Dental question

[Laurence Stein DDS]

Hi Boomx5,

I just completed an article for Dive Medicine Online for Scubadoc. Check this link: http://scuba-doc.com/ . Look under Dental Problems and then Jaw Spasms.

While the article starts out with a discussion of an internal derangement of the articular disc within the joint, it also goes on to discuss TMJ. There is also an excellent link to another dental site about TMJ.

The answer is long so please forgive me if I don't attempt to write it again. The answer to your question is most probably already there.

Regards,

Larry Stein

 

[boomx5]

That helped alot. I think I need to go see a Dentist and see if I can get some help.

 

[redacted]

boomx5 once bubbled...
That helped alot. I think I need to go see a Dentist and see if I can get some help.

I had some low level jaw pain preceeding a trip to Cozumel last spring. After 18 dives, the pain was much worse and good food wasn't helping. I went to Dr. when I got back. Told him about pain & that I was sure it was not teeth - it was in jaw bone and seemed to move from upper to cheek to lower and in the sinus cavity. I had never even heard of TMJ. He gave me antibiotics & told me to see a dentist if that didn't help. Two weeks later, dentist said TMJ & baby the jaw. I could eat anything I wanted so long as I didn't chew. To make a long story short; I converted to a sea-cure mouthpiece, started using a nighttime mouthguard (I'm a grinder) and went back to my daily vitamin M (motrin). Relief was immediate although it took months for pain to totally disappear. BTW, dentist made mouthguard was a couple hundred dollars. I went with a homemade job using a moldable athletic mouthguard. Six months later, it's still working fine

 

[Laurence Stein DDS]

Boomx5,

Glad to help. I hope you see why I didn't want to write that all again.

TMJ treatment can be time consuming, frustrating for both the patient and dentist, and expensive. You will have times when everything is ok and then you may get another episode.

If you have missing teeth--especially in the back, extruded teeth as a result of extraction of opposite teeth or a poor bite, restoration of the bite by prosthetic or orthodontics may go a long way to help.

You have to do it a step at a time. First an exam...see if the problem is with the bite or if there is an internal problem with the joint(s). You might try bite splint therapy. If you can be made comfortable, then either maintain what is successful or make changes to the bite to wean you off external devices.

Personally, I done not consider myself a TMJ "expert". I can recognize the condition but I have never been satisfied with the potential protracted treatment--I don't like the frustration either--I start to get guilty charging fee after fee with little change. Fortunately, I have some dentists I can refer to who can help.

I have discovered an FDA approved device that I have started to use. It is for bruxism, TMJ and headaches. The FDA approval is for migraine headache. I've started making them and those patients are reporting less bruxism and less fatigue and tenderness in the morning.

Do a web search for NTI-tss or Dr. James P. Boyd, DDS. He has a large website devoted to this device.

Good luck,


Larry Stein

 

[boomx5]

My TMJ symptoms are a sore or very stiff jaw and it only bugs me after a dive or after I have bitten down on somthing for an extended period of time. I am not missing any teeth nor have I experienced any trauma to my lower jaw. When I was younger I used to grind my teeth at night so I wonder if that has anything to do with it. I think awap has a good suggestion that I'll try, and hopefully that will give me some good results. If you have any more "home remedies" that I can try, I would appreciate the tips.

 

[Laurence Stein DDS]

Awap,

So like I said, the condition tends to persist for quite some time and it can recur.

If you brux or clench your teeth or "used to"(you can bet you still do) then you are probably more prone to the muscular fatigue needed to spasm the muscles.

The Ibuprofen and soft diet are fine. You may have to stay on the Ibuprofen (Motrin, Advil) for some time to be effective. One dose won't work. You gotta watch the old stomach lining though. Don't take this stuff if you are allergic to aspirin, have a history of ulcers, have asthmatic reaction to aspirin or are allergic to sulfonamide antibiotics.

Hmmmm....a boil and bite mouth guard. I know you tried this because the dental version is $$$. This was my point when I talked about the frustration of treatment. Actually, when the dentist makes the bite guard, he tries to capture the jaw joints in their proper position and leaves very few opposing dimples for the opposite teeth to catch on. Rarely would a patient be able to do this themself and there certainly would be an opposing surface with cusp indentations. These indentations are going to be positioned in your "acquired bite position" because that is where you are most comfortable. They are NOT in the position that allows the jaw joints to be in their best position.

While you have created a pad to cushion the bite forces, you joints are still probably out of position.

Boomx5, the Motrin or Advil as mentioned above can help. It may take several doses over several days to see a change. The OTC dose is 200 mg. It may not be strong enough for the initial problem. Limit wide opening and hard or tough foods. Stiffle a wide yawn. Don't sleep on the sides of your face. DON'T CHEW GUM! In a bind, sometimes holding a pencil between the front teeth for 5-15 minutes may stop a spasm. This is the principle behind the NTI-tss system.

You mentioned that you used to grind your teeth (bruxism). You can just about bet that you still do it.

If your symptoms persist, see your dentist. Let him check your bite.

The SeaCure mouthpiece can be useful but it has the same problem that the boil and bite mouthguard has...you tend to posture your bite in the most comfortable position. The movement to this position is controlled by an "engram"--a preprogrammed neurologic muscular pattern. You will repeat the improper closure until you deprogram it. Sometimes this can be done by pulling downward on you chin while closing into the hot mouthguard material onto your back teeth. This tends to seat the joints and allows a closure track that is more normal.

Good luck.

Laurence Stein DDS


Disclaimer
(No representations are made that in any way offer a diagnosis, treatment or cure for any illness or condition, either discussed or implied. Answers to questions are offered as information only and should always be used in conjunction with advice from your personal diving physician/dentist. I take no responsibility for any conceivable consequence, which might be related to any visit to this site.)
:doctor:

 

[KyMermaidDivr]

You have my loudest applause! I, too, learned some new things over here on the east coast of dentistry. Being a hygienist, I was naturally drawn to this thread and was very impressed with the response you gave and the interest it generated. Do you have any openings on your team? :lol: just kidding ... unfortunately, as much as I LOVE CAL, I couldn't afford to live there. I am hoping to visit again soon ... this time in Monterey and Carmel and do some diving, hopefully next year. Back to dental ... it's so much more fun to educate when people are eager to learn!

Monica, RDH

 

[Scubadent]

90% of all dental inquiries on this board should be directed to this thread and their questions would be answered.

PS: Thanks for spreading the "root canals dont normally hurt" line. Although we in the profession know this to be truth, I wonder how many patients truly believe it prior to the procedure? Only until after do they spread the word. One hot tooth out of a hundred seems to set us back alot more than the painless root canal moves us forward, unfortunately.

Keep up the wonderful posts.

 

[KyMermaidDivr]

Sorry, Dr. Stein ... just realized you're not in California. Don't know where I got that! I won't be too far from you in a couple of weeks ... FT Lauderdale here I come! And, NO I'm not bringing any dental intruments with me!ut:

Monica, RDH

 

[Laurence Stein DDS]

KyMermaidDivr, Scubadent ,

Thanks for the positive feedback. You both know the rewards and frustrations of dentistry.

BTW--I LIVE IN MIAMI, FLORIDA!!! It's always Summer here! So I get to dive nearly year round.

If you come down, let me know. I don't own a boat but I have 5 different diver friends who do (I'm not stupid) and most weekends I can be found underwater.

Hey, why don't you just call me Larry.

I just got lucky...DAN published two articles I wrote over the years and then Scubadoc@scuba-doc.com contacted me as well as Rodales. Then the board asked me to respond. It's been fun. I just have to be careful--some of the answers are so long that I have to save them--to write them again would take forever.

You guys are more than welcome to contact me.

Back to the old grind.

Kindest Regards,

Larry Stein