Help me summon the courage to get my jaw/tooth/bite/TMJ problems sorted out.

December 30, 2009 9:46 AM

Help me summon the courage to get my jaw/tooth/bite/TMJ problems sorted out. More inside, of course.

YANMD, but your experiences and encouragement could help me. The backstory: I had braces as a teenager, but did not wear my nighttime appliance properly, so my teeth shifted back a bit over the years. Several years ago, I developed a pain near my back left molars. I'd had a root canal in one of these molars during college, and wear a crown there. I went to my dentist at the time, who told me that my bite was unbalanced. He had me bite on the red paper and ground down my teeth a little on that side at what he deemed to be the high points. Regretfully, this actually happened a couple of times. My problem didn't get better, and I later decided that he was kind of a quack, or at the very least a creep. Time passed. I developed the symptoms of mild to moderate TMJ: persistent aching on the left side of my mouth, some clicking and popping, pain occasionally radiating up to my ear. Another dentist told me that I grind or clench my teeth at night, and made me an NTI device to fit on my bottom teeth, which I wear most nights. I think it helps, but it definitely hasn't totally made the pain go away; also, I think I've figured out how to clench a bit on the device itself. Recently, my current dentist, who I think is a good guy, replaced my crown: it didn't go quite all the way up to my gumline, and he thought it should. Either the new crown doesn't fit perfectly, or I'm having an unrelated flare-up of pain, but things have been particularly bad the last couple of weeks, and I've resolved to get things fixed as much as possible in the new year.

The thing is: where to start? I'm generally scared and mistrustful of dentists, and the last few years haven't helped much. I got in touch with my dentist and will ask him to make sure he thinks the new crown is fitting properly; he mentioned that they sometimes need to be adjusted. Should I go to an orthodontist? The bite on the left side of my mouth is, without a doubt, messed up. (I've been told it's an "open bite" -- my teeth don't meet in all the places they should.) Has anyone had good results with braces for this kind of a problem? I'm willing to do them if they'll help. Should I see a physical therapist? An osteopath? Is there another solution I'm not thinking of? I have a lot of dental fillings in my back teeth, which have had to be redone over the years (my hunch is that nighttime clenching/grinding weakened them), and I think part of the problem may be that they were not contoured well and are contributing to the bite problem. Has anyone had an experience like that?

Basically, I fear dentists and I fear this problem and I fear attempted solutions that only make the problem worse, but this pain, which I think is TMJ, has been cutting into my quality of life significantly enough and for long enough that I think the time has come to make a stand. Help me make it a smart stand.

I am in NYC, if anyone has had experience with specific practitioners.

Thanks so much.

posted by toomuchkatherine to health & fitness (16 answers total)

I would find a dentist who specializes in TMJ. I feel like (just based on my experience, so I could be wrong) most dentists don't actually know all that much about TMJ, and will just give you a nightguard and send you on your way. Here's a link on how to find a TMJ specialist in your area.
posted by amro at 9:51 AM on December 30, 2009 [1 favorite]

I had a different but related problem for which I eventually had jaw surgery two years ago, but not before seeing multiple dentists, orthodontists and oral surgeons over many years while I tried to decide what to do.

If I could do it over, I would start by finding the right orthodontist. A good one will know lots of different dentists, oral surgeons and other specialists, and can refer you to the right ones for your particular condition. It's important to find one who has a lot of experience with adult patients though.

I'm in NYC too, so feel free to email me for specific recommendations.
posted by pete_22 at 9:55 AM on December 30, 2009

By the way, hang in there. Finally getting a properly fitted nightguard changed my life.
posted by amro at 9:55 AM on December 30, 2009

Thanks! Amro, what kind of night guard did you end up with?
posted by toomuchkatherine at 10:24 AM on December 30, 2009

I used to have a TMJ-ish problem with my jaw "popping". It always happened unexpectedly and quickly and then involved a painful, deliberate and conscious maneuver to get back in place. It was one of two physical ailments (the other was a weak ankle) that cleared up completely when I began taking tai chi, to my surprise, as I was primarily interested in the meditative/relaxation benefits. Neither has recurred since, two decades on. YMMV.
posted by dhartung at 10:35 AM on December 30, 2009

I have a splint that I wear 24 hours, all except brushing. It does wonderful things, I will never live without it. The only time it sucked was the second day I had it, because at first, it felt like a Popsicle stick in my mouth, and that gets tiresome by the second day.

My new dentist makes me a splint every couple years, the time it takes for me to chew through it. The interesting thing is that he doesn't believe in it. My previous dentist's daughter grabbed my jaw, looked in my mouth and said, "You got TMJ bad, You need a small piece of plastic to separate your teeth, go see my father." So I took the bus from NY to Indiana. Best thing ever.
posted by rakish_yet_centered at 10:38 AM on December 30, 2009

I'm not nuts about dentists myself, and have recently taken care of a bunch of issues that needed looking after/started the process of either getting an implant or bridge-and-crown. Do you like your current dentist? Do you have the option to change dentists?

When I called my local office to set up an initial appointment, I explained that I tended to be nervous and self-conscious about tooth stuff, and they set me up with a *really* nice dentist. I know that my dental health is just as important as the health of other body parts, so I figure that I should feel just as comfortable with my dentist as I do with my GP.

IANAPT (IAA student in an OT/PT Assistant program), but, IMO, it is important to check for/address any underlying (dental) issues *before* addressing any musculoskeletal/joint issues that may have arisen because of your body's attempt at compensating for/managing said issue.
posted by purlgurly at 10:38 AM on December 30, 2009

There are massage therapists who specialize in TMJ - couldn't hurt to try out.
posted by yarly at 11:03 AM on December 30, 2009

toomuchkatherine, I've had a hard plastic one and now I have a soft plastic one, both are the kind that fit over your top teeth. But for both it took a lot of tweaking to get them just right.
posted by amro at 11:18 AM on December 30, 2009

I had my teeth cut down many, many years ago.

The problem was the teeth in the back of my mouth were longer than the rest, and they stopped me from having a complete bite. It took a couple of years to get them even, and I had excruciating TMJ during that time. I had a night-bite device for the top teeth, not the bottom. It worked when I used it. The TMJ pain was horrible, I hated it, but it went away as my mouth adjusted. I did clench my teeth too tight, especially when I was sleeping.

I am happy I had this done, since it decreased the problems I had with my teeth. Today I am fine. I liked my dentist then, and I like the one I have now. That helps a lot. But you need to know that this will result in success, that really important.
posted by chocolatetiara at 12:00 PM on December 30, 2009

I have had almost an identical experience to yours, OP. I suffered for many years with first problems from not wearing my retainer as a teen, and then later with problems from TMJ. Eventually, I decided I had to get it taken care of, and I spent almost 2 years trying out dentists, orthodontists and surgeons until I found one (actually, one of each) that I liked and trusted. Now, I find myself in the final 3 months of a new set of adult braces, after which I will have corrective surgery to take care of my TMJ (to be honest, the braces have nearly solved the bite and TMJ issues on their own).

Of course, since the big part-surgery-is still some months away, I can not comment on my total satisfaction with the process. I can say, though, that so far (3 years of treatment) I am completely enamored with all 3 of the dental pros working for me. They have been kind, considerate and amazingly helpful. In fact, after all of it, my nearly crippling aversion to and anxiety over dental work is basically gone. I know that I will see this current dentist for the rest of my life, and that sort of stability and trust is pretty helpful.
posted by broadway bill at 12:29 PM on December 30, 2009

IAAD, but, of course, NYD.
First let me assure you that your problem, or set of problems, is fairly common, and that there are different schools of thought as to how to resolve them.
It seems that your specific pain in the back left molar is dental and should be addressed by the dentist who did the crown.
Because your back molars take a lot of force when you bite they are often the casualties when a bite is not ideal. the problem may be in the teeth (if you have decay or failing restorations); or in the muscles (if you are clenching/grinding/bruxing) or in your bite (if the contacts are not ideal or you have anatomical features which cause interferences to a smooth action when you chew); or in a combination of those elements.
A thorough examination with a dentist whom you trust (or feel you can build a trusting relationship with) should illuminate the sources of your discomfort, but sometimes pain is referred from one place to another; and because your body is able to adapt pretty nicely to subtle changes, sources of pain can be masked and may arise elsewhere after adjustments.
If your bite is far enough off to warrant movement of your teeth, an orthodontist should be brought in for a consultation at the least. perhaps the solution will be purely orthodontic in nature, perhaps purely dental, perhaps a combination that might even include other disciplines.
Expect that a thorough work-up will include models of your teeth and bite as well as images.
I have no specific recommendations for colleagues in your area, but it's here that i might suggest going to one of the fine dental schools in the area. all of the disciplines will be in one place, so it might be possible to have consultations from the various departments without having to go all over creation.
Whether you go this route or stick with private practitioners, make sure you find someone with whom you can communicate, it's key to success in these cases.
Good luck.
posted by OHenryPacey at 1:24 PM on December 30, 2009

I had pretty much the same problem. The answer is Xanax.

I know it sounds flippant, but I'm 100% earnest. Your anxiety is preventing you from getting the important medical attention that you need.

I only actually took the Xanax for my first visit. For subsequent visits, it was enough to simply have it in my pocket, knowing that I could take it at any time.
posted by ErikaB at 5:06 PM on December 30, 2009

I have a similar problem and can tell you some of the things that were suggested to me (as far as stretches and jaw position). They have worked great and I haven't done anything else. I can also refer you to the great doctor I saw (from Columbia dental school) if you memail or email me.

--Do an N stretch: say the letter N. Keep your tongue in that position and slowly open your mouth all the way. Hold that for 6 seconds. Do that 6 times in a row, 6 times a day.

--N-rest: when you're not chewing, your tongue should be in the N-position and your teeth should NOT be touching.

--Avoid chewy food, hard food, and, er, phallic food. No whole pickles or giving blow jobs (sorry!)

Good luck...!
posted by kathrineg at 7:32 PM on December 30, 2009

I was born with a severe underbite, to the point where my top and bottom teeth only met in one place in my entire mouth. This, of course, caused me quite a bit of trouble. This is what they did to help me:
1) Put me on a daily NSAID regimen
2) Made me a splint that I wore all the time unless I was brushing my teeth- it filled the gaps and gave me a biting surface
3) Took X-rays of my jaw every six months to see when it would finish growing
4) Put me in braces to get my teeth aligned
5) When my jaw finished growing, surgically correct the underbite
6) Fine-tune with the braces to make everything match
7) Profit! (for everyone involved; the doctors got money out the wazoo and I got a blessed relief from the crippling pain.)

Now, I had an especially bad case, to the point where student orthodontists would come by to look in my mouth at my spectacularly bad bite. Plus, they had to delay treatment for several years while my jaw finished growing. But generalizing from the experience, I'd say: you need to find an orthodontist who specializes in TMJ, and ask the orthodontist to help refer you to a dentist. Your regular common or garden dentist will probably not have the specialized training to evaluate where your symptoms are coming from and what will help them. TMJ treatments differ widely depending on what is causing the problem- mine was an anatomical issue, but for some people it's coming from stress or what have you; and the treatment continuum is very broad.
posted by oblique red at 8:47 AM on December 31, 2009

Thank you, everyone. I made an appointment with a TMJ/facial pain-specializing physical therapist whom I met yesterday for the first time and like a lot. We had a very thorough conversation and examination; she's going to help me with some muscular issues but most of the signs seem to be pointing to what my dentist also thought: weird bite, needs orthodontia. I'm going to vet a few orthodontists over the coming weeks. I'm on my way. It's encouraging to read the anecdotes from those of you who had similar problems and worked your way to solutions!
posted by toomuchkatherine at 12:56 PM on January 5, 2010