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TMJ Disorder -TemporoMandibular Joint Message Board

TMJ Disorder -TemporoMandibular Joint Board Index

Hello. I'm a 23 year old female. About a year ago, my primary care physician ordered an MRI of my TMJ due to clicking/popping noises when I opened my mouth, some discomfort, and a small lump in front of my right ear. This is what the report said:

[I]Right TMJ meniscus anterior dislocation in closed mouth position but recapture and anatomic positioning wit mouth opening. Accompanying small joint effusion. Left TMJ grossly normal. Each TMJ meniscus normal size and no abnormal degenerative attenuation. No imagining signs of arthropathy at either joint. Normal configuration mandible condyles and normal marrow intensity. Both joints have normal condyle translation in open mouth positions.[/I]

She explained to me that when my jaw is closed, it is misaligned, but when it is open, it is aligned as it should be. The first oral surgeon I saw did not specialize in treating TMJD cases such as this, but he recommended a night guard and said that if my jaw stopped shifting to find a comfortable position, the ligaments would strengthen and pull things into place as they should be. He said that that I developed this issue due to not having braces as a child. We switched insurance companies and he was no longer in network, so I went to another oral surgeon.

The second oral surgeon didn't really answer my questions. He just said my only chance to regain normal function was to do arthrocentisis in his office that day, with a local block (no anesthesia). He told me I would be fine to go to work later that day (I'm a vet tech) and restrain animals. I didn't feel comfortable having the procedure done and then going to work, so I left. I felt rushed and pressured into doing the procedure without being 100% comfortable with it, so I never returned.

I had a dental cleaning a few weeks ago and the dentist who checked my teeth afterwards said that I developed my jaw issues because I am a "thruster" and my tongue is not where it should be when I swallow. Because of this, my upper teeth are aligned poorly with my bottom teeth. She seemed to know a lot about TMJD and recommended a splint, but unfortunately, she is not a participating provider.

I have had consults with two orthodontists who said they have seen positive results by treating TMJ with braces. I'm definitely willing to do that, but they said that orthodontists usually work with another doctor who actually treats the TMJD and together they will develop a treatment plan.

Since the appointment with the 2nd oral surgeon, it's been a struggle to find an oral surgeon who treats TMJD and is in network. The closest oral surgeons who do treat TMJD are over 80 miles away, and I'm going to set up an appointment with one of them. My other option is to go to partner of the 2nd oral surgeon, who is only 10 miles away, but I just felt so uncomfortable the last time I was there, I just don't want to have the same experience. I just want to have a doctor that I can trust throughout the treatment. I feel kind of silly for seeing all these doctors and getting different opinions, but I don't want to risk making things worse. Is it necessary to have an oral surgeon, or can my dentist and orthodontist develop a treatment plan together? Does the general dentist usually develop the splint, and if symptoms improve, then the orthodontist puts braces on?

Any similar TMJD stories or advice as to where to go from here would be appreciated.
Hi again NC711,

You are wise to gather some information about TMJ and think things through carefully before going into treatment.

I’m going to try to answer all your questions and give you as much information as I possibly can so I apologize in advance if my post is a little lengthy. If I don’t manage to answer all your questions or you have more, don’t hesitate to let me know.

I want to start by saying that I think things are looking pretty good for you. I reread the MRI results you posted and your TMJ situation is pretty good – no degeneration as yet, so it’s great you can catch all this before it worsens. I hate to say it, but you should know that with TMJ issues, things tend to worsen; they rarely go away or stay the same. The important thing now is to get the proper treatment for this so things don’t get more serious (from the condition itself or from a mis-treatment). Finding your way to the right TMJ treatment is so much harder than it should be…so many of us are in pain for longer than need be or have seriously worsened situations from the wrong treatments.

Your questions about how to know what kind of dentist you are seeing is not silly at all - the whole divide in neuromuscular dentistry is hidden under the covers. There's not really any way to find out about it and there’s no real language in the industry that speaks to this divide (the terms “traditional” and “modern” are more descriptive than anything. I’ll try to give you the lowdown on the limited amount that I’ve found out.

In North America (I'm not sure about other parts of the world) the two different types of neuromuscular dentists, modern and traditional, offer totally different kinds of treatment as they believe the causes of TMJD to be different. Traditional NM dentists believe TMJD can only be caused by muscle or joint issues while modern NM dentists include causes such as malocclusion/bite issues. Therefore, depending on which of NM dentist you see, you may or may not find the right treatment for you. I’ll use my experience as an example. I spent an extra year in pain because I started off with a traditional NM dentist and spent a ton of money on treatments (least invasive/safest first) and nightguards that only worsened my situation. Because the cause of my TMJ was a bite issue, and traditional NM dentists refuse to acknowledge this as a real issue, he was no help. He was one of the finest in my city (a big one at that) and he claimed there was absolutely nothing left for me to try, save botox, which I wasn’t willing to try as it is no long term solution and has many complications down the line. I had no idea that there were other types of dentists offering other types of treatments. My desperation finally drove me to research the most highly reputed NM dentist I could in my part of Canada or in the neighbouring US (if you PM me, I’ll tell you specifically how I found them – maybe you can try that as well). I was seriously considering going to LVI - the biggest post-grad training centre for modern neurmuscular dentistry in the US - where they also see patients. Finally I decided on a dentist who had LVI training, but did even more post-grad work than that. He could see my bite issue immediately and I soon went into reposition splint/orthodontics. I’m one year into treatment and almost pain free for the first time in years.

Now, on the other hand, if someone with a muscle-based issue (say they were a stress clencher with no bite problems) went to modern NM dentist and was mis-treated by being fit with a repositional splint (maybe the dentist is incompetent or looking for $), this person would spend tons of money on the wrong treatment and possibly end up in more pain and/or a bad bite.

So this is why I advocate trying to sort out what the cause of your TMJ is – as they are varied. However, this is no easy task!

As an aside, the divide I speak of is very contentious and dentists tend to avoid direct discussion about it. If you ask a traditional NM dentist about functional orthodontics, he/she will likely say something along the lines that The National Health Institute (NHI) doesn’t approve of contested and unproven treatments. But can we really trust the National Institute of Health? Do they only have our best interest at heart? I did some investigating to get some clarity for myself before moving forward with modern treatments and discovered some interesting things.

You might consider this: The NIH been telling us for years (and still claim) that aspartame is safe (although it’s been proven otherwise). If you follow this NIH advice, you risk getting sick from carcinogenic sweeteners! There is a clear conflict of interest here as the NIH government scientists and officials are in the pockets of the food & drug companies whose studies they are conducting. It’s hard for me to trust the NIH when they take large “consulting fees” from such companies – the NIH will have a vested interest in those studies being successful. Using corporate and federal records, the Los Angeles Times, exposed hundreds of NIH officials who took “consulting fees” from drug companies. The drug companies are also making a lot of money off of those whose TMJD remains untreated as they stay in pain and require drugs if no successful treatment is found. This represents a serious conflict of interest as NHI / government scientists are taking in huge consulting fees from the very drug companies that are getting rich off our pain and suffering. This state of affairs is apparently not uncommon. My husband was reading the biography of a prominent aids researcher who claims that there are 3 or 4 possible research areas that could very likely lead to a cure but they are not being pursued because, with drugs, people can live a full life span with AIDS and there is so much money to be made off these drugs. How sad for the folks in Africa how can’t access them. How sad for the folks here that they have to live a drug-addled existence rather than be cured.

Also, significant institutional change is very threatening to the establishment in question (traditional side) and takes time to implement. Imagine once the traditionalists finally include such issues as malocclusion as possible causes of TMJD, they will need to change undergraduate dental education, get more post-graduate work, buy new equipment...the list goes on. I believe it’s only a matter of time until the modern NM treatments are accepted as status quo but until then, we remain in a state of confusion and often without coverage for the treatments we need.

I’m thinking about your issues and it sounds like a case of misalignment/malocclusion. Interesting though that this only occurs with your mouth closed. I think the first oral surgeon you saw was on the right track…once your jaw finds a comfortable position, the muscles do relax and the pain/discomfort goes away. I guess the question is whether or not there is malocclusion. Did the dentist who diagnosed the thrusting see evidence of thrusting & malocclusion– was she certain and how did she know? Also, is the tongue thrusting causing the problem or a reaction to it? Apparently we swallow up to 2,000 times a day with about 4 pounds of pressure per thrust – this can easily push the teeth out of alignment if you thrust when you swallow. If you are thrusting as a response to issues in your mouth, the thrusting should go away with treatment. If your thrusting is a separate issue, it’s possible you could get treatment, straighten your teeth to fix your bit and then thrusting may push them back out of alignment. It may help to do some investigation about this.

Many TMJ people are bruxers and there is a lot of debate over the clenching/grinding issue. It’s sort of a chicken-egg scenario as TMJ can cause bruxing (usually because the jaw is desperately seeking a comfortable position at night) and bruxing can also cause TMJ. I wonder if it’s the same with thrusting.

Being a Canadian, I’m not familiar with the American medical plan system. What is a network exactly and why do you only have access to certain doctors? Can you contest this?

If you are unable to see the best modern NM dentist because they aren’t in your network, I would pay out of pocket if necessary to get the right professional and the right treatment. Sadly, there is often not coverage for the best TMJD treatments, but don't let this be the cause of your issues getting worse, not seeing the right specialist or getting the wrong treatment. It's too easy for TMJ issues to get really debilitating and your health is the most valuable thing you've got!

Once you go to an appointment, don’t be shy to take a page with questions and/or a support person who also knows the questions (and won’t let you leave without them being asked). I would often be in too much pain or anxiety to be fully present during such visits and so this is what I did. I also brought along a tiny tape recorder so I could capture the information correctly. Sometimes it’s easy to miss parts because there’s a lot going on physically or emotionally and sometimes the docs talk medicalese – too confusing to understand. Ask them to clarify simply. A support person can also act as another backup for information retrieval so I highly recommend it.

I guess some questions I would want to ask might include:

How long has the specialist been doing this treatment and how many people with TMJ has he/she treated with it?

What is the success rate like? What are the possible complications?

What kind of post-grad education/training has this specialist had in performing the treatment?

Can you be referred to another client they’ve treated to ask some questions about the treatment?

What precisely is the cause of your TMJ issues? How does the specialist know this to be true? Are there any other possible factors that could be the cause?

Could your thrusting undo the good work of the treatment after it’s done? If so, how can this be addressed?

Does anyone else have any ideas about important questions I’ve missed?

If you find out that you need functional orthotic/orthodontic treatment, there is likely a whole other set of questions to ask. This might be great as a separate post in itself because it could be useful to many people.

Well this is possibly my longest post to date…I hope you find some of this helpful!

I’m pulling for you! Let me know how things go and don’t hesitate to ask if you have any more questions :)

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