an update after seeing my dentist.
i learned so much.
very fortunate that my dentist is somewhat of an expert.
the exam he did was amazing; ~1.5-2 hours.
he took all kinds of photos of my mouth, had me move it in a variety of directions, felt the various areas that can be a problem, asked me all kinds of questions. very thorough.
a few things i don't have: the cartilage doesn't seem too worn. yes, i pop and click, but no pain associated with that. my jaw never locks up. when i move the chin in and out, its a smooth motion vs a "z" motion, so that's good. if i grind at all, its not much and questionable at best. but, maybe i clench? and since i had an incisor removed when i was young to make more room for my crowded teeth, that could be contributing a little.
he said the things he evaluates are the joint (bone), the soft tissue (muscles), and the teeth. the immediate problem is that one of the muscles is in spasm (the pterygoid) and when it started a few weeks ago, the whole muscle was sore. after a few days and now, its just where it attaches at the joint, very localized.
he said that we'd start with a night guard to see if that helped.
the old one i had covered all of the top teeth and he said it was good i threw it away years ago as it still allows one to clench and grind, just that you're doing it on plastic instead of teeth on teeth, but still bad, and can make the problem worse.
there is also a guard that covers just the front (2?) teeth and that kind should never be used either. it puts too much stress on the front teeth and can crack them. plus its small and could be swallowed in one's sleep.
that leaves two to try. the first one covers the top 6 front teeth with a buildup so that one's back teeth can not touch and thus one can not clench the jaw, relaxing the muscles. we started with a cheap temporary. and if it works, we'll have a permanent one made. the temporary is ~$50 and the permanent one is ~$350. won't break the bank if it works. kinda like the cost of orthotics.
if that doesn't work, he'll send me off to a specialist at our dental school. the dentist said this guy is like one of the top 10 people in the country on TMJ. don't know if that's true, but..... he'd have me try a different kind of guard that i didn't really understand that allowed more movement, etc. guess if i get to that point, or if i do more reading, i'll come to understand it.
the good thing was that my dentist tested all the various possibilities. and yes we talked about AS and bone spurs, bone fusion, joint degeneration. the other good thing was that he's a "let's try things out and see what the results are" type of person; i like that. sometimes you just don't know the results unless you do the experiment.
i used the guard for the first time last night. the teeth being covered hurt as it was pretty tight; i've been told it will loosen up. and i have the typical morning numbness in my face and jaw from my bone spurs pressing on the nerve(s). but too early to know if this will help, make matters worse, or not make a difference.
i go back in a few weeks to have a permanent one made if it helps. earlier if its not helping or making matters worse.