Tmj osteoarthritis and facial neuropathy

I was diagnosed a few years ago with moderate osteoarthritis in my temperomandibular joints after my discs were displaced during a dental procedure. At first, I just had pain in the lower back teeth on one side, and clicking of my jaw joints. My jaw would shift to one side when I opened it. I thought I would try the most conservative option possible, since my oral surgeon suggested injections and I did not wish to try that first. I went to a clinic where I was given an upper mouthguard and a lower one I already had was adjusted. For the first several months, I was remarkably better. Then, after a mouthguard adjustment, I ended up with tremendous pain and a multitude of other facial symptoms, including nerve pain. I have tried hyalgan injections to the jaw and then steroid injections as well as many other nonsteroidals (leaving me with GER and a lot of stomach pain).Since the steroid injections, the jaw pain is much better but I am left with nerve pain, facial swelling and muscle spasms in my face. I am going to a teaching hospital setting next for assessment. My oral surgeon suspected that my tmj disc is now pressing against a facial nerve. I have had some shock-like pains in my jaw in the past but mostly have the ongoing burning pain, sometimes in a line down the left side of my face. It also hurts to touch my teeth together and I have to leave my mouth slightly open to avoid this. I would be interested to hear from anyone with a similar situation, where tmj disc displacement may have resulted in facial neuropathy and whether any treatment has been successful for you. Thank you.

hi melody,

I'm sorry that after all this time you've not had a response and I hope that someone knowledgeable can help to answer your question.

Your description sounds very similar to the pain I experience, and its onset was some time after a TMJ problem started.

Teeth touching sometimes triggers also for me so there are a lot of similarities hopefully someone will be able to help us both.

Wishing you many many low pain days.

Lukey.

Hi Lukey,

Thanks for your response. It is so nice of you to take the time to comment! I will tell you what I've done since I posted that. First, I went to see another oral surgeon who contradicted the first oral surgeon's recommendation by suggesting I try another mouthguard. The first oral surgeon, whose opinion I respect, thought this was not at all good idea since, if, in fact, the TMJ disc is pressing against a facial nerve, using another mouthguard blindly might again worsen symptoms. That surgeon also suggested that I could just "leave my mouth open" if it hurt to touch my teeth together. I expected something a little more helpful than that idea, I must admit. I also went to a dentist at a major teaching hospital who heads a facial pain program, and he suggested the NTI mouthguard, and they gave me stretching exercises to do. When I looked up the NTI mouthguard, I found that some people develop an open bite from using this for a few months. Since I already have facial changes (swollen areas due to the muscle spasms), I did not want to take this risk. But I did do the stretching exercises, and the pain is better. Now, it's hard to know if it is solely due to the exercises, but I do not get as intense a pain when I touch my teeth together now. I wonder if muscle spasms might have resulted in further irritation to the nerve, and while they continue, they are not as constant as last year. I do eat a lot of soft food and baby my jaw. I am switching dentists so I can have a more modern cleaning with an irrigation tool rather than old-fashioned scraping (too hard on my jaw). I do massage the facial muscles which spasm and that seems to help a little. I am reluctant to get botox for the muscle spasms, since I know many people have not had success with this. I am planning two more appointments, one with an oral surgeon who specializes in TMJ and facial pain. I would like to see if some kind of imaging would reveal what actually is going on to cause the nerve pain. You probably need at least an x-ray or an MRI if you could get an oral surgeon to order one for you. I read somewhere that a thin-slice MRI will actually show the trigeminal nerve, so that is something to consider. I had a regular MRI before I tried the mouthguards but have not had any imaging test since then, and now I would like to ask for further testing to accurately diagnose what's going on now. After the mouthguard adjustment which had caused all the pain, I woke up one night in the middle of the night and heard a noise in my left jaw area and felt tremendous pain. For a few months, I had synkinesis (if I laid down at night and turned my head to the right, my eyes would close very hard ) and had tremendous difficulty with nausea and ear symptoms. So I would assume something moved there (maybe the TMJ disc) which subsequently caused all my problems. I am also thinking of seeing a neurologist who specializes in facial disorders. You might try looking at the facebook pages of TMJ Hope and the TMJ association for more info on TMJ as well. The TMJ association will also hook you up with a support person to e-mail with if that is of interest to you. Good luck to you. Last year was very bad for me (I cried a lot because of all the pain), but this year I have tried to wean myself off of pain meds with some success. I still have pain, but it is not as disabling as last year. I also wish you many low pain days. I don't think a lot of people understand what we are going through. I've been told by people that this means "I probably can't eat raw carrots" or they just don't know what to say. If I could do anything over, it would have been to push people harder and ask more questions before I embarked on anything like mouthguards. I know they help a lot of people, but they were the beginning of a nightmare for me. I wish you the best. Getting support is crucial, so please keep reaching out to others for this. Take care.

melody