Question:
I am desperately in need of some advise. I have a very severe case of
tmd and I need a significant amount of dental work done. More specifically,
I need a root canal (or maybe two) and four cavities filled. Two of the
teeth are near the front on the sides but two of them are the very back
upper teeth on both sides. My mouth only opens to about 2cm on a good day,
and usually it is even less. I've had an arthrogram done on my tmj's and it
showed that both of my discs are displaced and deformed. The muscles of my
jaw, temples, head and neck are in a constant state of spasm. I am in
constant pain and I have been completely disabled as a result. Now I am in
extra pain from my teeth so I have to do something about it. But I don't
know what the best course of action is. Since getting tmd I have gotten some
cavities at the very front of my mouth filled and even though I took lots of
breaks my condition worsened afterwards. My mouth closed up more than it was
before, my pain increased and I am still not recovered. I am terrified that
getting all this dental work done will make my jaw worse again, and I don't
know if I can deal with any more pain than I am in now. My dentist suggested
getting the work done under general anaesthetic but warned that even though
he wouldn't force my jaw past the point of resistance that the
anaestesiologist might need to force my jaw open in order to intabate. My
mother talked to her dentist about it and he said that I shouldn't get put
under because I would be unable to respond if the dentist used too much
pressure. But I don't know if I could take it if I was awake. Apparently a
root canal takes two hours without a break. Ten minutes of holding my mouth
open is too much for me. Do any of you have any suggestions? Is there
anything in between local freezing and general anaesthetic? Have any of
those of you with tmd conditions had dental work done either awake or under
general anasthetic? What were the results? Is there anything I can get done
that will relax my jaw muscles and decrease the pain in the jaw for the
duration of the procedure? Any suggestions would be whole heartedly
welcomed, I am really in a panic about this.
Answer:
You could describe the amount of opening you have of your jaw? Maybe
describing how many finger widths you can place between your front teeth
would give a good picture.
I have experience as a patient in this area. I am not a dental
professional.
Typo: I meant to be asking if you could/would describe the opening. Sorry
for any confusion. I'm in a bit of a rush here this morning.
Although there are no absolutes, I have seen remarkable improvement with
the use of NTI's for many 'TMD' patients. I'd try this first to see if
there is any improvement in your jaw pain before attempting the dental treatment.
In 2 hours time, I would do the complete root canal procedure and the crown.
Just the Root Canal Procedure should take between 30 and 70 minutes
depending on the tooth. Perhaps you should have the RCT done by a
specialist. They do these even faster than us.
Well... maybe isn't reading the newsgroup regularly enough. This post
was also offered to asj-d yesterday and I thought that by today there would
be some additional information from Annie.
My experience as a patient with severe loss of normal jaw function for
twenty years puts me in a unique position to "hear" what this poster, Annie,
is conveying ... but I "hear" with my own experiences -- not hers. So I
asked for more information.
In my experience, it isn't usual to describe mouth opening in centimeters.
It is usual to measure in millimeters. Therefore, to convey the function of
a jaw only by "about 2cm on a good day," seems a bit out of the ordinary.
For instance, how was this measurement obtained? If it is a forced opening
... prying open if you will... and the measurement is not reflective of what
is actually functional for the person... that would be important to know.
Forcing the jaws open and obtaining a measurement should be described
further.
I don't know what dentists are thinking about this post from Annie. If good
days are few and far between and the patient actually lives with an opening
far less than the measurement provided ... the situation may not be so
simple. As for the rest of the post which has to do with the joint
problems, again, I'm not really in much of a position to offer comment
because I am not a dental professional. But arthrograms ... arthrograms???
in the 21st century???? Where is the rest of this person's workup????
Going to sleep for this procedure may allow the dentist better access but
there will certainly be a price: aggravation to your TMJ's. Not seeing you
personally or your imaging studies limits my picture but you sound like a
surgical candidate to help release the joint and allow better function.
Improvement may not be gauranteed but with what you have mentioned splint
therapy with any type of device is unlikely to improve your situation. There
is only one way to treat scarred down joint tissue and that is with surgery.
