AboutJoel S. Teig, DMD, FABOMS Expertise I am a board certified oral and maxillofacial surgeon and I am available to answer questions related to tooth extractions, implant insertion, facial recontruction, facial and oral tumor removal, TMJ dysfunction and various successful treatments, including surgery if all else fails, and occlusal discrepancy requiring orthognathic or jaw surgery.
Experience Board Certified Oral and Maxillofacial Surgeon practicine for over 20 years. Assistant Clincal Professor and State University School of Dentistry.
Organizations American Dental Association, American Association of Oral and Maxillofacial Surgeons, American Board of Oral and Maxillofacial Surgeons
Education/Credentials BA
DMD
Awards and Honors National Honor Society (OKU), Philadelphia County Dental Society, Mosby Book Award, Oral Surgery Honors, Summa Cum Laude
Thank you for this service. I've had an ongoing TMJ problem for about 10 years that I've recently sought treatment for. My symptoms include bilateral clicks, muscle knots and periodic pain in the joint, mostly on the right. I've been using a Dawson splint since July and I've noticed no change in symptoms and despite feeling that the popping is worse/"deeper," examinations show there have been no changes in the points of opening where my clicks occur.
I had a consultation with an Oral/Maxillofacial surgeon on Monday. His report and review of my MRI from August indicated that I have bilateral reducing displacement of the menisci consistent with Piper classification IVa. To treat me he said my only option was bilateral open surgery with the intention of meniscetomies and fat grafts. My other option--essentially do nothing and hope.
I had a great conversation with my dentist today to discuss this jarring news. He agreed/explained why they felt this was my only option and why they felt appliances and other modalities were not. He did say that I could possibly find comfort in time by doing nothing as the tissues and bones would change shape or harden (I may not remember/be characterizing this correctly) and the click could go away. However my disks will always be displaced from the joint and he said I'm past the recapture stage. It didn't seem like there was any urgency to the surgery and he said my problem isn't going to get inherently worse/treatment option won't change by waiting (somewhat comforting)
I said I'd probably seek at least one other opinion and do some research, which he encouraged. He explained and warned me about the neuromuscular approach to dentistry/TMJ treatment. In the meantime my dentist wants me to continue to wear the guard and see him monthly to check/ adjust it while I decide what to do. I know I can ask him questions at any time, but I kind of want to hear it from someone else's mouth (in this case, hands).
My questions to you, understanding you can't examine me and appreciative nonetheless:
Does this sound like reasonable treatment for Piper Class IVa? The only treatment?
What are your feelings on neuromuscular dentistry?
Where do I begin in seeking another opinion?
As a point of commentary, I live in a major metropolitan city with plenty of OM surgeons but went to a town 1 hr away for the consult--my dentist says the OMS he SENT me to is the best/only person he trusts. He said I could go to Florida to see Dr. Piper but also said "I'm not sure he's the best anymore"
Is there anything palliative (medications? muscle relaxants? massage? etc) I can do to address symptoms, even if not cause, and/or speed up the process of getting to the "chronic phase" with the joint?
Is it reasonable for me to ask my dentist if he can connect me with patients who have had this procedure so I can learn about their experience?
I'm coming to accept this situation and I'm not necessarily looking for someone to give me another option if none truly exists, but confirmation that this is right (eventually) would do much for piece of mind.
Thank you for your help
Answer Dee - As you said, without examining you, it is a little difficult for me to tell you if the surgery is the correct approach. Fortunately and unfortunately for you, not many patients have need the joint surgery, so it might difficult to find many patients who had this surgery. You definitely need to see another oral and maxillofacial surgeon to get a second opinion. The surgeon you see must have extensive experience in this problem.
If you could get back to me and tell me where you live, I'll try to find a surgeon near you with extensive experience in your type of problem. There are often different options for the surgery. Until then, you need to be taking a non-steroidal anti-inflammatory medication to reduce the joint internal swelling and pain. A mild muscle relaxer might also be beneficial if the muscles have become inflamed. So get back to me and tell me where you live and I'll try to help.
