TMJ dislocating constantly after diving - jaw support?

[AndreaT94]

Hey guys, nice to meet you all! This is my first thread on this website, so I hope it follows the site rules (I've looked up TMJ on the forum, but the newest related post was from 2013, so maybe there is something new that's been developed since then?)

So basically, my right TMJ has been a bit dodgy for a long time. Usually, it doesn't bother me, but there are times when it suddenly starts "dislocating" a lot, pretty much every time I open my mouth even slightly more than what is necessary for speaking (e.g. while eating). The reason I put "dislocating" in quotation marks is that I'm not sure it's the right term - I feel and hear a crack, then the whole mandible shifts slightly to the left and down, which means my upper and lower teeth are not aligned and I can't close my mouth enough for them to be touching either. However, I can usually get it back right away, following another crack and a jump back to the original position. None of these horrific locked jaw problems I've read about where you have to go to hospital to get it back. Plus, none of this actually hurts, it's just uncomfortable.

I've just finished my OWD course and after my first dive within the course, my jaw shifted and got locked and it took me a while to get it back. And since then, it's been "dislocating" all the time (about 4 days now). During the next few dives, I tried just resting my jaw a little and not clenching the mouthpiece so tightly, but this resulted either in water getting into my mouth all the time or in the regulator literally floating out of my mouth. Holding it with my right arm helped, but it wasn't a comfortable solution. Eventually, I gave up and held it properly, but this worsened the problem again and also got a bit painful this time.

I've been wondering whether there are any DYI solutions for this problem - something like a jaw support suitable for diving. I've considered taping (never tried this and don't know if it's actually as useful as sportspeople claim it is) or getting one of these things. What do you think? Have you tried anything like this? Or should I just go with a custom mouthpiece?

Thanks a lot for reading this and for any suggestions!

Andrea

 

[annasea]

Fellow sufferer here, but not to the extent that you do. I went with a custom mouthpiece.

I never had the issue that my jaw was so loose that either water got in or the reg floated out... I would definitely play around with that while dry. If you haven't already done so, see where your lower jaw sits when your tongue is resting comfortably along the roof of your mouth while on land with no reg. This should ideally give you a sense of where your jaw should be and at this point, the reg shouldn't drift out or water get in when you're actually in the water with the reg in place.

What is your configuration? I'm wondering if there's something going on here that is causing the reg to not sit properly unless you're clenching.

Keep up posted...

 

[AndreaT94]

Hello Anna!

Thanks for your reply! Well, I can prevent that from happening (I mean the reg floating out or water getting in) but that just results in worsening the condition later. What mouthpiece do you have? Is it the one you mould yourself?

As for my configuration - during my course, I was using recreational gear - BCD, reg, etc., nothing special. I'd like to move to doubles and use a backplate, but that's not gonna happen for some time at least. The regulators we were using were Apex ones, seemed pretty standard, incl. the mouthpiece.

I wonder whether the problem might be that the regulator hose comes in from the right side, which I guess puts more stress on the right side of my jaw / right TMJ? Have you ever tried / heard of anyone changing the side from which the regulator comes in or is that like sacrilege in diving?

 

[Zef]

What you are describing sounds more like subluxation instead of dislocation but for conversational purposes this is more of a semantic issue.

The temporomadibular joint (TMJ) is a generally unstable joint that is capable of spontaneous dislocation. If the ligaments of your TMJ(s) are compromised (weak/over stretched) they can be exacerbated by diving via the regulator mouthpiece, especially a thick one.

I imagine you are new diver, based on that alone it would not surprise me that you have this issue, as it is common for new and experienced divers to clench their teeth and bite down on the 2nd stage mouthpiece....more so for new divers, and new divers are typically less aware that they are doing this until after the dive when their body can finally relax.

The issue can be exacerbated by an ill-fitting mouthpiece on the 2nd stage, one that is too big will force the jaw to sit wider, and one that is too small will cause the jaw to reflexively clamp down in an effort to keep the mouthpiece in place....then there are other factors like a short but thick mouthpiece or a long one that is rather thin, but even a properly fitting mouthpiece can cause problems until one is comfortable and allows their facial muscles to relax.

It would not surprise me if you were to state you have an issue with your mask leaking from time to time, as facial distortion due to muscle tension can cause that to happen as well as what you are experiencing.

I also imagine that you are not using your own regulator set, which would contribute to the problem as one potentially might have to accommodate a different mouthpiece each time you rent gear.

One thing you can do that may help a bit is buy a custom mouldable mouthpiece (and some narrow zipties if you are renting/borrowing gear)....these mouthpieces can be purchased at most any dive shop or online. They work by soaking in hot water and the placing in the mouth and biting down on them while they cool so that they take a set to your dentition. When you rent/borrow a reg set you can cut off the ziptie holding the mouthpiece and replace it with your customized one, when you turn it back in you just repeat the process and replace the original mouthpiece, it takes a couple seconds and is not a difficult procedure.

Edge Moldable Mouthpiece

Depending on what is really going on with your joint (the articulation, the ligamentation, and the musculature) this may help, but you might want to discuss the matter with your physician who can help by diagnosing if you have any underlying condition, and can prescribe medication for any inflammation and/or discomfort that may currently exist.

-Z

 

[Zef]

Hello Anna!

Thanks for your reply! Well, I can prevent that from happening (I mean the reg floating out or water getting in) but that just results in worsening the condition later. What mouthpiece do you have? Is it the one you mould yourself?

As for my configuration - during my course, I was using recreational gear - BCD, reg, etc., nothing special. I'd like to move to doubles and use a backplate, but that's not gonna happen for some time at least. The regulators we were using were Apex ones, seemed pretty standard, incl. the mouthpiece.

I wonder whether the problem might be that the regulator hose comes in from the right side, which I guess puts more stress on the right side of my jaw / right TMJ? Have you ever tried / heard of anyone changing the side from which the regulator comes in or is that like sacrilege in diving?

Some 2nd stage regulators can have the hose routing reversed but not many accommodate this to my knowledge.

There is a hose routing known as the "streamlined" set up where the primary 2nd stage is on a roughly 40-inch hose that is routed down from the 1st stage under the right arm and up to the mouth...to keep the stage from pulling to the side, a 70 or 90 degree elbow or swivel adapter is used between the end of the hose and the 2nd stage. This is often used as a "primary donate" setup with the backup 2nd stage on a 22 to 26-inch hose slung on a bungee cord necklace that keeps it under the chin.

While it is not necessary to switch to a short hose and necklace the backup 2nd stage, the primary 2nd stage can still used on the 40-inch hose with an elbow....the elbow should keep the hose from pulling to the side....with a standard recreational setup this is something one tends to get used to but if your TMJ is inflamed any pulling may just keep exacerbating the problem.

The issue you face is that you are not using your own gear and shops may not accommodate this configuration even if you brought them the parts. An elbow adapter is relatively inexpensive and a 40-inch hose typically won't break ones budget either. If a shop shop won't accommodate you with their rental gear and your/or their parts, then with a quick turn of the wrench you can do it yourself, but if you cause any damage you are liable.

Perhaps this is a reason to evaluate purchasing your own reg set.

-Z

 

[Searcaigh]

I'm not sure if this will help, but it's my preferable mouthpiece

Aqua Lung Comfo-Bite Mouthpiece, Black

 

[Zef]

I'm not sure if this will help, but it's my preferable mouthpiece

Aqua Lung Comfo-Bite Mouthpiece, Black

This is generally a good mouthpiece to recommend.

The OP should note that if her TMJ is currently inflamed, switching mouthpieces may not be enough to help the situation.

It should also be noted that although the comfo-bite mouthpiece is favored by many, some find it to be on the small-ish side and find that the palate arch does keep it adequately in place which leads to a tendency to bite down on it more. I had one on my primary 2nd stage and switched it out for a mouldable mouthpiece for this very reason.

-Z

 

[chillyinCanada]

I agree with everything above. Also, learn to keep your lips snug over the mouthpiece so that you can relax your bite.

When you finally get your own reg, do get the 40" hose that routes under your arm rather than over your shoulder. I love mine and also have a molded mouthpiece.

You need to see your dentist about the tmj. It may be that you should be sleeping with a specially prepared mouthpiece as well.

 

[-JD-]

Note: I dont have any experience with chronic TMJ, nor the following, but I wonder if it might be of some help by retaining the reg and providing some support. So for discussion ...

How about a rebreather "gag strap" or similar?

There are some good options here: Recommendations for Mouthpiece Retaining Devices for IWR

 

[Doctorfish]

Full face mask?
IMO that would alleviate the problem.