I think I might have to end early :(

[ladybug26]

I dont post here often, but I read frequently - I am currently on set number 19 out of 29 (both U and L). I started this treatment because of TMJ issues. My bite was off and I had crowding on the bottom, and after years of using a nightguard (no longer helping) we decided to try fixing my bite to alleviate the problems.

When I first started Invisalign, my TMJ issues and pain went away. No more locking, clicking, pain, etc. I loved it, and thought we were on the right path. Once I started tray set number 16 though, everything changed. My jaw is locking and tight again, I have so much pain I can barely eat some days. Forget about using the chewies or bite sticks - I need to use my jaw to eat, and using those are a sure-fire way to make my jaw worse. Of course, this means my aligners are not fitting properly now, and I have a couple teeth that are now not quite where they need to be.

At my last appointment a couple weeks ago, I was told to use prescription strength NSAIDs and given a Rx for muscle relaxer. While they do provide some relief, I am a stay-at-home-mom with 2 kids and I cannot be doped up. I also have concerns over using NSAIDS for extended periods of times due to stomach bleeding (family history).

I think I may be coming to the end of my treatment earlier than expected. I love the progress my teeth have made and I looked forward to them being perfect. I have paid a lot out of pocket for this treatment and I took it very seriously, was very compliant. But I notice that with the trays in, I do clench down on them unconsciously. I try to stop myself from doing it, but it just happens. I cannot continue like this - after almost 2 months in so much jaw pain, I need an end. We talked about possible options at my last appointment, and I go back next week -- I am really thinking that I need to either stop treatment, or delay it a bit. We talked about delaying treatment for a while (using retainers or the aligners to keep my teeth in place) or just stopping and moving on to a retainer/nightguard type appliance. I notice that when I do leave the aligners out for a bit, I stop clenching and my jaw relaxes somewhat. I was probably heading towards refinements, maybe we could stop where we are at and revisit the idea of doing the impressions and refinements a little further down the road? I dont know, and I realize no one out here is going to have the right answers.

Has anyone ever heard of someone stopping treatment early? Anyone else ever find that their TMJ issues got dramatically worse during treatment? As I have told my orthodontist, my pain is worse than it has EVER been. I am miserable.

If anyone has any words of wisdom, I appreciate them...if not, I just feel better venting to people who might understand where I am coming from! Thanks!

[ohioinvisguy]

I am sorry to hear about the problems you are having. It sounds very painful and I dont blame you for wanting a resolution!! I did just have a question for my own curiosity. Could you switch to traditional braces over the invisalign trays? I do not know anything about TJM so there might be an obvious reason why this isnt feasable. I'm sure there might be the issue of additional orthodontic costs if a new method of treatment is explored after having the invisalign system made for you.

Again, sorry to hear about your situation. I hope things work out in your treatment/TJM problems!

[ladybug26]

Thanks for your response.

In the beginning, I was told I was a better candidate for Invisalign - I asked that question specifically - but I cannot remember the exact reasons (or if I was even told why). Financially, paying more is not an option and to be very honest, traditional braces are not really something I'm sure I want to pursue at this point. It was not mentioned to me as an option at my last appointment so I am not sure if that is an option at this point - something I will definitely be asking about just for clarification when I go in next week.

Thanks again!

[Wireless]

Your case has some similarities to mine. I have a severe deep bite that had resulted in TMJ symptoms, including ear aches in the morning, sore jaws, and difficulty clearing my ears when flying. Like your case, I was told Invisalign was going to be the best method. I had braces twice before and had some tooth root damage that concerned my ortho. In my case, Invisalign was actually quite a bit cheaper as I was going to be required to have frequent X-rays with regular braces that would have made treatment more costly.

So far I haven't experienced any problems related to my jaw - the ear aches have gone away and I no longer have problems when flying. Part of my treatment has been wearing partial aligners to allow my rear molars to grow in. However, due to the length of time required, my last aligners were replaced with partial Essix retainers, which are thicker than Invisalign trays. This seems to be working ok although very S-L-O-W. It may be possible to make retainers that are like your last aligners if slowing down treatment may help.

With TMJ, jaw location is probably more important than tooth movement - perhaps a change in treatment plan could be done with a mid-course correction? In my case, there were problems with some tooth movement and this had to be done after about 17 trays. Its the same procedure as a refinement - just earlier in treatment. Perhaps your ortho could do this to help adjust your jaw to a better position.

Another question - if you stop treatment now, will your TMJ problem get worse. In my case the deep bite problem continued to get worse the longer I put off doing anything. Since I had braces twice before I wasn't willing to go for round three. Before it was over, the problem got bad enough to start damaging gums behind my upper teeth and I no longer had a choice. If you do decide to end treatment early, be sure you understand any consequences.

Good luck!! I hope you and your doc can come up with a good solution.

[ladybug26]

Thanks, Wireless. You definitely bring up some good points, many of the same concerns I have to discuss when I go back next week. I definitely don't plan to make a rash decision that could cause more problems down the road, and I really trust my provider. I know he will lead me to the best decision and he is as concerned as I am about the pain.

My husband also brings up a good point - that I should remind my provider about my arthritis. It flares up from time to time in my other joints, and perhaps a return visit to my rheumatologist is in order (haven't been in a couple years because pain wasn't all that bad). I have to wonder if that is part of this. You would think that at 35 I would not have to deal with that, but thanks to family genetics....

I just hope to find some answers so I can be in less/no pain! I would gladly go back to the intermittent TMJ pain I had prior to starting Invisalign over the horrible pain I have almost non-stop now.

[ladybug26]

Had my follow-up appointment today and talked to him again about the jaw pain. I have always had pain only in my right jaw, and over the past week have started developing tightness/locking in my right jaw as well (never, ever had it there).

He made me a new nightguard appliance today, and I am to wear that on my bottoms with my top aligner for the rest of today and tonight. After tonight, I will wear aligners during the day and swap my bottom aligner for the nightguard at night. I have to call him back on Friday morning with an update.

Basically, we agree to exhaust a few options (hopefully one will work) before we throw in the towel. He is as baffled as I am and we will just take it on a day-by-day basis. We did discuss that we may be facing the decision to discontinue treatment. It is disappointing to me because I have invested 40+ weeks, thousands of dollars, and have rather enjoyed the process as a whole. But the pain is just taking over and I really cant stand it any more. Being in pain all day and night is really taking a toll on me emotionally and physically.

I feel comfortable trying a few things, but I really dont want to go on like this a whole lot longer. Fingers crossed something we try will work. Right now, continuing with Invisalign is not even important to me...being pain-free is a priority.

[ladybug26]

Just another update, in case there is anyone following along or ever in a situation like this.

Went back in again today, as there was no progress. Still in pain, etc. Talked over all my symptoms, thoughts, questions, etc. He told me that if I am in pain wearing the aligners, stop wearing them. If that means not wearing them at all, he will just take more impressions and restart the case when I am ready. If I can wear them at night and keep my teeth as-are, we may be able to move on to set #20 (my next set) when I am ready and continue on with the next 9 aligner sets he has for me in office. He re-fitted the nightguard to make sure that my bite is where he wants when wearing it, and said to do what I am able and not do anything that causes pain. He also wants me to see my primary care doctor next week to get blood work done to re-check my rheumatoid factor as well as a few other levels (cant remember what they were but have them written down) since he feels arthritis could be behind this.

So, I am hoping to continue nighttime wear of the aligners/nightguard to keep my teeth in their place as much as possible and will continue to try wearing the aligners during the day if I can do so without pain. I go back in a few weeks and will hopefully have the results of my blood work back by then as well.