Just five and technical complex questions for the SPECIALISTS OF TMJ / TMD

I am a scientist in chemistry and biochemistry working in health sector

Hi
Just five and technical complex questions for the SPECIALISTS OF TMJ / TMD ! Please Help ! Writing from France and suffering from TMJ / TMD (dental malocclusion) – beside postural syndrome decompensation from three years now (very very tired) with vision troubles (I mean vertical heterophory of 2 diopters deviance : which corresponds to vertical strabism due probably paresya of nerve IV (trochlear) on the right side – with slight vestibular disorders also on the inner ear (idem : right side)
My questions are as follow :
1°) Generally paresya of trochlear nerve IV is congenital or could match with acquired syndrome due to mild traumatic brain injury (MTBI) or microvascular problems…
a) Do you think dental disorders (occlusion problems) could be another explanation ???
b) Physiologic links ??
2°) Concerning dental occlusodontic approach more specifically :
It seems that today there is no concensus locally in France concerning the reference of occlusal position (which needs to be searched and determined in the case of algic and/or non algic TMJ / TMD syndrome). From what I have understood, a part of specialists recommends to look for a position defined as centric relation (optimal comfort position with only two dental contacts) ; On the opposit, the others specialists seem to say that maximal intercuspidal position is good and need to be obtained with a maxium of dental contacts even if temporomandiular muscles are stimulated…
a) Therfore I would like to know what is your position exactly ??? with regard to this second point above, the main objective of course being to reequlibrate patient who has lost dental occlusion reference..
3°) My third question is related directly to the radioimagery approach concerning monitoring treatment of TMD and the evolution of TMJ repositioning program and / or occlusal treatment :
a) Do you Think that (in the case of non patholgic TMJ : with no irreverssible subluxation / meniscus and cartilage in good condition) the CBCT is a pertinent and a good technology to track the movement of the condyles in the mandibular fossa ??? is it a reliable and accurate ???
b) what do you think about of tomography with 3D reconstruction compared to the cone beam ??? (except the dose of Xray for the patient of course !), since tomgraphy 3D allows moreover a visualisazion of cervico-occipital area (C0 / C1 / C2 area : with potential sulbuxations if their exist) since this area is related to TMJ via hyoïd bone and also induces muscle disturbances and tensions.
c) what about axiogaphy to evaluate kinetic of TMJ and its repositionning ???
d) From a general point of view, what do you recommend and how do you mesure over time evolution of TMJ and occlusal treatment, and all aspects related to mandibular kinetic and the opening / closing occlusion ???
4°) My next question concerns evaluation approaches of the laterodeviation of TMJ, but also evaluation of the plane surface of occlusion ???
a) How do you assess these aspects ??? How can we be sure that we have a plane surface without inclination from one side to the other ???
b) What is your opinion concerning laxity of one side of TMJs vs the other side (not the same horizontal deflection stroke to the right and left), with one of the heads of the condyles which appears to apply laterally a greater pressure on the ear flap compared to the other ???
I specify that this hypermobility of one of the heads of the condyles (on the right side) is affected by successive movements of opening and closing the mouth while on the other side everything seems to be normal with a condylar head that does not move
Please note also that pains in the neck and cervical is located on the same side than this where the condyle is hypermobile
c) What do you think / What should be done in terms of therapeutic tretament ???
5°) My last issue concerns neuromuscular pains in all parts of the body, with what I could qualify as fybromyalgic points….
a) – Do you think TMJ / TMDs and bad occlusion are a cause or a consequence of fybromyalgy ???
b) – How can we explain this from a neuro-physilogical and biochemical point of view ???
P.S : I am a scientist / PhD in chemistry and biochemistry working in health sector
Thanks for your answers and for your help in advance / BR

Discussion

Melissa Alberts
You just discribe my whole case….. Woder what will be said. I’m so Following

Greg Ladd
TRY ASKING YOUR HEART AND BYPASS THE HEAD

Amelie Giraud
super helpful……

Simbad Lexou
What do you mean Amelie Giraud ?

Amelie Giraud
i mean that this does not answer at all to yours question

Simbad Lexou
You mean the content of my post above or the related comments below coming from.the other persons ?

Amelie Giraud
the coment to which i have responded.

Simbad Lexou
I think so / let us see if we will receive pertinent comments and technical and scientific response

Keren Purchase
have you seen a dentist, and asked them?

Simbad Lexou
Yes of course i have ! Treatment is in progress but i just want to have other opinions from specialists of TMDs since this pathology is very complex with plenty of colateral effects ! For instance does it exists a link with vision… ? especially paresy of nerve IV / i.dont know but it seems that scientific papers if straboloby bring up to.light vision disorders related to TDms / therefore i just want to get some explanations for other specialits…. on the other hand i.try to.understand more from a physiologic and neurollogical point of view / all dentists are not specialists in europe

Thelma Louise Davis
I think patients come to understand the relationship of tmj to all their symptoms more so than most specialists.

Simbad Lexou
Clearly

Katrina Sibulo
First time i heard someone say about condylar head not moving. Mine is also not moving on left side. I cant feel the ball like movement everytime i open my mouth. What could be the reason?

Katrina Sibulo
Finally i heard someone with same case. Also my left tmj seems a bit deep or deviated to right.

Simbad Lexou
Hi my other condyle move but it is not hypermobile compared to.the other

Katrina Sibulo
Same with me. My right condyle head move. Actually, I could feel both them before. My tmj started after ortho treatment last august 2015. But after a painful spasm on my left side, I suddenly noticed that my left tmj no longer move.

Katrina Sibulo
Ent suspect tmj subluxation but 3d facial ct scan results normal. I dont understand why it suddenly stop moving or felt push deeper inside.

Simbad Lexou
Exactly the same / it could be a laterodevation of tmd ?

Katrina Sibulo
Possible. But what matters to me is if it will ever come back to normal. Right now im on my phase 1 treatment using splint/appliance. Most of my symptoms have improved. But Im still worried if my mouth opening will get better plus my neck, shoulder and back pains are still persistent. Anyway, my treatment just started a month ago. Long way to go.

Simbad Lexou
That is what i.want to say / sorry.my english is not very perfect

Саша П. Јанковић
Simbad Lexou I’m sorry to hear you have such complex problems. Some of my patients also do, some have TMD and neck spine problems combined, others have TMD coinciding with neurological problems. It’s important to emphasise: TMD and neurological problems can coincide in time of occurrence, can indeed worsen each others, and treating TMD without addressing neuro will not help much, and vice versa. But, have in mind that TMD is NOT a cause of neurological problems, and, vice versa, neuro is NOT a cause of TMD, so each one of those shoud (must!) be treated by its own respective expert. Feedback and cooperation is also important: if you visit someone for TMJ treatment, your neurologist has to know about it, and your TMJ-doctor has to know if you are visiting a neurologist, and you should inform both of them about the other’s opinions, diagnosis, treatment, progress or regress, what helped or not… As for the fibromyalgia – it is one of the conditions mentioned in TMD textbooks, but it is not caused by bad bite.

Simbad Lexou
I can understand what you say since i am also in contact with neurologue / but what i am.looking for is concrete and medical explanations regarding tmj disorders / vision troubles and postural syndrome / of course it is probably not neurologic desease but noniceptive signals and osteo mechanisms disorders are of sure involved

Саша П. Јанковић
Unfortunately, TMJ disorders appear to have no concrete and medical explanation in manner that you (or anyone) would easily accept. That’s, partly, because the nature of those problems is complex (and complicated) and not fully understood yet, and partly because there appear to be several different “schools” of opinion – take those 10 professors, put them in one room, and soon they would be “talking” with their fists 😉

Nathalie Nat
any debate can be done quietly to the extent it is exchanging knowledge and do not want to stand firm on its positions…….

Саша П. Јанковић
Nathalie Nat Yes, but some are not very comfortable with their opinions and positions being questioned. When you preach something for decades, and you have built your career upon it… My perspective is different: I like to learn and I want to learn. In my 40 now, I wish to have more energy and more wisdom, and also to be happy to learn something new, even if it means I have to change my opinions and firm beliefs. If I can learn, if I can change, doesn’t it mean that I am growing? If I can grow, then I am young?

Саша П. Јанковић
Eva Willer-andersen A good illustration. First, the close proximity of neural structures to the TMJ doesn’t mean everything can be explained on neurological basis. But, some patients really have that kind of problem, and we still have no real explanation. And we have to learn yet…