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TMJ Disorder -TemporoMandibular Joint Message Board


TMJ Disorder -TemporoMandibular Joint Board Index


Hi all, I've found this forum very informative as I deal with my TMJ disorder, and thought I would post my own story to gather opinions as I move forward with my treatment. This is probably going to be very long - hopefully someone who has gone through something similar will be willing to read it! :P

Almost 4 years ago, when I was 18, my jaw began locking up often - and if it wasn't locked, it would constantly pop and crack. I would get almost daily tension headaches. I went to my dentist, who said I was likely grinding/clenching, and made me a normal acrylic mouth guard that covered all of my top teeth. I wore it - after a few nights it already had visible wear on it - but it did nothing for my locking jaw. I went back to my dentist who referred me to a TMJ specialist.

The specialist did an informal sleep test on me using one of those take-home monitors that goes over your finger and measures your heart rate and blood oxygen level. The results from this monitor led him to believe that my jaw was sliding backward in my sleep, which was limiting off my air flow and causing my body to react with severe grinding and clenching in my sleep. (However, he never actually took a CT scan of my airway or did an actual sleep study or anything of that sort confirm this.) But, I thought his explanation made sense and went along with his treatment plan. He made me an appliance called the TAP. It was a two piece appliance that pulled my bottom jaw forward and up to keep it in place. He also gave me an "AM Aligner" that I was to wear in the mornings to "put my bite back in place" after it had basically been pulled out of place all night. This appliance worked - my headaches went away and I had basically no problems for almost 3 years. However, I had no idea the harm it was causing to my jaw.

Fast forward to about a year ago. I noticed that my bite was changing. It was open - I couldn't bite my nails anymore and eating certain foods became hard. My smile looked different and it started to concern me. I went back to the specialist and told him that my bite was changing. I admitted that I hadn't been very consistent with wearing the AM aligner. He just suggested I keep working on wearing the aligner more throughout the day, but he was very unconcerned with my bite change, because I was still pain free.

Well, about 4 months ago I started not being pain free anymore. I gradually started getting more and more headaches. The pain was more severe than ever - I started getting pain in my actual jaw area and my neck, which had never happened before. I went back to my doctor, he prescribed migraine medication which didn't help. Again, he was unconcerned with my bite. He seemed like he was at a point were all he wanted to do was give me medicine and send me along - so I went out for a second opinion.

A second specialist gave me a CT scan, which revealed a pretty wide airway. He strongly believed that airway issues were not my problem. He did however, find that my jaw was not not in the socket right - it was pulled down and to the left a little (likely cause by the TAP pulling it that way each night for 3 years!) His treatment plan included a MORA splint, to be worn full time to realign my bite, and then phase II - braces, etc. etc. I decided not to pursue this treatment plan because I was not confident in the MORA device after researching it, and did not feel that braces down the line would really help things. I wanted something less intrusive first. I had already made the mistake of committing to an appliance that likely caused a lot more issues than it fixed, and I didn't want that happening again.

So, off to a 3rd opinion, the dentist I'm seeing now. This dentist uses the TruDenta program, which appealed to me because it seemed less intrusive - focusing on other therapies that seemed similar to what would happen in a chiropractors office. So I committed to 12 therapy sessions that use things like ultrasound therapy to relax my jaw muscles and get my TMJ pain under control.

I believe that the therapy part of this treatment plan is valid and was the right decision for me. However, some other things have me worried. They fit me for an NTI, which I have been wearing on and off for a few nights with extreme caution - I know these can cause more open bite issues. I know it is supposed to relax your jaw back to wear it's supposed to be, which makes sense, but even after wearing it two nights in a row, my bite feels even more off than usual.

Also, he wants to do a "minor adjustment of my teeth" on my next visit, because with my new open bite, the back molars are basically the only ones touching. I'm hesitant about this - I don't want to do something that is permanent. I had a perfect bite before all this, and I don't want to do anything that makes me unable to get that bite back.

I am just kind of at a loss. It seems like there are negatives to every treatment option out there. I blindly followed a treatment 4 years ago, and I firmly believe that this treatment was the reason my jaw is out of place, my bite is open, and my TMJ pain is constant. I want to follow this new treatment, but I don't want to make anything worse - I've made that mistake already.

Does anyone have experience with the NTI? With dentists filing their teeth? Or just have some encouraging words? :)

Thanks! TMJ is such a frustrating disorder - it's nice to know there are other people out there who understand.
[QUOTE=sds09c;5212756]
The specialist did an informal sleep test on me using one of those take-home monitors that goes over your finger and measures your heart rate and blood oxygen level. The results from this monitor led him to believe that my jaw was sliding backward in my sleep, which was limiting off my air flow and causing my body to react with severe grinding and clenching in my sleep. (However, he never actually took a CT scan of my airway or did an actual sleep study or anything of that sort confirm this.) But, I thought his explanation made sense and went along with his treatment plan. He made me an appliance called the TAP. It was a two piece appliance that pulled my bottom jaw forward and up to keep it in place. He also gave me an "AM Aligner" that I was to wear in the mornings to "put my bite back in place" after it had basically been pulled out of place all night. This appliance worked - my headaches went away and I had basically no problems for almost 3 years. However, I had no idea the harm it was causing to my jaw. [/QUOTE]

Did the same sleep test (why do you call it "informal"?) and the result was, that I might have sleep apnoe. After two nights in a sleep laboratory, that diagnosis has been confirmed. Your specialist could have been right, there is a connection between bruxism and sleep apnoe, which was shown by a study from Israel in 2003. Most TMJ-treaters worldwide did not seem to pay much attention to the study, no further studies were done - that's why we don't have further informations about this. We just now, that a percentage of people having sleep apnoe does already crunch their teeth at night which may lead to the conlusion that a snore splint could help with bruxism, too.

I've got a question about your splint: Does it fix your mandible in the forward position or does it work a different way? There are snore splints who lead the jaw forward only when you are opening oder closing your mouth, too. That information is necessary to recapitulate what happened to your bite and why (and that would be necessary to come to conclusion what could be done to get back to the former condition).

[QUOTE=sds09c;5212756]Fast forward to about a year ago. I noticed that my bite was changing. It was open - I couldn't bite my nails anymore and eating certain foods became hard. My smile looked different and it started to concern me. I went back to the specialist and told him that my bite was changing. I admitted that I hadn't been very consistent with wearing the AM aligner. He just suggested I keep working on wearing the aligner more throughout the day, but he was very unconcerned with my bite change, because I was still pain free.[/QUOTE]

Had it been an Aligner for the upper und another for the lower teeth? Did they covered all your teeth?

[QUOTE=sds09c;5212756]A second specialist gave me a CT scan, which revealed a pretty wide airway. He strongly believed that airway issues were not my problem.[/QUOTE]

As far as I know, you can't draw a conclusion if you are suffering from sleep apnoe by the results of a CT - the sleep test you describend and you called "informal" is more suitable on the way to a diagnosis (but there should have been some nights in the sleep laboratory to confirm the results of that test, too).

[QUOTE=sds09c;5212756]He did however, find that my jaw was not not in the socket right - it was pulled down and to the left a little (likely cause by the TAP pulling it that way each night for 3 years!)[/QUOTE]

Right or left side jaw? Could you tell more information about the TAP (look at the questions above)? At which teeth are the connections between the two parts of the splint?

[QUOTE=sds09c;5212756]His treatment plan included a MORA splint, to be worn full time to realign my bite, and then phase II - braces, etc. etc.[/QUOTE]

Could make it better or worse - depends on the construction of the TAP, so please describe it further.

[QUOTE=sds09c;5212756]I decided not to pursue this treatment plan because I was not confident in the MORA device after researching it, and did not feel that braces down the line would really help things. I wanted something less intrusive first. I had already made the mistake of committing to an appliance that likely caused a lot more issues than it fixed, and I didn't want that happening again.[/QUOTE]

Splints are lee intrusive than most other treatments, although they could change your bite. Maybe it would be an idea to make fotos and descriptions about your teeth in certain periods for yourself? By that way, you could recognize changes in bite earlier.

[QUOTE=sds09c;5212756]So, off to a 3rd opinion, the dentist I'm seeing now. This dentist uses the TruDenta program, which appealed to me because it seemed less intrusive - focusing on other therapies that seemed similar to what would happen in a chiropractors office. So I committed to 12 therapy sessions that use things like ultrasound therapy to relax my jaw muscles and get my TMJ pain under control. [/QUOTE]

Never heard of ultrasound at TMJ-treatment. Does it work to relax the muscles?

[QUOTE=sds09c;5212756]They fit me for an NTI, which I have been wearing on and off for a few nights with extreme caution - I know these can cause more open bite issues. I know it is supposed to relax your jaw back to wear it's supposed to be, which makes sense, but even after wearing it two nights in a row, my bite feels even more off than usual.[/QUOTE]

NTI may not work at open-bite TMJ-patients. It also may not work if your jaw is in a wrong position while you're working the splint. Does it work for you? (I would guess, it doesn't)

[QUOTE=sds09c;5212756]Also, he wants to do a "minor adjustment of my teeth" on my next visit, because with my new open bite, the back molars are basically the only ones touching. I'm hesitant about this - I don't want to do something that is permanent. I had a perfect bite before all this, and I don't want to do anything that makes me unable to get that bite back. [/QUOTE]

I think, you're right. I would never let someone file my teeth down!





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