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Posted: 3/21/2006 4:36:33 AM EDT
Have a couple of questions regarding a loved one.

For one, do MRI's definatively show this disorder?

Is this a Dentist issue, or an M.D. issue?
Link Posted: 3/21/2006 4:13:08 PM EDT
Is there a dentist or m.d. in the house?
Link Posted: 3/21/2006 4:14:32 PM EDT
Good news that I know is that most health insurances cover it.
Link Posted: 3/21/2006 4:19:50 PM EDT
As a dental student, this is definitely a dental issue. Find yourself a dentist that specializes in TMJ issues or a proths specialist because they are experts in occlusion.
Link Posted: 3/21/2006 4:20:56 PM EDT
It's a little bit of both MD & DDM, IMO. My cousin has TMJ & got fitted for a mouthpice to sleep in at night. I'm probably not too far off from that myself.

I would try the DDM first, IMO. See what he recommends & then make your choices from there?

My .o2
Link Posted: 3/21/2006 4:21:49 PM EDT
My dentist said that it is such an invasive surgery/breaking the jaw. That unless you are in immense pain he found that it is not worth doing.

I'm not worrying about it right now.
Link Posted: 3/21/2006 4:25:15 PM EDT
TMJ
Link Posted: 3/21/2006 4:27:44 PM EDT

Originally Posted By 2A373:
TMJ



terminal monkey jaw.
Link Posted: 3/21/2006 4:36:15 PM EDT
hey buddy, I happen to know one of the bust oral maxiofacial surgeons (jaw and stuff doctor) in the country. he is in CA. and his name is DR James Mossop (maybe mosop) he is located in castro valley i think. that is in the bay area. PM me if you need more info I could get his number for you.
Link Posted: 3/21/2006 4:41:10 PM EDT
[Last Edit: 3/21/2006 4:51:51 PM EDT by Hedonist]
My son has to wear a mouth piece at night, as the result of a high speed rear end collision - he was hit hard. Ever since he has to wear this thing at night and he also gets headaches often. If he doesn't wear it he wakes up with a nasty headache. His jaw has got a little better, but he can easily make it pop and tries not to as that also sends him into migrane city. He also has been on anti-depressants for like 3 years now.

I hate the entire situation, but love my son and would like to get him fixed. So far, nobody has provided permanent relief, and I have the feeling he may be stuck like this forever.

Don't get me wrong, we're happy he wasn't killed or maimed - but in fact he was damaged and as a Dad this is one thing I just can't fix for him (so far).

One of my concerns has to do with "bruxism (sp?)", one of his doctors said a prior doctors mouthpiece was more for "bruxism" than TMJ and I wonder what/why that is. "Bruxism" has to do with clenching, but he has the popping issue too. It seems like that doc is downplaying the TMJ or is it the priorities that I don't understand?

I'm also interested to see if an MRI would be helpful in helping to determine the issue so he can be fixed.
Link Posted: 3/21/2006 4:41:11 PM EDT

Link Posted: 3/21/2006 4:52:54 PM EDT
TMJ is a chiropractor issue. Every once in a while mine acts up, (childhood injuries) and the chiropractor can fix it in a few visits. Also, too hard of a pillow will set it off for me. If TMJ is a problem, make sure you have a very soft pillow.
Link Posted: 3/21/2006 5:02:42 PM EDT
[Last Edit: 3/21/2006 5:03:18 PM EDT by uxb]
It is positively identifiable on an MRI. The patient lies in the MRI with a plastic device similar to a pipe clamp held in the mouth. There is a handle with a lever at the other end.

They activate the magnet and start the imaging with the patients mouth closed. They are able to look at both right and left sides simultaneously.

After an initial set of images, the patient squeezes the handle one time. This opens the clamp a tiny bit and imaging is resumed. This procedure continues like this until the patient has the mouth open as far as they can tolerate.

The images are then generated and saved in a digital sequential format and are reviewed by a radiologist in a conyinuous loop showing the right and left mandible opening and closing.

This enables the radiologist to determine if the meniscus in the TMJ is working properly. Sometimes when opening the mouth, the meniscus slips behind the mandibular ramii instead of its natural position. Attempting to close the mouth applies stress to the meniscus, which eventually slips back into proper position. This is what causes the jaw to "pop" or "click" when opening or closing the mouth.

Definitely suggest an MRI (or MR, depending on where you're from) as it is a definitive tool for proper diagnoses of TMJ trouble.
Link Posted: 3/21/2006 5:07:39 PM EDT

Originally Posted By st0newall:

Originally Posted By 2A373:
TMJ



terminal monkey jaw.



I just spewed my drink all over my keyboard and display.
Link Posted: 3/21/2006 5:09:42 PM EDT

Originally Posted By st0newall:

Originally Posted By 2A373:
TMJ



terminal monkey jaw.



Link Posted: 3/21/2006 5:41:47 PM EDT
Hedonist,

This is a problem for a D.M.D. or D.D.S. There are no specialist in Temporalmandibular Joint Disfunction or TMD (which was formerly called TMJ) because the American Dental Association has not given this field specialty status. There are however dentists that "concentrate" in treating TMD, and many general dentist that also treat this disorder. I typically see and treat 20 to 30 cases a year in my practice.
There are several approaches for treating your son but you need a diagnosis first. Bruxism is the dental code word for grinding your teeth. This is usually diagnosable through exam and history. Exam will usually show wear on the teeth. Popping is not always present.
Popping of the joint(s) during function is usually a sign of TMD. TMD means the joint is not functioning properly. There is a disk located between the base of the skull and the condyle (which is the very top of the mandible or lower jaw) that should stay between these two boney structures during normal function. Popping is usually a result of the disk not staying in proper relationship and the condyle sliding off or popping off (or on) the disk.
I usually start with a biteguard, check on the patient in a week and generally see improvement in this first week. If improvement is not seen in a few weeks I then team up with a physical therapist . Be careful here because I have learned that all PTs are not knowledgable in this area.
If biteguard therapy and PT fail to improve the pain then surgery may be indicated. I have been practicing 17 years and have had one patient go to surgery. That patient had a simple scoping procedure that broke up scarred tissue and relieved the pain.
The goal is to relieve pain. If the popping stops that is great but it does not always go away.
Also note that some dentists may use drugs including muscle relaxers, anti-inflamatories etc to help. Good luck with your son.

Link Posted: 3/21/2006 5:49:04 PM EDT
[Last Edit: 3/21/2006 5:52:30 PM EDT by Tallbob]
Thanks uxb for the MRI description. Had a boat load of mri / mra done.. with and without contrast

I had TMJ that they said was caused by the way they did the orthodontic work on me in the very early 60's. So I had to have the teeth realigned again. IIRC, the device looked like an upper retainer but with the plastic continuing over the chewing surface of the teeth. This would keep the teeth from 'locking' when I closed my mouth. For example, bite down and notice how you can't slide your lower jaw unless you ease up on your jaw muscles. This gadget would keep the teeth from being able to lock together and allowed the jaw to go back to where it was supposed to be. ETA...see what dr grinderhill said above...that's what my dentist and ortho said.

I have a totally unrelated issue I'm dealing with and have found that doctors, like a lot of people, do not always guess right the first time and are unwilling to say, 'ok, that didn't work let's try this'. I finally found a neurologist that is good at communicating with the radiologist, my GP, etc. and I'm finally getting through it.

Before any surgery or other drastic measures I think they need to ascertain what happened in the accident. Was his jaw broken? Teeth damaged? other trauma? Multiple opinions are good.

By the way...any MRIs or xrays are your property. Get a copy. I had to drag about 5-10 pounds of film and reports with me to the specialists. It has been easier recently with the conversion to digital....they just print you a set.

Good luck.
Link Posted: 3/21/2006 7:04:14 PM EDT
A road construction sign fell off a median into the fast lane (left hand lane) of a 6 lane divided highway. 4 or 5 cars came to a complete stop in front of my son, my son was the last car to come to a full stop in an orderly fashion (no squeeling, skidding, etc.) My son was with his girlfriend, they were both wearing seat belts with shoulder belt, my son was driving. My son looked into the rearview mirror to see a minivan about to slam him at 45-50mph. There were no skid marks. As the minivan struck my sons car, my sons trailer hitch went right through the crumple stuff that would have normally cushioned the hit and contacted the frame of the minivan. Therefore the frame of my son's car bent, pushing the rear end upward on contact. My sons car was lifted and tossed into some relatively minor contact with the vehicle in front of him.

He saw it coming - and tensed. His girlfriend didn't see it coming and had no injuries. Apparently he tensed to take the hit and try to control being thrust forward into the car in front of him. He had no obvious external injuries (blood/broken bones/etc.) The airbags blew on the minivan, and they were taken to the hospital and released later that day. A kid riding passenger in the minivan had a bird in a cage on his lap, and upon impact the cage/airbag sliced up his face pretty good. The bird died. My son did not accept a ride to the hospital but complained of back and neck pain. Considering the blood all over the minivan passengers he felt like he wasn't hurt. But he was. Within a day or two he was flat out on the bed unable to move, started to get headaches, and complained of jaw-ache. He never overstating his injuries by any means, and his improvement has not been complete. This was maybe 3 or 4 years ago. He has some kind of soft tissue injury, however I'm not convinced all that can be done is being done. The docs all seem like their afraid to make any kind of diagnosis like were going to "win" some kind of ridiculous settlement and fuck up thier schedule with some court appearance on my son's behalf. With a 100 grand policy limit, I see no "winnings" here. So far, I see about 20K of medical expenses, a kid on anti-depresants, he sleeps with a "split" in his mouth or wakes with a splitting headache (he cant even cat-nap without it), he has been on all kinds of muscle relaxers and migraine "preventers" and migrane meds. The splits cost over a grand each, and last maybe a year or two before they need to be replaced. He has a nuerologist who seems disconnected from the dental guy. They never did an MRI on his jaw. It was determined shortly after the accident that he had a pre-existing upper spine degenerative issue which was advanced for his age but that only compounds his issues. They say he was an "egg" before the accident, and is a little scrambled now but that's not his fault. The woman who slammed him at 45-50mph is the fault, and my son just wishes it never happened, but it did. The docs are all like in this permenant "wait and see" zone, as he has improved, but the speed of improvement is no longer there, and I see a kid with the lingering effects of the accident. You know for a fact he will pay inflated health insurance premiums and/or deal with pre-existing clauses till the day he dies. In the meantime, he sleeps with a sexy splint in his mouth, is on anti-depressants, and misses a day or three each month with an all day headache. He takes all of this well to the point where he forgets what the accident has done to him. If he misses a day of work due to a headache, he gets a substitute and schedules himself to work on some time when he was supposed to be off. He used to ride cycles and quads with the rest of the boys, but now he rides for a while and has to stop, while everyone else rides all day.

He's a great kid. Handsome (like me), honor roll in H.S. - now going to college on a scholarship and working as much as he can at a restaurant where he has held the job for 4 maybe 5 years. His girlfriend is excellent - cute, smart (honor roll/scholarship as well), and has given him an appropriate amount of religion to live by. They have been together about 5 years now. He is 20.

I would like to have him back as he was. Since I can't seem to accomplish that, I would like to see him get as well as he can. Beyond that, he needs to be reimbursed for a lifetime of headaches and jawaches he never had before, and the costs of dealking with this shit. I really don't think a 100 grand is going to do it any justice, especially after the lawyers cut and expenses.

Whatever - I'd like to see an MRI with an issue, and then address that issue to get him in a better comfort zone. At this point I see less than perfect medical stuff, but who knows with internal stuff. I've even gotten into a arguement with a dentist - but thats an entirely different story.
Link Posted: 3/21/2006 7:06:16 PM EDT
you want an oral surgeon...

I broke my jaw in two places a few months back. It was not fun. No solid food for six weeks... and solid food is my favorite kind of food.
Link Posted: 3/22/2006 7:04:40 AM EDT
Bumping for my son.

So far the info has been excellent, especially how to do the MRI. I doubt the his dentist has the expertise to request or read one of them.
Link Posted: 3/22/2006 12:55:49 PM EDT

Originally Posted By sprist:
hey buddy, I happen to know one of the bust oral maxiofacial surgeons




Well, I admit to a "bust" fixation on women, but I'm not sure how this helps him????
Link Posted: 3/22/2006 12:57:42 PM EDT

Originally Posted By BobCole:

Originally Posted By sprist:
hey buddy, I happen to know one of the bust oral maxiofacial surgeons




Well, I admit to a "bust" fixation on women, but I'm not sure how this helps him????




I think it's worth checking out that fixation...
Link Posted: 3/22/2006 5:15:43 PM EDT
Last bump, any more info is appreciated...
Link Posted: 3/22/2006 5:32:39 PM EDT
[Last Edit: 3/22/2006 5:38:42 PM EDT by Crowkiller]
Ask around and talk with a GOOD oral surgeon. A GOOD one will not want to rush into joint surgery, but will not avoid it if needed. My advice is to call as many general dentists in your area as you can and see which oral surgeon they would refer to.
A good o.s. can read a MRI of the joint, it is what they do. It may not show enough for a diagnosis, because TMD has many ways of and reasons for presenting (i.e. you can have pain without visable problems in the joint itself). They will also have a much better idea of how the teeth are supposed to work together. If he thinks your son needs a new splint, he will give you an honest opinion. If he needs surgery, it will NOT be "breaking his jaw", but will most likely be work to repair structures in the joint itself.
Also, realize that this may be something that cannot be fixed, but can be managed.

I wish you both the best of luck. It is the most painful thing to watch a loved one suffer.
Link Posted: 3/22/2006 10:56:27 PM EDT
Since you're in 'USA', I have no idea if you are California or New York. You have to manage your own care today. I suggest you find a major medical center or teaching hospital and get an evaluation. The different specialties he may need are under one roof so to speak.

I've had cervical spine issues and sudden hearing loss and they've done numerous MRIs and CT scans and other lab work to determine the cause. If I was in a car accident and had to use some oral appliance to be able to sleep, by damn I'd want my 'condition' described to me in detail and what the treament options are. Wait and see doesn't cut it with out some more info such as wait for what? How long? I want to know what the treatment plan is and what the options are. ie, how long we wait for improvement, what are the next steps, etc. I want to see a plan.

I'm not doctor bashing. Lots of stuff is difficult to diagnose. I have just had a lot of things happen to me in my life and have learned how to deal with the system. If you like your GP, give him or her a call for their opinon or suggested course of action. The specialists are their 'sub contractors'. They know who gets results and those are the ones they use.

I hope they can get to the bottom of your son's problem.

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