TMD treatment | Sleep & TMJ Therapy https://www.sleepandtmjtherapy.com Wed, 18 Dec 2024 21:32:27 +0000 en-US hourly 1 https://wordpress.org/?v=6.7.1 TMD Treatment: So Why Does This Treatment Take So Long? https://www.sleepandtmjtherapy.com/tmd-treatment-so-why-does-this-treatment-take-so-long/ Wed, 18 Dec 2024 20:38:02 +0000 https://www.sleepandtmjtherapy.com/?p=952 In so many of our cases, the person we treat must wear their dental oral appliance for at least a year or so to see if the articular discs will actually return to their proper place in their socket. In almost every case these past years, the condyle (top of the jawbone) goes so deeply [...]

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]]> In so many of our cases, the person we treat must wear their dental oral appliance for at least a year or so to see if the articular discs will actually return to their proper place in their socket. In almost every case these past years, the condyle (top of the jawbone) goes so deeply into the glenoid fossa (the socket for the jawbone) that the articular disc (the cartilage material that covers the top of the jawbone) is displaced out of the socket. It is kind of like if your kneecap slipped off and is now off to the side- the pain can be quite extreme. Well, the condyle and disc are similar. If the articular disc is slipped off the condyle, it can and will rub into nerves and blood vessels and can lead to extreme discomfort.
In many of our cases the articular disc has been displaced for years, so to expect it to simply go back into proper position in just a month or two is not logical. Generally, we reassess your situation after working on the problem for a year or so. Most people will notice a change with the appliances in, but it takes about a year to figure out if they are doing better. If there is no improvement surgery may be recommended or just continue wearing the appliances a bit longer.
In almost all cases, the patient is doing better with their appliances even if the new MRI still shows some displacement. This is why TMD treatment can be so complicated. You really do NOT need to have a displaced disc go totally back into the socket. As long as you stop the condyle from pounding into the disc, the patient can feel better and live a good life even though
the discs may not be where they ideally should be.
In almost all cases, I can help our patients in managing the displaced discs for many years to come. Case in point; I am helping two of my immediate family members manage double displacements in both joints. The reason it works is that we took our time in the appliance therapy phase–a good year or more–and then ever so slowly erupted the back teeth so they would properly support the condyles and the discs in the sockets. Because of this, the surgery rate in my office is only one percent. That means of the 100 patients that I see in a week, only one person on average will be a surgical case. Not a bad percentage!
So, after a year or more of wearing dental oral appliances, we have to finish the case with orthodontics or crowns. Doing orthodontics is slow, boring and annoyingly time-consuming. You wear either braces or aligners for at least two to three years, and sometimes longer. The reason for this is that the back teeth need to erupt; i.e. grow upward along with the gum and bone around
them, and this process is very slow at all ages. That patient is also advised to consume a cup of bone broth daily to help stimulate the osteoblast cells (the cells that help bone grow).
So there you have it. Nothing I do is fast or exciting, but it works quite well for just about everybody. This is what I like to explain at the initial consult; allow me the time I need to help you and it is highly likely that you will feel better in the coming months!
If you currently struggle with TMJ issues and want to learn more about TMJ treatments in Falls Church, Virginia, please reach out to us. Dr. Jeffrey Brown and our team at Sleep & TMJ Therapy are excited to assist you! Just call 703-821-1103 today to learn more or schedule a consultation with Dr. Brown.

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]]> The Case of The Missing MRI https://www.sleepandtmjtherapy.com/the-case-of-the-missing-mri/ Wed, 02 Aug 2023 06:00:13 +0000 https://www.sleepandtmjtherapy.com/?p=667 At this time, it is the middle of 2023, and I am baffled and frustrated. Just in the past few weeks, I have met a respectable number of people who have reported chronic pain for years on end. They told me about their experiences with joint injections, physical therapy, massage and medications of course.  They [...]

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]]> At this time, it is the middle of 2023, and I am baffled and frustrated. Just in the past few weeks, I have met a respectable number of people who have reported chronic pain for years on end. They told me about their experiences with joint injections, physical therapy, massage and medications of course.  They were all just sick and tired (quite literally sick and tired) of having to deal with the pain and not knowing what was causing it. As our patients and referral healthcare providers know, I believe treating TMD is a cross-field need. When the problem of a displaced disc or an airway issue is being fixed and/or addressed, then other parts of the body need adjustments or corrections with osteopathy and/or physical therapy and even other modalities.

The other day I walked into our consultation room to meet a new patient and I could tell right away what was going on. The lady sat there with huge circles under her eyes. Her face appeared sunken and sullen. Her shoulders were slumped forward, and it was obvious she did not sleep well. Her pain was overflowing. As I did the palpation exam, I barely touched the muscles, and she winced every time as a few tears came out. I wanted to cry with her. She was on the edge, and I could tell she had dark thoughts in her head. She finally admitted that if I could not help her, she would not survive much longer. How sad that a person had to suffer so much and so long.

As you all know, dear readers, I ordered the MRI to figure out what is really going on. The MRI is the key to our understanding of her situation. Unfortunately, she had never had an MRI done in the past. To me, this seemed like such an obvious path to take. It was what I learned so long ago. Never assume. Do an MRI to know where your discs are located. This concept was ingrained into me many years ago and I have not wavered from it since. Obviously, the MRI can only show the soft tissue and along with the CBCT X-ray, we can come to a good diagnosis.  (This is another blog about what I am measuring and looking for.)

This lack of imaging and analysis seems to be missing in the world of TMD treatment. (I am making headway teaching and explaining this, but so much more is needed.) An X-ray most certainly will not provide the required views of the discs – the X-ray is good for looking at the hard tissue – the bone. Don’t get me wrong, the bone view is very important, however, it’s equally important to know what the soft tissue – the discs – are doing. So, let me pose it this way: if you went to your orthopedist with knee pain, would an X-ray suffice for a diagnosis? We all know the answer to that one…No Way! You definitely would need an MRI before treating the knee joint, especially if there was any need to consider surgery.

So why is it that most dentists out there who are treating TMD are not doing the MRI? Because of inconsistencies in treatment, this is likely why patients do not get relief with other types of TMD treatment. If all dentists did like all orthopedists do – take a good  MRI to diagnose their patient’s condition, then maybe the patient might not have to go from healthcare provider to healthcare provider, spending money and not knowing what is really going on.  It’s quite a conundrum, isn’t it?

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