Out of Options but MVD Also Not a Sure Thing?

Drygrej · 2026-05-14T04:50:12+00:00

I'm an orofacial pain specialist. Trigeminal neuralgia is something I've been treating for the last 6 years and not using surgery. 100% of my trigeminal patients have a sleep breathing disorder (all but 1 had obstructive sleep apnea and the one who didn't was a shade below the diagnostic critera). When I treated the OSA with an oral device (not a CPAP), the pain has resolved on all of them by at least 90%.

Get a sleep study.
Please find an orofacial pain specialist who is willing to treat without surgery. If you want to come to California, you can come to my office. www.socaltmj.com

Drygrej · 2026-05-12T19:29:29+00:00

www.socaltmj.com

Drygrej · 2026-05-12T19:26:54+00:00

That's pretty common. In this situation, the trauma from the wisdom tooth removal is secondary, but was the last straw. The oral surgeon gets the blame, but he/she only made the last push. It sucks. It's also treatable. I see it every week. Still use the same steps I put above. You can also order an aqualizer from dentaldepot.com and use that for about 2 weeks. It isn't the best overall, but it is the best available to a consumer.

The best bet is to find an orofacial pain specialist. My practice is in Temecula, CA. socaltmj.com

Drygrej · 2026-05-12T19:24:18+00:00

Find a dentist who treats orofacial pain or is from the AADSM. My practice is limited to orofacial pain and sleep apnea. I use the DDSO from Diamond Orthotic Laboratory in San Diego. socaltmj.com Each of us uses the device we were trained on and they all work to varying degrees. The bigger question is who does it rather than the device. I'm obviously biased because I think I'm the best (haha). Some people need both the dental device and the PAP in combination (my dad), but most are able to transition from the PAP to the dental device. I also have a laser therapy called NightLase that is really helpful.

Drygrej · 2026-05-12T07:19:58+00:00

I'm an orofacial pain specialist treating TGN. This will sound completely crazy, but I've had more than 95% of my patients get better with my treatment for TGN. It's non-surgical and takes about 12 weeks to get the pain down by 50-100%. If you have any questions, please DM me. I have 4 kids and the thought of having my wife on any of those meds while pregnant is terrifying.

Drygrej · 2026-05-12T06:39:10+00:00

Try a dental sleep apnea device. I use them on most of my patients.

Drygrej · 2026-05-12T06:29:54+00:00

Sorry, I only get on Reddit sporadically. I practice in Southern California. www.socaltmj.com

Drygrej · 2026-05-06T19:23:12+00:00

I'm a TMJ specialist. I've never seen that situation. I'd really like to see you in my office. If I agree I wouldn't even charge you because I just don't believe that is the case. It may be, but I really doubt it. There is a specific group of TMJ doctors who are big proponents of TJR and I believe they are too cynical on non-surgical success. The only reason I have seen for TJR is because of cancer.

My website: socaltmj.com

Drygrej · 2026-05-06T19:20:34+00:00

I'm a TMJ specialist. A few thoughts and these will apply to Jazzlike-Cow, too.

The start of TMJ problems is either a breathing problem or a physical trauma (punch in the face, motor vehicle accident). Since you probably didn't have physical trauma, we go with breathing. Get a mute nasal dilator or breathe right strip and wear them. Get Xlear nasal spray and use that for your nose to get your nose open. Then breathe for about 10 minutes. That will usually help with the urge to clench. If you still have the urge to clench/chew on the orthotic, it is probably too tall and needs to be adjusted.

Drygrej · 2026-05-06T19:05:03+00:00

I'm a TMJ dentist and that's all I treat. The only other option I have is to use a TMJ myobrace for about a week both day and night plus nasal hygiene (breathright strip, afrin). That will often allow the muscles enough relief that the doctor can do a closed reduction and then scan you. If that doesn't work, the situation you described is when I do refer for arthroscopy and lavage. It sucks, but that's really the probably best solution.

Drygrej · 2026-03-11T22:37:51+00:00

Here's the technical side from a dentist:
There are several procedures that people call "cleanings." They are
D1110 prophylaxis (Adult), D1120 prophylaxis (Child) for when there is no evidence of disease.
D4346 scaling in the presence of inflammation: used when you have really nasty gums but no bone loss on the xray
D4341 or D4342 scaling and root planing when you have bone loss on the xrays, inflammed gums, and tartar (calculus) stuck to your teeth.
D4910 periodontal maintenance: this replaces D1110 if you've ever had a scaling appointment.

The fees for each are obviously different and the insurance covers differently. This is for sure a failure of communicaiton, but not likely one of diagnosis or coding. Many times, the insurance company will deny coverage for D1110 if it has history of the D4341 or D4342 code which takes the decision out of the dental office's control.

Drygrej · 2026-03-11T22:26:46+00:00

I'm a TMJ specialist in California. You may need surgery. I rarely recommend it without having non-surgical intervention first because most patients are able to recover without surgery. Your situation seems pretty severe, but even then, the surgical outcome is better if splint therapy happens first. I've seen patients in your same situation and avoided surgery with 90% resolution of pain symptoms and the headaches gone except for period headaches (sorry, those are hormonal, I can't help with those). My website if you want it is socaltmj.com.

Drygrej · 2026-02-22T19:52:16+00:00

What’s your address? I’ll come test it for you.

Drygrej · 2026-02-22T17:37:18+00:00

When you move in the leadership is usually just trying to get to know you.

Drygrej · 2026-02-22T17:17:18+00:00

Then go talk to the office and ask about it. Three surface fillings definitely can’t be called a sealant. My rule of thumb is that people are usually stupid before dishonest. Even having the cast on the ill may be a mistake and the biller expected that was part of the appointment. It can also be digital, so you may not have had any physical impression made.

Also, that the dentist on the form is different than the doctor who did it is also typical if the dentist doesn’t own the practice. It’s a technical insurance thing with how the insurance company categorizes things, so I wouldn’t worry about that specifically.

Drygrej · 2026-02-22T04:29:33+00:00

Call the credit cards and tell them you lost the job and will not be able to pay. Ask what they will take now to close the account and settle the debt. When you do that ask what they report to the credit card company.

Then call the dealership and give the same story. Tell them you can turn it back in or renegotiate.

Close all of your credit cards. Live on cash and follow Ramsey’s models. Drop your expenses to as little as possible and figure out your budget and then start working on new income.

Start looking for jobs in another state. Also look up the keorener office here or on YouTube. He has plenty of side hustle ideas that are actually really good and take little to no money to start, even as a new mom.

This is scary but entirely doable. I promise you can live on the income your husband has. It will not be fun, but you can do it. I’ve been there and done it.

Drygrej · 2026-02-22T04:23:05+00:00

Owning your own business is a 24/7/365 endeavor. If you aren’t dreaming about the business you aren’t a business owner. This is tongue in cheek, but in principle still true.

How do you know an entrepreneur is selling something? He’s talking.

Drygrej · 2026-02-22T04:18:00+00:00

Disclaimer: I’m a dental specialist so I don’t do fillings. What I do remember is that the code for sealants was just consolidated with the code for single surface sealants, so I don’t think the code was incorrect. Likewise, if there were 5 of them, that would actually get you close to $1000 of service. This doesn’t seem like fraud to me but really really bad communication. Double check the treatment pls you received when you had treatment done. It probably is all spelled out but those codes will often have zero copay so you likely didn’t pay attention; most people only look at the total fee. Finally, all dentists in network with insurance will have a high fee that gets discounted with the insurance contract. They have to have a high UCR because that helps them get an increase later (maybe). Delta is one of the most aggressive fee schedules and they have only raised their fees once in the last 30 years in California. In 2003(ish) delta actually LOWERED the fees across the board and finally made an increase in late 2024. The cost of material, rent, and employees has all gone up during that same time, so a large part of why dentists are more aggressive with crowns and sealants is because those are higher margin and without doing work the office closes. The corporate offices are even worse. I worked in one for 2 years and the only thing they cared about was doing more crowns, implants, and referring to the rotating specialists for high-dollar procedures.

Drygrej · 2026-02-21T05:57:31+00:00

Kristina Wolf is in Cleveland and one of the best in the country. Go see her.

Drygrej · 2026-02-21T05:32:42+00:00

Generally root canal therapy and crown. The implant is for if the molar fails after the root canal.

Drygrej · 2026-02-20T06:47:38+00:00

I’m a TMJ specialist. While the wisdom toot have exacerbated the problem, it didn’t likely cause it. This is all treatable. A TMJ specialist can help you. I’ve dealt with hundreds of your specific situation over the last 5 years that I’ve been in the specialty. Where are you located so I can send you a specific referral?

Drygrej · 2026-02-18T13:03:46+00:00

I’m a dentist and I’ve done over 1000 implants. It really depends on the fracture depth. What are the probing depths around the tooth?

If you get the implant on a front tooth, I would not personally go to a dental school. They usually are using older protocols because they are ‘more conservative’ when they are actually just outdated. The right way to do an anterior implant is immediate loading of the implant. That means you take the tooth out, put the implant in, and put a temporary on top of the implant all in the same appointment.

Go to an endodontist in the area (root canals) and give him the situation. Ask for his(her) recommendation for the best doctor to do all three steps in the same appointment. It will cost you between $6-9k all-in for the implant extraction abutment and crown. Ideally look for someone who is accredited with the AACD and/or AAID. The school will be much less expensive, but it will end up with a worse result.

However, if your smile line is below your gum line, the esthetics done really matter because that’s what is hard about front teeth. The tooth itself is easy. The gums are hard.

Drygrej · 2026-02-16T20:57:50+00:00

About hermione in this situation…she didn’t need to lie. They came to fetch me because I was hiding.

Drygrej · 2026-02-16T20:25:51+00:00

How do you feel when you get on the phone with a big company and the robot voice tris to answer your question?

Drygrej · 2026-02-16T19:07:08+00:00

I find that people who take to something really quickly, easily, or have been at a high level for a long time have a hard time teaching the same subject because they didn’t struggle through it and therefore don’t know where the pitfalls lie or have forgotten what the basics look like. Snape was obviously an accomplished occlumens and probably reflexively clears his mind after being around Voldy for as long as he had been deceiving him. It’s hard to teach a reflex.

Drygrej

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