Ways to Manage Advance TMJ
March 2, 2016 12:36 AM Subscribe
My partner has TMJ. A disc in his jaw is all folded up, and it sounds like nobody can fix it. It causes him significant pain and he has no hope that his pain won't just get gradually worse until he can't mentally function anymore. What can we do to improve or manage his condition?
He's had jaw pain for about 2 years now. He clearly remembers the day it started -- it seems to have been triggered by grinding his teeth the night of a high stress event. We have seen dentists about it, and they did an MRI that revealed his disk on one side was all folded up. Several treatments (e.g. PT) have resulted in one-time decreases in his pain level, but the pain level keeps creeping upward over time, so we're once again getting close to the point where he won't be able to sleep well due to the pain.
Things we're already doing/considered doing:
* He has a splint, and it planning to see a dentist soon to get it replaced, since it's starting to show wear. He grinds his teeth at night; this splint is designed to both lessen the damage from that and I think to help his jaw position.
* The surgery to try to fix it (i.e. unfold the folded disk) isn't recommended because it often makes things worse.
* Physical therapy: he's tried it in the past, and we're thinking about looking around (we moved) for a PT around here. While it initially lowered his pain level, his pain level has crept back up since the one-time decrease.
* Meds. He's opposed to pain medication in general; thinking clearly is extremely important to him. He's currently on a (very low dose) tricyclic antidepressant to help with his sleep and with the TMJ pain. [previously, his pain got to the point where he couldn't sleep well because it hurt enough that it woke him up every hour or two, when he could even fall asleep at all; he's approaching that point again.]
* Stress. His life is pretty stressful right now, and his biggest stressor is the pain -- especially the thought that this is just going to get worse.
He's seen tons of doctors and a few dentists before we moved last year, but only a couple doctors since then. Before we moved, he had a jaw MRI to specifically diagnose his TMJ pain.
His MRI evaluation summary:
"On the right side, the articular disk is anteriorly displaced and folded and does not capture appropriately with the mouth in the open position. There is asymmetric translation of the mandibular condyles with the left translating more anteriorly than the right."
Our current doctor (post-move) said that he can only do pain management for TMJ; if we had a dentist that said it's not TMJ, he could maybe do more. [side note: it's super weird that doctors can help with anything except your mouth/jaw.]
My partner has read some papers about TMJ, and it sounds like the pain often gets better. However, in his case, the pain has steadily gotten worse over time, and every treatment has only brought temporary relief.
We really want a way to "fix" his joint and make it better. That's probably not possible, so management of the associated pain would be the second choice. We'd also be happy with recommendations of doctors or dentists in the Seattle area (we're on the east side) that have expertise in TMJ or pain management.
He's had jaw pain for about 2 years now. He clearly remembers the day it started -- it seems to have been triggered by grinding his teeth the night of a high stress event. We have seen dentists about it, and they did an MRI that revealed his disk on one side was all folded up. Several treatments (e.g. PT) have resulted in one-time decreases in his pain level, but the pain level keeps creeping upward over time, so we're once again getting close to the point where he won't be able to sleep well due to the pain.
Things we're already doing/considered doing:
* He has a splint, and it planning to see a dentist soon to get it replaced, since it's starting to show wear. He grinds his teeth at night; this splint is designed to both lessen the damage from that and I think to help his jaw position.
* The surgery to try to fix it (i.e. unfold the folded disk) isn't recommended because it often makes things worse.
* Physical therapy: he's tried it in the past, and we're thinking about looking around (we moved) for a PT around here. While it initially lowered his pain level, his pain level has crept back up since the one-time decrease.
* Meds. He's opposed to pain medication in general; thinking clearly is extremely important to him. He's currently on a (very low dose) tricyclic antidepressant to help with his sleep and with the TMJ pain. [previously, his pain got to the point where he couldn't sleep well because it hurt enough that it woke him up every hour or two, when he could even fall asleep at all; he's approaching that point again.]
* Stress. His life is pretty stressful right now, and his biggest stressor is the pain -- especially the thought that this is just going to get worse.
He's seen tons of doctors and a few dentists before we moved last year, but only a couple doctors since then. Before we moved, he had a jaw MRI to specifically diagnose his TMJ pain.
His MRI evaluation summary:
"On the right side, the articular disk is anteriorly displaced and folded and does not capture appropriately with the mouth in the open position. There is asymmetric translation of the mandibular condyles with the left translating more anteriorly than the right."
Our current doctor (post-move) said that he can only do pain management for TMJ; if we had a dentist that said it's not TMJ, he could maybe do more. [side note: it's super weird that doctors can help with anything except your mouth/jaw.]
My partner has read some papers about TMJ, and it sounds like the pain often gets better. However, in his case, the pain has steadily gotten worse over time, and every treatment has only brought temporary relief.
We really want a way to "fix" his joint and make it better. That's probably not possible, so management of the associated pain would be the second choice. We'd also be happy with recommendations of doctors or dentists in the Seattle area (we're on the east side) that have expertise in TMJ or pain management.
I suffer from TMJ (for many many years) and I saw a massage therapist who specialized in it and it was kind of miraculous. He's in Vancouver BC, which is not Seattle, but maybe within reach? His name is Jody Tennant and you will find him at Tonume Integrated Health. If you can swing it, my advice would be to book a series of appointments with him a few weeks apart.
In my case the jaw was out of alignment and was clicking hard, twice, each time I opened my mouth. Using some focused and rather painful massaging of the facial muscles, Jody managed to more or less get my jaw back into alignment, in just two treatments. It is not 100% cured but it is light years better, and I have exercises that help when I need them.
posted by PercussivePaul at 12:55 AM on March 2, 2016 [4 favorites]
In my case the jaw was out of alignment and was clicking hard, twice, each time I opened my mouth. Using some focused and rather painful massaging of the facial muscles, Jody managed to more or less get my jaw back into alignment, in just two treatments. It is not 100% cured but it is light years better, and I have exercises that help when I need them.
posted by PercussivePaul at 12:55 AM on March 2, 2016 [4 favorites]
If bruxing is still a problem, botox has been shown to work really well.
posted by mattbcoset at 1:52 AM on March 2, 2016 [1 favorite]
posted by mattbcoset at 1:52 AM on March 2, 2016 [1 favorite]
Meds. He's opposed to pain medication in general; thinking clearly is extremely important to him.
Maybe a dumb question, but has he tried something OTC like ibuprofen? Not all pain medicines muddy your thinking.
posted by jon1270 at 4:01 AM on March 2, 2016 [1 favorite]
Maybe a dumb question, but has he tried something OTC like ibuprofen? Not all pain medicines muddy your thinking.
posted by jon1270 at 4:01 AM on March 2, 2016 [1 favorite]
Best answer: Another vote for keeping up on the PT! I know it's really dispiriting when nothing seems to "work" but it can at least help with maintenance.
posted by teremala at 4:45 AM on March 2, 2016 [1 favorite]
posted by teremala at 4:45 AM on March 2, 2016 [1 favorite]
Best answer: PT and aggressive massage with someone who knows what they are doing. I did biofeedback training, to learn to release my jaw, which really helped me with my TMJ pain. I'd try some guided relaxation meditation right before bedtime. Make really sure the splint is correct for his bite. Also Ibuprofen and ice, ice, ice.
Once he accepts that he has a lifetime of self-care to do for this issue, his anxiety around it will probably decrease. Chronic pain is really a tough thing mentally, so working around acceptance might be helpful in terms of his over all wellbeing (which in turn could lead to less gnashing of teeth). Best of luck to him!
posted by PorcineWithMe at 5:42 AM on March 2, 2016 [1 favorite]
Once he accepts that he has a lifetime of self-care to do for this issue, his anxiety around it will probably decrease. Chronic pain is really a tough thing mentally, so working around acceptance might be helpful in terms of his over all wellbeing (which in turn could lead to less gnashing of teeth). Best of luck to him!
posted by PorcineWithMe at 5:42 AM on March 2, 2016 [1 favorite]
I have had TMJ for 20 years, and wear a bite plate at night to help with the teeth grinding. It was only in my 40s when I realized that the grinding was due to anxiety and have had some success with therapy in reducing the stress levels and grinding, but it is still there, at a lower level.
The biggest help has been an understanding acupuncturist who specializes in body alignment issues. While I still have some discomfort, after seeing him for 2 years, it is really minimal. Acupuncture (and some massage) helped me where all the doctors and dentists could not.
posted by bessiemae at 9:15 AM on March 2, 2016
The biggest help has been an understanding acupuncturist who specializes in body alignment issues. While I still have some discomfort, after seeing him for 2 years, it is really minimal. Acupuncture (and some massage) helped me where all the doctors and dentists could not.
posted by bessiemae at 9:15 AM on March 2, 2016
I would also recommend acupuncture. I was pretty skeptical about it (I'm a pretty hardcore Western Medicine type) and it's been immensely helpful for my chronic pain. TMJ is not my primary issue but I have a whole host of issues around the head/neck/shoulders area. Acupuncture has been so amazing at getting my muscles to relax.
posted by radioamy at 10:22 AM on March 2, 2016
posted by radioamy at 10:22 AM on March 2, 2016
One other thing you might research is "functional orthodontist". I got that word from another MeTa thread and was able to find a practitioner in my area who treats TMJ. I'm wearing a splint but it's completely different from the first one I had which was just to stop teeth grinding. This new one actively forces my lower jaw to move forward so as to reposition it, based on xrays, tamography, and applied geometry of where is the proper place for my jaw to be.
I know that when I searched "TMJ" or "TMD" in my area, I didn't find anyone who could help, but searching "functional orthodontist" opened up a lot more options.
posted by CathyG at 7:51 AM on March 3, 2016
I know that when I searched "TMJ" or "TMD" in my area, I didn't find anyone who could help, but searching "functional orthodontist" opened up a lot more options.
posted by CathyG at 7:51 AM on March 3, 2016
I agree with keeping up with the PT and splinting -- in my case it kind of had to get worse before it got better. However, the only thing that really downgraded the pain from ever-present to occasional was a procedure called an arthrocentesis. It involves draining the fluid from the joints with needles (under light anasthetic) then replacing it with saline and cortizone. For me it calmed down the inflammation and let the discs kind of float back into a better position. It's a procedure more commonly done on knees but I think it's a relatively new thing to try it on the TMJ joint. I'm in Australia so can't recommend you a surgeon but it may be worth looking into.
posted by imaginary_mary at 8:16 AM on March 3, 2016
posted by imaginary_mary at 8:16 AM on March 3, 2016
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Otherwise my only suggestion is sort of dumb- was he given exercises at PT? Is he doing them? If not, do them, even without a new PT. I have a recurring knee issue and when I am good about my exercises it doesn't hurt... When I flake out it is fine for a while but inevitably gets grumpy again.
posted by nat at 12:51 AM on March 2, 2016