Oral Surgery/TMJ Issues
QUESTION: Hi Dr,
I have contacted you before regarding my TMJ issues (bi-lateral disc displacement secondary to facial trauma 5 years ago) and was wondering about my next point of action.
Currently I experience night bruxism, which I know a lot of people attribute to stress however I am not under a lot of stress and regardless of my situation I always seem to brux every night. I have a bad bite (underbite, posterior open bite and unilateral crossbite) and think that maybe I am bruxing because sub-consciously my body is trying to make my jaw aligned again.
Lately I have been getting a lot of pain in my neck, specifically my upper cervical vertebrae (C1, 2, 3). I do spend a lot of time at the computer however this seemed to have come on suddenly. Is there anything I can do to relieve this pain?
And secondly, I have consulted with an orthodontist who said he can fix my underbite and open bite without surgery in approximetly 8 months, and that we should leave the cross bite, however i am worried that the pressure applied by braces might damage my condyles, should I get braces?
ANSWER: Shane - First of all, your "bad bite" is probably the inciting aspect of your bruxism. An awkward uneven, unbalanced bite is frequently known as the instigator of bruxism. Secondary to bruxism, the jaw muscles initially begin to fire unequally and accentuate the bruxism. I don't know if you are familiar with the old saying, "the hip bone is connected to the shin bone, the shin bone is connected to the....etc." , well that also happens with muscles. The jaw muscles are usually affected by the bruxism and often going into spasm. When this occurs, it is not unusual for the muscles of the jaw which end near the neck muscles cause the neck muscles to go into spasm. This is how neck pain can develop secondary to bruxism.
I, of course, cannot tell you if your bite problem is one that can be handled by an orthodontist, but the orthodontist you saw does not sound very knowledgeable. Leaving a cross bite is an accident waiting to happen. If the orthodontist truly knows his profession, he would never accept a crossbite, especially if the patient has bruxism. You need to be examined by an oral and maxillofacial surgeon.
So braces might be necessary to help align everything, but the crossbite needs to be cured and that might require surgery. So get the surgeon to evaluate your situation.
If you have additional questions, feel free to contact me again.
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QUESTION: Thank you for your reply dr. I have another question, I have bilateral disc dislocation as demonstrated in arthrograms I had performed on my joint, so I am aware that when I open my mouth and it clicks that is the disc slipping into position and when it clicks on closing that is the dis slipping out of position again, however just today I noticed that my disc on the right is no longer always clicking on closing, I have to mor my jaw back to make it click on close. I am aware that a clicking jaw that has stopped clicking can be a bad sign because it indicates that the disc is fully dislocated, however this is clicking on opening and will not always dislocate again. Is this a sign of improvement?
ANSWER: Shane - The change in the clicking could mean that the disc is moving correctly or it is fixed in a position. I wish I could be more definitive, but view another arthrogram is probably the best way to find out.
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QUESTION: Thankyou again for your response, I plan to engage with a surgeon to ensure my next step (orthodontics) is safe.
Just one last question, I feel that it is likely I could have a stuck disc, or adhesion, in my left side and developing in my right. The reason for this is that it clicks on opening (clicking onto the disc) and then while still opening towards my maximum range, it will click again to what I can only assume is back off the disc. If it is a 'stuck disc' what sort of treatments are available?
Shane - if you truly have a stuck disc, irrigating the joint can often reduce stickiness and allow a more normal functioning of the joint. If, however, the disc is fixed in place an incision and entrance of the joint might be necessary. In that situation a recontouring of the joint might be necessary, but only be knowledgeable, skilled and experienced board certified or and maxillofacial surgeon.