TMJ blues

[naomi]

Sorry guys but I need to rant a little bit about my TMJ issues .

In 2001, when I was 18, I was in a car accident and as a result of that, I developed TMJ disorder. As time went on my jaw problems were becoming unbearable. I had a big overjet so I thought maybe if I got braces and corrected my bite it would alleviate some of my symptoms. At my first consult the orthodontist told me that I needed braces (of course I already knew that) but he said my teeth situation wasn't causing my TMJ problems so braces wouldn't fix it. I decided that since I'd already come this far (by going to the consult) I'd go ahead with getting braces, despite the fact that it wouldn't correct my TMJ, because I hated how my teeth looked for as long as I could remember.

After being in braces for over a year and still having some TMJ flare ups I decided to have my impacted wisdom teeth removed (once again I was hoping that would alleviate some of the pain I was having). You guessed it, no change in my TMJ. At my last adjustment which was in february, the ortho had me stop wearing my elastics. I was pretty excited to see them go at first and then after a day without them my jaw was worse than ever before. My jaw keeps getting progressively worse lately and I'm getting worried. I'm not blaming it fully on the braces, it doesn't take much for my symptoms to flare up. Even eating certain things will do it. I keep getting swelling in the left side of my face, my ear aches on that side and it's miserable. All the orthodontist told me to do to keep the pain and swelling down was to not eat anything chewy like bagels .

I know a few people on this board have TMJ and I'd be interested to know how braces have effected your symptoms. Like I said, I don't think my braces are necessarily causing my symptoms to worsen but my jaw is really sensitive so after the orthodontist does his adjustments my TMJ acts up like crazy. I've had my braces for 22 months now and it wasn't until lately that my jaw started to really bother me more than it did before braces. My last adjustment was over a month ago and I woke up today with my face swollen again. I'm supposed to get my braces off really soon but now that I have a new smile I want a new jaw!!!!

[missingu]

How awful a situation. It sounds like you need to get to a TMJ specicalist, maybe in Facial Pain at a local university if there are none in your area.

If your DDS does not order one, ask for an MRI of the TM joints. My MRI revealed:

arthrosis in the TM joints with bone defects
anterior and medial displacement of the meniscus

If you are not familiar with these terms, which you may well be if you've been dealing with TMJ a while now, the meniscus is the padding between the upper jawbone and lower skull (roughly) and it is below the ear. WHen the padding (meniscus) is displaced, what you are left with is bone scraping bone when you move your mouth. Pain!!! I know that well as you do.

Depending how far along in getting specific TMJ treatment you are, I'll share the treatment recommendations I received but I STRONGLY recommend getting the MRI (if you have insurance in US) because it is the only way to know the physiology of what is going on in the joint area.

Keep us posted.

[Leslie022]

Oh wow, I'm sorry you have so much pain. With my TMJ, I had a muscular disorder. All they had to do was shock the muscles in my face and neck, "reprogram" them, and give me a fitted night guard. I stopped wearing the night guard because it gave me headaches. I really haven't had many problems since then. I get the occasional pain/numb feeling on the left side of my face and jaw.

Maybe things will get better once the braces are removed?

[whitmcb]

Okay, I've got some TMJ problems, too, that I'd like some advice on if anyone has any to offer.

I've had jaw problems for as long as I can remember (I can remember, specifically, back to about the 8th grade...I'm 21 now). I don't know when or why it started, but it's bad. Anytime I open my mouth wider than about an inch, it pops awfully...first the right side, then the left. Then when I close it it does the opposite. It's like it's subluxating everytime I open my mouth. Chewing is terrible...constant popping. Also, when I shift my jaw side to side or back to front, I get this "cartilage-y" sound in my right ear that obstructs my hearing.

Something I've noticed lately that really worries me is that, when I open my mouth past an inch, my jaw pops and then when I close it, it shifts immediately to the left about a centimeter. If I try to hold my bite in line with my hands, I CAN'T close my mouth. It stops at about a half an inch and I get a horribly sharp pain and my mouth won't close.

My orthodontist made me a splint to wear at night to keep my from grinding my teeth, but I also clench them during the day. I'll catch myself clenching them and stop, but I end up doing it again about thirty seconds later. I also catch myself with my lower jaw shifted over about one centimeter to the right all throughout the day when my mouth is closed.

I go back to the ortho next week and he plans on doing an occlusal equilibration where he shaves down my teeth to adjust my bite, but I just can't see how that can fix all of my problems. They haven't done x-rays or MRIs, and I don't recall him every feeling the joint or watching what it does when I close it.

My dentist says it's the worst case of TMJ he's seen, especially in someone my age. It gives me bad head and neck aches. I'm only 21, and I definitely don't want to risk this getting worse as I get older. Does anyone have any other advice about what I should do? I don't want to have my teeth filed down if it's not going to help the problem, and I need something different done.

Thanks!

Whitney

[whitmcb]

I forgot to add that I also get dizzy occasionally and have vision problems. I don't know if it's related, but it's worse when my jaw is worse, so I assume it is.

[susieq182]

From what I have been told TMJ has many causes and in most cases cant really be "fixed" with braces. My ortho explained to me that correcting my bite would help my jaw rest in a more normal possition and as long as i watch what i eat most of my TMJ issues will be gone after braces. My Dentist on the other hand felt that my TMJ was "phase" I was going through and would "outgrow" it. I am almost 24 I figure there would be no outgrowing it, so I went ahead with braces. So far I have had much less jaw pain and as my over bite and cross bite move into a more natural possition I fell like my jaw muscles are more relaxed.

I know this doesnt apply to your situation because your TMJ was caused by a injury so possibly you should see a specialist in TMJ or at least orthopedics.

[missingu]

Whitney-

PLEASE, before you have your teeth shaved, can you see a TMJ specialist (usually an ortho but who would not touch the braces). As I'm sure you know, TMJ stands for temporomandibular joint - TMJ problems can be, but are not necessarily, related to teeth and bite. If there is displacement in the joint, or degeneration, toothwork won't help it and I have no idea how it would help - BUT I am not a dentist. I am sure your ortho is a good ortho, but shaving teeth for TMJ without x-rays specifically of the TMJ and an MRI really scares me.

If I am coming across as alarmist, it is intentional. Many orthos do TMJ work, but please, check to see if he is affiliated with the:

American Association of Craniofacial Pain (website aacfp.org)

They have a referral list on the website of DDSs who are trained to deal with TMJ issues. Most are orthos who do about 20% TMJ 80% ortho. Proportions vary, but if they are AACFP they are specifically trained for TMJ. It sounds like you need a specialist from what your DDS said. If you live near a dental school or university, call them to find people who are specific in TMJ. It is complex and requires a lot of understanding beyond what most orthos have.

I cannot overestimate the importance of the MRI or x-ray --- how else does the ortho have any way of knowing what is going on in the joint, since it is internal and not external like teeth?

I am worried for you and do not want you to suffer any longer. You may have to be pretty aggressive in terms of finding a aacfp-approved ortho and making sure you get some sort of "internal picture" of the joint. Clearly stick with the current ortho for ortho, but if it is possible, find another practitioner (who may or may not be an ortho) to do the TMJ work. If the new person is an ortho, they would know not to adjust braces and things like that and just focus on the TMJ and leave the rest to your regular ortho.

Please keep us posted.

Missingu

[Leslie022]

I agree with <b>missingu</b> -- You need to see a specialist!!!! Of all the specialists in the world, we ended up having a Craniofacial doc here in town. The funny thing about TMJ is that we all can have different symptoms. I had MINIMAL jaw pain but had horrible pain in my neck and headaches. It got to the point where I couldn't even hold my head up after I would get out of class in the afternoon. I mentioned the slight jaw pain to my dentist and he referred me to Dr. Garabadian. I was shocked to hear I had TMJ.

Before you do anything the is irreversable, make sure you get all the opinions you can possibly get!

[whitmcb]

Okay, I've called my dentist and am waiting to hear back from him (he's a friend). I'm going to ask him about specialists because I didn't see any from my town listed on that site that missingu provided. There are two about 100 miles from here, though, that I can try if I need to.

My dentist is the one who mentioned the MRI to begin with, but the orthodontist didn't follow through with it. So we'll talk with him a little and see what he wants to do before I go back to my orthodontist next week. I'll definitely let y'all know what I hear. I really appreciate your help!

By the way, what do you know or think about seeking chiropractic help for TMJ? Is is something I should look into?

Thanks again!

Oh, I figure I should add that another thing I've caught myself doing a lot is thrusting my lower jaw forward when I'm not doing anything. My mouth isn't closed all the way--my teeth don't touch--but my bottom teeth are practically in line with my top teeth. It's really tight. I did have an underbite when I was little that was corrected. And now, when I look at my bite in the mirror, my top and bottom teeth don't line up exactly.

[susieq182]

I was seeing a chiropractor for my TMJ and it did help with some of the pain but it was a temporary fix. as i said in my earlier post my dentist though it was a phase. I feel I am at an age any phase i am in isnt going to change that is why I went in to get an ortho consult. it may or may not help you as everyone is different. it also depends on the chiropractor you go to some work more on muscle tension while others work on alignment of joints and bones. I started going to the chiro because i was getting terrible headaches from neck pain as he reduced the muscle tension in my neck i noticed more and more the pain in my jaw. they may give you some stretches to do to help relax the muscles. My TMJ was caused by my bite so this my not apply to you. Good luck to you and I hope you feel better soon.