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TMJ, tinnitus and neuromuscular dentistry
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TMJ, tinnitus and neuromuscular dentistry

Please help!!!
i'm asking this on behalf of a friend whose life is blighted by tinnitus.  He recently investigated TMJ and thinks his symptoms can all be accounted for via this diagnosis (popping, clicking, misaligned jaw etc).  He saw a neuromuscular dentist, who diagnosed TMJ and recommended a course of treatment including an orthotic.  (at a cost of £4k!) does anyone know anything about neuromuscular dentistry and if this will help his tinnitus????????? How does this kind of treatment compare to others? Is it worth it?  Please help.  Thankyou
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Avatar_m_tn
Myofascial trigger point pathology of lateral pterygoid muscle plays a significant role in the onset of tinnitus. Assuming ENT exam yields non-contributory results, seeing a competent tmj specialist to perform lateral pterygoid muscle trigger point injection to establish a diagnosis is advised. If the trigger point of lateral pterygoid muscle is the cause of tinnitus, the tinnitus generally will diminish or disappear right after injection.Definitive treatment requires occlusal appliance or occlusal equilibration, which generally yields long-lasting effect.
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Avatar_f_tn
I am having TMJ treatment at present. My dentist who specializes in TMJ has me on a TENS machine to relax the muscles 1-2 hours every 4 weeks. I wear a splint all the time exept when eating to correct my jaw which is out of alignment. It is expensive the treatments for TMJ but worth every cent, if you experience the pain first hand. And relief is around the corner.
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Avatar_m_tn
Ear pain and most of the time tinnitus are associated with a displaced disk in the TM joint.  I've found this to be true in over 90% of the cases (in 28yrs).  The unfortunate thing is that we can get rid of the ear pain nearly 100% but the tinnitus gets reduced but not completely in all cases.  scottma is correct about the lateral pterygoid spam, but that occurs with a because of a displaced disk.  I always have a ENT check for ear problems before treating the TMJ.  Neuromuscular in only one technique and will be helpful in the majority of cases.  If your treating dentist has no other treatment modalities he's overcharging you.  A TENS unit has no inherent magic with it.  It's effective for some, but not all in relaxing muscles.  Relaxed muscles alone will not always allow a disk that is out of place to be put back in place (we call in recapturing)--it's not easy (or anyone could do it).
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Avatar_f_tn
Hi TMJDoc and everyone,

I am new to this forum and am glad to have found the forum. I have tinnitus since Oct last year and my jaw and neck muscles are constantly in spasm . Done many tests, all clear, doctors think it is anxiety driven, however relaxation does not seem to get rid of this stiff neck and jaw spasms. I don't have much pain, with the TMJ, just tight muscle spasms and stiffness. I also have a deep overbite but always had this deep overbite in the past but did not have and spasms and stiffness.

My jaw does not open smoothly and deviates to one side a bit and locks a bit , in fact the whole area from the TMJ and neck and upper shoulder is kind of stiff and I feel like short of breath.  Event tried various neck pillows and tried sleeping on my back, nothing seems to work. So I have gone back to sleeping on my side.

My dentist checked me out and made a splint, he did not mention much about a displaced disk. Haven't worn the splint much as it makes me feel like I am going to suffocate. Should I have an X-ray to determine whether the disk is displaced. I thought people with displaced disks cannot close their mouth so never asked my dentist anything about disk displacement.

I am from Australia and any specialist TMJ is unfortunately too expensive for me. And one may have to shop around a bit before finding the right one, and that could be very expensive. I've been to a hospital TMJ specialist- prosthodontist. They think it is  anxiety driven jaw hypermobility and told me to apply moist heat 4 times a day and relax, does not do much.

Also I come across many sites, that mention that the ideal jaw rest position is when the tongue is up on the roof of the mouth behind the front teeth. I have a pretty bad deviated septum and whenever I do this after a while , my jaw muscles get all tight, and I can't breathe too well. In fact whenever I am clenching , my tongue is kind of glued to the roof of my mouth. Please anyone , please advice me whether I am the only one struggling to keep this jaw rest position.

So could anyone help me with some suggestions as to how I could perhaps asks my dentist some right questions and come to some solutions.  Anyone who has some good exercises - please respond. Please help, I am kind of desperate here for the last few months with this TMJ.

Thanks.

Sumi
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Avatar_m_tn
I am not convinced that jaw or tongue excersise can yield long-lasting treatment effect, although some phsio or soft tissue manipulation therapists claim that does work. If you can not afford the tmj specialist's charge, you may place a cotton roll between front teeth to seperate posterior teeth . Generally, this maneuver can maintain tmj in a musculoskeletally stable position . When the tmj is well aligned, masticatory , cervical and upper shoulder musculatures tend to relax. Most patients can perceive the joint position is different from the position while they swallowing. The differeence is , the joint is more backward and upward seated. Cheek muscle tend to relax very quickly once the joint is well aligned. However, definite treatment is occlusal therapy. Once financially affordable, seeing a tmj specialist is advised.
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Avatar_f_tn
Hi scottma,

Thank you for your response. I shall try the cotton roll trick and see.

Quote
Most patients can perceive the joint position is different from the position while they swallowing. The differeence is , the joint is more backward and upward seated.

Don't understand , if the joint is more backward and upward seated, is that a good thing? How will I know whether my joint is more backward and upward seated.

Thank you again and have a good day.

Sumi
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Avatar_m_tn
The joint position is compared to your jaw closing position while swallowing. Upper most joint position is the ideal position, which is generally more backward position than your volunteer closing position.
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Avatar_f_tn
Hi Scottma,

I understand what you mean now. Thank you again.

Sumi
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Avatar_m_tn
Hi, I don't mean to start a philosophical argument, but the jaw being positioned to far back and 'up' is many times indicative of a displaced disc.  When you mentioned that you deviate off to one side as you open that would suggest a disc displacement on that side.  Scottma's suggestion to bite on cotton rolls is a good one for temporary relief.  And I also agree that tongue rest position is way over rated by physio therapists and will not help long term.  Only a TMJ trained dentist will get you back to good function.  When you function properly on your discs the muscle pain gets better, and most of the time goes away with occasional exacerbations.  Proper jaw alignment (and cranial alignment, if needed) will improve neck symptoms and often helps with back symptoms as well.  Hope you can get the help you need soon.   TMJDoc
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Avatar_f_tn
Hi there,

Last week I had one of those TMJ X-rays and it came back saying that the disks were all okay and in fact nothing in the report read abnormal. And yet I still feel abnormal muscle tension more towards the left side and yet  it the right side that is locked up . When I say the right side is locked up, I mean not so the back teeth is coming together, but the molars in the front at the moment on the right that are coming together. It is almost I am constant resting my head onto the front molars in a tilted way. How do I reverse this imbalance, any suggestions.

My neck has a slight loss of lordosis due to posture, other than that everything is normal it seems.

Thanks.
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Avatar_m_tn
Seeing a tmj specialist is advised.
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Avatar_f_tn
Hi scottma,

My jaw seems less forward and I feel a lot better. So perhaps that cotton roll trick has helped.

Thanks.

Sumi
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Avatar_m_tn
I'm not sure what you mean by TMJ xrays, but only an MRI that is done properly will show the disk position.  Other images of the the hard tissues(bone) will show their relationships and give us a 'guess' as to the disc location.  But without an MRI you don't know for sure if the disks are in a normal position.  I don't know what you mean by locked up, but you need to see a qualified TMJ specialist.  Good luck.
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Avatar_f_tn
First off from my 14 years trying figure out my headaches/facial pain and tinnitus I'd say 95% of the problem is from teeth clenching and grinding.  Being in the "fight and flight mode" all the time will cause this.

Dr Janet Travell (JFK's White House Doc) and Dr David Simons wrote the Bible of myofascial pain.
http://www.triggerpointbook.com/travell.htm

I most be honest, These neuromuscular dentist are ripping people off by using a tens machine.  A tens WON'T break down the fascia and trigger points in the muscle.  Yes they will give temporary relief. But it isn't cure the trigger points.

Get this book.
http://www.triggerpointbook.com/tmjdisor.htm

Then get to a massage or bodywork (Rolfing or Hellerwork) therapist that does intraoral work.  Make sure they are good at it and have experience.  Most won't do it but Rolfers and Hellerwork usual will.

It's painful as HELL.  But it will break down the microscopic scar tissue and trigger points.

Another great book is by Ingrid Bacci called Effortless Pain Relief  
It's not exactly effortless by she is RIGHT on the money as to what causes the problems
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Avatar_f_tn
The trigger points in the lateral pterygoid muscle will make the jaw extremely tight. The pterygoid will cause the ringing in the ear.  

These TMJ Dentist are ripping people like crazy.  

Get the Trigger Point Therapy workbook by Clair Davies.  It is a laymen's version of Travell and Simons Medical book on Trigger Points.

You can deep tissue massage a lot of the jaw muscles yourself.  But it would be best to see a therapist that does that work.  See my other post.

The sternocleidomastoid muscle along you neck plays a huge part as well.  It can cause trigger points to start in your jaw muscles also.

Mouth breathing from not being able to breath through you nose can case trigger points in the lateral pterygoid muscle that makes your sinus really bad.  Kind of a catch twenty two.  If you have allergies mouth breathing cause trigger points and if you have trigger points in the jaw it can cause allergy time sypmtoms, ie nasal congestion, drainage etc.

Get the BOOK.  Research trigger points in the masster,pterygoid and sternocleidomastoid muscle on Google.  You'll see what I mean.

These TMJ Dentist are milking people for big money.
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Avatar_f_tn
However, some people have an early warning system that's a little too sensitive. For these people, the fight or flight responses are triggered by events that would be ignored by many others. This hypersensitivity can be caused by a number of factors, including:

An inherited imbalance in brain hormones, as in anxiety and bipolar disorders
A history of verbal or physical abuse in childhood
Other post-traumatic stress disorders

It's exhausting and uncomfortable to spend so much time in a state of high alert. In addition, there are possible physical consequences to feeling stressed all the time, including high blood pressure, tension or migraine headaches, fibromyalgia, and TMJ (temporomandibular joint) syndrome.

http://bipolar.about.com/cs/altercomp/a/0304_breath2.htm
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Avatar_m_tn
Hi everyone,

I too suffer from tinnitus, which was started only a few minutes after my left jaw joint was dislocated by chewing food (that was in Octrober 2009).

Not too long ago I had a MRI done, which shows, that my left articular disc is anteriorly dislocated forward with some degenerative changes in the condyle of the TMJ.

Is it possible, that the dislocated disc is causing the tinnitus or is it more likely that the facial (lateral pterygoid) muscles and/or ear muscles (tensor tympani, tensor vel paltini,...), which could be in spasm, are causing this high pitched ringing?

If the disc is recaptured with the help of a splint, could this stop the tinnitus? (I also suffer from constant neck and shoulder pain since this happened)

A few days ago a maxillofacial surgeon has suggested a procedure called arthrocentesis (flushing the joints with a needle), then he would like to do a arthroscopy (to reposition my disc) and finish the procedure with permanent denervation (in another words, he would like to burn my nerves). I'm not really sure about all this, because no conservative treatment was tried first. Any thoughts, please?

Thanks and best regards!
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Avatar_m_tn
Without a personal evaluation it is not possible to give a definitive diagnosis and it is advised to see your clinical provider. The mri images that were provided are incomplete because there are no tansverse views of the discs to show medial or lateral dispacement. Because of knowledge in reading mri's I do believe that you discs are not just anteriorly displaced but also medially displaced. Experience has shown me that it will be difficult to recapture the disc without surgery. Arthrocentesis has not shown to help reposition the discs and possibly may displace the discs even further. You must ask questions of your provider. Splint therapy in conjunction with plication  surgery will possibly help the most. Before having any type of denervation therapy utilize the conservative splint therapy to determine of the tinnitus resolves. The neck and shoulder pains should begin to resolve with treatment and the degenerative changes in the condyle should also resolve with time. Good Luck and God Bless.
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Avatar_m_tn
Hi! Thank you for your answer, I appreciate it.

I'm having an appointment with the maxillofacial surgeon this Friday. After our conversations via e-mails, we agreed, that he will make a splint for me and a splint therapy will be tried first. We did not talk about the type of this splint, but most probably it will be a relaxation splint, because as far as I know, these are the only splints that they are able to produce. Do you think that a relaxation splint by itself could help to recapture a dislocated disc such as mine?

Thanks for the medial displacement tip too. I was not aware of that. Also, I will skip the arthrocentesis procedure, because all I have read so far, only confirms what you have said.

Kind regards,
Henrik
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Avatar_m_tn
Splint therapy has proven to be good at reducing the discs  but it is also technician sensitve. You must ask your provider his level of experience in doing this type of treatment and what he expects will be the final outcome in your case. Good luck and God bless.
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Avatar_m_tn
Thank you for your help, I appreciate it.

God bless.
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Avatar_m_tn
Hi!  I have been working to figure out my tmj/tinnitus problem for the last 9 months.  I went to a specialist who put me in an anterior repositioning splint based off of xrays.  Tinnitus cleared up but face went into horrible spasms that took weeks to clear up.  This tmj doctor said one of my discs was completely off and the other was degenerating based on feel.  I had an MRI taken with another dentist that showed a pseudo displaced disc on one side and the other disc was fine.  So now I am in a permissive plane splint with no relief from my tinnitus.  I have had 6 months of physical therapy to correct my posture as well.  The tinnitus is debilitating.  I'm not for sure where to go at this point.  Anterior repositioning splints alter the bite and stretch face ligaments which scared me to death, but it was the only thing that helped my tinnitus.  I have been told I would be a good candidate for fat graft surgery.  I am only 38 years old...  What do I need to do?
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Avatar_m_tn
I paid $13,000 for neuromuscular dentist treatment and it did not work. My best suggestion is to try dry needling from a physical therepist trained to follow the work of Dr's Travel and Simons. I haven't resolved my condition but my research tells me this is the closest thing to a good outcome.
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Avatar_m_tn
I went to a dentist for new crowns and he recommended getting the optimal bite first by wearing a splint.  Mind you I had no pain or tmj issues.  He put me on a TENS machine with my facial and jaw muscles contracting for 90 minutes. The next day I awoke with a high pitched ringing sound in my head which has not ceased.  It has been a month and I don't know how much longer I can take it.  For two weeks when I would awaken in the morning I had to open my left eye with my fingers.  My eyesight has diminished, and everyone tells me that I look like a different person since the treatment. The jaw muscles were relaxed so much that my jowls are now hanging. There are wrinkles and lines all over that were not there prior.  Everyone tells me that I've aged 10 years in one month.  At this point I don't even care about the cosmetics of it, I just need this ringing to stop.
My md doctor said that I received a mild form of electric convulsive therapy.
My dentist dismissively says he's never encountered such a thing and cannot move forward with the splint without further tensing.  My question is - Is it possible that he overstretched the muscles so much that it displaced the disc in the TM joint? Or could all the excessive neuronal activity generated by the tens brought on the tinnitus? Would greatly appreciate any feedback you have to offer! Thank you - el59
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875426_tn?1325532016
An MRI is how they would look to see if your discs are displaced or not.  I'm sorry you are having tinnitus.  Have you seen an optometrist or opthamologist about your eyesight?
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Also, I'd recommend lodging a complaint against the dismissive dentist with the dentist licensing board about the matter- it is a risky matter to use a tens unit on the head and it sounds like they messed up.
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Avatar_f_tn
After finishing invisaligns to help fix my bite, my dentist did TENS for 45 minutes and charged me $730 for the TENSING! I have protested the cost since my PT does tensing on both my arms at the same time and for 30 minutes and charges me $35!  I paid the bill because they make me pay in advance or she won't do the work.  But it was clear that the bill for TENS wasn't for something other than a couple of pads on my jaw and the usual current.  I thought it would at least be something special- and the machine didn't even work for a while- it was old.  HOW can that cost $730?? I called and asked them to recheck that bill, but they won't call back.
Is that a normal charge for tensing at the dentist???
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scottma
taipei, Taiwan