Distortion

On Tuesday I had my first appointment with Dr. Kaplan, a TMJ specialist.  She was very thorough in my examination, taking multiple measurements, listening to my jaw with a stethoscope, asking many questions about my history of trauma/injuries, and taking a tomogram.  She also took an impression of my bite so that she could examine it and also use it if I needed splint therapy.

Well, I got a call from her late last night and she found some significant distortion in my left TMJ.  She was surprised that I wasn't in more pain.  This is something that has been going on for a while, and the orthodontic work made it flare up.

I am happy that I now know what the problem is.  Her recommendation is splint therapy on my bottom arch.  Planning to run this by my dentist before I go forward with it, but I don't think there are any other alternatives out there.

Too Little Too Late

On Monday of this week, I called the orthodontist to let him know of my big discovery and to let him know that I am back to wearing the bite plate.  He said that is fine if it makes me feel better.  Then I mentioned that I have an appointment with a TMJ specialist the next day.  He again got angry and said "There is no such thing as a TMJ specialist."  I told him that I need to get this problem solved and that the specialist will take a tomogram.  Not he is feeling threatened and says,  "I am going to send you an order for an MRI.  Get it signed by a doctor and go get it."

Only when I tell him I am going to seek help elsewhere does he decide to dig further and find the problem.  To late Mr. Orthodontist.  I am going to someone with a deep knowledge of TMJ disorders and who wants to do something besides make teeth straight.

Another Big Discovery!!

I stopped wearing the night guard as soon as my PT told me it was unbalancing my jaw.  I felt better the next day...but not the the same extent as the first time I stopped wearing the Invisalign.  I really think that particular night guard caused me to clench more...even without it.

I started researching types of night guards for clenching and most of them involve having your bottom front teeth meet a surface, preventing your molars from connecting.  That is really what I need.

As I gave it more thought, I remembered a bite plate that my orthodontist had me wear when I was in braces which did exactly that.  The purpose was to give my bottom teeth freedom to move up. I wore this appliance day and night for a period of time and eventually only at night while in the braces.  Once I got into the Invisalign, he told me to stop wearing it because the Invisalign is a night guard as well.  Well, I think the combination of no longer wearing that appliance (maybe I became too accustomed to it) and wearing the Invisalign (which promoted clenching), was the big downfall.

So, last night I wore the bite plate for the first time, and I already feel better this morning!!  I was even able to comfortably wear my retainer with it.  This just may be the solution, but I will need to confirm this is all good with the TMJ doc I am scheduled to see on Tuesday.  Hope is in the air again...and I still have a whole week until we leave for Disney.  Yeah!!

This is what the bite plate looks like:

Keeping fingers crossed that this is going to be a big part of my recovery!!  Oh, and why didn't the orthodontist think of this before he sold me that huge chunky night guard?

Another Setback -- Thanks Again Mr. Orthodontist

Well I figured out why I started getting more pain.  Remember that on Friday, March 1, I stopped wearing the aligner all together (was only wearing it at night).  AND I started feeling better almost immediately.  I remember feeling so good on the following Friday, March 8, when I went to my orthodontist to pick up my new retainer (non invisalign--it fits behind the teeth) and night guard.  He told me to wear the retainer as much as possible during the day and the night guard at night.  He also said I could try wearing both together and see how it feels.  Well, I started wearing the night guard on Friday, and remember on Sunday I started having pain again.

I didn't make the connection to the night guard as I thought night guards were supposed to stop grinding and clenching.  I thought perhaps it was the massage I had on Saturday (which was somewhat aggressive...but no more so than the one I had on Wednesday).  But as the week went on, the pain continued to get worse and I was getting that gnawing pain in the morning again.

Luckily I had a PT appointment today with the lady who specializes in jaw issues.  She had me put in my retainer and night guard and checked each one to see how it was effecting my jaw (something the orthodontist did not do).  The night guard is BAD!!!!!  It is putting my jaw in an unbalanced position and I am probably clenching too.  The good news is now I can stop wearing that silly appliance which is so ridiculously big and uncomfortable!!  She likes the retainer and said I should wear it as much as possible, which is a good thing because I need something to keep my bottom teeth straight after all that work.

I also made an appointment with a TMJ doctor/dentist.  This particular practice is very focused on PT, so I know they are good.  I will ask them for a new orthodontist referral because I have no intention of stepping foot in that office again!!

Let's hope I get bath on the recovery path...need to feel good for that Disney trip!!!

Today was a BAD day

I don't know why the flare up.  But I was not able to do much so just sat and watched 10 episodes of "Revenge."

I am really hoping that I am well enough for our upcoming trip to Disney in a couple of weeks.  Or maybe we go and I just sit by the pool.  Considering it is the Beach Club Resort, it could be worse :).

A Classic Case of CYA

Earlier this week I had a scheduled appointment with my dentist for my 6 month check up and cleaning.  I called on Monday to cancel the appointment because I didn't want to be sitting with my mouth open in my condition.  I spoke to the receptionist to explain the chain of events with the Invisalign and the TMJ.  Then I rescheduled my appointment for some time in April assuming I would be well enough by then.  Then toward the end of the week I called the dentist back because I thought it would be prudent to speak to the dentist anyway, and I would also like to get another orthodontist referral.  When I called, the receptionist went to get the Dr., and then she came back on the phone to tell me that I should call him after my appointment with my ortho on Friday.  "How does he know I have an appointment?"  Apparently the dentist called the ortho immediately after he heard about my story and discussed my case.  AND, the dentist will not discuss with me until I meet with ortho.  OK then!

I had my appointment with the ortho yesterday.  First thing he told me is that the the veneers were NOT causing the problem.  The veneers don't wrap around the tooth enough for them to hit the invisaign, and consequently the culprit was invisalign.  He made it a point to get that on the table right away.  So, apparently the conversation between the dentist and the ortho was more about don't blame me for your screw up!!

So Mr. Orthodontist, it was the Invisalign that caused the TMJ?  Yes, he says.

So why didn't he agree back in early February when I told him I had a diagnosis of jaw alignment issues and potential TMJ.  He adamantly stated that Invisalign does not ever cause TMJ...it fixes it!!  Just think how much sooner i could have started healing if he had investigated this or even payed attention to my situation back on January 31, when I had the diagnosis and made the call to him.

Third PT Visit Today

I have been making slow progress in the pt arena.  To be honest, I feel that my massage therapist does a better job at the massage.  But, I am getting some good stuff at PT as well.  The exercises are amazing...some involve eye movement...your eye muscles are very important in all of this.

Tomorrow I go to my orthodontist to get my retainer and night guard. I am going to have a nice long chat with my dentist once I am done with this chump.  My dentist recommended him, so maybe it's time to find a new dentist too.

I have to say that I am feeling so much better.  Not well enough to jump into a yoga class, but I am hopeful it won't be long.

Soon I will be weighing my options for legal action.  I just don't think this orthodontist should be an invisalign provider.  He is a really poor listener as well, and knows nothing about the risks associated with the product. I asked him 6 weeks ago to help me stop the treatment based on my diagnosis and neck pain, and and he convinced me my jaw was fine, the invisalign wasn't causing it, and to continue the treatment.  That is malpractice in my opinion.  What do you think?

My massage therapist is more competent than my orthodontist or other doctors

Today I had a massage.  Before I even got on the table, I started chatting with my massage therapist, whom I hadn't seen since early in the fall of last year.  She looked at me and said, "do you have TMJ?" I almost fell onto the table.  She could tell by my posture and just looking at my face.  My question is, why didn't the Orthodontist, Dr. Balint, or the orthopedic surgeon that I had seen in the past several months see this?

I know one thing for sure, I am on this therapist's schedule for the coming weeks.  She did a fabulous job at relieving all the tightness in my jaw, neck, and back.  AND, it is so nice to know that the evil cause of all that pain is out of my body for good.

EVIL = INVISALIGN

The peels continue to come off the onion...

The visit with the orthodontist was a very interesting one.

I arrived at his office and was seated while he finished up with another patient.  Before he even said hi or how are you, he immediately went into a line of defense.  "Give me a little history here...and I don't want to hear that the PT is claiming that Invisalign causes TMJ...you call the contact at Invisalign and they'll tell you the complete opposite.  It compresses the joint...it's in the literature.  It doesn't cause it!!!  It improves it!!!  You're the first patient who told me the TMJ got worse."

He tried to convince me to keep the invisalign as a retainer...which is what he asked me to do weeks ago.  I went through many minutes of trying to convince him to make a new retainer.

As we continued the discussion over several minutes, he started saying the problem was with my veneers (on the top teeth).  With the Invisalign, the veneers are forcing my jaw back.  And that is casing the TMJ.  OK, so in a sense, he is saying the Invisalign is causing the TMJ, right?  The veneers were already there when he ordered the Invisalign for me.  The interesting fact is that the Invisalign website claims that someone with veneers is a great candidate for Invisalign!!  So...who is at fault here?  Invisalign for advertising something that is not true, or the orthodontist who gave me the Invisalign and not noticing that it was pushing my jaw back. The other interesting fact is that my pain started immediately after I started wearing a retainer (after braces and before Invisalign).  That retainer is similar to Invisalign in design.  So this must be the culprit!!

So in the end, we agreed he will make me a different kind of retainer which will not push my jaw back.  He will also make me a night guard in case I am grinding.

But the bottom line is that I was given an appliance that harmed me.  And I don't know if the orthodontist should have realized this was going to happen.  Would love to get some insight from someone in the field.

The good news is that I feel like I finally know what is causing the pain...now I can eliminate the cause and finally start to heel.  Thank the Lord!!

Much Less Pain in the Morning!!!

Two days ago I stopped wearing the tray at night.  I was a little nervous about doing this because I considered the tray as important because I think I may grind my teeth at night.  But to me it was more important to try everything to improve this neck pain, and I wanted to try this experiment to see if the Invisalign was causing my neck pain.  Well so far I am feeling improvement when I wake up.  How do I know this?  Well when I was wearing the trays, I could feel pain in my neck when I stretched in bed first thing in the morning.  Now when I stretch, the pain is very minimal...this is a significant improvement!!  I still have pain during the day doing my normal chores, but I am sure that it is going to take time and physical therapy to heal my TMJ.  But it is encouraging that I have found and confirmed the cause of this ailment!!!

My next mission is to see if Invisalign even publishes any warnings about TMJ being a possible side effect.  I haven't found anything on line, but I am going to find the disclosures that I signed to see if there is anything there.

Despite my (former) orthodontist's claims, there is published research that PT works for TMJ

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813497/

And for those who like to cut to the chase:

Current Best Evidence in Physical Therapy Treatment

For many years, physical therapy has been used to treat TMD symptoms; however, the evidence supporting its use is limited. In this article, physical therapy treatments are assumed to include manual techniques (i.e., stretching, mobilizations, and manipulations of the TMJ and cervical spine); exercise instruction (i.e., self stretching and mobility strategies for the TMJ and cervical spine); patient education (i.e., postural instruction, relaxation techniques, and parafunctional awareness); and modalities that improve tissue health.

One recent systematic review of the literature on the efficacy of physical therapy interventions for TMD patients found 36 relevant articles, of which 12 met their selection criteria. Only 3 were found “to be of strong methodological quality”³⁴, and 4 of the 12 were dedicated to exercise and manual interventions, and only one did not demonstrate significant benefit from the chosen treatment strategy (an oral exerciser device). The remaining 3 studies evaluated postural training, manual therapy, and exercise, and all demonstrated significant benefit³⁴. The best Jadad score³⁵ obtained for the 4 studies was a 2³⁴. This systematic review concluded that “active and passive oral exercises and exercises to improve posture are effective interventions to reduce symptoms associated with TMD”³⁴.

A second recent systematic review that evaluated the literature on the efficacy of physical therapy interventions for TMD patients concluded that active exercise and manual mobilizations may be effective as well as postural training in combination with other TMD interventions³⁶. This review favored the use of multifaceted TMD treatment strategies, which coincided the with review authors' opinions. According to Sackett's rules of evidence³⁷, in general, the study quality was level II for 22 of the 36 studies reviewed³⁶.

Further validation for physical therapy's effectiveness with TMD patients has been published since these two systematic reviews. In general, validity and strength of the studies were weak; however, continued evidence supports that physical therapy may be effectively used as a stand-alone and/or, more effectively, used in a team approach with other conservative TMD therapies^38–41. One study suggested that Osteopathic Manipulative Treatment can induce changes in the stomatognathic dynamics, offering a valid support in the clinical approach to TMD”³⁸. A second concluded that “physical therapy seems to have a positive effect on treatment outcomes of patients with TMD”³⁹. A third found that “the combination of orofacial myofunctional therapy and an occlusal splint can be beneficial for patients with TMD-hypermobility”⁴⁰. An additional study compared four treatment strategies for TMJ close-lock: medical management (education, counseling, self-help, and NSAIDS); rehabilitation (occlusal orthotic, physical therapy, and cognitive-behavioral therapy); arthroscopy with post-operative rehabilitation; and arthroplasty with post-operative rehabilitation (i.e., physical therapy). The results demonstrated that “the four treatment strategies did not differ in magnitude or timing of improved function or pain relief”⁴¹. Since the four treatment strategies had similar efficacy, the authors of this article believed that the most cost-effective and conservative methods should be explored prior to progression to more costly, invasive procedures.

Some studies have correlated cervical dysfunction and TMD^14,42,43. One found that following a motor vehicle accident, chiropractic treatment alone for cervical spine pain was ineffective; however, providing the patient with an occlusal orthotic relieved the pain with continued chiropractic care¹⁴. Although this study evaluated chiropractor intervention, it appears there would be a similar correlation with physical therapy treatment for cervical pain following a motor vehicle accident. There is significant research supporting the use of physical therapy for cervical dysfunction, but more definitive research needs to objectively assess the effectiveness of cervical treatment for TMD pain and the reciprocal relationship.

Current evidence supports the use of physical therapy for TMD patients, but more evidence-based research is needed to firmly establish the role of the physical therapist. Both authors here encourage well-trained physical therapists to inform the dentists in their community about their interest and education in providing TMD treatments for the dentist's TMD patients, enabling the dentist to establish an effective team approach for these patients.

Orthodontist Lies to me about Research on Orthodontia Causing TMJ

Here is an article which proves that research DOES exist claiming the in some cases, orthodontic treatments can cause or worsen TMJ.

Click here to read the whole article.

Or just read below for the bottom line.

RESULTS

Two hundred and fifty four females volunteered to take part in the study and completed baseline sensory assessments, of whom 212 (83%) provided a blood sample and written consent for genotyping. Follow-up data about clinical TMD status were obtained from 186 subjects. Sixty two subjects with follow-up data (33.3%) had pain-sensitive haplotypes and the remaining 124 were classified as pain-resistant. Ninety-nine subjects (53.2%) reported a history of orthodontic treatment, 75 (40.3%) said they had not had orthodontic treatment but 12 subjects (6.4%) said they did not know and they were excluded from subsequent analyses.

Among the cohort of 174 people available for analysis, 15 new cases of TMD were diagnosed using RDC criteria during the follow-up period that averaged 30 months (range=8–42 months). The fifteen new cases of TMD represented a cumulative incidence of 8.6% (95% CI = 4.4% – 12.8%). Among subjects with pain-sensitive haplotypes, cumulative incidence was 15.4% compared with 5.7% among subjects classified as pain-resistant (Table 1). This yielded a statistically significant relative risk of 2.68 (95% CI = 1.03 – 7.01) comparing pain-sensitive with pain-resistant subjects. Risk of TMD was three-fold greater among people who reported a history of orthodontic treatment compared with those who did not, although the associated relative risk did not reach statistical significance, as indicated by the 95% confidence interval (0.89 – 10.35) that included unity. Two thirds (67.3%) of subjects with pain-sensitive haplotypes reported a history of orthodontic treatment compared with 52.4% for pain-resistant haplotypes, although the difference in percentages was not statistically significant (Chi-square, 1 df, P=0.07).