Jaw locking and neck stiffness

[sumihari]

Hi, Scottma and TMJ Doc,

I had posted a while back and had consulted a specialist in a Dental Hospital. He is an Associate Prof in prosthodontics. My symptoms are that my jaw is clenching forwards and upwards. When it does the jaw and mouth is locked and I feel a shortness of breath. I used to have the jaw deviate slightly but that has resolved quite a lot. When the jaw somehow relaxed down and back kind of balanced, I can breathe better as it is not locked. Chewing is particularly frustrating. When the muscles are too loose , I find chewing and swallowing harder. The swallow involves the jaw moving forward and I think I have a bit of a tongue thrust issue happening which makes me feel like I am suffocating.

Other symptoms I have are ringing in the ears, a bit better now, but a lot more of ear fullness on both sides now. So far I have only obtained an X-ray , not MRI and there is not any problem - no disk displacement. The specialist at the hospital checked the disks and he said the disks were fine. Interestingly enough , I rang one specialist from the website that TMJ Doc recommended . I reside in Sydney , Australia. Not only they quoted me around $5000 AUD and possible chiropractic work but they do not do MRI's . Instead the organise for X-rays to be taken at the same Dental Hospital my specialist teaches in. This didn't sound promising and unfortunately there aren't any other TMJ specialists in Sydney who one would trust. So I have to work with my current specialist with the issue.

I was given some jaw exercises - tongue up and open mouth, improve posture and shoulder stretches. It helps .

I also recall reading an article by DrJim Boyd regarding this kind of clenching where the jaw is forward a bit, it places a lot of force on neck muscles. I think he suggests an NTI.

From your experiences with patients , why is my jaw clenching forward and up, would the NTI resolve this issue. Or do I have a tongue thrust issue. I do notice when I am clenching, my tongue is sticking behind the teeth past the ridge . The mouth splint which my dentist (not the specialist) has made me is one I wear over all the top teeth at night. Does not seem to help as I can't breathe with the splint.

What do you think is going on , what might help, MRI I think is out of question . I have improved but I need more improvement. Any suggestion is appreciated so I can discuss with my next consult with the specialist.

Also can TMJ symptoms be so severe like neck stiffness, fullness in ear, shortness of breath, difficulty chewing and swallowing and ringing in ear and itchy ear, tightness in muscles when chewing so much so I can't feel my bite. I have been to many doctors to check my health, I have anxiety which is made worse by the TMJ and neck stiffness.

Please help.

Thank you.

Sumi

[sumihari]

Hi scottma ,

Thanks for your post. I have not consulted my physiotherapist on paradoxical respiration . But my understanding of paradoxical respiration is that the stomach moves inwards rather than outwards upon inspiration. If that is correct, I don't have this problem.

I have been to the physiotherapist today and told about my shortness of breath and she mentioned it was because my thorax was stiff and poor posture makes breathing a bit of a challenge at times.

Thank you again scottma.

Sumi

[scottma]

Consultation with physical therapist or chiropractor to rule out paradoxical respiration is advised.

[sumihari]

Hi TMJDoc,

Thanks for your post. With the shortness of breath, it is all the time and I get this when
the jaw is locked very tight. Because I have a rather deviated septum, I am a mouth breather, so when the jaw is locked, it is natural to have this uncomfortable shortness of breath feeling.

Out of curiosity , what if some patients can't do MRI's , how would the diagnosis of disc displacement be made. I know that for the brain MRI, people with metal implants of any sorts couldn't get it done. I am assuming it is the same for TMJ MRI. Not that it affects me but I am curious.

I shall bring up the displaced disc issue with my specialist , whether or not he will be convinced is another matter but he has to get the jaw more functional.

It is interesting that my main complaint is that I feel the jaw is too forward and up. This type of clenching is locking my jaw and causing the shortness of breath. With OSA I notice that there are special splints to place the jaw forward a bit to clear the throat. So I don't have OSA, I must have just jaw clenching problem.

Thank you again.

Sumi

[TMJDoc]

Without access to all of your examination results and not seeing a patient in person to examine it is speculation as to a proper diagnosis.  I would state however that in my professional experience that your ear symptoms are consistent with disc displacements as well as most of your other symptoms.  The one that does not correlate is shortness of breath.  If that is when you're sleeping it could be from a sleep breathing disorder such as obstructive sleep apnea or central sleep apnea.  Clenching and grinding of the teeth are often associated with OSA.  If it's during the day it is most likely associated with an anxiety issue.  Again I'm short on info.  If you have a displaced disc as I suspect, the NTI could easily make it worse.  The two most over used and abused 'splints' that dentists make are the upper flat plane splint and the NTI.  They are to help the 'muscle' problems.  But the muscle problems are a symptom and the the cause.  They may offer some temporary relief, but the problem in the overwelming majority of the patients I see is a discplaced disc, either reducing or nonreducing.  It takes an experienced clinician to know the difference and it is taught in many dental schools and other training programs that you can't recapture (reduce) discs in the TMjoint.  That is not true, but it takes more skill to recapture than to treat patients 'off the disc'.  You'll get heated arguments on both sides of that issue.  But either way the clinician has to find a way of 'unloading' the TMjoint---put your jaw on 'crutches' so the inflammatory process can be diminished and whatever soft tissue healing that can occur will take place.  Reducing that pain will reduce muscle tension and the pain associated with this.  I've done this a thousand times so I know it works.  Working with chiropractors or physiotherapists trained in understanding postural mechanics can be invaluable.  Treating TMJ disorders need to be a team approach.  I prefer correcting anatomic and functional relationships over pills and surgery.  But they all have their place in treating patients.  I don't agree that you don't have displaced discs and an MRI will take the mystery out of that.  Good Luck, TMJDoc