I wear this splint 4-5 hours throughout the day, and I wear the hard splint at night when I sleep.
6 Months
I return to the TMJ Specialist monthly, and get adjustments on the splints. I can feel when a splint needs adjustment, and the feeling is a deeply sore jaw. Overall, I feel much better still. My back, neck, and face feel better, but my bite is still out of alignment, and my jaw still gets sore after talking and eating.
The treatment remains the same, but now we add lidocane injections into the face and neck muscles, including attempts at the lateral pterygoid. These offered minor short term relief, but have failed to be the solution to the problem.
9 Months
My relief has plateaued. It hasn't gotten any worse and the splints continue to relieve the pain, but there has been little improvement the last few months. At this point I am running out of options. The next step is to try a stronger muscle relaxer called Clonazepam. interestingly enough, if you look up Clonazepam, you will see it does much more than relax muscles - it was originally intended as an anti-seizure or anti-anxiety medication.
The doctor's hopes is that will cause further relaxation during the night time and will reduce any clenching that is going on. The first few mornings after I began the drug, I felt a little better. My pterygoids still had not released, but I felt my range of motion was slightly better. However, if i take the pill too late at night, it is difficult to get going in the morning, so be careful and give yourself 8 hours before you have to wake up.
Looking Forward
This is where I am at right now: using splints and taking Clonazepam. If this doesn't work, the next course of action is ultrasound guided botox injections in to the ptergoids themselves. Botox will paralyze the muscle, ergo causing it to un-spasm. This is a last resort to my doctor as Botox is a toxin. Click here to read more about this process.
12-24 months
After 12 months, with some improvement, I hit a wall with the TMJ Specialist. She tried all of the conservative treatments, and is very reluctant to move forward with more aggressive treatments like Botox, surgery, or orthodontics. She recommended getting a second opinion, or just continue the maintenance injections. I don’t blame her for giving me an ultimatum. On the contrary, it was nice getting some truth: she’s stumped by my situation, and its not bad enough to try something more severe/permanent (easy for her to say).
So I went to a second TMJ Specialist and an Orthodontist. The TMJ Specialist just wanted to do it all over again, offering no real, new solutions but listen to relaxing, meditation music. The orthodontist was very knowledgeable, and confirmed what I already knew… there is nothing wrong with my teeth (bite), and my issue is muscular.
So for the next several months I continued on with the 3 splints (1 daytime, and 2 night time), and took the occasional muscle relaxer before bed. For pain relief ibuprofen continues to be the best option, and Miller Lite. At this point, I feel 35% better, which is a big difference. It still hurts, my bite is still off, but at least i can forget about the pain/discomfort once in awhile.
24 months +
In the midst of this I decided to switch jobs and of course medical/dental insurance. I had to find a new dentist, which was a godsend! I was fortunate to visit someone who actually wanted to help. The dentist didn’t know how to fix my problem, but he remembered a patient who had something similar, and found a sports medicine doctor locally who cured her problems. He also said he would call around and see if his colleagues have any insights.
I was given 2 things on my follow of visit which dramatically improved my condition:
I was given the name of a Chiropractor/Sports Medicine doctor in West Phoenix.
I was taught the pencil trick.
The Pencil Trick
Now the idea shared in the next few sentences will sound like one of the dumbest things that you have ever heard. In fact, I told my dentist that it was the dumbest thing that i have ever heard, but I was desperate and would try anything. My worst pain is when my jaws are idle. They will not find a resting position for whatever reason, and because of this they are always spasming and working against each other to find their equilibrium. So my dentist said we are going to give them something to rest on: a #2 Pencil. Quite simply, open your mouth a 1/3 of the way, and push the pencil back as far as you can so it notches between your teeth and let your bite rest on the pencil. If you have to bite down to keep the pencil in place, it probably needs to be further back. So once in correctly, your top and bottom teeth will be touching the pencil, but you aren’t using any energy to bite down on it.. rather your jaws are resting on it and keeping it in place.