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Dr. Andrew Rynne

Family Physician

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Suggest treatment for TMJ disorder

Answered by
Dr.
Dr. Mahaveer Patil

Orthopaedic Surgeon

Practicing since :2002

Answered : 1209 Questions

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Posted on Wed, 5 Apr 2017 in Bones, Muscles and Joints
Question: Hi, I am a 44 year old female and have had TMJ disorder since early 30's. I believe the orthodontist told me the right disc was either worn or the jaw was off the disc, so for many years my jaw leans to the left side. When I yawn or open my mouth my jaw and mouth moves to the right only so I eat, clean my teeth and yawn on a careful angle. Most of the time it is bearable although maybe not long term. It usually doesn't click or hurt unless I do something. Based on this only the teeth on my left side meet when closed but they are getting sore and damaged from the constant pressure of contact. I was suggested a corrective splint but didn't like the idea of using it to reposition my jaw as I have a big fear of it moving and worse locking.
Now 3 weeks ago I stupidly ate a few hard crackers and that night my whole mouth ached. I thought I had just hurt my teeth and gums but after a few days of it not getting better I began to notice my jaw had moved out of its usual crooked position. I tried gently to yawn and get it back in place as my teeth were all banging into each other and causing teeth and gum pain. It hasn't worked and my jaw, neck and head all ache. Not even panadeine forte or ibuprofen makes any difference. I have been only eating soup or soft food as teeth hurt to chew or close. So I went to the dentist and told him my history as just mentioned. He decided to drill a couple of teeth on the left side shorter so that both the left and right sides close evenly. But this hasn't helped my jaw because it is still not in its usual position. Now I am worried as both sides of my jaw hurt and won't stop. Jaw is stiff. Yes my teeth are now not sore as evenly close but I am worried about my jaw pain. Do you think that evening teeth made it worse? Do you think that the jaw will only be okay when and if it moves back to its original crooked position? He said that now teeth close evenly that will correct jaw as it will cause jaw to open and close straight but I worry that even though my mouth, teeth etc look better as when I open and close the mouth is not on an angle and when I close my mouth the teeth equally meet so that is good but I am asking if this will actually correct my jaw and stop the pain or if it will make no difference due to the disc problem or if it will actually make the jaw worse now because it needs to sit incorrectly leaning to the left but now it can't because my teeth are even, so it will never get back to that left position with no pain ever again. Please advise me because I can't sleep, work, eat, talk, laugh as I have 24 hours a day jaw pain, stiffness, migraine and clicking neck. Thank you. Looking forward to your advice.
doctor
Answered by Dr. Mahaveer Patil 1 hour later
Brief Answer:
TEETH CORRECTION WON'T AFFECT JAW PROBLEMS

Detailed Answer:
Hi Mrs. XXXXXXX

Thank you for posting the question.
I have gone through your medical history in detail.

From the history,it does not seem that the jaw and mouth pain will get better with correction of teeth levels. The basic pain is due to subluxation of the jaw position and the earlier disc problem.

Unless the jaw comes back to its original position,the pain will not go away.

You need to talk to your orthodontist about this and get the jaw position corrected.

Taking pain killer medicines will only help temporarily.


I hope the answer was useful.

Feel free to ask me any follow up queries that you may have.

Thank you.
Kind regards.

Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Mahaveer Patil 26 minutes later
Would the shortening of teeth have made it worse?
Will the jaw go back to its original position on its own?
I don't want to get a dentist to manipulate my jaw?
If not what else do you suggest I do to go back to previous position?
doctor
Answered by Dr. Mahaveer Patil 40 minutes later
Brief Answer:
Query answered

Detailed Answer:
1.Shortening of teeth does put extra pressure on the jaw muscles but it does not seem to be sole cause of pain.

2.The jaw won't go back to its original position by its own.It needs to be manipulated by a doctor.

3.An orthodentist (not a simple dentist) can do the manipulation better.
An Xray of the jaw needs to be done first to see the exact extent of jaw subluxation.Depending upon this the exact manouvere of the manipulation can be decided.

4.It would be rather risky to attempt the manipulation yourself as this may worsen the problems.It is better to atleast get an Xray first before deciding further line of management.

Thank you.
Above answer was peer-reviewed by : Dr. Remy Koshy
doctor
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Follow up: Dr. Mahaveer Patil 1 hour later
I definitely wouldn't do it myself and don't want anyone to do that really. Sounds horrible and I panic it would lock or be worse than now.
On previous times my jaw has gone back to its position on its own either over time or if I yawn or something it will click into place but hasn't this time.
That is why I wonder if it can't go back with even teeth.
My question is if I yawn etc and it clicks back on its own can it still do that or would the even teeth now prevent the jaw ever moving back to its original position?
doctor
Answered by Dr. Mahaveer Patil 39 minutes later
Brief Answer:
Even teeth will not cause any hinderance

Detailed Answer:
No,i do not think that even teeth would prevent it from getting back to its original position.

If it gets back during yawning,by a click,its well and good.You can definitely give it a try

Thanks
Above answer was peer-reviewed by : Dr. Remy Koshy
doctor
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Follow up: Dr. Mahaveer Patil 2 hours later
Hi just one last question- if normally my jaw is crooked due to subluxation but now whilst jaw is in pain the jaw appears straight especially when I open my mouth, yawn etc it opens straight not to the side. So why would a straight jaw hurt non stop yet the crooked jaw doesn't hurt. I would have thought that with my mouth now opening straight and additionally the teeth even the jaw should be fine but it isn't. It is more comfortable crooked. Why is that?
doctor
Answered by Dr. Mahaveer Patil 15 minutes later
Brief Answer:
LONG STANDING ARTHRITIS OF T-M JOINT

Detailed Answer:
Hi,

This is because the jaw was crooked for so many years which had led to a stiff joint and its adjoining soft tissues on one side. The capsule of the damaged TM joint,the muscles surrounding it etc ,all were shortened and fibrosed compared to the other side.The body had adjusted accordingly to the above changes.So you had no pain then.

Now,suddenly this incident occured which stretched / partially damaged the shortened tissues causing their inflammation.Though this has straightened your jaw and the teeth are even,such stretch is not known to these structures for so many years till now. That is why this is causing soreness and continuous pain.

I hope this answer was useful.

Let me know if you have any more doubts.
I will be happy to help you.

Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Mahaveer Patil 35 minutes later
Thank you that was very informative. So can the jaw joint, tissue etc ever be repaired and if so how? Is there anything other than a splint to re-align the jaw? If arthritis then do glucosamine etc help for jaw joints? And if with my jaw currently straight could the jaw over time get used to the new correct position as you said that it has forgotten that over the years and got used to the incorrect position, so with jaw straight would the joint, tissue etc become used to this and not cause pain again overtime?
doctor
Answered by Dr. Mahaveer Patil 57 minutes later
Brief Answer:
less chances of complete recovery

Detailed Answer:
Hi,
The joint / soft tissues cannot completely heal.Over the time the soft tissues may heal only to some extent.

Only splint can re-align the jaw.Other option is surgical re-alignment,but its better to be avoided as it will cause more harm than benefit.

Glucosamine helps only in stage 1 of arthritis.
In your case,it seems to be in a late stage and it will not help much.

Yes,its possible that these soft tissues may become used to this new corrected position over the time and cause considerable reduction in pain intensity.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Mahaveer Patil 8 hours later
Ok, so there isn't really anything that would correct the tissuesand joints other than a splint. Am I better to try and move it back to old position or keep it in straight position and hope pain goes?
Also since teeth even now pain and stiffness more on right jaw and ear? Is that good or bad?
They say to rest jaw but will that cause stiffness and jaw to get used to being closed so opening becomes difficult?
doctor
Answered by Dr. Mahaveer Patil 6 hours later
Brief Answer:
Complete rest not required

Detailed Answer:
Yes,only splint is the option.

I would suggest not to try to get it back to its original position and hope the pain goes.

Pain on right jaw is definitely bad for now,but it would reduce to some extent gradually.

Rest to jaw is necessary but not complete rest.

Try and move the jaw within the permissible painless range to avoid stiffness.
Above answer was peer-reviewed by : Dr. Remy Koshy
doctor
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Follow up: Dr. Mahaveer Patil 13 minutes later
Why do you suggest I leave it on current position? Is that better longterm? If it stays like this will it be harder to move it back to original position as time goes by, so shouldn't that be sooner done or you don't think I should make it crooked? If it is straight now will it eventually find its previous familiar position or will it get used to new position and stay?
doctor
Answered by Dr. Mahaveer Patil 59 minutes later
Brief Answer:
do not make it crooked

Detailed Answer:
You should leave it in current position and hope that the pain goes away gradually.Wait for the nature to act.Give it a chance to heal naturally.

In a long term,if the pain goes away and if the jaw muscles adjust accordingly,then it is definitely better long term.

Only if the pain increases,instead of reducing,then you can try to relocate it to its original crooked position.

If it is straight now,then it will get used to its new position and stay.There is very less possibility that it finds its previous familiar position by itself.
Above answer was peer-reviewed by : Dr. Remy Koshy
doctor
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Follow up: Dr. Mahaveer Patil 33 minutes later
Then how come one needs a splint if the jaw gets used too a straight position on its own. I believed only a splint or surgery could correct a jaw misalignment so I am wondering why the jaw would be able to adjust to a normal straight position justby temporarily moving it through eating? Please advise from your expertise .

And currently if I slightly move my jaw to either side or I lean forward or backwards the jaw actually moves so it is as though it is loose which is why I asked you if I should reposition it while loose? However even though moves loosely at the same time it is stiff to talk or open? Why is moving if I move my jaw sideways but stiff if I open or close mouth?
doctor
Answered by Dr. Mahaveer Patil 24 minutes later
Brief Answer:
The joint is partially subluxated

Detailed Answer:
A splint will provide support to the inflammed soft tissues and help in their healing process and thereby reduce inflammation and pain. Minimal jaw movements will make sure the jaw doesn't become stiff.

The joint moves only in one axis because it may have subluxated from its crooked position in that direction.(Normally,the TMJ is a saddle type of synovial joint with very less movement in lateral axis).

Thank you.
Above answer was peer-reviewed by : Dr. Remy Koshy
doctor
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Follow up: Dr. Mahaveer Patil 7 days later
Hi, I would like to follow up with the special I was communicating with before.
I had a CT scan of both TMJs and down both sides of my head skull to inferior mandible with axial, coronal and Sagital views. Report says TMJ spaces bilaterally are well preserved and articulate spaces are regular. No periarticular erosion. No soft tissue calcification in either TMJ. Only polypod swelling in maxillary sinus. I spoke to dr and dentist. They said scans and report show no damage of TMJ or degenerative problems. They both felt my tmjs and noted they do not click and seem normal but that I have limited opening of mouth. They believe that as I often clench my jaw that with that and then biting into hard biscuits I overly strained the jaw muscles causing jaw to be very tight. They said to take Valium 5mg and voltaren with soft diet. I am asking your opinion based on the report and history and Drs assessment of my current jaw.
doctor
Answered by Dr. Mahaveer Patil 1 hour later
Brief Answer:
muscle relaxants will help

Detailed Answer:
Hi Mrs. XXXXXXX

Nice to hear back from you.

Good that you got CT scan done to confirm the diagnosis.

Now that the CT scan has ruled out TMJ arthritis or damage,only jaw muscle spasm (caused due to over-strain) is the reason behind the symptoms.

I do not feel Valium is needed as it is a sedative and is used for treating anxiety and sleeping disorders.

To treat muscle spasms better,i would recommend skeletal muscle relaxants like tizanidine,thiocolchocoside or cholzoxazone.

These are available in combination with anti inflammatory drugs like aceclofenac or paracetamol.

You should check these medicines with your doctor and get it precribed for faster recovery.

Thank you.
Above answer was peer-reviewed by : Dr. Remy Koshy
doctor
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Follow up: Dr. Mahaveer Patil 12 minutes later
So you agree that the only reason is muscle strain/spasm (excluding the dr and dentists opinion) but based on my ct and symptoms?

If so I wonder why when at times now when I close my mouth my bottom teeth go into different positions eg sometimes the bottom teeth are to the left and hit the top left then other times the bottom teeth are to the right and hit the top right side. Occasionally the bottom feels forward and both my top and bottom front teeth hit. Is that from the strained muscles pulling jaw side to side or is there another reason not seen in scan? It is as though my jaw is loose and moves around. This again is only since eating the biscuits and the pain and tightness began?
doctor
Answered by Dr. Mahaveer Patil 14 minutes later
Brief Answer:
Muscle spasm is the only reason

Detailed Answer:
Yes,irrespective of the dr and dentist's opinion,i personally believe that muscle strain / spasm is the only reason (based on CT report and the symptoms).

The strained muscles on either side are strained and in spasm in different degrees.May be the left ones are in spasm to a greater degree than the right ones or vice versa.
This may cause your teeth to go into different positions.
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Mahaveer Patil 14 minutes later
Right that's good to hear. Prior to this clenching my teeth over the years made my jaw angle to the right when I opened my mouth but since this it angles a bit to the left eg if I yawn. Is that also the spasm and will this return to normal?

How long do you think it will take?

Drs always suggested I take Valium for anxiety and jaw clenching but I always declined but as my jaw has been so painful I agreed to try it.
doctor
Answered by Dr. Mahaveer Patil 29 minutes later
Brief Answer:
may/may not return to normal

Detailed Answer:
The recovery may or may not be 100 %.
Recovery period may vary between 15 days- 2 months.

Its good you try and avoid valium.

Only if the pain is very severe,you can take it.
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Mahaveer Patil 20 minutes later
So the left tendency is still just spasm of muscles?

I didn't see anything about the discs on the report. Was that on the report and if so ok?

Would a mouth guard for clenching actually reduce jaw tension and relax jaw muscles and stop me from clenching?
doctor
Answered by Dr. Mahaveer Patil 7 minutes later
Brief Answer:
mouth guard may weaken jaw muscles

Detailed Answer:
Yes,the left tendency is just spasm of muscles.

It was mentioned in the report that the joint articular surfaces are well maintained.This implies that the discs are ok.

Mouth guard may help temporarily but may weaken the jaw muscles in long run.
So,it would be better to avoid it.
Above answer was peer-reviewed by : Dr. Nagamani Ng
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