Dentist, doctor, or chiropractor for jaw alignment issues?

[LeeH]

Several weeks ago my 11 year old and I were wrestling around in the floor. Somehow she hit me quite forcefully and squarely across my open jaw. NOT intentional at all... really didn't bother me and I had a good laugh about it at the time. A couple of days later I realize that my teeth aren't quite aligned as they have been all my life.

I made an appointment with my dentist who is a true artist when it comes to all things teeth. He seemed more concerned with correcting the bite vs checking out or fixing the jaw.

Next stop was a chiropractor I know personally. I've never really thought cracking my back could fix my allergies, but thought since this was a joint/alignment issue that he may be able to help. Through some tweaking he was able to correct the issue temporarily (as in for a few minutes). A second visit yielded the same results - pop it back in, back out minutes later.

I took a couple of weeks trying exercises suggested by the chiro, but it's still out of alignment and increasingly a bit sore.

Trying to figure out what to do next. Back to the dentist? Back to the chiro? Start over with my sports medicine doc?

Overall there's not a lot of pain... dull ache at its worst and that's more in the mandible vs the joint. I wouldn't even really be aware of it, but chewing is an issue due to the bite being off. I'm ready to get this fixed, but not sure which doc to try next. At this point I've had no x-rays or other imaging. Suggestions?

[Zeke]

Not sure of your age, but I can tell you that in my case (older), it never totally went back. I had a special appliance made, the kind they make for you to sleep with so you don't grind your teeth.

That was by the dentist and was not a good fix. It didn't locate or "key" the alignment. I got one of those sports mouth pieces that you form yourself with boiling water and made sure I got my jaw back to where I thought it was supposed to be for the forming process. It helped using it at night and sometimes during the day.

[MRM]

What you have is commonly referred to as TMJ after the temporal mandibular joint where the pain comes from. I am a personal long term sufferer of TMJ and have spent several years litigating personal injury cases that involve treatment for TMJ and its various causes. I've done a lot of research on TMJ, both professionally and personally.

TMJ is really a catch all diagnosis for any jaw pain similar to what you describe. Most cases are caused by people grinding their teeth or "posturing" their jaw, usually related to stress. You have something a little different, but the treatment is pretty much the same. Your TMJ was caused by direct trauma to the Temporal mandibular joint. Your joint is swollen and inflamed from the trauma. The reason your jaw feels out of place and that your bite isn't correct any more is because with the pain and inflammation in your joint, your muscles are unconsciously pulling your jaw out of its normal posture. There's nothing you can do other than get your joint and muscles quieted down and relaxed. Whatever you do, don't let some quack talk you into some treatment to recapture your bite or recapture your joint. These are well known scams. They increase insurance payments but do nothing for you and can very well hurt you.

Don't go to a chiro. There are no manipulations that will help. Some physical therapy can help. The best they can do is give you exercises and some ultrasound. The ultrasound heat on your jaw feels nice, if nothing else. Sometimes you end up with a splint, or plastic mouthpiece that relaxes your jaw and keeps it more in place. Eventually your TM joint heals and you should be fine. In some cases the TMJ soreness never fully goes away.

What you really need is a referral from your dentist to a real live TMJ or TMD specialist. If you can't find one, let me know where you are and I'll get you a referral.

I'll leave you with the one exercise that has brought me great relief over the years. Do not overdo it. Just do it gently for 30 seconds at a time several times a day. Your normal bite should take two fingers between your top and bottom teeth without pain. You won't be able to do that. Put as much of two fingers between your top and bottom teeth as you can handle without feeling pain. You want to feel stretching without pain. Hold it there, try to relax and stretch the muscles for 30 seconds. Rest, give it some time, and do it again later. Whatever you do, don't try to force your jaw back to the normal bite. If you try that too long, the pain feels like someone's trying to rip your lower jaw off. Just relax the muscles and treat your jaw like a sprained ankle.

Best of luck. It's a painful and common condition.

[Gogar]

Cmon, this is PPOT! You need to hire a lawyer and file suit against your daughter immediately.

[Geronimo '74]

I had a a misalignment issue too a while back. Came from an infection of the joint. (i thought it was an ear infection at the time). It hurt when trying to bite too. After the infection went away, my bite was in alignment again.

[Rick V]

I'm thinking the story goes more like angry wife and frying pan. CLANG!!!!!!! right against the side of the head. (Sorry man I have no advice but I couldn't pass up the comment)

[DanielDudley]

This is a lifetime thing for me, and I have to stretch my neck and jaw regularly, and keep my neck in alignment with a Chiropractor when needed. I can put my jaw back in myself when it slips out, but sometimes I have to do a fair amount of stretching first. I cannot chew gum very often, or for long intervals.

I also get incredible headaches if I let this go. I had a serious headache for almost a year before I discovered I had TMJ. I was actually contemplating suicide before it was diagnosed. I don't really notice it in my neck or jaw when things are out of alignment, but over the course of several months, I will slowly develop a serious headache that just will not quit.

FWIW, I had braces as a kid, and my teeth are straight but even with my jaw aligned, the match up of my teeth pushes my jaw backwards when I chew. Now that there is damage, it is easy for it to slip out. It started with an incident much like yours, but more severe.

[GeorgeK]

Considering there was an initiating trauma and obviously no fracture (that would cause excruciating pain), your most likely problem is within the temporo-mandibular joint, and I would vote for a dislocated TMJ meniscus. Yes there are menisci in the TMJs, which have a complex cinetic movement (or "excursion") when opening the mouth actively.

Best way to diagnose correctly is to have an MRI of both TMJs performed, with closed and open mouth sequences, maybe in incremental opening. This will get a correct diagnosis of the menisci themselves, and of their excursion across the movement range.

You can simply not treat your ailment without knowing what it is. manipulation on a torn meniscus can make things worse over time.

[LeeH]

Originally Posted by GeorgeK

Considering there was an initiating trauma and obviously no fracture (that would cause excruciating pain), your most likely problem is within the temporo-mandibular joint, and I would vote for a dislocated TMJ meniscus. Yes there are menisci in the TMJs, which have a complex cinetic movement (or "excursion") when opening the mouth actively.

Best way to diagnose correctly is to have an MRI of both TMJs performed, with closed and open mouth sequences, maybe in incremental opening. This will get a correct diagnosis of the menisci themselves, and of their excursion across the movement range.

You can simply not treat your ailment without knowing what it is. manipulation on a torn meniscus can make things worse over time.

What's the typical treatment for this? I guess I'm trying to figure out if the time/expense of having the imaging done leads to treatment/cure or if it just gives me peace of mind that something is really wrong.

[MRM]

MRIs with open and closed mouth sequences will run between $1,200 and $2,400. And then you pay the doc to read the images and diagnose you. That's one reason why TMJ treatment is such a medical scam and I spent years of my life chasing bad TMJ docs. You almost certainly don't have damaged menisci. There is no such thing as a "dislocated" meniscus or joint, by the way. The meniscus of the jaw is very similar to the discs between your vertebrae. "Dislocated" is a shorthand term for layman use that can mean anything from a torn disc to bulges, to inflammation. Kind of like "slipped" disc to the back. It isn't really a medical term.

Fortunately you don't have to do any of that, at least right now. There are dentists who have advanced training in TMJ management. Go to either your regular dentist or your family MD and get a referral to one. Your health insurance should pay for it. It is treated differently under your health insurance than dental treatment. It is treated as a medical treatment. Get a referral to a real live TMJ specialist and follow his course of care. Do NOT consult a chiropractor. Do NOT call a dentist out of the yellow pages. This is the one area where personal referrals are meaningless because there are so many quacks out there. Quacks can convince people that they are receiving live-saving treatment when all they are doing is exacerbating the problem, and the individual doesn't know the difference. This is the one area where you can only trust the personal referral of a medical professional you already trust.

Typical treatment, whether you get an MRI or not, is physical therapy, mild anti inflammatory, and a flat plain splint (mouthpiece). It is hard to cure TMJ once you have it, but treatment can be helpful managing symptoms. Of course, the literature outlines various treatments that are effective over a 12 week period, and then compares it to the usual length of a TMJ flare-up (also 12 weeks) and concludes that not much out there cures TMJ, but some treatments offer symptomatic relief.

MRIs are of little practical value because they only tell you if you're a surgical candidate because you have a blown meniscus, and no one but the most desperate cases are surgical candidates because the surgery is worse than the disease. So unless something really unusual is going on, there's no need for MRIs. You need a competent exam from a TMJ specialist, and regardless of the course of treatment he suggests, you’ll feel much better in about 12 weeks. If he suggests an effective course of treatment, you'll feel better sooner.

A couple more questions: How far open can you move your mouth without feeling great pain? Do you hear clicking or popping sounds? Is there a grinding sound in your joint or a sensation like there's sand in your jaw joint as you open and close your mouth?

Basic first-tier steps are to cut out caffeine and alcohol. Stop biting your fingernails or eating hard to chew foods. Chew with your molars instead of your front teeth. Try small to moderate doses of Ibuprofen. It's an anti-inflammatory as well as a pain reliever. Massage your jaw as much as you want. Do gentle stretching exercises like the one I described above. Do not posture your mouth or try to force your bite back into alignment.

The next level of intervention is a flat plane splint, heat and ultrasound, simple exercises and PT.

Do call your HMO's care line and set up an appointment with a real TMJ specialist, though. They can help enormously.

Again, if you don't have a referral, PM me your location and I'll find an expert who takes your health care plan.

[LeeH]

Great info! Thanks for taking the time to share all of this.

Fortunately, the pain is minimal, if there at all. No popping and not real limits on how far I can open.

My only real issue is alignment. When I was a kid, my dentist said I had a couple of minor gaps that would typically be closed up with braces, but he said I had one of the straightest bites he'd ever seen and didn't want to risk messing with it. Now my left side seems to close normally while my right doesn't.

When it first happened (at my dentist's suggestion), I took fairly high doses of ibuprofen and naproxen, used the heating pad several times each day, and ate very soft foods. I kept that up for a week or so and nothing really changed. After the chiro, I tried a "business as usual" approach and ate hard chewy stuff thinking it might work its way out. The past couple of days I've been concentrating on relaxing and gentle exercises as suggested here. It seems to be improving ever so slightly with that approach.

[GeorgeK]

Originally Posted by MRM

There is no such thing as a "dislocated" meniscus or joint, by the way. The meniscus of the jaw is very similar to the discs between your vertebrae. "Dislocated" is a shorthand term for layman use that can mean anything from a torn disc to bulges, to inflammation. Kind of like "slipped" disc to the back. It isn't really a medical term.

MRIs are of little practical value because they only tell you if you're a surgical candidate because you have a blown meniscus, and no one but the most desperate cases are surgical candidates because the surgery is worse than the disease. .

Well, yes there is such thing as a dislocated meniscus. I see them quite often, and it is an accurate description. What do you call the image when a meniscus is folded on itself and no longer between the mandibular condyle and the temporal joint recess?

A TMJ meniscus is *far* more mobile than an intervertebral disc. And structurally it is closer to a knee meniscus.
A quick google (I am not near my books) with "tmj dislocated meniscus" gives you anough MRI images.

And, dislocated meniscus is not a term (is is in french), but a blown meniscus is??

And finally I agree that there is no good surgical solution.

[POORSH]

A dislocated disc is very real. When a jaw clicks or pops, it is MOST often (not all) associated with a dislocated disc or when you hear the term "recapture the disc", it is because the disc has traveled beyond its limits. To recapture a disc is not an easy task. You would have to undergo a series of treatment that will first involve relaxation of your masticatory muscles (temporalis, masseter, etc.) with a tens unit, then obtaining a bite with your muscles relaxed, and then having to wear an orthodic appliance.

As a side note for DanielDudley, this is how one would treat headaches or migraines derived from muscle tension associated with an "off" bite.

Hard to say at this point whether you have a dislocated disc or not. You would have to either get an MRI open/close or a 3D scan open/close to have any indications of the position of the disc. $1200-1400 is kind of steep. It is usually more in the area of $400-600 in my neck of the woods for a 3D.

As MRM has mentioned before, you'd want to seek a dentist with training in TMJ and TMD. If you need a referral, PM me and I will put you in contact with a group of people in your area. There are quite a few of us across the country that is able to do this kind of work.

I am sure there are other treatment modalities for this problem. Always get multiple opinions, and don't let anyone cut you up without having done your research. Good luck.

[POORSH]

Originally Posted by DanielDudley

This is a lifetime thing for me, and I have to stretch my neck and jaw regularly, and keep my neck in alignment with a Chiropractor when needed. I can put my jaw back in myself when it slips out, but sometimes I have to do a fair amount of stretching first. I cannot chew gum very often, or for long intervals.

I also get incredible headaches if I let this go. I had a serious headache for almost a year before I discovered I had TMJ. I was actually contemplating suicide before it was diagnosed. I don't really notice it in my neck or jaw when things are out of alignment, but over the course of several months, I will slowly develop a serious headache that just will not quit.

FWIW, I had braces as a kid, and my teeth are straight but even with my jaw aligned, the match up of my teeth pushes my jaw backwards when I chew. Now that there is damage, it is easy for it to slip out. It started with an incident much like yours, but more severe.

Pushing your jaw backwards is not a good thing. If you look at the TMJ compartment, there is only so much room for your condyle. If your jaw goes back or forward of the condylar space, your condyle is essentially placing pressure on your temporal bone. A big no no. I would have a capable person look into your continuous headaches. It can be as simple as adjusting your bite to prevent it from driving your jaw backwards, or it can be as complicated as having to re-establish your bite.

[89911]

I've come across cases like yours in my 25 years of practice and have some general advice. PM me if you like.