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TMJ, tinnitus and neuromuscular dentistry

Please help!!!
i'm asking this on behalf of a friend whose life is blighted by tinnitus.  He recently investigated TMJ and thinks his symptoms can all be accounted for via this diagnosis (popping, clicking, misaligned jaw etc).  He saw a neuromuscular dentist, who diagnosed TMJ and recommended a course of treatment including an orthotic.  (at a cost of £4k!) does anyone know anything about neuromuscular dentistry and if this will help his tinnitus????????? How does this kind of treatment compare to others? Is it worth it?  Please help.  Thankyou
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Avatar universal
I grind my teeth in my sleep, and sort of bite together in the daytime, and when I restrict too low it gets worse. Could be ED related since starving makes you way more tense. Do you know if you do these things I mentioned? If so, just try to be aware, try keeping your jaws a little open at all times, try actively to relax. Not easy. But after contacting [url=https://plus.google.com/+CronauerAngelakisOrthodonticsPembrokePines/about]Pembroke Pines Orthodontics[/url] and they prove best.
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Avatar universal
After finishing invisaligns to help fix my bite, my dentist did TENS for 45 minutes and charged me $730 for the TENSING! I have protested the cost since my PT does tensing on both my arms at the same time and for 30 minutes and charges me $35!  I paid the bill because they make me pay in advance or she won't do the work.  But it was clear that the bill for TENS wasn't for something other than a couple of pads on my jaw and the usual current.  I thought it would at least be something special- and the machine didn't even work for a while- it was old.  HOW can that cost $730?? I called and asked them to recheck that bill, but they won't call back.
Is that a normal charge for tensing at the dentist???
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875426 tn?1325528416
Also, I'd recommend lodging a complaint against the dismissive dentist with the dentist licensing board about the matter- it is a risky matter to use a tens unit on the head and it sounds like they messed up.
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875426 tn?1325528416
An MRI is how they would look to see if your discs are displaced or not.  I'm sorry you are having tinnitus.  Have you seen an optometrist or opthamologist about your eyesight?
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Avatar universal
I went to a dentist for new crowns and he recommended getting the optimal bite first by wearing a splint.  Mind you I had no pain or tmj issues.  He put me on a TENS machine with my facial and jaw muscles contracting for 90 minutes. The next day I awoke with a high pitched ringing sound in my head which has not ceased.  It has been a month and I don't know how much longer I can take it.  For two weeks when I would awaken in the morning I had to open my left eye with my fingers.  My eyesight has diminished, and everyone tells me that I look like a different person since the treatment. The jaw muscles were relaxed so much that my jowls are now hanging. There are wrinkles and lines all over that were not there prior.  Everyone tells me that I've aged 10 years in one month.  At this point I don't even care about the cosmetics of it, I just need this ringing to stop.
My md doctor said that I received a mild form of electric convulsive therapy.
My dentist dismissively says he's never encountered such a thing and cannot move forward with the splint without further tensing.  My question is - Is it possible that he overstretched the muscles so much that it displaced the disc in the TM joint? Or could all the excessive neuronal activity generated by the tens brought on the tinnitus? Would greatly appreciate any feedback you have to offer! Thank you - el59
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Avatar universal
I paid $13,000 for neuromuscular dentist treatment and it did not work. My best suggestion is to try dry needling from a physical therepist trained to follow the work of Dr's Travel and Simons. I haven't resolved my condition but my research tells me this is the closest thing to a good outcome.
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Avatar universal
Hi!  I have been working to figure out my tmj/tinnitus problem for the last 9 months.  I went to a specialist who put me in an anterior repositioning splint based off of xrays.  Tinnitus cleared up but face went into horrible spasms that took weeks to clear up.  This tmj doctor said one of my discs was completely off and the other was degenerating based on feel.  I had an MRI taken with another dentist that showed a pseudo displaced disc on one side and the other disc was fine.  So now I am in a permissive plane splint with no relief from my tinnitus.  I have had 6 months of physical therapy to correct my posture as well.  The tinnitus is debilitating.  I'm not for sure where to go at this point.  Anterior repositioning splints alter the bite and stretch face ligaments which scared me to death, but it was the only thing that helped my tinnitus.  I have been told I would be a good candidate for fat graft surgery.  I am only 38 years old...  What do I need to do?
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Avatar universal
Thank you for your help, I appreciate it.

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

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

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

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

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

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

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

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

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

Thanks and best regards!
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Avatar universal
However, some people have an early warning system that's a little too sensitive. For these people, the fight or flight responses are triggered by events that would be ignored by many others. This hypersensitivity can be caused by a number of factors, including:

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

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

http://bipolar.about.com/cs/altercomp/a/0304_breath2.htm
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Avatar universal
The trigger points in the lateral pterygoid muscle will make the jaw extremely tight. The pterygoid will cause the ringing in the ear.  

These TMJ Dentist are ripping people like crazy.  

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

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

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

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

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

These TMJ Dentist are milking people for big money.
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Avatar universal
First off from my 14 years trying figure out my headaches/facial pain and tinnitus I'd say 95% of the problem is from teeth clenching and grinding.  Being in the "fight and flight mode" all the time will cause this.

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

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

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

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

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

Another great book is by Ingrid Bacci called Effortless Pain Relief  
It's not exactly effortless by she is RIGHT on the money as to what causes the problems
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Avatar universal
I'm not sure what you mean by TMJ xrays, but only an MRI that is done properly will show the disk position.  Other images of the the hard tissues(bone) will show their relationships and give us a 'guess' as to the disc location.  But without an MRI you don't know for sure if the disks are in a normal position.  I don't know what you mean by locked up, but you need to see a qualified TMJ specialist.  Good luck.
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Avatar universal
Hi scottma,

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

Thanks.

Sumi
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Avatar universal
Seeing a tmj specialist is advised.
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Avatar universal
Hi there,

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

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

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

I understand what you mean now. Thank you again.

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

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

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

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

Thank you again and have a good day.

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