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Medical Forum / General / Dentistry / February 2008Serious mandible problem - looking for help
Hello, I've already posted this on alt.support.jaw-disorders but due to Webby's suggestion from that group and the low activity of the group itself, I'm posting here as well. My mom has been suffering from TMJ disorder for almost 10 years now. At the beginning it was a 'typical' TMJ disorder that was treated by doctors accordingly, that is, using occlusive splints. One of the splint had been adjusted several times in the course of such treatment. Adjustments consisted in adding some plastic-like substance that hardened and thus made the splint taller increasing the space between the upper teeth and the lower jaw. After one of such adjustments, something really bad happened to my mother's mandible. This was 3 years ago and that was when the problem really started. It is really hard for me to precisely describe what happened because I am writing what my mom told me she was/is feeling, and her description is based on her sensations. I am writing this because every time she told her doctor about what had happened to her mandible, he replied that such things are impossible and what she was feeling was merely a 'false' sensation and did not reflect what was really happening, and, according to him, nothing wrong was going on. Well, maybe true, but my mom did not made the whole thing up, all she wanted and still wants is relief of pain. But to the point. Three years ago, after the mentioned misfortunate adjustment of the occlusive splint, one of my mom's mandible condyles got somehow twisted and dislocated (lowered in relation to the second condyle) causing excruciating pain. Some time later, the same happened to the second condyle! Ever since, my mom is suffering awfully. Her face aches as if it was clenched (the sensation given by the tightening muscles, I guess). Mandible abducting and movements are also impaired, my mom describes it as "making sharp movements to the sides" when both using mandible (eating, chewing etc) and when the mandible is not being used. There are many other consequences as well, as you may guess. The pain of all the muscles of the body, impaired vision, hearing and so on. But the worst of it all is the excruciating pain and my mom says it is getting worse :( One thing that may make the image a bit clearer: when my mom clenches her jaws only the front teeth have contact with each other. The rear teeth do not touch. It seems like the rear part of the mandible is abnormally lowered (due to the condyles' dislocation?). We have visited many doctors and have done many tests, some of them several times, including magnetic resonance, many xrays and tests that measure the abduction of the mandible. According to the doctors the temporomandibular joints are just fine! My mom was made wear occlusive splints again but they only make things worse and do not give any relief. Later on, she was treated with an NTI splint which did not give any results. Looks like splints cannot help here anymore :( We don't know what to do. Doctors, claiming that nothing is wrong with the joints, try to use splints as if it was 'standard' teeth clenching or bruxism. Maybe someone knows about a similar case? I realize it is impossible to diagnose over the internet but we are really desperate and looking for any clues or possible solutions. Thank you in advance for any response and excuse me this lengthy thread. Peter, Poland Kindly begin by reading and browsing www.nti-tss.com and returning with specific questions.  Signature/ Amatus / > Hello, > I've already posted this on alt.support.jaw-disorders but due to [quoted text clipped - 59 lines] > > Peter, Poland > Kindly begin by reading and browsingwww.nti-tss.com and returning with > specific questions. [quoted text clipped - 3 lines] > > Amatus Thank you for your reply, Amatus. What would a specific question be in this case? Maybe something like 'what can be done if the mandible's condyles got dislocated and lowered due to the treatment with an occlusive splint'? I'm familiar with that website but there is nothing there about treatment of damage done by an occlusive splint. Or is there? Thanks. First you need to understand a "horseshoe" type splint vs an NTI type one. then, you need to understand what each type of splint is capable of accomplishing. The topic can be huge, so I need some way of figuring out what your level of knowledge is first. I doubt very much the [occlusive splint] caused permanent damage to any joints. However, muscle activity while wearing the appliance might "mess things up a bit". Signature/ Amatus / >> Kindly begin by reading and browsingwww.nti-tss.com and returning with >> specific questions. [quoted text clipped - 13 lines] > > Thanks. > First you need to understand a "horseshoe" type splint vs an NTI type one. > then, you need to understand what each type of splint is capable of > accomplishing. Well, I do understand what the difference between the two is. 2 years ago I corresponded with dr James Boyd, the developer of NTI, and he explained how both types of splints work. For example, he explained, if I remember correctly, that NTI is much safer than a regular splint as it influences the muscles bringing back their balance so an NTI splint is not likely to do any harm. > The topic can be huge, so I need some way of figuring out what your level of > knowledge is first. I realize that. When I was young, I myself was treated with both a regular and NTI splint. But frankly, my mother's experience and knowledge in this matter is much greater than mine. > I doubt very much the [occlusive splint] caused permanent damage to any > joints. However, muscle activity while wearing the appliance might "mess > things up a bit". Well, my mom is unable to wear any splint now as they make the pain unbearable and sensations much worse. She wears dentures whose role is to be a replacement for the missing back teeth but today another doctor said that the dentures fulfills no function in this case as 'everything is hanging in the air anyway' as he put it. Dartos wrote: > Was the NTI made for the upper incisors or the lower? For the upper ones. > How long was it worn before it was decided it was of no value? About six months. > How tall was the bite opening? Hmm.. My mom says it was minimal. The Webby wrote: > There is a lot to discuss about this situation so I > hope you'll be patient with the post/reply process involving so many > time zones! Thank you, Webby. Patience and perseverance are our last bastions :) Mark & Steven Bornfeld wrote: > In the U.S., I would send you to an oral and maxillofacial surgeon to > evaluate her mandibular function. While it is possible she just needs > the "right" splint, the duration and severity of her symptoms suggest > she needs a comprehensive evaluation by someone who knows about these > conditions. I am afraid the situation in Poland, regarding TMJ, is dramatically worse than in the U.S. The whole problem has been noticed relatively recently and seems like doctors' knowledge of it is still insufficient. My mom visited such a surgeon twice, maybe three times, but he treated her so horribly, he shouted at her and did not want to listen to a word she was saying claiming that she should see a psychiatrist as she is perfectly healthy, according to him. I am afraid we cannot find much help in our country. > I assume you are accompanying your mom to these doctors? I often do but I always stay in the waiting room so I don't hear what the doctors actually say. My mom tells me everything later. > Forget about the x-rays--can she be guided into a normal bite by a > dentist? I am afraid not :( Dentists don't even know what she is talking about. > If not, something is probably amiss with the joint, and I'm at > a loss to explain why the docs can't help her. This is NOT a rare > condition. Well, looks like something is wrong with the joint itself, as you say. Maybe it is not rare in the U.S., but the Polish doctors behave as if they had no idea how to act :( The Webby wrote: > I am thinking that this woman might be a candidate for the A.G.E.LK. I've read what you wrote about AGELK in some forum and found out that it is another appliance which is used by some doctor in Italy with good results. If you could write something about this method, I would be glad to find out more. I thank you all for the replies and if you could take a look at this x- ray: http://tinyurl.com/2e9387 This is how my mom's mandible looked like when the first condyle had got displaced from its original position (I mean the left condyle). Presently, both condyles look like the one on the left. I think the deformity is clearly visible. Both heads of the mandible have been somehow taken out of their spots making the jaw "hang" freely. Thank you all once again. >> First you need to understand a "horseshoe" type splint vs an NTI type one. >> then, you need to understand what each type of splint is capable of [quoted text clipped - 101 lines] > > Thank you all once again. I think sagital, rather than frontal scans would have been more useful. I cannot visualize the glenoid fossae clearly. I did not realize that your mom's occulsion was on dentures. This calls into question the issue of how accurately the registration for the bite on the denture was. Still, settling of the denture into the tissues as well as wear of the teeth (if they're plastic) can lead to open bite in the back teeth. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 My suggestion is that you contact Dr. Giuseppe Stradaioli via email. I am certain that he will be more than happy to communicate directly with you and will be in a better position to explain A.G.E.LK to you in a manner that addresses your specific issues. giustrad@tiscali.it Good luck to you both, Webby In article <be03bb6d-ccd5-4306-8085-47bae1a80cb6@s37g2000prg.googlegroups.com>, > > First you need to understand a "horseshoe" type splint vs an NTI type one. > > then, you need to understand what each type of splint is capable of [quoted text clipped - 101 lines] > > Thank you all once again. Later on, she was treated with an NTI splint which did not > give any results. > Peter, Poland Was the NTI made for the upper incisors or the lower? How long was it worn before it was decided it was of no value? How tall was the bite opening? All NTIs are not alike. D > Hello, > I've already posted this on alt.support.jaw-disorders but due to [quoted text clipped - 59 lines] > > Peter, Poland There is no way for me to evaluate this situation. The obvious derangement of the bite is concerning. More concerning perhaps is the doctors' inability to see a problem. I am very much inclined to believe that if your mom says her back teeth cannot be brought together that she knows exactly what she is talking about. In the U.S., I would send you to an oral and maxillofacial surgeon to evaluate her mandibular function. While it is possible she just needs the "right" splint, the duration and severity of her symptoms suggest she needs a comprehensive evaluation by someone who knows about these conditions. I assume you are accompanying your mom to these doctors? Forget about the x-rays--can she be guided into a normal bite by a dentist? If not, something is probably amiss with the joint, and I'm at a loss to explain why the docs can't help her. This is NOT a rare condition. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > > Hello, > > I've already posted this on alt.support.jaw-disorders but due to [quoted text clipped - 76 lines] > > Steve Hi Steve. I am thinking that this woman might be a candidate for the A.G.E.LK. Let's see what more Peter shares with us. I think you are familiar with the A.G.E.LK. If not, let me/us know and we can go from there. Webby > Hi Steve. > [quoted text clipped - 3 lines] > > Webby No, I'm not--howsabout a quick primer? Thanks, Steve Could be. She's also a lot closer to an expert in A.G.E.LK than the inventor of the NTI. <G> D > I am thinking that this woman might be a candidate for the A.G.E.LK. > Let's see what more Peter shares with us. I think you are familiar with > the A.G.E.LK. If not, let me/us know and we can go from there. > > Webby |
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