What kind of specialist do I need?

July 17, 2007 11:40 AM

What kind of specialist do I need for my jaw/headache problem?

From an early age, my jaw has had no real set "bite". I've had to really strain and concentrate to keep my mouth closed and my lips together. I have to pull my lower jaw back about a centimeter and slightly to the left to create a chewing surface. Because my jaws are relatively narrow, I've often bitten my tongue, and had a bit of a speech impediment growing up (and still stumble when tired). Sometimes food or spittle escapes. Jaw moves back and forth into several different positions all the time, and pops continually and quite audibly. At night I feel like I can't sleep and swallow my saliva at the same time; in fact, I was recently diagnosed with a severe case of Upper Airway Resistance Syndrome last year. The real issue this creates has been chronic serious pain in the head and neck area.
I did have braces for about 18 months when I was much younger; when they came off at age 13, orthodontist told parents that my bite problems (which weren't resolved at all by the braces) that I could end up "looking deformed" as I reached maturity. Due to family dynamics and attitudes towards health care, this became a running joke and not much else. Just like clockwork, at age 17, about the time my facial bones reached full maturity, jaw clicking and chronic pain in face, head and neck area began.
I waited for years to see if this would "resolve itself", and then had it dismissed as psychosomatic, and now I am trying to get it addressed properly. I just got back from an oral surgeon who spent 2 minutes looking at my face, had me bite down on a stick, and said that "nothing was wrong with my jay" based on that inspection. Before that, based on the advice of my sleep specialist, I saw an ENT, who said that because I didn't have any bite mark scars on my tongue, that meant my jaw was fine. What kind of doctor am I actually looking for to run the right kind of tests?
Complicating factor: I currently have only medical insurance, not dental. Orthodontics are not possible (again) in the short term--they would only be covered in the context of a medically necessary surgery. I really just need the pain to stop. I've been down several dead ends with this now and just need to know where to go next.

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posted by anonymous to health & fitness (10 comments total)

Sounds like temporomandibular joint disorder (TMJ), or closely related. I know that some dentists and specifically oral and maxillofacial surgeons treat these sorts of symptons. 'Find an OMS.' I'm not sure whether you can use medical (and not dental insurance) to cover the costs. I suggest calling your health care provider regarding coverage.
posted by ericb at 11:54 AM on July 17, 2007

FWIW -- I have clicking in my right mandible/jaw (and sometimes my "open mouth" gets "stuck"). My natural "bite" was altered due to braces. I had an OMS -- who is a family friend -- look at it. He said that I need not do anything regarding it as long as I don't experience pain and can put up with the minor annoyance.
posted by ericb at 12:00 PM on July 17, 2007

And you are positive you are not a teeth grinder/clencher? Might explain some of the pain and ache.

Anatomical pillows and mattresses, have you tried those?

Are you overly tense in neck and shoulders? Any back pain? How stressed out are you?

While your pain sounds like it is jaw related it could also be something completely different. Try to approach a doctor with your neck/sleep/trouble-swallowing symptoms and you might be able to get a better diagnosis.
posted by uandt at 12:11 PM on July 17, 2007

My general physician diagnosed my TMJ (and sent me to a dentist for treatment). Have you talked to your GP about this?
posted by amro at 12:38 PM on July 17, 2007

Sounds like you could do with a lookover from a maxillofacial surgeon.
posted by essexjan at 12:49 PM on July 17, 2007

This sounds like TMJ. In the past I had a doctor who was well versed in it. He explained that because the disorder is so difficult to treat, insurance companies will often refuse to cover it (!). That's why, he explained, he didn't treat TMJ. He treated facial pain. This might be helpful with seeking treatment.

One treatment I learned, and YMMV, is to open my mouth as wide as I can, shift my jaw slightly to the right, push down on my jaw with my hand (with gentle force, no more than two to three pound of pressure) and then close my mouth. There's an audible *pop* when I do this on the right side, but not on the left. My doctor explained that this pops the cartilage back into place in the joint. Apparently my right side is a bit off, and this resets things. It works for me, but I am not a doctor, this is not medical advice, do at your own risk, etc.
posted by mullingitover at 1:07 PM on July 17, 2007

Oh, and getting my wisdom teeth out also made a huge difference with my TMJ. If you haven't had this yet, it's something to consider.
posted by mullingitover at 1:11 PM on July 17, 2007

Another vote for TMJ. I've been dealing with it for about 15 years, so I can empathize. It sucks.

If you clench your teeth at night, seriously consider investing in an NTI. You'd have to go through a dentist, and it's not cheap (mine ran around $300), but it's much more effective than the cheapo night guards you can get at the drugstore. The only caveat is that if you're a serious night grinder, you may wear a groove into the surface of the device, which renders it fairly useless.

You may also want to look into craniosacral therapy. It may even be covered by your insurance, especially if you can find an osteopath who practices it.
posted by Vervain at 1:58 PM on July 17, 2007

If it's TMJ you might be able to manage it with higher than RDA doses of vitamin B complex. My friend has been managing his TMJ with GNC's "Big 100" vitamin for about 10 years. He takes a tablet at every meal though he does still get TMJ attacks when he's under unusual stress.
posted by Soda-Da at 2:32 PM on July 17, 2007

You might want to go see a trigger point therapist. Most often TMJ is caused in part by muscular adhesions in pterygoid muscles. Eliminating tension in the fascia and trigger points in the pterygoid muscles will often have a profound and positive impact on a patients TMJ symptoms.
You can find a trigger points therapist in your area by going to the website for the National Association of Myofascial Trigger Point Therapists at www.myofascialtherapy.org.
Good Luck.
Mike
posted by crazyeye at 8:59 PM on July 17, 2007