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TMJ Disorder -TemporoMandibular Joint Message Board

TMJ Disorder -TemporoMandibular Joint Board Index

[QUOTE=MountainReader;4116880]This is an update from my post above in my process of getting an initial diagnosis.

I actually got a written report from my chronic pain/jaw disorder Dentist today. It gave a summary of my current history of concerns, my past history and my functional history. It also had a summary of my physical exam, a detail of the imaging they did and what the impressions were of the dentist. Here are pieces of what he said:

Basically the physical exam showed: tenderness over the right masseter muscle, significant subluxation in both jaw joints due to extremely weak ligaments in the jaw joints. (He said it was fortunate I haven't had any catching or locking at this point.)

Evaluation of dentition and bite relationship: strong evidence of severe bruxism, extensive wear on all molars.

Imaging: He described exactly what type of imaging they did in detail. Findings from the imaging: Significant erosion on both condyles. Loss of 25-30% of the bone on the ball of both joints. Fortunately, "she" continues to have cortical bone on the articular surface of both condyles.

Impressions: "I" clearly have a severe parafunctional jaw habit of clenching and grinding "my" teeth. "I'm" also starting to significantly destroy her teeth beause of this harmful habit. "I'm" at risk for developing arthritis in my jaw joints in the future, especially if this problem is not managed adequately.

Recommend further assessment by my pulmonologist for further assessment for sleep apnea. Brusixm is now thought to be actually physiologic in individuals with sleep apnea. This is because they are attempting to maintain their airway by this parafunctional habit.

Individuals with hypermobility syndrome and genetically weak ligaments are predisposed to chronic musculoskeletal pain, including neck pain, shoulder pain, back pain and jaw pain. Weak ligaments is the cause of the instability in her jaw joints, and can contribute to bone loss and jaw joint disfunctions. While she does have a significant jaw disorder and harmful parafunctional jaw habit, this problem is part of a larger clinical picture. These symptoms are clearly having an impact on the quality of her life and imparing her ability to function.

He then included a summary of the steps I listed in the post above as recommendations for treatment. He also sent a copy of this to my dentist and the PT he recommended who specializes in orthopedic PT for treatments of my specific disorders.

Most of this I understand pretty well. I do have a [B]question for those of you on this board[/B] though.

How much bone loss is "normal" on the condyles in your 30's? How fast does bone loss typically continue once it has started?

Anyone else on this board have TMJ as a result of weak ligaments and subluxations? If so, did you do PT? How successful was it. I'm going to schedule an initial appointment, but it is $85 for the first and $75 for all follow-ups. Way out of my budget to continue. I hope I can get some things to try at home.

Anyone been diagnosed with Sleep Apnea based on your jaw issues without the accompanying snoring or gasping that are more typical of sleep apnea?

Frustration for me: I have to convince another doctor I need a sleep study to try to get it covered by insurance when my main symptom is the bruxism. Even with insurance, I need to come up with a couple thousand out of pocket for the sleep study.[/QUOTE]

Hi there--I'm really impressed with how your doctor is handling your case. He is extremely thorough, and that's excellent. I too have bone loss in my condyles, partly due to a whiplash accident, braces being done wrong on me creating a bad mandible position for 19yrs., and bone loss from constant spasms in my jaw for so long. If you are put in the correct madibular position by your new doctor, and your muscles settle down and learn to adapt to the position, which by the way will happen over time, you actually can grow back bone, I have been told. It's absolutely not a hopeless story like some of these doctors are telling us. Some orthodontist/dentist's don't even believe that expanders will work on palatial reconstruction in an adult, and that's simply not true. So many are too quick to send us to oral surgeons, when we really need to get to tmj specialist that are expert in treating us with Functional Jaw Appliances...I know this, because I've personally come across many in the last yr. myself. Don't focus on the bone loss, it will get better in time.
As for physical therapy for your condition, I believe that it is crucial in the healing process if you really want to be cured. I know it's expensive, but if you start with once a week for a while, and then maybe go to everyother week, you might be ok with that. Doing what they tell you to do on a daily basis is crucial to getting your muscles back in proper working order, I know this to be true, I'm in the process of doing this as we speak with my PT. I have been going 2x a week for almost 4mo, then recently dropped down to 1x a week, and have shown improvement. IT's clearly shown on my current x-rays. Let me know if you have any questions about my treatment, I would be happy to compare notes w-you. I wish you the best..J. :wave:
PS--about the sleep study, I would definitely get one done if I were you. They are an important role in determining what is going on with your case, can't they bill under sleep apnea w-your medical physician's office? That's what I was told could happen.

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