.

Kila Registered User

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.

Murph05 Registered User

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......

Big_G Moderator

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...

girlingalway Registered User

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.

Murph05 Registered User

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

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