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Have severe TMJ and using a night-guard, but still having pain
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Have severe TMJ and using a night-guard, but still having pain

I was diagnosed with TMJ in June 2010, and was made a custom night guard that I wear when I'm sleeping. My doctor said I had a pretty sever case.. meaning a 9/10 (if 10 was the worst). I've stayed away from chewy foods, and have really tried to limit my jaw movement, but my jaw is still popping (really loudly, to the point if I'm eating or talking, people will hear... especially in the morning) and still hurting. In addition, I've noticed on my night guard that there's a lot of wear and tear (dents in it from grinding/clenching). I also notice that when I'm relaxed or reading, I slide my jaw either in front of my front teeth, so that my bottom teeth are in front of my front teeth or to the side, so I have an uneven bite.

I don't know much about the treatment options besides the guard, but I'm only 20 and don't think this is an ideal situation for the rest of my life. I've also been waking up with ear pain, I'm assuming from clenching. Please let me know what other treatment options there are, and if I should go back to my dentist. Is this normal?

Thanks
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Avatar_m_tn
Without doing a personal evaluation it is not possible to give a definitive diagnosis and all treatment should be remedied by your own doctor. It sounds as if your temporomandibular discs are out of place. This is why you slide your jaw forward to help the disc go back into place temporarily. The limitation of chewing and popping are symptoms of this. I would recommend you to have your dentist order an MRI of your joints. A simple night guard may not be all that is needed but to progressively open the posterior bite to allow room for your discs to heal. Then you will possibly need orthodontics to allow the teeth to be placed in harmony with one another. If your dentist is confident in treating this disorder let him know how you are feeling  and if not please see a TMJ specialist who can. These are the types of cases I treat everyday. Good luck and God bless.
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Avatar_m_tn
Occlusal appliance therapy or night guard is generally highly effective for relieving tmd symptoms. However, fabrication of custom made occlusal appliance is highly technique sensitive, seeing a competent tmj specialist is advised. Clicking or popping sound of tmj is commonly associated with disc displacement. Manual reduction of disc can be achieved by manipulation, which is known as joint play of tmj. Seeing a manipulative medicine practitioner is advised.
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136956_tn?1363091289
I was told that my particular mouth guard that was specifically made so that I would only be putting pressure on the front teeth instead of all teeth was the thing that caused my jaw to shift and now once again after 17yrs I have 2 disk displacements with and without reduction.  

I feel that the night guard worked for some time but I grind so much that I grinded through 3 mouth guards in 17years, and they were the hard plastic ones.  

I am using a muscle relaxant but the one I am using makes me very angry so I am going to ask for another one that doesnt have those side effects.

I would get a couple of opinions from Oral surgeons to see what they suggest.  I am waiting for my second one and while I wait for that I need to somehow come up with $700+ for a new mouth guard that is specifically for my issue.
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Avatar_m_tn
Without personal evalution it is not possible to give a complete and comprehensive diagnosis and you should follow the advice of to provider. If you have 2 discs that are displaced you need to have an MRI for a definitive diagnosis. Then I would advise being seen by a TMJ specialist. Your discs need room to return to its normal position which probably means opening the posterior bite. Afterward a 2nd MRI should be done to determine healing. If discs have normalized then orthodontics to place teeth into position. If not then possible surgery to place discs into place then orthodontics. A displaced disc will continue to deteriorate at 3-7% per year. Besides pain there may be other comorbid disorders that can become associated with it.Always do conservative treatment first. Good luck and God bless.
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