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TMJ Disorder -TemporoMandibular Joint Message Board

TMJ Disorder -TemporoMandibular Joint Board Index

I am in the beginning stages of TMJ. For maybe a year I had a very minor version of it that presented as rare instances of extreme ear pain that lasted about a day. A few weeks ago I got a root canal. He had my mouth open for 2 1/2 hours. Then a week later I got the permanent crown, mouth open another 1 hour. I'm pretty sure this hyperextended my jaw muscles and made my TMJ worse. I did tell him beforehand that I had TMJ, all he did was give me muscle relaxer to take before and after. So almost 4 weeks later I still have symptoms, and based on panaramic X-ray it looks as though my condyles (particularity the left) are slightly out of alignment. My symptoms have slowly improved, but not subsided. (My bottom jaw is now slightly angled to the left/misaligned bite/malocclusion (my teeth don't meet properly) /occasional ear aches and pain/clicking sounds in the joints if I talk for too long/inability to chew/jaw joint inflammation and soreness/neck and shoulder pain/random teeth pain/temple aches).
I'm still in the time frame where my TMJ might go away on its own with "conservative treatment" (pain meds/muscle relaxers/hot and cold compress/facial massages/physical therapy/soft or liquid diet). So it's a wait and see game for me right now.

However, I've been researching obsessively just in case my TMJ increases. Here are some things you should keep in mind when deciding on a TMJ "specialist."

"TMJ specialist" technically does not exist as a profession because it isn't recognized as a speciality and because TMD straddles both the medical and dental fields. (Which is also why most insurance carriers don't cover anything related to "TMD.") BUT "cosmetic dentistry," "smile dentist," etc..are also not technically recognized specialities. So this doesn't automatically discount TMJ dentists. A good TMJ doctor will tell you that there are no guarantees. If someone 100% promised you a cure, run away. They are either money hungry or over confident/ego inflated. A good TMJ doctor will promise to always do his best for you. (A good TMJ dentist should also be able to tell you if his/her technique will benefit you or not, and if not will suggest other doctors or methods.)

Ideally, "TMJ specialist" simply means that some dentists have gone out of their way to continue their education into TMD/TMJ specifically. Not every "TMJ dentist" will be a good bet. They must prove their dedication to the specialty by actively pursuing continuing education and experience in the field while also utilizing the most up to date techniques and technologies to help support their practice and their patients. They will often also pay to send their dental team to undergo this training as well so that their whole practice is educated and useful. A good TMJ dentist will be committed to the patient. They will not constantly try to "sell" you on upgrades or treatments. They will provide a thorough physical and technological examination, diagnose your SPECIFIC TMD symptoms and causes, and then move forward with an informed and UNIQUELY TAILORED treatment plan JUST FOR YOU. Your body and your pain and your TMD will have different requirements than other patients. Your case may be similar to another patient's, but they will never be exactly the same.

Providing a "one size fits all" treatment modality is the first phase in failure. THIS IS IMPORTANT. If your TMJ dentist does not begin by addressing your SPECIFIC concerns and symptoms, the treatment is already less likely to succeed. After determining YOUR needs, a treatment plan should be created for YOU and YOUR condition.
In your consultation or in "phase 1" (if you're seeing a neuromuscular dentist, which most TMJ specialists are) you should be undergoing a ridiculously thorough physical examination (which will probably last a few hours), a thorough medical history, and a thorough testing process with multiple types of technology to determine your specific case, and from there your specific treatment needs. A consultation should never just be a physical exam in TMJ cases. It's just too complicated and multi-dimensional to diagnose with an oral examination. They should look at your mouth, your teeth, your head, your jaw joints, your neck and shoulders, your spine, your posture. Testing should include AT MINIMUM an iCAT scan or CT scan (to study your joints and any possible damage to them), JVA (joint vibration analysis), EMG, TENS, and K7. (Google these terms). An MRI (which will show the muscles involved), T-scan, CMS (computerized mandibualr scan) are other tech may be utilized. The tech is what aids in diagnosis and treatment, but the doctor has to be the one who, based on his training and experience, comes to a solution. Neuromuscular dentistry approaches are typically expensive because they are not covered by insurance. A consultation charge is pretty common. I've had two so far, one was $175, the other $140. It will depend on who you see, where they are located, etc.

The most important thing is to do your own research. Go to their websites (is TMJ just a side thing they offer or is it a main focus? Does it describe their method of treatment? Does it have patient testimonials?), go to their YELP page, their Healthgrades page, contact previous patients of theirs through YELP and see if they would still recommend them, find out if their medical license is still active, where they went to school, what they specialize in, if they've been in a malpractice suits, etc. GOOGLE THEM TO DEATH.

If you do have a consultation, ASK THE DOCTOR QUESTIONS. Make a list and bring it with you. Another good indicator of a good TMJ doctor is whether he or she has the patience and willingness to sit with you and answer every concern. Some questions to ask: -how many years have you been studying TMJ specifically? (It should be in years).
-where did you do your TMJ studies?
-do you continue your TMJ education and stay up to date on the most current TMJ treatment methods and tech?
-what is your TMJ success rate?
-what do you consider a successful treatment?
-what insurance do you accept?
-do you offer any kind of money back guarantee if treatment fails?
-what kind of tech will you use to diagnose and treat me?
-how much is phase 1 treatment?
-what does phase 1 treatment include? Just the orthotic or weekly adjustments for as long as I need them?
-will the orthotic change my bite?
-what is your TMJ philosophy? Are you more muscular based, bone/joint based, occlusion based, or all of the above?
-what is the difference between your orthotic device and other splints/mouth guards/night guards?
-will you be referring me to physical therapists, chiropractors, or other specialists to help my recovery?

Copies of all scans taken
Copy of a proposed treatment plan if possible
Cost analysis of treatment
Financing options
Contact info for successful current and past patients, a few who are a year or two into treatment and a few who are 3-5 years post treatment completion.

Beware of 100% success promises
Are you comfortable with this doctor?
Do they take the time to reassure you, answer all questions thoroughly, and explain what they are doing or what they found in their exam?
Do they provide a thorough examination?
Do they take into account your medical history?
Do they seem invested in helping you, or do they push for the "sale"?
A true spscialist will treat the whole patient, not just the TMJ.
Always get multiple opinions.
If the orthotic doesn't feel right in your mouth or causes more pain, it needs adjustment or is not working. An orthotic should be personally tailored to your mouth and fit comfortably.
Surgery should always be the absolute LAST solution. Surgery cannot be reversed and often has lasting side effects.

TMJ dentists very rarely offer any kind of money back gaurantee if treatment fails.
I personally believe that all TMJ dentists should offer this. A good TMJ doctor will tell you that there are no guarantees.

I hope this helps!!!

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