Breaking my splint / orthotic | Jaw Pain is Back and Worse than Ever!

How I broke it...

I had been on a work trip doing presentations in front of a number of families when I cracked my splint. I knew it was because I had been under a lot of stress that week and I was clenching my teeth considerably more. I definitely hold a lot of my tension in my jaw, which sometimes I become aware of, and try to make a conscious effort to relax. My other splint actually would break in the same place a lot too, and I think it’s a combination of it being the first point of contact for my teeth, and also the fact that I had a filling there and the dentist left that tooth somewhat sharp.

When I went to the bathroom to check on the damage, I was actually somewhat relieved. The plastic had split, but a significant portion of the splint was still intact.

Regardless, I had been pretty disappointed at the moment, mainly because I had finally gotten to a point where I was 90% pain free and would not even think about my jaw most of the day. There’s a twinge in my neck that constantly bothers me when I’m either not wearing a splint or when the splint is not sitting properly. It’s painful enough that the feeling wears me down and really adds a lot of stress to my life.

I scheduled my appointment as soon as I got back from the work trip, and was able to get in fairly quickly. It’s surprising how quick the pain returns, even though the damage wasn’t as bad as I initially thought, within a couple days I was having issues.

Don't be afraid to speak up!

For my appointment to fix the splint, they have you schedule two hours for repairs. Plus, every appointment I have to meet separately with the doctor, which I think is a bit overboard considering I just tell him the same things that the assistants write down.

This time around the assistant actually took the whole part of my splint out. So he put a notch in it so that my teeth weren’t hitting the splint at all in that spot. Now initially this seemed like a good idea, he explained how it would avoid me constantly cracking it. In hindsight I wished I just insisted on him putting that piece of the splint back...but this was his recommendation and I figured I’d trust in the process.

Big mistake. Within a day of the piece being removed, it was like I wasn’t wearing a splint at all! Which infuriated me because I felt like I had paid for someone to make my situation worse! I was unsure why he didn’t think the piece that cracked was critical to my splint, when I had cracked it in the first place... meaning I was forcefully hitting that part of the splint repeatedly, enough to cause a weakness and crack. This never happened using the Neuromuscular treatment because they were able to closely look at what parts of the splint I was hitting. It just seemed like a more calculated process rather than blindly going in and removing or adding to my splint --The frustration is real.

Well, needless to say I had to go back to the doctor’s office and have them add back the piece they had removed. There are a few things that frustrate me about this. 

1. They should’ve gotten it right the first time by closely looking at my splint and how I am using it. If I legitimately wasn’t using the part of my splint that broke, then they should’ve been able to tell. If I was, they also should’ve been able to make that deduction. I shouldn’t have to be the one to tell them. 
2. My time away from work is precious to me. I have a 30-minute drive there from my home and an hour long drive the other way to work. This is a lot of time for me to sacrifice, so please get it right the first time. 
3. Charging me every time I go to get this adjusted is just unfair. Especially when they don’t get it right. I never got charged more than the initial cost of the treatment with my Neuromuscular dentist. It’s a shame that her Phase II costs were out of my range, but she was fair in her initial treatment. 
4. Lastly, I think they are lacking the extent of the sensitivity and pain that comes with having a TMJ disorder. If my jaw could withstand minor changes, then I wouldn’t be paying hundreds of dollars for them to mess around with it. Clearly, it is not in a stable state if I’m being forced to get treatment. Therefore, have some foresight when you make changes to my splint! Meaning, be delicate and discerning, don’t just throw it together and then ask me how it feels. I can’t tell for a few days, and by then I am in a ton of pain, unable to focus at work, and now have to reschedule an appointment that is going to take a minimum of 4 hours out of my day.

I’m honestly a patient person, but this treatment is so half-hazard!

Is it fixed yet??

Back to my story...I returned to have the piece added back. This time, I left with my splint feeling a bit thicker than before. Part of me wanted them to shave it down, but part of me was worried that might just mean I’d be back in a month after cracking it again. The thinner the plastic is, the more delicate it becomes.

For the first couple of days things were fine. I had more difficulty speaking, but not as bad as the first version of the splint they gave me. I got used to speaking, but then by the third or fourth day, I was in excruciating pain. I had friends visiting during this time and it was hard not to break into tears by the end of the night because my head, neck, and jaw were killing me. Especially trying to chew and eat food.

There is more than just the pain that goes into this. ( If you've experienced TMJ pain then you know what I'm talking about! ) There’s the feeling of helplessness and of being unable to find a solution. Going back and forth from the doctor, then feeling as though I’m getting nowhere -- it definitely wears on you mentally, physically, and emotionally.

Should I make another appointment?

In this case, I decided to wait it out. I put an ice pack on my face whenever I could. The worst of the pain was at night, after it had built up over the course of a day. Then by the next morning it was a little better. I got through the weekend, feeling that I still might have to go back for them to fix the splint, but also thinking that I might be able to get through this.

I had Monday off from work to see my friends off, they were driving back  home after a fun weekend snowboarding with me and my boyfriend. I knew that Monday would be the perfect day to stop into the doctor’s and have this taken care of. Yet, I felt like it had somewhat improved, and as I mentioned before not only did I not want to pay for another visit, but I also didn’t want to compromise my splint any further by taking away more of the plastic.

I’m glad I managed to stick it out, because I got through the worst of the pain and by the end of the week it had calmed down a lot. Flash forward to today, and I am much happier with the splint and glad that I didn’t go back. My two worries were firstly, that the pain wouldn’t go away but get worse, and secondly that I was doing further damage to an already weak and arthritic joint. Apparently it was just a matter of the joint getting used to the wider position. Which luckily it did!!

Thinking back, it would've been nice...

I have to say, it would’ve been nice if my doctor would have explained this to me. (Or maybe he didn’t know this would happen??) I had no knowing that my joint would initially hurt tremendously, but then settle in. The assistants will typically ask, “How does this feel?” Which I always have difficulty answering since I’m not sure how it’s suppose to feel or how it’s going to feel in the long run. Clearly there is some lack of communication, but I’m figuring this out! To be honest, the pain was severe, not just a dull ache, but extreme muscle spasm-ing and it was a real struggle trying to just chew some soft food.

It’s not 100% comfortable wearing a splint, and it’s also not completely pain-free. I continue to have moments of sharp pain and also neck aches, but all I want is a more bearable, more stable situation for my jaw. Something that will last me in the long run. Now that I’m back to a “better” place with everything, I’m hoping nothing goes horribly wrong until my next appointment, which is June 10th.

Until then, wish me luck! And good luck in your own journey!

Jaw Splint Update | Managing Jaw Pain and seeing improvements | Physical Therapy for TMJ?

Back again with another quick update on my progress with my new-ish splint! About two weeks ago my splint chipped in the back left-hand side, the same place it usually tends to break! Which is also the most painful side of my jaw. Luckily it was an easy fix!

I went in early for my appointment (my original follow-up was supposed to be March 1st) and they were able to fix my splint by actually removing the spot that had chipped off. Luckily it was not a critical portion of the splint, so rather than rebuilding the splint only to have me crack it again, they just smoothed it over.

Lately my splint has been working well. I still find that I have some significant pain in my left TMJ, but overall, I can't complain. This isn't something that will just be 100% resolved, rather my goal is to maintain a relatively pain-free state. I haven't had any chronic neck pain, which has definitely been a relief! Just have to take care of the joint and try not to aggravate it. In general, this splint has allowed me to do that, which means I'm hopeful for braces down the road! Mainly to close the open bite in the front of my teeth. Although my doctor said I will have to wait a year, which will be August 2016, before I can start considering next steps.

Since I have arthritis in the joint already, I've been referred to physical therapy, which I have been putting off. This is only because I just finished paying off the big bill from the splint and adjustments! So I'm thinking this year, since I won't have to have my splint adjusted or fixed much more (fingers crossed) I'll be able to start going to physical therapy, which my doctor believes will help calm the joint more. Which I could really use!!

So that's it for now! I will keep you updated if I try out the physical therapy. If you have any questions, please don't hesitate to comment below. Also, if you have any experience with PT for TMJ, I'd love to hear more about it.

Signing off,

Celeste

TMJ/TMD Your Pain is Real!

A student who I work closely with is going through a situation very similar to mine. While I feel terrible that she is going through this pain, I am glad I am able to relay some of my experience with having jaw pain.

Her jaw pain actually accelerated after having her wisdom teeth taken out. This was very similar to what happened to me! Now her jaw is drifting backwards and causing her to wake up with her jaw locked shut, muscles strained, and unable to chew comfortably.

One of the things that I think is most helpful when someone is going through this kind of pain, is to reassure them that they are not imagining the magnitude of the situation -- TMJ pain is REAL! It is also so vital, from my experience, to address it right away. So many things can get WORSE if you do not address these issues:

• Arthritis in your jaw joints, neck, shoulders, etc.
• Wear down your teeth, leading to cavities and root canals.
• Difficulty breathing.
• Stress, increased pain.
• ...and a number of other compounded issues.

I'm writing this post to anyone going through this to let you know that it is not worth just dealing with this kind of pain. Even though it may feel like a hassle to see a specialist and get a consultation, you will not regret it! 

When I first started talking about my jaw pain, the initial reaction from my family was to downplay what I was going through. For example, suggesting that I take some pain killers, focus on relaxing my jaw, massaging it, etc. Understandably, the common treatment for this kind of problem (TMD) is surgery, braces, and other very invasive treatments! So I understand why they would try to steer me away from that path. 

Luckily I didn't have to take that route and I'm very glad I didn't. (I may choose to get braces, but I've been very comfortable with my splint and have not needed surgery.) Unfortunately, no matter what treatment you choose, there is still a chance that you will always have to manage your jaw pain, but it doesn't have to be unbearable!

It's really difficult to express to others , who are not experiencing your pain, just how awful jaw pain is! It's not like an arm or leg that feels better if you rest it. Your jaw is constantly working and relies so much on a good bite to rest. If you don't have a comfortable bite, it can feel like you are constantly straining. When it's on your face, it feels even more exposed and uncomfortable, which for me caused further stress, anxiety and depression. The other part that makes this type of pain difficult, is that it isn't something that is visible to others. If it were a visible injury, it might be easier to convince someone that you are in pain.

If I can accomplish one thing in this post, it is to empower people, young or old, to look into their jaw pain and find a comfortable alternative. You're not alone in your pain, and I can personal validate that it is not something you can just "get over." I know how it feels when your pain is not being taken seriously, so I extend my utmost sympathy to anyone going through TMD and searching for a solution. There are many options out there, it's just a matter of getting started on this path and finding the right one for you. Good luck!

TMJ/TMD Pain Update, Happy New Year!

It has been a few months since my last update, and the reason is mainly good news! After my last adjustment to my "new" splint, I've been relatively pain-free. I had a visit right before an 11-day, much needed vacation, and by then I think my splint was almost perfect.

After a few minor adjustments, I definitely felt a world of difference! As I mentioned, this wasn't without many uncomfortable weeks, but I was glad that I could finally go about my day without being in constant pain!

The trip went great! I had many days relaxing on the beach and eating a ton of good food. I didn't once have any issues with my splint, and this "new" splint (I say "new" because it's my newer splint, but I've had it now for three or four months) doesn't have to be taken in and out for eating. Which is embarrassing when you're dining in a nice restaurant! Plus when you're on vacation you worry about dropping, breaking, or losing it every time you take it in and out.

So, ultimately this new splint has afforded me less stress and less pain. Which I'm so grateful for! I know it's working well when I forget it's in my mouth.

A few downsides to this splint, are still kind of embarrassing...

You may remember that (when wearing a splint or orthotic) my upper and lower front teeth have a gap between them. This means my teeth never close and I have what is called an "open bite." This new splint doesn't cover my front teeth, so it appears as though my teeth are permanently open.

This hasn't been an issue, I'm pretty good at hiding my lower teeth when talking, chewing, smiling, etc. Yet there is another problem with this. Whenever I salivate or are chewing something, it sometimes falls right out of my mouth! How embarrassing! It's especially bad because I don't think I salivate more than average, but sometimes it just flat out drops from my mouth. So awful! Also, there's just a tendency to eat messier and get food bits stuck in it.

Moving Forward...

My next appointment has been postponed to March 1, 2016, since I have been doing fine with my current splint. The only thing I've noticed of concern is that there is a crack on the side that always tends to break for me. It's where my teeth close the tightest and there's the most stress on my joint. So I'm hoping to get that fixed or reinforced.

You may remember that I've been desperately trying to find a permanent solution to my TMJ disorder, but have yet to take the leap. My hope is to one day have braces to better form my bite, but even with braces there's no guarantee the bite would hold and be less painful. 

I'm planning to ask when I can start considering braces at my next visit. At the very least it would be nice to close the gap in the front of my mouth, to make chewing, tearing, etc. easier for me. But I'm not sure if they're going to tell me to wait, or even suggest that I just wear the splint instead of any permanent solution. It can be very traumatizing to have braces on my teeth as well as for my jaw, and being that I already have scar tissue built up in my TMJ joint as well as soreness and instability, braces might cause more damage than good.

One thing that I am happy about, as I've mentioned before, is that my current doctor's office makes repairs to splints in-house. Meaning I don't have to pay extra to have it fixed or to send it away and have to wait a few weeks without anything. This is literally my life support and I rely on this splint so much! I'm certain of this, more than ever, after my last one was broken for months on end. 

I guess I'll have to find out what this new doctor recommends and go from there. Either way, I'm hopeful and at least comfortable in my current state, so if I have to wait, that's okay too! 

Hope everyone is enjoying 2016 so far!

The Difference between Neuromuscular Dentistry and Traditional Splint Treatment - My Experience

So, it's been a difficult few months. I have to say I was reaching the end of my pain limits. No, it wasn't the worst pain I've ever been in, but it was the worst pain my joint has ever been in. This is round two for me of having a splint fitted for my jaw.

I was told by the doctor I'm currently working with, who is an orofacial doctor, that he didn't find a difference using the Neuromuscular approach, versus the treatment he currently uses. My personal experience has been VERY different! I'm by no means saying one way is definitely better than another, but for me personally, my experience with a traditional method for fitting a jaw splint was significantly LESS painful via the Neuromuscular approach, and I will tell you why!

1. Neuro starting point didn't seem like a shot in the dark: In order to find a splint to start with there were two very different ways that these doctors began. I will refer to the Neuromuscular dentistry as the "Neuro" approach and the Orofacial doctor as the "Oro" approach, just to make things clearer.

The Neuro approach was to find my most relaxed state by using the tensing unit, that sent electrical impulses into my jaw muscles to relax them and remove the "muscle memory." Molds were taken for my jaw in this state. (There was more to it, including scans, but this was the main difference.)

The Oro approach was to take a Cone Beam scan, and then having spoken with me and also taking some current molds, they created a splint based on my issues visually. Granted I appreciated the time taken to speak to me and also evaluate my current pain. The doctor also probed my face physically to determine the areas of highest pain for me.

The Results: Neither splint felt 100% when I first started wearing it, however the Neuro splint did not cause me unbearable pain. The Oro splint was so completely off that I was in excruciating pain for the first two weeks to the point where I couldn't wear it any more. The Neuro splint was somewhat tight on my teeth, that would be the biggest discomfort, but it was immediately helpful to my jaw. I think the only reason the Neuro splint was tight on my teeth was because when she took my molds the tray was a bit tight to begin with so I think it pushed my teeth back. (They can definitely give you more room for your teeth though, so just tell them if it feels tight!)

In my humble opinion, the starting point for the Oro splint was more of a guessing game. After three visits (at $120 a pop!) I'm finally starting to feel that I've reached a level of comfort with my splint. The amount of pain I was initially in, seemed unnecessary in comparison to the methods that the Neuro dentist used to find my comfortable bite.

2. Oro relying on me to figure it out: It was a bit unnerving how much the Oro was relying on me to figure out how my splint should fit. It seemed much less calculated and precise than the Neuro splint. For example, the Neuro would have me TENS for an hour before making adjustments. My muscles were relaxed and I didn't question where I was biting on the splint. The Neuro's adjustments were very accurate and small. When she returned, the splint was definitely better.

The Oro would similarly have me bite on the ink paper then the splint, without Tensing first. They would adjust and come back asking if it felt okay. Initially I said it seemed fine, then after a very bad first two weeks I started really dictating what they should do. I was relying on them to shape it to my mouth, like the Neuro had, but they failed me completely! I felt I had to really think about what felt weird, but at the same time it's difficult to tell at first, especially if your muscles are used to the wrong bite!

3. Final Pros and Cons: So, is there a difference? Well I honestly thought the answer was going to be a solid "No." I went into this new treatment with the mindset that all the bells and whistles of Neuro was more of a show than an actual benefit. I even believed that it might just be a reason for them to charge more. What I discovered, at least to start out with, was that finding a base-level for the jaw muscles using instruments that measure when they are activated, actually saved me a lot of unnecessary pain. Granted, there was initially discomfort with the Neuro splint as well, but honestly I've never experienced so much pain as when I was wearing the Oro splint! It was actually better without it, and my jaw causes me a considerable amount of pain normally.

I felt this was a bad way to start out my experience with this new treatment, but I continued to revisit the office for adjustments and feel as though I've reached a more comfortable level. I know that this is a process, but having a basis of comparison, I do believe the Neuro method has something to it...at least in my experience. I will continue to be hopeful...as you know the reason I switched from my Neuro to the Orofacial doctor was mainly because of the next steps.

I wasn't unhappy with my Neuro splint, it had unfortunately broken due to wear and tear (I had it for 3 years or more!). I decided to try another doctor mainly to see if I could find a more affordable way to reach a permanent solution using braces. You can read about what my Neuro Phase II options had been in my previous blog post.

Well, that's my two cents so far. At this point, Oro treatment is slightly less expensive than my Neuro treatment has been, however not by much, and I foresee spending more on this treatment over time. My Neuro orthotic cost a flat fee of around $3,000. I'm probably close to $2,000 for my Oro treatment. This is a common argument, and while it still is holding true, the splint treatment seems to be close in cost. This may be entirely different when I get to a Phase II of treatment such as braces, but I guess only time will tell.

TMJ Pain - Won't go away

So...after yet another visit I am still experience TOO much pain in my jaw while wearing my new splint. My latest adjustments have caused me to be unable to chew. I've worn it consistently for two weeks (?) and I now have unbearable pain in the joint. Luckily it isn't traveling down my back like before, but it is now affecting my chewing. This just does NOT make any sense...this is a lot of pain for something that is suppose to help me. I'm just so confused.

I heard great things about this doctor, but so far I have been really disappointed and I'm not sure why I'm not seeing improvement. I know this is a process, but I feel like this is actually doing damage to something that is already so unstable!

I am trying to remain calm and level-headed, but the doctor seemed to think I would be okay with the adjustments I currently had for SIX WEEKS! I barely made it a week without experience major pain. I stupidly trusted in this process, but was severely disappointed, especially now that I can barely eat...I probably should've had an earlier appointment set up, knowing what happened last time. I really tried to make this one work. Hopefully the next time around will be better...I'm really upset about it for obvious reasons. I don't think my original splint ever caused me MORE pain...other than it being somewhat tight on my teeth at first.

I set up an appointment for this Friday, three days from now. I really hope this will be resolved soon...I'm worried that I've done some damage to my joint, not permanently, but it has definitely flared up. This stinks!

5 Ways to have a Good Doctor's Visit

I just got back from a visit with my new orofacial doctor's office. In my last post, I mentioned how I have moved on to a new doctor and am working on a new splint. The one they made previously for me actually multiplied my pain...actually it was 10 times worse than when I started. I literally ended up in tears after two weeks, tore it out of my mouth and felt better not having anything than wearing that splint. Very upsetting experience.

After my visit today I am hopeful, but still extremely wary. Sitting now I can feel my jaw is already very achey in this new version of my splint, but it's still too early to know for sure if it's because of my splint or because of the tapping/grinding motion they had me do to make the adjustments. I really hope things feel better tomorrow.

So, coming into the visit today I was less than pleased. I knew that this was just the beginning, but it is definitely frustrating when you are paying a large sum of money only to feel like you've purchased an expensive torture device. So here are a few tips that I feel I've learned throughout my time visiting orthodontists, dentists, and other doctors. I'm not an expert, so these are purely opinions based off of my most recent visit.

1. Don't start on the wrong foot. Even if you are having a bad experience, jumping in with all of your dislikes will instantly turn the person who is "helping" you, against you. In my personal life and my career I've been on both sides of the customer service conversation - and it applies to the medical industry as well. I've found that it feels as though it's even harder to gain attention and respect when in a medical atmosphere, because it can feel as though you are being treated like an uninformed patient, rather than a person with emotions. Rather than speaking to you as a person, doctors can be somewhat insensitive and speak about your body as if it's not in the room with you.

They've heard it all before and feel they know what's best for you. Either way, starting the appointment with only negative feedback isn't going to get you anywhere. This is typical of any scenario where you are working with another person - they bring their past, thoughts, emotions, life story wherever they go. Yes, you are the customer, but you are also trying to get something you want, hence your emotional intelligence is going to get you farther than an emotional outburst.

2. Listen. Try to listen to their experience in an open and respectful way. Even if you still disagree, giving them the chance to share their side of things will make them feel that their opinion is being valued. Yes, they are human too and they have their own human ego that wants to be fed. When I went into my appointment, I started to try and express what I'd been feeling and what changes I thought might be needed in order to make my splint better. I could instantly see that I was not being heard.

Every time I would start to explain in a calm manner, he would interrupt me and just try to start working instead. He even made me feel like it was my fault for not having scheduled a longer appointment, when I was not aware that this was needed. But I knew I had to take the high road if I was going to get what I wanted. I knew I would have to change my approach. After a little while I inquired as to what he meant by how I was not describing things properly. It was hard not to be insulted, but I try to take myself out of the situation and just focus on what I was trying to accomplish.

When I listened to how he explained what the goal was of the splint adjustments, I was able to not only allow him to open up, but I as a result he listened to me to. I was also able to explain it in a way that suited both of us.

3. Take the high road. Ultimately as long as you get what you need (in my case my splint was adjusted more to my liking) out of the interaction, it was worth it, right? You don't always have to be "right" in order to get what you need from your treatment. Sometimes you need to help the other person come to the conclusion, especially if they feel it is their expertise. It can be difficult for someone to admit that their treatment isn't working, but that's alright. They don't have to admit to anything, they just have to help you and listen to your issues.

4. Be open to not knowing everything. As a patient, this might be your first experience with the treatment, and you are going to someone who has an expertise in that area for a reason. So it's okay to listen and actually change your mind about what you initially thought. You might be wrong, and the treatment might be working, or your solution to something might not be correct.

For example, I thought I knew how my splint should look, but when listening to the medical assistant on his prior experience, I realized that I might be going about it in the wrong way. I started to realize that his methods had worked in the past, so even though the splint wasn't currently working, there was still hope that by cooperating with him I could make it better.

5. Get a second opinion. It's also a possibility that this is not the right doctor, treatment, or office for you. Sometimes it's okay to let go when a treatment isn't working. If you tried to make it work, were open to new ideas and gave it a good shot, but it still doesn't meet your needs then maybe it's time to move on. Don't settle for less when it comes to your health. I had to do that with my last doctor. I was happy with many aspects of the treatment, but the next steps were not in my budget and not going to work for me. Even though it's difficult to pick up everything and start over somewhere else, if it's too difficult trying to make it work, then it's not worth the hassle. If your doctor isn't listening to you or if you aren't seeing the results you want, maybe it's not you, but your doctor.

These are just some of my humble opinions. Sometimes we forget that working with people no matter what situation or what industry is very similar. Having your needs met also means opening yourself up to others. Being an effective communicator and also being a cooperative patient can help you work towards your goals and solutions. Sometimes it's not you, and in that case you just need to move on.

My treatment over the past 4-5 years has weighed on me heavily. Sometimes it brings me to tears just trying to find some relief from the pain I've been experiencing in my jaw, neck, head, and back. I keep moving forward knowing that I will find the solution that is best for me. No one can know exactly what I'm going through, which can sometimes make it even more frustrating to share my situation over and over again. If a doctor isn't able to help, then they aren't for me, but I still respect all people I interact with and at the end of the day I feel I did all I could to be the best person I can be.