[watsonsh]

Hey Byranna,

The joint (right side where the bone graft is) is still pretty painful. Actually both jounts are. Have not been able to move forward with any of the iplants and its close to ta year. They say its inflammation, not TN and that they might try flushing the joint.

What does that involve.

[Bryanna]

Hi Shelley,

The procedure of flushing the joint is called Arthrocentesis. I found a quick blurb on it from the mayo clinic site which gives a description and picture of the actual procedure. You have to enlarge the picture to see it. Here is the site: http://www.mayoclinic.org/tmj/treatment.html

Although this article states "minimally invasive", it is not to be thought of as a minor procedure. When comparing it to Arthroplasty (tmj surgery) it is minimal. But the pros and cons of the procedure should be discussed thoroughly before consenting to having it done.

Some questions to ask the dentist:

1)How many arthrocentesis have you performed?
2)How many of those were successful....to what degree and for how long?
3)How many of those patients went on to have tmj surgery?
4)How many of those surgery patients had successful results, to what degree and for how long?
5)Can arthrocentesis be done more than once? If so, how many times?
6)Does arthrocentesis cause any damage to any part of the joint, ligament, etc? What if it's done multiple times?
7)How long before I would notice a positive result?
8)Can this procedure worsen my tmj condition?
9)What solution do you use to inject into the joint to flush it out?
11)Do you also inject steroids into the joint?
12)If yes to steroids, what are the possible short and long term side effects... both positive and negative from using the steroids?
13)What anesthesia is used for sedation purposes....and why?

Shelley, are they positive of the diagnosis?

Bryanna

Originally Posted by Shelley

Hey Byranna,

The joint (right side where the bone graft is) is still pretty painful. Actually both jounts are. Have not been able to move forward with any of the iplants and its close to ta year. They say its inflammation, not TN and that they might try flushing the joint.

What does that involve.

[watsonsh]

Hi Byranna,

And thanks for the information.

So here is the latest. Its Friday and I was supposed to have the next step of the implants done today. I need to get it done before the end of the month because I am changing jobs and I will lose the FSA I have set aside for this.

So on Wednesday I went to my regular dentist for a new flipper with two teeth instead of three so see if it would put less pressure on my jaw and I could wear it. Well I got there and they had also scheduled a whole new set of xrays for me since it had been a year and half (have not gone becasue of all the pain) and a dental cleaning. I really did nto want the xrays because I did nto think I needed to spend the money and the oral surgeon had just done a CT scan a month and a half ago. But they insisted for sake of checking for cavities. So I did it. They stretched my jaw a bit and I was like ugh this was probably a bad idea. Then I warned the dental hygenist that I have really bad TMJ issues and I am a chronic pain patient with a RSD now in my left shoulder. Well sure enough the cleaning falired me. She used some ultasonic wand maching that helped get deposits off and I could tell the vibrations might cause pain. Sure enough later that night my jaw was painful and inflamed and my right side face on the side of the bone graft was slight swollen. The right side was throbbing like I could hear my heartbeat in my year and had this buzzing vibrating feeling in my face and behind my right eye. And the pressure from the night guard on my lower teeth back near the right side joint was painful. All this was on Wenesday and the oral surgery was supposed to be today Friday. I knew I probably should not have done the cleaning and was mad because i really just wanted to come in for the new flipper.

So yesterday I called the oral surgeon and the dental pain specialist I have been seeing. The Dental pain guy said to put ice on the joint and some anti inflammatories. The oral usrgeon told me the same thing.

So today I go to the oral surgon and I am pretty flared up. Right side is better but the left side jaw joint is really bad and its on the same side as my bad shoulder so it just makes things worse when that shoulder spasm's up and pulls on that left side.

So anyway went to the oral surgeon today and he could see I was in pain and he felt the jaw alot and tested it. Said he did not want to do the impants today based on the pain and how inflamed everything was. He could see that my jaw was just jammed back in my head.

Instead he suggested the arthrocentisis that the dental pain specialist recommended. So he put me under and did both saides of the jaw. While it hurts and is sore from the injection I can tell my jaw is much more forward and not as receded. He is also sending me for TMJ PT.

So we have put off the oral surgery until next week friday and hopefully the jaw will be better.

So thats the update.

Any thoughts or suggestions on the arthrocentisis or the implants?

Thanks Byranna!

Shelley

Originally Posted by Bryanna

Hi Shelley,

The procedure of flushing the joint is called Arthrocentesis. I found a quick blurb on it from the mayo clinic site which gives a description and picture of the actual procedure. You have to enlarge the picture to see it. Here is the site: http://www.mayoclinic.org/tmj/treatment.html

Although this article states "minimally invasive", it is not to be thought of as a minor procedure. When comparing it to Arthroplasty (tmj surgery) it is minimal. But the pros and cons of the procedure should be discussed thoroughly before consenting to having it done.

Some questions to ask the dentist:

1)How many arthrocentesis have you performed?
2)How many of those were successful....to what degree and for how long?
3)How many of those patients went on to have tmj surgery?
4)How many of those surgery patients had successful results, to what degree and for how long?
5)Can arthrocentesis be done more than once? If so, how many times?
6)Does arthrocentesis cause any damage to any part of the joint, ligament, etc? What if it's done multiple times?
7)How long before I would notice a positive result?
8)Can this procedure worsen my tmj condition?
9)What solution do you use to inject into the joint to flush it out?
11)Do you also inject steroids into the joint?
12)If yes to steroids, what are the possible short and long term side effects... both positive and negative from using the steroids?
13)What anesthesia is used for sedation purposes....and why?

Shelley, are they positive of the diagnosis?

Bryanna

[Bryanna]

Hey Shelley,

Wow.... it just never ends for you!
The dental cleaning was done to eliminate calculus and other bacteria from your teeth before the implant surgery. This is usually routine in a case such as yours. However, it sounds like the cleaning was not done as gently as it could have been. The ultrasonic used to remove hard deposits can be quite irritating if not used gently. I'm so sorry they did this to you!!!! :-(

They did an entire set of new xrays (about 18-20) or just 4 bitewings to detect cavities? If they did a full set, that is because they are concerned about the health of your jawbone in certain areas and these xrays give a close up look at those areas.

So he did the arthrocentesis...... did he inject steroids into the joint? How are you feeling today?

I know you are losing your FSA funds as of the end of the month. If you are not ready to do the implants next week...... perhaps your oral surgeon could "pre date" the paperwork irrelevant of when you actually have the implants done? This is not something I generally would suggest but you have everything in place to proceed with the implants and it would be a real shame if you could not utilize that money after all of this!

My heart goes out to you Shell....... I know this has been a real trip!!!

Keep me posted....

Bryanna

Originally Posted by Shelley

Hi Byranna,

And thanks for the information.

So here is the latest. Its Friday and I was supposed to have the next step of the implants done today. I need to get it done before the end of the month because I am changing jobs and I will lose the FSA I have set aside for this.

So on Wednesday I went to my regular dentist for a new flipper with two teeth instead of three so see if it would put less pressure on my jaw and I could wear it. Well I got there and they had also scheduled a whole new set of xrays for me since it had been a year and half (have not gone becasue of all the pain) and a dental cleaning. I really did nto want the xrays because I did nto think I needed to spend the money and the oral surgeon had just done a CT scan a month and a half ago. But they insisted for sake of checking for cavities. So I did it. They stretched my jaw a bit and I was like ugh this was probably a bad idea. Then I warned the dental hygenist that I have really bad TMJ issues and I am a chronic pain patient with a RSD now in my left shoulder. Well sure enough the cleaning falired me. She used some ultasonic wand maching that helped get deposits off and I could tell the vibrations might cause pain. Sure enough later that night my jaw was painful and inflamed and my right side face on the side of the bone graft was slight swollen. The right side was throbbing like I could hear my heartbeat in my year and had this buzzing vibrating feeling in my face and behind my right eye. And the pressure from the night guard on my lower teeth back near the right side joint was painful. All this was on Wenesday and the oral surgery was supposed to be today Friday. I knew I probably should not have done the cleaning and was mad because i really just wanted to come in for the new flipper.

So yesterday I called the oral surgeon and the dental pain specialist I have been seeing. The Dental pain guy said to put ice on the joint and some anti inflammatories. The oral usrgeon told me the same thing.

So today I go to the oral surgon and I am pretty flared up. Right side is better but the left side jaw joint is really bad and its on the same side as my bad shoulder so it just makes things worse when that shoulder spasm's up and pulls on that left side.

So anyway went to the oral surgeon today and he could see I was in pain and he felt the jaw alot and tested it. Said he did not want to do the impants today based on the pain and how inflamed everything was. He could see that my jaw was just jammed back in my head.

Instead he suggested the arthrocentisis that the dental pain specialist recommended. So he put me under and did both saides of the jaw. While it hurts and is sore from the injection I can tell my jaw is much more forward and not as receded. He is also sending me for TMJ PT.

So we have put off the oral surgery until next week friday and hopefully the jaw will be better.

So thats the update.

Any thoughts or suggestions on the arthrocentisis or the implants?

Thanks Byranna!

Shelley

[watsonsh]

Thanks Byranna,

Yeah this whole implant thing has been a nightmare. I did switch oral surgeons. I really like the new guy and he is a TMJ specialist as well.

Yeah the regular dentist explained the cleaning issue you also mentoined as inporant to have before surgery. And it was needed as I was over a year since a cleaning because of all the pain. Yeah the tech tried to be gentle, she understood the jaw issues and the RSD but the vibrations of that ultrasonic thing just spasm'd everything and flared it all up.

They only did a partial set of xrays to look for any decay. The jaw bone was fine as the CT from a month and a half ago showed. I just felt they were more abotu the money but just my gut. But hey good news was no decay and no new cavaities. I still have one tooth with a mercury filling and might have that taken out later in the year but not a priority.

So yeah the oral surgeon opted for the artrocentisis in both sides. No cortisone. I told him no cortison as I dont react well to it, it tends to crystallize for me and I have had enough cortisone this year for the shoulder. The clicking in the jaw was pretty bad and he could see my range of motion opening was bad (not locked though). I showed him the only way I could take pressure off was if I shoved my lower jaw forward and then it would take pressure off both sides, but especially the bone graft area.

He put me out for the arthrocentisis. I guess he injected anasthetic and flushed the joint. Both joints have been inflammed for so long.

It's sore and sore to open from the trauma of the shots but The fluid is kind of holding the lower jaw forward and the pressure is off. The top and bottom teeth actually line up now. So beyond the soreness I am glad right now that he did this. It feels like that inflammation is down as well.

He is sending me to TMJ PT and before this I had looked up exercises I could do as well. Hopefully it all helps and he wont have to do any arthroscopic surgery on the jaw joints. I hear that is not always successful.

So actually I think it was a good choice. Hoping it makes it better for the implant /abuttment surgery next week.

Good idea on the FSA. I will talk to them on Monday, I should be ok since its getting done on the 30th so thats the end of the month and I should still make it.

Thanks for your insight Byranna . Will let you know how it progresses.

Shelley

Originally Posted by Bryanna

Hey Shelley,

Wow.... it just never ends for you!
The dental cleaning was done to eliminate calculus and other bacteria from your teeth before the implant surgery. This is usually routine in a case such as yours. However, it sounds like the cleaning was not done as gently as it could have been. The ultrasonic used to remove hard deposits can be quite irritating if not used gently. I'm so sorry they did this to you!!!! :-(

They did an entire set of new xrays (about 18-20) or just 4 bitewings to detect cavities? If they did a full set, that is because they are concerned about the health of your jawbone in certain areas and these xrays give a close up look at those areas.

So he did the arthrocentesis...... did he inject steroids into the joint? How are you feeling today?

I know you are losing your FSA funds as of the end of the month. If you are not ready to do the implants next week...... perhaps your oral surgeon could "pre date" the paperwork irrelevant of when you actually have the implants done? This is not something I generally would suggest but you have everything in place to proceed with the implants and it would be a real shame if you could not utilize that money after all of this!

My heart goes out to you Shell....... I know this has been a real trip!!!

Keep me posted....

Bryanna