When I was in my teen years, I wore braces – the metal kind not the invisible plastic ones. I also wore elastics and headgear. I wore these contraptions for two years, followed by a year of retainers. My bite problems were fixed.
A few years later, I was diagnosed with TMD – temporal mandibular joint disorder – and I’ve used a succession of splints in my mouth ever since, either on my upper or lower teeth. Some splints I’ve worn holes through with my clenching.
My teeth changed over the years – the bite and teeth placement which I thought was been corrected by braces in my teens was only temporary. A few years ago I went through braces and retainers again, primarily to coax a wayward tooth into alignment. These treatments were only marginally successful.
The TMD continued. The latest splint I’ve been using since 2011 was a NTI Splint – formulated so that the back teeth do not touch so it eliminates grinding and clenching.
I was at the dentist last week for a cleaning and check up. Some ab fractures (miniscule parts of the tooth chipping away) were found. The cause that was given was my improper bite. Supposedly by enduring yet another round of braces the bite will be corrected and my jaw (TMD) problems will be over. The dentist referred me to a neuromuscular orthondontist.
The NTI splint broke this week. I went back to the dentist yesterday to get a new splint. Impressions were taken of my mouth and the splint was ordered – a different one this time, that is fitted over the lower row of teeth.
Today, I started to do some research. We cannot afford another round of braces for me – there is no coverage. I came across this website about TMD: http://www.tmj.org/site/ I was quite surprised to learn that patients with TMD are cautioned to avoid dental work (i.e. orthodontia) which causes permanent changes to the teeth or jaw. Does this mean the orthodontia in my teens was responsible for the development of TMD in my 20’s? TMJ.org thinks so – on this page http://tmj.org/site/content/tmjd-basics they list “dental procedures” as a cause.
I also learned wearing splints are not medically proven to help TMD and, in some cases, make matters worse. The NTI splint I wore, for example, because it only covers the front few teeth, places a stress on those teeth which could be harmful. How do I know the ab fractures weren’t caused by this NTI splint? The teeth that have the fractures are the ones the splint covers. Is this just a coincidence?
Positioning splints which put the jaw in a new position are ones to be particularly cautious of:
Because studies so far have shown inconsistent results at best, you should be especially wary of having a repositioning splint. Because the effects of the use of this type of splint are permanent, prolonged use (over 6 weeks) raises the risk of changes in the bite, long-term damage to the joint, and increased pain, requiring further treatment and possibly including surgery. http://tmj.org/site/content/splints
It’s too late to cancel my splint order. However, this will be my last one.
TMJ.org also had some interesting things published about neuromuscular orthodontia; interesting enough for me to cancel my appointment:
According to the American Association For Dental Research’s March 3, 2010 Policy Statement on Temporomandibular Disorders (TMD) “…the consensus of recent scientific literature about currently available technological diagnostic devices for TMDs is that except for various imaging modalities, none of them shows the sensitivity and specificity required to separate normal subjects from TMD patients or to distinguish among TMD subgroups.” In other words, those who practice neuromuscular dentistry have their own standards for what are normal and abnormal readings which may lead to a “false positive” – meaning people may be told they have a TMJ problem when they really don’t, leading to unnecessary treatments.
Neuromuscular dentistry is NOT a specialty recognized by the American Dental Association.
Although a variety of healthcare providers advertise themselves as TMJ specialists, treatments available today are based largely on beliefs, not on scientific evidence.
The recommendation from TMJ.org is that “less is best.” Treatments such as moist heat, a soft foods diet, and over the counter medication for pain control are all inexpensive and can be done at home. http://tmj.org/site/content/help-yourself-first-remember-less-best
There are approximately fifty different treatments listed for TMD. There’s probably at least as many as that listed for fibromyalgia and other chronic illnesses.
When there are many treatments for a single condition, it is because none of them work. – Sir William Osler (father of modern medicine)