Bioesthetic Dentistry for TMJ dysfunction

May 21, 2008 5:57 PM

"Bioesthetic" dentistry: expensive quackery or my last best chance at a pain-free life?

I have chronic pain; specifically, I've had a headache for 13 or 14 years now. As you can imagine, I've been subject to many tests and treatments, none of which have helped; years ago a doctor sent me to a pain clinic, where people learn to live with chronic pain. And I've lived with it, for a long time.

Then I got tired of living with it. Over the past year, my doctor and I have been exploring various options, none of which have paid off yet. Recently, she referred me to an oral surgeon to evaluate me for TMJ problems; he identified TMJ issues as a contributor to my headache. It seems very plausible to me.

For treatment, the oral surgeon referred me to a "bioesthetic" dentist. I had my consultation today. He would like to treat me with a device that would trick my jaw into thinking I have a proper bite, which would let my jaw relax. Over a period of months, he says, with periodic adjustments, my bite, jaw joint, and facial muscles can be returned to healthy position and functioning.

That's Phase I. In Phase II, we would supposedly be able to evaluate steps that could be taken to maintain correct bite without the appliance: jaw surgery, modification of tooth surfaces, and orthodontics are three possibilities.

It all sounds lovely, but I'm skeptical for a few reasons:

1. I've gotten my hopes up before only to have them dashed. Which isn't entirely relevant to the question.

2. Some elements of the dentist's spiel seemed a bit sketchy to me: a bit of excessive reverence for the dentist who discovered this amazing thing; a few references to things "mainstream dentistry" just doesn't want to pay attention to. Rhetoric I've heard before from proponents of unscientific, unfounded alternative treatments.

3. It's tremendously expensive: $4500, not covered by insurance, for Phase I.

4. One website I consulted about TMJ treatment warned specifically against treatments that required the wearing of a bite appliance 24 hours a day for extended periods of time.

Any experience or knowledge of bioesthetic dentistry as a treatment for TMJ problems? Personal stories as well as general info very welcome. If I decide not to pursue this (very likely since, among other things, the money to pay for it just pretty much doesn't exist) what other options might I pursue for TMJ treatment?

Please don't suggest other headache treatments; whatever you know about and swear by that changed your life, I've probably already tried it, and it will only depress me to hear about your miracle.

posted by not that girl to health & fitness (5 comments total)

I had a nightguard designed by a dentist in England to cure my bite problems. It was an unusual shape - contoured and not much overlap with the teeth, so it looked as if it would not stay put. But it really did correct my bite. It cured an underbite, over about a year, plus it stopped me grinding my teeth. I had to keep wearing it every night, or the bite problems would return. So yes, this sort of treatment does work. My nightguard cost about $1000 (private treatment in the UK means you pay the full cost). $4500 sounds very expensive. But if you are in the USA this could be the going rate - dental treatment is very much more expensive here, in my experience. I am not convinced by wearing a brace 24 hours/day, either. I would try other dentists - but this type of treatment is frequently not covered by insurance, so be prepared for at least a $2000 bill. I'd be unconvinced by the surgery aspect - you may end up with wobbly teeth and more pain.
posted by Susurration at 6:36 PM on May 21, 2008

I had this done about ten years ago. I am a hardcore clencher and was in the early to mid-stages of TMJ, plus I had chronic headaches. Phase I was a small biteguard that I wore 24/7 for four days and then nightly for a month; Phase II was resurfacing of my teeth to "correct my bite".

Phase I was AWESOME and I still wear the biteguard every night (it's a hard plastic, not the soft gel kind, and it only covers the front top six teeth). I didn't even mind wearing it at work.

Phase II, however? I wish I hadn't done it. My teeth still feel slightly out of sync - for example, I can't bite through a cotton thread or anything that requires incisors to be lined up - and the resurfacing exacerbated the sensitivity on a couple of teeth. Plus, it was not covered by insurance and it cost about $3000 in 1996. I knew my dentist socially and I still feel like I was coaxed into a treatment I didn't need just because it was the usual next step.

I would recommend investigating the Phase I treatment. It did enough for my clenching and jaw tension to alleviate about 80% of the problem; my jaw still clicks a bit and I still get headaches, but it's nothing near as bad as it was. A competent and ethical dentist should be OK with you delaying the decision about Phase II until you've given the biteguard a fair shot, which should include reshaping the guard until it feels almost natural. Adjusting the bite adjusts a lot of other tiny muscular movements in your head, which is sort of the point, but if it's not done right? Well, they can't exactly undo it.

Best of luck to you in any event - mine were never near as bad as yours sound, but I hated every minute of it so I can only imagine.
posted by catlet at 8:02 PM on May 21, 2008

I just got a biteguard for TMJ a few weeks ago; they're pretty mainstream as far as I can tell. Almost everybody I've mentioned it to knows somebody who's had the same thing. My dentist did all the fitting for it; I haven't heard anything about surgery or anything, and she's quite clear about what's going to be going on.

IIRC, it was about $1000-1200 and my dental insurance paid half, although it was apparently a bit of a pain for the dentist's office to get through. (2 years ago at my old job it wasn't covered at all, last year they said it was covered, but not yet because I hadn't been there long enough.)

I grind and clench, and I've had clicking in my jaw since my early 20s. A year ago, my jaw (on one side!) just refused to open all the way. My massage therapist swears that it contributes to the tension in my neck and upper back, so I can see where it would contribute to headaches, too.

Also, someone I work with said she wished she'd gotten a biteguard years ago; her teeth are actually fracturing from all the years of grinding, and THAT is some expensive dental work.
posted by epersonae at 8:47 AM on May 22, 2008

Epersonae, do you have a regular nighttime bite guard to protect your teeth from grinding, or a guard that is mean to correct your bite? As I'm learning, there's a big difference between the two. I've had a regular, dentist-supplied nighttime bite guard for years; this is something different from that. I remember my guard costing about $600 when I had it made.
posted by not that girl at 12:34 PM on May 22, 2008

If I understand correctly, it's supposed to be correcting my bite while protecting.
posted by epersonae at 4:50 PM on May 28, 2008