TMJ : Here We Go Again!

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Hey, Mom!

Happy New Year! Here's hoping that 2009 is a great year for everyone.
So much happened in 08', that I'm thinking if I can get through that, I can get through just about anything.
Unfortunately, an old problem I used to have, has recently poppped up again.
Not as severely, but it's definately a concern.

So, I'm not sure if you remember back that far, but do you recall back when I lived "up north" and I had such extesive TMJ that my jaw used to lock shut? It had to be around 1986-87....Anyway, one day I was eating a sandwich and BAMMO! Something happened on the left side of my jaw and it locked shut. I freaked, and didn't know what to do. Trying to "unlock" it with pressure was totally un-successful, so I eventually just waited (2 hours the first time) and was able to manuver my lower jaw to the side and it unlocked. Apparently the jaw joint was swollen or aggrivated and it needed to relax or un-swell. Unfortunately, this became a regular occurance after that. I would guess that it happened at least 20 times a day. Fortunately, I didn't have to wait 2 hours each time to successfully do the lower-jaw manuver. Only a couple of minutes.
I eventually went to a dentist who refered me to UCSF in San Francisco. The doctors there informed me that the disk between my upper and lower jaw became "deranged" whenever I would bite down my regular bite.

After a series of MANY tests, several visits and a whole lot of dough, I was fitted with a clear plastic "re-positioning splint" that fit over my lower teeth, which kept me from biting down too far. This took the pressure off of my jaw joint. I wore that stupid thing (even after it broke in half) for many many years. Finally, I had the means to afford braces because of the bad overbite I'd always had. After two years in braces, I wound up with straight teeth, and my jaw no longer locked. In fact it rarely even popped after that unless I ate something REALLY chewy like bagels or steak.

Fast forward to 2008, and MMA surgery in June.
After the surgery, Dr KL decided not to fully (rubber) band me to stablize my jaw because he discovered (during the MMA operation) that upper jaw bone was rather weak and thin, which would later prove to be a problem.

At about the 5 to 6 month recovery mark, I started experiencing some light "snapping" of the joint on the left side and it was getting progressively more annoying/painful -- especially in the morning, after waking up.
So, Dr. KL referred me to an orthodontist Dr. RI, who specializes in TMJ, who is OF COURSE not in my insurance network. (all the good ones never are!) I see dollar $ign$!

It's tough to say exactly what really happened, but first off Dr. RI said it is not that uncommon for MMA patients' bites to not be perfectly lined up after their surgery.
After I told him the part about my weak upper jaw bone, he said it *might* have moved back a little bit after the surgery.
As a result, my back teeth don't really meet in the back at all, only in the front. So when I try to bite down, there is a lot of pressure on the jaw joint disk.

Dr RI suggested the first line of defense to be a plastic guard (not unlike the afformentioned repositioning splint of 20 years ago, but not so large) to take the pressure off the jaw joint. He also ordered a full set of X-Rays.
All tolled, I am about $1,700 dollars poorer than I was before I got there. I've submitted the bills to my insurance company for re-imbursment, but my guess is that it's going to be a while before I get it back. That's how they "roll". ;-)

I realize that it may take some time for it to help. The orthodontist says he wants me to wear this guard for 6 months, and then decide the next step.
My common sense would guess that if I'm ever to see my teeth where they used to be (pre MMA surgery) I'll probably need braces, but I'm no professional.
Patience is mostly what I need to have right now. I would just as soon get banded up with braces and start that, but I've never been one to put off getting what I think I need.

Fast forward....
It's been about 2 weeks since I started wearing this "appliance" and I'm not sure how well it's working. The snapping on the left side persists and when I take it out to eat, there's not only snapping on the left, but also popping on the right side.
Snapping on the left. Popping on the right.
Paul asked "Where's crackle?" (A bad Rice Crispies reference).
Not exactly what I was hoping for, but I guess I still need to give it more time.
I have an appointment with Dr RI in February, so we'll have to see what he thinks about all of this.

It should be a(nother) real adventure.

Much Love;
Pinski