TMJ Phase 2-orthodontics

[dnjwtmj]

Well, this is my first time on this board, so just doing a lot of reading!

I have been wearing a lower splint for my TMJ issues for about 3 mos. now. I have had it adjusted every week or sometimes 2 and am very close to pain free in the jaw and headache free...which is amazing!!

Today the ortho said he wants to do a bite registration at the next appt. and then talk about phase 2. I am feeling nervous about what phase 2 is going to be AND how much it is going to cost!

My bite is now crossed on one side and completely open in the back. The midline is off and I am almost edge to edge in the front.

What is the most common phase 2 treatment? Is it conventional braces? Or are the other options? Also, does anyone know if dental insurance will cover phase 2 treatment? They would not pay for the phase one splint treatment citing that they do not cover TMJ related issues.

[pellepee]

Welcome! I am so glad to hear you are having less pain from your jaw, it is amazing when you realise how long you have been living with the problem hey? You will feel like a new person every day.

I had splint therapy for about 3-4 months and then the extra months (roughly another 3-4) were waiting for my orthodontist appointment. I have always had a small open bite at the front (opposite to you), but I found that when my jaw was shifted into the correct position that I had quite a narrow upper jaw; it just looked like it never grew out towards the right; stupid jaw!

My treatment to correct this is a quad-helix expander and upper & lower braces. People will pipe in about non-surgical jaw expansion, but I have absolutely no crowding of teeth to fill in any gaps left by proper jaw expansion (I actually have gappy teeth) so I am having to go with 'fake' expansion. I am three months into braces, and whilst my open bite is still there, my right upper teeth are sitting right above and in line with the lower molars; so its as if they just have half a tooth to go. I cannot wait to get this stupid expander taken out I can tell you!

I was scared to not live with my splint when I got braces on but my jaw adjusted riding solo nice and easily. I still have a bit of neck tightness, but I have not had a migraine for about 2 months now. My jaw can also hold its own while I sleep now too; when I first removed the splint it was falling back (I had my jaw pulled forward a bit) and caused pain through the day but the muscles are learning what to do now.

This month is wisdom tooth removal and TDA's put in for closing my open-bite by intruding my molars back up into the gums. You can search TDA's in Google, just type in orthodontic TDA and information will come up. I am not sure what they do for open-bites in the back of the mouth though. My mid-line is off as well, but I think I am having everything shifted left/right/back/forth to correct this. Even though my mid-lines are in line with my actual upper and lower jaw individually, my jaw is structurally off so I think they are going to make it appear balanced and my jaw will just stay off-center.

In regards to insurance, I live in Australia and am paying for this myself. I found it to be more financially viable for me than to upgrade my insurance and only get a little bit covered. My braces were $8,000AU, but calculating every appointment, consultation, dental check-up, X-ray, mould and appliance I have easily cleared $10,000AU for this. I'm looking at braces for 18-24 months... with only 3 down!

Good luck!!

[dnjwtmj]

Thanks for the response! I will post again after the ortho gives me a rundown of what he wants to do now. I am really fine with the splint...but I guess I can't wear it forever and night time only isn't going to work because even leaving it out just for the day, my headache returns and jaw starts to move.

[TMJJill]

Hi,

As you can see from my name, I'm dealing with TMJD as well. In fact, I joined this board after beginning Phase II.

It was at about the 6 month mark of splint therapy for me that my muscles were "happy" enough to start talking Phase II. During my Phase II consultation appointment, my dentist gave me a choice of options:

1. continue with splint therapy indefinitely
2. try to wean myself off of the splint and see how I do
3. changing my bite with a series of caps/crowns to maintain the new bite I'd achieved
4. orthodontics

I actually stayed with my lower mandibular repositioning splint for about a year until I had enough money to move on. It kept my TMJD symptoms in check so I was happy enough. Once I got my bite adjusted, I rarely had to go in for splint adjustments.

As for the second option, it really wasn't even a consideration for me. With my discs slipped, my lower jaw had been pushing back towards my ear causing ear pain and significant hearing loss. There was no way I was going to chance that again.

I never really considered the third option, I wanted to get my bite into place more naturally. I may still need a couple caps on molars that are ground down if I can't get them high enough with braces though.

I went with option 4. I'm in Damon self-ligating braces. I started with upper braces with my lower repositioninng splint. When my upper arch was widened to a certain point, I got my lowers on. In my case, it took 11 months to get there. I got my lower braces about 5 weeks ago.

I will say that I've had a bit of trouble adjusting to not having the splint though. It will take a bit of time for my lower braces to get things in place.

Neither my medical nor my dental insurance covered any of my direct tmjd treatment. That has caused me to take my treatment much slower since I have to come up with the money as I go through the process. I did have physical therapy for cervicalgia and myofascial pain that was covered by my medical insurance. Basically, the PT worked my facial, neck and shoulder muscles that were in spasm because of the tmj. It did help a lot.

I wish you well with your treatment.

[dnjwtmj]

Wow....I was really thinking that the orthodontic benefit on the dental insurance might kick in for phase 2...uggh.

Does anyone know if there are widely used option available other than braces? I just hate the thought of having them again having already had them as a teenager. I just keep hoping there is some removable option that might work as well.

It is good to hear that the Damon system was used to widen your upper arch as I was thinking I would have to have something seperate to expand my upper arch due to the crossbite. Maybe I will not..

I'm just nervous waiting to find out what the recommendation is as I really don't want braces and I really don't want to spend thousands out of pocket. However, I realize that I almost HAVE to do something.

[TMJJill]

If you are looking for a removable option, why can't you keep wearing your splint longer? I had mine for 26 months before moving on. It worked well for me.

Most insurances don't cover treatment, but there are a few out there that cover some. You should certainly check to make sure.

[dnjwtmj]

I suppose I could wear the splint somewhat longer.....but I really can't wear it forever, nor do I want to. I'd rather have a permanent solution, so whether I do it now or 2 years from now, isn't going to make much difference. Plus, right now, I'm not working full time outside of the home, but rather staying home with our kids....so I may as well get anything I am going to have done orthodontically now rather than later.

My splint has already broken once and had to be repaired, too....so I doubt its going to last too terribly much longer.

[pellepee]

I have only had braces on this once, and I can imagine the dread of going back into a prison sentence would put you off. But I'd say it is best to get it done with braces if that is what is suggested (whether fixed, removable... depends on what you can get!) and I'd say being an adult with braces is much better than being a teenager. You have a much better understanding and appreciation for the treatment; honestly I never brushed my teeth as a teen so if I had braces well, lets just say I'd have worse teeth than I do right now!

My 'jaw guy' said I will probably have a night-time splint after my braces to stop my jaw falling backwards at night if that is still an issue. I don't know if that becomes my retainer too? But I'm not thinking about the 'after-life' yet as I still have quite a ways to go with just the braces.

I have ceramic upper and metal lower, and most people at work never noticed I had braces until now because I am turning down food at work functions (thick crust sandwiches etc; I sit there with my home-made soft mush of a lunch instead!). I have seen so many adults with braces now only because I am obsessed with looking at peoples teeth, but before I felt like no-one in the whole country over the age of 18 had them. I never noticed them, so no-one else will. And if they do, it is probably because they had braces, have braces or want/need braces.

[dnjwtmj]

Are the ceramics much more costly than the metal? The Damon system is only metal, correct? Or does it come in ceramic as well?

I hear you on the lower jaw falling back thing. I think mine is doing that at night right now. I don't think I am clenching or grinding much anymore and when my mouth is open while sleeping my lower jaw seems to be sliding back because if I wake up on my back, I feel like I have to gently/slowly slide my lower jaw forward to the position it is in during the day. Its like it slips backward towards the back of your throat and you know if you don't slide it forward slowly/carefully you are going to get a big, painful click.

So anyway in regards to the backwards slide, I was thinking that might be permanently fixed after the phase 2 orthodontics....but you are saying that you might always need a night time splint for that? Well....I guess I am thinking too far ahead....have to wait and see.....

[TMJJill]

I think the pricing for braces varies by orthodontist. My clear Damons were $300 more than the metal.

Until I got my braces, I wore a nighttime splint with a wedge that came down and kept my lower jaw from falling back while I slept. It worked incredibly well. I hated giving it up. I now wear elastics at night to hold that forward positioning.

I haven't talked about post-braces treatments with my orthodontist yet. I'm assuming I'll probably have some sort of sleep splint.

I can't believe your splint broke. There was no way my splint would ever break. I'm a major bruxer and never saw any weaknesses in the 26 months I wore mine. I guess that all splints are a bit different though.

[dnjwtmj]

Yes, my splint did break....it was rather thin...now its been fixed with a wire and acrylic, which seems a bit thicker/more reinforced than it was before....but still don't know that it would last for an indefinite time. I'm trying to understand what your splint with the "wedge" was like. Mine is a lower splint and it just basically covers all of my lower teeth...but it has nothing to hold the lower jaw forward. When you say a wedge that came down....do you mean the splint was on your upper teeth? Just trying to understand....

I think I need to ask the ortho about my lower jaw falling back at night...as it is uncomfortable when I wake up and as I said, I have to gently move it forward. I've almost intentionally tried to avoid sleeping on my back so that this won't happen.

Thanks for the info on the clear vs. metal Damon cost. It doesn't seem like its too substantial in the overall price consideration, so that is good to know. I might possibly consider ceramic/clear/etc. but I'm not going metal!!! NO!

Also....does anyone know if Inivisalign an option for this phase 2 tmj treatment? I had a couple of people tell me that it really isn't a good option because its really for minor tooth movement and tmj orthodontics is beyond the general purposes of Invisalign...but I was just curious?

I am really liking all the info I am getting here!! YAY ME! I feel like at least I am attempting to do my research on this before I spend several thousand dollars!

[TMJJill]

I actually ended up with two splints for Phase I treatment. From what I understand, that is atypical. My daytime splint was a lower mandibular repositioning splint. It covered all of my lower teeth and had "bumps" on the top that aligned with my upper teeth when they were in proper positioning. I wore a nighttime splint that had a "beak" in the front that kept my bite in the same positioning as the daytime splint and a "wedge" that came down in behind my lower teeth and kept my lower jaw in a forward positioning.

My TMJD symptoms started out as mainly ear issues. With the discs slipped, my lower jaw was pushed back towards my ears causing me ear problems and hearing loss. When I sleep, my jaw was falling back and making things worse. That is why the upper splint. The one I wore was custom made by my orthodontist for my needs.

[pellepee]

I'm not 100% sure if I will get a night-time splint at the end, but it was mentioned. As my jaw is keeping itself in place for now (it seems) I might only need it on hand for bad days?? Who knows.

I was told as well that it takes 2 years for the stretched tendons in and around your jaw to tighten back up, so not sure what that might have to do with night-time splints but it's something I found interesting enough to share. I also think the night-time splint for me will just allow my jaw muscles to relax a bit as I clench when stressed.

Yes, I totally understand having to 'slide' your jaw back into the intended place! I still have to do it from time to time, but I think it's because I've turned onto my back whilst asleep. I came from being a tummy-sleeper, and it was a hard habit to break (I was ordered to!). I was sleeping on my back for awhile and it would fall back, but I can sleep on my side again, now that my jaw has settled. I have a high profile pillow (memory foam-like one), and I kind of sleep so that it's my cheek-bone on the edge of the pillow that is near/under my shoulder if that makes sense?? It allows my jaw to sort of sit by itself and hold its own and not be forced into any which way by the pillow surface. I am petite, so it might not work for everyone but I'm glad it works for me because I cannot sleep facing the ceiling!

I have normal braces with the ligatures. I am sure if I asked for all metal I would have been offered it but I was never given the option; I was always going to go with ceramic on top because I would look like I'm 16 (I'm 24). As a result, I couldn't tell you how much the difference was, sorry! I also can't advise about clear ligatures and staining as I have only had white wire-ties around my ceramic brackets...

Let us know what your treatment options end up being! If you are able to, get second opinions and third if need be. I would have been half-way through my braces already if I had stuck with my first consultation which was JUST braces with my incorrect jaw position. Errg... makes me sick to think I almost went that way. I am happy with the team looking after me now though.

[dnjwtmj]

So I think the ortho is somewhat unsure as to what he wants to do with my current bite! He says that the way my jaw is deviated to the left side is not common after wearing the splint. He is "not convinced" that its in the correct position and thinks we should try to "walk it slowly back to the center of my top teeth". So, he is making a new splint with my teeth in the new bite and keeping the old splint as a back up. I don't know what to think. To me, when I look in the mirror it seems that my lower jaw IS in the correct position in the middle of my mouth/face/lips now and that my upper jaw is not...however he is wanting the lower jaw to move back to the center of the upper. I'm not convinced that I am buying into his philosophy but since he is not charging for the new splint, I guess I will stick it out and see what it entails.

I was quite bummed thinking I was moving into phase 2 and now it seems I am just going into a repeat of phase 1 if you will. GRRR.....

Has anyone had this sideways deviation of the lower jaw after wearing the lower splint? And how is making a new splint with the teeth in the new bite going to "walk the lower jaw back to the center"? I need to ask more questions because I am quite confused!

[jem]

Hi dnjwtmj

In answer to your question above, Damon do make clear brackets. I have them on my top teeth and am happy with them. They have apparently also started to do clear brackets for lower teeth. When I started, they only offered metal brackets for the lowers, not that it was an issue for me as I am only having uppers.

Good luck with your treatment

Jem