First Visit to the TMJ Doctor

Yesterday I went to the TMJ doctor. My dentist didn’t really care when I told them about my jaw, and my orthodontist thought I was being overly sensitive when I said my teeth didn’t feel like they met the same way anymore. So GG has been bugging me for the past couple years to see a specialist. He got a recommendation for one from his doctor (turns out he’s the TMJ doctor’s family physician, too), and I made an appointment.

They’d sent me a packet of papers to fill out about my history and any past treatment, so I handed those in when I first got to the office. I also had records from my dentist and orthodontist sent there ahead of time. Then the doctor took a few minutes to look over everything before I went into his office to meet with him. We basically went over everything I’d written out, and he kind of restated things in his own notes. He also looked at the x-rays sent by the dentist and orthodontist. (While he was looking, he was like, “Oh, you got your wisdom teeth removed?” and I was like, “Um, no, I don’t have wisdom teeth.” [Well, I have one. But it’s way up there.])

Then we moved into the examining room, where he looked at every tooth and made comments on it while his assistant wrote everything down. Then he took some measurements with a very tiny ruler. The jaw is one of the most complex joints of the body, because it can move up and down, left to right, and forward and back. He measured my jaw doing each of these movements, to see how far it went in each direction. He also noted at approximately how many milimeters it would make a popping sound. (Only the left side pops, but it pops loud! Both he and the assistant were commenting on it, like, “Wow, I heard that one!”) He also noticed something that I’ve kind of felt and suspected for a log time, but no one has picked up on – when I open my mouth, my lower jaw kind of swerves to the right after the left joint pops. When he went to measure the forward/backward motion of my jaw, there was no popping noise. That was odd. It turns out, I was unconsiously swerving my jaw to the right while doing that move, too. When he held my jaw so it couldn’t move to the right, it made a loud pop as it moved forward.

I put my retainers in, and he did all the measurements again, to see how far I could close my mouth and everything, while wearing those. He also tried to slip a piece of paper out from between my back teeth while my retainers were in. A thicker piece of paper could be held between my teeth, but he was able to slip out the thinner paper. After all the measurements, he felt around different areas of my face, neck, and shoulders to see if there was any pain. There really wasn’t (except for the pain of him pressing my face).

The doctor left the room, and came back with a chunk of hot wax that had been formed into a vaguely retainer shape. He put the wax into my mouth and had me bite down, and positioned my jaw in a certain way, to make an impression. Then he ran some cold water over the wax to harden it. He put the wax back into my mouth, and with my jaw in that position, I opened and closed my mouth. There was almost no click!! In maybe five times of opening and closing, there was a very slight click twice. It was amazing!

Because he was able to get that paper stuck between my teeth, even with my retainers in, he said I was really able to clench my jaw at night. What he wants to do is put an additional piece on my upper retainer that will keep my mouth further open. This is something called Nociceptive Trigeminal Inhibition (NTI). The theory behind this is that the usual mouthpiece people get to treat nighttime tooth grinding (the kind that covers all your upper teeth like a sport guard) may also increase the intensity of jaw clenching. The NTI system is a piece about the diameter of a pencil, which goes between your upper and lower front teeth. If you bite on this, your teeth don’t have high intensity contact, and your muscles contract only slightly. The doctor used the wax mold to figure out exactly how many milimeters he wanted to add in thickness to my retainer.

Finally, they did two types of therapy on me. I didn’t really enjoy either, couldn’t feel anything while it was happening, and don’t feel any difference now that it’s the next day. The first was ultrasound therapy. The assistant used an ultrasound thingy to rub cold goop all over both sides of my face for five minutes each. While the assitant was doing this, the doctor left the room to get me this thing called a Therabite. It’s a U-shaped piece of rubber that goes between my upper and lower teeth. For five minutes at a time (he said definitely before bed, and maybe another time, like driving to or from work), I’m supposed to clench and relax with this in my mouth. The theory is that it will tire out the muscles (so they don’t clench as much on their own), but no real damage will be done because there is this rubber layer between my teeth. Then the second therapy they did was Diathermy, which is basically a sound wave therapy. It was only done on the left side of my head. The doctor and I both wore ear plugs, and he held this gun-like thing to the side of my head. It made a really loud noise, and something about the sound waves was supposed to be good for my jaw. He had me wear the Therabite thing and clench and release while he was doing the sound waves. It was really loud, and the thing was held right next to my ear. He also gave me my ear plugs back at the end, which I assume means I’m supposed to bring them back next time in case he does Diathermy again.

When I was all done, the doctor and I went out to the front desk together. He said my next appointment should be for an hour and fiften minutes, and he wants it to be in a week, no more than two weeks. Well, I don’t know if that’s going to happen. Also, this doctor doesn’t do anything with insurance. I have to pay them up front, and then they just give me a form that I can send to my insurance to be reimbursed. I’d been told that the cost of the consultation would be about $200, which was true, but… then they added the Therabite and Diathermy and the ultrasound, and it came out to more like $300. Ugh. (Which I may or may not even be reimbursed for!) They also gave me a form with the costs of everything they plan to do at the next visit. I was looking over it, and it didn’t look so bad, probably about $200 again… then I got to the line about adding the NTI thing to my retainer. I thought it said $59 (sounds good, they’re just adding a small piece of plastic to my existing retainer). Then I looked again. Squished near the edge of the page was an 8. $598?! If my insurance isn’t going to cover this, I don’t know about going back there for a $600 centimeter of plastic, you know?

So, overall, it went really well. The doctor noticed things that others had missed, and didn’t think I was crazy in the least. In fact, I thought I had a pretty minor case, but out of four options for the severity of the patient’s condition – Limited, Intermediate, Extended, and Complex – he has categorized me as Extended. He was friendly (so were the rest of his staff!) and thorough, and although his office is a pain to get out of at rush hour, it’s relatively easy for me to get to, even from work. So… we’ll see. We’ll see what my insurance company says, we’ll see if anything is covered (or goes towards my deductible, more likely), and we’ll see if I go back. I guess I would like to.

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