Dear Sir,
Thanks for your help.
I am seeing an oral and maxillofacial surgeon for it. My LR (Lower Right) wisdom tooth has been extracted, the teeth adjacent to it was given a root-canal and crown was put on it, and root canal and crown was done for another LR tooth which is 4th in number from the removed wisdom tooth. The surgeon has found problem with my bite and has sent me for a mouth guard to be made to another doctor.
The problem started 3 months back when I was infected by Oral herpes and tongue ulcers appeared on my tongue. I took anti-viral (Valacyclovir) and steroid (Prednisone dispersible, to prevent facial palsy as there was a slight twitching in my face and the doctor gave me the steroid as a precaution) for it. I, however kept on taking these medicines for a prolonged 1 month, which is longer than the usual 15 days, and although pain wasn't present then in my jaw, I could feel the "invisible pressure" on my upper jaw while lying down. This pressure went away in between for some weeks and has now returned. Is it possible that such strong medicines damaged my TM Joint and/or muscles, because I felt that they were quite harsh on my system and I even lost some hair during that while.
Also, for the initial 2 months, the problem was only in the right chewing muscle and not in the ear, but after I did some TMJ exercises of the jaw (isometric exercises, like pushing the jaw to left and right, from the internet), the pain in my ear and that went downwards from it, developed.
The medicine that I'm taking these days, which is Amitryptiline 10 mg twice day, has relieved the tension in my neck muscles which used to come along with the ear and jaw pain, but the ear and jaw pain remains. Last night I also noticed popping sound in my ear while talking. I don't hear the usual clicking when opening the jaw wide or closing it.
Sir, I'm quite scared to be honest, after looking at the horrible stories of chronic TMJ on the net, and seeing that my problem is also becoming chronic.
I'm also enclosing some "notes" that I made during these months, in my email, regarding the fine points of my problem. I'm enclosing them here. These are a bit long, but I request you to please read them as that might help us shed some light on the root cause of my problem:
1.) I want some device to fix at night between the teeth, to find out out if I'm actually grinding teeth or not.
2.) Could the pain be because I sleep with my jaw open, on my back and without tossing/turning to sides, for the entire night?
3.) I used to sleep on my right side for entire night, for 1 year, and didn't chew with it either. As a result, my right chewing muscles are thinner as compared to left jaw muscles. Also, now when I lie down at night, I feel that my jaw 'aligns/slides' more to the left side as com.pared to right side. Could the pain (which is mainly on my right side of jaw and which started after I sleeping on my back since 3 months ago) be because of this 'muscular atrophy' or 'change in muscles due to bad posture' or 'wrong alignment of the jaw due to sleeping posture'?
4.) The pain in jaw increases visibly when I am using my neck muscles and they are in spasm, like when I work on computer.
5.) Is there a Voveran injection that I can inject into neck muscles to relax them?
6.) Is there an 'Range of Motion test' (in which an orthopaedic doctor asks us to make certain physical movements of the neck, along with the usual jaw movements that the Dentist does to diagnose TMJ Disorder) to find out if my TMJ pain is neck-related. I read about it on this link:
http://www.round-earth.com/CervicalTests.html
7.) What should I do to build my right jaw muscle which has reduced in bulk compared to my left jaw muscle.
8.) My TMJ pain gets resolved completely when I take muscle relaxants like Flexon MR, or psychiatric medications: Clonazepam, Risperidone and Fluvoxamine, which were prescribed to me by Dr Rohit Garg (psychiatrist)
9.) A doctor (Dr Amit Setia in Sirifort Road) suggested that I get my remaining wisdom teeth extracted, get a steroid injection my TMJ to reduce any inflammation there, and get 'plate' (which are like braces) to re-align my teeth. Another doctor (Dr Gagan Sabharwal in Fortis) also suggested that I get Botox injection too in my jaw muscles, to reduce muscle spasm and pain from it. But won't the Botox cause my right jaw muscles which are already a little atrophied as compared to left jaw muscles, to atrophy even more?
10.) When I lie down and put my head to the bed a little fast and it collides with the bed, then I hear some 'small bone' in the left side of my head go 'tick-tick'
11.) Should I get a bone density-scan for TMJ to see if there's degenerative bone loss.
12.) When I lie down on my back, it sometimes starts feeling as if some invisible force/braces are pulling my upper teeth outwards. Also, while this is happening, if I take a deep breath or if I bring my upper and lower teeth together to touch each other, then the outward-pulling force on my upper teeth increases exponentially.
13.) I have a feeling that the problem in my right side of face is because I work ONLY with my right hand on the computer, like holding the mouse, typing, etc. I think that tenses up the muscles in my right hand and shoulder and increases the pain on the right side of my face. Also, I keep only my right elbow on the arm-rest of chair while doing so while my left elbow droops on left side without being supported by any arm rest.
14.) When I tap on my right TMJ, my forehead twitches A LOT. Is there a nerve in the area that is getting impinged.
15.) Could this be because of fibromyalgia (maybe after oral herpes) or connective tissue disorder? Also, this TMJ pain started occuring after I took high dosages of Valcyclovir (herpes anti-viral drug) and Wysolone for a month? During this time i noticed that some wrinkles appeared on my skin and I had a lot of hair-loss, so could it be that after high doses of these medicines, the connective tissue in my joint degenerated because the wrinkles and hair-loss also happened because of damage to the connective tissues/collagen in my body, be it in my skin, hair or TMJ?
16.) I used to sleep on my right side ONLY for the entire night for a whole year on a hard pillow, until it actually started paining on my right side of face. Could it be that sleeping on one side continuously damaged/changed the structure of my joint on that side, or that I've got fibromyalgia on my right shoulder and right jaw (whose muscles have atrophied due to sleeping on right side and not chewing from right side)? After that, I've started sleeping on my back for the entire night, and don't sleep on my sides (I tie my feet to to bed-post to avoid changed sides)
17.) Earlier, the problem was only in my chewing muscle of right side of jaw, but after I did some isometric exercises of the jaw, I started having pain in the joint, ear pain and pain that went down right from my ear (both left ear and right ear) to the cervical along the edge of my jaw touching the neck. Could it be that due to the exercises, my TMJoint has become a little inflamed and a little lavage and/or steroid injection in the joint will relieve the pain/inflammation?
Also, during the time I was doing the isometric jaw exercises, I stopped putting night-bite guard, because of which I think my muscular pain in the right jaw muscle went away.
18.) It feels that my right shoulder is at a different height than my left shoulder, and it feels that there is more tension in one of my shoulders than the other.
19.) When I smile wide such that my teeth show while smiling, my lips' right corner opens up noticably lesser than my left corner.
20.) I used to sometimes feel pain in chest at night in my heart area, and whenever I tried to take breath the pain increased more and more as I tried to inhale deeper. Yesterday, I filled my lungs with a deep breath despite the pain and suddenly I heard a 'pop' in my chest area, and suddenly the pain in my chest area vanished! So could it be heart related?
