TMJ? flare up - what should I do?

QuiteInterestin

Hi all,
Hope someone on here can help. I think I have TMJ syndrome. While its never been said to me for certain, my dentist thinks an infection in my wisdom tooth last summer set of an underlying problem in my TMJ joint. At the time I was getting pain up each side of my face, pain in my temples, sore ears and I could only open my mouth about 2cm. At the time I visited a doctor who thought my symptoms were caused by a throat infection and gave me antibiotics to clear it and also told me to visit a dentist once the infection cleared as it may be my wisdom teeth. When I visited the dentist he said he thought the problem was due to the joint in my jaw and referred me on to a specialist. In the meantime I was attending physio for neck/shoulder problems, and when I mentioned my jaw pain/restricted opening, the physio worked on that and got my jaw opening fully again and gave me an exercise to keep it moving. My symptoms were alot better by this point, just occasional aching down my face. When I attended the specialist, he recommended jaw stretches and anti-inflammatories, which didn't really help so then he recommended a hard splint, which I got in May and have been wearing since at night.

Things had being going grand since, until last weekend when it suddenly all flared up again and I'm back to where I was last year. Have the face and ear pain and splitting headaches and finding it difficult to open my mouth and eat. While my jaw hasn't locked, its getting difficult to open it (though I'm back doing my stretches which I hope will prevent it locking like last time). So my question for all others with this condition, what do ye do when ye get a flare up? I'm not sure if its a wisdom tooth infection ( though I'm rinsing my mouth out with salty water just in case) or something else (I've being having problems with my sinuses recently too) thats causing this flare up. Should I attend a doctor or dentist or physio? Should I just keep taking nurofen and using heat packs on my face and hope it'll ease off in its own time? Any advice appreciated!!

Susie564

I'm not really in a great position to advise you as I'm still in a bit of a jocker myself I have really struggled with my sinuses all along & been on many courses of antibiotics to cure a "sinus infection" - which was never there in the first place. For me the best I have found to alleviate my painful and congested sinuses is Olibas oil and applying heat.

The jaw stretches don't seem to have any effect to me. I wear a soft splint for a couple of hours a day and I find it really eases my pain. I am currently looking into having arthrocentesis (on the reccommendation of my consultant), if anyone has any experience of this I'd really apreciate hearing it.

As to who to go to - my choice would be to the dentist first, esp as you are concerned about your wisdom teeth.

carrickmilo

I've been through the loops with TMJ and may be able to offer advice. If you aren't able to open it means the disc is 'anteriorly displaced'. This happens when the mandible (lower jaw) is too far back. The usual treatment is a repositioning appliance to move the mandible forward to 'recapture' the disc. The way the upper and lower teeth meet, the occlusion is intimately tied into the functioning of the TMJs.

There are specialist in Ireland who know how to treat this. PM if you need names

QuiteInterestin

Thanks for the replies. Things seem to have improved a bit (fingers crossed, touch wood etc). Hopefully it'll clear up in its own time. I do think its my wisdom teeth being infected setting of the TMJ problem, they're impacted and I need to have them removed, but with the problem with my jaw I'm reluctant to have them removed until I really have to. Its such an annoying problem to have, especially when you're not even sure who to go to when it gives you bother. The teeth are the dentists problem but the jaw joint is more the doctors.

Susie564 wrote: »

The jaw stretches don't seem to have any effect to me. I wear a soft splint for a couple of hours a day and I find it really eases my pain. I am currently looking into having arthrocentesis (on the reccommendation of my consultant), if anyone has any experience of this I'd really apreciate hearing it.

Sorry you're not having much luck with yours, hope your procedure goes well. I wear a hard splint at night, it takes some getting used to but hopefully it'll sort out the underlying problem.

carrickmilo wrote: »

I've been through the loops with TMJ and may be able to offer advice. If you aren't able to open it means the disc is 'anteriorly displaced'. This happens when the mandible (lower jaw) is too far back. The usual treatment is a repositioning appliance to move the mandible forward to 'recapture' the disc. The way the upper and lower teeth meet, the occlusion is intimately tied into the functioning of the TMJs.

There are specialist in Ireland who know how to treat this. PM if you need names

Thanks for this, but my jaw didn't lock this time (so far) so I'll keep away from any unnecessary appliances for the time being.

Esel

QuiteInterestin wrote: »

I do think its my wisdom teeth being infected setting of the TMJ problem, they're impacted and I need to have them removed, but with the problem with my jaw I'm reluctant to have them removed until I really have to.

Sounds like a chicken and egg situation?

Big_G

carrickmilo wrote: »

I've been through the loops with TMJ and may be able to offer advice. If you aren't able to open it means the disc is 'anteriorly displaced'. This happens when the mandible (lower jaw) is too far back. The usual treatment is a repositioning appliance to move the mandible forward to 'recapture' the disc. The way the upper and lower teeth meet, the occlusion is intimately tied into the functioning of the TMJs.

There are specialist in Ireland who know how to treat this. PM if you need names

This is at best an oversimplification and at worst wrong. And it may not apply to what this person is experiencing. There are people who would completely disagree with the last statement (I'm not saying I am one) with regard to the relationship of the teeth and the TMJ. In my opinion, a significant proportion of this type of pain is not from the joint but from the muscles. The joint has to become very degraded before it starts giving pain, like any other joint in the body.

Please everybody, let's not engage in giving treatment advice. The best advice is to attend the dentist and maybe to see a specialist for treatment. The correct treatment will follow from the correct diagnosis which we simply cannot achieve on an internet forum.

Susie564

It seems to me that there are a wide variety of problems all lumped in under the heading TMJD. Even though the cause/actual diagnosis may be completely different a lot of the symptoms are similar. I find it very useful to hear how other people with this condition cope or treat their symptoms. I feel confident in the specialist I am now attending, but still need to cope with the symptoms in the meantime.

btkm8unsl0w5r4

Its a very complex area and there is a lot of Schools of thought on treatment. Any dentists that treats this tends to follow their learned philosophy with religious fever and often instils this into their patients.

You go to a person that feels its based on occlusion and you will get your teeth adjusted, crowns, or orthodontics.

You go to a person that feels its based on joint biology and you get treated with medications.

You go to moderates and they treat both ways but use splints are they can restore occlusion without the irreversible nature of crowns etc.

There is no right or wrong answer. The fact is that a lot of patient get better over time regardless of what you do, placebo and nocebo are strong in TMD (this does not mean its not a real problem just that it self resolves in a lot of cases, tend to return from time to time also).

Occlusion may play a factor but experimentally it has not been shown that people with problems with their bite have more TMD than those without, also creating artificial experimental problems does not create TMJD It has been show that people who receive orthodontics don't get TMJD nor do those with TMJD to start with get better.

Very complex issue. Beware anyone that claims to have the definitive answer. If however you find something that works for you share it, but dont assume its a panacea for all.

Good luck

carrickmilo

Big_G wrote: »

This is at best an oversimplification and at worst wrong. And it may not apply to what this person is experiencing. There are people who would completely disagree with the last statement (I'm not saying I am one) with regard to the relationship of the teeth and the TMJ. In my opinion, a significant proportion of this type of pain is not from the joint but from the muscles. The joint has to become very degraded before it starts giving pain, like any other joint in the body.

Please everybody, let's not engage in giving treatment advice. The best advice is to attend the dentist and maybe to see a specialist for treatment. The correct treatment will follow from the correct diagnosis which we simply cannot achieve on an internet forum.

The original poster asked for advice. The whole point of message boards is to exchange information.
My input is based on personal experience. Most dentists in Ireland have no idea about TMJ disorders

I had extraction / retraction orthodontics as a teenager, finished as a class 2 division 2, mandible set too far back causing compression and damage to both TMJs, bringing the mandible forward resulted in cessation of TMJ pain, clicking & increased opening to 55mm.

These are facts, not opinions.

btkm8unsl0w5r4

carrickmilo wrote: »

I had extraction / retraction orthodontics as a teenager, finished as a class 2 division 2, mandible set too far back causing compression and damage to both TMJs, bringing the mandible forward resulted in cessation of TMJ pain, clicking & increased opening to 55mm.

These are facts, not opinions.

There are ten of millions of people with class II division II jaws out there either natural or orthodontically created that have no TMJD above the general population incidence. Cause and effect seems to make sense in your case, but could be alarming and untrue for almost all others. As we discussed before extractions for orthodontics also have been well proven not to cause increased incidence of TMJD. Also a retruded position doesn't cause TMJD or pain unless its an acute trauma.

I would dispute that your facts are transferable to the OP....

Big_G

carrickmilo wrote: »

The original poster asked for advice. The whole point of message boards is to exchange information.
My input is based on personal experience. Most dentists in Ireland have no idea about TMJ disorders

I had extraction / retraction orthodontics as a teenager, finished as a class 2 division 2, mandible set too far back causing compression and damage to both TMJs, bringing the mandible forward resulted in cessation of TMJ pain, clicking & increased opening to 55mm.

These are facts, not opinions.

If you read the forum charter, we do not give medical advice here nor do we engage in diagnosis for obvious reasons. It is helpful to say that you have experienced relief from your symptoms based on your subjective experience of treatment.

Based on the current state of TMJDS science, that is exactly what it is - opinion. The only fact in that statement is that you've experienced relief in symptoms.

As fitz said, some people experience relief with a neuromuscular approach, some with a biological/surgical approach, and some with combined approaches. As fitz will tell you, some people are so tightly attached to their own tmj dogma, that at the annual scientific meetings riots have been known to happen. My limited experience of the problem is that not everyone can shoehorned in to one treatment modality, some can though.

maryk123

quiteinterestin

I have this for the last couple of years but recently flared up too, now I wouldnt have it as bad with my jaw not opening. but the headaches are unreal i feel i am dragging myself through the day and i am really tired from it.

however, i went to a cranial osteopath for the headaches and he has been a huge help and definitely helped with the headaches, he was excellent.

hope this helps

QuiteInterestin

Thanks for all the replies,
Went to the doctor who gave me antibiotics for throat/tooth infection so hopefully they will sort things out. She also said to push forward with having my wisdom teeth out (by local anesthetic if possible) and suggested seeing a cranosacrel therapist afterwards. I'm due to see my specialist in November (as I will be wearing the splint 6 months by then) so hopefully if things haven't calmed down by then he will be able to advise me further. Fingers crossed it will all sort itself out...

maryk123

any updates on conditions

i went back to malofacial surgeon and he is slow to injection into the jaw feels it may or may not work and is quite pailful. not happy with meds gp gave (lyrica) thinks acupuncture would work.told him i got great relief from cranial osteopath but cant keep going forever. also feels he could refer me to specialist that would cost price of good holiday but said go on the holiday instead as that may not fix it - its one of those things that cant be truly and fully pinpointed and its definitely stress related.

yes he also suggested mouth guard - i have read up on these and to be honest they dont seem to really work and i feel all i am doing is paying dentist for another thing that doesnt work.

i have neck pain and have to go to get injections there so might do this in the next couple of weeks and see does it make any difference on the head.

anyone any updates on their situation i am sick of headaches - all i am doing is taking painkillers - not taking the lyrica

Susie564

No change for me. Arthrocentesis is working out very expensive and only a temporary fix anyway, so I'm holding off on that for the moment. I tried acupuncture before and it did give me some relief from the headaches and sinus pain but only in the very short term. I can't afford €50 a week forever unfortunately. Like you say, I'm fed up paying out for stuff that doesn't really help. Although I do find the splint helps me. As has been said on here before every condition is very different and what helps one may not help another. I'd be interested to hear how the injections go.