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Hamidreza Nassery , DMD, FICOI
Hamidreza Nassery , DMD, FICOI
Male, 43
Miami Beach - FL
Interests: all sports, Travel, My family, Dentistry
Male, 43
Miami Beach - FL
Interests: all sports, Travel, My family, Dentistry
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Best Treatment for TMJ
Feb 25, 2009 08:55PM
- 87 comments
For the past few weeks I have been throwing arround ideas as to the best way to respond to this matter. You see a recent article ( Feb.3 , 2009 NY times) titled "Best treatment for TMJ May be Nothing" nearly made me clench my jaw to pieces.
While well written, I found that the author, Ms. Brody, relied heavily on out dated and narrow perspective supplied to her by a small group of dentists. The information provided to her would lead one to beleive that TMD ( or "TMJ' as it is wrongly called by many) is easy to traet and self-manage or that it may all be in the patient's mind. The sources in the article stated that, "TMJ problems were originally thought to be caused by dental Malocclussion but that this was an infrequent cause of the problem".
The American Academy of General Dentistry (AGD), an organization of some 40,000 of the nation's leading dentist, recognizes the relationship between maloclussion and headaches. Their website states " The average person swallows 2000 times a day, causing the upper and lower teeth to come together and push against the skull. People who have a poorly aligned bite or missing teeth can have related problems, such as frequent headaches or Sleep disroders, because their Jaw muscles must work harder to bring the teeth together, straining the surrounding muscles."
a simple google search for TMD would have provided this author with a wealth of informative sources regarding her subject.
I, as most responsible medical professionals, believe in using the most conservative successful form of treatment. As one who treats patients with most severe TMD symptoms, I can assure you that my patients are unable to manage the pain associated with these conditions by simply receiving counseling on their habits. What's more is that I find that dental malocclussion is frequently one of the principle causes of the TMD.
The article went on commenting that MRI and CAT scans are among the biggest advances in diagnosis of TMD, that is just ludicrous.While those are valuable diagnostic tools they do not show what is the underlying cause of the misalignement. I frequently find that to be the malocclussion.
Another statement that I found very irritating was " 80-90 % of the needed information can be obtained just by talking to the patient". Now we all know the importance of a thorough and complete history, it is a vital part of diagnosis. However, when objective evaluation tools such as Electromyography to study the muscle condition, computerized jaw tracking to record and document functional abnormalities, x-rays and MRIs to study the structure are available and yet ignored, it is like saying " lets just do away with the EKG, just ask the patient if they have chest pain".
Dentistry has traditionally been a profession guided largely by mechanical concept. It does not have to that way anymore. It is time for the profession to recognize that occlussion and jaw function are governed by physiological processes and diagnose and treat them accordingly.
While well written, I found that the author, Ms. Brody, relied heavily on out dated and narrow perspective supplied to her by a small group of dentists. The information provided to her would lead one to beleive that TMD ( or "TMJ' as it is wrongly called by many) is easy to traet and self-manage or that it may all be in the patient's mind. The sources in the article stated that, "TMJ problems were originally thought to be caused by dental Malocclussion but that this was an infrequent cause of the problem".
The American Academy of General Dentistry (AGD), an organization of some 40,000 of the nation's leading dentist, recognizes the relationship between maloclussion and headaches. Their website states " The average person swallows 2000 times a day, causing the upper and lower teeth to come together and push against the skull. People who have a poorly aligned bite or missing teeth can have related problems, such as frequent headaches or Sleep disroders, because their Jaw muscles must work harder to bring the teeth together, straining the surrounding muscles."
a simple google search for TMD would have provided this author with a wealth of informative sources regarding her subject.
I, as most responsible medical professionals, believe in using the most conservative successful form of treatment. As one who treats patients with most severe TMD symptoms, I can assure you that my patients are unable to manage the pain associated with these conditions by simply receiving counseling on their habits. What's more is that I find that dental malocclussion is frequently one of the principle causes of the TMD.
The article went on commenting that MRI and CAT scans are among the biggest advances in diagnosis of TMD, that is just ludicrous.While those are valuable diagnostic tools they do not show what is the underlying cause of the misalignement. I frequently find that to be the malocclussion.
Another statement that I found very irritating was " 80-90 % of the needed information can be obtained just by talking to the patient". Now we all know the importance of a thorough and complete history, it is a vital part of diagnosis. However, when objective evaluation tools such as Electromyography to study the muscle condition, computerized jaw tracking to record and document functional abnormalities, x-rays and MRIs to study the structure are available and yet ignored, it is like saying " lets just do away with the EKG, just ask the patient if they have chest pain".
Dentistry has traditionally been a profession guided largely by mechanical concept. It does not have to that way anymore. It is time for the profession to recognize that occlussion and jaw function are governed by physiological processes and diagnose and treat them accordingly.
I had a TMD(J?) issue for more than a year. The cartilage in my ears hurt so much while sleeping on my side that I awoke every half hour to switch sides and after 6 hours both ears hurt so much that I ended up sleeping on my back with Tylenol. I drilled a hole in my memory foam pillow to try to isolate the ear, but that wasn't very effective since sleeping for me involves movement and there was very little tolerance for that before the ear cartilage would hurt.
An orthodontist did some Xrays and other personal tests then made me an upper night splint which he swore would work in a few months. It took about 4 or 5 months, but he was right and I have not had trouble for almost a year. I doubt there was a placebo effect, because I did not think after a few months that the splint would work.
He had a self-confident air (totally justified if you ask me today) and said he was surprised that it took more than 2 months for relief, which was unlike what his patients took. He said a lower splint could never work, and regular dentists can't make upper splints.
I hope this post is not off-topic.
An orthodontist did some Xrays and other personal tests then made me an upper night splint which he swore would work in a few months. It took about 4 or 5 months, but he was right and I have not had trouble for almost a year. I doubt there was a placebo effect, because I did not think after a few months that the splint would work.
He had a self-confident air (totally justified if you ask me today) and said he was surprised that it took more than 2 months for relief, which was unlike what his patients took. He said a lower splint could never work, and regular dentists can't make upper splints.
I hope this post is not off-topic.
No birdie0907, not at all.
It actually make sense. however, I don't think that it is a permanent solution. You all of us have this issue to certain degree. The issue , I mean TMD, but to differing degrees. Tinnitis and other ear symptoms may have several different etiologies, the one that I see most is a misaligned jaw, and it certainly sounds your was the same issue.
You see by placign a night guard what you are doing is creating a space between the tip of your jaw bone and your temporal bone. This area should be housing a disk not very different from the miniscus in our knees. However, for most of us this space is ovr taken by the jaw bone as we have more posteriorized jaws and teeth. What you are doing is giving it a break at night.
I hope this makes sense.
It actually make sense. however, I don't think that it is a permanent solution. You all of us have this issue to certain degree. The issue , I mean TMD, but to differing degrees. Tinnitis and other ear symptoms may have several different etiologies, the one that I see most is a misaligned jaw, and it certainly sounds your was the same issue.
You see by placign a night guard what you are doing is creating a space between the tip of your jaw bone and your temporal bone. This area should be housing a disk not very different from the miniscus in our knees. However, for most of us this space is ovr taken by the jaw bone as we have more posteriorized jaws and teeth. What you are doing is giving it a break at night.
I hope this makes sense.
It's good to see this topic discussed! I've had TMJ issues for many years. I clench my teeth & I think it's due to the way I deal with stress. I do wear a jaw splint at night, which I've had for close to 10 years. I still wake up with pain on my right side. It feels like I'm putting a lot of pressure on my lower right teeth. I'm curious if my right ear & right neck pain could be associated since it seems like everything is on the right side. My right ear has always had a feeling of being plugged & when I massage the right side of my neck or my jaw, my ear has a brief sense of relief.
I have been dealing with severe TMJ problems for boy at least 5 years now .It took years to figure out what it was.I had smashing headaches shoulder pain,neck pain, tooth pain for months after dental appts. I would have vertigo and pain .Finally somebody had me open and shut my mouth a few times and picked up on it right away . I have since found out the joints are arthritic and have flattened and shortened up.The dentist told me a night plate would do me no good.I really just suck it up and deal with it .However being that it gets so bad after dental appts I am afraid to have any more work done which of course is not healthy .Tmj can be a severe problem for some. I hope that they can come up with better treatments.
Thank you for your comment, believe it or not all those symptoms could be explained and are very typical of my patient pool. the good news is that most of the symptoms that you just described are myofacial pain. Hurt muscles can be made to feel better. Depending on the age of the person and the progress of the problem the symptoms could all or most be removed if the position of the jaw is aligned to it physiological place.
I know it sounds like a lot of jargon, but most if not all the these symptoms could be explained. The ear aches and congestion, the stiff neck and shoulder, headaches and total body alignement. So as I have mentioned in my other posts the treatment are rarely single modality, I regularly work with Pt's, Chiros, and some DO's and Nueromuscluar massage therapists, because soemtimes the muscles are so wound up and tense that it is impossible for me to start off on those patients.
For more detailed questions about your case you can write me on my page.
warm regards.
I know it sounds like a lot of jargon, but most if not all the these symptoms could be explained. The ear aches and congestion, the stiff neck and shoulder, headaches and total body alignement. So as I have mentioned in my other posts the treatment are rarely single modality, I regularly work with Pt's, Chiros, and some DO's and Nueromuscluar massage therapists, because soemtimes the muscles are so wound up and tense that it is impossible for me to start off on those patients.
For more detailed questions about your case you can write me on my page.
warm regards.
Doctor Nassery, I am so glad I came across this post. Thank you. It is very informative. Now I know why my right ear has felt full all these years.
My problem with TMD started whilst wearing braces as a young teenager for an overbite. I'm 45 yrs. old now. I did not have TMD before having braces. When my mother explained my symptoms to the Orthodontist, he shrugged it off and said that the movement of my bite due to having braces had absolutely nothing to do with it. That was approx. 30 yrs. ago.
I've tried and wore the custom made plastic mouth piece at night for some time; but, it did not help. Now, after all these yrs. there's no more pain; but, the clicking on the right side remains upon opening and closing mouth.
Ya wanna hear somthin funny? As a teenager in high school, I was on my first date, with the coolest guy in school at the time and after dropping me home from a school dance we kissed goodnight. When we kissed, the right side of my jaw clicked really hard and my jaw locked open! Now, that was absolutely emabarrassing, as it took a minute or two which felt like an eternity to me, for my jaw to unlock and for the pain to subside. We both laughed about it. And can you believe it, he asked me out again. Imagine that!
My problem with TMD started whilst wearing braces as a young teenager for an overbite. I'm 45 yrs. old now. I did not have TMD before having braces. When my mother explained my symptoms to the Orthodontist, he shrugged it off and said that the movement of my bite due to having braces had absolutely nothing to do with it. That was approx. 30 yrs. ago.
I've tried and wore the custom made plastic mouth piece at night for some time; but, it did not help. Now, after all these yrs. there's no more pain; but, the clicking on the right side remains upon opening and closing mouth.
Ya wanna hear somthin funny? As a teenager in high school, I was on my first date, with the coolest guy in school at the time and after dropping me home from a school dance we kissed goodnight. When we kissed, the right side of my jaw clicked really hard and my jaw locked open! Now, that was absolutely emabarrassing, as it took a minute or two which felt like an eternity to me, for my jaw to unlock and for the pain to subside. We both laughed about it. And can you believe it, he asked me out again. Imagine that!
Wow! I am glad I found this site. I had been suffering from jaw pain in my mid 20's. An orthodontist had me wear many different appliances to move my lower jaw forward, to no avail. However, I consciously held my lower jaw out for many years. Six years ago, I had surgery with complications and was sedated for one week. Since then, my jaw has regressed and the pain is back - so is the clicking. Is there anything that can be done for me at my age? The headaches are becoming more frequent. Thank you. lorco12
I just visited an ENT physician today to get a read on my sinus CT scan because I was convinced I had chronic sinusitis. It turns out that my sinuses were completely clear. She told me that I might have TMJ instead because there are not many other causes for myofascial pain, which would account for the terrible headaches I get. Most of the pain is located behind the eyes, at my temples, my cheek bones, and my upper teeth. Right now, I can't find a comfortable position to rest my jaw. But I also have severe stiffness and pain in my neck, shoulder, and chest. The headaches have been a daily occurrence for many years, but the neck, shoulder, and chest pain has worsened over the last year. It is now to the point where I am distracted and irritable at work. By the way, I'm a 27 year old white female. I have been extremely fatigued - which initially brought me in to see the doctor. I'm now being (SLOWLY) evaluated for Sjogrens, having extremely dry eyes and chronic dry mouth and unexplained thirst and a recently cracked tongue. I have a positive ANA titer of 1:320 (homogenous) and an ESR of 32. Rheumatoid Factor was negative. The ENT doctor poked around at the sides of my mouth applying pressure and asking if it hurt (it didn't really) - which made the diagnosis of TMJ less certain. Does this sound like TMJ to you?
I've been put on a soft diet, ibuprofen 600mg three times a day, and ordered to actually use my mouth guard. But I'm not sure what else to do. This pain has been around for so long that I can't imagine a few weeks of jaw rest solving my problems and I'm really starting to have trouble keeping up at work. I'm exhausted and in pain all the time.
I've been put on a soft diet, ibuprofen 600mg three times a day, and ordered to actually use my mouth guard. But I'm not sure what else to do. This pain has been around for so long that I can't imagine a few weeks of jaw rest solving my problems and I'm really starting to have trouble keeping up at work. I'm exhausted and in pain all the time.
I am so pleased I found this thread, I have a question about TMJ problems. I had an operation on my jaw for TMJ problems after suffering years of excrutiating pain and unsucessful alternative therapies i.e splints, massage, ultrasound, pain killers, soft diet, hot compresses etc. I finally saw a surgeon Mr Simon Holmes at The Royal London (UK) who confirmed that I had an anterior steep and disc misplacement. He operated, replaced the disc and realigned the jaw. This immediately improved my condition. I no longer had the painful clicking, limited opening, constant pain and disclocation. Sadly 1 year on I now have the exact problem on the other side which is also causing the repaired side to have a constant dull pain. Would you advise I go back and see the consultant? I really don't want another operation as the pain afterwards was awful and took a long time to heal and I also had to have my head shaved 2 inches above my ear which has left me with a scar which is 3 inches long from an inch above my head running down the front of my ear to the bottom of my earlobe which is extremely sensitive. I would appreciate your advise
Ok , I am going to start with BonBon,
Your story is like a reccuring nightmare for me.. this month so far I have started treatment on two teenage girls whose symptoms have worsened with Orthodontic TX. You see most orhtodontic therapy is still done to the teeth and not to the joint. The prevalent philosophy in ortho school is that the positon of the teeth has nothing to do with the position of the joint.. still today ..so don't feel like you're alone.
They are still posteriorizing the jaws and that makes the problems worse or starts them .. the issues can be made better by re-aligning the jaw into the correct place. Then ,of course, the ortho will need to be done to the correct physiologic position.
Hope this helps.
www.drnassery.com
Your story is like a reccuring nightmare for me.. this month so far I have started treatment on two teenage girls whose symptoms have worsened with Orthodontic TX. You see most orhtodontic therapy is still done to the teeth and not to the joint. The prevalent philosophy in ortho school is that the positon of the teeth has nothing to do with the position of the joint.. still today ..so don't feel like you're alone.
They are still posteriorizing the jaws and that makes the problems worse or starts them .. the issues can be made better by re-aligning the jaw into the correct place. Then ,of course, the ortho will need to be done to the correct physiologic position.
Hope this helps.
www.drnassery.com
Lorco12,
There is something that can be done.. you already know the answer, your jaw is begging to be more down and forward . you can get this down even now, to be honest with you the bulk of my TMD patients are women in their 40's and above.. the cases are more complex and take longer to resolve completely but a lot of resolution to symptoms come fast as they are mostly muscular. True healing of the joint sometimes takes couple of years but that doesn't mean they are in pain during that time.
Hope, I answered your question.
There is something that can be done.. you already know the answer, your jaw is begging to be more down and forward . you can get this down even now, to be honest with you the bulk of my TMD patients are women in their 40's and above.. the cases are more complex and take longer to resolve completely but a lot of resolution to symptoms come fast as they are mostly muscular. True healing of the joint sometimes takes couple of years but that doesn't mean they are in pain during that time.
Hope, I answered your question.
MMJ81,
This all makes complete sense, bey that I mean your headaches, and soreness and neck stiffness and so on.. your jaw is connected to the body by your neck, why would it not make sense.. Let me see if I can explain this.. your jaw like most us is too far back, the position is dictated by our teeth you see.. so the teeth make the programing for the muscle, the muscle takes the jaw back so you can put your teeth together, but this is not the physiological position that your muscles really would want if it was up to them .. you follow me so far.? our teeth dictate the path of function for the muscles..what if I told you that for the past 250 years we have been getting our teeth in the wrong position.. well documented in the Orthodontic research. our upper teeth are going further back..
I like to compare it to having a pair of bad shoes and having to walk with it all day, and , ah, you can't take it off when you get home..
the issues have been there since the begining, but the symptoms are getting out now.. in short if all medical issues have been ruled out find yourself a TMJ specialist.. the methodology should not be surgical ,(at first anyway), they should be able to advance your jaw to comfort, stabilize it there and then figure out how to get your teeht to meet there later.
This all makes complete sense, bey that I mean your headaches, and soreness and neck stiffness and so on.. your jaw is connected to the body by your neck, why would it not make sense.. Let me see if I can explain this.. your jaw like most us is too far back, the position is dictated by our teeth you see.. so the teeth make the programing for the muscle, the muscle takes the jaw back so you can put your teeth together, but this is not the physiological position that your muscles really would want if it was up to them .. you follow me so far.? our teeth dictate the path of function for the muscles..what if I told you that for the past 250 years we have been getting our teeth in the wrong position.. well documented in the Orthodontic research. our upper teeth are going further back..
I like to compare it to having a pair of bad shoes and having to walk with it all day, and , ah, you can't take it off when you get home..
the issues have been there since the begining, but the symptoms are getting out now.. in short if all medical issues have been ruled out find yourself a TMJ specialist.. the methodology should not be surgical ,(at first anyway), they should be able to advance your jaw to comfort, stabilize it there and then figure out how to get your teeht to meet there later.
Debs40
your case is very interesting, I am not a big believer in surgical lavage of the disc space, I don't believe that really creat or causes the relief. I can think of many on this same forum that would confirm that for you. The reliefe comes from the realignment of the jaw. That was what made you comfortable..the question is what changed to change the position of your jaw? did you loose teeth on that side?
So to answer your question, no jaw surgery, just re-align your jaw and that should take the pain away..
your case is very interesting, I am not a big believer in surgical lavage of the disc space, I don't believe that really creat or causes the relief. I can think of many on this same forum that would confirm that for you. The reliefe comes from the realignment of the jaw. That was what made you comfortable..the question is what changed to change the position of your jaw? did you loose teeth on that side?
So to answer your question, no jaw surgery, just re-align your jaw and that should take the pain away..
I haven't been directly told that I have TMD but have had a lot of issues with my jaw. I started ortho work when I was 6 years old because my jaw was so tiny and all my teeth were coming in crooked. I had two sets of braces, applicances and retainers up until age 14. My overbite then came back and gave me very bad jaw/face pain. The maxofacial surgeron that took out my wisdom teeth wanted to do jaw surgery to fix the overbite.
I know surgery is discouraged for TMD problems but could my situation be different and benefit from the surgery? Or should I look into a TMJ doctor and get another opinion on it. My muscles don't really hurt that much (nothing an advil can't take care of) unless I'm stressed. They are constantly tight and I have to consciously loosen the muscles every couple of minutes. I do wear my night splint every single night because otherwise it is very painful. When it doesn't become sore is throughout the day when I am unable to wear my splint. The only suggestion my regular dentist had in regards to the discomfort is to wear the splint more often.
I also don't know how to go about looking for a good TMJ doctor, I live in calgary, AB in canada and all the ones I have found are US based.
I know surgery is discouraged for TMD problems but could my situation be different and benefit from the surgery? Or should I look into a TMJ doctor and get another opinion on it. My muscles don't really hurt that much (nothing an advil can't take care of) unless I'm stressed. They are constantly tight and I have to consciously loosen the muscles every couple of minutes. I do wear my night splint every single night because otherwise it is very painful. When it doesn't become sore is throughout the day when I am unable to wear my splint. The only suggestion my regular dentist had in regards to the discomfort is to wear the splint more often.
I also don't know how to go about looking for a good TMJ doctor, I live in calgary, AB in canada and all the ones I have found are US based.
Tammy,
You are actually in luck because there more Nueromuscular dentists in your neck of the woods per capita than here.. Canadien dentist have been on the forefront of these new teachings in dentistry.. Eventhough your dental schools like ours, frowns on us.
And Tammy it is not ok to have to loosen up your neck or grind and clench teeth or take advils all the time, I know you can bear with it but that is not normal.. I say that because I see so many people like you that have adapted to a less comfortable state of being.. your story of jaw relation and childhood malocclussion is the typical story..
Look up these poeple they are in your area.
You are actually in luck because there more Nueromuscular dentists in your neck of the woods per capita than here.. Canadien dentist have been on the forefront of these new teachings in dentistry.. Eventhough your dental schools like ours, frowns on us.
And Tammy it is not ok to have to loosen up your neck or grind and clench teeth or take advils all the time, I know you can bear with it but that is not normal.. I say that because I see so many people like you that have adapted to a less comfortable state of being.. your story of jaw relation and childhood malocclussion is the typical story..
Look up these poeple they are in your area.
I am a 40 year old male. My smile is a mess. My jaw is no better. My bite is a joke. Currently none of my molars [4 adult and 4 baby] even touch when I bite down.
I am missing a total of 17 permanent adult teeth, I currently have 20 of my own teeth in my mouth, half of them are my "baby" teeth.
I have had a snapping/clicking in my jaw for years. My jaw has locked a few times, which was scary. I have learned a lot just by reading this thread & am so glad that I found it. I am scared of surgery, I don't have a lot of money to spend on something that will mask a problem without truly fixing it, so I have been hesitant to pay for a new bridge or implants because I don't know how to get my bite/jaw corrected first.
By reading your thread here, it sounds like you believe in correcting the jaw & bite, then correcting the teeth after...HOW? How in the world can this be done? I have all but given up hope.
I am missing a total of 17 permanent adult teeth, I currently have 20 of my own teeth in my mouth, half of them are my "baby" teeth.
I have had a snapping/clicking in my jaw for years. My jaw has locked a few times, which was scary. I have learned a lot just by reading this thread & am so glad that I found it. I am scared of surgery, I don't have a lot of money to spend on something that will mask a problem without truly fixing it, so I have been hesitant to pay for a new bridge or implants because I don't know how to get my bite/jaw corrected first.
By reading your thread here, it sounds like you believe in correcting the jaw & bite, then correcting the teeth after...HOW? How in the world can this be done? I have all but given up hope.
Hello everyone. I am new to this, so bar with me. It's about my sister. She is 52 now and back about 25-30 yrs ago she had braces and wore some kind of relaxer mechanism that allowed her jaw muscles to relax and she was left with a very obvious misallignment of upper to lower teeth. She developed joint pain and the Doctors decided to take out her lower jaw and cut it and reshape and wired it together. Then, they cut off her upper teeth from her scull and reduced the width a bit and wired it back in. She still had the joint pain, so she was fitted with an orthotic (fake) joint and after a few years it disintegrated. They they cut out a piece of her scull taking just a few layers and made a lever for her jaw to work with (the bad orthotic had left an opening to her brain that had to be closed), She is in constant pain, can't eat or talk much and is now addicted to prescription pain meds. I asked her couldn't she have another surgery or have a nerve cut? She said no to options of surguries andthe nerve would be the trigeminal and that wasn't an option either. Her life is ruined...from pain and more so by the pain medication. Any comments?
Clarkbar7,,
You actually understood the bulk of the subject very well.. there are ways to first get thejaw corrected.. as amatter of fact our moto is do not touch anytooth untill you get your bearings right. we do our testing on plastic and acrylic orthosis.. not your teeth, when we get the position right and the aptients has no more licking and poping and pain ect. then we proceed to make a treatment plan on how to put the teeth in the right place .. is a long and cumbersome road specially in advanced patient and have to add that it is not inexpensive, but once there your investment pays off..
Let me ask you one question? which goes to show you how 95% dental work done is in the wrong place.. if you keep breaking your teeth , and or loosen them up and have visible turns and assymetries in your jaw, wouldn't that mean that the current position is pathological? Then why as dentist we fix you back to the same place just put new crown or implant in the same pathological position? Any wonder why in a few short years or less we break the porcelain on the crowns, or if the are gold then we have sorejaws or teeth..
Just some questions I asked myself when I practiced that way.. makes no sense does it?
You actually understood the bulk of the subject very well.. there are ways to first get thejaw corrected.. as amatter of fact our moto is do not touch anytooth untill you get your bearings right. we do our testing on plastic and acrylic orthosis.. not your teeth, when we get the position right and the aptients has no more licking and poping and pain ect. then we proceed to make a treatment plan on how to put the teeth in the right place .. is a long and cumbersome road specially in advanced patient and have to add that it is not inexpensive, but once there your investment pays off..
Let me ask you one question? which goes to show you how 95% dental work done is in the wrong place.. if you keep breaking your teeth , and or loosen them up and have visible turns and assymetries in your jaw, wouldn't that mean that the current position is pathological? Then why as dentist we fix you back to the same place just put new crown or implant in the same pathological position? Any wonder why in a few short years or less we break the porcelain on the crowns, or if the are gold then we have sorejaws or teeth..
Just some questions I asked myself when I practiced that way.. makes no sense does it?
litbee,
I am so sorry to hear your sister's story.. this is why I am not a big fan of surgical intervention.. it is a slippery slope..that is not to say that some times it is not the choice, but only after careful calculation .. It sounds to me that your sister had Condylectomy, a procedure that was popular back then because they thought that source of the pain was the joint, we now know that 75-80 % of the pain is muscular, that is why she still has pain..I have only had one patient with these similar circumctances , addiction and all, and I had to excuse myself from that case because we never could get beyound her need for more pain meds. I prescribe pain meds maybe once a year.. I am not very fond of meds and only prescribe when pt. is in severe inflamatory discomfort..I find that most patient I can get very comfortable with in weeks of the treatment. I hope this helps. All the best to you and your sister.
I am so sorry to hear your sister's story.. this is why I am not a big fan of surgical intervention.. it is a slippery slope..that is not to say that some times it is not the choice, but only after careful calculation .. It sounds to me that your sister had Condylectomy, a procedure that was popular back then because they thought that source of the pain was the joint, we now know that 75-80 % of the pain is muscular, that is why she still has pain..I have only had one patient with these similar circumctances , addiction and all, and I had to excuse myself from that case because we never could get beyound her need for more pain meds. I prescribe pain meds maybe once a year.. I am not very fond of meds and only prescribe when pt. is in severe inflamatory discomfort..I find that most patient I can get very comfortable with in weeks of the treatment. I hope this helps. All the best to you and your sister.
I was told I grind my teeth by my dentist a few months ago and since then I've developed a slew of problems, including a full feeling in my left ear. I'm being worked up for multiple sclerosis and there is some indicia of lestions that may account of nerve problems I've had (like tingling in my cheek and jaw and gums and lips on the same side as the ear fullness). Yesterday I realized I felt I couldn't quite control my jaws as I used to. Could TMJ be the cause of some of these symptoms, or if it is MS, might not TMJ be a symptom of it and a mouthguard still help with the fullness in the ear?
I am desperate for help, really. Anything you might suggest would be so appreciated!
I am desperate for help, really. Anything you might suggest would be so appreciated!
Mallie52,
The first thing you should do is to rule out any major medical issues such as CA tumors and nueral issues such as MS. Although there sre evidence in lit. connecting MS and TMD,all medical steps take priority.
Once your medical work up is done and if they should rule out MS or any other Nueral damage as the root cause then it is possible to have the tingling and other symptoms that you described because of the grinding.. As a matter of fact we often see this with very acute cases.. the easiest way to explain it is this.. the nerves that you described ( facial nerve or Cranial nerve 7) travels part of it way through muscles, those would be muscles of mastication in some parts , and if your are that tense and clench and grind very hard you could theoritically get the muscle so wound up that they pressurize the nerves going through them.. We see this in patients with Bell's Palsy and we have noticed a great correlation between TMD or mislaignment of jaw and pts. that get that issue.
But first rule out all the bad stuff, hopefully it is not anything serious, TMD can be resolved. Always remain optimistic..
All the best.
The first thing you should do is to rule out any major medical issues such as CA tumors and nueral issues such as MS. Although there sre evidence in lit. connecting MS and TMD,all medical steps take priority.
Once your medical work up is done and if they should rule out MS or any other Nueral damage as the root cause then it is possible to have the tingling and other symptoms that you described because of the grinding.. As a matter of fact we often see this with very acute cases.. the easiest way to explain it is this.. the nerves that you described ( facial nerve or Cranial nerve 7) travels part of it way through muscles, those would be muscles of mastication in some parts , and if your are that tense and clench and grind very hard you could theoritically get the muscle so wound up that they pressurize the nerves going through them.. We see this in patients with Bell's Palsy and we have noticed a great correlation between TMD or mislaignment of jaw and pts. that get that issue.
But first rule out all the bad stuff, hopefully it is not anything serious, TMD can be resolved. Always remain optimistic..
All the best.
I want to put a quaetion to all who answered here.. how many have had issues or been told they have Carpal tunnel Syndrom? please let me knwo if you have had work done on that already or seen a physician for it??
Thanks.
Dr. Hamid Nassery
www.drnassery.com
Thanks.
Dr. Hamid Nassery
www.drnassery.com
I am amazed at hearing all these stories -- for the longest time I thought I was going crazy. When I was 15, started having horrible headaches, pain in the cartilage of my ears, feeling like my jaws were bruised. And I can't remember when my neck didn't feel stiff, and my shoulder muscles weren't sore. The doctor diagnosed TMJ Disorder. He told me the upper arch of my teeth was too narrow, so the braces pushed the arch outwards, so the upper teeth sat on slightly to the outside of the lower teeth. (I hope that makes sense). For many years, I had relief after the braces, but there were periods throughout my 20s when the pain would return, especially after dental work, during stressful periods, or teaching a night class when I had to talk for a few hours almost non-stop, or (embarrassingly) after kissing!
About 4 years ago, when I was 33, my life changed dramatically resulting in a lot of stress, and it continues to be stressful. (And I think my teeth, corrected in my teens, have since shifted back to their original positions.) Since then, the pain has returned in my jaws, my temples, my neck, my shoulders, and here's the thing -- I also have been thinking I had sinus infections or a problem with my ears, but I had no idea the two problems could be related. For 4 years, I have been going to doctors trying to figure out why my ears feel stuffed, heavy, and sore all the time especially at night when I try to sleep and am not distracted by other things. I also hear a strange muffled crackling when I "adjust" my ears which drives me crazy. I thought it was an issue of pressure in the inner ear. So all this time, it was my jaw? I just want to verify that because the physiological experience doesn't seem to correspond with jaw pain but inner ear pressure.
I have recently asked my dentist for help, actually crying when I realized that she didn't think I was crazy, and she has fitted me for guards to wear, but they aren't ready yet. Also, I now live in France, and I'm not exactly sure how everything is going to work -- my French is okay, but sometimes I can't understand everything, so I'm not certain she is doing the right thing for my problem. Will guards "fix" everything? It seems a lot to hope for given the extent, duration, and frequency of the pain.
About 4 years ago, when I was 33, my life changed dramatically resulting in a lot of stress, and it continues to be stressful. (And I think my teeth, corrected in my teens, have since shifted back to their original positions.) Since then, the pain has returned in my jaws, my temples, my neck, my shoulders, and here's the thing -- I also have been thinking I had sinus infections or a problem with my ears, but I had no idea the two problems could be related. For 4 years, I have been going to doctors trying to figure out why my ears feel stuffed, heavy, and sore all the time especially at night when I try to sleep and am not distracted by other things. I also hear a strange muffled crackling when I "adjust" my ears which drives me crazy. I thought it was an issue of pressure in the inner ear. So all this time, it was my jaw? I just want to verify that because the physiological experience doesn't seem to correspond with jaw pain but inner ear pressure.
I have recently asked my dentist for help, actually crying when I realized that she didn't think I was crazy, and she has fitted me for guards to wear, but they aren't ready yet. Also, I now live in France, and I'm not exactly sure how everything is going to work -- my French is okay, but sometimes I can't understand everything, so I'm not certain she is doing the right thing for my problem. Will guards "fix" everything? It seems a lot to hope for given the extent, duration, and frequency of the pain.
Hello LeAnn,
As you have noticed your stories are actually very similar to the rest of the group. TO answer your question quickly, if you are just getting a night guard it may provide you with some relief for a little time, however it will not last too long.
I see if I can explain this and hope everyone reads this piece. the major difference between a night guard any kinda of guard that is fabricated from a simple impression or imprint of your teeth and an orthotic that is made by Nueromuscular dentist is that they are two very different trajectories. What does that mean..? we also take impression from your teeth obviously, but then we spend three hours relaxing and listening to your musculature to see where would your jaw would have functioned if your teeth were not there...we capture that trajectory and fabricate our orhtosis in that path.. you see most of you have a posteriorized trajectory, because if you have read my note above most of us do have our teeth further back than we should..now depending on how far back things are, is the reason behind why some one can cope and some one would be so symptomatic..
Regular guards are made on the same trajectory as you currently have only in the lab they open the cast by 4mm and fill the space with acrylic. Thats why people still clench and grind and muscular symptoms come back
I invite you all to read my other log on snoring, there is a big correlation between TMD and snoring and you all should be aware of it.
All the best.
As you have noticed your stories are actually very similar to the rest of the group. TO answer your question quickly, if you are just getting a night guard it may provide you with some relief for a little time, however it will not last too long.
I see if I can explain this and hope everyone reads this piece. the major difference between a night guard any kinda of guard that is fabricated from a simple impression or imprint of your teeth and an orthotic that is made by Nueromuscular dentist is that they are two very different trajectories. What does that mean..? we also take impression from your teeth obviously, but then we spend three hours relaxing and listening to your musculature to see where would your jaw would have functioned if your teeth were not there...we capture that trajectory and fabricate our orhtosis in that path.. you see most of you have a posteriorized trajectory, because if you have read my note above most of us do have our teeth further back than we should..now depending on how far back things are, is the reason behind why some one can cope and some one would be so symptomatic..
Regular guards are made on the same trajectory as you currently have only in the lab they open the cast by 4mm and fill the space with acrylic. Thats why people still clench and grind and muscular symptoms come back
I invite you all to read my other log on snoring, there is a big correlation between TMD and snoring and you all should be aware of it.
All the best.
Dr Nassery,
Thanks so much for your response, and I might add more thanks for your obvious care and concern about this issue. It is such a huge relief to learn from someone who understands the problem and takes the time to help others. I've always felt like some kind of weakling or sissy or complainer because no one seemed to take the intensity of the pain seriously.
I am going to talk to my dentist about what you said. If I understood her correctly, I am going to a 2nd appt. (the 1st was to have the molds made) during which she is going to put some kind of helmet on me (sounds weird!) and investigate how my jaw moves. Maybe that is similar to what you described? If so, great. If not, I'll see what I can find out about finding someone here in France who could help me in the way you described.
Sincerely,
LeAnn
Thanks so much for your response, and I might add more thanks for your obvious care and concern about this issue. It is such a huge relief to learn from someone who understands the problem and takes the time to help others. I've always felt like some kind of weakling or sissy or complainer because no one seemed to take the intensity of the pain seriously.
I am going to talk to my dentist about what you said. If I understood her correctly, I am going to a 2nd appt. (the 1st was to have the molds made) during which she is going to put some kind of helmet on me (sounds weird!) and investigate how my jaw moves. Maybe that is similar to what you described? If so, great. If not, I'll see what I can find out about finding someone here in France who could help me in the way you described.
Sincerely,
LeAnn
LeAnn,
You are very welcom.. it sure sounds she is on the right track, a jaw tracking machine is the full proof way of finding the correct trajectory.. or close to it anyway, sounds like she is well advanced in her practice, I am so happy to hear that.
Keep in mind that healing is a process and not an event, the very first bite that she captures is only the start and it will be refined over the following months but the good news is that much of relief starts immediately in the first couple of weeks in most cases.
I will tell you a neat story, based on this same science we have patented a sport gaurd, called PPM or Pure power mouthguard, we have it in over three hundred professional athletes and they all have gotten imrpovements , physically.. it is fun to watch, has anyone noticed how shaquil Oneal is quietly hitting his best free throw percetage of his career now 16-17 years in the league? he is wearing our mouthpiece..
More on this in later blogs..
You are very welcom.. it sure sounds she is on the right track, a jaw tracking machine is the full proof way of finding the correct trajectory.. or close to it anyway, sounds like she is well advanced in her practice, I am so happy to hear that.
Keep in mind that healing is a process and not an event, the very first bite that she captures is only the start and it will be refined over the following months but the good news is that much of relief starts immediately in the first couple of weeks in most cases.
I will tell you a neat story, based on this same science we have patented a sport gaurd, called PPM or Pure power mouthguard, we have it in over three hundred professional athletes and they all have gotten imrpovements , physically.. it is fun to watch, has anyone noticed how shaquil Oneal is quietly hitting his best free throw percetage of his career now 16-17 years in the league? he is wearing our mouthpiece..
More on this in later blogs..
hello, I have tmj, tmd, if they are the same, and been told by my dentist to get one of those mouth pcs. of course, the reason i clench my teeth is b/c i have Epilepsy, and in my sleep i clench my teeth, thus, also flattening my teeth, tried teh mouth pc, and couldn't sleep with it in, was like trying to sleep with a mouth full of bad tasting plastic, what alternatives could be suggested?
Running the entire gammit of all the TMJ treatment theories has left me taking care of myself. Starting with mouth guards, ortho, cortizone shots, arthroscopy, 8 crowns, 4 TMJ surgeries all of which did alsolutely nothing. Just plain spacing by keeping my bite slightly open, using heat, and mouth guard at times, and antiinflamatories of course.
My 4 tmj surgeries were a result of ego related Physician ideas. The first 2 were done in 1986 and Vitek implants were used without FDA approval. The vitek company says they grandfathered it in. Well the FDA did a total recall on these implants saying there would be a 100 percent failure rate. It was widely known in the march 1986 meeting of the american oral surgerns meeting of these problems and my doctor at the time still used them without my knowledge.
On the complete news relates info on the Vitek implants I chose to remove them in 1993. It only helped in one side. The otherside has been horrendous. On advise of the explanting surgeon I know how to help control these problems as stated earlier.
I've discovered the Lidocaine Patch it is a prescription item and I cut one to fit my ear/cheek area. It give direct penatation the the source of the pain. It is a lidocaine simular to what dentist use for numbing ones teeth. I recommend trying them. Also don't let cool air hit the area. Not many patients know about these patches I told my doctor about them and hopefully he let others use them.
Be careful of what surgery you let them use. I've not heard of anycase that was successful.
Good luck
My 4 tmj surgeries were a result of ego related Physician ideas. The first 2 were done in 1986 and Vitek implants were used without FDA approval. The vitek company says they grandfathered it in. Well the FDA did a total recall on these implants saying there would be a 100 percent failure rate. It was widely known in the march 1986 meeting of the american oral surgerns meeting of these problems and my doctor at the time still used them without my knowledge.
On the complete news relates info on the Vitek implants I chose to remove them in 1993. It only helped in one side. The otherside has been horrendous. On advise of the explanting surgeon I know how to help control these problems as stated earlier.
I've discovered the Lidocaine Patch it is a prescription item and I cut one to fit my ear/cheek area. It give direct penatation the the source of the pain. It is a lidocaine simular to what dentist use for numbing ones teeth. I recommend trying them. Also don't let cool air hit the area. Not many patients know about these patches I told my doctor about them and hopefully he let others use them.
Be careful of what surgery you let them use. I've not heard of anycase that was successful.
Good luck
I developed myofacial pain, earaches, headaches, stiffness in my neck, etc. in 1999 (age 29). I went to my family doctor who did some blood work and a few other tests, then she sent me to an ear, nose and throat specialist, who said there was nothing wrong there. So then it was recommended that I see an orthodontist/periodontist in our area who specializes in TMJ disorders. He took diagnostic ex-rays, constructed molds of my jaw, etc. He gave a complete explanation of what was happening. My lower jaw was too long and the way my teeth had formed (I had upper, lower, and then upper again behind in one place) forced the jaw upwards/back and pushed on the nerves and the disc in my jaw. He said he would be happy to provide whatever treatment I chose. I could go with just a bite plane/splint (which we did for six months of constant wear without really minimizing the pain in any way), I could have braces and the bite plane/splint, or I could have braces, bite plane, and surgery by a maxilo-facial surgeon to match the shape/size of my lower jaw to that of my upper jaw. I decided to get the braces as my smile was a little lacking - a "fang" on the right, teeth off-center, and an overbite. He didn't make me decide about the surgery until we were at the point where the teeth would have to be moved differently for the surgery option than for just the braces - it was about 2-3 years in. Interestingly, my symptoms abated somewhat while I had braces on - perhaps the tenderness made me recoil from clenching, giving some relief.
I chose to have the surgery in Halifax, NS. The surgeon broke both my upper and lower jaw on each side. I still have the metal plates he put in to hold the bone together temporarily. You can feel the ones on the upper jaw, just behind my nostril. It is a very invasive surgery. Recovery time is long and difficult because you cannot eat, your mouth is held together by heavy duty rubber bands. Yet you MUST try every day to move it a little bit, or your jaw will set in place and you won't be able to open it when they take the bands off. I was off work for 3 months, (2005) on varying degrees of painkillers from codeine down to tylenol 3 on down to advil.
Overall my experience has been very good. My jaw no longer pops with every bite I eat. I haven't had to take a pain killer for facial pain for more than two years. I do have flair ups (brought on by stress, mostly) but I cope with them by going to my physical therapist who specializes in treating TMJ D symptoms. I do facial exercises daily. I also recommend a really good overall exercise regimen - it helps your muscles to relax.
The biggest thing I learned through all this is how much pain in your jaw can cause your quality of life to deteriorate. By the time I begin receiving treatment from the orthodontist and the physical therapist (the orthodontist sends all his patients to physio), I had lost 35% of the mobility in my neck and upper body - without really noticing it! I just stopped moving/stretching because it hurt!
As I said, I still have flair-ups, and I have a few symptoms I didn't have before - tinnutis (ringing in my ears), and my jaw pops when I yawn, despite all I do to control it. I still have hopes of eliminating the yawning pop with exercise - it takes a long time to retrain muscles to match the new shape of the jaw bone.
For those of you looking for a solution - don't rush. Try just a splint - it works for many people, but monitor it! Go in stages, don't just assume that surgery or other invasive options are the only choice. For those who have been suffering for a long time and have tried all sorts of things, way the risk and don't be afraid to take it if you feel it is right for you.
I chose to have the surgery in Halifax, NS. The surgeon broke both my upper and lower jaw on each side. I still have the metal plates he put in to hold the bone together temporarily. You can feel the ones on the upper jaw, just behind my nostril. It is a very invasive surgery. Recovery time is long and difficult because you cannot eat, your mouth is held together by heavy duty rubber bands. Yet you MUST try every day to move it a little bit, or your jaw will set in place and you won't be able to open it when they take the bands off. I was off work for 3 months, (2005) on varying degrees of painkillers from codeine down to tylenol 3 on down to advil.
Overall my experience has been very good. My jaw no longer pops with every bite I eat. I haven't had to take a pain killer for facial pain for more than two years. I do have flair ups (brought on by stress, mostly) but I cope with them by going to my physical therapist who specializes in treating TMJ D symptoms. I do facial exercises daily. I also recommend a really good overall exercise regimen - it helps your muscles to relax.
The biggest thing I learned through all this is how much pain in your jaw can cause your quality of life to deteriorate. By the time I begin receiving treatment from the orthodontist and the physical therapist (the orthodontist sends all his patients to physio), I had lost 35% of the mobility in my neck and upper body - without really noticing it! I just stopped moving/stretching because it hurt!
As I said, I still have flair-ups, and I have a few symptoms I didn't have before - tinnutis (ringing in my ears), and my jaw pops when I yawn, despite all I do to control it. I still have hopes of eliminating the yawning pop with exercise - it takes a long time to retrain muscles to match the new shape of the jaw bone.
For those of you looking for a solution - don't rush. Try just a splint - it works for many people, but monitor it! Go in stages, don't just assume that surgery or other invasive options are the only choice. For those who have been suffering for a long time and have tried all sorts of things, way the risk and don't be afraid to take it if you feel it is right for you.
By the way, I have "incipient carpal tunnell" syndrome, which I treat with vitamin B-6 and a wrist splint when doing activities that might aggravate it. My job is full of fine motor repetitive motions requiring strength in the fingers and bending the wrist at awkward angles.
Deds,
I am glad that you have had some relief, but again, as I have mentioned , based on your remaining sysmptoms your jaw is still not in the correct place as evident by your click and pop.. and flare ups.. that is why I am not a fan of surgery prior to correction of the position through more conservative means.
If you are going to cut someone and do an irreversible procedure, you better know if it is going to be successful.
All the best .
BTW, your carpal tunnel could be the result of subluxation of your C4, C5 cervical spine due to your posteriorized jaw joint, which would place pressure on the nerve as it exits your spine. Just another thing to consider.
I am glad that you have had some relief, but again, as I have mentioned , based on your remaining sysmptoms your jaw is still not in the correct place as evident by your click and pop.. and flare ups.. that is why I am not a fan of surgery prior to correction of the position through more conservative means.
If you are going to cut someone and do an irreversible procedure, you better know if it is going to be successful.
All the best .
BTW, your carpal tunnel could be the result of subluxation of your C4, C5 cervical spine due to your posteriorized jaw joint, which would place pressure on the nerve as it exits your spine. Just another thing to consider.
Hello, I believe my TMJ was caused by surgery to remove teeth for braces when I was young. I have used a night splint for 14 years because of my jaw locking up. My dr. thought my jaw would be better in no time but it's not.
If I lay on my left side or just lean to the left my jaw locks up. Even if someone hugs me and their head pushes against my jaw it locks up. I can't use this splint the rest of my life. I don't what I'll do when I get 50-60 yrs old.
If I lay on my left side or just lean to the left my jaw locks up. Even if someone hugs me and their head pushes against my jaw it locks up. I can't use this splint the rest of my life. I don't what I'll do when I get 50-60 yrs old.
Hi, just reading all of this, and I was diagnosed with TMD, rather back 20 years ago they did tell me TMJ,which came about when I got my wisdom teeth out. anyway, I have been suffering with this that long. I was able to make myself better, as the doctors put it, and were thrilled as I was, that I was able to pay attention to my body, and listen to their ideas.
I had an appliance made that also had a "key" and moved my two front teeth forward a bit, and it was built up so that my jaw "rested" away from clenching or even touching my molars together. This, along with eating nothing but mushy stuff, and staying away from hard candy, apples, etc, for about a year, did wonders.
Of course, over the years, I have taken for granted the feeling of being symptom-free mostly, and could ignore the whole thing, only sleeping with applicance when I felt symptoms.
I started really feeling the symptoms a few years ago again, along with allergies, and was diagnosed with carpal tunnel syndrome and have treateed that the same way-only sleeping with the splint wrap thing when I felt the symptoms. REcently, I felt that this has made it worse, and I always have a neck and headache, and thought that I had an ear infrection, ......so, my sharing I hope makes some sense, and my question, is, what was your correlation with CTS a nd TMD? I am getting two teeth pulled next week,and then two weeks later getting a new appliance made, so hopefully I am getting backon track. I do, really get relief from chiropractor, esp. for my CTS symptoms!!
Momizgreat
I had an appliance made that also had a "key" and moved my two front teeth forward a bit, and it was built up so that my jaw "rested" away from clenching or even touching my molars together. This, along with eating nothing but mushy stuff, and staying away from hard candy, apples, etc, for about a year, did wonders.
Of course, over the years, I have taken for granted the feeling of being symptom-free mostly, and could ignore the whole thing, only sleeping with applicance when I felt symptoms.
I started really feeling the symptoms a few years ago again, along with allergies, and was diagnosed with carpal tunnel syndrome and have treateed that the same way-only sleeping with the splint wrap thing when I felt the symptoms. REcently, I felt that this has made it worse, and I always have a neck and headache, and thought that I had an ear infrection, ......so, my sharing I hope makes some sense, and my question, is, what was your correlation with CTS a nd TMD? I am getting two teeth pulled next week,and then two weeks later getting a new appliance made, so hopefully I am getting backon track. I do, really get relief from chiropractor, esp. for my CTS symptoms!!
Momizgreat
Pat.
If your jaw moves out of place so easily, it could be that you have posterior torn ligament , which means that capsul that holds the joint together is damaged.. I have not seen it happen from an extraction, though I am not saying It could not happen, but most commonly we see this in car accident cases.
You need to have an MRI of the joint to verify this and if that is the case , it may need surgical repair. However, prior to the surgery the jaw should be aligned in the proper postion.
Hope this helps.
If your jaw moves out of place so easily, it could be that you have posterior torn ligament , which means that capsul that holds the joint together is damaged.. I have not seen it happen from an extraction, though I am not saying It could not happen, but most commonly we see this in car accident cases.
You need to have an MRI of the joint to verify this and if that is the case , it may need surgical repair. However, prior to the surgery the jaw should be aligned in the proper postion.
Hope this helps.
mom,
the very "I do, really get relief from chiropractor, esp. for my CTS symptoms!! " sentence tells you that your CTS is actually impingment of your nerves coming out of your cervical area.. a posteriorized jaw joint will creat subluxation in the cranial spine and we commonly see CTS type symptoms associated with C4, C5 subluxation.
Good luck.
the very "I do, really get relief from chiropractor, esp. for my CTS symptoms!! " sentence tells you that your CTS is actually impingment of your nerves coming out of your cervical area.. a posteriorized jaw joint will creat subluxation in the cranial spine and we commonly see CTS type symptoms associated with C4, C5 subluxation.
Good luck.
Hi Dr Nassery,
Thank you for your reply. You are quite right and I know you are not alone in believing surgery is not the best option for jaw problems in fact I was made to wait 7 years before I was referred to a surgeon. However in my case it did aliviate all the problems I was having as when I opened my mouth to put in food, yawn or speak the disc was slipping forward and down and was getting stuck which was preventing me from closing my mouth without my manually malipulating my jaw and easing my mouth closed again. The jaw problems started with a jaw injury caused by a blow to the head (a punch from a past violent marriage). I am pleased you dont think I will need further surgery but am concerned that the jaw pain is going to get severe like it was on the other side. My GP sent me for further Xrays to see what is happeing and it revealed that the jaw is dislocating on the side which is now giving me pain.
Thank you for your reply. You are quite right and I know you are not alone in believing surgery is not the best option for jaw problems in fact I was made to wait 7 years before I was referred to a surgeon. However in my case it did aliviate all the problems I was having as when I opened my mouth to put in food, yawn or speak the disc was slipping forward and down and was getting stuck which was preventing me from closing my mouth without my manually malipulating my jaw and easing my mouth closed again. The jaw problems started with a jaw injury caused by a blow to the head (a punch from a past violent marriage). I am pleased you dont think I will need further surgery but am concerned that the jaw pain is going to get severe like it was on the other side. My GP sent me for further Xrays to see what is happeing and it revealed that the jaw is dislocating on the side which is now giving me pain.
Thank you for the article. Like many others, I also have TMJ problems. I had bilateral TMJ surgery in 1988. I so regret having it done. My sxs did not improve but have worsened over the years. At the time (in 1988) I was told I had arthritic changes and both of the menisicus were crushed. I was 23 yrs old then. The surgeon repositioned the menisicus and sutured them in place. But my opening is more limited now and I have more pain now. Sometimes, the pain is severe- especially my ears will hurt so bad. I have been told by an ENT friend of mine that the ear pain is coming from TMJ. I had braces when I was a teenager. It is torture to go to the dentist and have to leave my mouth open for any length of time.
I wish there were something else I could do besides just taking ibuprofen. It truly is a very painful condition.
I wish there were something else I could do besides just taking ibuprofen. It truly is a very painful condition.
I wanted to add I have a neuromuscular condtion ( mitochondrial myopathy). I assume this could affect the jaw muscles as well. Maybe this is why I have more pain now . I know my jaws will tire easily-like if I am chewing something etc.
I have been treated by a dentist who only treats TMJ he does not do any dental work. I have been to Physical therapy with the tens unit ultra sound and heat. He also has done steroid injections. It has helped a very little. I take tyenol Just to get through the day. I have ringing in my ears and pain in my jaw and temple. I wear the appliance all day and it seems to bring the pain down a llittle. But I am afraid to talk or even eat most of the time. Because I know if something aggervates it I will be in pain all day. My doctor has three stages of treatment. thearpy---injections----and last resort something called Radiofrequency Thermoneurolysis which is suppose to elimate the pain. "SUPPOSE TOO" I am getting second a opion from a oral & maxillofacial surgen. Because If the precuder is tempory why should i go through it. I rather fix the problem now and deal with the pain and healing then have to go through it all again. What do you think? My doctor website is www.headaches.com
Let me know what you think. You seem like a nice doctor who want to help people.
Let me know what you think. You seem like a nice doctor who want to help people.
Hello doctor, I hope you can help. I am a 21 year old male, and a few weeks ago I started to notice slight discomfort in my jaw joints. Since then, the pain has increased so much so that I feel better holding my teeth slightly apart. Can TMD pain cause severe head pain? I ask because I went to the ER after suffering a severe headache, for fear that it was an aneurysm. They did a CT scan, and found nothing. I was also laying in a strange position when the pain started. I have had LOTS of orthodontic work in my life; two teeth removed from the top because they were coming in wrong and my wisdom teeth have been removed. I had braces as well. I also admit to having "popped" my jaw frequently when I was younger, and have fallen dead weight onto the left side of my face. I ate a potato chip tonight, and after I finished I got a little lightheaded. Since then, my ears have had a ringing sound and my neck and shoulders feel stiff. My teeth also have a tingling sensation to them. Do these symptoms sound like typical TMD?
Ray Ray,
I checked the website and read thru. I am affraid to say that I did not see an explanation of a defintive treatment. Seems like all roads ends in basically burning your nerve endings. I know that some cases will absolutely be very advanced , however, none of what you have written is a treatment, they are all palliative options to get some one out of pain.
I beleive that 99% of the time the most simplest explanation is the key not looking for that unexplained condition or sysmptom. The surgeon will probably suggest either a surgery or more palliative treatments. More Advil and tylenol.
Find yourself a Nueromuscular dentist or another TMJ person, but ask for a definitive treament. An end point, I understand that I can never promise that I can take all pain away, I am pretty confident I can make things 70-80% better, but there is always an end point in mind. And that is not burning your nerve endings..
Knock on another door.
Good luck.
I checked the website and read thru. I am affraid to say that I did not see an explanation of a defintive treatment. Seems like all roads ends in basically burning your nerve endings. I know that some cases will absolutely be very advanced , however, none of what you have written is a treatment, they are all palliative options to get some one out of pain.
I beleive that 99% of the time the most simplest explanation is the key not looking for that unexplained condition or sysmptom. The surgeon will probably suggest either a surgery or more palliative treatments. More Advil and tylenol.
Find yourself a Nueromuscular dentist or another TMJ person, but ask for a definitive treament. An end point, I understand that I can never promise that I can take all pain away, I am pretty confident I can make things 70-80% better, but there is always an end point in mind. And that is not burning your nerve endings..
Knock on another door.
Good luck.
DMK,
You have the history and the symptoms, all the symptoms you described point to an over closed and distalized jaw joint with the articulating disk out of position.
You see, yo teeth did not come out in the wrong place, they were not even too large as I sometimes hear from my patients, "My dentist told me my teeth were too big for my mouth, that's why they had to take some out "
Yah..we see god make mistakes like that too often lately.. don't you think?
We were meant to have all our teeth, what happened to you happened to most all of us, as a matter of fact it has been happening for the past 250 years. Our arches are getting narrow due to a number environmental reasons, ie pollution , western diet.. this will be the subject of my next blog as many have noted to me that they want to understand. Extraction orthodontics is exactly the wrong direction we want to go..
DMK the good news is that at your age recovery is fast, find yourself a TMJ practioner.. make sure their idea of TMD treatment is not just a nightguard
good luck
You have the history and the symptoms, all the symptoms you described point to an over closed and distalized jaw joint with the articulating disk out of position.
You see, yo teeth did not come out in the wrong place, they were not even too large as I sometimes hear from my patients, "My dentist told me my teeth were too big for my mouth, that's why they had to take some out "
Yah..we see god make mistakes like that too often lately.. don't you think?
We were meant to have all our teeth, what happened to you happened to most all of us, as a matter of fact it has been happening for the past 250 years. Our arches are getting narrow due to a number environmental reasons, ie pollution , western diet.. this will be the subject of my next blog as many have noted to me that they want to understand. Extraction orthodontics is exactly the wrong direction we want to go..
DMK the good news is that at your age recovery is fast, find yourself a TMJ practioner.. make sure their idea of TMD treatment is not just a nightguard
good luck
Hi Doc hey all,
I had bi-lateral open joint surgery on both tmj joints! Pulled and snipped tendons in jaw (that had hole in them) then put back together. Skin graph done to put dermis on actual joint. Very, Very painful...but after literally 20 "2nd opionions" they all said the same..you need surgery. I heard wild stuff when I was on my second opionions like breaking jaw and pulling it back..NO! Filling all my teeth down (which my PT thank goodness warned me not to do.) The surgery was done also after 2 years of PT on mouth with no relief. I know you all are coming up with great new concepts and are great at what you do but I have a question that you might or might not know. Do you forsee the insuranse companies paying for the treatment again? There is some wonderful massages patients can do in their mouth to help when mouth is spasming. But other than that without insurance people are looking at a no win situation. Do you see the medical or dental ever picking this up again? I was very lucky I was like the last patient my insurance company would cover. Also, ever in doubt get 2nd, 3rd, 4th opinion this isn't a surgery that you say woops I should have done something different. Mine was so bad by age 12 people wouldn't eat with me because of popping and clicking of jaw dislocating. Sorry I hope this helps someone. Michelle
I had bi-lateral open joint surgery on both tmj joints! Pulled and snipped tendons in jaw (that had hole in them) then put back together. Skin graph done to put dermis on actual joint. Very, Very painful...but after literally 20 "2nd opionions" they all said the same..you need surgery. I heard wild stuff when I was on my second opionions like breaking jaw and pulling it back..NO! Filling all my teeth down (which my PT thank goodness warned me not to do.) The surgery was done also after 2 years of PT on mouth with no relief. I know you all are coming up with great new concepts and are great at what you do but I have a question that you might or might not know. Do you forsee the insuranse companies paying for the treatment again? There is some wonderful massages patients can do in their mouth to help when mouth is spasming. But other than that without insurance people are looking at a no win situation. Do you see the medical or dental ever picking this up again? I was very lucky I was like the last patient my insurance company would cover. Also, ever in doubt get 2nd, 3rd, 4th opinion this isn't a surgery that you say woops I should have done something different. Mine was so bad by age 12 people wouldn't eat with me because of popping and clicking of jaw dislocating. Sorry I hope this helps someone. Michelle
Thanks doctor, I appreciate it. Do you have any suggestions as to what type of treatment I should pursue, and what to definitely avoid? I am majoring in theater, and sing in musicals, and can't imagine having irreversible surgery done that would affect the way I speak.
MOJO,
I regularly file all the work we do with the patients medical insurance, however, the coverage is very spoty at best and depending on the area of the country it could be better or worse. If medical insurances were actually smarter they would recognize this as it could be the underlying issue with many systemic medical problems which I am going to address in my future blogs.
I regularly file all the work we do with the patients medical insurance, however, the coverage is very spoty at best and depending on the area of the country it could be better or worse. If medical insurances were actually smarter they would recognize this as it could be the underlying issue with many systemic medical problems which I am going to address in my future blogs.
DMK,
You ned to find yourself a TMD specialist that can do Nueromuscular repositioning of your jaw with an orthotic. once your symptoms subside , ie, pains and headaches and poping etc.. then you need to do what it takes to get the teeth to meet at that new position. That will most lkely mean orthodontics to redo the work done before.. knock on many doors and ask many questions.. if you need more clarification come back here and ask.. from here thats all I can do..
You ned to find yourself a TMD specialist that can do Nueromuscular repositioning of your jaw with an orthotic. once your symptoms subside , ie, pains and headaches and poping etc.. then you need to do what it takes to get the teeth to meet at that new position. That will most lkely mean orthodontics to redo the work done before.. knock on many doors and ask many questions.. if you need more clarification come back here and ask.. from here thats all I can do..
Hey Doctor,
I have to say I am with a lot of the people on this page. For the past 10 years my left side of my jaw has been swelling on and off. Needless to say I have been seen for severe sinus infection or what was TMJ? Going back and forth on how to help my situation. This past Nov. I had sinus surgery done. Once that was done none of my problems have gone away. I suffer daily from severe left eye pain and dryness, along with a very swollen left jaw, tightness in my neck, and last very dizzy. I have been wearing my bite plate for the past 3 months and still nothing. In the past week I went and saw an eye doctor(nothing wrong perfect 20/20) Then on to my ENT and sinus is perfect! Then on to my Dentist not TMJ not anything but gave me a script for and antibiotic. Hasn't done a thing. I was hoping you might be able to help me. I feel like they are all giving me the run around. I'm 30 years old and have a 10 month old daughter and have no energy at all to play with her. I want to enjoy my life!!! I'm not brought to tears daily because I hurt so bad and am dizzy.
Please Help,
Mom in need
I have to say I am with a lot of the people on this page. For the past 10 years my left side of my jaw has been swelling on and off. Needless to say I have been seen for severe sinus infection or what was TMJ? Going back and forth on how to help my situation. This past Nov. I had sinus surgery done. Once that was done none of my problems have gone away. I suffer daily from severe left eye pain and dryness, along with a very swollen left jaw, tightness in my neck, and last very dizzy. I have been wearing my bite plate for the past 3 months and still nothing. In the past week I went and saw an eye doctor(nothing wrong perfect 20/20) Then on to my ENT and sinus is perfect! Then on to my Dentist not TMJ not anything but gave me a script for and antibiotic. Hasn't done a thing. I was hoping you might be able to help me. I feel like they are all giving me the run around. I'm 30 years old and have a 10 month old daughter and have no energy at all to play with her. I want to enjoy my life!!! I'm not brought to tears daily because I hurt so bad and am dizzy.
Please Help,
Mom in need
I do apologize for Hey Doctor, I meant to start with Hi Doctor. I'm very new to this.
I hope that my story of suffering and recovery from TM? may be of help to someone out there. My case is a single one person's experience and therefore of limited relevance, but if it can help even one other person, great.
For most of my 62 years I have suffered from headaches. neckache, sore and clicking jaw etc.
For me a headache was a headache etc.Only in recent years have I looked at things logically and cured myself with help from others.
At 8 years of age I had a serious accident which resulted in my jaw being wired up for weeks.
Since then my jaw has always been lopsided and my bite uneven.
I never related the pain from headaches etc with this accident.
What I did realise was that by simply feeling the muscles around my jaw, ears temples,,, almost anywhere related to my jaw, I felt pain.
My Doctor thought I was suffering from "tension headaches" due to Bruxism or jaw clenching whilst asleep. My wife has forever complained of me grinding my teeth at night especially after I had had an enjoyable night drinking probably too much alcohol.
I was referred to an Orthodontic Specialist who recommended a Night guard or "Bite rising appliance".
This was awful to wear but I persevered with a little improvement in my condition.
It occured to me that if the problem was painful muscles in spasm then the treatment was simple.
I
(1) cut down on the drinking and I now grind my teeth less.
(2) try to eat soft food
(3) went to a professional physiotherapist to massage and relax the painful muscles for about six sessions.
(4) learnt a good muscle relaxation system. I found that "Autogenic Training" worked for me. And practised this twice a day every day. Now just once.
Providing I keep to moderate drinking and practise my relaxation I'm good. If not,, I only have myself to blame
Not much of a story, but after fifty odd years of misery it's like music to my ears.
For most of my 62 years I have suffered from headaches. neckache, sore and clicking jaw etc.
For me a headache was a headache etc.Only in recent years have I looked at things logically and cured myself with help from others.
At 8 years of age I had a serious accident which resulted in my jaw being wired up for weeks.
Since then my jaw has always been lopsided and my bite uneven.
I never related the pain from headaches etc with this accident.
What I did realise was that by simply feeling the muscles around my jaw, ears temples,,, almost anywhere related to my jaw, I felt pain.
My Doctor thought I was suffering from "tension headaches" due to Bruxism or jaw clenching whilst asleep. My wife has forever complained of me grinding my teeth at night especially after I had had an enjoyable night drinking probably too much alcohol.
I was referred to an Orthodontic Specialist who recommended a Night guard or "Bite rising appliance".
This was awful to wear but I persevered with a little improvement in my condition.
It occured to me that if the problem was painful muscles in spasm then the treatment was simple.
I
(1) cut down on the drinking and I now grind my teeth less.
(2) try to eat soft food
(3) went to a professional physiotherapist to massage and relax the painful muscles for about six sessions.
(4) learnt a good muscle relaxation system. I found that "Autogenic Training" worked for me. And practised this twice a day every day. Now just once.
Providing I keep to moderate drinking and practise my relaxation I'm good. If not,, I only have myself to blame
Not much of a story, but after fifty odd years of misery it's like music to my ears.
KMSmom,
Dont; worry this is a very unformal setting.. if all medical issues have been ruled out , as it sounds, then you should find yourself a TMJ specialist, and you need to see several of them as you may have noticed from our previous notes here . They should be able top perform diagnostic x-rays and exam on you and give you a definitive reason for what is going on with you. Most of the pain is from tired and spamadic muscles, there is a reason why ? that should be expalined to you.. regular dentist unfortunately can not tell you what they don't know.. beleive me I was one of them for much of my career.. we are not tought these in dental school. I know it sounds crazy, but it is the truth.
Knock on many doors and ask for answers. Run them by me if you need help navigating
good luck.
Dont; worry this is a very unformal setting.. if all medical issues have been ruled out , as it sounds, then you should find yourself a TMJ specialist, and you need to see several of them as you may have noticed from our previous notes here . They should be able top perform diagnostic x-rays and exam on you and give you a definitive reason for what is going on with you. Most of the pain is from tired and spamadic muscles, there is a reason why ? that should be expalined to you.. regular dentist unfortunately can not tell you what they don't know.. beleive me I was one of them for much of my career.. we are not tought these in dental school. I know it sounds crazy, but it is the truth.
Knock on many doors and ask for answers. Run them by me if you need help navigating
good luck.
Tommy 47,
I am glad to hear you have found yourself a way to cope.. the truth is that most men do nt become as symptomatic, you have a history of trauma, and that is why probably your case is different.. 3 out of 4 TMD patients statistically are women, actually in my practice it is even more greater the other way..I have a 1 to 5 ratio of men to women, this maybe that us guys are just not good patients, I am guilty as well. Just before I left for my current confference , my wife was reminding me about my yearly checkup that I missed last year..
Anyway, the pont I wanted to make is that most female patients can not deal with the pain and discomfort just by palliative treatments, they need correction..
Nonetheless, I applaude your ingenious way to cope with your situation.
All the best.
I am glad to hear you have found yourself a way to cope.. the truth is that most men do nt become as symptomatic, you have a history of trauma, and that is why probably your case is different.. 3 out of 4 TMD patients statistically are women, actually in my practice it is even more greater the other way..I have a 1 to 5 ratio of men to women, this maybe that us guys are just not good patients, I am guilty as well. Just before I left for my current confference , my wife was reminding me about my yearly checkup that I missed last year..
Anyway, the pont I wanted to make is that most female patients can not deal with the pain and discomfort just by palliative treatments, they need correction..
Nonetheless, I applaude your ingenious way to cope with your situation.
All the best.
Hi Dr. Nassery, I have had a TMJ condition for 40 years diagnosed by MRI as a "anteriorly subluxed TMJ meniscus which reduces with open mouth positioning, the meniscus is diffusely degenerated in appearance". They recommended braces when I was an adolescent. I have a history of overbite and a TBI that results in nocturnal bruxism. They have tried medications, which work fairly well but affect concentration and alertness. In the past two years I had cortisone injections with relief and a repositioning splint. The disk is I guess "recaptured", and I do not have a loud click any longer. However the repositioning splint is worn on the upper teeth and slides my lower jaw backwards. I have cervical issues in addition and although I like the click and locking being improved, the neck pain I feel is worse. Could the repositioning splint sliding the jaw backwards be aggravating this and is the Powergard appliance appropriate for TMJ. I live in Melbourne Florida and would be open to consulting in Miami if you feel it would not be difficult to manage appliance adjustments etc. from a 2-3 hour distance. Thanks. Jim O.
Jim,
Generally speaking the orhtotics that I make go on the lower arch and they are not flat.. they have normal tooth anatomy and engage the opposing dentition as if your teeth were there.. it sounds to me that your splint is flat..Correct me if I am wrong..I don't want to be pressumptive...
the other thing that is important to discuss is that rohtotic is not the end point, it is the therapuetic part of the treatment , yes, but the teeth need to be finished to that position.. now as far as your cervical problems, I would say that you have always had these issues, and that they are now more symptomatic. If you have read my other post you will see that I have spoken about subluxation of the neck spine very often. What happenes when we put someone in an orthotic they will start to get correction in the cervical spine however sometimes they are so stuck that they will start to hurt. I actually know that I am on the right track once my patients tell me that they are sore in the neck.. because I know if I can make it worse, I can make it better.. I also work closely with a chiro or a PT. depending on my patients preferrence..
As far as the power guard, I assume you're eluding to the Pure Power Mouthguard.. that product is not a therapuetic appliance..but it is build based on the same science.. when treating patients such as yourself we realized that not only we were getting patients more comfortable but also they were reporting increase in their physical performance.. isn't that crazy? they would say things like " My neck pain is gone doc. but you know I am really hitting the ball down the fairway harder and farther than I ever did.." " I am kicking but on the teniss court, or running faster than I ever did"
These reports got us to think, and we , ( there is a group of us, about 350 dentist in US and Canada) that took this appliance to the pro athelets, and we now have some 300 professional athletes wearing this and playing better and more efficient.. some names you may know " Manny Ramirez, Scott Maccarron, golfer, Shaquile O'neal, who is having his best free throw percentage of his career wearing this appliance.
As far as helping you with your case, I would be happy to , but I can also find some one closer to you in Jacksonville..if you want. the important thing is for you to find relief.. BTW this will also help you with snoring..
Alll the best.
Generally speaking the orhtotics that I make go on the lower arch and they are not flat.. they have normal tooth anatomy and engage the opposing dentition as if your teeth were there.. it sounds to me that your splint is flat..Correct me if I am wrong..I don't want to be pressumptive...
the other thing that is important to discuss is that rohtotic is not the end point, it is the therapuetic part of the treatment , yes, but the teeth need to be finished to that position.. now as far as your cervical problems, I would say that you have always had these issues, and that they are now more symptomatic. If you have read my other post you will see that I have spoken about subluxation of the neck spine very often. What happenes when we put someone in an orthotic they will start to get correction in the cervical spine however sometimes they are so stuck that they will start to hurt. I actually know that I am on the right track once my patients tell me that they are sore in the neck.. because I know if I can make it worse, I can make it better.. I also work closely with a chiro or a PT. depending on my patients preferrence..
As far as the power guard, I assume you're eluding to the Pure Power Mouthguard.. that product is not a therapuetic appliance..but it is build based on the same science.. when treating patients such as yourself we realized that not only we were getting patients more comfortable but also they were reporting increase in their physical performance.. isn't that crazy? they would say things like " My neck pain is gone doc. but you know I am really hitting the ball down the fairway harder and farther than I ever did.." " I am kicking but on the teniss court, or running faster than I ever did"
These reports got us to think, and we , ( there is a group of us, about 350 dentist in US and Canada) that took this appliance to the pro athelets, and we now have some 300 professional athletes wearing this and playing better and more efficient.. some names you may know " Manny Ramirez, Scott Maccarron, golfer, Shaquile O'neal, who is having his best free throw percentage of his career wearing this appliance.
As far as helping you with your case, I would be happy to , but I can also find some one closer to you in Jacksonville..if you want. the important thing is for you to find relief.. BTW this will also help you with snoring..
Alll the best.
Hi Dr, I'm a woman 53, I have had TMJ problem since my 30's, sore, clicking jaw, ear plug etc. finally, I went to see a doctor. He prescribed me with a lot of medicine: carbamazepine, iboprofen 800mg, piroxican20mg and methocarbamol 750. I'm just taking carbamazepine and piroxican, is helping, but I think this is not going to solve my problem, is just going to help while taking the medicine. What should I do? After the doctor got my mri and my xray, he told me that seems like I had a trauma many years ago, I do not remember of having a trauma. However, he told me my jaw looks ok. Must likely he will ask me to wear the guard. Should I keep taking the medicine?
Pupis,
All cases are different and without having your complete history and other diagnostic tools in front of me it is hard to tell you what to do.. I will tell you however, I don't beleive in masking symtoms, I believe in attacking the cause and correcting that. I do not prescribe any meds during my therapuetic treatment as I use symptoms to gauge my treatment.
Hope that makes sense.
All cases are different and without having your complete history and other diagnostic tools in front of me it is hard to tell you what to do.. I will tell you however, I don't beleive in masking symtoms, I believe in attacking the cause and correcting that. I do not prescribe any meds during my therapuetic treatment as I use symptoms to gauge my treatment.
Hope that makes sense.
Hello doctor, I have a rather specific question to ask you about tmj. I acquired this after having a wisdom tooth removed and I had a neuromuscular splint made that made things a lot worse. He just used the tens on me and made the splint, but not any of the other electronic equipment was used like jaw tracking. I have a lot of symptoms, many of which have been addressed in this thread. The one I didn't see was facial changes. My face is really crooked, it also looks like all my fat is gone in my face and my cheekbones stick out. When I try to open my jaw my platysma and other muscles go into spasm, this has all basically made me look like a different person. My sister actually started crying when she saw me because my face looked so different she thought something was really wrong with me. I was wondering if there is any way to fix this. As a female in her 20s this is really kind of distressing for me. My bite and face were always normal before this. Thanks for any advice you can give.
TMJgirl23,
I am really troubled by reading your story.. a tens unit is a very useful device but that is the extent of it.. it is neither a treatment nor a solution to the problem. It is a means to an end. Like any other device it does not make one better, just like a handpiece (dental Drill) just because you have one it does not make you a dentist.
Quite frankly, without the other electronic computers to track the jaw you are only eye balling the difference, and there it is again, subjective evaluation. A wise teacher of ours once said, without objective data everything is only an opinion.
It sounds to me that youhave a tourque in your jaw, eventough your symptoms worsened or came out after your third molar extractions, the issues were there more than likely.
Don't give up, look and research more for dentists who have had extensive training in this field. You are too young and have many years ahead of you.. Top3 dentists is a good place to start..
to answer the other part of your question about facial changes, it absolutely makes sense, the muscles of facial expressions and loose tonus and atrophy like any other muscle in the body which in turn will make your face look thinner.
All the best.
H.Nassery, DMD, FICOI
www.drnassery.com
I am really troubled by reading your story.. a tens unit is a very useful device but that is the extent of it.. it is neither a treatment nor a solution to the problem. It is a means to an end. Like any other device it does not make one better, just like a handpiece (dental Drill) just because you have one it does not make you a dentist.
Quite frankly, without the other electronic computers to track the jaw you are only eye balling the difference, and there it is again, subjective evaluation. A wise teacher of ours once said, without objective data everything is only an opinion.
It sounds to me that youhave a tourque in your jaw, eventough your symptoms worsened or came out after your third molar extractions, the issues were there more than likely.
Don't give up, look and research more for dentists who have had extensive training in this field. You are too young and have many years ahead of you.. Top3 dentists is a good place to start..
to answer the other part of your question about facial changes, it absolutely makes sense, the muscles of facial expressions and loose tonus and atrophy like any other muscle in the body which in turn will make your face look thinner.
All the best.
H.Nassery, DMD, FICOI
www.drnassery.com
My name is Steve and I am a 36 yo male. For the past week or so, I have had ear aches, right side neck pain (stiff) when turning my head as well as head aches. My wife informs me that I make noises at night coming from my mouth as if I am grinding my teeth in conjunction with snoring for quite sometime. (a treat for my wife I may add). I came across this topic with a bit of relief with a possible answer of TMJ. I have been extremely scared thinking this is an early stage of throat cancer as I used to chew tobacco in the past. No sore throat or sores with-in my mouth are present nor any visible / non-visible tumors. I made an appointment with a ENT specialist for this coming Friday. From what I read, my symptoms are consistent with that of TMJ; although some of the symptoms such as ear ache, neck ache are also symptoms of throat cancer. My jaw also cracks when I open/close it no matter how many times I open.shut it. Scared. Any posts are appreciative.
codeblue,,
You are absolutely correct all your signs and symptoms are in line with the TMD.. I would still go and see my ENT..to rule out anything serious, however, if you click and pop your joints when you open and close, that means that your jaw is too far back and up and has pushed your articulating disc out of position and the sound you hear is the disc poping back into its normal place when you open.. these are all connected to your neck and your cervical spine or you neck vertebrae are in subluxation due to the same thing, and most people with those positioning typically show snoring and sleep breathig issues.. as your jaw is too far back and closes your airway.. so not to diminish the importance of that latter one, see your ENT, and when you find out there is nothing medical then find yourself a good Neuromuscular dentist, that is familiar with TMD and treating the joint issues first..
All the best.
You are absolutely correct all your signs and symptoms are in line with the TMD.. I would still go and see my ENT..to rule out anything serious, however, if you click and pop your joints when you open and close, that means that your jaw is too far back and up and has pushed your articulating disc out of position and the sound you hear is the disc poping back into its normal place when you open.. these are all connected to your neck and your cervical spine or you neck vertebrae are in subluxation due to the same thing, and most people with those positioning typically show snoring and sleep breathig issues.. as your jaw is too far back and closes your airway.. so not to diminish the importance of that latter one, see your ENT, and when you find out there is nothing medical then find yourself a good Neuromuscular dentist, that is familiar with TMD and treating the joint issues first..
All the best.
My name is Philip and I am a 39 year old male living in the UK. Here is a potted history of my TMD problems!
September 2006
I had 2 NHS incisor crowns replaced with 'lava' crowns and position adjusted to more aesthetically appealing shape. However, there was slight discomfort due to a narrowing of the space for my bottom teeth to come up. My dentist filed one of the incisor crowns down to accommodate this but wouldn't go any further as this would negate the point in having such expensive crowns.
During the next 10 months there was a constant feeling of 'wrongness' in the mouth but, as I was told I'd have to get used to the new crowns, I attributed this feeling to unfamiliarity with the new crowns.
July 2007
I woke up suddenly in the night with my jaw locked shut. Upon opening there was a loud click. At the same time, and now I know not coincidentally, I went to my docotr complaining of a high pitched sound in my ears, particularly the right. Was told this was tinnitus and there is no cure. Whoopee.
Was told by my dentist that what I had was TMJ, and was told this was unlikely to be caused by the new crowns. The cause was more likely to be grinding my teeth at night. She reccommended a flexible plastic mouthguard to wear at night. I didn't like the idea of this and decided I would try relaxation exercises, which she had also recommended. I never had such a 'locking' experience again until 2009, but woke up every day with clicking in the jaw.
June 2008
I researched TMJ dysfunction on the internet and frequently read that an osteopath can help the problem. As I had had a long-standing back problem (clicking of right shoulder blade and tension on right side) I went to an osteopath to kill 2 birds with one stone. He 'fixed' the clicking and told me I just needed to get the right side regularly massaged and it would be fine. However, the osteopath who looked at my TMJ said he was not experienced enough to treat it and recommended another osteopath. However, my dentist told me not to see her as I could be wasting my money.
I saw the specialist at the EDI in June. She could find no evidence of strain put on the TM joint. She strongly felt that it was not the crowns and that I should try a mouthguard. So I arranged this with my dentist.
October 2008
Was fitted with a mouthguard. This brought a degree of relief from the jaw clicking. However, the headaches I had been getting in the morning, which I now realised were connected, were not going away. I phoned my dentist at the end of November and she arranged an appointment with another specialist in March.
March 2009
By this time, the tinnitus had got worse, along with the head and neck tension. I had also started to get a slight twitch or pulsing in my right optical nerve. Hurray!
The specialist arranged sessions for a fitting of a splint. All this time (at each appointment) I had been saying how I felt almost sure that the crowns were the main cause of this and that I was not aware of 'grinding' my teeth at night (neither was my wife). At these appointments I was told that there was no evidence that I was grinding my teeth at night. However, I may be clenching, I was told.
The splint was put in in the last week of March. However, it was not the magic cure they had been expecting, as, while my jaw felt slightly better with it in than with it out, there was no real difference in my symptoms. The twitching in my eye has gone away though. The speciailist said that if the crowns were to blame, there would be no point in changing them back now as my jaw had 'adapted'. He was against the idea of seeing an osteopath as the changes made by one would be too sudden, and thought a chiropractor would be better, although he sounded a bit vague about this. He said my symptoms were textbook. Other possible treatments were anti-depressant medication to relax the jaw muscles and possibly surgery.
They tried a form of elctro-therapy to see if it would be of benefit. However, my reactions to this were within the normal range so the practioner decided not to go ahead with it. She did, however, suggest that if I thought the crowns were to blame I should insist on this at my next meeting with the speciailist. She also suggested I see a chiropractor.
Sorry for the long post. I am about to see a chiropractor and hope this will be of help, but I can't shake the idea that I need to have the crowns put back where they were. Any thoughts you have would be very much appreciated!
September 2006
I had 2 NHS incisor crowns replaced with 'lava' crowns and position adjusted to more aesthetically appealing shape. However, there was slight discomfort due to a narrowing of the space for my bottom teeth to come up. My dentist filed one of the incisor crowns down to accommodate this but wouldn't go any further as this would negate the point in having such expensive crowns.
During the next 10 months there was a constant feeling of 'wrongness' in the mouth but, as I was told I'd have to get used to the new crowns, I attributed this feeling to unfamiliarity with the new crowns.
July 2007
I woke up suddenly in the night with my jaw locked shut. Upon opening there was a loud click. At the same time, and now I know not coincidentally, I went to my docotr complaining of a high pitched sound in my ears, particularly the right. Was told this was tinnitus and there is no cure. Whoopee.
Was told by my dentist that what I had was TMJ, and was told this was unlikely to be caused by the new crowns. The cause was more likely to be grinding my teeth at night. She reccommended a flexible plastic mouthguard to wear at night. I didn't like the idea of this and decided I would try relaxation exercises, which she had also recommended. I never had such a 'locking' experience again until 2009, but woke up every day with clicking in the jaw.
June 2008
I researched TMJ dysfunction on the internet and frequently read that an osteopath can help the problem. As I had had a long-standing back problem (clicking of right shoulder blade and tension on right side) I went to an osteopath to kill 2 birds with one stone. He 'fixed' the clicking and told me I just needed to get the right side regularly massaged and it would be fine. However, the osteopath who looked at my TMJ said he was not experienced enough to treat it and recommended another osteopath. However, my dentist told me not to see her as I could be wasting my money.
I saw the specialist at the EDI in June. She could find no evidence of strain put on the TM joint. She strongly felt that it was not the crowns and that I should try a mouthguard. So I arranged this with my dentist.
October 2008
Was fitted with a mouthguard. This brought a degree of relief from the jaw clicking. However, the headaches I had been getting in the morning, which I now realised were connected, were not going away. I phoned my dentist at the end of November and she arranged an appointment with another specialist in March.
March 2009
By this time, the tinnitus had got worse, along with the head and neck tension. I had also started to get a slight twitch or pulsing in my right optical nerve. Hurray!
The specialist arranged sessions for a fitting of a splint. All this time (at each appointment) I had been saying how I felt almost sure that the crowns were the main cause of this and that I was not aware of 'grinding' my teeth at night (neither was my wife). At these appointments I was told that there was no evidence that I was grinding my teeth at night. However, I may be clenching, I was told.
The splint was put in in the last week of March. However, it was not the magic cure they had been expecting, as, while my jaw felt slightly better with it in than with it out, there was no real difference in my symptoms. The twitching in my eye has gone away though. The speciailist said that if the crowns were to blame, there would be no point in changing them back now as my jaw had 'adapted'. He was against the idea of seeing an osteopath as the changes made by one would be too sudden, and thought a chiropractor would be better, although he sounded a bit vague about this. He said my symptoms were textbook. Other possible treatments were anti-depressant medication to relax the jaw muscles and possibly surgery.
They tried a form of elctro-therapy to see if it would be of benefit. However, my reactions to this were within the normal range so the practioner decided not to go ahead with it. She did, however, suggest that if I thought the crowns were to blame I should insist on this at my next meeting with the speciailist. She also suggested I see a chiropractor.
Sorry for the long post. I am about to see a chiropractor and hope this will be of help, but I can't shake the idea that I need to have the crowns put back where they were. Any thoughts you have would be very much appreciated!
Phil,,
I am sorry you have been run arround for so long..and that you have had to endure all this..Let me start with saying that I truely believe that you have always had some degree of TMD. I also believe that your initial feeling about the crowns is correct I think that they may have some how provided you with that last straw to push you to become symptomatic..
As you have already found out this is a much more comprehensive issue than just your Jaw joint.. this process of discovery is painfull, yes, but it is an evil necessity.. you already know more than all these guys you have been seeing.. because none of them have realized that someone needs to connect the dots... Your jaw is locked too far back and too closed.. but it probably always was there to some degree and these last crowns just pushed them enough back to get all the symptoms brought to surface.. The good news is that there are ways to definately get you some relief, the bad part is that it is very time conssuming and perhaps expensive.
I do know that there are Nueromuscularly trained dentists in London ( don't know how far you are from there), Nueromuscular approach is one of many ways one could approach this issue as basiccally we need to unload all the pressure and undue force off of your TMJoint.. then over a perod of time refine your bite and finally perhaps throught Orthopedic Orthodontics or other restorative means get the teeth to the right place..
If you are still in search of more info about the origins of these issues please read my other blog on the relations of TMD and Sleep apnea.. All the best. www.dr.nassery.com
I am sorry you have been run arround for so long..and that you have had to endure all this..Let me start with saying that I truely believe that you have always had some degree of TMD. I also believe that your initial feeling about the crowns is correct I think that they may have some how provided you with that last straw to push you to become symptomatic..
As you have already found out this is a much more comprehensive issue than just your Jaw joint.. this process of discovery is painfull, yes, but it is an evil necessity.. you already know more than all these guys you have been seeing.. because none of them have realized that someone needs to connect the dots... Your jaw is locked too far back and too closed.. but it probably always was there to some degree and these last crowns just pushed them enough back to get all the symptoms brought to surface.. The good news is that there are ways to definately get you some relief, the bad part is that it is very time conssuming and perhaps expensive.
I do know that there are Nueromuscularly trained dentists in London ( don't know how far you are from there), Nueromuscular approach is one of many ways one could approach this issue as basiccally we need to unload all the pressure and undue force off of your TMJoint.. then over a perod of time refine your bite and finally perhaps throught Orthopedic Orthodontics or other restorative means get the teeth to the right place..
If you are still in search of more info about the origins of these issues please read my other blog on the relations of TMD and Sleep apnea.. All the best. www.dr.nassery.com
I am writing this in response to what Dr. Nassery's comment on ( Feb.3 , 2009 NY times) titled "Best treatment for TMJ May be Nothing". I found and first read this news posted on TMJ association' web link. I was very frustrated too after reading this article. I am a TMJD patient currently just about finished my phase I treatment (wearing splint) and going to move on to phase II using orthodontic to reposition my teeth to permanently hold the current harmony jaw joints position. I have TMJD due to my class II over jet over bite (I had orthodontic once when I was 16 years old and 4 of my premolars were taken out to create more spaces). Who says TMJD is not due to malocclussion? I had emailed AACP - American Academy of craniofacial pain on this news posted by TMJ association. I believe AACP need to work on more general public awareness on educating TMJD patients on this one. TMJ association is pointing the patients into the wrong direction.
Martha,
thank you for your comments, we are fortunate that these days we have venues such as this to get the word out. We need patients such as yourself to also help with the good news. Your course of treatment sounds great.
Warm regards.
H.Nassery, DMD
thank you for your comments, we are fortunate that these days we have venues such as this to get the word out. We need patients such as yourself to also help with the good news. Your course of treatment sounds great.
Warm regards.
H.Nassery, DMD
Hello Dr,
Thanks for this fantastic website, you are doing fabulous job! I have a question all the way from London, England.
I had lost my two bottom teeth (second and third molar) 8 years ago, they have not been replaced. I have all of wisdom teeth.
Roughly 3 years ago, I had this weird sensation in my jaw which felt little swollen. The only thing relieving was opening mouth really wide.
After doing this for a week, one day my jaw just clicked and had been this way ever since.
I don`t have a pain anywhere. The only thing that bothers me is that every hour or so I have to click my jaw as otherwise it feels like pressure is building up in my head.
I went to see a dentist couple of months ago who diagnosed me with TMJ (TMD).
He said that my bite is incorrect and suggested fixing it with custom made splint (over roughly 6 months) to get the bite into correct position and then adjusting my crowns / fillings on the back.
He also suggested implant on the missing teeth.
The dentist is: http://www.londonholisticdental.com/
Can you let me know if based on your experience this would be correct solution or should I get couple of other opinions?
I will be spending close to £10,000 and want to get it right first time!
Thanks,
Maria
Thanks for this fantastic website, you are doing fabulous job! I have a question all the way from London, England.
I had lost my two bottom teeth (second and third molar) 8 years ago, they have not been replaced. I have all of wisdom teeth.
Roughly 3 years ago, I had this weird sensation in my jaw which felt little swollen. The only thing relieving was opening mouth really wide.
After doing this for a week, one day my jaw just clicked and had been this way ever since.
I don`t have a pain anywhere. The only thing that bothers me is that every hour or so I have to click my jaw as otherwise it feels like pressure is building up in my head.
I went to see a dentist couple of months ago who diagnosed me with TMJ (TMD).
He said that my bite is incorrect and suggested fixing it with custom made splint (over roughly 6 months) to get the bite into correct position and then adjusting my crowns / fillings on the back.
He also suggested implant on the missing teeth.
The dentist is: http://www.londonholisticdental.com/
Can you let me know if based on your experience this would be correct solution or should I get couple of other opinions?
I will be spending close to £10,000 and want to get it right first time!
Thanks,
Maria
Maria,
Thank you for your kind words.. I am just trying to do my best to help ..in any which way I can. It is very difficult for me to diagnose the issue from the few words here, also I have no way to check the doctor's abilities.. Actually it is hard even if they were here..
I would say that if you have clicking and poping it is definately and indication that there is pathology there.. normal joints don't make noise.. As per the doctor, I would ask for the name of a few patients that he has treated.. I do this routinly for my patients, as there is no real body of oversight to measure one's knowledge in this field. Anyone can say they treat TMD, to me success in results is the best indication..
Finally, rarely just one crown or implant can effect the bite to the degree that it would heal all issues, once the correct physilogic position is achieved you may find that you will require orthodontia, or major restorative work.. before proper diagnosis and work up all these discussions are just speculations.
all the best.
H.Nassery, DMD
www.drnassery.com
Thank you for your kind words.. I am just trying to do my best to help ..in any which way I can. It is very difficult for me to diagnose the issue from the few words here, also I have no way to check the doctor's abilities.. Actually it is hard even if they were here..
I would say that if you have clicking and poping it is definately and indication that there is pathology there.. normal joints don't make noise.. As per the doctor, I would ask for the name of a few patients that he has treated.. I do this routinly for my patients, as there is no real body of oversight to measure one's knowledge in this field. Anyone can say they treat TMD, to me success in results is the best indication..
Finally, rarely just one crown or implant can effect the bite to the degree that it would heal all issues, once the correct physilogic position is achieved you may find that you will require orthodontia, or major restorative work.. before proper diagnosis and work up all these discussions are just speculations.
all the best.
H.Nassery, DMD
www.drnassery.com
Hello,
I live in Port St Lucie, FL and can not find a doctor who takes my insurance that can help me with my jaw problems. For about a year now I have been having problems, normally when I wake up, with my jaw clicking or popping when I open my mouth too wide. But for the past 2 weeks I have not been able to open my jaw all the way, maybe just about half way. This is causing me to not be able to eat a lot of foods unless they are soft and thin (so they can fit in my mouth). Can you please advise what I can do to help open my mouth all the way? I have read so many different stories online, I do not know what to believe. I don't mind the clicking or popping, I just want to be able to open my mouth to eat!!!
Please help!
Jennifer
I live in Port St Lucie, FL and can not find a doctor who takes my insurance that can help me with my jaw problems. For about a year now I have been having problems, normally when I wake up, with my jaw clicking or popping when I open my mouth too wide. But for the past 2 weeks I have not been able to open my jaw all the way, maybe just about half way. This is causing me to not be able to eat a lot of foods unless they are soft and thin (so they can fit in my mouth). Can you please advise what I can do to help open my mouth all the way? I have read so many different stories online, I do not know what to believe. I don't mind the clicking or popping, I just want to be able to open my mouth to eat!!!
Please help!
Jennifer
Jennifer,
the issue that you are experienceing is due to the displacement of your disc infront of the head of your jaw bone..I know you don't know what I am talking about ..just imagin having a big rock infront of one your car's wheels, only one side can move.. the click and pop you used to hear was the same disc that used to pop back into its place, and now it is stuck..
You need to find an experienced TMJ specialist.. appliance therapy should be able to correct the situation and once the correct place for your jaw was established you should look into ways to keep it there..
Unfortunately, in Florida we have terrible insurances, be it medical or dental, as a practioner I can tell you I have never seen coverage from any Florida insurance.. the only patients that have gotten coverage thru their medical have been people who have had out of state medical insurances. This maybe a bier pill you need to swallow with or without insurance..
Meantime, stay away from hard foods, and anything that gets your muscle over worked, I am sure you have felt the pain if you try otherwise.. look into top3dentist.com and see if they have recommendation for your area. Good luck.
the issue that you are experienceing is due to the displacement of your disc infront of the head of your jaw bone..I know you don't know what I am talking about ..just imagin having a big rock infront of one your car's wheels, only one side can move.. the click and pop you used to hear was the same disc that used to pop back into its place, and now it is stuck..
You need to find an experienced TMJ specialist.. appliance therapy should be able to correct the situation and once the correct place for your jaw was established you should look into ways to keep it there..
Unfortunately, in Florida we have terrible insurances, be it medical or dental, as a practioner I can tell you I have never seen coverage from any Florida insurance.. the only patients that have gotten coverage thru their medical have been people who have had out of state medical insurances. This maybe a bier pill you need to swallow with or without insurance..
Meantime, stay away from hard foods, and anything that gets your muscle over worked, I am sure you have felt the pain if you try otherwise.. look into top3dentist.com and see if they have recommendation for your area. Good luck.
Thank you for getting back to me. Unfortunately when I tried the website, top3dentists.com, there are no THJ specialists in the area I live or work. So I am again back to where I started. Is there any thing I can do at home to help pop my jaw back into place? Will it stay like this forever with getting help or will I wake up one day and it will be back in place? This is very frustrating! Thanks! Jennifer
Jennifer,
The muscles need to relax and sometimes it requires some manipulation of the jaw to get it over the displaced disc.. we need to find someone close to you.?? how far are you from Jax. or West Palm, I may know people in those areas..
HN
The muscles need to relax and sometimes it requires some manipulation of the jaw to get it over the displaced disc.. we need to find someone close to you.?? how far are you from Jax. or West Palm, I may know people in those areas..
HN
I have Had migraines, Earaches, Sinus trouble, and The List Goes On . I've Had test Run And Nothing Has Showed Up, While I Was Pregnant last Year, My Denist Prescribe Muscle Relaxers, And They Helped.He Said I Was Under So Much Stress I Was Grinding my Teeth( He Had Made A Lot Of Different Mouth Guards, I Ate Through Them).I Have A Really Thick One Now That had Lasted For About 5 Months, But It's Getting Thin. When I quit Taking The Muscle Relaxers My Teeth Grinding Is Back (worse Than Ever My Husband Says I wake Him Of A Night). He (Denist)Told Me He Thought My Migraines Was From The GrindingAnd I AHave Wore out The Hinge In My Jaw. Is Ther Anyway To Get It To Stop for Good Or Do Ihave To Live The Rest Of Live In Pain. Even with The Guard I still have Pain.
I actually work in Palm Beach Gardens. So West Palm Beach is close but Jacksonville is about a 5 hour drive. I appreciate you pointing me in the right direction. Even if they don't take me insurance.
Thanks,
Jennifer
Thanks,
Jennifer
Dawn,
All the signs and symptoms you have referred to are in line with what we see all the time. The good news is that your type case has a very good prognosis for successful therapy with appliances. I know everyone thinks of these as nightguards but they are not. they are based on a more precise and physiologic position of your jaw ..
Try to find yourself an experienced TMJ specialist , preferrable one that is well versed in appliance therapy. In my hands Nueromuscular modality has worked well but it is not the only way to get there..
hope this helps.
H.Nassery, DMD
All the signs and symptoms you have referred to are in line with what we see all the time. The good news is that your type case has a very good prognosis for successful therapy with appliances. I know everyone thinks of these as nightguards but they are not. they are based on a more precise and physiologic position of your jaw ..
Try to find yourself an experienced TMJ specialist , preferrable one that is well versed in appliance therapy. In my hands Nueromuscular modality has worked well but it is not the only way to get there..
hope this helps.
H.Nassery, DMD
Jennifer,
In West Palm , there is Dr. Marisol Lopez. office Number is 561-791-8184..she is very nice and experienced. Speak to her and also ask your local dental society they maybe able to also recommend others.. speak to a few drs. and see which ones philosophy is closer to yours .. feel free to sound off here with us again.
www.drnassery, com
In West Palm , there is Dr. Marisol Lopez. office Number is 561-791-8184..she is very nice and experienced. Speak to her and also ask your local dental society they maybe able to also recommend others.. speak to a few drs. and see which ones philosophy is closer to yours .. feel free to sound off here with us again.
www.drnassery, com
i currently am going through a TMD problem. I crushed both sides eight years ago in a work injury. I have no dr. and some are saying it's in my head. I have forwarded this article to my attorney to give to the insurance company. I want to know what i can do. I would like surgery on both areas but insurance says that is not necessary. If anyone can help or help to get information to me to give to my lawyer i honestly just want to open my mouth again. I can''t eat, talk, sleep, or stop crying from the pain, please help me
sincerely
william vallance
611 north tower street
colorado springs, co. 80905
sincerely
william vallance
611 north tower street
colorado springs, co. 80905
Vallance,
I hear what you're saying. it is very frustrating, with insurance companies.. I would howeve, cautoin you to first see an experienced TMJ specialist , and go the rout of appliqance therapy.. much higher percentage of succes getting pain subsided/ I am not saying you don't need surg. you mqay very well need it, however, the position of the jaw has to be established poperly first throught applaince therapy and then the need for sugery be evaluated.. most patient having only surgery experience just as much pain after the surgery.
If yo can not find a properly trained TMJ specialist in your area then check www.top3dentist.com or you can check www.lvismile.com for a Neuromuscular dentist.. sorry can't be of more help.
All the best.
www.drnassery.com
I hear what you're saying. it is very frustrating, with insurance companies.. I would howeve, cautoin you to first see an experienced TMJ specialist , and go the rout of appliqance therapy.. much higher percentage of succes getting pain subsided/ I am not saying you don't need surg. you mqay very well need it, however, the position of the jaw has to be established poperly first throught applaince therapy and then the need for sugery be evaluated.. most patient having only surgery experience just as much pain after the surgery.
If yo can not find a properly trained TMJ specialist in your area then check www.top3dentist.com or you can check www.lvismile.com for a Neuromuscular dentist.. sorry can't be of more help.
All the best.
www.drnassery.com
Hello-
I have worked with a NM dentist and went through all the repositioning scenarios and wore a repositioning device for several months with no benefit after several adjustments to the device (and seeing a chiroprator) . In the end I never went to phase three because PII was of no benefit. I am a clencher at night that before the dentist visit was giving me some pain in my head at times but nothing as severe as I have now after a lower molar extraction (only one left-I am 41 female) and decided to have it out for "preventive reasons". It was supposed to be an easy extraction since it had conical shaped roots. it took about 2 hours with lots of pressure on my jaw and joints. I am now in severe pain (esp. over my right jaw joint/ear), have headches over my sinuses, able to open my mouth about 1/2 inch, neck and shoulder pain, and what feels like burning nerve pain. I have gone back to the dentist and he diagnosed "dry socket" and tmd complex. I have tried ibuprofen 800mg three times a day, vicoprofen, and most recently heat, flexeril, and mobic. Is my life ever going to return to normal again??? Anything else to do in this case or will this resolve on its own time???? It really hurts and I am desperate!! Does botox work??
Sincerely
diane
I have worked with a NM dentist and went through all the repositioning scenarios and wore a repositioning device for several months with no benefit after several adjustments to the device (and seeing a chiroprator) . In the end I never went to phase three because PII was of no benefit. I am a clencher at night that before the dentist visit was giving me some pain in my head at times but nothing as severe as I have now after a lower molar extraction (only one left-I am 41 female) and decided to have it out for "preventive reasons". It was supposed to be an easy extraction since it had conical shaped roots. it took about 2 hours with lots of pressure on my jaw and joints. I am now in severe pain (esp. over my right jaw joint/ear), have headches over my sinuses, able to open my mouth about 1/2 inch, neck and shoulder pain, and what feels like burning nerve pain. I have gone back to the dentist and he diagnosed "dry socket" and tmd complex. I have tried ibuprofen 800mg three times a day, vicoprofen, and most recently heat, flexeril, and mobic. Is my life ever going to return to normal again??? Anything else to do in this case or will this resolve on its own time???? It really hurts and I am desperate!! Does botox work??
Sincerely
diane
u2star,
Sorry to hear about your condition. I am not clearas to the chronology of the events.. Did you go to see the NM dentist after the extraction or before..
In any case , proper diagnosis is the first step of any succesful treatment.. we need to to seperate the dry socekt from your TMD, and correct one at a time. How long ago did you get the third molars out? have you taken A/B for the possible dry socket..
As per your description, it is very common to dislocate the disc during the surgery, if the duration is long and pressure is great.. where you could have had a situation with a recapturable disc , you may now have a dislocated disc with no recapturing, hence the limited opening.. again I am really streching here and trying to guess what has happened. However, the short answer to you is that in the right hands with proper training you could have relief..I am certain..keep looking. As for botox, it will have short term relief of muscular pain but is just a bandaid..
I truely hope you find the proper care..
regards.
HNassery, DMD
Sorry to hear about your condition. I am not clearas to the chronology of the events.. Did you go to see the NM dentist after the extraction or before..
In any case , proper diagnosis is the first step of any succesful treatment.. we need to to seperate the dry socekt from your TMD, and correct one at a time. How long ago did you get the third molars out? have you taken A/B for the possible dry socket..
As per your description, it is very common to dislocate the disc during the surgery, if the duration is long and pressure is great.. where you could have had a situation with a recapturable disc , you may now have a dislocated disc with no recapturing, hence the limited opening.. again I am really streching here and trying to guess what has happened. However, the short answer to you is that in the right hands with proper training you could have relief..I am certain..keep looking. As for botox, it will have short term relief of muscular pain but is just a bandaid..
I truely hope you find the proper care..
regards.
HNassery, DMD
Just wanted to give everyone some hope and tell them that orthotic appliances do work. I had orthodontic work as a kid, and teeth pulled because my mouth was too small. My jaw was always tense during the day, I would find myself aware that I was clenching it. Last year, I started to suffer badly with ear pain, jaw pain, headaches, nausea and dizziness, went through antibiotics for suspected ear infection (didn't have one), saw an ENT (said everything normal), then remembered one day the story of Burt Reynolds, who famously suffered from TMD problems. I thought this could be my problem. So luckily, there was a TMD dentist in my city (that's his whole practice, just TMD) and I made an appointment - he immediately recognized all the symptoms, looked at my bite and jaw position and told me he could help.
He made a day time appliance for my lower teeth and a night time appliance for the upper teeth to prevent grinding at night (which I was doing). Within days of starting to wear the appliances, most of my symptoms left. My appliances wear down and the symptoms start returning, so I've had them relined and then I'm fine again. In my case, the correct jaw position seems very specific, just a millimeter out and the pain comes back.
My question to Dr. Nassery is what to do now that I've found a stabilized position where I can be symptom free? I tried a weaning program to get off the day time appliance, but the symptoms of ear pain, jaw pain and headaches start coming back when I'm off the day time appliance more than a few hours. My dentist gave me the options of continuing to wear the day appliance (with the need to replace it as it wears out every 6 months), wear a different appliance made of harder material that will last longer (but costs more), or go to orthodontic treatment to permanently move things. I would like not to wear the day time appliance any more, but am worried about making permanent changes with orthodontics. Do you have any comments on how best to continue my treatment?
He made a day time appliance for my lower teeth and a night time appliance for the upper teeth to prevent grinding at night (which I was doing). Within days of starting to wear the appliances, most of my symptoms left. My appliances wear down and the symptoms start returning, so I've had them relined and then I'm fine again. In my case, the correct jaw position seems very specific, just a millimeter out and the pain comes back.
My question to Dr. Nassery is what to do now that I've found a stabilized position where I can be symptom free? I tried a weaning program to get off the day time appliance, but the symptoms of ear pain, jaw pain and headaches start coming back when I'm off the day time appliance more than a few hours. My dentist gave me the options of continuing to wear the day appliance (with the need to replace it as it wears out every 6 months), wear a different appliance made of harder material that will last longer (but costs more), or go to orthodontic treatment to permanently move things. I would like not to wear the day time appliance any more, but am worried about making permanent changes with orthodontics. Do you have any comments on how best to continue my treatment?
PDK22,
You are way ahead of most and have found out the results of this course of treatment.. appliance therapy in the experienced hand can be very effective.
That is the first phase of therapy, in the second phase you must figure out how to bring the teeth into that speacific position and that part could be orthodontics, restorative or a combination the two.. Weaning off of the appliance is not an option, since that is what currently keeps your jaw in the right position.. there is the posiibility of the need for opening the spaces for the teeth that were removed, and that means later you will need to replace them.. there are other things that you will find out or you may have already be experincing, such as better breathing, and sleep.. less chances of sleep breathing disorders and therefore, saving you from a host of other diseases..
I am happy to hear that you have gotten good results, now its time to take it to the next phase and make the position permanent.
All the best.
H.Nassery, DMD
www.drnassery.com
You are way ahead of most and have found out the results of this course of treatment.. appliance therapy in the experienced hand can be very effective.
That is the first phase of therapy, in the second phase you must figure out how to bring the teeth into that speacific position and that part could be orthodontics, restorative or a combination the two.. Weaning off of the appliance is not an option, since that is what currently keeps your jaw in the right position.. there is the posiibility of the need for opening the spaces for the teeth that were removed, and that means later you will need to replace them.. there are other things that you will find out or you may have already be experincing, such as better breathing, and sleep.. less chances of sleep breathing disorders and therefore, saving you from a host of other diseases..
I am happy to hear that you have gotten good results, now its time to take it to the next phase and make the position permanent.
All the best.
H.Nassery, DMD
www.drnassery.com
Hi
I just found this site and you are the first doctor that has made sense to me about TMJD. My first experience was about 30 years ago, my jaw locked shut for about 6 months. I do not remember a lot of pain, just that I couldn't eat and my dentist put me on vallium. I was like a zombie, but it finally unlocked. It has locked up for shorter periods since then, but I have just weathered them because I don't want to take the meds. My jaw always clicked and popped. Two years ago, out of the blue, I had a heart attack. The doctors could not figure out the cause, but I have several blocked arteries and am very scared. My cardiologist just told me that 30 years of inflammation from TMJD could be the cause of the blockages. He said there is no way to prove it, but it makes sense to him. Last November, my jaw locked shut at 22mm and this time there is intense pain. I finally went to my dentist in February, and I have been sent to several doctors, had an MRI,which was excruciating because they jacked my jaw open, and been given so many narcotics, but no real relief. The last DDS I went to wants to do a "scope" where he sends in a camera and cleans out the inflammation, but he said that will only give me 2 years relief. Then he suggests a jaw replacement. I am scared, and I will have to pay for everything myself, so I want to do what is going to help the most. The things you are saying seem like the best answers to me. I have not been able to eat anything solid since last November and I am desperate. The anti inflammatory meds they put me on interact with the heart meds and make them less effective. I do not want surgery that will only last 2 years and I certainly don't want a jaw replacement. How do I find the right person and the right treatment? I looked at the site and there is a top 3 dentist in a town less than an hour from me. Do all top 3 dentists use the methods you have discussed? I need to get off of the meds that are making my heart worse.
Mel
I just found this site and you are the first doctor that has made sense to me about TMJD. My first experience was about 30 years ago, my jaw locked shut for about 6 months. I do not remember a lot of pain, just that I couldn't eat and my dentist put me on vallium. I was like a zombie, but it finally unlocked. It has locked up for shorter periods since then, but I have just weathered them because I don't want to take the meds. My jaw always clicked and popped. Two years ago, out of the blue, I had a heart attack. The doctors could not figure out the cause, but I have several blocked arteries and am very scared. My cardiologist just told me that 30 years of inflammation from TMJD could be the cause of the blockages. He said there is no way to prove it, but it makes sense to him. Last November, my jaw locked shut at 22mm and this time there is intense pain. I finally went to my dentist in February, and I have been sent to several doctors, had an MRI,which was excruciating because they jacked my jaw open, and been given so many narcotics, but no real relief. The last DDS I went to wants to do a "scope" where he sends in a camera and cleans out the inflammation, but he said that will only give me 2 years relief. Then he suggests a jaw replacement. I am scared, and I will have to pay for everything myself, so I want to do what is going to help the most. The things you are saying seem like the best answers to me. I have not been able to eat anything solid since last November and I am desperate. The anti inflammatory meds they put me on interact with the heart meds and make them less effective. I do not want surgery that will only last 2 years and I certainly don't want a jaw replacement. How do I find the right person and the right treatment? I looked at the site and there is a top 3 dentist in a town less than an hour from me. Do all top 3 dentists use the methods you have discussed? I need to get off of the meds that are making my heart worse.
Mel
Mel, I am sorry to hear about your experience, I am still a big believer in appliance therapy, I also do believe that the muscles do need to be relaxed and happy to be able to stabilize things.. it is possible that you will need joint replacement but I would only recommend it after stabilization of the jaw.. and the muscles. Neuromuscular dentistry is one of the ways this could be accomplished , I don't care what one would call it as long as the result is achieved. To answer your question about the doctors in top3 not all of us are in the same level though we are all very active in the educatiion process and keeping up with different modalities of treatment.. for instance I have been treating patients with similar issues for 5 years and don't really consier myself and expert in it, though I have had considerable success in relieving many patients. That is perhaps due to knowing my limits..
You need to interview several dentists that have studied different modalities of appliance therapy, you have started it by just being here. listen to them and ask many questions.. and see what maks sense to you. You already know more than you think.
If you find someone and want to run things by me here feel free.. that is what this site is built for .. honest exchange of ideas and advice. All the best.
H.Nassery, DMD, FICOI
You need to interview several dentists that have studied different modalities of appliance therapy, you have started it by just being here. listen to them and ask many questions.. and see what maks sense to you. You already know more than you think.
If you find someone and want to run things by me here feel free.. that is what this site is built for .. honest exchange of ideas and advice. All the best.
H.Nassery, DMD, FICOI
Dr. Nassery,
I am a 30 y/o female with a right anteriorly disclocated TM disc without recapture. This has been dislocated for nearly one year. I have worn braces on my top teeth for about 5 months to which I now have a huge space between my top incisors and bottom incisors making it difficult to bite into anything. My orthodontist thought he could fix things with minimal invasive treatments (maybe just an arthroscopic procedure later on). I recently saw an OS who said my lower mandible needed to come forward to meet with my top teeth. Then I would require another surgery later for my right TMJ. I am not in a great deal of pain. My main complaints are that I have limited opening of my mouth (two finger widths) and I have difficulty chewing and eating my food. I have read so many horror stories and what I desperately want to avoid is a worse situation that I'm in right now. Do you have any suggestions?
Thanks,
Susan
I am a 30 y/o female with a right anteriorly disclocated TM disc without recapture. This has been dislocated for nearly one year. I have worn braces on my top teeth for about 5 months to which I now have a huge space between my top incisors and bottom incisors making it difficult to bite into anything. My orthodontist thought he could fix things with minimal invasive treatments (maybe just an arthroscopic procedure later on). I recently saw an OS who said my lower mandible needed to come forward to meet with my top teeth. Then I would require another surgery later for my right TMJ. I am not in a great deal of pain. My main complaints are that I have limited opening of my mouth (two finger widths) and I have difficulty chewing and eating my food. I have read so many horror stories and what I desperately want to avoid is a worse situation that I'm in right now. Do you have any suggestions?
Thanks,
Susan
tmjgirl1
your case is interesting. It is hard to diagnose and treatment plan from here, but from what you have told me so far I would say that you need to have appliance therapy, to reposition your lower jaw down and forward.. this first, and give a chance to your disc to recapture.. actually based on your age I would not give up on recapturing yet.. it is more difficult if you don't recapture on opening but it is not impossible. after that you will need to see an orthodontist that knows orthopedic orthodontics.. I believe Dr. Ramin Mehregan has a very nice article on that in this same forum, make sure you read it.. it describes the difference very well.
Finally I am not saying that you will not need surgical intervention for sure, but I think there is agood chance you won't. Hope this helps and please let us know how it goes.
H.Nassery, DMD
www.drnassery.com
your case is interesting. It is hard to diagnose and treatment plan from here, but from what you have told me so far I would say that you need to have appliance therapy, to reposition your lower jaw down and forward.. this first, and give a chance to your disc to recapture.. actually based on your age I would not give up on recapturing yet.. it is more difficult if you don't recapture on opening but it is not impossible. after that you will need to see an orthodontist that knows orthopedic orthodontics.. I believe Dr. Ramin Mehregan has a very nice article on that in this same forum, make sure you read it.. it describes the difference very well.
Finally I am not saying that you will not need surgical intervention for sure, but I think there is agood chance you won't. Hope this helps and please let us know how it goes.
H.Nassery, DMD
www.drnassery.com
Dr. Nassery, Have you heard of the doctor in Rockford, Illinois who is trying to get FDA approval for a device for TMJD that goes into the ear canal? It is called the CID for Clayton Intra-Aural Device, developed by Dr. Larry Clayton. He is an audiologist who discovered that when he made hearing aides for people, some would come back and say that their TMJ symptoms were gone. So he has been researching and testing for 12 years and he seems to have a device that works as well or better than a splint for TMJD. There was an article in our Sunday paper Oct. 4 all about it. I was just wondering if you had heard anything about it, and if so, what are your thoughts? Rockford is only 30 miles from me. I do have an appointment with a neuromuscular dentist today that is about an hour from my home, and I can't wait to see if he can help me. Melanie
TMJMel,
sorry about the delay. I was looking into what is available in terms of info on the device. Very little, aside from the info from the company itself, was available. From what I read on the research papers, it is a plastic tube inserted into the canal, now in theory, I can see that it in some cases it could relieve some pressure in the ear, and may improve hearing. Also I noticed that their research was very thin, meaning the number of patients in the study were too few in my view to really make a clear assesment, and it was compared to flat splint devices only.
I would tell you however, that to me it would be a paliative treatment, anything short of correcting the position of the jaw and maintaining that position, either through appliances or orthodontics, or restorations, is only directed at hidding symptoms. Please, let us know about your experince at the dentist and the expected results.
All the best.
H.Nassery, DMD
www.drnassery.com
sorry about the delay. I was looking into what is available in terms of info on the device. Very little, aside from the info from the company itself, was available. From what I read on the research papers, it is a plastic tube inserted into the canal, now in theory, I can see that it in some cases it could relieve some pressure in the ear, and may improve hearing. Also I noticed that their research was very thin, meaning the number of patients in the study were too few in my view to really make a clear assesment, and it was compared to flat splint devices only.
I would tell you however, that to me it would be a paliative treatment, anything short of correcting the position of the jaw and maintaining that position, either through appliances or orthodontics, or restorations, is only directed at hidding symptoms. Please, let us know about your experince at the dentist and the expected results.
All the best.
H.Nassery, DMD
www.drnassery.com
Dr. Nassery,
I agree with you about the few people in the trials. I thought about that too. My appointment with Dr. Hey went well. He thinks he can help me and it sounds like he uses the exact treatment you described. He said it may take a little longer since I have been dealing with it so long, but I can be a very patient person and my pain tolerance is high so I expect the best and am very excited to get started. Dr. Hey said he could possibly restore about 80-85% of my jaw function. The last 2 doctors said 50% and 60-65%, So this sounds so good. I know there are no guarantees, but I am very positive he can help me. I am going in next Tuesday for the long appointment to get started. Thank you so much for the information on this blog. If I had not seen it when I did, I would be having surgery that may or may not help and the doctor himself told me it would likely only provide 2 years pain relief. But ANY pain relief at the time sounded great. You never appreciate something until you lose it. This method makes so much more sense and I believe in it. I am very hopeful again after almost losing hope of ever being pain free again. My goal is to be able to eat something other than liquids by my birthday (in February). Thanks so much for the information. I am very grateful to you. I really hope it works for me.
Melanie
I agree with you about the few people in the trials. I thought about that too. My appointment with Dr. Hey went well. He thinks he can help me and it sounds like he uses the exact treatment you described. He said it may take a little longer since I have been dealing with it so long, but I can be a very patient person and my pain tolerance is high so I expect the best and am very excited to get started. Dr. Hey said he could possibly restore about 80-85% of my jaw function. The last 2 doctors said 50% and 60-65%, So this sounds so good. I know there are no guarantees, but I am very positive he can help me. I am going in next Tuesday for the long appointment to get started. Thank you so much for the information on this blog. If I had not seen it when I did, I would be having surgery that may or may not help and the doctor himself told me it would likely only provide 2 years pain relief. But ANY pain relief at the time sounded great. You never appreciate something until you lose it. This method makes so much more sense and I believe in it. I am very hopeful again after almost losing hope of ever being pain free again. My goal is to be able to eat something other than liquids by my birthday (in February). Thanks so much for the information. I am very grateful to you. I really hope it works for me.
Melanie
Melanie,
I am glad to hear the news. I think that you will be surprised at how soon you will feel better. It is correct that the full healing will take a long time but the pain usually subsides a great deal with in three to four weeks. All the best, and make sure to post your results for others to read. Just like you there are others that can benefit from this.
H.Nassery, DMD
I am glad to hear the news. I think that you will be surprised at how soon you will feel better. It is correct that the full healing will take a long time but the pain usually subsides a great deal with in three to four weeks. All the best, and make sure to post your results for others to read. Just like you there are others that can benefit from this.
H.Nassery, DMD
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