Diagnosis of the problem is paramount. A really well-done MRI is critical in determining the path of treatment, and many times getting good imaging is quite difficult. So here is the first ‘delay’ in fixing the problem, getting an appointment for a well done and well-read MRI. It can take several weeks to get that appointment and quite honestly some people just do not want to wait. I can’t blame them either. Let’s get it done now!

The next delay is just getting an appointment at the office to discuss all the issues. This is where we look at the bone from the CBCT X-ray and the soft tissue from the MRI. In most cases, people want their insurance to pay at least something and that in turn creates the next delay. Next on our list is the fact that with TMJ appliances, they are custom-made. This takes time. They are not something sitting on the shelf, ready to put in the mouth. It takes weeks to make them since they are custom made for each person.

Now let’s get to the next big delay. You have to wear the devices for 12-18 months to give the discs a chance to move back into the proper position. That’s right folks, it takes that long, especially if the discs have been displaced for several years. The discs don’t just fall back into place instantly. It will take time and patience. Of course, some are not willing to devote such time (and patience) to their health, so they do not do anything. That is OK as not everyone is experiencing the same level of pain or discomfort. When it gets really bad, the patient will pursue treatment but generally now the problem is harder to fix, costs more, and takes more time. This is like most things in life.

Finally, the biggest time consumer of all – finishing after the discs are back in place. In most cases, orthodontic work is needed to grow the teeth taller to protect and support the TM joints (the jaw joints). Orthodontics can take 1 ½ -3 years, easily! So here you are, having spent all this time on appliances only to realize it’s going to take another couple of years. You are basically dedicating up to 4-5 years of your life toward fixing a TMJ problem. This is why we always tell our patients phase one is appliance therapy and phase two is finishing. Thus, the question has been answered. Now you know why TMJ treatment can take so long!

The post The Case of: “Why Does This Take So Long?” first appeared on Sleep & TMJ Therapy.

But now let’s be realistic.  If a potential patient reports that they have ‘TMJ,’ they really are just trying to say that their jaw is a problem, and it might need some help. The way to help such a person is to measure how big they can open their mouth, and then palpate the various muscles that attach to the TM joint. This goes a long way in diagnosing the problem. In many cases, it is necessary to further that diagnosis by ordering an MRI to determine what the articular discs are doing in the jaw joints. The articular discs are the cartilage that covers the top of the jaw bones and protects the joints from going bone on bone, which really can hurt badly.

In addition, a specialty X-ray called a CBCT must be done to further determine if the bones of the skull are out of alignment. So first, the MRI, then the CBCT to figure out what is really going on in the joints. At this point, a discussion must be done about how best to treat the problem(s). Each person has unique symptoms and determining the best appliance is critical. Often, wearing an appliance or an appliance for each arch in the mouth works to ‘decompress’ the joints. This is very effective. The appliance(s) must be worn for a year or more in order to be effective. Then a new MRI and X-ray must be done to see if the discs have moved or are moving back where they should be.

Sometimes,  unfortunately, the disc is either damaged or is not moving back. At this point, it may be necessary to do surgery to help move the discs back into place or remove the damaged disc. Other therapy options to help with the symptom management are prolotherapy, BOTOX®, or even stem cell therapy to help. Surgery is always the last-ditch option because it is more invasive than any other choice. It is, however, very effective and can provide much needed relief to that person who has suffered for many years. The other options, often called the ‘injectables’, help to lubricate the joints so the displaced discs have a chance to move back where they need to be. Sometimes this works quite well, other times not so much because they are not actually fixing the underlying problem.

So, if you do indeed have ‘TMJ’ problems then you most likely have other body pain or symptoms as well. The TM joint can be a problem and you will want to fix it. If so, see the right doctor, analyze the problem, and treat this before it becomes more difficult.

The post “I Have TMJ” What Does That Really Mean? first appeared on Sleep & TMJ Therapy.

Many people will find that the turbos do not really slow them down too much when eating, but they do need to eat softer foods than they normally might. In general, if your food is fork tender, then it should be easy enough to eat and swallow. Mastication (chewing) is good for your digestive system and muscles, yet when you have a TMJ problem, it is better to go softer for a while so the joints can heal.

Another frequent topic that arises is what exercise can be done when a person has a TMJ problem. The issue when a person has a slipped articular disc is the disc needs time to heal and try to recapture its proper position in the socket. If you work out too hard at the gym, this oftentimes causes a pull on the neck muscles (sternocleidomastoids). These muscles will pull on the slipped discs and make them worse. This is why a more carefully crafted exercise program for TMD cases has been developed.

One of the most important aspects of exercise for the TMJ patient is to make sure you do not lift above the height of the shoulder. A guide would be to not lift above the arm when it is stretched out horizontally. The reason for this is that the body will tend to ‘detach’ from this motion, and you will lose strength. Example: If you swam the ‘crawl’ as it is called, your arms would go above the shoulders, and you would pull the water toward you. In this action, you will stress the muscles in the neck and inadvertently pull on and potentially damage the discs in the joints. This is why over-the-shoulder lifting must be avoided.

There is a nicely modified program for TMD patients that involves being careful to protect the joints while still getting in a good workout. Some of these exercises involve using the elliptical machine. As an example, the Peloton is a quality elliptical type of workout. It is not recommended to use the treadmill because it is so much like running that the neck gets pounded. This can hurt the discs as well. There are several other modifications of exercise programs, but they need individual attention and modification per patient.

The post Considerations When You Have TMD first appeared on Sleep & TMJ Therapy.