Best Treatment for TMJ

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.

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'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.

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!  

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 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

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.

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.

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..

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.  

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.

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.

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?

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 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!

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.

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

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.

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.

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

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..

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

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.

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.

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.

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

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.

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.

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 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 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.

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.

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

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  

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.

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..

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 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.

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.

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.

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.

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.

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

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.

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!

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 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

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

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

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

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.

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

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

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

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

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

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

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

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

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?

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

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

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

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

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

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

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  

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

Dr. Nassery,

I'm a 36 year old male. The past year I have been to the ENT for dizziness and ear problems. My ears ring and feels like there is fluid in there and they pop often. At times it feels like I have a bad ear ach. I was told by my wife that I grind my teeth at night a lot to the point were it wakes her up. The ENTsaid there is nothing he can see that is wrong with my ears. They did a hearing test and my hearing is very good. My dizziness isn't all that bad I still go out and exercise ride Mountain Bike so that dosn't effect my daily life. I have noticed in the past few weeks that my jaw at times feels like I chewd gum for 10 hours and my neck feels stiff. I do get crazy headachs at times. Do's this sound like TMD? It's been over a year now with the problems.

Dear seadoo,

everything you described is hallmark sysmptoms of TMD. Get yourself to a dentist that treats TMD, you can have relief from most your sysmptoms.

Hope this helps.
H.Nassery, DMD

Thank you for you help. I will find a dentist in my area that can help.

Hello, I really need help fir my siste, She is 16 years old and I think she may be suffering from TMJ she has chronic headaches and horrible muscle pains shortly after. She has a very bad underbite and will be having surgery to fix it and overall make her profile slot nicer she also has an overbite, she is very thin for her age about 45 kg and is a vegitarian, Could any of these things be causing her pain and what can she do to stop it?
        Please help me and thankyou

123lzzadora,

People with overbites are prime suspect, however, we can not make a diagnosis from just these few facts. I am not a big fan of orthognatic surgeries. Though they help with the profile, they don't have a good trac record when it comes to pain relief. It sounds to me you need a differential diagnosis. If it were my sister, I would get the headaches resolved and then would do the retrognatic correction. Of course, it is entirely possible that if the jaw was placed in the correct position there would not be a need for the surgery..
Hope this helps.
Good luck.

Thankyou for your fast responce, I really appreciate your help and I am wondering how she could reslove these headaches?
One again I appreciate it.

Hello Dr.  Nassery,
I have written to you before.  I went to the Neruomuscular dentist and started treatment in October.  I told you that my hope was to be able to eat (actually chew something) before my birthday.  Well, my birthday was last week, and I did not reach that goal. The doctor told me that I am the most affected patient he has ever seen.  But there has been progress.  I used to be in constant pain.  Now, most days, the pain is well controlled with the two pain meds I take. I sometimes have headaches or jaw pain in the daytime, but not anywhere as much or as often. I also can open a little wider than before.  Night is different.  I go to sleep, and wake up in about 2-3 hours in severe pain.  I cannot sleep in my bed, and have to go sit up in a chair to sleep.  Sometimes the pain is too much and I have to take stronger medications to sleep and sometimes, I just don't get back to sleep at all.  I still hope he can improve beyond what he has, but I am much better, at least during the day.  I don't know why nighttime is so difficult.  Do you have any suggestions for that?
Melanie

Hey Mellanie,

I am glad to hear that there has been some improvement. Remember, healing is a process and not an event. Having said that it sounds to me there should be more refinement done to your orthotic. Also another thing to monitor during your sleep for sleep breathing disorders. It is not uncommon at all to have that problem as well. I beleive there is a 75% cross over. So check that as well, at night the jaw has a tendency to fall back and close the airway, and that will enhance clenching and muscle hyperactivity.
Hope this helps.
H.Nassery, DMD

I do understand that the healing will take time.  I get the orthotic adjusted every 3-4 weeks.  I am going there today and I will ask about the night time problems again.  I know I am a clencher.  I used to wake up with my teeth clenched so tight it hurt.  I even fractured several teeth before I got my first appliance.  I have worn several different  types of bite guards for almost thirty years.   I just need sleep.  I am so tired!  I will ask about the sleep breathing disorders and if it is a possibility.  Maybe my primary care doctor should be the one to ask. He said he is willing to work with the dentist to control this.  I have also lost over 25 pounds and my doctor is not happy about that. I was at the perfect weight before this flare up.  Heart doctors want your BMI to be like at 22.  Mine is now at 17 so now I am underweight and that is also bad for my heart.  At least I might get some sleep during the tensing today!
Melanie

Melanie,
Is your doctor working with a physical therapist. was there any x-rays taken from your cervical spine? if so are you seing anyone to correct that. This is a big and important piece, the jaw will not go into its correct place without correction of the subluxation in the neck.. clenching can be induced by the impingment in the cervial area.. and that I can gaurantee you have.. check it out and let me know.
H.Nassery, DMD

Dr. Nassery,
No, I am not seeing anyone except my general physician and my neuromuscular dentist.  I have seen a chiropractor in the past for TMJD.  She was unable to help.  She worked on it for about three years and also she said I had mild scoliosis, but she messed up my sciatic nerve and I refuse to go back to her because I don't need any more pain!  Both of my above mentioned doctors suggested that I get an adjustable bed and try to sleep in a semi-upright position.  I hated to spend the money, but I finally decided to try it and I will get the bed delivered tomorrow. We'll see if it helps.  Right now I sleep on my stomach, which I am told is the worst for your jaw.  But no matter what position  I start sleeping, I end up on my stomach and wake up in about 2 hours in a lot of pain.  If the bed helps me sleep, it will be worth the money.  The dentist said that the orthotic is not helping me when I sleep because of the position of my jaw at that time.  This should correct that problem.  I am once again hopeful!
Melanie

Melanie,

Perhaps that will help some.. however, I still believe that having a good therapist will get things moving forward much better and faster. You see, there is no doubt that you have issues in your neck by now, and given the fact that it is a long standing issue, they may not resolve wihtout some help. One of the things that is different between a PT and a Chiro is that method of putting the vertebrea back into position. While chiros place then into position in one quick motion, while with PT's there is more of a extention or retraction in the soft tissue first, and then allowing your musculature to move things into the right position. In my experience, this works better and creates more stability longterm. Coupled with NM orthotic and a good training regimen to get your posture and tone back, I am convinced you will see the results.
There is not a one modality approach to your condition, as this is not a localized issue anymore.

All the best.
H.Nassery, DMD

Physical therapy was suggested by another dentist- the one who said I was too far advanced that he could not help me.  Our insurance agreed that physical therapy was "medically necessary" but would not pay for it because we have a $5,000 lifetime limit to cover TMJ issues.  That was exhausted long ago.  So, I never went to a PT.  I have to pay for this NM dentist all out of pocket, too (well, our dental insurance paid $14.00.  That was almost an insult.)  So, I am not sure if I can do the PT because we are so stretched by this other and I still have to come up with the follow-up when they do the orthodontics.  I don't know where that will be coming from.  I also have been in the hospital from drug reactions from strong meds used to treat the severe pain I have had from this condition.  I have been in the E.R. three times, once taken by ambulance, and admitted to the hospital once since November.  All those bills take their toll.  We owe the hospital so much we will be paying them forever!  Actually, the one admission to the hospital was partly covered by insurance because my EKG was abnormal and they billed it as coronary.   But it actually was a reaction to a medication I took for TMJ.  I now have a case manager to help with the billing issues, but she can only do so much and has to work within the insurance itself.  She can find ways around their limits sometimes, but not often.  She did get them to help with one ER visit where I could not swallow from the TMJ pain and had to get a shot of something very powerful.  Still, I will ask the NM dentist about it next time I go there. So far, we have always found a way to pay.  I just don't know how much longer we can do it.  Maybe the case manager will have some ideas for paying for it.  As far as the bed, I can now sleep about 5 hours and wake up in mild pain.  Then I apply ice and can get back to sleep with the ice on my jaw.  So the bed is helping quite a bit.  I am at least getting some sleep now.
still hopeful,
Melanie

Hey Melanie,

Glad to hear that there is some improvement. I am however, disappointed that financially it is burdening you. I understand. This is exactly why we should all be writing to our Reps. in congress to include TMJ as a medical condition. It effects all your health. Tell your case worker to put it down as a sleeping disorder, with possible implications o you heart, sugar levels,and even possibly Alzihmers in the future. Beleive it or not there are strong correlations.
Again, I am most joyfull with the news of your better sleep, and pray for your continued improvemnt.

H.Nassery, DMD

I have had TMJ since i was little and i would shift my jaws and didn't really know why.
  My regular dentist died about 7 yrs ago and i am not liking the one who replaced him...
I went through the retainers and braces ect. when i was young, I think i was 4 when i started going to him.
I am now in my late 40's and a dentist told me the other day that i needed a night guard. ( This is the first i have been told about this)
For the last few years i have noticed that i don't hear quite as well as i use to and i just thougt it was cause i was getting older.
Well i got one of the guards and i have noticed a big difference in my ears and my bottom teeth have the nerves showing and i look like  i have baby teeth on the bottom from grinding them. Kinda like the fish that eats flesh (Pararonnia)_

I have had the # 30 & 31 extracted in the last 2 weeks and i am finally starting to feel better. I had them filled when i was young due to deep crevicius. I had to get the fillings re-done and i guess the person who did them didn't clean them out very well and they must have had an infection or something very painful for several months, I had 2 un- restorible  teeth.
I was in alot of pain and when i would bite down the teeth felt like they were getting soft? Weird but true .
Has this happened to anyone else or am i the only one? After reading some of these comments i'm starting to think that the loss of hearing also in my case could be from the tmj too. Thanks for the information.

Hi, I am 57 years old and had successful surgery in January 2009 to remove a small breast cancer.  I have always had a dodgy jaw one side (clicking and so forth) but a month after surgery (and a week after starting Tamoxifen) I started to hear funny sounds in my ear (tinnitus like a vacuum cleaner sometimes and a feeling that the back of my head was moving).  Also the side of my face seemed dead.  I have lost some low frequency hearing in that ear and have had an MRI which was normal.  I have seen a Maxillo-facial consultant who says I am grinding so I started wearing a lower mouthguard at night, which seemed to improve the tinnitus.  I am now having physio on my neck, the physio says my neck has very little mobility and the muscle right at the top of my neck just underneath my ear is really hard.  I seem to have one good day, then the next bad, the noises change constantly and things pop, like when yawning or going in a plane.  I can't say I am in real pain, it is just so annoying, especially as I am a piano teacher and sing a lot. It feels very disorienting

The ENT consultant says get a hearing aid, but I wonder if anything else can be done.  If I put my fingers in my ears the left one has a hard bit of bone that seems to jut out into the ear.  Could it be arthritis?   My next visit to the physio she is going to try acupuncture, could it be the blood flowing differently that causes the different sounds?  I don't understand why the noises change all the time.  Any ideas would be welcome.  I have had this for a year now, and don't know what to try next!

Dear pianowoman:

If they have checked your ear and evrything is normal then why a hearing aid?  I would go a bit on the limb here and say that you have always had the issue with your jaw as you said.. It is not at all surprising to me about your feeling this after the surgery.. you see you were intubated for your surgery and that requires that your mouth to be opened to its extreme, this is not at all different to patients that start feelingthese sympthoms after a wiplash accident.. anotherwords, things were not right there however, when they opened your mouth very wide you probably hyper extended the posterior ligaments of your disc, or temporarily recaptured it at the open..in any case things weremoved arround in there and now you are feeling the pressure that you have always placed and loaded on that joint.. regular night guards will help some but a correctly fabricated oral appliance will be better. this of course should be followed by definitive stabilization in the new position. I would guess that you will find much relief from your hearing during the first phase therapy.

hope this helps.
H.Nassery, DMD
www.drnassery.com

Thank you very much for the advice, which was very interesting.  I will let you know what happens after my next appointment with the maxillo facial consultant in April, and will mention your suggestions.  I am also due to have acupuncture next week with the physio, so I will see if that does any good.  Thank you.

Dr. Nassery,
  My case manager said that if the insurance refuses to pay for pt, we can appeal and if it is deemed medically necessary, then we can ask for a variance.  Our insurance knows this, and has not refused it, but has deemed it medically necessary already and said they will only pay to the limit of our policy.  That is nothing anymore.  So I am not sure I will be able to go that route either.  We are trying to make the case that it is damaging my heart because it is the sole cause of my heart issues.  There are no other factors to explain them.  She said that is rare and convincing them may be hard, but if they look at my history, they will see it plain as day.  
   Also, the NM dentist re-did the K-7 test and the black line (not sure what it was called) was still very much in spasm.  It was very high still. The others had shown some improvement.  I know there is some improvement in the way I feel.  I have way more good days than bad now.  Still, if I chew anything, I get severe pain in my ear and left jaw joint.   He said this orthotic has been adjusted as much as possible, so he is making a new one.  So, basically, I think I am starting over with a less severe situation than when I went in the first time.  Hopefully, he can get that group of muscles under control now.  I am still hopeful that things will improve further.  I have visited other TMJ support sites and suggested that the sufferers check out neuromuscular dentists.  I really do believe in your methods.  I know my case is different because of the severity and duration of the problem. If I had found this dentist years ago, things would probably be different.
                                                            Melanie

I am glad to hear about the improvement, Melanie. Remember, healing is not an event, it is a process. It took  many years for you to get to this point and going back will likely not be quick. Also bear in mind that there are things that had happened ie, tearing and deforming of soft and hard tissue that will not ever be repaired. So your recovery will have a "medicall limitation". however, at this point even a 50% reduction in your discomfort will generate a great difference in your quality of life.
As per the orthotic, in advance cases I have sometimes made three or even four orhtotics. I don't expect to get the best resolution on that first bite.. each time there will be some improvement and a better bite will emerge.. so you are on the right track.
All the best.
H.Nassery, DMD

thank s god for this site  my pain start like 3 years ago   one morning i can,t open my mouth  but no pain and then  like 2 weeks after i start to feel like my teeth need to pull them only my right side  so i went  to a dentis he pull 2 molars  o , i holmost  forget to  tell you i told the nurse i can,t open my mouth  she poen my mouth any way  the next day i was feeling much better  but then  like 5 days after i start  to feel like i have nidles in my right cheek  so went to the dentist again he say  ? i have some thing like a root coming from where they remove my molars  he remove,it  and gime antibiotics and sen me home i feel good for like a week and that same pain come back went back   he say the some thing happen again  i ask this  is going  to happen again he say he was not sure by this time i was felling like my cheek was  in fire plus i cry constaly  the pain was so bad plus he say he can.t not do nothing no morei went to a specialist  he treatme so bad  but he teke some piece of my bone he toldme  i think is call root canal he say he can messup something in my nose but if is what i want he well do the surgery i was craying  but the pain was so bad  i pay 300,00 cash is other thing he tell me i need to pay right there well  the surgery was for nothing  i start going down the hill  i cry all day i stop eating sleeping  i want  to kill my self i.m 50 years i feel like i.m 90  my lfe is no the same the only thing i do  is going to doctors  dentist specialist tmj . chiropractics   i have 2 surgery,s  for nerve pain  the first one  don,t work second  finale work  but  since june  i  have so much trouble whit the tmj  is getting so much  worse  i take  wherever people tell me they do like 15 shoots don,t work my teeth are in constant pain only the ones  in myright sidemy sheek is in pain  my ear  feel like is full   of  something my temple  is  like somedody  is pulling my skin from  the inside  when i open  my mouth i feel a lot of pain if  i eat  o brush  my teeht when i talk  is like  my mouth  is so tired  i know  sound  wird my neek  my right  arm  feel so   tired  i feel so much stress all the time  i have  so many  things  but  is  really  to much  to be  in the com  i feel like  my life  is over  i try  to keep  going  but  some times  is so hard   i,m still working  because  i need the job  my husband  don,t  have  insurance   i stop working  for a litle while only because they  do  2 surgerys  i used  a  mouth piece for like  a limro then a year  but i don,t really feel  any reliff  but one of children broke  it  i can,t aford another one my insurance dont cover a lot of this things  i start going to another chiro  but  i start to feel the same pain  like when i start this road he say is normal  in  first i  just don,t trust no body no more is like every place i go  they  don,t listen they  just want money  and some doctors  just tell me   i,m under to much stress so they just gime pills for depression  and  some  just tell me  is just  in my head  my life is so diferent know  the only thing i do is to try to find doctors  and  o  somebody to help me  but just  promises is the only thing i find so for o  i almost forget to say  wheni start whit this one  doctor tell me  i problabe have a  bunch of things  in the same time so they need to fix one thing and then the next one  one doctor say one thing and other one say something diferent  i can,t sleep  because take me forever to go to sleep because when i lay down my all face crack and hurt so bad  plush  i can sleep side ways my right ear is always swellen in the back i know  sound wird  but  is like i have a bone stiking out in the back god bless all this people  and help us

what a great site . I like many others here have had braces as a child but am at times suffering from tmj and clench my teeth a lot when I am stressed.
I have been wondering though if our jaws need to continually adapt to our changes in life ,our teeth becoming old ,changing conditioned patterns etc..Are the jaws holding tight to maintain our attitudes and beliefs ,do we need to keep control so we assist by clenching tight  unconsciously .So I have been trying to work with the idea of ,not resisting ,of allowing my jaw to readjust when it needs to  .I say  'I relax, I release ,I let go '.
I am 62 years of age and my teeth have certainly altered over the years .I have noticed that when I have a severe attack of tmj it usually coincides with a growth process ,a time when I need to overcome something in my life .
A group of friends formed a support group and have been taking notes as to the events ,the psychological and emotional happenings before ,during and after acute attacks and have come to an understanding that usually it relates to what we consider to be WILL .When another person imposes their will on us we respond by bringing our own will to meet this .The upper jaw is affected by the others will and the lower jaw is our attempt to meet this oppression .The two wills ,contained in the upper and lower jaws ,grate together ,lock without movement or compromise and there we are stuck .
Chronic cases seem to relate to lifelong feelings of being oppressed with no avenue for release of the emotions involved .
Grief is big in our group as is anger ,resentment and trauma memories all we think held in the jaw .We have worked out various strategies such as filling the mouth with air and blowing out to release the emotion, humming in different tones,painting ,laughing .Most effective though has been the recognition of the moment when we feel oppressed by another and the body using the bottom jaw to counteract this .Therapy as in talking with each other has really helped and this has cost us nothing except a cup of coffee
I think there is definitely advantages in seeking tmj dentists but I also believe that personal work on releasing held emotions etc should be included otherwise the jaw will not be able to find its own place suited to the individual .
We as a group also noticed that for a time the symptoms get worse after releasing emotions because there is a period of readjustment naturally .
carla

Painunknown,

I think you can find the answer to your issues right here.. you need some one that can provide the proper diagnosis and treatment for your case..you have all the signs and symptoms of very advanced TMD. Top3 dentist should be able to refere you to an experienced TMD specioalist in your area..

Best of luck.
H>Nassery, DMD

Dr. Nassery,
   Hello again.  I have some new questions.  I got my new orthotic and for the first week, I couldn't keep it in very long and then had to switch back to the old one.  I went back to the NM Dentist, and he adjusted it and after that, I didn't have any trouble keeping it in.  I do have some new issues, though.  First, I have a pain under my jaw.  I had it at times before the new orthotic, but now it is there much more.  It is not unbearable, just uncomfortable.  I mentioned it to the dentist, and he said that it could be the disc unfolding and pressing on the nerve and he is going to x-ray it at the next visit.  The other issue I am having is with my left arm.  It has been feeling like someone punched me real hard, or kind of like I got a tetanus shot.  It has been this way for about a month or so.  Then, last Friday morning, I woke up and my hand felt like it was sunburned, but it is not.  By Friday night, the sensation was all the way up my arm and half way across my shoulder.  It is still there and I can hardly stand to have anyone or anything touch my left hand or arm.  The worst of my TMJ problems are on the left and that is the side that is locked.  I was wondering if you think this has anything to do with the TMJ or if it is something else.  It does not seem to me that it could be related, but I don't know.  Tomorrow I am going to call my primary care doctor for an appointment.  If you think it is related to the TMJ, I could call my NM Dentist and make an earlier appointment.  My next appointment with him is on the 21st.  
Thanks, Melanie

OK, lets disect the issues.. first the pain under your jaw, need to be more specific, if it is the angle of your jaw, you know where your jaw turns up, then it is a problem with prematurities, more adjustments is needed, just trust the process, and let it work its way.. more occlusal adjustments..
As for your arm, it is a trapped nerve in your neck, that goes to your axial plexus, don't get nervous, this agaim means that the process is working. Remember, if we are able to effect the issues in a bad way it means that we can effect it ina possitive way as well. I would have my patients see a therapist at this point a put them through a good amount of retraction therapy, extending their neck and gently moving the cervical spine into the right place, and creating enough room for tension free exit of your nerves in between your cervical vertebra. Have the dentist take a Cephalometric x-ray of you and I gaurantee you will see the subluxed C3, and C4. free them up and you will get relief. All in all these are good signs, means that the therapy is working. You muscles are relaxing more and things want to go back into their normal place.
All the best.
H.Nassery, DMD

The pain under my jaw is a little more forward than that.  If you trace a line from the outside of my left eye, down to under my jaw, it's around there.  As for my arm, my primary doctor said the same thing.  He said it is a pinched nerve.  He gave me prednisone, and if it doesn't get better, he wants to do an MRI and injection.  I will talk to the NM dentist before I would allow that now that you said it is probably related.  My primary doctor said it is not.  I tried to get him to call the NM dentist, but that didn't happen.  I also tried to get my NM dentist to call my primary Dr. so they could work together, but that didn't happen either.  But maybe, now that I have a pinched nerve, the primary Dr. could order pt. I can't do it for TMJ, but they allow it for a pinched nerve.  I will have to call my insurance advocate.  
             Thanks,
                      Melanie

Hello, Dr. Nassery.

Thank you so much for all the help and info you are providing via this website. It is a very useful read for all of us who suffer from TMD.

I would very much appreciate if you could provide an opinion about my tinnitus, which was caused by a dislocated jaw.

In October 2009 my jaw dislocated on the left side while chewing food. My jaw was pushed to the right at it locked itself at about 0,1 inches from my upper teeth. This was really painful and trying to open or close my mouth resulted in even greater pain, which I felt right in front of my left ear. I started to massage the painful area and I had no option but to forcefully close my jaw. The pain went away and I was fine for a couple of hours. Then the exact same thing happened all over again. After forcefully closing my jaw for the second time, the tinnitus developed about an hour later. From that moment on, I'm hearing a constant ringing in my left ear (it's a 15 dB whistle at 8000 Hz - this was "measured" a couple of months later by E.N.T. doctor, who also confirmed, that my ears are otherwise fine and a brain CT scan showed no anomalies).

My jaw joints do not hurt. However, my right jaw joint is clicking and slightly popping out of its place whenever I jawn or eat for as long as I can remember, but it never produced any discomfort or pain, nor does it now. My left jaw joint always worked smoothly, but after dislocation, I feel and hear soft bruising sometimes. I also think, that my bite remained unchanged despite the dislocation, but I can't be sure about that.

After the dislocation, these symptoms have developed:
- a constant high pitched tinnitus in my left ear and an occasional "static-like" tinnitus in my right ear
- stuffed left ear feeling (as if something is pulling my drum inward)
- constant neck and shoulder tenseness and pain

I can change the pitch of my tinnitus (to higher only) by pressing my jaw inward, by pressing the area in front of my ear or by turning my head to the left.

I'm currently waiting for an MRI scan of my jaws (I was sent there by a maxillofacial surgeon), which will be in December this year.

In the meantime, I visited the only NM dentist in our country, who saw that my bite is not exactly perfect (my teeth were only touching on the right side). He decided to "grind" down my teeth so the tension in my muscles should be smaller (now my teeth currently do not touch at all since my upper and lower front teeth are preventing that). This has helped a little with my neck and shoulder muscles. Now he gave me a NTI splint (although I don't clench or grind) which I should wear while sleeping to relax my jaw muscles. I'm in my third day of wearing this splint (so far no changes).

I would very kindly like to ask you for an opinion about my problem, because as I said, he is the only NM dentist in our country (and he does not posses any equipment for TMD diagnostics) and none of our maxillofacial surgeons had a patient with a tinnitus of a TMD origin.

By the way, I'm also going to see a chiropractor/manual therapist on Monday. He said that maybe he can help.

If everything else fails, I'd just like to ask, if you take patients from abroad too? If no one will be able to help me here, I'm willing to travel to Miami.

Thanks in advance and best regards,
Henrik from Slovenia

Dear Henrik,

I am sorry to hear about your pain..but like so many others the writting has been on the wall.. your jaw has been posteriorized and over closed for many years, as evident by the clicking and popping, and now you are starting with the more severe symptoms now. When your jaw locked, BTW, that was an open lock that you experienced, basically all your discal tissues were bunched up at the back of your condyle( sorry about the anatomical refrences, but that is the tip of your jaw bone in the joint) and would not let the condyle to go back, you then forced all that tissue more posterior inorder to close, and that placed a great mount of pressure on your middle ear and hence the tinnitis.
As for the adjustment of the teeth so that you can close more... that is the last thing you need.. NTI?? also I am not a great believer in , it is a band-aid of sorts.. the position of the jaw will need to be correctly determined and honed with the correct appliance, and it will take a lot of time to see results for the tinnitis in this case, but you need to certainely create the room for the discal tissues to go back to their places.. I hope you can find someone that can help you there
If not would be happy to do what I can.
I hope this helped. Kind regards.
H.Nassery, DMD

Dear Dr. Nassery,

thank you very much for your detailed reply. This is the best explanation I ever got.

I was wearing the NTI device for the 4th night and I woke up at 1 A.M. with a louder tinnitus than ever. I removed the NTI immediately and went back to sleep. The tinnitus is now back at its usual level but I'm not sure if I want to wear the NTI again. I will need to contact my dentist about it.

By the way, if the MRI scan will reveal a misplaced articular disk, is it advisable to correct this problem via minimally invasive surgical procedure, or would it be better to start the treatment with a suitable appliance/splint? I know that the surgical treatment should be the last resort, but I'm not sure if anyone here will be able to produce a correct appliance for me. We have no "real" NM dentists here, but there is a one maxillofacial surgeon, who is a TMJ specialist and was trained in America.

If I won't be able to find help here, I will try to find any kind of a temporary job in Miami and move there. I would be very grateful if I had a chance to be treated by you.

Kind regards and all the best,
Henrik

Dear Henrik
You already understand more than most dentist.. the joint is loaded with pressure, and needs to be decompressed. Without decompression you are rotating around the same axis ( NTI) and it will either make it worse or no difference. In an open lock case like yours where the tissue is trapped in the back it makes things worse, in a closed lock case it would not make any difference. You need something between your back teeth..
As far as the US trained surgeon, the teachings are varied and could be completly different from one place to another.. I don't know what to tell you there..
As far as, Surgical intervention...you nkow my feeling about it.. all you have to do is read all the posting here and get the general idea..
I wish I could help you there.. Canada has many practitioners and Autralia I could help you too.. but Europe.. not so much.
I am sorry.
All the best .

H.Nassey, DMD

Dear Dr. Nassery,

thank you once again, I appreciate your help.

I have read all the posts with great interest and I noticed that surgery should not be the first, but the last option for TMD patients. I also came across this interesting post (about surgical treatment) on a UK based forum (btw, the mentioned Dr. Piper should be one of the best maxillofacial surgeons around):

"No dentist should ever use a splint to correct a TM disorder without seeing an MRI scan of the joint because only MRI scanning can accurately show the position and state of the meniscus and it is the state and position of the discs that determine the right treatment.

At the point before I was put onto Dr. Piper, it never even crossed my mind a MRI scan would be necessary for any doctor / dentist / surgeon to correctly ascertain with any accuracy the position of the discs and extent of damage and that is absolutely vital in order the right treatment plan to be made.

Dr. Piper does not like to operate on anyone and always uses conservative treatment whenever possible and cases where surgery is truly needed are extremely rare but I was at a point where bone fusion was about to begin (within a year by Dr. Piper’s estimation) and seeing the MRI scan and having everything explained in layman’s terms was a godsend because at last here was somebody not only with the knowledge but a caring compassionate man that knows how to explain everything in great detail in a way anyone can understand. I feel I owe him my life."

I decided to stop wearing my NTI device and I will get a MRI scan of my joints ASAP. Then I will try to find someone who will be able to produce a right kind of splint based on the MRI analysis. If I don't succeed, I'll contact you again Dr. Nassery and if you'll be prepared to take me as a patient, I will find a way to temporarily move to Miami.

Kind regards,
Henrik

It sounds great , you are on the right path.I hope yo can find some one closer as this type of treatment is time consuming.. however, I would be happy to do what I can.
All the best.

H>Nassery, DMD

Hi Dr Nassery

I would just like to know from you wether you think I suffer from TMJ too.  For the last 2 and half years I've been having a crackling popping sound in my ears, at first it was only the right ear but lately both.  I also have a strange pressure in my right lower jaw, sometimes both sides.  It is not really painful but a discomfort.  I constantly push my jaw forward to pop my ears.  This popping goes on non stop!  Sometimes like today the skin at the jaw would start to twitch and I get stiff muscles down my neck and down my throat.  I also get headaches up the sides of my head.  It feels like i want to rip off my jaw.  I have been to the doctor probably 8 times in the last two years.  He says he cant see any infection.  He says its moisture behind my ear.  I was prescribed nasal sprays, celestemine,antibiotics, sinus pills,, nothing helped.  Did not even feel better of one day i was on the medication.  I had braces when i was younger.  I even went to a dentist, he said he can not see any signs that i clinch my teeth.  He took xrays and the only thing he said was that i have very strong muscles along my jaws.  I was so desperate to get this solved that i even had my 4 wisdom teeth removed at the beginning of this year, still no luck.  Please tell me whether you think this is TMJ?  If not, what else can it be?  I am starting to get really worried about not getting this solved, besides the terrible discomfort.  

Thank you

Teri

Teri,

It would bewrong to diagnosis based on these symptoms alone. thorough clinical examination needs to be performed before a diagnosis is made. However, I would agree tht many of the sysmptoms you described are in line with what we see in general in TMD cases.  I would say there is definite indication that you should find yourself a TMD specialist, regular dentists were  not trained to diagnose and treat this issue. I was one of those dentists for a large part of my career.
The key is not stop looking for the answer, there is a logicaa explanation for it all.

H.Nassery, DMD

Hi Dr Nassery

Thank you so much for your quick response!!!!!!  I'll take your advise and have my GP make me an appointment with  TMD specialist.  

Thanks again

Teri

Hello. My name is Emily, and I am a 33-year-old female who has suffered from TMD for the past 8 months. Like many others, I originally went to an ENT for symptoms of vertigo and a clogged left ear (all pain is on the left side). They ruled out infection, allergies, and sinus issues -- and diagnosed me with TMD and recommended physical therapy and getting a night guard from my general dentist. I did all of this and am now back to drawing board because I got very little if any relief. The night guards (he made two for me, including one that keeps the jaw open) made the problem worse, and to make a long story short, I'm now seeing a chiropractor for neck adjustments 3 times/week. I'm in week 5 of this therapy and am not getting much relief. I do have an appointment this week with an orthodondist who specializes in myofacial pain, but I feel like I'm running in circles. The thing that's helped the most is trigger point therapy by a massage therapist, but the chiro says this will provide only temporary relief b/c the real problem lies in my neck alignment. When the chiro took x-rays, he detected a forward head posture, the kind caused sometimes by whiplash of the neck (I was rear-ended in a very minor car accident a month or so before my symptoms started). Does any of this make sense? Can a chiropractor really help TMD, or am I better off sticking with massage therapy and/or getting check out by a TMD dentist? Any insight is appreciated! Thank you, Emily

Emily,

We see this very frequently. Exacerbation of sysmptoms by an accident..What I amsayin is that more than likely most issues were there before, but now they have come to surface sooner due to the accident.
As ar as the proper step for therapy, I would definately see the person familiar with TMD, the neck issues will not be stabilizede till the jaw finds its home, I personally prefer the massage therapy over cracking the neck , although I have had the procedure done to myself before.. it is a good emergency option.. but massage or PT is the better alternative longterm. regular night guards will not do the job as they are aribitrary in position, you need a better and more precise appliance. The good news is that ll your syspmtoms are fixable and treatable in the hands of a good clinician.
Keep searching. All the best.
H.Nassery, DMD

Thank you for your advice. It makes good sense ... And I do think it's time to give the chiro a rest (since it's not really helping) and spend my time and unfortunately more money on a massage therapist and dentist who know TMD.

Thank you again!

Emily

Hello sir,i am Hinna, 20 years old and the problem i am facing since a month is that while laughing,i have a inner feeling and many times,i have noticed it in the mirror too that while laughing my facial expressions get weird and it feels like i will burst in to tears and my mouth is getting dry. It's like my muscles are being pulled back or something. Many other people even noticed this change in me.I shall be thankful to you if you could come up with some explanation of what is wrong with me and how i can fix it as i am very conscious about it.Thank you.

Can TMD cause extreme dizziness? I know I have TMJ and have had it for a long time. I have grinded and clenched my teeth my entire life. I grind my teeth so bad during the day that I practice putting my toungue between my teeth to avoid clenching and grinding.
Last night I woke up from a nightmare and lift my head to check on my 3 y/o son who was sharing a bed with me. As soon as I lift my head the room is spinning. My head felt heavy, my neck was cold and sweaty. I was scared. It led to nasuea, acid refulx, no sleep, and IBS. Finally a few hrs later I decide to lay down again. My son wakes up and I jerk my head up to look at him. There it goes again, bad spinning. Its worse with movement, with picking my head up, laying down just felt light headed.This time my ears felt clogged and one had pain deep inside of it. My ears have felt funny all day.  I have never felt a dizziness like this.
I took a nap today and I was ok. It didn't happen again. But I am scared to go to sleep. I am stressed right now. Scared of losing my job, buying a house, my grandmother is dying. So I am sure my immune system is compromised and my grinding is going crazy.

the short answer is yes. for the time, have your neck checked and try to get a massage. This could also signal an issue with sleep breathing disorder. Rmember they ago hand in hand.. DO you Snore? lots of times the nightmares are due to de-ox. just some ideas to run with.
Try a Chiro or PT whichevre you prefer.
Hoope this helps.
H./Nassery, DMD

Hello, Dr. Nassery. I posted a week or so ago (thank you for your response!) but have a few more questions. I was diagnosed with TMD in Feb. 2010 by an ENT. I then started going to physical therapy, followed by chiropractic therapy for neck adjustments -- all to no avail. My general dentist also made two night guards that actually seemed to make it all worse. Massage therapy has helped some, and I recently noticed that relaxation/breathing exercises helps a good bit (but doesn't get rid of all the symptoms).

The past year has been stressful, with a new job, an out-of-state move with two young children, and the purchase of a new house. My TMD may be stress-related, but complicating matters, I was rear-ended in minor car accident prior to the onset of most of my symptoms (though the dizziness was there beforehand).

My questions are: (1) Would you recommend getting an MRI to know for sure what's going on? My money is tight, and I've already spent a lot on all of this. (2) Might biofeedback work as a way to help me relax? Again, I'm not sure all of this is caused by stress (as opposed to the accident), but I'm willing to bet that some of it is.

Basically, I'm trying to decide whether I should bite the bullet and spend a small fortune at the TMJ specialist's office (he orders MRIs on all patients, and my health insurance will pay only about half of his fees) or to try biofeedback therapy (which is covered by insurance and much less expensive). Any thoughts are appreciated. Thank you!

Emily  

Hi Doctor,

My story started in the begining of May this year I am a Boxer and I clench my teethe. I started getting headaches daily for weeks, tight face especially temples and jaw line, pressure in my head (which was thought to be sinus). I had Ct scans done went to several doctors and was told they were tension headaches.  I then went to a chiropracter and was told that I have subluxtion in my C4 and 5. however after months of treatment the tightness in my temples and face never went away I forgot to mention I also get swelling in my right cheek which is the side the majority of the tightness is.  finally I went to a Physio therapist who noticed my jaw wasnt in line and suggested i go to a dentist. I did this and he agreed it was a jaw problem, however not satisfied I went to a tmj dentist who did a full thing of xrays and confirmed what the problem was. Is there someone you would suggest in Winnipeg Manitoba canada to go see for a proper splint? also is the tightness in the temples normal for tmd sufferes?

thank you

Jeff

Em321,

answers "My questions are: (1) Would you recommend getting an MRI to know for sure what's going on? " All diagnostic information is useful, remember before you can fix it you need to diagnose it..
"2) Might biofeedback work as a way to help me relax?" any way you can get your muscles to relax is going to be helpful, however, I am betting that the cause of these are that your jaw is in wrong position.

"Again, I'm not sure all of this is caused by stress (as opposed to the accident), but I'm willing to bet that some of it is."
Stress is a trigger, it will hit you where you are the weakest, your weakest link sorta say.. it seems that its pointing to your jaw.
Hope this helps.
All the best.

H.Nassery, DMD

Dear TMJEFF,

all info sounds good, and right. Lucky for you there are many denist that practice what I do, in your neck of the woods, check with top3dentists, website or leadingdentist.com and you should be able to find someone up there to take you through the right steps.
Down here in Miami beach I am invovled with the 5th street gym, Mohammad Ali's old stumping grounds, and treat many of the fighters and trainors.
All the best.
H.Nassery, DMD

Hi Dr. Nassery,

I have a buddy that went to train there for a bit a few years ago heard its amazing. Just a couple more quick questions if you dont mind, is pressure in the temples and back of the head a symptom of the TMD? Do you recommened ice or heat at home?  Also i have made an appt. with a neuromuscular dentist for next week, I am looking forward to it the treatment is expensive but hopefully its worth it!! I will update you with my progress, Thanks again

Jeff

Hello TMJeff,
sorry for the delay, was away. As for your questions, the pain and pressure in your temples and the back of your head are definitely related. There are probably days that your head feel too heavy for your neck?? Please share your experience with your doctor with us here as others may benefit from that too.

All the best.
H.Nassery, DM
PS. In september, 5th street gym will have a celebration and the guest of honor will be none other than the great one himself.. hoping to get a picture with him.. if I do, I'll post it.

Hi Dr. Nassery,

That is awesome that would definatly be the chance of a lifetime to meet him, I would love to see the pictures.

Thank you again for your reply,  and yes there are many times where my head feels very heavy on my neck almost a full feeling. One other question I forgot to ask is when all of this started at times I have been having issues with my sinuses over the eyebrows, bridge of nose, and the nose itself, feels like pressure aswell and almost like its tingling as if the nerves are affected.  I have taken antibiotics ETC. nothing really worked. If this started with everything else and comes and goes is it safe to say its related to the TMJ? I have never in my life had sinus issues befor.  

Also as a side not I went to the Neuromuscular Dentist yesterday, the dentist was great, I have wait wait till sept 17 however to get fitted for my splint. It will be a splint that I wear 24-7 except when i eat and brush.  in order to fit you correctly so your jaw is in its normal position they go into great detail to find this out and it takes 3-4 hours. If anyone is in the Manitoba Canada area and is interested you can check out www.allanwinchardmd.com.

Thanks again and sorry for all the questions but this blog has really taken away alot of anxiety for me.

Tmjeff,

You will see that once you get into the appliance, your muscles will relax and much of these other sympthoms will ease up as well.. I am talking about the frontal sinuses and twiching that you describe.. these are nerves that are being pinched by the over contracted muscles..
I have heard Dr. Winchards name , he is a great guy and you are in good hands..
All the best.
H.Nassery, DMD

Hi, Dr. Nassery. I've written you a few times but now have MRI results and am seeing a dentist who specializes in TMJ (Robert Grill, Baltimore, MD). His assessment reads that: "the MRI reveals minimal TMJ damage but damage nonetheless. Any TMJ damage is capable of causing a change in the occlusion and therefore a change in the mechanics of jaw movement. The patient's pain appears primarily muscular although there exists synovitis in the L TMJ. Management is suggested to be conservative and include the fabrication of an orthotic appliance on mounted study models. The orthotic appliance is to be worn 24/7 or as much as possible with periodic adjustment to the occlusion of the orthotic. Concurrent specific head/neck P.T. should be beneficial. Once the occlusion on the orthotic and symptoms stabilize, an occlusal analysis will be required to assess how to manage the dentition with regard to more stable jaw position."

So, like the patient above, I'm about to get an orthotic device/splint for the lower teeth. My questions, however, are: (1) is splint therapy really necessary since the jaw damage is minimal and my condition is "primarily muscular"? (2) will the splint help relieve the knots in my neck and shoulders? Are these knots likely related to the jaw damage?

I've had several deep tissue massage sessions and am following a workbook on self-treating trigger points, but I'm seeing very few results. The knots keep reappearing. At this point, the knots in the neck and shoulders are causing more discomfort than the jaw.

Thank you for your help! This forum has been such a huge help.

Emily

Hey emily, nice to hear from you again.  
All sounds about right, to answer your questions; Yes, the splint is the traetment. The reason for your muscles to be in this state is that your teeth which dictate the position of your lower jaw, are not in the correct place.( like most of us), however, this discrepancy is enough that your muscles can no longer accomodate and adapt. So they ache. The splint will hopefully bring you into a more favorable position muscularly speaking. This will allow for your muscles to relax and the knots as you said it will have a chance to get better. The help of the PT and or massage then can be lasting. Later you guys have to figuer out how to get the teeth into that position.

All the best.
H.Nassery, DMD

Hi Dr. Nassery,

I got in early with the neuro dentist and saw him today.  He ran all the test and fitted me for my appliance then will come in shortly.  The appt took almost 4 hours.  He believes I will be in my appliance 24/7 for the next 6 months to a year and then more then likely get braces.  my top jaw is much narrower then my bottom one,  it seems my problem has always been there and boxing just completly aggravated it.  

I am really hoping that this is the answer.  I will keep you updated with my progress!

Jeff

Hi again,

It has been about 5 days with my orthodic and I would say my tmj has had a slight improvement.  I notice that the swelling on the left side has gone down. I can still feel the muscles tighten off and on through out the day and my headache is still there.  I also notice that it almost feels like my headaches and tightness are coming more from my neck now, dont no if that is a good thing or a bad thing.

I also notice when I take my appliance out to brush it feels really weird and I almost feel dizzy, is that normal?

I go back on tuesday to have my 2 week checkup, I do think it needs a slight adjustment.

My neuromuscular dentist said it will probably take 3-6 months to start really feeling my symptoms subside, is that usually on par?

I also have an appt with a cranial sacrial therapist tommorow, and will be going for massage therapy and chiro.  hopefully this all helps, I can't wait for the day I am headache free!!

Thanks again,

Jeff

Hi again, Dr. Nassary. I've written a few times about my TMD condition, and I'm now undergoing splint therapy (after many months of plugged ears/intermittent vertigo/neck and shoudler aches -- and after an MRI showed very minor damage to the left TMJ and surrounding inflammed muscles). My worry is that the splint might not be working. I've been wearing the device, which fits on all of my lower teeth, for 3 weeks now, and I get it adjusted every week. The problem is that my muscles are still tight and bothersome, and I think they're changing my bite. So I might go in on a Friday to get the device adjusted, then experience changes in muscles the next day or even a few hours later, and the splint no longer provides a perfect bite. And my muscles get even more unhappy. Seems like a vicious cycle.

Does this mean the splint isn't the right therapy for me? The dentist just put me on the very low-dose anti-depressant to try to relax my muscles, and after one week of taking it daily in the evening, the muscle knots (along the side and back of my right neck -- interestingly on the opposite side of my jaw/ear pain) will not let up.

I also wonder what role computer usage plays in all of this. I sit at a computer for my job, and even though I take breaks and do my best to set up an ergonomic work station, I think it's partly to blame ...

Any advice is appreciated. I spent $2700 on the splint (after paying $1400 for the first two visits to "the best and only real TMJ specialist in Baltimore"), and not sure what to do at this point.

Many thanks,
Emily

Emily,

Please tell me if this is a flat splint or is it a anatomical one, also did you have any ULF tensing doen to your neck and jaw before your bite was aquired?

Thanks
HNassery, DMD

Dr. Nassery,
My splint is anatomical. No, I didn't have any ULF tensing done to my neck and jaw before the splint was made. I was told to do a series of "taps" with my jaw relaxed as much as possible. Each time I go back now for adjustments, I do the same series of "taps" a number of times throughout the visit.

My doctor/dentist uses color coding (green and red) to detect the pressure from my molars on both sides. Usually when I go for an adjustment, the marks are not at all equal. And then the goal of the visit is to make them equal before I leave (i.e., the "perfect" bite, which changes, I feel, within an hour or so of walking out his door). I'm starting to question how this method could possibly work ...

Many thanks,
Emily

Emily,

In my experience and my hands, ULF tens is the key, to really advance the process. I am sure thee those that can do this without, however, I think that tens will take the guess work out and get the process much further along. Just my opinion, and 2 cents.

Regards.
HNassery, DMD

Don't know where to turn to...but found your site. I have been grinding my teeth for years now. I am 50 yrs. old.
I have had 3 mouth splints made- upper ones-as I have a really out of place tooth on the bottom from having braces
when I was 15.For years I have had the clicking and jaw joint pain and the odd dislocation.All 3 of the splints i broke
while sleeping also. Now the left jaw has been completely dislocated for a month now and will not go back. What can I do? Please help as it is very hard to eat proper as nothing very big can get into my mouth. and extreme pain when yawning or brushing teeth. Thank you

Susehn,

I am guessing abit here but it sounds like you have a situation we call an open lock.Basically the derangemnet in your joint has been there for a longtime , and somehow you captured the disc back into its normal place in the joint, and now it does not allow for your condyle( head of your jaw joint) to go back into its place.
Try and find a dentist who is familiar with TMJ traetment and get started.. I wish I could be of more help ... but based on the info here thats all I can say.

H.Nassery, DMD

Hello,

I was diagnosed with TMJ about 4 weeks ago because of an onset of jaw tightness, temple headaches, and tension in my face. Prior to this my jaw would pop on the right side for the past couple of years. Ever since the discomfort started, the popping ended on the right side. My GP referred me to an Oral Surgeon that specializes in TMJ. He prescribed me a hard custom made mouth guard to be formulated by my dentist. I am still awaiting this appliance and am wondering if it will help. He said that my pain should diminish greatly and that the disc could go back in its 12 o'clock position. I am also currently getting massage therapy on my jaw and acupuncture.  Also I don't feel any pain while eating or talking and my mouth can open to a normal range. Actually it's interesting when I do eat (soft diet only) it seems to diminish my discomfort.  I am wondering what is my prognosis and what else can I do to feel better.

Natalia

Natalia,

based on the information provided ;  The only thing that I know is that you had a click and pop, which means that you used to displace and recapture your disc on the right side, and now it does not recapture, which means that you have permanently displaced it.. not good. something had to have happened, so now you you are closing more than you did before, hence the reasoning behind your muscle tension.. I am not sure what type of splint thay will be making for you but in my experience flat splints won't help much.. massage is good but finding the correct position of your jaw is more important.. keep us abreast of your situation and condition.

Regards.
H.Nassery, DMD

hi, i had lots of dental problems growing up. i had braces at one time but my mother stopped taking me and when i got out on my own i could never afford dental and i lost quite a bit of teeth. i was diagnosed with tmj and the dentist says i have a severe overbite and need jaw surgery, i sure cant afford this. is there anything else that can be done? thank you

Lori

Hi,

I had orthodontic work done as a pre-teen/teen.  I have had issues for years with the nerves in my right arm (numbness, tingling, burning at times, chronic wrist, elbow and shoulder issues), neck issues (tension, pain in neck and skull muscles, jaw tension/pain, now diagnosed with a reverse curve in my neck due to the tension of my cervical muscles) and thoracic sublaxations/spasms.  I have recently been seeing a chiropractor who is working on the curve in my neck, and as a result of his treatment, my bite/jaw have started causing me a lot of discomfort.  Initally I thought it was his treatment that was at fault, but I can't help but wonder if his treatment is letting the muscles in my jaw move back to where they are intended to be, and the bite issues that I am having are indeed just showing the true colors of the orthodontic work I had done, as my jaw actually feels better in the position that I am finding it in now, just none of my teeth fit together in this position.  After my orthodontic work was completed, I still had an overbite, my centre of my upper and lower teeth still did not line up, I had my upper wisdom teeth extracted and my lower 12 year molars extracted.  

I guess what I am wondering is if it is possible that the chronic issues I've had with my neck/right arm/jaw could all be related to my orthodontic work and the current position of my teeth/jaw, and if so, if this is treatable, could this possibly finally be the answer to these symptoms that have now haunted me for the past 15 years (that no MD could give me any other explanation than I have chronic inflammation of this, and this "-itis"...)?  I can only imagine how much greater my quality of life could be if I can finally get to the bottem of this!!!

Hey Lori,

First I want to say ..put the word surgery out of your mind.. first things first.. you need to replace the missing teeth.. then find a dentist that has specific training in reposition your jaw into its correct space.. this is not done surgically, but with appliance therapy.. keep looking for the right person.. and keep us informed.
All the best.

H.Nassery, DMD

Dear Hedzup,

You already know more than 95% dentist out there the intrictae connection of our jaw with the cervical spine and by extention to the rest of our body.. kudos on connecting the dots. most professionals can't do that..
Your jaw is most likely too far back and over closed, which means it will inevitably pulls your C1 forward and the rest is history as they would say.. it will go down the spine as you can imagin.. I am a patient and sufferer of that myself, and I can tell you based on my experience as a clinician I can tell you that I see a big correlation between scoliosis and Malocclussion.. there cases of Scoliosis that have shown up to 70% reversal just by correction of the bite.. the rest could be corrected by the thereapist/ Chiro..
Find yourself a good TMJ Doc and start repositioning your jaw into its physiologic place, the rest will fall into place automatically.

Good luck.

H.Nassery, DMD
www.drnassery.com

thank you for responding but what if i cant afford to replace them? i have quite a bit missing. i honestly dont know what to do, ive been having neck and shoulder pain lately and im starting to assume its coming from this. i did see a chriopractor before i was told i had tmj and he took xrays of my neck and of course it was out of line. do you have any other suggestions? i dont have dental insurance of course thats why im in the place im in now. i dont know what to do

Lori

Lori,

even if you don't get lets say implants, you can get removable partial dentures or dentures made in the proper position.. they also have costs involved with them but to a much lesser degree..
As far as what other things you could do to help yourself, definately seeing a chiro/PT would be highly recommended as well as some sort of training to help keep your posture right.. something like pilates or Yoga...this is what I see helping people to a great extent.

hope this helps..
H.Nassery, DMD

thank you very much, so you dont think id have to get surgery to move the jaw in place? i have been seeing a chiro but i started seeing him before i found out about the tmj, and he did an xray of the neck that show my spine crooked. hes been treating me for that but i havent told him about the tmj yet because i just found out. the dentist also told me they didnt see how id live well if i didnt have this surgery and that upset me and has put me under stress.

Lori

nice post .
keep post such interesting content again.
Temporomandibular Joint Dysfunction (TMJ) is the term utilised to describe conditions affecting the Temporomandibular Joint. The Temporomandibular Joint is the point at which the jaw opens and closes.

tmj dentist
www.cosmeticdentistmelbourne.com.au

Lori,

They don't know what they don't know... you are just an appliance away from feeling well.. the obstacle in your way is the properly trained dentist, not your ailment.. please keep that in mind.. don't stress over things you can not control, focus on things you can instead.. that is finding a dentist that has been trained in appliance therapy for TMJ dysfunction.. I would tell you that a very small percentage of cases are truely surgical, that is why I am willing to go on a limb and say you don't need it..Keep looking for the right Doc.

H.Nassery, DMD
www.drnassery.com

Dr. Nassery,
   I have never had any jaw pain, but was prescribed a night guard by my dentist 2.5 years ago because I had significant wear (from nighttime teeth grinding, presumably) on my back molars.  Over the course of the past 1-1.5 years of wearing the guard every night, I have noticed that my normal biting pattern has shifted.  I actually first noticed it when I couldn't bring my front teeth together to bite my cuticles anymore.  Now it appears that my jaw has moved into a new position permanently (perhaps the one it should always have been in?) due to wearing the guard at night.  I don't like the way my teeth are hitting now, though, because two molars on my left side are the only ones that make full contact when I bite down normally, and there is no direct contact anywhere else.  I did have braces for four years when I was in 4th-8th grades many years ago, and until this shift happened, my bite was normal (except for some teeth grinding that I was not aware of until the wear showed up).  My dentist (and my son's orthodontist) both are at a loss as to how to get my jaw to return to the other position that allowed for a normal bite, or if that is even possible or desired.  Any thoughts?
   Sheri Ochs, PhD  

Sheri,

It sounds like you were wearing a type of night guard that only seperated the front teethand possibly did not have any coverage on the last two teeth that are now in contact. What this type of guard will produce is exactly as you described, anterior open bite. Now in most caes this is a very difficult issue to overcome, however, this is not to say that it is bad for you. You need to see a Neuromuscular Orthopedist, someone that can find your correct jaw position and get your teeth into that place. Regular mainstream orthodontist will not know what to do, thsy need to have TMD background, and I don't mean the ones that have been making nightguards..
Perhaps you needed to be open a bit more, I don't know, hard to diagnose over words alone. but if you were grinding before chances are that your jaw position was wrong, and your airway was compromised.

hope this helps.
H.Nassery, DMD
www.miamibeachdentistry.com

Dr. Nassery,
   You are correct that my night guard only fit onto my bottom front teeth and separated my front teeth top and bottom, nothing more.  If the first position was wrong for 40 years (hence grinding at night) but my teeth were aligned, how could a neuromuscular orthopedist find a jaw position that would put my teeth back into alignment without it being "wrong" again?  Also, how does one go about finding a neuromuscular orthopedist in Virginia Beach, VA, who would know what he/she is doing enough to fix this problem?  I actually am more aware of my jaw now than I ever was before wearing the night guard, although I don't have noticeable pain.  Any help would be appreciated!  Thanks,  Sheri

Sheri,

Thanks for confirming my thoughts.. you have posterior super-eruption caused by that instrument (your nightgaurd).. How far are you from Mclean, VA.. yo may have to travel a bit to get to the right person.. Look up Doctor Stephen Burch, in McLean.. He is one of my idols.. I hope to be as good as he, one day..
If anyone can help it would be him.
All the best.

H.Nassery, DMD
www.miamibeachdentistry.com

Dr. Nassery,
   Thank you for your guidance.  If I am understanding you correctly, this is a problem that could possibly be fixed by a dentist.  When I spoke briefly with my son's orthodontist yesterday (after seeing my dentist), he mentioned the possibility of super-eruption of my molars.  So, does that mean that my jaw position may not have actually changed for good, but rather to accommodate the growth of the molars over time?  Unfortunately, we're four hours from the DC area (where McLean) is, so I doubt that I could travel to see Dr. Burch easily.  Sheri

Sheri,

Please take all his with a grain of salt.. hypotethically speaking, ( since I have not seen your case)

Anteriror open bite, what you inherited from your appliance is one of the  most difficult cases to tackle as an orthodontist. Hence his/her reaction. However, based on few thing you wrote, ie grinding etc.. it is entirely possible you needed to have your bite more open?? so this may not end up being a bad thing..but that has to be verified and finally your dental arches need to be finished in that position. So it depends on the position of the jaw, on how much super-eruption was created, and most importantly on your airway and cervical stability.. not typical things thought in ortho school.. look for  an orthodontist that is familiar with TMD, or a TMD dentist that does ortho.. and orthopedics..I can't get too specific with out crossing lines here.

I hope this helps.
H.Nassery, DMD

Dr. Nassery,
    Taken with a grain of salt!  I just spoke with my dentist, and he wondered if you have heard of mandibular muscle deprogramming and jaw auto-rotation into the correct position?  The thing about my molars is that they're only touching on one side (left) and on two teeth.  You would think that with super-eruption of teeth not affected by a night guard, it wouldn't just be two teeth that are touching when I bite, but rather all of them not affected by the guard.  Just food for thought since it's obviously not an easy issue to address.  Sheri

P.S.  My dentist mentioned that he has prescribed probably 2,000 night guards and only seen four cases of this, and the other three (besides mine) all wore night guards the covered their full set of teeth.

Sheri,

1-You are assuming that all teeth will erupt at same rate. that is not so, I do ortho and can tell you that they do not behave the same in the same person. 2- jaw rotaion and movement can only be stable if it is supported by teeth, anotherwords, jaw does not change position majically and go to another place with out hard tissue stop, that being teeth. Seems like your teeth are doing that.
With out proper diagnostic information we are really shooting blanks.

H.Nassery, DMD

Dear Dr,
I have been suffering daily now for 4 years with pain in my left ear but it seems it is coming from the angle of my lower jaw, I also have pain like a toothache but I can  feel these pains on my right side sometimes (but not as sharp). I have tried everything, 2 mouthgards within 2 years (from occlusion specialists), and the rest of medical professionals. My jaw does not hurt when I eat. Could it be ernest/eagle syndrome? I am about to travel to London to have prolotherapy. If that does not work, I am prepared to travel to USA to have radiofrequency as I am so desperate to have my life back. I also developped tinnitus. I am 53 french female and use to be joyfull before this horrible condition.

Dr. Nassery,
   I followed up with my dentist to have models made, etc., and in the ensuing two weeks before I met with him to discuss options, my bite returned to its pre-night guard position--just with not wearing the night guard anymore and even after over 1.5 years of an altered bite with only wearing it at night.  I do have a lot of wear on my back molars, so at some point we may correct that by crowning one or more teeth down the road.  Otherwise, I'm not going to worry about it since the night guard apparently created more problems for me (completely altered bite) than it solved (tooth grinding at night).  Sheri

Marl00

Sorry for the delay in response.. was out of town and got backed up with work. You ceretainly have a terrible situation and I wish I could just tell you what to do, however, not having any diagnostic info it is hard to jump into conclusions about some ones ailment.
One quick thing I would suggest that would give me more info is to print my latest blog, actually it is a sheet of questions about signs and symptoms .. I realize that you may not be able to answer all of it but try your best.. and if you need clarification just ask.. I will try and help you the best I can..

All the best.
H.Nassery, DMD
www.miamibeachdentistry.com

Shari,

Now back to you.. we have new information.. so if you actually were able to bite back into your  old bite it tells me that by wearing that appliance you had actually done some good.. what you successfully chewed back through was your articulating disc which you had actually recaptured by wearing that little night guard. that is actually the goal of any good TMD doctor to get that joint back to normal health..

All the best .

H.Nassery, DMD
www.miamibeachdentistry.com

Hi Dr. Nassery,

My name is Ricky and I am from the UK. I have been following this blog for some time. I would be very grateful if you could provide some advice re. my predicament. I have TMJ on the right (clicking, jaw opens to the right, tinnitus etc.)  The tinnitus has extended to the left as well.  I have been looking into treatments and have been confused by the options: (a) to get a splint before getting orthodontic treatment providing the orthotic resolves the issue or (b) get NMT to relax the muscles before getting an orthotic and orthodontic treatment.  Is there a material difference between these treatments?  I am from the UK and would greatly appreciate your advice.  I am looking for anyone that can help me resolve these issues.  I came across a "Patrick Grossman" in the UK who advertises as a TMJ specialist.  Are you familiar with this dentist?  I would be grateful for any advice you could provide.

Regards,
Ricky

Ricky , thank you for your question. I should have made some of these things you asked clear long ago..
Clicking and popping as we call them, are definite signs of TMD.. now as to make other issues clear, Neuromuscular dentistry should really be classified under a branch of appliance therapy.. the way you relax the muscles is with a properly made appliance in the correct anatomical and physiological position to provide the environment for the muscles to feel better and relax. Personally, I get that position through NM.. however, by no means do I want to suggest that is the only way.. There are many fine clinicians that get there by other methods and have been successful in doing so for a longtime.
So I guess to answer your question, you need an appliance to get you relaxed and as symptomatic first, only then you would do orthopedics.. it does not make sense the other way does it. Note that I said Orthopedics.. not orthodontics, plz read the blog by Dr. Ramin Mehregan on this same site about the differences, he has explained very nicely.
Also go ahead and print my last post which is a signs and symptoms sheet essentially, and post it for us, I am curious.
As for the name of the colleague, unfortunately I have not heard of him but that does not mean anything.. go interview him and ask him how he does what he does. Write back and tell us about your experience. This is exactly what this forum is all about. Your health.

H.Nassery, DMD
www.miamibeachdentistry.com

Dr. Nassery, I was wondering if you could help me.  My wife has been suffering with TMD for several months now.  After muscle relaxers, antibiotics for a sinus infection that did not exist, and most recently a night guard that is not working, she is very frustrated and in severe pain.  I was wondering if you knew a respected doctor for TMJ that takes a similar approach to you in diagnosing and treating TMD in the triad, NC area?  We have already contacted insurance and this is an excluded benefit, so everything is out of pocket.  She has the clicking in her jaw, pain that leads to migraines, etc. A CT scan showed the joint looks like it has a hook on it and according to this dentist, it looks like arthritis.   She is miserable and more than anything in this world, I do not want my wife to suffer and hurt.  When your wife hurts, you hurt.  Any help or suggestions would be greatly appreciated.  Thank You

Glenn
King NC

CG1967,

Where in NC, there are several great clinicians there.. give me a city.

Regards,
H.Nassery

Winston Salem, Greensboro, or High Point.  I sincerely appreciate it.  Thanks

Thank you for your reply Dr. Nassery.. since your post I have read comments posted by Dr. Ramin Mehregan re. Orthopedics vs orthodontics and came across the "Occlusion Connections" website.  This seems like the best approach to diagnose my natural jaw position before adopting orthopedics to permanently correct the issue I am having.

Do you know any practicing professional who is aligned to Occlusion connections, nmt and orthopedics in the UK?  

Many thanks.
Ricky

Dear Dr. Nassery,

I've contacted you before in June last year. In short - I had a jaw dislocation on my left side when chewing food (the articular disc was most likely pulled posteriorly to the condyle). After only a minute or two, when I pushed/clenched my jaw back to it's position (with some force), the tinnitus has developed.

I went to have a MRI (here are the images: http://tinyurl.com/3bv6qcd) and a bite splint (also on the images) was developed for me in a University Clinic (however, this is the only type of splint they know how to produce and they have no experience with treating TMJDs with splints - only with surgeries).

Thankfully, I was directed to a very good PT, who immediately noticed, that I have a forward head position and that my swallowing is not normal. He also worked on my jaw muscles/joints and as a result I have a much better mobility, but unfortunately it had no effect on my tinnitus. After several months of visiting the PT and doing exercises, my posture is now corrected and the swallowing is better.

I also had a polysomnogram sleep study, which revealed, that I have a sleep apnea (because of my deep bite and posteriorly placed jaw), when I sleep on my back.

Since there are no NM dentists available here where I live, I will most probably need to seek help overseas. I spoke to a very helpful and knowledgeable dentist in L.A. and he has recommended a Oral Sleep Appliance and a device which should re-program and strengthen the facial muscles and the soft palate. He believes that the main cause of my problems are the muscles which control the Eustachian tube (I also feel a slight pressure in my left ear).

I did a lot of reading about TMJD related tinnitus and most of the time forward repositioning splints are used to try to treat the problem. However, this doctor thinks that I don't need a FRS and he also thinks that computerized jaw tracking, joint sonography etc.diagnostics are not necessary in my case.

I would very kindly like to ask you for your opinion, because traveling overseas and being treated will be quite a financial burden for me, so I want to think it over where and how to address my problem.

Thank you and best regards,
Henrik

Henrik28,

Sorry about the delay , computer troubles..I hope that I am not too late.. Based on what you have told me and what I am reading , I have a very difficult time seeing how we can come up with the right diagnosis just based on these few words.. thats what troubles me about this doctor in L.A.  
Lets go back to what we know... You have a deep bite, and posteriorized lower jaw, and if I understood correctly, the MRI showed that you have a postrioly dispositioned disc, This is what has to be adressed first everything else is a bandaid and designed to mask your symptoms.

I hope I have made my self clear on this subject.
All the best.

H.Nassery, DMD
www.miamibeachdentistry.com

Hello Dr Nassery, I have developed TMD symptoms mainly on my right side. I was fitted with a temporary crown on a back bottom left molar by my dentist. When I arrived home I ate some yoghurt and the crown came off. Off I went to the dentist who placed it back on. Two days later it came off again. The tooth was very painful without it and as it was evening I went to an emergency dentist who placed it back on after numbing the tooth. I became paranoid of the crown coming off again, so only ate soft foods on my right side, but was not chewing the food properly and believe this was how I developed the jaw problem. The day my crown was fitted, my dentist didn't numb me and by the time I arrived home the tooth was very painful and I thought the nerve was going. I took some medication and went to bed, but was woken by an earthquake 5.3 magnitude. I live in Christchurch, New Zealand where we have been having major earthquakes since September 2010. About an hour later we experienced another earthquake 6.3 magnitude. I have also had other dental work done. I don't know what treatment I should do for my jaw apart from eating soft foods and massaging it. My doctor wanted to give me muscle relaxants, but I think I'll just try other methods. I am due to have a hip replacement next week, so I am hoping once I am over the hurdle of this and on the mend, the jaw problem might resolve itself. I having taken up meditation as I think this will help my anxiety. Do you think this is the best approach?

Kind regards
Louise

Louise,

sorry to hear about your recent difficulties. I have to say that it sounds familiar. Many times after a long dental appointment symptomology such as you mentioned will come about. This does not mean that the work was the primary cause, actually some issues have always been there but you just did not have any symptoms from them. Nonetheless, in such cases with a little care things usually go back to where they were.
Stay on soft diet, avert from opening your mouth really big, and continue taking an anti-inflammatory like Ibuprofen. Things should get better.
I wish you and all the rest of the people there all the best.

H.Nassery, DMD.

Hello Dr. I am 47 and 2months ago had a impacted wisdom tooth removed.I have never been in so much pain in my entire life.First he treated me for dry socket,that was the end of week one.Still no relief.Then week 3 he went back in and debrided the area.I think I am spelling that right.Still terrible jaw pain.I cannot eat any solid foods and can barely open my jaw wide enough for an icecream sandwhich.He put me on muscle relaxers and told me to put moist heat.Its been a week since I have seen him.I go back tommorrow and the horrible jaw pain is still there and has moved into my ear.What should I ask him on tomorrows visit?Please give me some advice this pain is driving me crazy.I wish I would have never pulled that wisdom tooth out,because before that my jaws never bothered me.

Kitty,

It sounds to me like there maybe several different things at work here. We need to rule out things one by one,
First off, infection. or Dry socket.. did you get any Antibiotic? what and for how long, Iodine dressing?
Did you have lots of injections during the procedure, this may cause lots of tears in the muscle tissue and cause lack of opening and mobility and pain if stretched. Moist heat is good for this..
Finally, direct pain in the joint?? is there any? clicking and popping?

Hope these help.
H.Nassery, DMD
www.miamibeachdentistry.com

My son had terrible alignment and he had "popping and clicking" all the time.  I know it sounds mean..but I couldn't sit near him when he would eat!  His jaw used to lock up on him and it was just awful...usually he could unlock it on his own after a few minutes.  One day it was locked when he woke up..and it was still locked when he went to school, we didn't think alot of it and figured it would unlock on the bus or something.  He called me around 9:00..talking through his clenched teeth.  (I'd already made an appointment with an orthodontist  for braces)  I called the orthodontist who told me to take him to the oral surgeon next door.  I did this and they had to pry his mouth open..it was painful.  He used some flat metal tool and would open it a little and shift his jaw, and then repeat..a few times.  That left him very sore.  He got some muscle relaxers, some pain killers and a stint to sleep in..as he was doing most of the clenching in his sleep..but can you imagine!  Anyway, it was real..and really bad and I just want to say that braces were the answer in his case.  He stopped having the popping, clicking, clenching and all that after having braces for about four months..Thank God!!

I also want to add that the orthodontist initially thought my son would have to have surgery on his jaw to correct his bite as well.  He's had braces a little over a year and the orthodontist says he is right on track and doing great and there will be no surgery needed.  I'm so greatful.

Dr. Nassery,
Could you give me the name of a good TMD specialist in my area? I live in Leesburg, Virginia.
I'm really relating to the stories here....I had braces and headgear as a kid; bad overbite; 2 teeth removed. Then all 4 wisdom teeth. Started with unexplainable constant headache when I was 22. Pain has gradually spread throughout my body. I've worn night guards off and on for years. Have had occasional good periods, but experiencing major problems the last few years - I'm 42 now - lots of popping and jaw pain (which the mouth guards never seem to fix!). Also bad neck and back pain - you name it - it is everywhere! Sometimes I wonder if I should have never had braces or used any mouthpieces.

Hey Alisa,

That is easy, not sure how far you are from Mclean, Va but  there is a Doctor that I aspire to be more like..
Dr. Stephen Burch
8270 Greensboro Dr., Suite 101
McLean, VA 22102
(O)  703-827-9250
Also take a look at this really cool video by another one of our colleagues, it really breaks things down so you understand even more,
http://www.youtube.com/embed/oAdKVu6vS20

Regards,

H.Nassery, DMD
www.miamibeachdentistry.com

hi dr,
Im from New Zealand. Im a 20 year old student who has been suffering from tinnitus for the last 4 weeks. I would really appreciate if you could answer a few of my questions. After several visits to various doctors I have finally been diagnosed with TMJ. The dentist took a few an Xray of my jaw and it showed the gap between my bones on each side to be too small. There is still tissue between the bones but its a very thin line. A lot less than it should be.
My tinnitus started a few weeks ago when i was playing around with my mum and sister. I grabbed my mum by the shoulders and was pretending to squeeze her really tightly. While i was doing this I was clenching extremely tightly. Which triggered a really severe pain in the back of my head/top of my neck. Which lasted for about 4-5 minutes. Within an hour the tinnitus started. It initially started in my right ear. But within a few days it started to alternate between ears. I never get the ringing in both ears at once. Its either 1 or the other and sometimes the noise seems to be coming from my head. Within a few days i started getting really bad headaches which were sinus like headaches and migraine headaches. they always kept moving around though. never in 1 place for a sustained period of time. I also heard clicking from my jaw and would get occasional jaw pressure and tingling in my fingers. The thing is Ive had Jaw clicking for many years and never took notice of it till now. It may have gotten worse I'm not a 100% sure. The other day i went to the physio and he said there is tenderness in the upper neck and it feels as if there's a muscle spasm there. He also took an xray of my spine and there is no curve in my neck. Also when i swallow i always hear a crackling sound from my ears and occasional even feel a tickle in my ears from swallowing. Ive had my ears checked and there is no hearing loss. The Xrays showed that my muscles in the face are quite large around the jaw area which means that i clench alot.
My questions are.
1. Do you think from what you've read, my TMJ and tinnitus are related ?
2. ive been wearing a splint now for just over a week. How long do you think it will take for the tinnitus to go away ?
3. have you ever heard of cases where tinnitus starts in 1 ear then keeps alternating even in TMJ ?

Thankyou for taking the time to read this.

I also forgot to mention that i have started to get chiropractic treatment done. there is subluxation of the cervical spine. Everytime he adjusts them, my tinnitus changes to a very faint low pitched murmur for about 50 minutes. do you think this means that the chiropractic treatment is working? or should it be going away completely for 50 minutes if the treatment was working? thanks again !!

regards
Tushar

Dear Tushar,

Many of what you have experienced is in line with TMD, I highly suggest you watch this little video  

http://www.youtube.com/embed/oAdKVu6vS20

I do believe it will answer many of your questions, I was going to suggest to see a chiro, but you beat me to it, basically you have a structural/functional issue. As for the splint it all depends on the type of splint and and  how the position was found.. Watch the Video.. As  for the Tinnitus, it is one of the most difficult symptoms to get rid of but it is possible. You already know more than most with the connection of the jaw and your cervical spine, the nerve impingement is one part of the problem and muscle spasm is another..   Good Luck.

H.Nassery, DMD
www.miamibeachdentistry.com

Dear Dr Nassery

Many thanks for this page and all the information.
I would appreciate some advice.
The history of my TMD is as follows: premolar extraction age 9 ; I had a 3mm (count -em)so-called overbite. What they actually did to my growing jaws was to prevent the maxilla from growing forward with braces and guide my lower jaw backwards while it was still trying to grow. Not very nice for my joints or indeed the balance of my facial growth. Not surprisingly, i had blinding migranes, but no one made any connection between these and my wired-up face. The headaches left, but i had increasing neck and shoulder pain. From my original x-rays you can see how my cervical spine rearranged itself (i think my body was trying to take the pressure off my jaw joints). Well, i just put up with all of this (being a child , i thought it was 'just me') until increasing disability lead an osteopath to manipulate my atlas with horrible consequences.
I am now 35 and about 7 years ago I connected all of this pain with my teeth and jaws and have been trying various forms of help since then.
I have non-reducing disc displacement on both sides. On the left, i seem to have little problem, but the right joint is very crunchy and grindy and clicks and blocks over what i presume is ligaments (as the disc on that side is way out in front of the joint and screwed up) I spent 3 years and a lot of money with an experienced TMJ dentist who tried splint therapy to reduce pain and recapture the disc. When it didn't work, he said I needed bi-lateral jaw surgery to stitch the discs back in pace to stabilise the joint. I decided I didn't want surgery so gave up on treatment.
I have recently found another occlusion specialist who suggests centric relation splint therapy and says his experience is that he can stabilise the joint and having no discs doesn't matter.
The questions: in your experience can patients function well on no discs and do the ligaments behave or do they 'snag'?
Will this type of splint (presuming it gets me out of pain) then allow an orthodontist to reconstruct my bite without undoing all the work of the splint?( I would like to widen my arches and reverse the premolar extraction; hopefully for functional and cosmetic reasons.) Finally, do you know of any non- surgical way of bringning the maxilla forward in adults ?My flattened mid-face is not very pretty :(
Many many thanks

Hello Erdi,

I am sorry to hear about your story. This is a very common problem and one that wrote about in my other blog as dentistry's  dark secret. No one wants to really speak about this as it will open doors that can't be closed.

Now to your situation, I will try and answer one by one,
1- do we need the disk or meniscus.. well in a perfect world we would, but it is not the source of problem and pain, though we reduce the disc in most cases, it is not  really in good working shape, or in cases that it is torn completely it will not get back into position. So the answer is; you can be perfectly comfortable without it. What you need is to take the load off of your joint.
2- Jaw surgery to stitch back the disc?? not sure if that would even be possible!! but lets give it the benefit of the doubt.. if you tore up your perfectly healthy disc in the current position of your jaw, do you really think that another man can out do the work of nature and make you a better disc that won't tear?? All I am saying is that  the position of the jaw must be corrected first, and the LOAD must be taken off the joint. Then if you are asymptomatic why do any surgery?? the stabilization of the joint come from its terminal position on TEETH, not the disc.
3- I don't really believe in Centric Relation, as in my 20 years of practice I have come across 9 different explanations of it. In a study performed in 2007, in 7 different dental schools, interviewing 150 students and professors, there were not one solid consensus as to what it is.
4- the last part, it is not easy to open the old spaces back up, though I have done it in Maxilla, it is nearly impossible in the Mandible( lower Jaw) , and unfortunately there is no other way to bring the maxilla forward, if you need anything close to what I am guessing you need..10mm or more??  am I guessing right?  

All the best.
H.Nassery, DMD
www.miamibeachdentistry.com

Dear Dr Nassery

thank you so much for your reponse. I hadn't seen your other blog. Will try to find it!
Your comments re surgery have confirmed my suspicions
Do you have any advice as to what IS the best treatment protocol for getting my joint/ occlusion stabilised? I really have been through a number of specialists now here in london (UK) Is there anyone here you recommend?

Many thanks again

Look up Dr. David Cook  in London. He has taken many of courses as many of my colleagues have.. All the best.
H Nassery, DMD

hi Dr. Nassery,

First, I would like to thank you for your dedication and advises regarding TMD.  I'm a 36 yr old Asian female.  A year ago I have this pain in my lower right teeth or jaw.. can't exactly tell which because the pain is like moving from teeth to jaw and back and forth.  I consulted an orthodontist and told me that this might be TMJ/TMD.  He also said that I have an open bite.  My front teeth are not aligned and my lower front teeth are protruding a few millimeters.  He did some cleaning and the pain was gone.. so I thought that was it.  But I have been thinking of getting braces because of the open bite but thank God I still haven't done it.

Now I have pain in my temple going down to the back of my neck.  Back to another dentist, and this time she told me about getting braces.  She also said that the pain might be TMJ.  Now I get confused.  Got a second opinion and was told that a splinter must be used first and if it's corrected then there's no need for braces.  But I have read that some teeth appliances causes open bites?  and my friend, who also has TMJ, first got a splinter, then braces, but she had them now for 5 years.  

What I really wanted to know is should I go straight to braces to correct my open bite and that it should correct my TMD? or splinter/guards first?  I'm weighing my option since braces here are too expensive and that braces for TMJ are more expensive (as what my dentist told me) and splinters are also expensive.

I don't know but I feel like the orthodontist I'm seeing just giving me the highest price they can offer :( I hope I made sense.

Thank you

Oh I forgot, I also grind my teeth at night :) and I feel like sometimes without actually knowing that I'm doing it, but i do push my lower front teeth with my tongue.

Hey Kitty,

First of all I am glad to help in anyway I can. Your symptoms are in line with TMD, and if you have an open bite then it all makes sense. The way  I would approach your case would be the same as I do with most cases. I would first make you a REMOVABLE ANATOMIC SPLINT, I highlight this because not all splints are the same.. many offices just take your models and your bite in the same position that you normally close and send it to the lab and make you a splint or a night guard, This is a very arbitrary device, and would not do anything for you, the splint that we make, is in a very specific position. One that was found by getting your musculature relaxed. This till your symptoms have disappeared.
I would then and only then , would start with the braces. Open anterior bite is one of most difficult cases to treat, and the last thing you want is to put the teeth in another position that does not harmonize with your muscles.
You understand that the reason for your teeth being in all these wrong positions is that disharmony.( the war between your teeth and muscles)

Hope this helps.

H.Nassery, DMD
www.miamibeachdentistry.com

Salam and hello Dr.Nassery.I would first like to say thank you for the help you provide to people suffering from TMJD,I myself have been suffering from this condition for the past few months and I never knew such a problem existed.I now know all too well how real it is.I will make my story brief yet detailed.It all started back in may 2011 when I had a broken molar pulled,the tooth had a root canal in 2005 and I was suppose to have a crown put on it but never did.The molar eventually broke but I was not pained by it so I did not fix it and over the years it kept breaking more.One day after eating some hard pretzels the tooth hurt very badly,I went to the dentist clinic in a major hospital and had it removed with no issues.About 2 months later I started having tenderness and soreness in the cheek and gum area on the side the tooth was pulled.I returned to the clinic and was told the area was healed but they gave me a script for antibiotics.I took the course of antibiotics but it did not help and the tenderness and soreness was still present but it would lessen for a few days but return,especially after I slept.After seeing a few dentists in the clinic they all told me the same thing,"you need your wisdom teeth on that side taken out".I felt this was not the problem as my wisdom teeth were fully erupted and being 27 years old and not have had an issue with them prior,this was wrong advice from the dentists.Fast forward to late August 2011 and I noticed my bite was off and the right side of my face was in spasm but not very bad.I did some quick searching on the web and read about TMJD and realized this was my problem.I went the next day to the dental clinic only to be told that even though I was correct in self-diagnosis of TMJD,they could do nothing for me as they do not treat it.I was referred to the Oral Surgery clinic across the hall where an oral; surgeon told me yes you do have TMJD,we can help you by pulling out your wisdom teeth on your right side.I said alright and booked an appointment to remove them.This was my mistake as I now know I had a lock in my right side.The oral surgeon turned out to be completely inept at pulling teeth as he was of giving advice.The removal was bad,it took him over 35 minutes to remove my bottom wisdom tooth.On the follow up I told him I was having bad ear and jaw pain and he simply told me " go google a TMJ specialist and get a split made".I made an appointment with a TMJ doctor .He took a tomagraph of my joints and explained to me I have a locked disc on my right side.He suggested that I could have it manually manipulated back into place which I was very hesitant about.He gave me a second option,that I could do these exercises that could get my disc unlocked and back in place.I did the exercises for 2 weeks multiple times a day and they seemed to work as when I returned I was able to open my mouth 47mm when measured.I was very happy and the Dr. gave me a instructions to do sets of resistance exercises to help train my muscles to keep my disc in place.I felt ok for a short time but about 2 weeks later I noticed clicking on my left side this time.I had noticed clicking on my left side before but that side never really hurt,it was the right side that hurt me.I returned back and was told that I most likely have a clenching problem which I feel I do.I agreed to an NTI device that also functions as a retainer since the Dr.explained to me that having missing teeth means my teeth will shift.I agreed.The device however seemed uncomfortable and made me droll so I did not wear if often.A few weeks ago the clicking in my left side returned and I started to do the unlocking exercises that the Dr has recommended prior to help me unlock.This would work for the day to stop the clicking but when I awoke the next morning the clicking would be back.A week ago the left side started hurting,almost like a dull burning feeling around the joint so I returned to Drs officeand explained my problem along with telling them the NTI device felt uncomfortable.He had his assistant shave it down but he never checked it himself.The front of the split,the area that keeps the teeth from touching contacts multiple teeth,not just my front.I tried it for a bit but woke up having pain in both sides of my face.This device was made only using a cast of my teeth,there was never anything else done to ensure that it helps my teeth and jaw meet in a position that relaxes my muscles.What should I do Dr.Nassery?The device cost me almost $600.I have pictures of me wearing it prior to them altering it and after they altered it and you can see the alteration changed it a lot in the front as it now meets multiple teeth.Please Dr,I would really appreciate some advice as I feel I am getting worse and am very depressed over it.Thank you for your time and thank you again for helping us out.

Dear Heyoh84,

I am sorry to hear about your troubles.. it sounds like a classic case of miss diagnosis.. You probably always had some minor issues, which got acute when you lost the tooth and did not replace, you started to over close and removal of the wisdom teeth made it  worse.. and it just spiral downed from there, Although exercise is ok, and NTI is a good palliative treatment neither are definitive, you need support for your joint as it is getting too loaded  with the force of your muscles trying to bring your teeth together, and your muscles are getting spasmodic as they are working too hard to do the same..
Unfortunately there are too many individuals out there who say they treat TMD but they really don't.. If you wish you can contact me off the forum and i'll try to find some one qualified in your area.

All the best.
H.Nassery, DMD
www.miamibeachdentistry.com

Dr. Nassery,
    I have written to you several times.  I have been going to a neuromuscular dentist since October of 2009.  I have had my jaw locked and been in pain since November of 2008.  The NM dentist was able to help a lot, but I still have a lot of pain, so I have to take many meds.  The dentist has now told me that he has done about all he can to help me.  You also have helped me.  I did go to a physical therapist and I did have a pinched nerve in my neck (like you said) that I do exercises for now.  That is helping the neck and back pain.  But, I have had four different dentists tell me that I have the worst case of TMJD they have ever seen.  Even the one at the Mayo Clinic.  They also found out I have arthritis of the jaw, which is why my NM dentist told me that he has done all he can.  But the good thing is that it allows my insurance to pay for the treatment now!  Now, my NM dentist called  me and told me he went to a seminar and he learned about a connection between sleep apnea and the severity of TMJD.  He wants me to have a sleep test done to see if I have it.  I am going to have that done in January.  I know you have mentioned sleep apnea connected with TMJD, but have you heard of it affecting the severity?  If I do have it, is there maybe more they can do to help?  I am so tired of being in pain, and I am depressed to think that I will have to live with the pain for the rest of my life.  I also do not want to be on all these medicines forever.  They make me so tired, but without them, the pain is too much.  With the meds, the pain is tolerable most of the time, but it is always there.  The Mayo clinic has sent me to a pain clinic, which just added more medicine and not much relief, just the realization that the pain will be with me forever and that scares me.  Do you have any more ideas to help me?  
Thank you for all the help
Melanie

Hello Melanie,

Sorry for the delay in answering you, was out of town for the season. There are several things here that I need to answer,
First , yes there is a 75% cross over in TMD and OSA patients..it makes complete sense, as our jaws are too far back and closed taking our tongue right into our airway..Is it the source of the pain, not sure.. Arthritic joints are pretty common in long standing patients, severity is the important..What you have to realize is that even between NM doctors the styles can be very different and training levels are important.. like everything else.. IF your doctor feels he has done all he can then my suggestion is try elsewhere, my personal recommendation would be Dr. Clayton Chan, in Las Vegas.. He is my mentor and you could say guru. If some one could help you it would be him ... that is my honest opinion,
A properly designed and adjusted removable orthosis should have taken you out of pain by a great deal, if that has not happened then we are on the wrong road.
God Bless, happy holidays.
H.Nassery, DMD
www.miamibeachdentistry.com

Hello,
I am a white male age 60 and have had TMJ symptoms occastionally for 25 years or so. My TMJ came on in conjunction with seasonal changes in allergens. One time my daughter and I went to the same Dr. with the same symptoms (TMJ on one side) at the same time, and the Dr. (Spring Hill, FL.) had no idea what it was or how to treat it. The symptoms subsided on their own. It seems like the TMJ is a reaction to an allergen entering through my ear canal and triggering a reaction in the TM joint on that side. I can shorten the duration of the symptoms by clenching my jaw on the affected side  in increasing amounts over a 10 minute period until the pain becomes mild when I clench. It may stimulate blood flow and fluid exchange in that joint and promote healing. All I know is that it works well, especially if I catch it early in the episode. I have also chewed bubble gum, gently then fully, on the affected side.
I had a dentist friend tell me that there is a lot of uncertainty regarding the cause(s) of TMJ.
Just sharing my experiences.
Blessings,
R. K. P., Pastor

Dear rkp,

Thanks for sharing your experience, I am glad that you have found a way to cope with the issue. I have to say that most men cope with these issues better than female patients do, I wonder if the trick works for your daughter.
As per your dentist friend comment, yes there is a lot of uncertainty, mostly in the minds of those who have not studied the treatment. It also seems to be the stance of the main stream dentistry, as there are forces out there trying to make this into a new specialty for dental schools... lots of unfortunate turf war and politics which has nothing to do with patient's best interest. there is no mysteries with this joint, if you want to learn about the origins of this issue read my other post about the origins.

Regards.
H.Nassery, DMD
www.miamibeachdentistry.com

Hi Dr. Nassery,

Here is a question that I have been trying to figure out for the past 9 months.  I was having TMD pain..told I had anterior displacement with reduction on the left TMJ and anterior displacement without reduction on the right TMJ.  Put into an anterior repositioning splint.  Tinnitus almost vanished and ear pain and fullness went away.  Three days into it, my face goes into total spasm.  So much so that I was on all kinds of pain killers, etc.  I stopped the therapy in a week.  Had an MRI done which showed different diagnosis...left TMJ anterior displacement without reduction and right TMJ completely normal!  After that week of splint therapy, my left TMJ never has popped again, so I think the splint made it much worse.  I brux so a flat plane splint did not help me but made it worse.  I still have very bad ear pain and tinnitus.  I'm just not sure where to go from here because of the money I have already spent and so many different schools of thought.  I never had facial spasm before the splint.  Not for sure where to go from here.  I live in Kansas.

Good Morning Dale,

We don't believe in flat splints exactly because it does what it did to you, gets the muscles to clench more, and therefore muscle spasm.
To start, you really can not anteriorly re-position  a jaw with a flat splint, as there is no indexing for the teeth, and it is more likely that your jaw will slide further back, as I think was the case for you and making things worse. We fabricate our orthosis based on a optimized Nueromuscular trajectory, a process that has been refined painstakingly by Dr. Clayton Chan. This is gained by first relaxing your muscles for hours, the orthosis is a fully anatomical one, by that I mean it has perfect and detailed occlusion that engage your upper arch in a specified position and then we further refine that bite to micro-occlusion.

Look up "Occlusion Connections" on the web and see if you can find some one close to you. All the best.
Hamid Nassery, DMD
www.miamibeachdentistry.com

Hi Dr. Nassery,
My story is long but will condense it as much as can.  I started having really messed up symptoms one week after I had a chin implant, I was nicknamed "no chin" and just thought it was normal to have no chin but it affected me so I had surgey.  Anyways, one week after surgery my symptoms was an initial dizzy spell as if I were to  faint followed by tingling sensations down both arms.  That same night my right thumb got numb.  That off balanced wierd hazzy lightheaded feeling stayed and hasnt gone away along with popping of both  ears when I swallow, sometimes ringing in the ears, neck and shoulder issues.  I went to every doctor and couldnt find anything.  I went to a chiro which found I have a straight cervical spine and right hip is lower. The chiro was back in oct and stopped going cause I got scared of all the manuel cracking to my neck.  Im currently under treatment here in Miami using a splint and night guard.  Been on the splint since december and the off balanced feeling is still lingering along with the rest.  My tx plan is for 8 months.  I also was told I need prolotherapy.  Does it help?  I was told that I already had tmj but my symptoms came out after surgery.  As a teen I had braces and one premolar was removed on my upper  right side.  Should I be feeling some relief by now?  Im starting to learn about NM therapy on a tmj group on facebook and Im afraid I might be wasting my time on my current.  Thanks Emy

Emy,

I am sorry about your hardship.. your story is way too familiar. I would say that on average my patients feel some relieve  with in the first two weeks. If your splints are not anatomic and don't provide you with a very specific position to close, you will not see any relief.  There are several good clinicians in and around Miami, if you need help with referrals tell me the area  you are close to and I try to match you with some one good.

Regards.
H.Nassery, DMD
www.miamibeachdentistry.com

Hi Dr Nassery,

I have been having facial pains for the last 6 weeks or so, but only on the lower left side.  The first pain I had was when I brushed my teeth, it was an excruciating electrical shock type pain which lasted around a minute or so. Then nothing for a week or so, then the same pain again.. At this time I noticed a constant dull ache from the ear down towards the upper jaw, but I could live with that. Then the pains started , especially when eating and talking. often electrical shock type pains interspersed with muscle spasms. My gums felt as if I had a bad tooth especially as cold and heat effected them, but I had recently had a dental check up, so was unlikely. When areas around nose and upper lip are touched slightly, the shock type pains were there, only for a few seconds. The pains were getting more frequent so I went to my GP who diagnosed trigeminal neuralgia, prescribing Carbamazapine. Most of the pains subsided over the next few days, except for the dull ache from ear to jaw.After 3 weeks I decided to stop the medication as, although the pains were almost gone (except for gums) my mouth was becoming very, very sore, which can be a side effect of the drug. After a few days the pains started to return, I was becoming anxious again, and then my husband mentioned that I had always had a jaw which often clicked when eating. I had not made the connection before, and now it makes sense. I also have mild tinnitus which I also put down to side effects of Carbamazapine. I tried the self test, by touching the jaw joint while opening the mouth and there is definitely a lot of movement and noise there. The right jaw has the same problem but nowhere near as bad. Anyway, after that test, which obviously aggravated the joint, the facial pains came right back with a vengeance, and now affecting the lower jaw, teeth and neck, so I have had to recommence the carbamazapine. I am sure that it is because the joint is inflamed that it is irritating the trigeminal nerve. I would appreciate your thoughts.

Josi, Many of the signs and symptoms of what you are describing does fall with in the category of TMD issues.. having aid that it is not prudent to just make a diagnosis based on some subjective descriptions. I suggest that you pursue the medical rout and make sure there are no major medical issues( ie. malignancies and tumors or vascular pressure on nerve trunk) present. In the absence of any major medical problems, you should then see a TMD dentist to further diagnose your problem.
It is more than  likely the issue you think it is, however, we should be thorough in the matters of health.

Regards.
H.Nassery, DMD
www.miamibeachdentistry.com

Thank you for your quick reply and comments. I will continue the consultations with my GP and also mention the jaw problem at my next visit. Maybe he will suggest an Xray or MRI to ascertain the reasons behind the nerve pains.

hello Dr Nassery.  

So i am not really to sure if my problem is a TMD problem or a face problem or what.  For the past 7-8 years feel as though my face has been becoming more and more asymmetrical.  I feel as though the left side of my face is becoming more and more skewed and is of its axis.  When I talk my whole jaw and mouth feels funny.  I have major clicking and popping in both my jaws and ears.  My mouth does not feel in a natural position at all when i chew or speak.  I get alot of pains radiating from the left side of my ear to my cheek, where it gets to the point that that whole side of my eels asymmetrical and I dont even want to be around anyone.  I know for sure I dont grind my teeth at night, because my mouth is always open as i always breathe through my mouth.   I get this spasms and ripples come on my left side of my face some times, and then  its like my muscles feel tired if i talk too much or if i smile, it feels that is my jaw bone or my muscles are not correct on the left side of ym face.  I hate even speaking to anyone anymore

I just dont really know who to see about tI have just been living with it thinking if I exercise  and run my face will be fine.  
I have made an appointment to see dr Patrick grossman in 2 weeks, i dont know if you have hearof him, he is a TMD specialist in London.

Mitz,

If you have checked yourself medically and medical issues have been ruled out, then I would say that most symptoms are in line with TMD. I would recommend seeing Dr. Cook, I am not sure how active he is in practice but he has taken many of the same training as I have.
David Cook
London Holistic Dental Centre
39 Harley Street
London W1G 8QH
020 7323 1363
www.londonholisticdental.com

Regards.
H.Nassery, DMD
www.miamibeachdentistry.com

Thanks for the reply.

I am preety sure i dont have any medical issues
I am planning to make an appointment with dr David cook as well, after I see Patrick grossman.

I want to see what an orthodontist says and then what NWD says.  After that I will decide what route to take.  Only thing Is I have been reading on a few health forums that NMD is really expensive compared to orthodontist treatment, and that if I need orthodontist treatment after the NMD that it can get even more expensive.

Mitz,

You are correct , NMD can be expensive. However, if traditional treatment was correct then we would not be here on this forum discussing this .. Practitioners like Dr. Cook and myself , spend many hours and days over period of years to learn how to treat patients such as yourself, it does not come cheap, neither financially nor time wise.

All I can tell you, is thanks god that most of us are adaptable and have the ability to cope with our malocclusion. Choose wisely.
All the best.

H.Nassery, DMD
www.miamibeachdentistry.com

Thanks for replying back Dr Nassery.  I have an appointment with dr patrick gorssman on the 27th ofApril, so will keep you updated on what he says.

Hello - I recently found your blog and an hoping you can help me. I am a 32 year old female who has closed lock since mid jan- 32mm. Local dentists told me not to worry since it was not causing any pain. Well... 3 weeks ago I discovered horrible tmj pain on my left side. I finally found a TMJ specialist  in Nashville. He was able to do an emergency consult and tell me that I likely have a non reducing disc on my left side. He suggested that he could attempt to unlock me but given the amount of time that has passed, the success rate is not high. The pain has now progressed to my right side. I have noticed my bottom front  are turning inwards and I am having trouble speaking. Very nervous... Scared... I have a full consultation w this dentist on Monday. Just wondering Iif this whole attempt at manually unlocking me is a good idea. Or if I should request to go directly to splint therapy... Many thanks

Gretel,

It is possible to open this type of lock, so don't panic. it can be done if the Doc. has experience in this.. need to relax the muscles and open little by little.
Let me know how it goes... I'll try and find you a name in Nashville..

All the best.
H.Nassery, DMD
www.miamibeachdentistry.com

Thank you for your quick reply! I actually live in Huntsville, Alabama (land of no doctors it seems). The dentist I went to go see in Nashville (a 2 hour drive) was Dr. H Clifton Simmons. I found him on the Internet because it seems he has done a lot of research, experience, and has publications on TMJ in established journals. I have just read horror stories online that the procedure will make it worse, and am really starting to panic.

After I had the closed lock initially, I honestly didn't notice because I had no pain, and could continue on with daily life as normal (with the exception of eating large sandwiches and apples). Then, 3 weeks ago the pain started and I felt a lot of pressure on my bottom teeth. I also feel like my teeth are moving and are getting in the way so I can't speak properly! Almost like I am developing a lisp. There are also the muscle spasms, ear pain, headaches, and everything else that goes along with TMJ. I've switched to a mostly soft food/liquid diet, using a heating pad & IB profen, and am taking muscle relaxers when I absolutely HAVE to (like 1-2x a week).

This all came on somewhat suddenly - I had popping forever, then after the birth of my 2nd daughter last summer it got worse - popping all the time instead of occasionally. I ignored it because as any working mother knows "you never have time to take care of yourself". The stress has been crazy with 2 kids and a job, so I know I've been clenching at night. I've now cut out the coffee and started a yoga class. This closed lock thing has been a huge and very scary wake up call for me...

Thank you for any advice or recommendations you can provide.

Gretel,

Obviously if you always had clicking and popping, then it means you had this problem coming all along. Unfortunately as we get older our ability to conform and adapt to these issues is also reduced.
What you are suffering from right now is an extremely spasmodic muscle. If it were in my office you would be getting on a Tens unit and get relaxed in all your muscles for couple of hours and we would open the posterior space with cotton rolls gradually and get your jaw open.
You need to have your jaw put in the right place, and I don't mean surgically, but rather with an occlusally  optimized oral appliance which has been fabricated on the correct optimized trajectory. I know, too many words that have no meaning to you right now, but you should study and learn carefully.
Check "occlusion Connections" on the web and read on.. your homework.

All the best.
H.Nassery, DMD

Dr. Nassery - Just wanted to follow up with you and let you know that the TMJ dentist was successful in recapturing my disc through manipulation yesterday. Hooray! My opening is now 50mm. However, the disc won't "stay" in position so I now "pop" back out of position. Wouldn't be a big deal, but am unable to unlock myself on my own. So - per dentist suggestion - I am now wearing a very large repositioning splint (10mm as opposed to 5mm) in order to keep the disc in place. The dentist's thought is that with prolotherapy injections every few weeks, and with the disc held in the proper position, over time there may be a chance that it will "stay" and I can keep my normal mouth opening (with treatment, or course).

The alternative is I accept a limited mouth opening, without a disc, and have a smaller splint.

I am going for the former - might as well try. Aside from looking somewhat ridiculous (can barely keep my lips together and people tell me I look like I have a dip in my mouth!), and my inability to speak clearly (hopefully that will improve with time), for the first time in a looong time I am pain free. So that is WONDERFUL.

Have you ever seen, in your experience, the use of injections and splints help a patient such as me? That is, a patient who was locked, but whose tendons are now "loose" and can't seem to keep the disc in place?

Thanks
Jessica

Hey Jessica,

Glad to hear you are doing better.
As for other things, I am not a big believer in Prolotheray..  Look its very simple, The reason your disc is out of position is that your teeth are not meeting in the correct vertical position. That means they should come to meet a bit sooner than where they meet now..Hope you are following, this means your teeth , most likely your back teeth are under erupted.
So you can wear as big an appliance as you want and do as much sugar injection in your joint as you want, you will not get that disc stable.
Ask yourself this if there was enough space for your disc , why would it be dislocated? and if we don't make a permanent  space for it, why would a partially torn disc now stay in place when the healthy one didn't?  

You need an anatomically designed orthotic that stays there permanently, something that you eat with sleep with and only remove to clean... thats how your disc will return to its space, heal and you will get rid of your click and pop... then your good clinician will help you get your teeth to the right position where it supports the joint and the muscles and your disc.
Hope this helps, I am sorry if I did not tell you what you want to hear but I am tiered of some of these side show therapies which turn into annuities and over time get patients to loose faith in the industry.

All the best.

H.Nassery, DMD
WWW.miamibeachdentistry.com

Dear Dr. Nassery,

I believe I have a Class III malocclusion in addition to TMJ, at least in part caused by premolar extraction when I was young. I was wondering if the neuromuscular treatment for TMJ would be able to address the Class III malocclusion as well?

Thanks!
SS

Dear SS,

Nueromuscular treatment is not based on skeletal  classification , but rather whether the muscles and the joint are in harmony with the position of the teeth. So the answer is yes, with proper diagnosis, if there is need for correction it can be done.
This is not to say that we can bring the jaw back if the re is true skeletal class three, but keep in mind the 85% of these cases are due maxillary hypoplasia, and some are just functional.  As always, proper diagnosis is the key.

Hope this helps.
H.Nassery, DMD
www.miamibeachdentistry.com

Dear Dr. Nassery,

Thanks a lot, that's really helpful! That certainly motivates me to consult a neuromuscular specialist. I'm based in the UK, so perhaps Dr. Cook.

Thanks,
SS

Hi Dr. Nassery,

If you get a chance, I would love your thoughts on my "story." Three years ago, facial pain under my cheek/eye (right side only) started a couple of months after wisdom teeth extraction. It's a dull, constant, "heavy" pain that gets better with sleep. It's also very cyclical -- some days are pain-free, others days hurt badly. Over time, the pain has spread to the tip of the nose and the teeth (still only right side).

A year and a half after the pain started, the jaw joint started popping and becoming misaligned. I've used two TMJ splints full time, neither of which provided significant pain relief. The most recent splint corrected my jaw but not the pain. It reduced the popping and made the opening/closing motion very fluid. I wore it for two months, and the pain was maybe slightly better but not significantly. This week, I've started to wear it at night only (pain has somewhat increased, but probably just part of the normal cycle).

Two weeks ago, I had two sets of trigger point injections in the temporal tendon, and one set in the masseter, lateral pterygoid, and temporalis muscles. The second set of injections eliminated pain for 24-36 hours, but it returned after that, along with more muscle tightness. Twice in the slew of doctors I've seen, I was diagnosed with temporal tendonitis as well.

** My question: Is two months long enough that I should have noticed significant or total pain relief (considering that the jaw motion itself was pretty much healed)? Should I continue to try for relief through trigger point injections, or what would you suggest I do?

I really appreciate your recommendation. It seems like you are a great blessing to many people on this blog.

Thanks,
James

James,

The type of pain described can certainly be part off the whole complex. It sounds like impingement of Cranial nerve 7, and its branches.
It is hard for me to make a statement about the treatment as not all orthotics are the same, also, I am not sure what yo had injected? was that botox? if so you have tainted a great big part of the whole process. While you get temporary relief, it basically shuts down the muscle.   So there are too many variation here to just guess.
However, I would tell you one thing, Healing is a process, not an event. I know that your pain and discomfort started three years ago, which in itself  is a long time, but that was just the last straw. The setting for the problem had been there all along, the extraction episode just pushed it to a head.
So be patient, the orthotics need to be refined in order to get all issues resolved. There are also other issues that should be helped through by other practitioners, such as PT, or chiros.. this is not a one sided approach.

Hope this helps.
Regards.
H.Nassery, DMD
www.miamibeachdentistry.ccom

Thank you very much for the response, Dr. Nassery. I appreciate the reassurance that this is a multi-sided issue and will take time. To answer your questions, the injections were just local anesthetic. There may have been one steroid injection a while back, I can't remember. The splint is on the lower teeth, made of some type of clear hard plastic (and refined with acrylic?). The position was determined from a number of tests including motion tracking and muscle activity readings.

When I massage the temporal tendon and masseter area, it usually provides some temporary relief. Moist heat also works. I'm assuming this means there is muscular pain in addition to the impinged nerve you mentioned?

A couple follow-up questions if you don't mind: How is an impinged nerve in this case treated (and is it impinged in the neck or face), and what type of doctor should I see? In your opinion, is it fine after 2 months full-time to now wear the splint at night only (as long as jaw motion remains fluid)?

Thank you so much for your help—

James

Hey James...

Ok , lets start with the good news, if you get relief when you massage your temple and masseter, then that is exactly where your impingement is, as the nerve travels through the muscle it is getting pinched, which means your muscles are hyperactive. In other words they are working too hard to bring your teeth together.
So based on that , you should know that you can not be wearing the appliance part time, anytime its out of your mouth you are tiring your muscles.. you need to stick with the program. You also have to recognize that the position indicated by your orthotic is where your teeth have to be at the end, so this is not a situation that you will get better and can take off the orthotic and go back to your own teeth.. if your dentist has not explained this to you, you need to have a conversation with him/her.

Regards.
HNassery, DMD

Dr Nassery, My greetings to you. I see a good thread of TMJ Patients here. I am writing here to get some good tips and opinion from you.

I had my dental visit in Oct 2011 as i had few sensitive teeth and wanted get them checked . My dentist took X-ray told i have 6 -7 cavities, i should get them treated. I was planning to conceive then, So thought getting them treated before i conceive, I scheduled 5 appointments. After i got 3 of them treated, i came to know i was pregnant and i postponed remaining 2 appointments for 2nd trimester, as suggested by my doctor. But after my third visit, i started getting jaw pain and it used to hurt a lot, even the nerves used to pain and my teeth were sensitive. I followed up with my dentist and he said, he need to take X-ray, i refused as i was carrying and did not want any exposure to radiations, he agreed. and just had normal check up of teeth and told that it looks that jaw must be sprained because of wide opening. This is in Jan 2012.
He asked to take painkillers and avoid biting hard things for few days. Unfortunately I had a miscarriage. But since then till date, I never had a single day without pain. I have either sensitive teeth, jaw pain, chick-bones pain. ear pain and headache sleepless nights in episodes. MY dentist told me i am grinding my teeth , so should try for mouth guard. He took impression; i should get my mouth guard soon. Recently i had terrible ear pain so i visited PCP. I told her all symptoms, She wrote note to my dentist saying i should have a X-ray to check for nerve exposure or any infection, if its negative she would like me take Sinus X-ray or TMJ  X-rays. My dentist refused to take X-ray this time, said I had one 6 months back and not needed now.

I would like to know, Do TMJ patients have sensitive teeth, ear pain, pain at the end of jaw.
Secondly, if I have TMJ does wearing mouth guard helps it or makes it worse?
HOW does TMJ trigger, in my case i started having it after my tooth treatment for Cavity, if i have it because of grinding as my dentist says, why did not I have this kind of pain before, I must have not started grinding recently. Its tough to diagnose the root cause, I am really loosing faith in doctors.
I would be grateful if you have answers to my question. I want to get my pain resolved, before I conceive this time.
Regards,
Raj

Dear Raj,

Sorry to hear about your discomfort;  See below;


"I would like to know, Do TMJ patients have sensitive teeth  (yes) , ear pain ( yes) , pain at the end of jaw ( Absolutely).
Secondly, if I have TMJ does wearing mouth guard helps it or makes it worse? ( it will not make it worse, but help is also not a guarantee)
HOW does TMJ trigger, in my case i started having it after my tooth treatment for Cavity, if i have it because of grinding as my dentist says, why did not I have this kind of pain before, I must have not started grinding recently. Its tough to diagnose the root cause, ( the simple truth is , if in reality it is  TMD, it could trigger from a number of different situations, including just a simple filling)
Read on the other posts and you will see many very similar stories, and symptoms. You will very likely find your answers among them..

Regards.
H.Nassery, DMD
www.miamibeachdentistry.com

Thank you for your reply Dr. Naseer,

  I am just hoping to get relief with night guard. I would like to know if night guard come as a pair for upper and lower jaw or just one of them is enough.

Any other precautions i should take , to avoid making it worse.
Is it problem of life time, or it does get cured with time or treatment.
Do you think a  dental Xray will help me to check if anything went wrong with my Cavity filling or nerves.
What is proper diagnosis for TMJ, Xray( what kind of X-ray) shows it up. Can you suggest me specialist in NJ area.

I feel , i should not have done my cavity fillings in short duration, it would have been good , if i had a good time gap in between each filling.

Thanks and Regards,
Raj

Hey Raj,

TMD can be a life long problem if not fixed for some people. But I feel we are jumping a few steps. First you must have the right diagnosis. In NJ I would recommend the following Drs.

Nahel S. Yani, D.D.S.
385 Cranbury Road
East Brunswick, NJ 8816
Country: USA
Phone: (732) 254-0033

Richard Nadler, D.M.D.
425 Amwell Road, Suite 104
Hillsborough, NJ 8844
Country: USA
Phone: (908) 359-6655

Thomas C. Streko, D.D.S.
169 Mountain Avenue
Westfield, NJ 7090
Country: USA
Phone: (908) 654-0095

Patti Swaintek-Lamb, D.D.S.
10 Anderson Road
Bernardsville, NJ 7924
Country: USA
Phone: (908) 221-1188

Hope this will help.

Regards.
H.Nassery, DMD

Thank you for quick responseDr. Nassery.
I shall schedule appointment with one of them , if mouth guard does not help.

Regards,
Raj

Hi Dr. Nassery:

Three weeks ago I had bimaxillary orthognathic surgery (LeFort I and bilateral sagittal split ramus osteotomy) as well as a chin implant (they alos broke the chin).  I've suffered from TMD for years and although I know the procedure has corrected my open bite, we are hoping the new, "normal" bite will relieve pressure on the jaw joint by evely distributing the bite.  

My question is this: following surgery, my jaw locked, and is still locked.  I can open less than one finger.  It also hurts much worse than it did before surgery.  I am in physical therapy, going 3 times per week, but haven't seen much improvement.  Can a jaw be unlocked using PT, and if so, about how long does it take?

Thank you in advance for your time,
Lisa

Hi Dr. Nassery:

Three weeks ago I had bimaxillary orthognathic surgery (LeFort I and bilateral sagittal split ramus osteotomy) as well as a chin implant (they also broke the chin).  I've suffered from TMD for years and although I know the procedure has corrected my open bite, we are hoping the new, "normal" bite will relieve pressure on the jaw joint by evenly distributing the bite.  

My question is this: following surgery, my jaw locked, and is still locked.  I can open less than one finger.  It also hurts much worse than it did before surgery.  I am in physical therapy, going 3 times per week, but haven't seen much improvement.  Can a jaw be unlocked using PT, and if so, about how long does it take?

Thank you in advance for your time,

Lisa

Lisa,

I am fundamentally against surgical procedures, as you may have noticed from my previous postings. I am sorry about your pain and issues , this dose not mean that surgical procedures are not needed at times, but rather we need to have better protocols for stabilizing lower jaw during the procedure.
You see, the issue that you are facing is happening because when during the surgery they cut your lower jaw and realigned the anterior part, they then pushed the ramus, or the ascending part of your jaw all the way back and up to wards your middle ear. This position is pathological to your joint as it further pushed your disc and other components of joint out of place in front of the ramus, hence creating an impediment to your opening.

PT, will just get you to tear these tissues and eventually, hopefully the pain should subside. So unfortunately I don't think this will be the end of your treatments. I wish I had better news. All the best.

H.Nassery, DMD
www.Miamibeachdentistry.com

Dr. Nassery:

Thank you so much for the information.  How are the disc and other components then put back in place or are these the tissues you mentioned PT would tear?  Is there hope for me and if so, what does the process to restore the jaw to normal look like?

Thank you,
Lisa

Lisa,

I  hope I did not make it sound like your case is hopeless. Something can always be done. I just don't think you are at the end point yet... for now monitor your symptoms, if the pain does not subside and you can not open still , then you must see  some one that does and know appliance therapy. The muscles must be relaxed and your disc components must be retrieved back into their rightful place. Just know that in that place your teeth may not be in touch and you may need to do braces to get them together there..
I am sorry if this is not a complete and thorough explanation but this case is complicated. I hope I am wrong and  you will get better on your own.

Regards.
H.Nassery, DMD

Dr Nassery,
I hope I am posting this in the right place. What type of appliance do you use. I have tried the one on the front teeth and several others including one to reposition the manible. My bite is good, however I have more clenching when I sleep on the left side. 20+ years of suffering. Ready to try again, but have just started looking at you and a couple of others including someone in AR. I have tried someone in Ocala, FL and Chattanooga, TN and someone in Birmingham, AL. Also I know mine is aggravated by stress, it seems my only solution for the next few weeks, is to isolate as anything else stresses me. Thanks, BOD

Dear BOD,

It is unclear to me what type of appliance you have had, the only one I can guess is the anterior deprogramer. They all seemed to have been palliative in nature. Once you have been through proper way to get your bite and had your appliance made you  would never forget it. To find a clinician near you check out "occlussionConnections.com" .

Let me know how it goes. This is not something you need to live with.

Regards.
H.Nassery, DMD

I will find out what type of appliance I had. I'm not sure what you mean by " you would never forget it" but the TMJ Association says there is no "one" treatment that works universally, maybe you can change their minds and list this as a "cure." No dis-respect intended, just frustrated. Thanks again, BOD

Dear BOD,

I hear the frustration in your comments. What I mean is that there is a very scientific way of getting the correct position and that is the main thing. The type of appliance and how it fits is secondary. I am well aware of where TMJ assoc.stands and lets say I don't see eye to eye with all they say. That is not to say they are wrong or I am wrong.. there are many ways to do the job, I just prefer my way.
They way we get our bite is through very specific set of protocols, with computerized jaw tracking and relaxation of jaw through low frequency transcutanous electrical stimulation. I think you would remember this one. Even with in this very small group of practitioners there are subgroups and different philosophies. I hope this gives you some idea. The only thing I want you to remember, is that as bad as you think you are, I am certain you can be helped and you can be pain free again.

H.Nassery, MD

Hey Hami, I'm astounded after 3 years you're STILL replying to problems.

My girlfriend has recently been having serious issues with TMJ, she has been to TMJ specialists (best in the country, Australia) and they haven't been able to help with the intense pain she is going through. She is unable to do simple tasks because the pain is so immense and both paracetamol (panadol) and ibuprofen have stopped working as effectively.

She does live under un-preventable stressful circumstances, which she manages but we need a non-surgical remedy to help even just ease the pain. Massages have helped, but only sometimes, heat packs seldom work also. When she's at ease and the pain does subside a little it is easily flared up again.

Do you have any options?

Much appreciated, Rick

Dear Hami,
Thank you for keeping up with this forum you seem to have helped so many people and I hope you can help me too. I have had ear pain and clicking in my left ear for the last three years. It clicks mostly when I swallow. I have been seeing a doctor for the last two years who has diagnosed me with TMJ and gave me a night guard that goes on my lower jaw. Things did get better with the guard but I want the pain and clicking completely gone! He's been adjusting it every couple of months but not much improvement I still have this damn clicking and pain all the time. He's even filed down my teeth some so my bite is more even. My question is could my doctor be doing any more than he is? Does he know what he is talking about?

Sincerely,
John

I forgot to ask is there any TMJ doctors in Atlanta you would recommend?

Hey Rick,

Thanks for posting.. Yes, this post probably has the record for the most active and longest tread of any on this forum.. which is a sad testament to the state of repair and treatment of TMJ disorder.
The prime examples are the experts you  have been to.. there are vast differences between modalities of treatments and many of the people who hold themselves up as expert.. Please note I don't. I am just a dentist and I believe that all of us should be treating this ailment.. I know for a fact the it can be treated.
Look for the following Doctors,  
Dr. Adrian Kat
43 Wellington Road
Perth, Western Australia 6062
Country: Australia
Phone: 61892768550
Or
Dr Anne-Maree Cole
151 Robertson Street Fortitude Valley
Queensland 4006 Australia

Hope this helps. Keep us updated.

Regards,
H.Nassery, DMD

Hi John,

This tread has been just amazing. Thanks for posting, I do what I can to take the mystery out of this ailment we call TMJ disorder. You have already told me more in few sentences than I need .. If you feel the click and pop as you open and then close, it only means one thing.." where you teeth come together, does not coincide with your joint anatomy, so for your teeth to come together you have to push your disc out of place"
So, now you tell me , if this was your knee, and every time you put your foot to the floor to walk your meniscus, popped out, would it help you, if I just gave you a brace to wear at nights?  Just a hypothetical question.. you don't have to answer.. but I think you know the answer... We need to get your teeth to meet at the right position, a position where it would not require for your joint to get damaged for that to happen. I don't have anyone in Atlanta, off the top of my head, but will try to get you some names. I am sure there are a few.

I hope that helps .

Regards.
H.Nassery, DMD
www.miamibeachdentistry.com

Thanks a lot for answering so quickly and understanding what I'm going through. Obviously I am in need of more treatment than a night guard and you have given me clarification that I need to look for a new doctor.  

Sincerely,
John

So good to find a forum such as this..ive had clicking/popping for about 10 years..my dentist diagnosed me and said if i have no pain no treatment should be sought and to just stop chewing.gum..i am now 28  (female) noww about a week ago i wake up with my right jaw very sore and it hurts to open wide or bite down..i have been using a heating pad and anti inflammatories and they help a little..im very worried it will get worse..i can open my mouth wide and still have clicking and popping...what is happening amd what should be my next step??

-worrier from massachusetts

Just to add..my jaw has never locked or caused any paid before this past week..i cnt remember anything that could of triggered this flare up..any thoughts will be appreciated..

Hello Miryam08,
If you have read my other posts, you would know that clicking an popping is not normal. It is an indication of pathology in the joint. You would be categorized as an asymptomatic patient, remember lack of symptom does not equate presence of health.
To give you more of an insight, most my patients are female ( 3/4), in their mid forties and up...which tells me that the severity of the disease gets more with time. These individuals were asymptomatic for most their life or they could cope with their issues better when younger.
As for your current issue, I would stay away from hard foods, also do n ot open your mouth wide, continue with the anti-inflammatory regimen and give it time to heal.
Having said that you probably have other signs and symptoms that have been over-looked and not connected to the issue before. If you need to see a qualified dentist that can help you more, there several goo ones in Mass. One being Dr. Mehregan, who is a contributing doctor to this site.

All the best.
H.Nassery, DMD FICOI
www.miamibeachdentistry.com

thank you for such a quick response Dr. I have an appointment with my dentist (the one who diagnosed me years ago) this thursday...and i have also made an apt with a Neuromuscular Dentist for the end of next month..as far as symtoms go..i still have soreness in my joint area when i open wide or bite down...it does get alliviate alot when i excersice the muscles..but the pain always comes back...i will follow your suggestion with not opening my mouth wide anymore..im honestly just scared i will end up having to live this way..i know stress is a big contributing factor but to one day live care free and then wake up to pain that doesnt seem to want to go away? iv read sooo many horror stories online about TMJ and how bad it can get...i just hope im not too late..even though my issue has always been my right side..lately iv been hearing some noises at times from my left!..im probably being paranoid..i dont know...this is all very scary to me..i just want to be pain free again..

dr. do you have any good tmj specialist in mind from MA? maybe around the south central area??

i have so many questions and i know it is impossible to give proper diagnosis without physical evidence but..in regards to the time iv had my popping/clicking how much damage have i done? how bad are my discs? is my pain muscular or are my disks basically gone and am i rubbing bone to bone?.do my symptoms seem mild or severe? is there hope for me that i will one day return back to "normal"?

sincerely,

miryam

Hello Miryam,

Do not worry, you are not late. To answer your questions, most of the pain is muscular. The bone and the retrodiscal tissue don't really have too many sensory nerves.
The extent of damage to the disc and inside is really not so important to me, when I treat patients, I know many clinicians want to see MRIs and visualize where or which side the disc has displaced to, but it does not change anything in my treatment. We still need to put the jaw into a neutral physiologic space. Create the space and the body is designed to heal itself.
As far as your symptoms, compare to my patient pool, you are mild..
Hope this answers your questions.

H.Nassery, DMD FICOI
www.miamibeachdentistry.com

Im so happy i found this forum and you Dr! you seem very understanding and caring to all the people here!...i feel much better now and hope the specialist i am going to see is current and understands tmj and will be able to help me stop this disorder from progressing..

his name is Larry Lockerman and he works out of Umass hospital in Worcester, MA...have you heard of him? if you have any other options that seem better please let me know!

thanks a bunch!

-Miryam

hello again, i am back with some serious disheartening news..i just went to see my primary care and as he put his hands over both my jaw joints and asked me to open and close my mouth he just kept sayin..o wow..yea..wow...and began to explain how he has never encountered someone with my type of tmj case and said BOTH of my jaws were bad and slightly dislocated...he also mentioned about 3 times how he doesnt have the education or experience to help me or even offer advice..i of course broke down and felt like it was OVER for me..my question is..how accurate would his diagnosis be since he lacks the education and experience? i have absolutely no other symptoms besides the clicking ive had for years and now this uncomfortable joint pain on my right side that has been showing improvements with daily muscle exercise..heating pad and anti inflammatories..i need to have hope that i will conquer this disorder or atleast live a pain free life with no progression of symptoms...

please help...

-Miryam

Miryam,

Please calm down.. for the record when pathology exists in one side, it is rare that the other side is completely healthy. The work does not change, nor does it mean it is doubly hard now. It is the same process, because if I were to treat you I would not fix one side at the price of the other, would I?
Just find Dr. Mehregan, he is in your neck of the woods, and he is an incredible practitioner. Things always seem more complicated when you have not trained for this. I promise you can be healthy and pain free.

Regards,

H.Nassery, DMD FICOI
www.miamibeachdentistry.com

thank you...is dr.Mehregan a tmj specialist or a regular dentist that would offer the same expertise..treatment plan and positive outcome?

Another question for you. What about the emotional state of the person being treated? I am angry at god. I hate life, since i don't really have one and i hate all suffering. I have daily anger. Do you work with a therapist? Could you still help me?

Miryam,

Dr. Mehregan, is a general dentist, as I am. However, the basis of our training for years has been the physiologic bite. If you ask me, all dentist should know this, as it is the foundation of all we do.

All the best.

H.Nassery, DMD FICOI

Dear Angrybutkind,

I hear the pain in your writing. To answer your question, yest I do see this often. You have to consider that by the time most patients get to us, they have been through the ringer, sorta speak. They have seen the ENTs, and Nuerologists, and pain specialist, and usually the last stop, the psychs. Who put them on antidepressants and anti-psych meds, because they think there is nothing wrong and its all in their heads.
Believe it or not there is a group of so called "TMJ" specialists in the dental community who believe that TMJ is a "psycho-social" issue, and that practitioners like me are basically taking advantage of those patients . All you need is more meds and to re-assure you that nothing is wrong with you and send you home.

Personally, I would like to see some stabilization in patients mood and behavior, as what we do requires total patient engagement and commitment. I have had patients that were too far gone and I had to refuse treatment as I did not think I could be effective in what I had to do.  As such I am not always against anti-dep. meds, but I do prefer more organic and natural supplements instead. I do frequently work with a Dr. of Chinese herbal medicine, and acupuncture therapy.

I hope this helps, don't give up.

H.Nassery, DMD FICOI
www.miamibeaachdentistry.com

Hi Dr =)

i made an appointment with dr. Mehregan..for next Saturday and i am feeling very optimistic...i it still hurts alot to chew on my "regular" bite and open wide..although, i have adopted a new bite for eating and i get to pain or clicking when doing so..maybe that was where my jaw supposed to be all along? i dont know..its all very complex and strange...all i hope is that i dont fall into the small percentile of this needing any type of surgery for treatment...my primary care scared me big time!

-crossing my fingers

sorry for the mispelling..i meant to say *i get NO pain or clicking**

Miryam,

Forget about surgery. You will get all your answers next week. He is a very experienced clinician.
H.Nassery, DMD

I just got diagnosed with TMJ.  My ENT told me only to take Advil. What else should i do?

KD,

Most of us all have some sort of issue with our TM Joint. You have to be more specific with your symptoms.

H.Nassery, DMD

It's BOD again. Thanks for all your help so far. I have checked the site and I do not have any one close to me who has taken very many courses in this. This was also verified by his office.
I am going to go to the site and try to really understand (as much as I can about the treatment process) But I can't resist in asking for an overview. It appears to me that you find the right occlusal position by using a couple of machines and then verifying that by making a splint. How long does this process take? I may have to drive 12 hours to see you. Do I need to plan on staying there for a few months or how long? (i know it could be different for everyone, but i need a estimate) Also how much does it cost?  My understanding is that the splint is not worn day and night. How long is it worn? how do i know it's right if i am not chewing with it? My last attempt in the 90;s was with a modified crozat flat plane appliance that I wore 24/7 and the Dr adjusted every month. Thanks I will go back to the site and keep reading.
I just tried to find more info on the occlusalconnections site but not finding what i need to know. Also what is the purpose of the low level tens machine that is different from a regular TENS? Does it relive pain and if so why would you want to do that while you are trying to find out a pain-free bite? Anyone can make anything sound possible. As you know I am as skeptical as many of us are. Thanks again for all your help, BOD and Angrybutkind I keep forgetting my password.

PS I will mentiion that my bite is not off by much, yet I clench like crazy. Every day I wake up tired I think the fatigue and lack of life is much worse that the pain and muscle sorenss (which has progressed) If you or your readers would like to know the progression it usually starts in the jaw, then temples, above the ear, back of neck C2 C3 scapula, under shoulder blades, scalenes and the SCMS. and pecs. I have suffered since the early 90's. Now I do not get restorative sleep when i sleeep at night but sometimes get it by going back to sleep during the day. TMJ can also exacerbate MVP. I often have fight or flight syndrome. My top teeth are separated and get wider toward the ends of the teeth.so i think maybe a very slight overbite. Bite lines up fairly well when closed. When I get it adjusted it just comes back/

Dear BOD,

As I have mentioned in my other posts, we all have some level of discrepancy in our bites. I think the estimate is that only 3% of people worldwide, will naturally have their teeth and muscles in perfect harmony. Now thanks god that only a quarter of us become symptomatic.  This only means that some of us have narrower goal posts and some have wider ones. ( to use a sport analogy)
So even though your teeth may not be looking too bad, it means little to me. Actually, you already gave me a big clue, if you have spaces between your upper teeth, it only tells me that your lower jaw is trapped behind the upper arch and is trying to physically remove the obstacle out of its way to get more forward, in a position that its muscles prefer. In this case the obstacle is your upper teeth.
You are very correct about the progression of the disease. Most my patients are female, and most of those are mid forties and above.  It seems as we age our coping abilities diminish more.
As for your other comments, your assessments about the procedure are pretty close. While the machine does not take the bite, it does help us to get the position accurate to a tenth of millimeter.
As far as the type of orthotic, we only make one, for the whole day, you eat with it, sleep with it and keep it in the all time. Only remove to clean and maintain. You see we believe, god gave us one set of teeth for all times, and we should be able to provide our patients with a similar thing.
I hope this helps.

Regards,
HNassery, DMD FICOI
www.miamibeachdentistry.com

Dr..if i may...what has been your success in treating Tmj/tmd? also, do you consider success as a cure or just able to manage the condition?

ive been in pain now for over a month..reading and researching obsessively..some say no cure..some do..does it even exist..? reading online stories can really get you down...

Dear Oversoon,

Your question is complex. First let me answer the second part, "Cure" I am not sure sure if what we do qualifies as a cure. TMJ, is a functional problem, its not a disease like appendicitis, that you can just take out and voila, you are cured.
Most often, there is a disharmony between where your teeth are and where your muscles would want to optimally function. We find that and naturally re position your jaw in to a more friendly space where all is in harmony.  Then issues resolve, with some help from the patient him/herself, keeping and maintaining their posture right.
As per my success rate , I would say when attempting a case that has been properly diagnosed as an malocclusion then the success rate is better than 90%.
The only other factor you must keep in mind is that, there is a degree of medical attainability. Meaning that there are components of your jaw that have been torn and damaged and there are perhaps arthritic joints and such that can not be repaired. However, in most cases pain can be alleviated to a great degree.

I hope this answers your question some. All the best.

H.Nassery, DMD
www.miamibeachdentistry.com

hello Dr..i finally met with Dr. Mehregan...it was my first consultation..over all it was pretty good although i still have questions.. he does seem to believe i can be "fixed" but it is going to be a long process..phase 1 being customizing a splint to stabilize my jaw..and then phase 2...braces to permanently keep my new bite. i will be needing a palate expander which i always believed was only achievable in adults through surgery..he believes otherwise..this has me a little nervous...

he didnt exactly tell me what was wrong with my TMJ (probably since there was no testing done yet)..he did mention my left tmj is worse than my right..because upon opening my jaw deviates to that side..which is something else im questioning since ive always had the popping and now pain only on my right side...i have decided to begin treatment with him...my next appointment is in 2 weeks to do a whole lot of testing..im hoping i can get alot more clarification after that..

if you have any thoughts or opinions towards my concerns...please share =) thank you!

Hello Miryam,

First, I am glad you made it to the consultation. I have known Dr. Mehregan for over 20 years an you are in good hands. Let me see if I can make things a little clearer for you. First the notion that you can not expand an adult. We only mostly treat adults, and all of us who have studied this path and this way of doing braces have come to find out that what we were told in school and gets repeated out there over and over, is not true. I expand adults all the time, and actually we know for a fact that bones remodel well into our seventies. I have patients in progress right now that are easily two and a half times older than you.
Concern #2, left joint  vs. right joint. Let me see if I can explain this one this way... Ok imagine you are pushing your car forward. The front wheels are not the greatest, as you are moving forward, all of a sudden your left tire blows up and its not turning, now your car moves towards left and you have to push harder to move an now more weight is on the right side.. just an analogy, but you get the picture.

You will get better. Go with it. He is more experienced than I .

Regards.
H.Nassery, DMD FICOI
www.miamibeachdentistry.com

thank you very much for such a quick response and clearing things up for me! i am feeling very positive..a BIG thank you for recommending him...even though he is 1 hour and a half away im sure in the end it will be well worth it. =)

ps.. i mentioned you referred me and he smiled and said he knows you very well and for a long time!

i wish there were more drs like you!

Hello Dr. Nassery,
I am new to this site, have been reading all of it this past week and find it relieving as well as useful and in line with what my chiropractor, who is great, is saying for the long term.  He is close friends with my father who is a retired doctor (strongly believes in alternative approaches and understanding the body completely).  I have a few structural issues, the chiropractor is working with me to alleviate as many symptoms as possible, get rid of my 5 degree neck rotation most likely built up from a major car accident in 2005, and fix my forward head tilt and posture.  I had a breakdown physically (kind of like symptoms built up i didn't know what was wrong with me very scary) and emotionally (terrible anxiety), leading to begin my quest to find what was wrong.  Many symptoms have been alleviated with my chiropractor, and I look forward to working with him.  I had a discussion with him about tmjd the other day, knowing that for years now my jaw never opened smoothly and lately the left side particularly clicks and makes noises sometimes, plus ear pain that started about a month and a half or so ago, it is better now in the ears it comes less frequent and not as bad, but still there sometimes, the left ear feels very full, hard to pop it, occasionally i feel a dull ache in the back of my throat. He believes it is definitely a possibility and looked at my jaws too (prob will do xrays this week or next of the jaws, already did my neck and head), but that it is important first to align the spine and posture correctly and get rid of my subluxations, which I agree with.  He also mentioned down the road a tmj specialist but wants me to wait a few weeks as he treats me (three times a week), and also wants to make sure I find a really good one, not one that will end up messing me up or giving me the wrong treatment or orthotic device, making it worse down the road. I used the site you mentioned on here (top3dentists or something like that) and the live chat rep provided me with Dr. Martin in Totowa NJ.  I am wondering if you are familiar with him and what you think of him? Do you think there are better in the tristate area?  I want my health to be taken care of correctly as not only is it very important to me but whatever insurance doesnt cover i will have to pay, and I am a tight budgeted woman right now who is just finishing up college and planning a wedding for next year (I do work full time but I am far from rich or having any real savings besides wedding fund which is lacking as well).  Thank you for your time and for this forum, It is great and you seem like a great person and doctor, keep up the work.  

Cem17,

I hear you.  I tend to disagree a bit with your Chiro, and I'll tell you that until you get your jaw in the right position, you will not stabilize the neck.
While I regularly work with Chiro's and PT's , lower jaw effects the top block and without  your jaw in the right place, your atlas will always be out. Now I do agree that the person who would do this would need to be really good. My rec. for you would be Dr. Peter Ferro, in Manhattan.  He is a colleague and teacher.
All the best, and keep us informed.

H.Nassery, DMD FICOI
www.miamibeachdentistry.com

Thank you for your response it is greatly appreciated.  I will speak with my Chiro again, as he does believe I should probably get my aligned properly but wanted to relieve some of my symptoms and spasms first though (alot of the original big symptoms have been relieved, but still some weird ones remaining).  For example, alot of random pains which I have been told is referred pain (not super strong but I feel it), and what to me feels like weird pulses in certain areas like you can feel it over the skin when it happens, beneath my left shoulder is one area that bothers esp when laying down at night making me worried and hard to sleep, and of course the jaw is still not opening totally smoothly with particularly the left side seeming troublesome (it never opened fully smoothly). One thing is strange ever since all this crashed too, the last two weeks or so there is this strange feeling that occurs in my neck area near the top more, it is like when a clock hand tics almost, I can feel the small buzz and motion its a very small exact area and keeps happening especially when I am walking, i don't know what it is....will be mentioning this afternoon to my Chiro too...
Over the weekend, I emailed the original TMJ specialist I was referred to from the Top3 website, Dr. David Martin in Totowa, basically giving him a summary and asking a few questions of his practice.  He did email me back, basically said he has been treating TMD for over 30 years and neuromuscular approach for the past 13 years and completed all levels that the LAs Vegas Institute offers, he said he treated over 150 patients with a neuromuscular orthotic the past 13 years and success rate is in the 90s, does this sound okay to you?  I can send you the email if it helps at all...He says he has satisfied patients, should I ask to speak with one of them or two?  Also, have you not heard of him then?
I will be looking up Dr. Peter Ferro today too and taking down his contact info, I suppose you would say it is good to seek more than one opinion?  Thank you for taking the time to read all this and answer the questions, just trying to get myself in top shape now before it gets worse down the road causing anxiety to return.... have a great day!  

Oh and I am okay with you calling me by my first name, Cristina, but the username is fine too if that's easier ;-)

Cristina,

It sounds like Dr. Martin is very qualified. I just put a name that I am very comfortable to recommend. GO for it and please share your experience with us here, as it may be helpful to others.

All the best.
H.Nassery, DMD FICOI
www.miamibeachdentistry.com

Thank you so much, I will keep Dr. Ferro's info on hand just in case I don't get a good vibe or something from Dr. Martin.  My concern was I read a review from only one person that since he moved to Manhattan he charges alot more.
Just an update with the Chiro, he said the ticking buzz thing in my neck was most likely a sensory nerve (has gotten better since I saw him Monday), and took a few more x rays to see progress and other problem areas (lower back has a tender spot as well).  My neck rotation from a car accident years ago is doing better which is good I suppose, less muscle spasms that I can feel lately.  What worries me most though is this muscle tightness for lack of a better word, I feel on the sides of my head, forehead, eyebrows and sometimes feels like a pulling in my nose? Is that something that others with TMJ feel?  Also, can TMJ cause patients to sneeze more often and get a little more mucus or is that a result of muscle inflammation?  Sorry for all the questions just concerned... my chiro i guess feels similar to me, it's not that he doesn't want me to seek answers and work with others just is scared I fall into the wrong hands which would make things worse...  
Will definitely keep you and the community posted through this journey, esp since being here provides me with comfort too ;-)  

Just as an update, I finally had my consultation with Dr. Martin yesterday, the TMJ specialist I mentioned in Totowa.  It went well, he seems pretty down to earth and possessing the right knowledge. After much discussion, symptom questions, talk of my history and what not (dental work recently and ever, car accident), he checked around a few areas on my jaws and neck and inside my mouth and had me try a few things.  He said TMJ could definitely be causing many of the symptoms I have been feeling and went over how the first phase works (the orthotic mouthpiece), not knowing I had already researched that as well, and then options for afterwards.  He answered any questions I had to the best of his knowledge and we are now in the process of seeing how much of this first phase my medical insurance will cover.  Hopefully somewhere close to half at least, so that it will be financially feasible (can use care credit for the rest, but would rather not put so much on it as the interest rate is crazy high).  I want to be excited but right now am just staying calm, filling out the predetermination papers for insurance an waiting to see their answer.  
In addition, Dr. Martin agreed, as to my request, to remove my two mercury fillings and replace them with a better material (don't want the toxic in my mouth anymore and want to avoid any future issues with it being in my body).  Insurance pretty much covers most of this if not all and I have dental so that helps of course.  I am still seeing my chiropractor regularly and getting some blood work done this week and next to check a few things, as I had a few weird body symptoms as well that may or may not be TMJ related (aches moving around in diff sites of my body, nerve sensations, and small bruise spots appearing on my thighs-that last one may very likely not be related).  Thank you again for this site and being such an understanding and outreaching doctor.    

Hello Dr. Naserry,

i just wanted to update you on my beginning journey..i have finally began Phase 1 with my orthotic...it was placed just yesterday..Dr.mehregan was very detailed in making sure it fit perfectly in my mouth...i am still getting used to it as it is pretty bulky and noticeable if you are up close..im wondering and hoping you can shed some light..is it normal for it to cause discomfort not only sore teeth but also sore muscles and around jaw joint area?..im hoping its just the getting used to...i wasn't in pain before it was placed but i am not all that worried since Dr. mehregan is very optimistic which helps me feel the same...

so i am on day 2 of the re-positioning orthotic..i go back to see him in 2 weeks for adjustments. i will keep you updated..im very excited but even more anxious for it to be all over and having a successful outcome =D

-Miryam

Miryam,

Thank you for the update. It is too soon, but most what you are saying is absolutely normal for the first few days. What you must remember, is that your muscles were accustomed to working in a different place and now we are having them work in an entirely different position. I would not be surprised if you also develop some soreness in the neck and cervical areas, but don't be alarmed. that is part of the unraveling of the structures as your muscles will recognize the new place is more to their liking. As for the size, it is one of the challenges with this treatment modality.   Most the patients have very constricted arches and that means their tongue spaces are limited, and then we go and place another thing in there. But rest assured you will see the benefits soon enough. Make sure you make a list of your symptoms and take it with you to the appointment, every bit of info helps us to know what to look for and where to adjust.
Keep updating the results, as it will help others.

Thanks for sharing.

H.Nassery, DMD FICOI
www.miamibeachdentistry.com

Good Morning..ive spent a few days reading more into NM dentistry and feel like i might want/need to give it a try. like many here ive had a clicking jaw for 10+ years. no pain though.

What LVI certified Clinicians would you recommend in Massachusetts? Ive seen you mention Dr.Mehregan but he is a little out of my way. I would just like to know my options before settling.

thank you for all that you do.

-Jen

Good morning  Jen,

Would this work for you;

Steve Bader, D.M.D.
1400 Centre Street 106
Newton, MA 2459
Country: USA
Phone: (617) 795-7170

Regards.
H.Nassery, DMD
www.miamibeachdentistry.com

thank you for such a quick response Dr. but that is actually further away north from where i am. do you know of any doctors around the worcester or springfield, ma area?

i appreciate your help tremendously.

-Jen

Dear Jen,

This is the closest I found to you;
Peter B. Nelson, D.D.S.
717 Newfield Street
Middletown, CT 6457
Country: USA
Phone: (860) 347-1227
I don't know him personally, but he has studied some of the same things. Now Doctor Mehregan, I can personally vouch for as I know him and his work closely.

All the best.
H.Nassery, DMD

Hi there I have a ? I am trying to find a good tmj specialist, well my situation I was born with or grew that way underbite and crossbite, when I turned 17 I got braces they str8tned my teeth but did not fix my bite they wanted to break my jaw and push it back and line it up, I was like no way I was going to go threw with it at frist then decided not too, so I went the rest of my life with the same bite up until 4 years ago my jaw locked I already knew or was told I had arthiritis of my tmj joints or one I dont remeber but, I found an orthodontist that placed braces corrected my bite I am still in the braces should be coming off soon, I went to see a tmj specialist because I am now just getting excruciating headaches and pain in my ears which I never experienced till a few months ago or sometime this year, I started having a metal taste in my mouth the ? is that related to the TMJ problem sometimes its very persistent I can not bear it, my doctor or my dentist could not tell me what taste is. so basically trying to find out why I am experienceing that taste.

I only been to one tmj consultation so far she is offering the tens treatment, and splint along with massage therapy and I am at a level 4 which is the highest, and should be done in 12 to 8 weeks does that sound correct, I have mostly my right side that bothers me more with ringing and fullness and pain in my ear. I have grinding clickin and popping is this fixable without surgery?

Dear Marg,

It is hard to diagnose over the computer. You certainly have many of the signs and symptoms. I would say that if you are having such bad headaches and ear pain and so on, then you must take the braces off at once.. they are exacerbating your problems..
I am not sure what the level 4 means .. or 12 to 8 weeks for that matter.. shouldn't it be 8-12 ??
I am familiar with tensing an fabricating an anatomical removable splint, but most importantly it has to be on an optimized trajectory. You can read more about the optmized bite on "occlusionconnections.com"

Hope this helps.

H.Nassery, DMD
www.miamibeachentistry.com

I could take the braces off but I am almost finished reason for braces I had a crossbite and underbite that caused my tmj in the first place if I take the braces off I paid so much and then I am left with gaps between my teeth, I went to a Dr.Harriss Dental here in Phoenix the tmj specialist practices with massage and uses the Tens level 4 is the most severe you can hear the grinding in my jaws, I am 41 now been having this problem for more than 20 years I just started with ear pain towards the end of my braces therapy I almost done with them, and headaches kooled down after I started to relax I starte worrying bout the coppertaste in my mouth why was I feeling tthe way that I did, ear pain is not so much but is still there, and the treatment this specialist has to offer says it should only take me 8 to 12 weeks to be healed I don't know why in such a short time, they are a natural practice...Do you know of any Great TMJ specialist in my area Phoenix AZ.

Just thought I'd come back on and update you since your guidance here inspired me to seek resolution for my TMJ...I had the initial consultation with Dr. Martin in Totowa, of which dental reimbursed me 90% very pleased on that part.  He would like to go ahead and do the next step which is the relaxing of the jaw muscles and finding the best relaxed state for the orthotic adjustable device.  He gave me an estimate (5500) that includes all of phase 1 treatment-finding relaxed state, TENS, the orthotic itself, adjustments, etc-but phase 2 is separate as that part is dental work as needed, sounds correct right?  I said I would definitely like to but need to know how much insurance will cover, so currently he is working on getting a pre determination from my health insurance who said supposedly they cover some portion of it, so just waiting to hear back from Horizon now... in the meantime I decided to have an appt with him to remove and replace my mercury fillings (I have two I believe in the back right) since I have wanted to for a while anyways and feel that is good for my health prior to beginning TMJ treatment; that will be this Tuesday coming up next week so looking forward to that at least in the meantime... my chiropractor has helped me with alot of the muscular pain and nerve sensations I was feeling, there are a few things that don't seem to go away completely but that may be related to the TMJ too...I have been approved for a spinal MRI so I am trying to find time to do that this week so we know exactly what is going on in the neck area too.  Thank you for your help again, look forward to being able to come back on here with further positive feedback.  

Hello Dr. Nassery,

i have been wearing the orthotic for a little over a month now and have had about 3 different adjusments..this last adjustment was focused more on the fact that i wake up almost every single morning with my jaw very sore..like my muscles are very tight and i need to stretch them...during the day i am fine..so with the adjustment the dr is hoping the soreness will go away..i meet with him again in 2 weeks. im wondering..do you have any thoughts as to what might be causing my morning discomfort? let me just add that i usually sleep on my stomach but have tried a couple times to sleep on my back and end up with the same problem..also, through out the night i usually open my mouth just to stretch my jaw muscles and feel the discomfort as well..

i am just wondering if you have experienced this as a complaint in your practice with patients already having the orthotic in place and what you think might be causing this? also..should i be having discomfort still? is a month still too soon? also, when i move my jaw from side to side i hear a weird crunching noise coming from my right jaw area..if i do this enough i end up with pain for the day...i have stopped doing this..im just wondering what it is..

ps. i do no clench (that i know of) and if i did wouldnt the dr have already noticed if i did by just looking at the orthotic? the question hasnt even come up on my appointments..regardless of these small issues i now longer have clicking and am able to eat almost anything i want =) i am still very positive!

thank you for your help!

Hi Miryam,
Everything that you have said is very normal so far. You see the first thing that gets corrected is to recapture your torn and damaged disc tissue, which from the sounds of it he has done a great job. The issue with the clenching could be some small but very important areas that hitting prematurely, knowing him I am sure sure he checked your bite for those interferences. Those gritting sounds you hear in the joint when you move it side to side, is all the scar tissues and remnants of your disc tissue. Actually I have my patients do that few times a day. Don't over do it so you don't end up with pain.
What i am saying is trust the system, he knows what he's doing.
Remember, it had taken a long time to do do all this damage, don;'t expect things to just get healed at once.
Hope this makes sense.

H.Nassery, DMD
www.miamibeachdentistry.com

Dr.Nassery,
My jaw has been locked shut on the left side for 3 days now and i am in a lot of pain.
I went to the dentist and he thinks i either have TMD disorder or my wisdom teeth are causing the pain, aloth they are unerrupted. but he couldnt give me an xray because i couldn't open my mouth wide enough. Its still lock and i can hardly eat. I have been taking co-codamol to deal with the pain:) Is there any way of unlocking my jaw as i dont think it will to is on its own?
Many Thanks

SophieW

Sophie,

The condition you are descrribing sounds like what we call a closed lock. Basically you have had this problem for sometime but did not have sysmptoms. I highly doubt that this is your third molars.
To answer your concern, yes its possible to open it back but you need to see a dentist that is well vversed in treatment of thee jaw joint.
If you are going to take any meds , the best thing would be a muscle relaxant, as the spasm in the muscles in your jaw on that side is what is holding it closed.  Let me know if youneed some one near you maybe I can recommend some one.

All the best.

H.Nassery, DMD
www.miamibeachdentistry.com

Thanks Dr.Nassery,
Yesterday i managed to push my jaw to the right and it unlocked, but when i closed my mouth again iy re locked and wouldnt open.  My dentist told me that it will get better on its own but its been 5 day and theres been little improvement.

I live in the UK, do you know of anyone in Cambridge, England who could be of more help?

Thanks in advance, Sophie

Sophie,

The only NM dentist I know in England is ;
Dr. David Cook
London Holistic Dental Centre
39 Harley Street
London W1G 8QH
020 7323 1363
www.londonholisticdental.com

Hope this helps.

H.Nassery, DMD

Good Morning Dr.

I come to you once again for guidance and some understanding...i am still waking up with very sore jaws and muscle tightness..Dr.Mehregan really had to think about what could be causing this...he decided it might be that i need another adjustment (which he did) and/or i need to see a chirpractor. i dont usually have back pain besides a bad night in a bad bed but nothing through out the day..my neck doesnt hurt either..im just not sure what to think from here on out..what could be causing my muscle tightness and jaw soreness every morning?? maybe clenching?...maybe you have some better insight and could offer your opinion on this?

ps. besides this im doing great.

-always thankful,

Miryam.

dear sir ...i hv heard so much of u . plx help me. my mother is sufferring frm jaws disorder or tmj or whatever ...i dont knw exactly ..she cant eat properly cant speak properly cant drink without straw even cant close her mouth ...her jaw bones got disordered .it is since 6 years ..before she was normal ..gradually she started pain nd stiffness..she is in sever pain ..she got weaker nd weaker day by day becox she is not able to eat properly...plxx tell me which doc i should consult ???help me

my mother is about 60..

Dear Miryam,

There is much more to what we are doing than the mouth. Dr. Mehregan is very experienced in the coronoplasty or the adjustments as you call it, so I am sure he has already checked for what I would check here. The extend of changes that we are causing goes well beyond the mouth, and though I know you think you have no issues in your back, but it would be like saying your neck is not connected to the rest of your spine. I know you are asymptomatic there but it is possible that there still be a subluxation that has not resolved . I would get an adjustment there and then see Dr. Mehregan for a follow up coronoplasty.
Hope this helps.
PS. I am happy to know that most other issues have been resolved.
Regards
H.Nassery, DMD
www.miamibeachdentistry.com

Shazai,

You have to give me more info... where are you guys located.. what started it all, these types of issues are rarely sudden onset. how is the condition of her mouth? ie. does she have all her teeth? partially edentulous?
Without more info I am afraid I can't be of much help..

H.Nassery, DMD
www.miamibeachdentistry.com

Dear  Hamidreza

I want to discuss following medical issue with you.

i started weight training in gym 1 year back. I used to lift very heavy weights because of this my cheek(zygomatic bone) and jaw bones have expanded . Now i have stopped lifting weights.I can hear bone cracking noise from cheek and jaw bones during facial movements. And now if i lift weights or do exercise, my cheek and jaw bones again further expands instantly and  after 1 week gets back to normal position. There is no pain felt.

Please let me know if its related to Tmj and what treatment is required

Maz

Dear Maz,

IT sure sounds like you are quite a clencher, very common with lifters. I highly suggest to get yourself a sports mouth guard . I am of course biased towards Power Balance, performance mouth guard, due to the fact that it is based on Nueromuscular science, be it a little watered down. Still it is better than the rest on the market.  So if you have no pain and issues, I would suggest wearing this appliance during your work outs.

Hope this helps.

H.Nassery, DMD
www.miamibeachdentistry.com

Thanks for reply Dr. Hamidreza

I'm not clenching teeth,the situation is more worst.  Even on doing daily task of lifting 5-10 kg home item stuff(bags, water container etc)  and on doing light exercise such as doing push up exercise or which involves blow head position of head. There is a visible expansion of zygomatic bone and jaw bones and jaw cracking noise from area  near middle of both ears.

It usually takes one week to get to original facial structure , if i do not lift any weight(home item ,bags, water container etc) and do not perform exercise that requires blowing down head.

There is no pain but there is visible change in facial structure which is noticed by me and others and  this effects my confidence level.

I feel like there are some facial joint that are loosen up , which gets displaced when it get any sort of stress.

Please let me know what further needs to be done to diagnose this issue.

Mazik,

As you know it is impossible to diagnose anything over the computer.. certainly, there are obvious connection between the muscles of mastication and the zygomatic bone and the jaw bone (Mandible) . The crackling sounds in joint also indicate perhaps advance degenerative joint issues.
However, proper diagnostic records are needed to make any statement. Try and find a seasoned TMJ practitioner near you. I have previously indicated a site that can help with finding such practitioners. Try the site "occlussionConnections" of Dr. Clayton Chan, he has a wonderful tool for finding such practitioners.

Hope this helps.

H.Nassery, DMD
www.miamibeachdentistry.com

by hamidrezanassery, Nov 15, 2012
Shazai,

You have to give me more info... where are you guys located.. what started it all, these types of issues are rarely sudden onset. how is the condition of her mouth? ie. does she have all her teeth? partially edentulous?
Without more info I am afraid I can't be of much help..

H.Nassery, DMD
www.miamibeachdentistry.com
sir
salam
we live in karachi pakistan , 6 yers back my mother felt a little bit paralysation on left side of face ....but it ws not sever ....unfortunetely a family physician advised physiotherapy...she went through physiotherapy only for 3 to 4 days ...but she felt so much pain during the process...she left it ..by that day she started pain during talking eating drinking nd day by day it got worst ...she became weaker nd weaker cox she couldnt eat properly ..now the condition is that she cant even close her mouth ..x rays shows that her jaw bones are not in order ..her mouth wide open all the tym ...sometimes she feels sever pain from jaw to ear or to head on the right side..in the meantime she lost her mostly teeth ..the remaining is moving ...she drinks with the help of straw otherwise she cant ....plxx just tell me what is it nd which doc we should consult ??? i shall b veryy gratefull to u ...

Shazia,

I am so sorry to read your mother's story. Having lost my mother to another illness and watching her suffer during it, was one of the most difficult things I have faced in life.
I wish I knew some one there that I could recommend, in absence of that knowledge, I would have to say your best bet is to find an oral surgeon, possibly in the dental school, and see if they can help you with the situation. Your mother is suffering from an open lock, where the torn discal tissue is not allowing her jaw to close back into the normal place. It is a difficult  situation, but can be helped.
Find an Oral surgeon, and the use of some muscle relaxants and manipulation it maybe possible to put the jaw back into its normal position.

I hope this helps, all the best.

H.Nassery, DMD

Dr Nassery -
I am 7 months into my repositioning splint. Many of my symptoms are gone, although I am still having some joint and ear pain (I believe it is my lateral ptygeroids that are in spasm since I have pain right in front of my ear, sort of "within" my left joint, and inside my mouth toward the cheek is tender). Despite being in a repo splint, my left joint still pops, but my TMJ dentist has told me that because I was locked for so long (4 months), that this may always be. My left joint unlocked in my repositioning splint about 2 months in. I also have some grinding noises in the joint in addition to the "pop".

I guess my question is -- is that it? Do I go into phase 2 and just accept that I will always have some pain? I have pain pretty much everyday - although it is manageable. Is there anything else I can do to relax the lateral ptygeroids? I am going to see if we can do some trigger point therapy on them.

Thanks

Dear Gretel,

This is where things get tricky. Personally, I don't go forward unless we have taken care of all symptoms. A popping joint is not acceptable to me... You need to have a new bite taken at an optimized position which is where and when that disc is recaptured.  
The Nueromuscular arena is very small, however, within this small arena, there are stark differences in the way the bite is captured. I , personally, take the bite according to the teachings of Dr. Clayton Chan, who in my mind leads the field in many ways. Optimized bite, or occlusion, is a very detailed way of capturing the best physiologic bite for our patients. I can tell you that we do not accept a popping joint as ready.. we would be taking our bite and recapturing that disc before we would go forward.
I hope this helps.

H.Nassery, DMD
www.miamibeachdentistry.com

DEAR SIR
             im really very thankfull to u that u replied me back ...its great honour to me ....inshAllah i will follow ur instructions ..hopefully it will work ....if not , then i will let u knw ....
                
thanking u

Dear Doctor,
I have all the classic symptoms of TMJ, and I live in excruciating pain with severe migraines. I am using an NTI but it doesnt really help. I still wake up with pain in the  TMJ joint and  have limited mouth opening. Now I noticed my lower jaw moved forward and my chin appears smaller, and I looks like my face is shorter. One side of my face looks asytmetical, the left side of my face is the side I have jaw popping and clicking. I noticed the muscles became so stiff and hard that it looks like I have less facial volume on that side. I was recommended to get braces because the two back teeth always touch and put puts pressure on that muscle. The doctor said it is a structural problem. Is this whats causing my TMJ problem? Should I get the braces. I heard of repositioning splint, is this a good idea to move the jaw backwards or will braces be able to correct that problem. Hope u can give me some advice, I am tired of seeing numerous dentists and living in misery and depression because of this.
thanks

Ferdous,

What a name, named after my favorite Persian poet Ferdousi.  
OK, so lets begin with the fact that you already know you  have an ailment.  I know its hard to think rationally when in such sever pain, but please stay with me. Would you do any other medical procedure if you were not sure it would fix your ailment? Another words, are they guaranteeing that you will be pain and symptom free at the end of the orthodontic procedure?  
If  not how do they know for sure you will be better? just because you will have straighter teeth and you are gonna feel better about your smile, are you gonna be better in your neck and jaw and so on and on?  
I have a radical idea, lets first get you pain free and symptom free and then do irreversible work on your teeth... Actually that is not radical and strange it is the prudent way to do things....
So here is what you need to do, find yourself a practitioner that can first threat your jaw joint and get you better with an appliance...yes and appliance will remedy most cases, then only when we know where your lower jaw should be, you can start to do orthopedics to bring the teeth together....
I have to tell you this is not the way orthodontics is done out there, unfortunately! their main pre-occupation has been with the esthetic value of straightening the teeth, which in your case would not fully address your needs.

I hope this helps.

H.Nassery, DMD FICOI
www.miamibeachdentistry.com

Dear Dr Nassery,

My issue with TMJD started when I was 13 years old. I have tried many different treatments through the years, and finally ended up using an electronic device to help relax my facial muscles along with dentistry guard. A couple of years ago, I quit my positon of 25 years as an electrical engineer to form a company and designed a portable Microcurrent stimulation device for both professional and personal use. We have just launched our device in the market and I'd like to ask you to consider trying our device in your TMJ correction process. If you are interested, please conatct me at ***@**** or  visit our website at www.tamaresearch.com.

Thank you for your time and consideration.

Tina Abnoosi

Hi Dr Nassery,

I have consulted with a maxillofacial surgeon regarding my TMJ . and was informed that there is no TMJ problem.but my facial joints are weak. I was asked to use glucosamine chondroitin tab daily for joints strength.

Dear Mazik,

Good luck with that diagnosis.

H.Nassery,DMD

Good Morning Dr Nassery =)

i would just like to give an update and ask for you opinion on a couple things...i have been seeing Dr. Mehregan since the end of September and have been on the respositioning orthotic since October (4 months now)...all in all everything has been going smoothly..the dr is happy with how things are going. If you recall my last update i mentioned waking up with sore jaws that would get better as soon as i got up from bed. Dr. Mehregan suggested it might be time i see a Chiro..which i did and was cleared..(had no misalignments). which was surprising to both the Chiro and Dr. Mehregan as i was considered one of the "lucky one"...i was very happy by this...although i do have a couple worries..1 being..even tho i still wake up with sore jaws am i ready to geing phase 2? and also..is it normal after these couple of months living pain free for me to feel a minor set back? I woke up yesterday with the all too familiar "ache" on my right jaw i had before beginning treatment..this has got me a little worried as i thought i should be going forward and this feels like a step back..

basically what im asking is..am i ready for phase 2?

thank you!!

Good morning Miryam,

I hear a lot of good news.. and some set backs.. first I want to say remember that we are not saying that this is cure all. During the span any day we do all kind of things that could effect our posture in a manner that would influence our bite.. yes it is a two way street. If I believe that the bite will influence the   posture, then I would have to agree that the reverse is possible too.
Having said that I will try and make sometime to speak to Dr. Mehregan about your case and see if I can make some suggestions.  I would add at this point that in some cases where the arch is extremely narrow, I have found that there is a skeletal functional limit to the degree of relief we can achieve. Once we start phase two and start to improve on the position and shape of the arch we can attain better bites and function. Meaning this will not be that last orthotic you will have, during phase two I regularly resurface my orthotics at least once  if not more.
I hope this makes sense. All the best, and keep the updates coming.

H.Nassery, DMD
www.miaamibeachdentistry.com

thank you for such a quick response..Dr.Mehregan has mentioned the fact that i will be fitted for a new orthotic once the expansion of my top arch and braces have been put in place..i am a little disheartned with your response regarding this is not a "cure all"..i was hoping with this whole process and how expensive and high tech it is i would achieve the best possible result which to me means living a pain free life and not worring about ajother flare up again..and since i do have a extremely narrow top pallot what does this mean? my outcome will not be as successful as others?

i just want to make sure i am doing the best i can do and this treatment is my best option..it can be quite depressing thinking i am going through all of this just for a "maybe or lets hope" it fixed your issue.

Miryam,

I think you  know by now that the effects are far from hope  or maybe. There has been definitive improvements in your conditions from where you started. With all medical work, there is a degree of realistic attainment. What we don't want to portray is that this is going to fix everything even if you don't exercise and maintain your posture. I know for a fact that my best cases are with patients that use a three pronged approach of the orthotic, therapist and exercise. When all combined we achieve high degrees of resolution.
I, also think you know by now that by making the arch form better, you will provide a setting that will lend itself better to alignment. So go for it, but help yourself with proper exercise.

Regards.

H.Nassery, DMD

Dr Nassery,
I have been experiencing extreme tmj  symptoms for 8 years after some dental work. A CT of the jaw 6 years showed that both discs were out. I started on an anterior repositioning splint which moved my lower jaw down & forward & had some relief but the doc who specialized in tmj never examined or relaxed the muscles or tracked the jaw to see where it wanted to be.  I then had the upper arch expanded a little & my front teeth pushed forward &  braces & felt pretty good especially the last 2 months of my brace. But my front teeth seem too far out from my lower front teeth in my opinion  Since having the braces 3 removed 3 months ago despite full time retainer wear my facial muscles are in content spasm & I'm constantly trying to find  my bite & my occlusion has changed & all my ear stuffiness & itchiness has returned as well as little popping noises in them along with upper molar pain again.  It hurts to talk and my left jaw still pops when I open wide. My questions are 1) is it possible to be positioned too far forward or vertical, 2) could i possibly still need to come more forward 3) should I go to a new dentist I found who says he does neuromuscular dentistry & uses jaw tracking, emg, & tense. My current guy just keeps saying "you need more time to heal".  Thank you so much!!!

Dr Clint Esler in Amarillo Texas is who I am thinking about going to. He is a top3dentist according to the Internet.

Dear Frustrated,

I hear you. All your symptoms are in line with TMD. As for your the orthodontic work you have done, unless they are familiar  with orthopedics, they would not know how to finish your case so that you would not loose your bite.. which it sounds like you have already. If your jaws pop, then it is a given that your discs are out of position which means you are still over closed and too far back. If they think you are just gonna get better, they either don't know anything about this or they just hope you get used to it and stop complaining.  
As for Dr. Ensler, I really don't know him, don't know the extent of his training. I mostly endorse those who have further trained with Dr.Clayton Chan.  Look him up and see on his site, there are great info and a great application to find a doctor who has trained above and beyond the basic Nueromuscular training. With proper training and approach your case is very treatable.

I hope this helps.

H.Nassery, DMD

Thank you so much for your quick reply. I was moved pretty far forward but maybe I do still need to come more forward. I live in the Lubbock Texas area and there are few neuromuscular trained dentists in this area. Dr Ensler has trained at the LVI in neuromuscular dentistry. I previously found Dr Chan on the Internet & I will check out his site again for a recommendation. I would still like to know if it is possible to be moved too far forward or as my current guy says "the muscles won't allow that" but my muscles are not happy here that's why I was wondering if too far forward is possible because it also hurts More when I talk and move my jaw forward a little to articulate an s sound. Thanks again for your quick reply. I was feeling hopeless. Like I was stuck like this forever with irreversible damage from the braces.

Dear Frustrated,

You are not too far forward, even if you were brought forward, in the past they obviously did not maintain your bite and you have returned back to your old position. the reason is that they don't know what they don't know.  Here is a great operator nearest to you..
Gregg E. Ueckert, D.D.S.
7030 Village Center Drive
Austin, TX 78731
Country: USA
Phone: (512) 345-3166

Brian Hale, D.D.S.
1100 NW Loop 410, Suite 511
San Antonio, TX 78213
Country: USA
Phone: (210) 308-7008

I can personally vouch for these guys, excellent doctors, with superior training. We all started in LVI but there is much more than that out there. Lets leave it at that.

Hope this helps.

H.Nassery, DMD

Thank you very much!

Good Morning Dr,

i was wondering if you were able to review my case with dr mehregan..i have an appointment to see him tomorrow for an adjustment and probably talk about when i will begin phase II. i will mention my small setback and see what he says..although the "soreness" lasted about 3 days and went away..it made me think..and i hope you can give me an answer...in my case..having TMJ disorder for over 10 yrs..and just now getting appropriate treatment..how does my future look? will this treatment be the only thing i need or is TMJ a condition that will have to be maintenanced through out my life? i cant see having to go through all of this over and over..and im sure uve had plenty of experience to know what a persons outlook might be..

i am trying to stay positive through this journey and i thank you for being someone i can come too with questions and concerns.

thank you!

-Miryam

Good morning Miryam,

I have not spoken to him but now that you reminded me , I will call him this evening. The other questions... you have a good prognosis, once Dr. Mehregan puts the teeth in the correct positions, then your muscles will be more relaxed and the chances of relapse are much less than regular ortho.
this is not something yo have to do over and over, you should keep your posture right and keep healthy just as you would do normally.
remember, it took a long time to get to this state, healing will not be a quick event, it will be a process.

Regards.
H.Nassery, DMD

Thank you for responding..i just want to make sure i will have the "healing"...Dr.Mehregan is very condifent i will do great with the end result. i am hoping for the same.

thanks again.

-M

Hi, I am hoping that you can point me in a new direction. I was dx with TMD back in the 80s when hardly any dentists or Mds were treating it. I have had dentists who wanted to pull all my teeth (no I did not let them), had one that did put braces on me to re-align my already aligned straight teeth, I have had a permanent block (cant remember the actual term) placed behind my two front upper teeth (this has since been shaved down as no one can remove it because no one knows how is was actually permanently attached). I had bilateral open joint surgery in the 90s to shorten the ligaments and to put the discs back into place with PT afterwards. That gave me about 7 years of good relief. Then I had bilateral arthroscopic surgery that resulted in not being able to even get near the joint because of scar tissue. Then about 5 years I had another bilateral open joint surgery by the head of oral maxilfascial surgery at a very prestigious hospital where I live. At that time, he took out one of the discs altogether because it was so destroyed and he was able to save my other one. I have had some of the best PTs and Mds in several states address this issue. Well, now everything is back. I have limited AROM secondary to the first surgery which I have learned to deal with. But all the pain in back (fortunatley not to the point YET that I was last time), all the ear pain, ear stuffiness, TMJ swelling, and resulting muscle issues around my TMJ, down my neck, shoulders and upper back. I have no idea what my next move is. Can you suggest something. Thank You. Guess I should mention I am 47 yrs old, female and this was originally diagnosed when i was 17 and they thought I had tetanus.

Dr. Nassery,

I want to start by thanking you for being such a great resource on TMD and taking the time to respond to questions. This thread has been very informative. I am a 25 year old with the telltale symptoms of TMD. My jaw clicks, grinds and pops when I open it more than a finger width apart and sometimes from side to side motion of the jaw. I was told by a girlfriend that I clench and grind my teeth in my sleep (this was about 5 or 6 years ago) and this was reiterated by another partner recently.

A bit of history; I was told I needed to remove my wisdom teeth when I was about 17 or 18. I never had this done out of fear of surgery. The bottom two are mostly exposed, while the top are impacted. When I was about 20 or 21 my bottom left molar adjacent to my wisdom tooth cracked on the inner side and a piece broke off. I was told I needed a root canal and crown, a 2nd dentist told me he could simply fill the broken part with a filling (the tooth colored variety). I chose the latter. This dentist also gave me a couple other fillings for cavities which I feel perhaps weren't exactly even with where my teeth had previously interlocked. The only tooth pain I really ever feel is on the tooth above my bottom right 1st molar which had a filling which protruded slightly more than it should. I think the top one (the occasional painful tooth)  has been ground down a bit by this in my sleep. I probably have been grinding my teeth in my sleep since long before this, but I'm sure fillings that weren't exactly even with where the teeth were naturally made it more devastating.

My symptoms now, besides the sounds my jaw makes, include; occasional headaches, my jaw and facial muscles often  feel tense and tired, I get occasional jaw pain and pain where my wisdom teeth are, my jaw muscles get sore and tired if I chew anything chewy or hard, and my neck has been cracking and clicking very frequently (pain free) with many typical everyday motions for about 2 or 3 years now. I attribute this to poor posture (head leaning forward) possibly caused by TMD? I'm very physically active so perhaps these postural issues have had even more cumulative wear on my neck from weight lifting, tennis and competitive cycling. Also, my jaw does feel very full from the lack of space due to my wisdom teeth. Despite this and the jaw cracking, I can still open my mouth fully (unhinge the jaw-but this really cracks and hurts a little when the jaw sets back into the closed position) Beyond all of this, I have had a strange sensation in my chin and cheeks a couple of times which I wasn't sure if it was caused by muscle tension or nerve issues (perhaps from wisdom teeth roots?). I have always had an overbite, which would make me think maybe my teeth are making my lower jaw sit too far back. However, I am wondering if the issue might actually be my wisdom teeth and fillings actually making the jaw sit too far forward now because of crowding and uneven clenching back there.

I guess my questions essentially boil down to whether you think the neck issues are TMD related, the jaw/TMD issues are related to wisdom teeth/uneven dental fillings, and what my best recourse is? I am worried that removing the wisdom teeth now will exacerbate my TMD issues, but if they are contributing to it maybe I need this done. I am in the Pittsburgh area, so If you have any docs that you specifically recommend I would appreciate that info as well. I am intrigued by the websites of Dr. Babak Firouzi, DMD and Dr. Alexandra George, DDS. I am sorry for the lengthy post, I just wanted to make sure you had the proper info upon which to base your response. Thank you, and I also want you to know that you are a true asset to your profession.

Dear APOTR,

"all the ear pain, ear stuffiness, TMJ swelling, and resulting muscle issues around my TMJ, down my neck, shoulders and upper back. I have no idea what my next move is. Can you suggest something. Thank You. Guess I should mention I am 47 yrs old, female and this was originally diagnosed when i was 17"

Reading your story just kills me...I am sorry for all the agony you have gone through, because in my heart I  believe that all you needed was the right diagnosis and an appliance. The pain and discomfort is 85% muscular, and all they did was treat the symptoms...
You can still get relief from all this if your jaw is placed in a neutral position, using an appliance, not surgically.

Try and find a practitioner near you , by going to occlusion connections website and clicking on "finding a Neuromuscular dentist"  You will be able to see the level to which they have studied.

I hope this helps, and please keep us informed.of your case.

H.Nassery, DMD FICOI
www.miamibeachdentistry.com

Dear MMILO,

You are correct, your symptoms scream, TMD.
To answer your concerns,
1- It is a common belief that wisdom teeth have some to do with this but I have to disagree, while there is a minute possibility that your jaw would be pushed back if your wisdom teeth get exposed on an angle, it is more likely they only exacerbated an on going condition.
2- While the name of the practioners you  mentioned are familiar to me, I can not endorse their work,. I don't want to get into the details of the different camps and ideologies. I, as well as many other Nueromuscular practitioners started at the same center, however, the success of my cases and the resolution of my patients cases markedly increased when I followed Dr. Clayton Chan's protocols. I hope this helps.

H.Nassery, DMD

Hello Dr. Naserry,

I'm a 29 year old white female. I got braces when I was a teenager to correct my overbite. I kept wearing my mouth guard in the evening until I was 18 when I got crowns placed on my two front teeth. My mouth guard didn't fit any more so I just stopped wearing it instead of getting it re-sized. Over the years, my overbite came back but not as bad compared to when I was a child.
The last 5 years, my symptoms have become worse. After seeing so many different specialists, I was told that I had TMJ.
I have been seeing a TMJ/TMD specialist to help my symptoms. I got day and night appliance to realign the position of my jaw. All is great when it comes to my jaw position but now, over the last two years, my top teeth have shifted positions not aligning with any of my bottom teeth.
I now have a big gap between my bottom and top teeth. I have been experiencing lots of pain in my face causing my headaches to be unbearable.

I have a good feeling that my top teeth need to be re-aligned, but how?
Will I need braces again? I feel lost again and right back at square one.

Melissa,

I am sorry about your pain. First , Please tell me when you had braces as a child, and they corrected your over bite, did they accomplish that by extracting any of your teeth? if so which ones?
As for for the TMd Doctor you  have been seeing.. personally, I am a simple person, and my thinking is that we have one set of teeth, and I should be only giving my patients just one orthosis, that they should be ok in day and night..

The reason you can not bring the teeth together is that you have actually had some healing in the joint, and your discs have been recovered to some extent, ...thats a good outcome, but you need an anatomic orthotic that you can wear and function with 24/7..so that you would have positive contact with.. and yes if your teeth are in otherwise good condition, then  you should get braces to correct things at the end.
When choosing your TMD dentist make sure they can finish your cases, be it orthopedically or restoratively... these should be discussed with you at the onset..no surprises..

Hope this helps.

H.Nassery, DMD
www.miamibeachdentistry.com

Dear Doctor Nassery,

I have read many postings today and want to thank you for being more than a health care provider, but a human being that cares about pain. Forgive me as i hope not too take too much of your time, but am at a loss for what to do next, live with daily pain, and have spent money that I need, but would be ok, if I had relief or a plan. I am 51 year old female and since early December have been to my dentist many times as I had left cheek pain, especially when palpating with my finger deep in left mouth adjacent to molars. It feels like a rope, that apparently is a muscle. I also have ringing in ears, initial deep ear pain, periodic temple pain, cheek can hurt with too much smiling and talking. If I close lios and use my nuscles to pull left cheek towards ear, I feel the pain or if I stick a melted ice cube in cheek, its painful. After I chew a dinner, the pain increases. It is tender in mouth and also to press on outside. If I lay on my left side, I feel worse, even bending down makes it hurt.. I take Baclofen and Tylenol and also try an occassional Celebrex. Two weeks before this started I had left knee surgey with intubation and a painful( knee) healing. Prior to the surgery, I had a session of minor trigger point injections in neck and lower back of head due to prickly neck pain and arm pain from doing some cleaning.  I had been doing upper cervical care for this neck/arm pain and with the shots and exercises the neck and arm pain left.   Within a week after the shots and also the knee issue, the cheek pain started. I went to an ENT and sinus CT was fine, but he did notate a calcified and slightly elongated styloid process, but was clear that had nothing to do with cheek issue. He offered to do a styloid injection, but ive not done this. I had a negative MRI of my head back when neck pain was being accessed. My dentist sent me to an Orthodontist and his thought was possible TMJ and to massage.  He put me in a supine position and moved my relaxed my jaw with both hands, commenting my bite may be off. I briefly saw an uninterested Oral Surgeon, who ran a negative panoramic and did not feel clicking or popping and suggested a mouth gaurd from Walgreens. I might add he was most expensive for a ten minute talk. I called another dentist duo in St. Pete to see if I could just get a cone x-ray they advertise and they referred me to Dr. Piper. My  dentist said she could make a mouth gaurd for $350, but suggested I try massage first, although she noted I was a grinder from my teeth and I do wake up clenching. I can only put to small fingers in my bite.  She asked me of I felt my teeth meet and I do, but right side first. She used some grey strips to test bite as a right molar crown was built back up after I ground through it in December, and six times that same day re-ground to adjust bite. At that time of crown repair. the assistant pulled my cheek so high and far to the left due to small bite, it was stretched and hurt bad. Much poking, pulling and prodding has taken place in the past months. I know I'm physically and mentally exhausted and really have had to avoid all social events.  I opted to try acupuncture ( once last week and twice this week).  I've had two treatments of which I can say I feel better for about 24 hours, but afterwards did hurt where TMJ needles were placed when I bit down, but briefly, then better for a day. The Accupunct commented my left jaw was out of line when she felt TMJ while looking at her. I am again trying self massage. I thought an MRI or Ct of my TMJ would be good choice, but it was not an offer. I called Dr.Piper's office, but he's booking into July and a consult is $2000 up front. I live in St. Pete and know my next move must be the right move as it will probably take all I have left, but so be it if i can have a diagnosis and plan? I see an Orafacial Pain center in Jacksonville, but that would be a stretch for me with flight, hotel, etc. and then then how to continue treatment if I lived in St. Pete.  Shands has a satellite office in Seminoke, but not taking new patients.

I am grateful for your time and most of all wisdom and kindness on any specific guidance you may offer as I am at my wits end.

Thank you,

Kathleen

Dear Kathleen,

I am truly sorry about all that you have been through. Just last week I had a patient that clearly had the same concerns as you. With all the mis-information out there and with all the differences of opinions and modalities, I can see how consumers can become so confused and loose their trust in the profession.
The only thing I can do is to tell you what I would do, or wouldn't do for that matter. Let me list the things that I don't believe in and therefore I don't do;
1- I don't do trigger point injections, as they are masking a problem, clearly there is a problem that's causing that and we need to find what that is.
2- I don't do any restorative or orthodontic treatment, until the pain and symptoms are alleviated. Just doesn't make sense to go from point A to point B, if you don't know for sure, point B is really your destination. So I don't touch your teeth.

There are many different groups that suggest that they treat TMD, most in my opinion, are focused on treating the symptoms. From your description, I gather that you have a closed bite, also that most your pains are muscular. Most of your treatments so far have focused on your pain symptoms. There has to be a reason why your muscles are so over worked that they are in a state of spasm constantly,   ask yourself, if you always got spasm in your leg, would you get shots in your muscles or would you try and rest your leg muscles and relive them from over working.
What I am trying to tell you is that maybe where your teeth meet is not exactly where your muscles like to work ..
That makes you like most of us.. most of us can adapt and deal with these issues and some can't
My approach is different from the other clinics you mentioned and in my view less intrusive. The closest Dr. to you that I can recommend is
Mariela K. Lung-Compton, D.M.D.
5055 S. Lakeland Dr.
Lakeland, FL 33813
Country: USA
Phone: (863) 647-322

I hope that helps and please, regardless of whom you decide to see, keep us informed of your progress. Like you there are many people that can benefit from this site.

H.Nassery, DMD

Dear Doctor Nassery.

I have just been diagnosed as suffering from "TMJ Arthritis"  (just 5 days ago).
I thank you for this very informative website.

I am 54, female, with a history of dental problems due to gum problems and have lost two molars at the top jaw and 4 front teeth in my lower jaw. Another tooth was due for extraction on the right end of the jaw but I had had a lazer surgery in the right eye and therefore postponed the extraction for over a year. I do think this may have caused the TMJ ?

I have recently developed clicking sound in my jaw, ear block in my right ear and a general uneasy sensation around the Jaw joints especially after a meal.

The Orthopedic Doctor I went to has put me on some Tylenol like medicine and has asked me to rest my Jaws - No talking and only liquid diet for the next 10 days. I have a uncomfortable feeling around my jaws most of the time.

After reading some of your postings I understand there is going to be lot of pain coming my way.
Can you tell me what the difference is between TNJ Arthritis and Disk displacement  ?
Are they the same ?

Would you know of any TMJ Specialist in Bangalore, India ?

Please suggest.
Thanking you for your time and kindness
Lalitha Ramesh, Bangalore

Lalitha,

TO answer your question, TMJ Arthritis is not the same as Disc displacement. Usually displacement happens early on due to malocclusion,  and then the arthritis will happen after many years of bone to bone contact and poor function.

I always tell my patients; If we believe that form follows function, then deformity follows dis-function.
You have lost many teeth, and this has caused your jaw to stray from the normal closing position to provide you with some way to eat. But this is a pathological position, and therefore, the damage to the joint has occurred.

Having said that, it does not mean you have to live with pain. If things are corrected you can live pain free.  We all have certain degree off arthritis in our joint.. well most of us.. I know I do.
Unfortunately I do not know anyone there that I can recommend to you, but I would start with re-establishing my bite by replacing the teeth that have been lost, and opening the vertical dimension of your mouth as close to the original space as possible.

Hope this helps.

H.Nassery, DMD
www. Miamibeachdentistry.com

Good Morning Dr!

I just wanted to update you and others following my progress..i have now been wearing my orthotic since the end of September of last year..roughly 7 months...the progress has been great..i do not have any discomfort except for my only continuing complaint ive had since the beginning...every morning i open my mouth and my jaw muscle is very sore.. then it goes away..i still dont understand what might be causing that..my only thought could be clenching in my sleep..but i am not 100%...i just dont what this to ruin my treatment and the progress in the long run...i always feel a little tense in my jaw area..but dont know what might be causing it for me to find a resolution..hoping you have insight?

Moving forward..this saturday, Dr. Mehregan will begin phase II of my treatment which will be Braces and an Expander in addition to my orthotic. I am a little scared but more excited than anything else.. with this i am hoping the jaw deviation will reduce, if not eliminate..i am hoping for the best.

thank you again for all you do and the help you've given to many including myself!

-Miryam

Miryam,

First thank you for sharing your whole experience with all of us here on this forum. You have helped many.  I am glad to hear that for most part you are doing well. I had a visit to Boston earlier this year and got a chance to visit Dr. Mehregan and we spoke about your case in length. I assure you he is on top of everything.
Remember that we are trying to bring some what of a normal function to your mouth with the oral appliances. However, as you know there is a degree of attainability, now its time to bring your real teeth into the right position and inch in the last little remaining issues resolved.
Again, I appreciate you sharing all this with our readers. Keep it coming.

H.Nassery, DMD ,FICOI ,FAGD

I was told years ago that I have TMJ or TMD. its sore if i talk too much and it means i cant put the teeth on my right side together without really trying.
But in all honesty it does nothing. Its not life threatening and the guy knew as soon as he felt the joint and my face.

MRI and CAT scan my backend!.
My tmj/tmd is actually bizzarely a genetic trait. Both my mother and her mother have the same problem on the exact same, neither of which ever got it fixed.
Again they were told just by feeling the joint.
Sure you cant tell the cause but you can sure as heck know that its there. (our jaw joints sit just slightly out of place because of it)

Was nice to hear someone standing up to those people who cant even use google...

Hello Doctor, Thank you so much for helping everyone out. :)

I have a quick question.

I have very mild TMJ or TMD, but I also have to extract my dead tooth (bottom right, second one from the back). My dentist said he can open it and close it back up afterwards.

Is it good or bad idea to proceed?

Thank you so much for your help.

Omgirl,

I am not sure exactly what you mean by opening and closing? please clarify..

Thanks .

H Nassery,DMD

Good Afternoon! its been a few months since ive posted so I thought it would be time to give an update. I have now been in treatment with an orthotic for a year, wearing it 24/7. my pain has subsided and I can do things almost completely normal..i currently have an expander on my top arch and braces on my top teeth. seems like a lot at once and at first does feel that way but I have been gradually getting used it with no issues.

although the expander is taking more time to widen my arch since I like I am still very optimistic it will work. I am just hoping after all is said and done I will feel back to normal..example..if I open my mouth wide my jaw deviates..Dr. Mehregan says I am hyper extending but that's how everyone opens up..wide!..im just not sure if my jaw will open and close effortlessly (like I never had TMD) by the end of all of this..and if will ever eat anything id like or open wide without being scared

either way I am grateful and happy with my progress and will continue to keep you updated =)

thank you!

Miryam,

So very good to hear from you. I am grateful for your updates, as it is a great help to others so that they find the power of Gnueromuscular approach.
As per the specifics of your case, I am sure once the expansion of your upper arch has been done and the movement is and before starting your lower arch he will refine your orthosis once more.. during which time he will probably take care of these small things again.  

Thank you for sharing your journey with us.

H.Nassery, DMD
www.miamibeachdentistry.com

Hi Dr.Nassery,

I am a long term TMJ patient, almost 20 years since orthodontics and tooth extractions when I was 16. It all started with inner ear cramp while I was eating but then progressed to fullness in ear, sinus headaches, dull pain on my right side, extending to my occiput, then to my neck and even lower to my shoulder blades. Also I have a masseter muscle that is always in spasm and bigger on right. While I have these on right, I have tinnitus and clicking on left side and some abdominal pain which improves when my neck is better!

So I went to a neuromuscular dentist which has worked with occlusion connections, spending a lot of time and money. They made a orthotic and corrected it a couple of times. My problem is my neck tension is better (not completely gone) but my tinnitus is gone over the roof! I cannot even work! They say that it is ok, I cannot believe it. What is your opinion on tinnitus? I feel like it comes and goes with the tension in my muscles and cannot understand why a NM orthotic would exacerbate that.

Many thanks for taking your time to answer these questions. I found this long forum really helpful.

Regards,
Ege    

Also I have to add that I have overbite and when I close you cannot see my lower teeth. I feel like turning my jaw to right when I open my jaw every time. The dentist used K7 and jaw tracking to find my "ideal" position but then he offered me 3 impressions which then he picked one on randomly. He said that machine cannot differentiate between them. I found his approach a little bit hit and miss. My orthotic feels like I am holding it in my mouth. It does not click into place. The practitioner says adjusting will take time. 2 weeks of high pitched tinnitus and it seems things are not improving.

Regards,
Ege

Hello Ege,

This is a bit long and technical in nature but I am glad you asked.
There are two ear/hearing related muscles that can be effected by TMD issues. Tensor Veli Palatini and Tensor Tympani. Unlike other nerves in our ear , these two are innervated by the Trigeminal nerve and are part of the feed back loop. When deep pain happens from a primary source like your muscles of mastication (i.e. masseter, temporalis, pterygoid) the effects can spread to other divisions of the same neural segment.The severity of these effects will depend on the intensity and duration of the primary pain.
TVP, opens up the narrowest part of the Eustachian tube lumen to ventilate the middle ear and protect the middle ear. If this was effected, you would be complaining of fullness or pressure. Kinda like talking in a Drum, or echo chamber.
Your problem sounds like a dysfunction of the TT, Tensor Tympani. This muscle reduces the oscillation of the oscicles, protecting against loud noises. Patients usually complain of extreme sensitivity to loud noises.

Ear symptoms are some of the most difficult ones to resolve, and as I mentioned the recovery is highly dependent on the duration and intensity off the primary cause. However, I would tell you something from experience; if we can make it worse, more than likely we can make it better.

Hope this helps answer some of your questions.

Regards..
H. Nassery, DMD FICOI FAGD
www.miamibeachdentistry.com

Hello Dr.Nassery,

I have TMJ my jaw clicks when i open my mouth wide and close it and sometimes when i eat and there's ringing in my ears for 4 years now , im 21 i tested my ears many many times and it was fine! i made CT scan on my jaw it was fine too, my dentist told me it's because of the molar that i have lost 4 years ago on the right side of my lower jaw which made a muscle strain on the right side and imbalance bite and there are two teeth that drifted on the right side too! so im wearing a splint for a month now i take it off when i eat or when i brush my teeth and in two weeks im going to implant a new tooth to balance my bite again but i don't know should i put braces first to adjust those drifted teeth or what ? or should i wear the splint more time? will the implant fix that problem ?

my splint

http://s10.postimg.org/z4yjy3709/image.jpg

my right side

http://s23.postimg.org/on125e8l7/image.jpg

http://s13.postimg.org/4m1x3ymav/image.jpg

http://s11.postimg.org/treima10j/image.jpg

Raul,

Based on the story you told here, your bite is collapsed, and if you place an implant crown in the same collapsed bite you will continue to have the same issue.
If you have the symptoms you mentioned, it is a sign that you jaw is over closed and that the condyles of your jaw, the part of your jaw bone that is in contact with your temporal bone, is too far up and back, and hence has pushed your disc out of position.( the reason for clicking and popping) you need to set the jaw in the right place and then , yes do the orthopedics to bring your teeth to that position and lastly put the implant and crown.

I hope this explanation helps.

Sincerely,

H.Nassery, DMD
www.miamibeachdentistry.com

thanks doctor so now i have to wear the splint longer ? the splint already helped me in a month and the clicking sound is not loud as before!
and i have no limited opening i can fit 3 fingers, is that a good sign ?

Raul,

I really can not make a comment on your splint as I can not see what it is.. When I think of an appliance, I think of an orthotic. Orthotics, are fully anatomic and functional, they are made based on very specific measurements done by computer  jaw tracking. You function 24/7 with them. Only that way you can have full healing and resolution of your problems.  
Flat splints, that are worn part time are based on arbitrary position, and at best only alleviate the issues, but will not resolve it.

Regards,

H. Nassery, DMD

ww.miamibeachdentistry.com

thank you doctor i understand now and i guess i need to wear it 24/7 and so it's not the right splint for me that im using now! im sorry for being annoying but it's kinda like I'm my own doctor cause there's no TMJ specialist in my area and all dentists are just underestimating my problem! so please tell me what kinda of splint i should use? does it have a name ?

Raul,

Don't apologize, there is no need.. You are absolutely right, there is a big void in our profession in this area.. and most dentists do not have enough experience in the matter.
The appliance I  talk about is fabricated based on very specific principles. Please go to occlusionconnections.com and read more as my teacher, Dr. Chan has extensively written on the subject. There is also a way for you to find some one qualified near you.
You are on the right track, the more you learn the better decision you will make when it comes to your health.

Regards.
H.Nassery, DMD

wwww.miamibeachdentistry.com

thank you doctor, i just have one more simple question. can a displaced disc back again to the normal position as long as there's no damage in the joint? or those therapies are just treating the related symptoms and not the real case ?

Raul,

This is a very good question. First let me tell you that I , personally have never had a patient come to me for treatment because they thought their disc was out of place. They always are in some sort of pain. Be it, headaches, neck pain, jaw joint, or other postural issues that arise from this problem.
The fact that disc is out is hardly the issue in their mind. As practitioners, we always look for the most physiological place for the jaw, the muscles, and the joint. This happens to be where the disc will also have the room to hopefully go back to and stops the re-injuring process to it.
If I had to guess I would say that sometimes the disc is re-captured and sometime it can not be due to the extent of damage to it. But the patient would be comfortable and function just fine.
I hope this helps.

H.Nassery, DMD
www.miamibeachdentistry.com

thanks Dr.Nassery indeed it helps i appreciate it, i had a late a late opening clicking and now it's kinda early opening click and i feel way better no loud noises anymore but a few days before i get my splint i used to hear noises like crunching or something with no pain at all and this crunching is gone in just two days after wearing the splint but i wanted to know what was it? is any crunching means in the joint means osteoarthritis ??

Raul,

You have great questions. The crunchy noise you describe is called "Crepitus". It is the sound of your retro-discal tissue getting squeezed between your jaw bone and your temporal bone..
I describe it like pressing on a bag of chips when you have the bottom crumbs in there only. I don't know if that makes sense, but that's how it sounds to me..

By this time you understand that your disc is damaged, you have had bone on bone function for sometime, and more than likely there is Osteoarthritis..Is that a death sentence? No, if you are like most and have done sports as a young man, you will probably experience this in other joints in your body.
When  it becomes really unbearable, then you will learn how to treat it.. I have bad knees and broken toe, from playing soccer for many years.. Nowadays, I can only run slowly, in a straight line and for a limited distance..

Most patients I treat have more symptoms than just noise.. You are pretty lucky to just have that.
Hope this explains things, happy holidays.

H.Nassery, DMD

www.miamibeachdentistry.com

thanks doctor that's very helpful:) this crunching sound used to appear after a specific slight click happens and then after a few hours or a day it goes away! so is that slight click means something ? and if the crunching stops is that means the disc is not being squeezed anymore?

Raul,

Yes, all these information helps us make a diagnosis and paint a picture of what it maybe like inside the joint.. Generally the later the click the more damage has been done to the disc.
And yes, if you are wearing the splint all the time , you are basically creating space for the disc to recover and you are preventing your jaw bone from squeezing and damaging it more.

H.Nassery, DMD

thank you so much doctor :) so as long as there's no squeezing anymore the disc can be recovering ?

I'm in search for a Doctor that can treat my hyoid bone syndrome.
I was hit in the neck, it fanned out, I've been in severe pain ever since.
I've had brain surgery for the 9th & 10th cranial nerves, still in pain.
I've seen countless ENT specialists that have no knowledge of this syndrome. Dr. Edwin Ernest DMD has a published report about this syndrome, however, I've not been able to find a Doctor that will help me.
I am wondering if you have any knowledge of this disorder? Or, do you know of a DMD in the Metro New York area that does? If you can help me, I'll book the next flight to Miami.
I've contacted the Ernest Clinic, they are not accepting new patients. They referred me to another Dr. in Ohio, also not accepting new patients. My pain is my life, and the quest to find relief is never ending.
Any information would be greatly appreciated.
Thanking you in advance.
JustinPain

Dear Just inpain,

I really think this is outside of my realm of practice. It sounds like you should see a Neurologist. I know that many of the signs cross over with TMD like issues, but I always ask my patients to rule out any and all possible medical issues before trying out the dental route.
Having said that, the best Nueromuscular dentist I know in NY, is Dr. Peter Ferro. He is in Manhattan. If anyone can helps you and if this is the way too help you, he can do it.

I wish you all the best. Please keep us informed as per to your findings periodically.

H.Nassery, DMD
www.miamibeachdentistry.com

Dear Doctor,

I am 20 years old and live in England. I am pleased to have found this site. My experience is that six months ago I had tonsils and adenoids removed and then developed terrible jaw pain which I find debilitating, I struggle to talk, eat or walk and wonder how I can get through each day. There is also clicking in my jaw joints every time I swallow.  I saw a specialist at a London hospital who advised me to take an antidepressant (notriptyline). I doubt whether that will be the solution. I would be very grateful for any advise you are able to give me on what I should do to alleviate the pain and sort this problem out.

Very best wishes

Claire

Hello Claire,

I am sorry to hear about your issue, but rest assured that there is concrete evidence that these cases can be helped. I know that main stream dentistry has not caught up to our work and they tend to think of this as a psycho social disease..and it definitely can, in long term have those effects, but it is in its root a skeletal issue.
The only person I know in England that does something similar to what I do is
Dr. David Cook
London Holistic Dental Center
39 Harley Street
London, W1G8QH
020 7323 1363

I hope this helps.

H.Nassery, DMD

Thank you for that information, I will check that out.

Best wishes

Claire

Hello Dr Nassery,

now im about to put braces on but i don't know but that slight click is still here but crunching is gone and im seeing an osteopath to help with my posture issues so what do you think should i go with braces to fix that drifted teeth ?

Raul,

This is very difficult to ascertain with out a clinical exam. Personally I don't go forward till I have resolved the clicking. However, having said that, there are times that clicks can not be fixed. It depends on the timing of the click, and when during the chewing cycle it happens.
Generally speaking the later a click happens during the cycle the more difficult it is to correct.
I hope this gives you more information to make a better decision.

Regards,
H. Nassery, DMD FAGD, FICOI
www.miamibeachdentistry.com

Hello Dr. Nassery,
I am amazed to see that you are so helpful and consistent by answering each and every post since this started in 2009! What a great doctor you are to be willing to help so many people with their questions and concerns.
  I too, have TMD and I have read so many articles and forums about people who suffer from this problem. While it is sad that so many people have it, it is also a great thing to be able to read what others say about it and what has/hasn't helped for them so we can all learn more about this disorder.
  I am curious to see what you would recommend for me and my situation. I have had problems with my jaw since I was a teenager (I am 33 now). It used to pop and lock when I was a teen and it caused headaches as well. Now it has become a constant problem for me. I am always in pain and it pops and clicks whenever I open my mouth to eat or yawn. There is always a dull constant pain that feels as if I have chewed for a week non-stop and it has caused constant neck and shoulder pain and tightness. My husband has helped by massaging my neck and shoulders every few days and that loosens it up but it comes right back. I have seen a dentist who told me that he can make me a customized mouth guard to wear at night but my insurance doesn't cover a penny of it and it would cost me around $1300 to get it, which I can't afford. Right now I use a store-bought night guard which helps a little. I went to a chiropractor and asked me if I had been in some kind of accident to cause my jaw to be so messed up and he couldn't believe I hadn't. I am not sure what caused it. Anyway, he helped relieve the tightness in my neck and shoulders and he gave me some excersizes to try for my jaw that consisted of massaging the joints while slowly opening and closing my mouth. It resulted in my jaw popping worse than before and even more pain. After seeing him for a couple of months I felt like I was at a stand-still so I quit going. I was taking Ibuprofin throughout the day every day and even after taking 800 mg, it would only take the edge off my pain. My doctor prescribed me Hydrocodone for the pain as well as a muscle relaxer (Flexeril) and a nerve-pain blocker (Gabapentin) and he told me to not take them all together but to try them at seperate times and see what works best. The Hydrocodone helps more than the Ibuprofin but I don't want to take that all the time because of the risk of addiction. I tried the muscle relaxer for the first time last night and while it did help me sleep well, I felt groggy and 'out of it' this morning and still have pain. I am nervous to try the nerve pain blocker after doing research because one common side effect is extreme depression. I have depression now and I worry about it worsening. I think my depression is a little bit from the pain I am in every day on top of other issues. My husband is getting irritated by all the stuff I've had to do with my jaw and he says we can't afford to keep going to different dentists and specialists. He just doesn't understand what I am dealing with. He thinks I should just be able to find something that works and move on with my life and it is very frustrating that I can't do that. It isn't that easy. What do you recommend I do now? I feel hopeless and lost right now. I appreciate your help.

Kitty,
Thank you for your kind complements, yes this post has been active you could say..

First let me tell you that you are not alone in this... I see an average of three patients like you per week.. I mean patients that are highly symptomatic, I don't really count all the people I see with multiple signs..
All things you said are related and related to the same problem.. I am going to go through your list as I remember..
1- clicking and popping of the joint: All this means is that, where your teeth come together  has never been in harmony with where your jaw joint and musculature would want to be or work... hence your muscles are all sore, and your disc in the jaw joint is torn..and pushed out.. the popping you hear is the disc jumping back in the joint when you open real big..
2-I am glad you did not spend $1300 on a night guard... that would not do anything that the $35 over the counter one from CVS or Walgreen wouldn't..they are all palliative at best..
3- What the chiro did was actually more helpful than you think, however, when it is combined with the proper treatment dentally. What do I mean? .. You are currently continuously damaging your jaw joint, "every time you put your teeth together"...on the average that is 2000 times per day for an individual..So he was helping you recapture your disc into the joint, and from the sounds of it it was working but then you would eat or swallow and crushed it back out again, hence more pain again..so I would not recommend it unless you can stabilize the jaw joint and position first..
3- As for the pain meds... I am not big proponent of them as this is a skeletal/functional  problem and needs to be corrected accordingly..not by meds..but I do understand they serve a purpose.

Look the reality of it is that the treatment needed is expensive, it should be covered by medical insurance but that is another discussion for another forum perhaps.

4- Depression and high emotions are all part of the complex as well.. I can only imagine how difficult it maybe to deal with these pains everyday.. if it makes you feel any better, the demographic of my patient pool is 3/4 female, average age 45.. As for the men, it a lot less to get them here .. our tolerance for these types of pain is a lot lower than you guys... It always amazes me how much pain female patients put up with.. so I know when you guys complain it has to be real bad..

Look you need a good Nueromuscular dental practitioner, and you can be a great deal better.. look up some of my colleagues in your area on "occlusion connections".. Dr. Chan is my mentor and teacher and on his site you can find practitioners that have completed his training..

I hope this helps.

Regards,

H.Nassery, DMD
www.miamibeachdentistry.com

Hello, I just came across your website and I am so thankful that I did. I am hoping you can tell me if I am in the right hands, per se. I had my wisdom teeth taken out about 12 years ago. Ever since then I had on occasion slight clicking or popping in my rt jaw joint when eating. Back in Nov 2013 I woke up with my neck stiff ( slept on my front which I normally don't do and realized that my neck was a little over extended ). As the day progressed I started noticing numbness across my right cheekbone to my ear. This numbness slight pain would radiate down to right side of chin and back. Occassionaly would move down right side of neck too. The next day I was told to come in the ER as they thought I had had a stroke. This was not the case, thank goodness. A week later I had an MRI which showed nothing. for the 2 months I dealt with the facial numbness off/on, something with burning pain or a pain right by the right side of my nose. I then was told by my dentist that maybe could be something to do with my clenching at night. never realized I did that as I really never woke up with mouth pain, ect. Early part of January I saw a TMJ specialist in Middleton, WI who went thought all the tests, touching here and there and in most case that hurt like you would not believe. He stated the following on me:
anterior disc displ w/reduction
capsulitis
cervicalgia
cephagia
From there I started to wear a 2MM soft lower splint then after 1 week a 3MM soft splint. Almost immediately I felt some relief ( small amount of numbness rarely and more when I wear shoes with more than 1/2 in heel ). I went though the TENS and having what looks like a helmet a few weeks ago. Now I am wearing a harder, acrylic splint that to me is so big that my front bottom and lower do NOT touch. I was told that they may never touch again!!!! I had all hopes that I was on the right track, especially after spending $4000 so far. Now I feel like I should have given my mouth more time. maybe it would have gotten better or maybe the numbness symptoms would come and go less often and I could deal with them. I go back in a week to see how this orthodic is working, but I can you tell you that I am really worried. When I was wearing the 3MM splint and had so little issues. When taking out to eat I would get some clicking or popping in right jaw, but of course would go away once I put the splint back in. Now when I take out the orthodic ( I am having a terrible time eating with it and keep biting my cheeks ) I now have clicking on both sides...
Please can you tell me if this all seems part of the course? Is it right to be told that I may never seen my front and bottom teeth touch again? Keep in mind all my teeth touched before. The issue the dentist said I had was a overbite.

Please any help or suggestions would be great!!!! I am feeling so depressed and hate to sound vain, but would like to be able to smile and show my teeth....

I should have also noted some other symptoms I was experiencing before the 1st splint.

facial tiredness, whole jaw would feel tired - I know sounds odd.
headaches behind right eye mainly
and my jaw locked right around same time I noticed I slept wrong ( really wish that I could remember if before or after ). it actually locked 3 times. I would not notice except when I would wake up at night it was locked ( all 3 times ). I was able to unlock it myself.
I now have had since starting the splint therapy terrible facial redness and some swelling. ( redness goes from face to upper chest ) and now I am being told that I have rosacea ( which I know you can't do anything about ), but seems odd that that start right after wearing the splints...

Dear better health,

the answer to your questions are all in the previous posts.. I have probably answered them many times over.. your symptoms are very typical, none of it really seems strange at all..So from what you have put thus far, the only strange thing is how long it took for you to become symptomatic.
Obviously the TMJ doctor is on the right path.. what I have so far understood from you, is that you are over closed, and you definitely have a torque or turn to the right. ( we are talking about your jaw, of course)

So you think because your teeth met before that things were ok? not at all , you are in this pain because it took too many other parts of your body to compensate for your teeth to come together there..namely your neck, and your jaw , are so far the ones that you are feeling.. but don't be surprised if you start having lower back pain and other postural issues as well.. Forward head posture? one shoulder up, one down?  have you analyzed your whole body?
So what has to happen? they have to stop the damage you are inflicting to your joint and the meniscus or disc in it.. that is the clicking you hear, the disc getting back in and then out of the joint..
There are ways to bring the teeth back together again, but after there is more healing, and then doing braces the right way. Dr. Clayton Chan, my mentor has refined this process. You can read more about him and his teachings.

I hope this helps. Get more information and learn more about your problem.The ore you know and understand the better decision you will make about your treatment options.

H.Nassery, DMD FICOI  FAGD
www.miamibeachdentistry.com

Dr. Nassery,

First, Thank you so much for this site.  Fortunately, after reading this blog I do not have TMD as bad as a lot of people,  which I am greatful.  My question for you is where do I find a dentist who has experience in this ?  I have gone to 3 they all say they are experts but, I get little or no help.  When I go to the next one he says the last DR, made a mouth guard that is incorrect. " I will make you another for $2,000"  I am on my third Dentist / Orthodonist , I saw him today he says both of my previous splints are wrong. He will also make me a new one for $2,000.00 Not sure if I believe him. The last one I had made was by a Dentist / Ortho.  in DE.  He made a mold, then a guard,  it fits on the top of my teeth.  It does not allow my back teeth to touch but my bite is off and I have  terrible pain in my jaw when I lye down or sit.  When I am up walking around the pain is low.  I go from a 8 or 9 to a 2-3 when I am up.   I am so unsure of what to do about who to see and should I attempt to have another splint made. I live in Danville, Va. I am 1 hour away from  Greensboro, NC. I am 3 hours away from Charlottesville, Va.  I wish I  was closer to Florida.  Please help    There is of course much more to the story but I do not want to bore you with small details.  I will say I have had this for 10 years,  Some times I have gone 2 years with minor jaw problems. then I have a year of torture. This is one of those times.  Thank you..  Joan                      

Hi Joan,

I am sorry to hear about your issue, your experience is very typical unfortunately. I have thought about this for a long time, after all  am another one these guys telling you my way is better.. I usually give the name and the number of at least three of my patients for reference. I think patients must ask for it .. how would you know if some one is better or not?
Look I have all the respect for all other clinicians and their methodology, but I have to do things that makes sense to me, and my patients have to understand the treatment as well.. there has to be an end point. The first objective is to take pain and discomfort away, and the second phase is to bring function between the two arches in that comfortable place. You as a patients needs to understand the objectives of your treatment.  

Now as far as your issues go, first you have to understand that you have had this issue all along what you consider health 10 years ago, I consider being asymptomatic. Now you are symptomatic. My prototypical patient is female(75%) with mean average age of 46. They all have had this issue ever since they had their second set of teeth, its just that most of us can cope with and accommodate imperfect bite when we are younger, but as we get older our coping mechanism does not work as well... other joints like our jaw, our neck and back which have been compensating to allow that bite to come together have been paying the price.. our muscles have had it.. they don't want to do it anymore..and they are now vocalizing their dismay..

As for a clinician I can recommend..please visit my mentors site, Dr. Clayton Chan, and first read more and learn about your issue, then look up for some one in your area on his site that has had his curriculum completed or nearly completed..

I hope this helps.

H.Nassery, DMD FICOI FAGD
www.miamibeachdentistry.com

Dr. Nassery,
     Thank you so much for this valuable information.  What a wonderful person you must be,  to give of yourself.  There are not a lot of doctors like you giving their free assistance. The best to you.   Joan

Dr. Nassery, I see you've mentioned you know Dr's in Jacksonville. I have a long history of this disorder and right now it's out of control. The dentist I previously went to is now retired and I've been referred to a specialist by my current dentist as I have a pretty advanced condition and it is prohibiting me to get dental work I need. I've had TMD since before 10 and I'm now in my 30's. The specialist that I was referred to does not take insurance which stinks because I have very very good insurance, multiples actually. I was referred here theorofacialpaincenter.com/ . Do you have any suggestions for other Drs?

Any advice is greatly appreciated!
Sara

Sara,

With all due respect to this clinician and her methodology, this is not what I do. The debate goes on, and I guess the only thing that matters is the results we get for our patients..
As for insurance, I have to be honest, the word "good insurance" is an oxymoron, specially when it comes to dental coverage. I have yet to see one of my patients properly covered by any one insurance plan.
Please visit the site of my mentor Dr. Clayton Chan, and both read about what we do and also there is a place there that you can find a clinician close to you who has completed the curriculum with him.
I hope this helps.

All the best.

H.Nassery, DMD
www.miamibeachdentistry.com

You are awesome and I completely agree with "good insurance" currently mine covers about 70% of care that's not the basic stuff. I apologize for you having to repeat yourself on Dr. Chan but I am thankful, I wasn't sure where to go and I will check him out.

Thanks again!!

Sara,

No need to apologize, I have been answering this thread 2009... as I think there are many like yourself that need direction. I like to think that I make a difference by these few words. I sincerely hope you find help in both understanding your ailment and its resolution.

warm regards,

HNassery

Hello Dr. Nassery,
the click doesn't happen that much during the chewing or i could say that i try to avoid it and i can eat the whole meal with no noises at all or pain! my lower teeth are already drifted and there's a missing back tooth so sometimes i just think about getting those things fixed maybe will help?:/ one more thing doctor does jaw exercises are helpful or they would make the problem worse ? cause when i do some jaw exercises the clicking stops for a while and then back! im really thankful doctor for all your answers and im sorry that i keep coming back with different questions:)  

Hello Raul,

No need for apologies.. Here is the way I see it..The bite has everything to do with TMD, I know some of the other TMD experts don't agree with that but that's the way I see it and believe it.
So that's saying that if you have lost back teeth then your bite had collapsed on that side and  therefore anything else you do will only be palliative. Meaning that you need to replace the teeth lost but more importantly you must reestablish the original bite before you collapsed, and how to find that bite is the real trick..
I hope that answers some of your questions.. as for exercises, so long as they don't hurt you I don't see any problems with it.

Warrm regards,

H.Nassery, DMD FAGD FICOI
www.miamibeachdentistry.com

Dr. Nassery,

I had a first molar extracted two weeks ago on the lower left side.  When I was receiving injections, prior to the extraction, I felt severe pain three different times.  I have had my wisdom teeth removed and two other molars removed and several fillings, but I have never felt pain like I did when receiving the injections two weeks ago.  After two weeks, I can barely open my mouth enough to insert my toothbrush.  I tried eating a hot dog today, and I could not open my mouth wide enough to do so.  And attempting to open my mouth wide enough to eat a sandwich or donut is very painful.  How much longer should this last?

Thanks for you help.

Patrick

Patrick,

This sounds like trismus. Basically, a deep tissue hematoma. When they were giving you the injection the tip of the needle was still in your muscle and tore the muscle. Now you have a hematoma in the middle of your Masseter muscle, and it is tender and can not stretch.
Best remedy is moist heath from the outside, and warm salt water rinse through out the day. It will get better in a few days.

H.Nassery, DMD

Good Morning Dr =)

I am back again to keep everyone updated on my treatment/progress..i have been in treatment for TMD with my orthotic for a year and a half now..ive had braces for about a year am on my 2nd expander that ive had for 6 months or so..getting more expansion and sore teeth along with it (happy)

Overall my experience has resulted in minimal to non existent pain..compared to how i used to live i am 100% satisfied with the current process..i am happy i decided to begin this lengthy journey since it has proven to be beneficial in more that 1 way.

Dr. H. Nassery my question is, although i have been improving continuously i am still concerned about my range of motion and my jaw deviation as i open my mouth...im sure i have asked this before but since ive now been in treated well over a year i am wondering if and when will this part be resolved? i am wondering..will i be able to bite down on a large apple with no discomfort or fear once this whole process has concluded?

i do have about 2+ years left..per Dr. Mehregan's prognosis...

Thanks again for all you do for all of us!

-Miryam

Miryam,

Thank you for the update.. this is powerful stuff, and I am sure it will help many.
as per your question, since you are still in the expansion phase it is not really possible to pin point the perfect position. Sorta like trying to hit a moving target.. I am sure once he gets your final position on the upper arch, he will then retake your bite and make a new lower orthotic, which should resolve most those issues for you.
Of course here I have to qualify my words by saying that I am not privy to the details of your case but I have complete trust in Dr. Mehregan's work.

The great news is that you are pain free.

All the best.

H.Nassery, DMD
www.miaamibeachdentistry.com

Hi, I saw this article and was wondering if I could get some advice as well. Hopefully, the symptoms I am getting are due to either TMJ or a misaligned bite. I'll explain a bit.

Back in July, I needed a crown put on a molar that I chipped. About 3 days after this, I had very unusual symptoms (I was also in PT for a neck issue but the PT was going fine prior to this). I was getting some weird balance problem and felt like I was going to pass out at times, but never did. I even suddenly was having issues with heights when I never did in my life -- I've even been to the edge of the grand canyon! This lasted for months, and still lasts today (I've seen a neuro who could find nothing wrong in my head but suggested an inner ear problem)

Fast forward to September and I needed a root canal done and also had a crown put on. Sometime during this time, I developed ringing in my right ear. The root canal was on the tooth directly next to the one that already had a crown on it. Both crowns are gold crowns on the bottom right side.

My dentist retired so I had to find a new dentist, who did some evaluation on me and told me that my bite was off on the side my crowns were on. He gave a few suggestions but said the best way to fix it, is to replace the crowns with properly fitted ones -- and also suggested to go porecelin, which is what I wanted to do in the first place.  I do grind my teeth at night, more so than I ever did now.

Today, I still experience the balance issues, neck pain, ringing in the ear, issues with heights and my legs feel a lot lighter than normal (almost weaker). Can a tooth really cause all of this? I'm considering going to see a Prosthodontist to get this fixed. Do I need to replace my crowns? I'm not happy with them being gold to begin with... .

Dear Lucky,

It sure sounds like you have many of the signs and symptoms of TMJD, but really with out an examination this is just speculative.
The only advise I would tell you is before investing in another set of crowns you need to make sure that your symptoms have alleviated or gone..This can only be done by first finding your correct physiologic jaw position, which by the way should help your neck issues and grinding and so on.. only then you should think about restorations, so that you don't keep repeating the same mistakes.

Regards.
H.Nassery, DMD
www.miamibeachdentistry.com

Dear Dr Nassery,

First it is great that you keep on top of this thread 5 years after you started it!

If I may, I was hoping for some advice. I ama 30 year old male and moved to the US from the UK around 7 months ago. As soon as I arrived I had a minor dental issue - periodontis under a couple of teeth. I had deep cleaning but at the same time the dentist did a 3d xray of me - something I had not seen in the UK before - and discovered a whole lot more issues. He recommended a lot of work and, perhaps naively I went ahead with it all without a second opinion.

This involved;

October 2013 - Periodontal Scaling
October 2013 - Crown lower left first molar, onlay, upper second right molar
January 2014 - Two crowns - upper right, first molar and the tooth in front
March 2014 - 8 Poreclain Veneers, front upper 8 teeth (this was "to ensure I did not lose teeth through erosion and / or decay /and or have root canals over time periods ranging from3 months -18 months" according to the dentist, so preventative rather than cosmetic.
April 5th 2014 - all 4 wisdom teeth removedincluding two lower impacted, and an implant laid to replace right lower first molar lost to a sports injury

When I arrived I had absolutely no pain, though maybe not perfect teeth. Now I have lovely looking teeth, but am in some discomfort. Between having the veneers done and the wisdom teeth out / the implant laid I had a couple of bite adjustments, which were allegedly standard. After the second of these I started having bad tension headaches and on occassion pain radiating down both sides of my jaw bone. I was told to wait until I had mywisdom teeth out to see if that alleviated the problems. After having the wisdom teeth out these particular symptoms have dissipated, but I am still left with;

- Tight / Tense Jaw Muscles that come and go
- Fullness in ears / occassional earache
- Occassional tension headache
- Increased tooth sensitivity and teeth / gums that ache after eating
- Occassional random pains in teeth unaffected by the work
- A bite that does not feel like it comes down as it should

Also, having sought a second opinion, the front left canine veneer has an improper margin, so will need to be replaced before long to avoid gum problems or decay of the tooth under the veneer.

It has been 5 and a half weeks since my last procedure and while the symptoms are lessening I am still troubled by them and concerned at their longevity. The dentist I originally saw, the second dentist and a friend who is a dentist in the UK feel that given the amount of work I had done my mouth needs time to settle down. I however am concerned that it is obviously easier to treat TMD - which is my primary concern as a potential issue given the prevailing symptoms - the earlier it is identified.

Sorry for the long post but I felt the background was important!

My questions are;

- How much longer should I give it to see whether it is just my mouth healing?
- Could this amount of work, done poorly, lead to my symptoms and indicate TMD?
- I am in the process of moving to NYC from Washington DC - is there anyone you recommend in NYC that, should these symptoms persist beyond a reasonable lenght of time, I should see as regards potential treatment? I did someresearch and found Drs Mello and Tabib, who appeared to be in the correct area as regards NM dentistry for the treatment of TMD.

Sorry again for the long post and thank you for any reply / advice.

All the Best

Duncan

Duncan,

I am sorry about your experience. See below;

October 2013 - Periodontal Scaling : 3d xray ? not indicated for diagnosis

October 2013 - Crown lower left first molar, onlay, upper second right molar :  3d xray ? not indicated for diagnosis

January 2014 - Two crowns - upper right, first molar and the tooth in front :  3d xray ? not indicated for diagnosis

March 2014 - 8 Poreclain Veneers, front upper 8 teeth (this was "to ensure I did not lose teeth through erosion and / or decay /and or have root canals over time periods ranging from3 months -18 months" according to the dentist, so preventative rather than cosmetic. :  3d xray ? not indicated for diagnosis, and reasoning highly questionable.

April 5th 2014 - all 4 wisdom teeth removedincluding two lower impacted, and an implant laid to replace right lower first molar lost to a sports injury : 3D xray, can be justified.

Quite frankly, i sounds to me like you have an over closed bite to begin with,, (just really going out on a limb here with out seeing you or any x-rays or picture) and during all this work your jaw is now set more back and your muscles can not handle this anymore..
I know both Dr. Mello and Tabib, and they are excellent choices for the work you need, both the TMD issue and Dr. Tabib is an excellent cosmetic dentist that can fix your restorative issues if needed. But before you spend another penny on restorations you must first make certain that your jaw is in the right place.

All the best.

H.Nassery, DMD
www.miamibeachdentistry.com

Hello Dr. Nassery!
I am quite desperate for advice!  I'm so grateful to find someone who specializes in TMJD, and is so willing to answer questions.  I am 33 and I have quite a severe open bite at the front, as well as an underdeveloped lower jaw - so I basically always have to be pushing my jaw forward to articulate when speaking, eating, etc.  But eating is kind of funny regardless because those teeth don't meet no matter what!  My molars have worn down like crazy.  I have gone through many ups and downs with jaw joint pain, crackling, popping, the occasional locking, and tearing sounds. I am currently undergoing braces in preparation for jaw surgery as I have been told this is the only solution by at least 5 orthodontists I have seen for opinions.  (I have been a bit hesitant to commit!)  

I am very confused and overwhelmed by the process of orthodontics I have gone through since I was 10!  I knocked my two front teeth out when I was only 2, so I think it started then - developed a strong tongue thrust.  I am also a mouth breather and have been since I was a small child.  Many of my family members have recessed lower jaws (or short/underdeveloped lower jaws, or overbites) so it is partially hereditary.  The height of my top jaw is double what is "normal" because my tongue is usually at rest between my jaws rather than up in my palette and I guess that caused it to grow down?  The width is at least 8 mm less than it should be to be aligned with my bottom jaw.  My bottom jaw is at least 6mm recessed than the top.  Does that make sense?

Anyway, I got head gear when I was 10, a bite pad when I was 12, supposedly to reduce the angle of my top jaw and encourage growth in my bottom jaw.  Finally someone suggested the removal of my adenoids, which seemed to help with snoring - but I was still a mouth breather.  I was told at 14 that the only solution to my problems was to have surgery to remove a wedge from my top jaw.  This would allow my bottom jaw to come up and forward to close better.  However, my parents were afraid of the procedure and decided against it.  My teeth worsened over time and my jaw clicking and popping began.  By the time I was 18, I really wanted braces to correct my crooked teeth, and tame my ever expanding open bite.  I found a dentist willing to do this "Band-Aid" fix through cosmetic braces.  He put in an arch wire too.  My teeth never looked so good! haha  But I think I was still getting jaw pain.

I wore the retainer until one day it fell behind the toilet and I thought it would be a good idea to boil it for sanitation - but I melted it!  Very soon after, my top arch narrowed into a canoe shape, the front teeth pushing forward, the back molars sagging downward and also wearing down.  

So now I have completed a year of splint therapy to force my bottom jaw back, and relax the joint.  I am in braces again, and I have had two surgeons opinions: one said SARPE (surgically assisted rapid palatal expansion), then braces, then double jaw surgery (the wedge out of the top, the bottom brought forward), the other said, SARPE with just the bottom advancement and braces to close the gap.  My Ortho somehow felt confident he could just use braces and elastics without any expansion, to align things better in preparation for surgery.  The elastics of course have pulled my teeth downward since most of the time my jaw hangs open for me to breathe!  I show more gum now because of it.

Last week I got yet another opinion, from a guy who does non-surgical solutions.  He wants to start the process over again with his own braces after first using one of those palette expanders with a key that you crank every day, even though I am an adult and have stopped growing.  My roots are really shortened from all the years of dental work so of course I am concerned about root resorption if I change course yet again.  This dr says no one is addressing my mouth breathing and that everything will regress if this continues.  So he thinks widening my upper arch will open my airways.  Sounds great if it's actually possible on an adult - without surgery!?!  I'd love to breathe through my nose better but I can't close my mouth comfortably or naturally.  He also says he can train my bottom jaw forward using bite pads and elastics.  I asked about my jaw joint pain from holding my jaw forward all the time anyway, and he says my condyle will reshape or find a new position or something.  SO confusing!!!  Possible?  My condyle by the way, on the one side has worn down into a spear shape rather than a light bulb.  

I have had really constant aches and pains through this process but especially in the last few months as my bite has closed and my front teeth are getting closer - if I pull my bottom jaw forward I can actually make contact!!!  I'm sure I am grinding at night.  

Sorry this is so long!  Please help me to know what is best for my joint...

Thank you!!

PS I am experiencing ear aches and headaches, and muscle tension daily.

Inko,

Thank you for the detailed info. There seems to be many things going on at the same time here. I understand where each and every one of these clinicians come from..
With out seeing your diagnostic records, ie xrays , models, pictures and so on I can only make general comments.

First I want you to understand the pains you are having are almost all muscular. Meaning it is from the dysfunction of the muscles because they don't like the present position off your teeth. In my book in cases where the patient has pain, we need to first stop the pain, before we get into any other treatment.
With out knowing if you are going to feel better, why would we do anything? just for the sake of doing something?

As for the direction, you have to understand that the very root cause of your issue is upper airway problems, and both the surgical and orthopedic approaches will in some way address that, the proper way would depend on the severity of the case. there are extreme cases that will not be resolved by braces alone.

But again I go back to my initial comment ; how do they know if you will be better off after what they do? and that is what they can not  tell you. You  can be better in this same state if you wear the rightly designed orthotic to bring the lower jaw into proper contact with the upper arch. This orthotic need to restore proper function of your anterior teeth, which is currently missing from the equation and is the source off your pain and ache in the  neck muscles. Once the pain and ache is gone then you can evaluate the case and see how you can bring the two sides together.Be it orthopedically or surgical.
As far as the condyles re shaping, yes over the years, granted that the position is corrected and the pressure is taken off the joint, yes they can reshape.

H.Nassery, DMD
www.miamibeachdentistry.com

Hello Dr. Nassery,

I have had chronic 24 hour a day facial pain for the past 3 years. I have pain in my jaw muscles which feels like a burning ripping feeling, and they are tender to touch, pain in my teeth,  burning in my mouth, pain when chewing and  opening my mouth as well.
I had an MRI which showed right joint effusion and limited anterior translation of the left mandibular condyle and disc on open mouth sequence.  The ENT I saw who gave my my results said he doesn't deal with these issues and didn't explain what these findings mean, what causes it or what the treatment could be. He just told me I should get a referral to a TMJ/ orofacial pain clinic.

Would you be able to shed some light on what these findings mean?

Thank you for your help.

Rhea

Dear Rhea,

I am so sorry to learn about your difficulties. I assume that you have exhausted all medical avenues. If they have not found any specific medical issues then I would say that there definitely is a great possibility this is TMD.
Impingement of Cranial nerve 5, and 7 could result in the issue you are suffering from.
The fact that your MRI shows dislocation , confirms that your teeth are not in the right place and dictate that your jaw adapt to their wrong position, which has caused the damage in the joint.( like most of us, so don't feel bad)
We just have to find your physiologic bite, and things should calm down, regardless of the damage in the joint..Don't get too worried about the joint damage, most pain you described are muscular, and if your jaw was ever placed in the correct functional trajectory, things should improve greatly.
As far as which methodology I prefer, I have not made it a secret.. while I have a great deal of respect for Orofacial pain people, I prefer to start with Nueromuscular functional correction. I accept that there are strong emotional parts to TMD, and some of those will have to be addressed medically at times, but the core of the problem remains a skeletal/ functional problem which will not be resolved with medication.

I hope this helps.

Regards,
H.Nassery, DMD
www.miamibeachdentistry.com

I'm a 19 year old female.For the past 4 months, I'm having swallowing difficulty, mainly a tightness in my throat while swallowing. It all started after I was diagnosed with a big ovarian cyst & I cried continuously for few days. I first experienced strange symptoms like air getting trapped in my food pipe everytime I swallow, specially my saliva. My symptoms changed over this course of 4 months. I underwent a laparotomy for my cyst removal last month. I still have the swallowing disorders. Apart from that, since the last 2 weeks, I started having chirping sounds in my right ear with my jaw movements. After a few days, I started experiencing strange muscular tightness & pressure below my chin & ears & region just above my hyoid bone. I also started experience a clicking & (rubbing of bones) sound in my throat (while swallowing liquids, while opening my mouth wide open & moving my neck down). Sometimes, I feel a heaviness in my head these days. I'm very scared because my throat is getting tighter day by day & also those crackling sound in my throat! I've been to many ENTs......they keeps saying everything is right with my throat. Some said GERD, but Antacids are not working. Can this be TMJ? I've read many such cases like mine. They have underwent many exams...but couldn't find any solution. I'm very scared that mine will also not get cured or my symptoms will keep increasing! My doctors haven't told me to undergo ny swallowing tests like videoflouroscopy or tests like ct scan. I've read about Hyoid bone syndrome & Eagle syndrome. I'm very much worried about this!! Can this condition be diagnosed correctly & treated??

Dear Titli,

I hope you have not given up.. First I want to say that I am not able to diagnose you or anyone over this few word exchanges. I or anyone else would need all the proper records to do so.. I certainly have had patients with many of your symptoms, and barring any other medical issues TMD, and cervical issues should be considered as a possibility.
I wish I could say more but with out proper examination and data it is not correct.

Let me know if I can help in finding a qualified person near you.

H.Nassery, DMD
www.miamibeachdentistry.com

Dear Dr. Nassery,

I want to get your opinion. I have recently been diagnosed with TMD by both my dentist and my physician (a DO who has done a bit of manipulation for pain).

About 6 months ago, I went to see a new dentist because we had moved across town. My biggest mistake was not going to a dentist recommended by someone and only looking at a few reviews on the internet. After a few appointments, he had convinced me that one of my front teeth was going to "fall apart" because when he put a powerful light behind it, it showed microcracks. He filed down the back of that tooth and applied bonding to the tip of it. Ever since then I started to get jaw discomfort. I saw a new dentist who said that there was too much enamel taken off and tried to thicken the tooth back up, but most of the bonding wore off quickly. For the short amount of time that the thicker bonding was there, my jaw did actually feel much better.

I have developed constant pain in my jaw, with tension headaches that are severe. The tension is greater in one side of my jaw than the other. I am taking a muscle relaxer and NSAID to try and deal with the pain, as well as massaging the TMJ around the clock. I went back to my old dentist across town and he fit me with a bite guard, but said that he does not want to do anything to restore the tooth that was operated on. I have been wearing the bite guard/splint around the clock besides meals and it has not helped the headaches. If it is not in my mouth, my lower jaw shifts forward and my lower teeth hit my upper teeth in multiple places. One of places that hit is the bonded top tooth on one of my bottom teeth.

Do you have any advice for what I should do? Do you think that a crown on the front top tooth to restore the original thickness would possibly help? Do you think braces on my bottom teeth to bring them in a bit closer would help? My hesitation with putting more bonding on the tooth is that it will wear down again since it is weaker than the enamel on teeth it comes in contact with. The engineer in me thinks that if the original tooth thickness and shape is restored (dentist that filed is unwilling to share imaging records unfortunately), the jaw should be realigned.

Thank you!

Thank you for your reply. I forgot to mention that I'm wearing braces since August 2012. I never had any problem with them. I went to my orthodontist regularly. But due to my gynaecological problem (for which I had to undergo the operation), I'm unable to visit my dentist since the last 3 months. I read in an article on the internet that orthodontic treatment can cause hyoid bone displacement! I got very very scared after reading that & started crying thinking all my symptoms are being caused due to my braces!! I wore them to correct some of my misaligned teeth, can this cause such dreadful effects too? Can it cause TMD too? & if it can cause such symptoms, then can they be corrected too? Can repeatedly rubbing/clicking of hyoid bone cause it to displace? Can TMD cause hyoid bone problems? I'm very much scared that it might never go away & it'll keep increasing!! I can't concentrate on even my studies ( I'm a 3rd year Electronics & Communication Engineering student) because of this discomfort!! I've almost given up hope as everyone (from ENT docs, general physicians & even my parents!) keep saying it's all in my head since nobody is able to cure it!!
I would have been very happy to take your help in finding a qualified person near me, but I live in India.
Can going through any tests help in diagnosing my problem? I experience regurgitation of food sometimes & also nasal regurgitation of liquids while some processes like salt water gargling (some people told me to do that for my thraot issues but that doesn't help much) Can u please tell me other than an ENT, who else can help me in diagnosing & treating it? Shall I visit a dentist?

Dear Jose,

It sounds to me that your assessment is correct.. basically, by thickening the back of thinned out front tooth, the dentist created a pre-mature contact.. which in turn send a signal to your muscles to pull back your jaw to avoid the contact.. ( non-voluntary protective mechanism) .. this position is more posterior to your normal , and already over closed perhaps, position.. and your neck can no longer accommodate this move.. yes your neck, I said..you see the workings of your lower jaw and your Atlas (Cervical spine #1) are intricately connected..by pushing your jaw back they have pulled your C-1 forward and by virtue of that they are  turnicating your blood supply to your head.. hence the headaches..

SO long story short, have the composite removed from the back of the tooth, not the front..and if things don't go back to normal, see a Physical therapist, or even your DO doctor to do some neck therapy in form of extensions and try and release the C-spine to go to their normal position..

Al the best.

H.Nasseryy, DMD FICOI  FAGD
www.miamibeachdentistry.ccom

Hi Dr. Nassery,

Thank you for the quick response. My thought is that the original tooth never should have been filed down or thinned out by the first dentist. After he did this, only one of my front teeth makes contact when I talk etc. and not both, which I think is the cause of the misalignment overall. Before any work was done, both of my front teeth were relatively equal in thickness. After the first guy thinned one tooth out so that there would not be contact, I feel like that is where all of the trouble started.

That is why I am asking if the tooth should be thickened back up with composite or a crown placed on the tooth that was thinned out? Does this make sense?

Thank you!

Dear titli,

Did you have any teeth extracted for this orthodontic treatment?

Jose,

More than likely you had certain amount of misalignment before hand and this latest adjustment or filling took you out of your equilibration or accomodative space. I would say that it is much harder taking you back to where you were, than just filling and thickening that tooth.. but you should give it a try.

Regards.
H.Nassery, DMD

Yes, I had to extract 4 teeth & one milk teeth on my upper right side. I have the chirping sound in my right ear only (which I had developed only a month ago). But I put on those braces exactly a year ago & got my teeth extracted 2 weeks before that. In January this year, my orthodontist told me that Temporary Anchorage Device (TAD) will be required in my case to close the gap in my upper side. I got those TADs implanted in my gums in February. But I didn't get the opportunity to get strings attached to those TADs for the actual treatment to begin as my treatment came to a hault after my diagnosis of Ovarian cyst. The TAD on my left gum came out on it's own soon after it was implanted (it got loose coz of some infection maybe). The screw on my right upper gum was there without any other support for 5 months. I got it removed after convincing my orthodontist like hell!! Could my all symptoms be caused due to these BRACES?! I never knew about this otherwise I would have never got them! My first symptom was swallowing difficulty, swallowing excessive air & belching. I'm having these symptoms of ear popping, right side headache, throat clicking, pressure & spasm on the sides of my neck since a month only. Can this still be TMD? If yes, then can this be corrected using braces (coz I'm still wearing them)?

Titli,

I am fairly certain that the main issue here is the type of orthodontic treatment you are having.. I would stop all at this time and try and find another orthodontist that would agree to reverse the treatment..
These type of ortho treatment know as retraction orthodontics, posteriorizes your jaw and puts the condyles ( the tip of your jaw bone in your temporal area) too far back and up, hence the pressure in your ear and spams in your musculature..
It also sound like he/she over closing your bite and hence changing the position of your hyoid bone..
This is not to disparage the orthodontist, he/she is doing what she was taught, unfortunately they don't teach them that these movements will have adverse effects on other parts of the head and neck.

I wish you health, I hope this helps in some small way.

H.Nassery, DMD
www.miamibeachdentistry.ccom

Do you have any other suggestions for getting me back to my accomodative space? Would an ortho consultation be suggested in this case?

Thank you

Jose,

I can not make any more specific suggestions as I really don't have any diagnostic information except your view of the events. It is neither prudent nor ethical to provide directions to a problem which I have not really studied.
Whats for certain is that  you need to find a dentist that is well versed in Gnahtology and has a good understanding of TMD and its signs and symptoms.
If you need a recommendation in your area I could do a search and let you know.

Regards.

H.Nassery, DMD

I would definitely appreciate that. I have been having trouble on where to look as it seems over half of the dentists in the area say they treat TMD on their website.

Thank you!

Reverse my orthodontic treatment!!?? Is it possible?? Does that mean making my teeth misaligned again?? Creating those gaps again (which have almost filled)?? That sounds so scary!! Can't there be some other way in which my problems can be solved without creating those gaps again or without making those teeth misaligned again?? Please, tell me that it is possible! Shall I go to another orthodontist or an oral & maxillofacial surgeon? I just got those TADs implanted on my gums but never got those strings attached to it. Now, I've removed them. There's only one gap on my upper right side that needs to be closed. How can I get a definite diagnosis in which I'll get to know that all my symptoms are caused due to this orthodontic treatment? If I stop the orthodontic treatment now, will my symptoms stop progressing? or can it get any worse??

Titli,

the reason you had gaps was so that your lower jaw would have the freedom to move forward.. by closing those gaps and not creating the proper adjustments you have basically locked your lower jaw in a position too far behind the physiological space you can accommodate.. hence all the muscle spams, and now your body is telling you that this position is wrong..
In short, yes it can be done, but not the way you are thinking.. not to open the spaces or misalign your teeth.
You must find some one who understands orthopedic correction of your jaw position, not orthodontic.. your lower jaw needs to be freed to come down and forward..and most likely you will need those teeth that were removed..
The key is to first find the practitioner that understands what has to be done.
Stop panicking and start looking for the right dentist. Read the upper part of this note carefully and understand it..Your lower jaw needs to come down and forward..where you are closing is wrong and is causing strain on all your muscles of mastication.

H.Nassery, DMD

Jose,

You need to tell me where you are close to, I can't guess on my own..

H.Nassery, DMD

Troy/Sterling Heights/Livonia, Michigan.

Thank you!

Jose,
Here is a colleague that has studied at the same center as I  have.. with Dr. Chan.

James J. Caris, D.D.S.
43200 Dequindre Ste 107
Sterling Heights, MI 48314 Zoom
Country: USA
Phone: (586) 731-1999

Thank you for your answer. But I didn't understand one thing, I will need those teeth that were removed?? How is that possible? It all sounds a very difficult procedure & painful procedure! What kind of dentist will be able to help me & understand this situation? I'll also try to discuss this issue with the local dentist in my area........

Titli,

What I meant is that we all were supposed to have all our teeth in our head, and I am well aware that apparently some orthodontists think that its ok to remove four teeth and pull back the others. But physiologically there are patients like you that can not accept that.
Done correctly, you do not need extraction. If yo find some one that does "functional orthodontics" , that would be your best bet.

H.Nassey, DMD

Then, does that mean I'll need DENTURES?? I never had a problem till one year after getting my teeth extracted & putting on those braces. It started all so suddenly one day (since it all started after me being depressed for quite a few days, everyone used to convince me like hell that's it's all psychological!) Do these symptoms appear all so suddenly like this?
& Functional Orthodontist? Do u think I'll be too old for this treatment? I sometimes think since I started this treatment at 18, all these things have happened! I'm afraid whether such a dentist is available in my country...
If I remove my braces now, will my symptoms stop getting worse?
Once again, thank you for your help.

TItli,

I am not sure how got the "dentures" from our discussion.. I did not say that at all. It is very simple, if you are having all these symptoms, then  you must remove all the wires and forces that are pushing your jaw back..the relief will probably not be sudden but rather as your teeth will start moving to a more forward position and free your lower jaw, you will start feeling better and better.
Start from there.. once you fell better, worry about finding some one to finish the case that has a different approach.

HN

Hello Doctor. I've had two TMD surgeries. Both on my left side. They took out the disk and just left it bone on bone contact. My last surgery was over 10 years ago. I've been having pain in both sides. The left side is cracking and locking and the right side is now locking and popping. I'll be honest and say I really don't want to see my surgeon again for fear of a third surgery. My question is since there is no disk on the right side could this be the cause of all the cracking, popping, locking and pain. If it is, what would be the treatment for it?

Dear Mommie,

If you had the surgeries on the left side , then that is the side that does not have any disk. The popping you hear should be on the right side. Yes, the bone to bone contact will make it hard to move, with low crunchy sounds..or as we call them crepitus..
This is exactly why  those of us that treat patients with your issues are against surgical intervention with out appliance therapy. I would go on a limb to most patients would do fine without surgeries, just using the properly designed appliance. Your case is exactly that, an example of unsuccessful surgical intervention, you still have pain. The truth is that most pain, some 85% of is muscular.. and that comes from them working in the wrong position..so no amount of surgery will do anything for that..
The good news is that you can have a good amount of relief still, and it can be done all with out surgery.

H.Nassery, DMD
www.miamibeachdentistry.ccom

Dear Dr. Nassery,

I was just fitted with a night guard to address my TMD symptoms, which are tingling and tight muscles in jaw and face, and it has made it worse. All other health conditions have been ruled out. Two months ago my symptoms came on during a time extreme stress in my life. I was clenching 24/7. I have never had any popping. When I spoke with the dentist about my symptoms he did not even take and x-ray and I did not get any significant instructions when I received the guard.

The first night I wore it, I woke up feeling like my face was the most relaxed it had been in months.

Then every subsequent night it has just gotten worse from there. My muscle spasms returned with a vengeance when I removed the guard, when they were otherwise slowly getting better. Things were loose with the guard in -it was awful when I took it out. I also developed pain in my left jaw joint and muscle spasms on that side which had been generally without symptoms for several weeks.

I can see where the guard can break the spasm cycle. Since I had an almost continuous spasm in my right jaw and the guard almost immediately stopped it. Could the symptoms that developed when using the night guard be because those areas were no longer being pulled on by the on going spasm.  I am scared to death to try the night guard again.

When I contacted the dentist that gave it to me the receptionist told me I had to wait almost 2 weeks for an adjustment and advised me to either not use it or use it 24/7?!?

Is there an adjustment time to get used to such guards? Do symptoms sometimes get worse before better? Would an adjustment on the night guard help?

I am meeting with a different dentist this week. He is supposed to be a tmd specialist and uses the t-scan, emg and other methods to diagnose tmd.

What are your thoughts on the night guard. I am feeling like I just got taken for $500.00. I wish I had educated myself about tmd.  I am getting very discouraged that this will ever get better.

One more question, what are the success rates in your experience with patients returning to normal or near normal. And what therapies are the best. Is there a gold standard in breaking the muscle spasm cycle.

I apologize for all of the questions and Thank you in advance for sharing your knowledge.

-Paula

Dear Emeroo,

Hope things are little better..The answer to many of your questions are long and require lengthy explanations. Here is my take..
If you had never had these symptoms before your acute episode , then you should first treat it as such. That means treat Muscle as muscle and joint as joint. SO when you  have spastic Muscles you need a muscle relaxant. For the Joint you need an anti inflammatory, and you need to be soft diet..As far as night guard, I no longer make them, or I should say I don't make as many. I suggest one of the over the counter ones from the pharmacy.. I like them as they are smaller than what I see fabricated in most offices, and they stay soft.. I find that there is no magic in the ones made in offices. They are often too thick and trigger more spasm in the patient.

All these, though are palliative treatments. The above is not cure or fix. There are ways to correct this. What's more is that you have always had this issue, this just the exacerbation of your issue.

For now, Do the above regimen I suggested, if that does not help and if you do not go back into your asymptomatic state again, then we need to have a more detailed conversation about how to fix this.

H.Nassery, DMD  

Dear Dr. Nassery,

Thank you very much for the reply.

I have spent a lot of time reading message boards and articles on the web about this condition. Many of the people posting tell stories  about chronic symptoms that have undermined their quality of life. I have only been dealing with this about 9 weeks and I can say it has definitely affected my life negatively. I have a 1, 2 and 3 year old that I cannot keep up with between taking the medications prescribed and not being able to project my voice from the jaw discomfort. I have lost 16lbs since June.

In the 9 weeks since the onset of symptoms, I have had on several occasions had days with no symptoms but they keep coming back. The worst is that I feel like I cannot open my mouth all the way often. (it is actually opening around 40-42mm it just feels so tight).  If I try to open it when it is tight, I get a pain in the one joint that can last for hours and deep muscle spasms. I try not to open but it happens sometimes.

I have been taking Celebrex for the inflammation, Ativan and Flexeril to relax. They help, but improvement has been generally slow. I was off the prescription medication from August 7th to  August 20th. The night guard flared everything up so bad I had to start the Celebrex again.

Its been 2.5 months since the onset of symptoms- at what point would you recommend moving forward with a more involved therapy (splints)?  - I apologize if this is a bad question.

Sincerely,

Paula

Hey emeroo,

As I mentioned to you in my previous writing, you have had the issue all along. The thing is that most people mistake lack of symptom with health or lack of disease.
In my practice, I can tall you that the largest block of patients are female (75%), and their average age is 47 y.o.  What this means is that the average patient starts to get symptomatic around that time..Now I have patients as young as 16 years old and as old as late 60's.

If your issues don't subside, I would say that yes, you must pursue a treatment with a conservative approach. Appliance therapy is what I do and of course I am biased to the modality I know best. However, there are many different approaches and you must keep on educating yourself about these and then choose the one that makes most sense to you.

From the sound of the things it sure seems like you have a displaced disc, and very spasmodic muscles. Stay with smaller softer night guard. Only you can decide, when is it enough disruption to your life..that warrants treatment.

Regards.
H.Nassery, DMD
www.miamibeachdentistry.com

Dear Dr. Nassery,

I am extremely grateful for the independent expert opinion especially since my frame of reference on this matter is extremely limited even with all of the information that is available.

Sadly and happily my face and jaw feel normal today when I have a very expensive consultation scheduled. I was able to open my mouth with little effort and no spasms this morning but I know its not going to last!

Two more questions, if you wouldn't mind of course, do discs ever go back in on their own? Can an x-ray be used to diagnose a displaced disc? I see that the x-ray is mentioned as a diagnostic tool in this thread but not specifically for a displaced disc.

Thank you in advance and I hope you are having a great day!

Paula

Emeroo,

You are probably right and your symptoms will return. There are many other signs that we go with as well as other diagnostic tools. X-rays are only a part of those.
The quick answer to your questions are , No , usually the disc are displaced due to the incorrect position of your Jaw and by that I mean the tip of the Jaw bone or Condyle. As long as you have closed your teeth where you close them, the disc has been pushed out.. So if that position does not change, the disc issue will not change.
Only an MRI can show for certain where the disc is, soft tissue does not show on the x-ray. Having said that, an x-ray of your jaw joint in closed position will show whether there is room for any disc at all or not and by deduction one can assume the disc is displaced.

Hope this helps.

H.Nassery, DMD

Thank you very much for all of your insights. The article that inspired this thread I also read. There is so much conflicting information out there about this condition. If there is a displaced disc in my jaw I think it needs attention rather than to be ignored and endured. I am grateful for an independent perspective, especially one that is not going to make a profit from their recommendations and insights. The insight and information that you provide on your own time is truly a benefit for the greater good. Because of this thread I am able to better advocate for myself than I would have been prior to reading it.

Thank you very much for everything.


Paula

Hi Dr Nassery

This is a fantastic service you are providing I cannot thank you enough. I have some jaw troubles too and need your advice.

I'm from the UK and as you probably already know TMD is not well recognized here and the treatment for it is next to none.

Im a 30 year old male, and have been suffering from Jaw pain for around 10 years. I used to have a overjet, smallish pallet and a weak chin. This was treated with Braces. the from teeth bought back, pallet widened. Since then my jaw has not been the same.

I have continuous muscle pain around the cheeks, jaw joints, back of the neck, head aches, and a flickering eye. I have been to a orthognathic surgeon who apparently treats TMD, he recommended I wear a  bite splint.

Wearing the splint help to a degree, it pushed my lower jaw back and down, but at this position my lower jaw recedes and leaves a open mouth type posture, and when I talk the pain flares up again.

I don't know what to do? I have tried medication, I have tried a splint, tried all the exercises, and my teeth look very straight.

What would you advise I should do, would really appreciate it.

Regards
Dean

Dean ,

Thank you for the kind words. Your story reds like so many others. I can't help but to feel bad as a practitioner because I know that there are so much information and mis- information out there about this issue.

Certainly by now most of you guys realize that main stream dentistry has no clear answer for this issue, but what's more disturbing is that there are small interest groups that oppose clear concise protocols to correct it, as well.

The problem you have is that the position they straightened your teeth in, does not coincide with where your musculature or joint would want to function. Does that make sense? more than likely, your lower jaw should be more down, and forward. however, your upper arch of teeth basically imprison the lower arch and make it work in a more posterior path. A path that is super uncomfortable to the muscles..All this creates other issues in related structures such as head, neck , and so on.. its a long discussion.

I am not what to tell you as I don't really know anyone there that can do the type of treatment I believe would help you. The good news is that I know most if not all these issues can be corrected. What sfor certain, your present teeth position is in direct conflict with your musculature..Have you tried Dr. Mew? he is there and a lot of the work he does is very similar to what we believe..look him up

Hope this helps.

H. Nassery, DMD
www.miamibeachdentistry.com  

Thank you Dr

I have done a search for the said the doctor, he has a practice in London and seems like he does treat tmd.  unfortunately though it seems like he primarily treats children through their growth phase. However I will still give him a try and see if there is anything he can offer me.

I was once given a splint to wear, it was to advance my lower jaw forward, in description it was worn over  both my top and bottom teeth but held my lower jaw in a forward advancement position.

Paradoxically having worn it at night, on some mornings I woke up really refreshed and on others I woke up with pain in the jaw joints worser then ever
It left my bite totally out with my jaw in a much advanced position and lower down. My dentist/ maxillofacial surgeon advised me to stop wearing it because of the changes it caused in the bite.

Dean

Dean ,

I am telling you that your jaw needs to be lower and more advanced.. however, it can not be done with a static appliance. Our jaws are not meant to be static.

The reason it changed your bite after you wore it for a while, is that you were recapturing all the torn and displaced ligaments and disc tissues into their rightful place and in the morning you had to push all back out before you could put your teeth together again.
So in a way both those guys were right, if you can not follow the treatment , and finish this casein the more down and forward position, it is better not to wear the appliance.
I know Dr. Mew, really focuses on the children, but I think he would know what to do to help you..I am actually thinking about incorporating his work into my practice as it makes sense to treat the kids right and prevent a lifetime of pain and discomfort.

Regards.
H.Nassery, DMD

Hello Doctor,

I am concerned because my son who is 20 has an improper bite. By this I mean his teeth come together when he bites down, instead of the top teeth overlapping. His dentist never mentioned this when he was younger, and now we're told it needs to be corrected.

He informed me that he's recently experiencing clicking from his jaw, and I'm concerned it's from the bite problem.

We were told to see an Oral & Maxillofacial Surgeon that specializes in Orthognathic Surgery among other things. We were also told he would need braces.

Any thoughts would be appreciated.

Bill

Hi Bill,

I love it how we go from nothing to orthognatic surgery in no time.. If we were a car we would be a racer. This is the thing that bothered me most in conventional practice. We would ignore obvious signs, such as poor bites and clicks and pops, and deviations and so on...and kept telling our patients there is nothing to be done..till they would get to the point when they could not take it anymore, then we would tell them, oh you need surgery.
How interesting that we would not have any other options other than surgery.
I would think you would want to upgrade your dentist for one, because ignorance is not bliss. It is his/her job to know about occlusion and choices of treatment. It is a shame that 95% of our practitioners don't have a clear understanding nor a philosophy of occlusion.

Enough about that,, find yourself a practitioner that understands appliance therapy. If you have read the posts here you would know that most surgical patients do not get resolution of their issues. I would say maybe 10%, based on my own unofficial survey.
Most cases can be resolved with out surgery. Please look up Dr. Clayton Chan, read his blogs and notes. There on his site you can also find a list of doctors who have studied with him and  find one near you.

I hope this helps. Sorry about the rant.

H.Nassery,DMD

Thank you. I will look into this.

I also have problems with tmd that started about a year and a half ago that resulted from grinding in my sleep. A dentist made an acrylic guard for my lower teeth, that I still wear.

I finally went to a Chiropractor that uses Myofascial Release and after 5 sessions it cleared up for just about a year.

It came back this spring and the Chiropractors treatments didn't help this time. I also went for physical therapy, but still can't shake it.

In the past I've had clicking and crepitus, which is gone now. What I'm experiencing now is Tinnitus, and occasionally my jaw cracks when I open.

I've been able to massage the masseter and lateral pteyrgoid muscles and it seems to help for a day or two, but the problem always comes back. I went to a tmj dentist last week, and he took a panoramic x-ray, and said things looked good. (no arthritis) although he did say an mri would show more, but wasn't needed because I don't need surgery. He also measured my bite opening and said it was good (50cm?)

I told him I have Tinnitus and sometimes tingling in my fingers, but he said these are not related to tmj problems.

I'm hoping that the problem is muscular in nature and can be resolved.

Hi Dr Nassery

Can you advise me regarding my post above. Do you recommend the same treatment for me that you listed for my son?

Thank-You
-Bill

Bill I'm currently at a seminar and don't have my computer with me and its really hard typing on my phone. But I would definitely see another TMJ expert since he does not seem to know the connection of your issues with your neck and other symptoms like tingling fingers and tinnitus. But yes you will need the same type of approach.
I can put a more indebt answer when I get back.

H.Nassery, DMD

Dr. Nassery,

I am looking at current treatment options for my TMD/TMJ.
I have had TMD since I was 18. I am now 55.
I began wearing a splint 20 years ago much to my delight as it alleviated significant back/shoulder/neck pain and frequent headaches.

Over the last few months I've had the following symptoms:

Thought my eyes were going to explode...
Pain in and around my eyes...
Double vision...
Severe migraine...
Cluster migraine...
Severe pain/crunching in right ear when yawning...
New and exciting tinnitus sounds, sounding like a constant base drum in my ear...
Exhaustion...

I have had my eyes examined and no problems there...
I passed a recent stress test and had a head MRI and all is well
Recent blood work for possible neurological issues has come back normal, next stop spinal tap.
I also had an MRI for my jaw:

Right TMJ: the right-sided meniscus, as seen on closed jaw images, is essentially completely anteriorly subluxed. The condyle is seated in the posterior aspect of the glenoid fossa. Miled arthritis of the condyle is noted. Fairly normally formed temporal eminence and fossa. On the open jaw imgages, the condyle translates anteriorly to 6:00. The meniscus does not recapture.

Left TMJ: The left sided meniscus as seen on closed jaw images is moderately anteriorly displaced. Mild condyle arthritis is noted. The condyle is posteriorly seated in the glenoid fossa. Nor,al te,pral eminence and fossa. With jaw opening, the condyle translates anteriorly to 7:00. There is recapture of the meniscus.

It has been recommended I have a new splint specifically modeled to adjust and correct my bite, followed up by surgery to essentially tie the disc to the tip of the jaw joint to guarantee  tracking.

Even before surgery, if my symptoms do not clear up in a month with the splint I will go on to have the spinal tap.

I am curious if you have a opinion on current surgeries for TMJ and if you feel the above symptoms are related to TMJ/TMD.

Best Regards,

Linda S.

Dear Linda ,
It seems you have left no stones unturned. Therefore, I would go on a limb and say that in absence of any other medical issues your symptoms are most certainly due to your TMJ. Here is the issue. Most of us, by that I mean dentists, mostly focus on the joint, and it is important, don't take me wrong. However we would be more correct to look at it as a cranio cervical disease. Most of your issues stem from severe stenosis of your cranial nerves and arteries in your neck therefore surgery in your jaw joint would not benefit you at all. What would help is resolution of the compression in your neck followed by stabilization of your bite in correct physiological position.. The torn disc will not be of any consequence to most patients I have found. It is important to try and recapture it however I don't see any advantage by sewing it back in place. With out correction of your bite all else is futile, and when you correct that you will most likely find that you don't need any other treatment.
The neck however will need to be addressed.

H.NASSERY, DMD

Bill,

It sure sounds like you have the same issues. The thing most people fail to understand, is that our lower jaw is the that part of our postural system. We need to bring this understanding to the different fields that no singular approach will have complete resolution. This is a complex issue and will require  a complex multi faceted approach.
You do need a good therapist for your neck, and you need a TMD dentist to stabilize your neck by placing your bite in the correct physiologic position to support that neck position.
Only then can you become free of your symptoms. I hope this explains the issue.

Regards.
H.Nassery, DMD
www.miamibeachdentistry.com

Dr Nassery,

Thanks for getting back to me. I live in Mass and will make an appointment with Dr. Mehregan that you recommended in earlier posts.

I understand your point of the jaw being in the correct position etc. But what if the problem was due to trauma? I was in a fight back when I was about 16 and hit in the jaw and it may have been broken. (not sure I never sought treatment)

I suspect this might be the cause of my problems, and curious if the treatment would still work for me?

-Bill