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Medical Forum / General / Dentistry / June 2007malocclusion after root canal
I had a successful root canal done on my farthest back upper molar (got rid of my wisdom teeth decades ago), and soon there after noticed that that same tooth was now "taller" striking first in my mouth on closing. My dentist kept grinding away the opposing bottom tooth until my bite became even once more. Weeks and months later my bite changed with the tooth growing once more. Again more grinding down of its opposite to even the bite out The crown was next replaced over my root canal creating an even bite for the third time. Now months later I again have the same malocclusion, that tooth striking first and raising my bite off all other teeth. Any idea what is going on? Bob 63 USA Possible that the TMJ condyle may be re-positioning up & back. >I had a successful root canal done on my farthest back upper molar (got rid >of my wisdom teeth decades ago), and soon there after noticed that that [quoted text clipped - 6 lines] >malocclusion, that tooth striking first and raising my bite off all other >teeth. Any idea what is going on? Bob 63 USA Bingo!!!! Thank you thank you thank you. This diagnosis fits very well. I had casually noticed that my malocclusion seemed to have been triggered by a particular biting action, that of biting my nails which I did rather infrequently but with some gratification when say driving, a time I could not get out nail clippers to tidy up ragged edges. (For those who would like to inquire why an adult man would chew on his nails, please direct all questions to Paul Newman.) I will assume that some mechanical stress on the jaw during my root canal (despite the comfort of a nice bite block) got the condyle to shift then and at later times when the jaw was used in unaccustomed ways. I will hope that the displacement will ease overtime and my bite will return without to much more done. But if it does not then will go to a maxo-facial specialist. Bob-- Here is the Merck reference: Internal joint derangement is anterior misalignment of the articular disk above the condyle. Symptoms are localized joint pain and popping on jaw movement. Diagnosis is based on history and physical examination. Treatment is with analgesics, jaw rest, muscle relaxation, physical therapy, and bite splinting. If these methods fail, surgery may be necessary. Early treatment greatly improves results. The superior head of the lateral pterygoid muscle may pull the articular disk out of place when abnormal jaw mechanics place unusual stress on the joint. Abnormal jaw mechanics can be due to congenital or acquired asymmetries or to the sequelae of trauma or arthritis. If the disk remains anterior, the derangement is said to be without reduction. Restricted jaw opening (locked jaw) and pain in the ear and around the TMJ result. If at some point in the joint's excursion the disk returns to the head of the condyle, it is said to be with reduction. Derangement with reduction occurs in about 1?3 of the population at some point. All types of derangement can cause capsulitis (or synovitis), which is inflammation of the tissues surrounding the joint (eg, tendons, ligaments, connective tissue, synovium). Capsulitis can also occur spontaneously or result from arthritis, trauma, or infection. > Possible that the TMJ condyle may be re-positioning up & back. > [quoted text clipped - 8 lines] >>malocclusion, that tooth striking first and raising my bite off all other >>teeth. Any idea what is going on? Bob 63 USA Too bad they never heard of an NTI. D > Treatment is with analgesics, jaw rest, muscle relaxation, physical > therapy, and bite splinting. If these methods fail, surgery may be > necessary. Early treatment greatly improves results. Please share the information with us/me. Thanks > Too bad they never heard of an NTI. > [quoted text clipped - 3 lines] >> therapy, and bite splinting. If these methods fail, surgery may be >> necessary. Early treatment greatly improves results. > Please share the information with us/me. Thanks > [quoted text clipped - 5 lines] > >> therapy, and bite splinting. If these methods fail, surgery may be > >> necessary. Early treatment greatly improves results. "If these methods fail, surgery may be necessary." Does anyone wonder what that necessary surgery would be? (I do.) Webby >>>>Treatment is with analgesics, jaw rest, muscle relaxation, physical >>>>therapy, and bite splinting. If these methods fail, surgery may be [quoted text clipped - 5 lines] > > Webby Yes, that statement is even more alarming than the omission of an NTI device. Dangerous, outdated advice. I should have addressed that as well. D > Dangerous, outdated advice. It needed to be repeated ! > > Dangerous, outdated advice. > > It needed to be repeated ! Where did the original poster go? Are we just preaching to the choir? I'm still here, listening. Thanks for the information and the advice. >> > Dangerous, outdated advice. >> >> It needed to be repeated ! > > Where did the original poster go? Are we just preaching to the choir? I lost track. What question did you need to discuss?  Signature/ Amatus / > I'm still here, listening. > [quoted text clipped - 5 lines] >> >> Where did the original poster go? Are we just preaching to the choir? > I'm still here, listening. > > Thanks for the information and the advice. What are you thinking at this point? Webby > >> > Dangerous, outdated advice. > >> > >> It needed to be repeated ! > > > > Where did the original poster go? Are we just preaching to the choir? 1. Probably my root canal was not related to the joint problem in the jaw (or related in a way so tenuous as to be casually incidental). 2. If I avoid stress on the joint, ie avoiding biting my nails, I may be lucky enough that the capsule will calm down and not get worse, 3. If it does get worse despite my efforts then I will look for a maco-facial specialist and see if he would be willing to go for an injection there. >> I'm still here, listening. >> [quoted text clipped - 9 lines] >> > >> > Where did the original poster go? Are we just preaching to the choir? > 1. Probably my root canal was not related to the joint problem in the jaw > (or related in a way so tenuous as to be casually incidental). Agreed > 2. If I avoid stress on the joint, ie avoiding biting my nails, I may be > lucky enough that the capsule will calm down and not get worse, If you are clenching and create muscle spasm, it sill continue. > 3. If it does get worse despite my efforts then I will look for a > maco-facial specialist and see if he would be willing to go for an > injection there. Botox injections can help in some instances. However, you need to prevent the muscle activity to get the Botox to really be helpful. >>> I'm still here, listening. >>> [quoted text clipped - 9 lines] >>> > >>> > Where did the original poster go? Are we just preaching to the choir? > > 1. Probably my root canal was not related to the joint problem in the jaw > > (or related in a way so tenuous as to be casually incidental). [quoted text clipped - 12 lines] > Botox injections can help in some instances. However, you need to prevent > the muscle activity to get the Botox to really be helpful. I'm thinking that with the outdated nature of the info hierax is relying on... injection technique *other than* botox combined with para-functional activity control would not likely be packaged in the same "literature". ??? That is why I asked what sort of injection hierax had in mind. I could guess but what would be the point of that? Webby [cut] I was referring to: "I should have addressed that as well. D{artos} NTI-TSS <headachehope.com> It's marketed heavily for migraines, but it is great for TMJ problems as well." ++++++++++++++ In answer to the idea idea of muscle spasm, in my case there is none. I am betting on it being a strictly mechanical issue that I can walk way from. +++++++++++++++++++++ I am not entertaining any ideas of treatment unless and until I get more symptoms. >> > 1. Probably my root canal was not related to the joint problem in the >> > jaw [quoted text clipped - 25 lines] >> > [cut] But my question about the injection came from your point #3: > >> > 3. If it does get worse despite my efforts then I will look for a > >> > maco-facial specialist and see if he would be willing to go for an > >> > injection there. So I asked what sort of injection you had in mind. Webby Botox. I would be inclined to reach for that than the mouth device. I do not clench my jaw at all, don't grind my teeth. I do not notice any joint pain or sensitivity. My sole issue was the teeth no longer meshed. > But my question about the injection came from your point #3: > [quoted text clipped - 5 lines] > > Webby > I do not clench my jaw at all, don't grind my teeth. I'll bet you're wrong. *Everyone* does some clenching during stages of sleep. Many just get carried away and go way over a 'normal' level. I've had major clenchers look me right in the eye, set their jaw sternly (the teeth were in contact right then!) and make the same statement. I can see their teeth and I know the damage to them simply cannot happen with normal wear and tear. The teeth have to be in forceable contact. Without seeing you, I cannot say that you do clench an abnormal amount, but it is also impossible for you to make the statement that you do not clench. D 1. My teeth do not mesh now. I have to purposely set my jaw to avoid contact with the protruding crown. 2. In sleep I must be breathing through my mouth as it is constantly dry and I take sips of liquid several times a night to get it more comfortable. Thank you for your concern and sharing your experience. >> I do not clench my jaw at all, don't grind my teeth. > [quoted text clipped - 17 lines] > > D >1. My teeth do not mesh now. I have to purposely set my jaw to avoid contact >with the protruding crown. Get this looked at, an adjustment may be necessary. >2. In sleep I must be breathing through my mouth as it is constantly dry and >I take sips of liquid several times a night to get it more comfortable. >Thank you for your concern and sharing your experience. You can try Biotene to help alleviate the dry mouth. Perhaps, addressing your noicturnal breathing with decongestants or a CPAP may help. >>> I do not clench my jaw at all, don't grind my teeth. >> [quoted text clipped - 17 lines] >> >> D Below is a list of Examples of Reported Uses with Botulinum Neurotoxins: Focal Dystonias . Blepharospasm1 . Cervical dystonia1,2 . Oromandibular facial-lingual . Spasmodic dysphonia . Task-specific (Writer's Cramp) Other Involuntary Movements . Voice, head, and limb tremor . VII nerve facial spasm disorder1 . Hemifacial spasm . Palatal myoclonus . Tics Abnormal Muscular Contractions . Strabismus1 . Cerebral Palsy . Multiple Sclerosis . Spasticity (Post-CVA or TBI) . Spastic bladder (OAB, detrussor) . Achalasia (esophageal) . Chronic anal fissures Other Applications . Hyperhidrosis1 . Migraine /Tension headaches . Myofascial Pain Under "Other Applications" which would be the therapeutic sites allowed under the Dental Practice Act for your dentist to legally adminsiter botox, you would be looking at having somewhere in the neighborhood of 100 to 150+ units injected at a cost roughly of 12.00 to 15.00 per unit. Chances are good that your insurance will not cover this expense and you will need to pay out of pocket for this treatment. The duration is about 3 months, so theorectically you could be looking at an out of pocket expense of 5000.00 or more annually. On the other hand, a properly fabricated and fitted NTI device might cost you anywhere from a few hundred to a 1000.00 depending on who does it, and chances are extremely good that it will be a partially covered expense by your ins.co Your NTI will last for many years with occasional needs for relining and refitting. To just suggest you would opt for botox is not as easy as it sounds, you would need to be evaluated and have a proper diagnosis before it could even be considered. The top doctors (neurologists and dentists) in the USA that are using botox for treating trigeminally mediated disorders (TMD's) use botox in conjunction with proper parafunctional control. The botox rarely preceeds the parafunctional control and almost always is secondary to that parafunction control. best wishes > Botox. > [quoted text clipped - 12 lines] >> >> Webby Thank you for the information. > Below is a list of Examples of Reported Uses with Botulinum Neurotoxins: > [quoted text clipped - 68 lines] >>> >>> Webby > Botox. > > I would be inclined to reach for that than the mouth device. > > I do not clench my jaw at all, don't grind my teeth. I do not notice any > joint pain or sensitivity. My sole issue was the teeth no longer meshed. How would the "Botox" change your situation? Who would provide this treatment? Webby P.S. My guess as to the injection you were thinking about was *not* Botox. > > But my question about the injection came from your point #3: > > [quoted text clipped - 5 lines] > > > > Webby While I have followed this tread closely, I may be mistaken. It was my reading that Botox was the only injectable mentioned in the postings. I am not invested in any treatment program. I have not gone forward beyond bookmarking the device http://www.headacheprevention.com/pages/whatisit.html and copying all responses into a file for future reference. Thank you for your interest. >> Botox. >> [quoted text clipped - 22 lines] >> > >> > Webby > In answer to the idea idea of muscle spasm, in my case there is none. I > am betting on it being a strictly mechanical issue that I can walk way > from. IME, it is rare for a perfectly normal patient to have this type of complication following appointments with extended periods of holding their mouth open. Yours would have to be a pretty unusual case. Maybe possible, but still unusual. You may return to a level where overt symptoms disappear. That does not mean that everything is just fine. D > > In answer to the idea idea of muscle spasm, in my case there is none. I > > am betting on it being a strictly mechanical issue that I can walk way [quoted text clipped - 3 lines] > complication following appointments with extended periods of holding > their mouth open. Some years ago, I was put through two operating room procedures ... without knives ... for the purpose of *stretching open* my jaw under general anesthesia and blocking it at that point with rubber blocks for three days. I can not begin to tell anyone about the torture of such a procedure... suffice it to say that morphine didn't touch the pain. When the blocks were removed, it took several more days for the closing muscles to "relax" enough to allow me to close my mouth for the purpose of swallowing *anything*. The reason for the procedure was based in a need to prevent the post surgical contraction of the muscles -- scarring of the muscles... the joints were already beyond hope at that point. We were merely trying to force the muscles to heal in a longer length. Anyway, ... it isn't something that is done often. Furthermore, it didn't "work". Webby > Yours would have to be a pretty unusual case. Maybe possible, but > still unusual. [quoted text clipped - 3 lines] > > D > > In answer to the idea idea of muscle spasm, in my case there is none. I > > am betting on it being a strictly mechanical issue that I can walk way > > from. Have you consulted anyone about this problem other than posting on sci.med.dentistry? For someone who bets on it being something you can walk away from ... you've certainly gone to a lot of trouble! Webby > IME, it is rare for a perfectly normal patient to have this type of > complication following appointments with extended periods of holding [quoted text clipped - 7 lines] > > D No, no other posts in other groups. My interest was more in a diagnosis than a treatment. I am willing to wait, espc since I do not have any insurance coverage for either medical or dental care at this time. >> > In answer to the idea idea of muscle spasm, in my case there is none. I >> > am betting on it being a strictly mechanical issue that I can walk way [quoted text clipped - 17 lines] >> >> D > No, no other posts in other groups. > > My interest was more in a diagnosis than a treatment. You got a diagnosis here in smd? > I am willing to wait, espc since I do not have any insurance coverage for > either medical or dental care at this time. Webby Yes: >Possible that the TMJ condyle may be re-positioning up & back. >> No, no other posts in other groups. >> [quoted text clipped - 6 lines] > > Webby > Yes: > >Possible that the TMJ condyle may be re-positioning up & back. The person who posted that comment will need to address its value as a "diagnosis". Webby > >> No, no other posts in other groups. > >> [quoted text clipped - 6 lines] > > > > Webby > 1. Probably my root canal was not related to the joint problem in the jaw > (or related in a way so tenuous as to be casually incidental). [quoted text clipped - 3 lines] > maco-facial specialist and see if he would be willing to go for an injection > there. What sort of injection do you have in mind? What is the risk/benefit ratio of such a "treatment" to the TMJ as you understand it? Webby > >> I'm still here, listening. > >> [quoted text clipped - 9 lines] > >> > > >> > Where did the original poster go? Are we just preaching to the choir? > 1. Probably my root canal was not related to the joint problem in the > jaw (or related in a way so tenuous as to be casually incidental). Having your mouth open for an hour or so getting a root canal will tip many patients with borderline jaw problems over the edge. > 2. If I avoid stress on the joint, ie avoiding biting my nails, I may be > lucky enough that the capsule will calm down and not get worse, Also avoid chewing gum, yawning real wide, chewing steak (or other tough foods), and don't keep moving your jaw around to see where it hurts. > 3. If it does get worse despite my efforts then I will look for a > maco-facial specialist and see if he would be willing to go for an > injection there. For my money (and comfort) I would try an NTI device before any drugs or invasive therapy (and beware of 'specialists' in TMJ disorders). JMO, D > 1. Probably my root canal was not related to the joint problem in the jaw > (or related in a way so tenuous as to be casually incidental). [quoted text clipped - 3 lines] > maco-facial specialist and see if he would be willing to go for an injection > there. I still don't understand what "injection there" is all about. Two questions: 1. What is being injected? 2. Where is "there" that it is being injected? Webby > >> I'm still here, listening. > >> [quoted text clipped - 9 lines] > >> > > >> > Where did the original poster go? Are we just preaching to the choir? NTI-TSS <headachehope.com> It's marketed heavily for migraines, but it is great for TMJ problems as well. Steve > Please share the information with us/me. Thanks >> Too bad they never heard of an NTI. >> >> D >>> Treatment is with analgesics, jaw rest, muscle relaxation, physical >>> therapy, and bite splinting. If these methods fail, surgery may be >>> necessary. Early treatment greatly improves results. |
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