Monday, September 22, 2014 
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If you have recurring head, face, neck or jaw pain and have been unable to find help OR if you have 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, months or 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 if your particular complaints justify a second opinion.

Examinations:

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 from developing.

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

  • Headaches
  • 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
  • Dizziness
  • 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 tissues are 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 far removed from compromised neck muscles. Too often these headaches are misdiagnosed as "migraines".

Premature fatiguing of these tissues results in a victim awakening after a night's sleep still fatigued, or "tiring 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 mutually 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 treatment of the victim's complaints should preclude this occurrence.

Latent temporomandibular joint dysfunction complaints may not surface until months after the trauma episode. The presence or absence of pain in the specific jaw joint site is not necessarily an indicator of permanent damage to the jaw joint mechanism. In addition, the effect of other injuries sustained 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 tissue damage. Blunt trauma victims present a different forensic profile.

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 diagnosis.

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 splint 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.

Orthotics 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 little; there 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 limb 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.

After 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. This can be accomplished by adjusting the splint; in this fashion the lower jaw can be advanced, rotated, moved bodily and otherwise repositioned to its optimal relationship to the maxilla (upper jaw). When properly executed this splint therapy 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 BECAUSE IT IS THE PHYSICAL FINDINGS FROM A COMPREHENSIVE CLINICAL EXAMINATION 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 (etiology) will be obtained, and again treatment will be flawed and ineffective.
Many of our patients have been pleasantly surprised with the success of our approach to integrating splint therapy as part of our overall treatment. More specifically, those chronic pain patients who had been unsuccessfully treated by so many doctors over so many years, are now free of pain and recommending our TMD treatment to their 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!