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complete upper reconstruction?

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I recently began TMJ treatment with a NM dentist. Phase 1 of treatment was a $6,0000 fixed appliance. Dr. wants to move on to Phase 2, which is a complete upper reconstruction for a total of $23,000 which intial treatment will be approx. 4 to 5 hr. I am still experiencing facial pain and nightly headaches/clenching which leads me to believe that Phase 1 is not working even if the bite analysis shows it is. Here are my questions:
1) I'm certain i would have never started this had I been told it would cost up to $30,000. Is this ethical?
2) How can it be advantageous for a TMJ patient to have their jaws pryed open for up to 5 hrs?
3) Is it possible that additional dental treatments cannot stop some ppl from clenching or even make them worse.
4) Where to do i go from here?

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replied January 25th, 2011
TMJ Answer A18909
Hello, and thanks for your medical question on E Health Forum.

Based on the history provided it is not clear what exact treatment modality and device has been advised for your specific TMJ problem. Additional history and data would help to clear your doubts.

TMJ Disorder is a multi-factorial condition, meaning that is a result of both physical (biologic) and psychological (emotional) factors, in various combinations. The constellation of symptoms associated with TMJ disorder can be complex and difficult to properly diagnose.

There are many TMJ treatments. They may yield no change, improvement, or may worsen the condition. Without evidence based research it is up to you, the consumer, to decide on the course of treatment.

Your particular TMD treatment though not clearly mentioned should be determined through consultation with a dental professional highly experienced in temporomandibular joint problems.It is important that you follow your dentist's instructions. You should also keep up with routine dental visits so your dentist can regularly monitor your TMJ symptoms.

Though it is usually difficult, various treatment procedure for TMJ involve prolonged hours of oral interventions.

There are no standardized costs for TMJ treatments. The expected costs and steps involved if discussed earlier, would have clearly given you a basic idea.

Best Treatment for TMJ May Be Nothing. Some conservative measures that can help your symptoms include: -

Resting the jaw is the most important therapy. Stop harmful chewing and biting habits, avoid opening your mouth wide while yawning or laughing (holding a fist under the chin helps), and temporarily eat only soft foods like yogurt, soup, fish, cottage cheese and well-cooked, mashed or pureed vegetables and fruit. It also helps to apply heat to the side of the face and to take a nonsteroidal anti-inflammatory medication, for up to two weeks.

Other self-care measures include not leaning on or sleeping on the jaw and not playing wind, brass or string instruments that stress, strain or thrust back the jaw.

Physical therapy to retrain positioning of the spine, head, jaw and tongue can be helpful, as can heat treatments with ultrasound and short-wave diathermy.

Low-dose antidepressants taken at bedtime, or antianxiety medication will also help. Stress management and relaxation techniques like massage, yoga, biofeedback, cognitive therapy and counseling to achieve a less frenetic work pace are also helpful.

If you clench or grind your teeth, you can be fitted with a mouth guard that is inserted like a retainer or removable denture, especially at night, to prevent this joint-damaging behavior.

Maintain caution against embarking on “any expensive, irreversible treatment” before a thorough diagnosis is completed and simple, reversible therapies have been tried and found wanting.

Surgery is a treatment of last resort primarily in patients with jaw malformations, arthritis (which needs condyle reshaping), where medical management has proved ineffective.

I hope this helps.

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