Three months ago I moved to a new state to take a new job (one that I don’t particularly like as much as my old job). Not too long after I moved I noticed that the joints in my jaw started to feel tired and sore towards the end of the day. They didn’t really hurt, but I could tell something was different. I also found that I was sleeping worse than before. My first thought was that maybe the stress of the changes in my life was causing me to grind my teeth or clench my jaw during the night, and that I am in the early stages of developing a Temporomandibular joint (TMJ) disorder.
I know people with a TMJ disorder, and, although it’s not the end of the world, I’d rather stop the problem before it gets too far. I’ve been to see my physician, dentist, and an oral surgeon. All of them say that there’s nothing seriously wrong with my jaw yet, but that I’m a candidate for a TMJ disorder down the road. The dentist and oral surgeon recommended a splint to keep me from clenching my jaw. I have a few questions and/or need some advice:
- Both my dentist and oral surgeon told me that it would be better for me to come to them for the splint and follow-up exams. Does it matter at all if a dentist or oral surgeon works with me on this, or does it just depend on who the particular dentist or oral surgeon is?
- My dental HMO won’t pay for the splint, which my oral surgeon says costs around $900. Why does this thing cost so much?
- Why in the world would insurance not cover something like this?
- If the splint is just a piece of plastic designed to keep my teeth apart at night, are there cheaper, over the counter mouthpieces out there that would do the same thing?
- Am I overreacting and considering doing something that would be a waste of money? Or am I doing the right thing by trying to take care of this early?
If anyone out there is a dentist or a physician, or has been through something like this, and can offer any advice or answers to my questions, I’d really appreciate it. And I’m sorry if I haven’t provided enough specific information, just let me know what I’ve left out.
Also, I think there are some factual answers to some of these questions, only opinions to others. Mods, feel free to move this to the best place.
My dental insurance doesn’t pay for it either. My guess is because TMJ, like back pain, can be pretty hard to document. It may not show up on X-rays, and it’s hard to draw the line between it and normal jaw wiggling.
The difference between the splint and the thingy you can get at the drug store is that the splint is molded to your mouth and teeth. I’ve had both the over-the-counter and the custom-made versions, and I can tell you, the custom-made one is 100 times better. Of course, as you’ve discovered, it costs about 100 times as much. IANADentist, but you could probably invest $20 in the drug store alternative and see if it helps.
Whether the person who makes the split is a dentist or oral surgeon really doesn’t matter. Choose the one with the most experience in making dentures and bridges. That’s the one who knows how to take your impression, work with the materials and fit the finished product. That said, you’ll hopefully be seeing your dentist on a more regular basis and can get the follow-ups while you’re having your teeth cleaned.
I started grinding my teeth when I was laid off a couple of years ago, and I told my dentist I flat out could not afford the hundreds of dollars for a splint. He’s a nice guy, and he cut me a big break. If you can’t afford it, say so.
From my experience, medical insurance considers TMJ to be a dental problem, so it’s not covered. Dental insurance considers it to be a medical problem apparently as it’s not actually in the mouth so it’s not covered. Both my dental and medical insurance plans specifically deny coverage for TMJ.
And here I am, with one side of my lower jaw longer than the other, resulting in a half-tooth “crossbite” and fairly constant clunks out of the joints. Over the years, my teeth have been trimmed down here and there to alleviate high spots and “ramps” that try to move my jaw sideways or rock it - ie: high spot on the left makes contact, and the right side continues to move, causing the jaw to tilt slightly.
If I want to pursue any sort of treatment, it would be entirely out of pocket. I don’t as the only significant symptom is the clunking and occasionally, the jaw dislocates momentarily, generally causing me to take a big bite of cheek.
I’ve had TMJD for 6 years now and am on my second round of treatments. Everyone I know that has had treatment has had different forms of treatment. From splints to elaborate splints to minor surgery to several years of agonizing surgery.
No one I know has had medical to cover it. And that has always been a problem for long-term sufferers. I’ve put $8000 into it, myself.
I don’t think you’re over-reacting if you’re in pain. Yes it can get worse. It can also not get worse. For me, I was nearly bed-ridden with pain and couldn’t open my mouth. It can get that bad. This time, after a few years of relatively pain-free-ness, I decided to go back to the Dr. before it got bad enough.
I’m not sure if you want to go to an oral surgeon. This is just IMEO (educated…I’ve researched it alot) but surgeons get paid to do surgery and many times TMJ surgery ends up causing way more problems than it fixes. Temporary releif between surgeries. Here’s an article I wrote for a journalism class a few years ago that sort of sums up some other peoples’ experience with TMJ surgery.
I was lucky enough to find an orthodontist who did everything with just orthodontics and no surgery. He did a fabulous job. I had to go back for more simply because my body has changed alot since I saw him last.
This site used to be a really good TMJ resource with a good message board and links. Now it’s just kind of so-so with links. I wish there was more there so someone could help you find a good reputible doctor in your area.
If you’re interested in skipping the doctor experience, you might want to try some of Dr. Uppgaard’s approaches in his book. Generally relaxation techniques for the face. He’s in the camp of doctors that don’t agree with surgery.
You might also want to do Google searches and Google Groups searches for more info. There are just SO MANY options as to what to do with TMJD. Lots of people just go with what their doctor says and then regret it. Many dentists aren’t well-read on TMJ (as far as I’ve been told, it’s not covered in most dentistry schools) so it’s one of those areas where the patient has to help educate themselves and the doctor.
Ok that’s all. My jaw seriously hurts now. Just mention of TMJD sends it off to inflamation!
Good luck, I hope you get the treatment you need!
Thanks for your help. I did get the over the counter mouth piece. It helps, but I’m sure the custom-made one is a lot better. I’ll probably end up getting one, but now I know that it’ll help a lot, since the generic one helps so much. I also went to Dr. Uppgaard’s website, and have tried some of the relaxation techniques he has there. They’ve helped me sleep better, too. Thanks!
I’ve got TMJ on one side of my mouth from nerve damage I got from a car accident. Having the one side dislocate is a lot of fun, let me tell you.
That said, dental insurance seldom covers treatment for TMJ. Occasionally, health insurance will cover treatment, but the problem has to be so severe that it causes significant pain, inability to eat, frequent dislocations, and the like. All of these must be documented, and it’s still a problem getting it paid. In my case, my health insurance would cover some treatment because my TMJ resulted from trauma.
Now for the good news. While TMJ is not covered, bruxism (grinding) is, and treatments like mouthguards are also prescribed for that. Grinding is a frequent companion to TMJ, at least according to my former dentist, and a good dentist will look for signs of bruxism in TMJ patients. You might ask your dentist of you grind your teeth, and can he prescribe the mouthguard for that? Insurance will cover about half of a mouthguard, so you’re still looking at $450 or so. (NOTE: Do NOT ask your dentist to diagnose bruxism just so you can get something covered. If it’s not there, it’s not there, and reporting a non-existent diagnosis for the purpose of receiving payment is insurance fraud. Don’t get me started on insurance fraud.)
The reason the custom-made mouthguard is so expensive is because (duh) it’s custom-fitted. These things involve X-rays, molds, multiple fittings, and the appliance may need to be altered before it fits properly. Once it does, it’s wonderful and well worth the cost.
Robin