Question for Dr about my TMJ appt

[mouse26]

Hi Dr.
I had an appt with a TMJ specialist yesterday and was disappointed with what he told me. I guess I had loftier goals for my appt. First, he said that he can only help me manage the pain in my jaw, neck, back and shoulders. He can only treat the symptoms not fix the problem. He said the TMJ pain, popping, etc will improve with age. I am 28 and have had the pain and popping only increase over the past 9 or 10 years. What do you think of that assessment?

He thinks my left jaw may be locked but did not indicate how he was able to determine that. Maybe because I am only able to open my mouth slightly? He would like to do a MRI to determine if that is the case. He said he would not consider surgery on a young mother like myself. It seemed like the treatment options he outlined would be the same if the MRI showed my jaw was locked or was not locked - physical theraphy (which I have tried previously to no avail) as well as meeting with some psychologist to change my reaction to stressors in my life. I do not want to an MRI unless it will change the treatment plan he has addressed.

I have had three splints over the past 9 years and none have completely alleviated the pain. The anterior positioning splint I have now has helped the most (very little jaw pain and no clicking on the right side) but it is quite cumbersome in my mouth. This does not feel like a long term solution to me though - I can't wear this for the rest of my life. I asked what a splint is supposed to accomplish and he said he did not know and there is no concrete evidence that it works or doesn't work. He said some people realize a decrease in pain from them so it is a technique they try. He said he might consider another costly splint if the MRI came back with a locked jaw. I am not sure what other kind of splint would be available considering I have GELB/MORA, anterior repositioning, and a protective uppper one when I was diagnosed at 19 with bruixism.

All along I have felt my bite was off. I cannot recall when it changed however I do remember a time when I bit down and my back molars all touched on both sides. Presently I am biting down on my front right teeth as the initial contact. This is not comfortable for me. The splint helps in this respect because my back teeth all meet when biting down onto it. There is not an obvious gap in my molars touching and the doctor did slide, almost like a piece of tinfoil, into my bite all over and would pull then try to pull it out through my clenched teeth. He did not remark that there was a problem there. Is that how you would recommend diagnosing a bite problem? Do you think this type of a bite problem could impact the TMJ pain and clicking? Possibly cause it? I feel so much more comfortable with my bite with the splint in.

The doctor I said comes from a very well respected clinic and is extremely nice but I feel like he wants to start back at step 1 with the PT, stress management, maybe another splint. I want to fix the problem, not treat the pain. Am I just being way too optimistic? Thanks VERY much for your insights. I was very nervous at the appt yesteday and thought of additional questions almost immediately afterwards. He wants to do the MRI next week and then I cannot get in to see him for another month so I would love your perspective.

Mouse 26