TMJ

I suffer from TMJ. A forum member suggested I try to recreate some posts that were lost during the crash.

TMJ is one of the other diseases that can mimic Meneire’s. TMJ stands for Temporomandibular Joint disorder (the jaw hinge).

Symptoms include:
Clicking in the jaw hinge
Locking of the jaw hinge
Sinus congestion
Tinnitus
Dizziness
Balance problems
Ear fullness
Nausea
Headaches
Ear pain
Pain in the face, neck, or upper back
Jaw pain
Numbness in the hands (a nerve bundle runs through that area).

Causes and contributing factors include:
Grinding your teeth (usually at night)
Clenching your teeth
For some reason my with TMJ had braces as a kid
Accidents/injuries

Treatments:
First line treatment is a hard plastic & metal splint (similar to a retainer but it goes on the lower teeth). This splint snaps on the teeth. It’s worn 24/7 for 6-8 months. Some are allowed to eat without it some are only allowed to remove it to brush their teeth. Along with this treatment that can they suggest muscle relaxants and moist heat or ice (which ever feels better at the time).

Second line treatment is to either cap all the teeth to change the bit (by increasing the heighth of the teeth) or braces.

Third line treatment is surgery on the jaw joint itself. In the past this was the first line treatment, but no longer. This is now a treatment of last resort.

More to follow, Tracy

 

How I got diagnosed:
I’ve known I had TMJ for at least 15 years. I’ve worn a soft plastic night guard (over the top teeth) similar to what athletes wear to prevent chipped teeth for 13 of those years. About 6 or 7 years ago the clicking and pain in my jaw got bad and my dentist sent me to a TMJ specialist. He was an oral surgeon. He used a stethoscope to listen to the hinge and gave me a written test (asking questions like “Do you believe that you doctor can cure what’s wrong with you?”) His diagnosis was I need to get a life and/or see a psychologist. I gave up any hope of treatment at that point. I continued to wear the night guard, but it doesn’t treat TMJ it just hopefully helps to keep it from getting worse.

My atypical MM symptoms started January 04. At some point between then and when I was diagnosed in June of 05 with EH (a form of atypical MM) I developed BPPV (positional vertigo). I had the EH under control, but the BPPV was happening every 6 to 8 weeks. It was so bad I spent over 16 weeks in vestibular rehab therapy learning how to reposition the balance crystals because it was happening so frequently. It would sometimes take me two weeks of repositioning to get the balance crystals back in. From September 05 on I was unable to drive a car, or work more than 3 days a week.

In December 05 I developed almost constant nausea even when I wasn’t dizzy. I assumed it was either the EH or the BPPV. In April of 06 I developed stabbing ear pain in both ears usually when I was talking or eating. I feared I had an ear infection so called my specialist (he is easier to get into than my gp). After examining me and me telling him about the nausea, he told me there was no infection. Also he said something else had to be going on because I shouldn’t be nauseous without some sort of dizziness. As he continued the exam he placed his hands on my jaw hinges (both sides at once) and asked me to work my jaw up and down. I literally jumped 2-3 inches off the seat. It was so painful that my jaw ached for an hour afterwards and my teeth ached for 48 hours afterward. His diagnosis was TMJ.

One of the interesting things he told me: in utero the bones of the ear and the bones of the jaw hinge start out fused together and later separate. The inner ear and the jaw hinge are very close geographically in the skull. There is only 1 pain nerve that runs to both the middle ear and the jaw hinge, the brain has no way to distinguish where the pain is coming from, it simply knows that something on that line hurts. That’s why I thought the pain was in my ears!

I went to my dentist for a referral and I told her right off there was no way I was going back to the same doc that dismissed me last time! She said, Oh there’s a new specialist in town and we send all our patients to her! So I got on the waiting list.

The specialist is an Oral and Maxifacial Surgeon. The exam included a full facial x-ray. Three x-rays of each jaw hinge, with my teeth together, jaw relaxed and mouth all the way open. They also measured how much I could open my mouth, and shifting the jaw all the way to the left and right. An ultrasound of the jaw hinges, and there was also all kinds of manipulation of the jaw.

I was absolutely amazed! It was so obvious on the x-rays. First thing we noticed was that my jaw is tilted it’s about 2 cm higher on the right than the left. Also there is a dent in the jaw bone on the right side. She said that was caused by the fact that the muscles on the right side were trying to compensate for the damaged jaw hinge on the left side. Then we saw the hinge x-ray’s. The left hinge was so inflamed we couldn’t even see it on the x-ray. The right hinge was only about 40% visible.

The doctor asked me “What was my greatest concern?” My answer “That you won’t believe me.” Even after I saw the x-rays! I was still afraid that she would blow me off. Well she didn’t! Second for me was the nausea. The relief I felt at being believed was overwhelming.

Another thing I’ve learned through all this is that woman are much more likely to suffer from TMJ than men, and they are much more likely to be dismissed by a doctor, especially if they seek treatment early in the disease.

Tracy

 

The Treatment:

The impressions for the splint took about an hour. Part of it was putting me on a tense unit to relax the face muscles so they could take a proper impression of the distance between my upper and lower teeth. Two weeks later (last week of May) I had my splint. The instructions included, wear it 24/7 except to brush after eating. I’m to take smaller bites. Shoving too much food in the mouth stresses the joint. If I’m in pain I’m to try to put even amounts of food on each side and chew at the same time (try it, it’s really hard to do!) No hard, chewy, sticky or tough to chew items, no ice, hard candy, carmel, taffy, bagels, raw vegetables, nuts, popcorn or dried fruit. No singing, no shouting and I’m to place a balled fist under my chin when I yawn.

I was given muscle relaxants and pain killers for about the first month to help me adjust. I go back once a month so they can check progress. Measurements are taken and the splint is tightened if I feel it’s loose. By the end of the month it’s loosened to the point where it feels spongy or loose when I chew. It’s not like braces where the tightening is done to further the treatment. This is tightened simply to make it more comfortable.

They told me that whatever symptoms that were being caused by the TMJ would clear up during the first 2 months. The nausea disappeared in 1-2 weeks. My balance started to improve as well. I wasn’t walking into walls as much and could stand without feeling the need to lean against something.

By the end of the first month (June) I began to notice dramatic improvements in my balance. Balance exercises that I couldn’t dream of doing in April were easily done! By the end of the second month (July) the nausea was gone and I was able to start driving again. Soon after I worked my first 5 day week in 11 months.

I’ve now had the splint in 4 months. I’ve not had a BPPV episode since I got the splint. This is the longest I’ve gone without one in 2 years. My MM doc confirmed that it is possible the TMJ was causing the balance crystals to move out of place.

I have my life back!

Tracy

 

I have not heard of this before. The orthodontist I was refered to by my dentist said surgery, but only after my dizzyness was stabilized. My neurotologist feels TMJ may be a trigger for me. I went to a chiropractor for treatment and found some releife in my jaw, but if this works... Who would I need to see? Dentist, surgeon, GP, etc.?

 

DL,

You need to see an oral & maxifacial surgeon that specializes in TMJ.

Good luck, Tracy

 

after talking with tracy about tmj
my dentist reffered to a TMJ specialist, he is not sure if i have it as i have
alot of inflamation in my jaw which has to settle before he can do a proper exam
and diagnosis but now i have a specialist looking into it, he says
that it might take six month to confirm but hey i have lived with this for four
years now so six month isnt that bad ;D ;D

thanks tracy


lisa

 

Lisa,

Your welcome. I'm not sure why he has to wait for the inflammation to go down. I hope it happens sooner rather than latter!

Hugs, Tracy

 

I too suffer from TMJ. I've been through all the same tests and have been in therapy for a few months. Been wearing the lower guard days and the upper nights. Am now able to eat without it and sleep every other night without the upper. My symptoms have improved dramatically. I can open wider and the clicking and ear/jaw pain is nearly gone. Some symptoms still remain, but my doc adjusts my therapy to my progress. I'm still unable to lay on a pillow comfortably. I just feel like my jaw doesn't belong on my head, strange I know.
I was in an automobile accident in March and all my problems started about one week later. The not singing is what bothers me. I sing 24/7, to the kiddos, to myself, to the cat, to my garden, anything or anyone. I can't stand to hear my own voice now. It just sounds so loud and seems to echo through my body. Often bringing on anxiety.
Do you think the TMJ and menieres are related. My doc and oral doc have agreed the symptoms are of each separately and not just the TMJ. Did this make sense?

 

dizzymom,

TMJ mimics MM (that's short hand for Meniere's.) This means for some people they have similar symptoms to MM but they don't have it, they have TMJ instead. Some of us are special ;D we have both!

The TMJ didn't cause the MM, nor did the MM cause the TMJ. One can complicate the other though. If you have lots of nausea with MM and clench your jaw that can aggrivate the TMJ, I'm sure there are others examples.

Sounds like your treatment is working. Keep up with the therapy!

Good luck, Tracy

 

Now isn't that the truth! I had to wear braces for 8 years. I suffer from TMJ and MM. My mom who never had braces suffers from MM in the same ear and has TMJ as well. Go figure.

I'm keeping this thread as a watch so I can follow your progress. Who knows how well things will turn out.

Thanks!

Peace!

Stev

 

Thanks Stev,

I've had a bit of a set back. The doc thought I was ready to wean off the splint. But I wasn't and the TMJ got active again. I put the splint back in and I'm doing better. So I'll have to wait until January and see what the doc has to say.

Hugs, Tracy

 

Tracy I didn't relize untill recently I am doing this and the TMJ is worse when MM symptoms are worse. I have been watching to see what is triggering the TMJ because I can go awhile without it bothering me then boom its back. I now notice when I'm stressed I tend to clench. I go back to the dentist in a few weeks and going to see about a referal. She had talked about doing this the last time I was their and told me to let her know when I'm ready. She checked also checked to see what Insurance would pay for was part of the reason I was reluntant to see someone. She sent me a letter after saying Insurane would pay most of it so this time I will let her do the referal. Thanks Tracey for all the info.
Joe

 

Joe,

Be sure to let us know how it goes! You never know what's contributing to what until you start try sort it out!

Tracy

 

I was dx'd with TMJ in 1998. All my oral & maxifacial surgeons have put me in top mouth guards. I have had MRI's to rule out the surgery. I never heard about caps before? I know braces have helped migraine suffers so that would make sense for TMJ. I also have gone to physical therapy for my TMJ.

 

Hi Tracy,
After 6 months of dizziness, ear pressure, tight / dullness on the left side of my head, tinnitus, eustachian tube dysfunction I've been diagnosed w/ TMD. It's been a long labyrinth of different doctors and tests to get here but I'm glad to have some certainty in the cause of my symptoms. Yesterday was my first visit to the neuromuscular dentist. Though I had almost no jaw pain, the x rays and bite examination revealed that my jaw is misaligned and that my left molar is taking the initial brunt of all my chewing and grinding at night. When the dentist had me move my jaw side to side, I could feel the tight areas of the left side of my head flexing. The dentist said that basically those muscles are full of lactic acid and metabolic waste products and are in constant state of being flexed. He also explained how a lot of the other symptoms I'm having can be caused by the irregular bite and jaw.

As far as treatment goes, he recommended a splint (~$4000), physical therapy, and after the bite and jaw is ok, some work on the damaged teeth (extending the cuspids and crowning some other teeth). He said that the splint should get me 60-70% better and the physical therapy would help get me the rest of the way. I hope to start on this regimen right away after I square things up w/ the insurance co.

Thanks so much for sharing your story and answering my questions. I'll let you know how the splint and PT work out.
-David

 

David,

I'm so glad you have found the right doc. I know the splint is horribly expensive, and I can understand the need to make sure the insurance company will cover it. Mine did, I was a bit surprised. Luckily I'm in a financial position where we could afford the splint so I'd had my splint for a while when the check from the insurance company showed up.

Don't forget that TMD is a medical condition so your medical insurance should cover it (not your dental insurance if you have it.)

Good luck, Tracy

 

Time for an update. I’ve now been in the TMJ splint for 14+ months. I’ve not been able to wean off the splint. I was given 3 options: continue to wear the splint, have all my teeth crowned to change the height, or see a TMJ orthodontist. Living with the splint was not a good option because of how difficult it is to chew in, and speak with it in. I spoke with my dentist about the crowns. She advised against it based on my age and my family history of bad teeth. Crowns would likely result in total tooth loss during the next 20 years. So I went to see a TMJ orthodontist.

After x-rays, pictures, medical history, impressions and a special 3-D head CT, he gave me his opinion of what can be done. Basically the orthodontia I had as a kid has caused and/or complicated the TMJ I have now. It was common practice to pull teeth and move the front teeth back (I had a severe over bite). My upper front teeth are tipped in (the cutting edge). The upper front teeth should be slightly tipped out. Because of where my upper front teeth are, my lower front teeth have no clearance. This is why I can’t wean off the TMJ splint. The impressions were something to see. It was easy for us to tell that the only way my lower teeth can clear the upper ones is if the jaw is way back and jammed up into the joint.

The plan is to put braces on the upper teeth first. Once the uppers are where they belong we will try once again to wean me off the TMJ splint. If that doesn’t work then braces will be places on the lowers and rubber bands will be used to pull the lower teeth up to where they need to be. If I can wean off the TMJ splint I’ll still have braces on the lowers because the molars will no longer mate up to the upper teeth.

I got the braces yesterday. It’s set off the TMJ which in turn set off the BPPV. This is a minimum of a 2 year commitment.

For those that have had success with surgery, because of where my upper front teeth are surgery won’t work for me until those teeth have been moved.

 

Hi all, Yes, I have some TMJ problem affect my ears and balance.

Thanks,

Michelle A.K.A. Jackson

 

Tracy

Your bite sounds very similar to mine, upper teeth tipped in. I decided to get braces in Feb of this year because my lower teeth were so crowded and I had a 80% overbite. I have a very small mouth, and my teeth did not match up well. My ortho put braces on my upper teeth for five months before my lower. Got lower ones a couple of weeks ago.

The most interesting part for me was that three weeks after I had the upper braces put on, one day I was speaking to my husband and midsentence I just stopped talking. He asked me what was wrong because I got this strange look on my face. I told him it felt like the fullness in my MM ear just melted away and I could hear so much better. I don't know if it is a coincidence or if there was a connection with the braces.

A little history, I have had MM for at least 6 years, I had the End. Shunt surgery last July, my ear still felt full and hearing was same nine months after surgery until braces and when I had my latest hearing test in April they confirmed hearing had improved a great deal. I know when I was checking into braces (went to 4 consults) all said I had slight TMJ. I could hear a slight clicking, but never had any pain or locked jaw. I was clenching at night as well. So I am very hopeful this will help in this arena of my life as well.


I hope you see some improvement in your situation soon. It is a slow process, but hopefully it will be worth it. At least now they have products to help care for teeth better with braces. I now have to remember not to put off flossing until I go to bed because I usually too tired to bother with it that late, who knew it could take that long.


Karen

 

Oh, wow! I'm having a surreal moment right now...could this be my problem???!!!! I know that my dentist has told me in the past that I grind my teeth and I wake up every morning with ear and jaw pain. My jaw doesn't make noises or lock, but every time I open my jaw is when I hear the "clicking" noise in my ears. Could TMJ really cause me to feel all this ear fullness and pressure???!!!! I am just now trying to figure all this stuff out and I have no idea what doctor to go see first!
I'm trying to go with what my "gut" says, but right now I'm pretty overwhelmed with information. Ugh.