If you have recurring head, face,
neck or jaw pain and have been unable to find help OR if
been told that "it's all in your head and you will just
have to live with it", your jaw joints may not be functioning
properly and this information on TMD and associated dysfunctions
of the jaw joints may be helpful.
Our patients have experienced a wide spectrum of general
health problems. Unresolved pain over a period of weeks,
many years is a very common complaint! Many people are victims
of unresolved chronic pain following car accidents (whiplash
injuries) or other forms of trauma. Many have been diagnosed
with recurrent sinusitis or labeled as fibromyalgia or migraine
patients but have received medications only. No root causes
were ever established for these diagnoses.
Our goal is to
explain why differential diagnosis is so important to ensure
that no person suffers unnecessarily from chronic
pain. Obviously the enclosed information will not be an
answer for all; it is meant to be a guideline only to see
particular complaints justify a second opinion.
Extensive examinations are required to differentially diagnose
unresolved pain complaints. A five or ten minute examination
by a doctor who is also writing out another prescription
for you at the same time is not adequate.
Only if the physical findings from an extensive clinical
examination justify further diagnostics will such be recommended.
Our recommendations may well require input from other doctors
and we will provide that referral to doctors whose practice
is focused in the particular area of expertise required.
The Temporomandibular Joint:
The Jaw Joint is the most complicated joint in the body;
it consists of two bony parts (the condyle of the lower jaw
and the bony fossa of the skull) separated by an insulating
disc. There are many soft tissues intrinsic (inside) and
extrinsic (outside) this jaw joint.
Damage to this jaw joint mechanism is often noticed early
with clicking or popping sounds during jaw movement. Early
detection at this point could prevent more serious problems
Further damage to the jaw joint mechanism could lead to limited
jaw openings and more serious problems.
Chronic TMJ Dysfunction will cause neck problems; these are
mutually provocative because of their close proximity and
interconnecting soft tissues.
Twenty-five per cent of the nerves in your body go to your
mouth and jaws and more than one third of all nerves that
go the brain pass near this jaw joint.
Common Symptoms which could Suggest TMJ
- Uncomfortable when chewing gum
- Ringing or other sounds in ears
- Ear pain
- Pain in sinus areas or behind eyes
- Sore throat without cause
- Neck, shoulder & back pain
- Pain in front of the ears
- Clicking, grinding sounds in jaw joint, popping
- Gum & bone loss around teeth
- Sensitive teeth (unspecific to any one tooth)
- Limited opening of the jaws
- Clenching or grinding teeth (day or night)
- Awakening with jaws clenched
- Feeling fatigued after a full night's sleep
- Feeling that your teeth don't meet right
If your jaw joints are not functioning properly, you should
at least know the reasons for the associated dysfunctions
and be aware of possible treatments available.
Dysfunctions associated with chronic TMJ problems:
Unresolved TMJ (or TMD) problems usually lead to
compromised function of soft tissues (muscles,
tendons and ligaments
often far away from the TMJoint location). If both
normal working and resting lengths of these soft
affected, blood circulation is reduced. The lack
of nutrient for
these tissues results in premature fatiguing. The
building up of
waste products (mostly lactic acid) results in
the development of "trigger points".
Trigger points can refer pain that will be felt
by the victim in sites far removed from the trigger
points; consequently a victim can feel head pain
neck muscles. Too often these headaches are misdiagnosed
Premature fatiguing of these tissues results in
a victim awakening after a night's sleep still
out" early in a workday.
Any stress will magnify these complaints.
Common complaints of victims suffering from "whiplash" will
probably include, but not limited to:
- Head pain
- Neck pain
- Shoulder pain
- Ear pain
- Dizziness with or without nausea
- Tinnitus (ear noises)
- Numbness and/or tingling in the arms and hands
- Restrictions in head and neck mobility
- Pain and/or pressure behind the eye
- Visual and auditory changes
Immediately following the
trauma episode, jaw joint pain and/or jaw joint noisesduring
function may or may not be present. However, since
cervical dysfunction and temporomandibular dysfunction are
provocative, lack of effective treatment, poor treatment
or mistreatment will inevitably result in the following complaints:
- Jaw joint crepitus (popping, clicking, etc.)
- Jaw pain
- Facial pain
- Pain and/or difficulty in chewing
- Restrictions in jaw opening and other mandibular
ranges of motion
- Ear congestion
The more time that lapses from the trauma episode, the more
the victim's complaints
will include symptoms and dysfunctions further removed from the
head and neck.
Early effective diagnosis and
the victim's complaints should preclude this occurrence.
until months after the trauma episode.
of pain in the specific jaw joint site
an indicator of permanent damage to
In addition, the effect of other injuries
in the trauma
episode may well have the attention
of the victim.
Blunt trauma in a "whiplash" trauma episode is
not a requisite for permanent injuries; in fact, an uninterrupted "whiplash" sequence
has a potential
for more permanent
Chronic Pain Profile
Pain, which persists for more than a few weeks or months,
has a profound effect on a person. This constant, unrelenting,
self-feeding cycle of daily pain results in disappointment,
frustration, and depression, leading ultimately to loss
of dignity, loss of self-worth, and helplessness.
Repeated visits to doctors who do not find reasons for this
pain often lead to victims losing total self-confidence,
even to second-guessing their own stability, causing them
to feel it really is "all in their heads".
Continued medications may hide the root causes of this chronic
pain, making diagnosis more difficulty.
My staff and I is dedicated to diagnosing unresolved pain
complaints. Our facility is equipped with the most current
bio-instrumentation and imaging equipment to facilitate differential
Splint/Orthotic Therapy for TMD Patients
Although many of our TMD (temporomandibular joint dysfunction)
patients have heard of the use of splints or orthotics
in treating TMD, few are knowledgeable of just how effective
this aspect of treatment can be if utilized properly.
In fact, many doctors are not fully trained to integrate
therapy to its full potential as part of a TMD treatment
regimen. Consequently many TMD sufferers have not benefited
much from previous splint treatment applications.
or splints which have not been designed specifically
for that patient's unique problems are doomed to failure.
Similarly, splints which are not designed to be worn
full-time, especially when chewing food, accomplish very
is more forceful action in the jaw joints during chewing
than when the jaws are at rest. (If a patient with a
fractured leg removed their cast during walking, the fractured
would obviously never heal!)
Properly designed splints
ARE worn full-time, except when cleaning one's teeth; patients
are given appropriate instruction
to accomplish this comfortably. In addition, these
splints MUST be monitored and adjusted at specific intervals
if jaw joint function is to be restored without interference.
appropriate diagnostics are completed and that patient's
particular jaw joint problems are confirmed, it is imperative
that any interferences in joint function be resolved.
can be accomplished by adjusting the splint; in this
fashion the lower jaw can be advanced, rotated, moved bodily
otherwise repositioned to its optimal relationship
to the maxilla (upper jaw). When properly executed this
is extremely effective in helping to eliminate temporomandibular
joint (TMD) dysfunction.
Since there are so many underlying
reasons for TMD, differential diagnosis is the KEY to successful
treatment. The physical
findings from an extensive clinical examination are
critical here. A CURSORY FIVE OR TEN MINUTE EXAMINATION
OF THE TMD
VICTIM IS TOTALLY INAPPROPRIATE AND YIELDS LITTLE
INFORMATION; IT IS ALSO A TOTAL DISSERVICE TO THE PATIENT
IT IS THE PHYSICAL FINDINGS FROM A COMPREHENSIVE CLINICAL
WHICH DETERMINE WHICH DIAGNOSTICS ARE ESSENTIAL IN
ANY GIVEN CASE OF TMD!
If these diagnostic protocols are
not utilized, little meaningful information on root causes
will be obtained, and again treatment will be flawed
Many of our patients have been pleasantly surprised
with the success of our approach to integrating
as part of our overall treatment. More specifically,
those chronic pain patients who had been unsuccessfully
by so many doctors over so many years, are now
free of pain and recommending our TMD treatment
friends and others
with TMD problems. This has been a most gratifying
experience not only for these particular patients,
but also for me as
their treating doctor!