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Neuromuscular Dentistry - TMJ FAQ

Question:
I have had jaw problems for manu years now. It started with my jaw locking when I was 16, and has continued with popping, clicking, etc. I had my wisdom teeth removed in 1995, and my bite changed completely, but not for the better. I had some problems, had 3 different nightguards made over the years.

About 2 years ago, I had a couple fillings done, and my jaw flared horribly. I could hardly eat or talk. My dentist made an impression to make another nightguard, and upon viewing it, called me speechless stating that he could not help me and referred me to a surgeon. The surgeon referred me to a facial pain/TMD specialist, and I have been seeing him ever since (2 yrs now).

I have had physical therapy, biofeedback, muscle relaxants, and a new nightguard made. I have times when it calms down, but then it flares again. I do not feel like I have a comfortable placement when I close my mouth. Ever since I had the wisdom teeth out and my bite changed, nothing feels right.

I had an MRI done 2 yrs ago, and my disc are completely displaced ("gone" is the word he used) and one side of my mandable is shorter than the other from wear and tear. I am currently coming down off a major flare again. I've been dealing with this for 14 years, had 4 surgeons want to break my jaw, and leave every dentist I see speechless at my bite.

The last one asked me if I could eat like this......of course realizing afterwards that obviously that I had to adapt. If you were to just look at me, you'd think I was normal, I look normal, no overbite, no underbite, but when it comes down to it, I guess it is bad. I only have 2 teeth that touch...on the back right side. I am curious what your thought on orthodontics and surgery are at this point. I am seriously considering it. ....Visitor from North Carolina

Answer:
Your situation is quite complicated but I have seen it before. What we like to do is get the jaw joint feeling comfortable with a bite guard before we do anything irreversible. However, some patients can't get comfortable with a splint and need to have surgery and orthodontics first. You may be one of those patients.

Let me tell you what I do with my splint therapy. Basically, we use 2 types of splints, the upper type put added pressure on the joint but relieves the jaw muscles. The other type fits on the lower back teeth and is called a pivotal appliance. It relieves the pressure on the joint. This allows joints that have "lost" their disc to heal. The healing takes awhile, up to a year.

The "new disc" that forms is histologically identical to a TMJ disc. We get most of our patients to the point where they can stand significant biting forces without pain and then we proceed with surgery, if necessary.

Some points to ponder:
Never let surgeon cut off your disc
Find a TMD doctor who has experience with the pivotal appliance
MRI results are wrong 35 percent of the time

David Krueger, DDS






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