www.tmjcherin.com
TMJ Section:
Providing Treatment for TMJ Disorders and Headaches
The constellation of symptoms associated with TMJ Disorders
YOUR TMJ TREATMENT
We care about your temporomandibular problem. It is our desire that you are able to avoid prolonged drug therapy and achieve pain free daily living.
Many people suffer from dizziness, earaches, face, head and neck, shoulder, and back pain. They may also suffer chronic fatigue, irritability, blocked or ringing ears, difficulty swallowing, temporary loss of memory, and arthritis like joint pain, or numbness in parts of the body that seem to have no relation to the teeth and the jaws. These cases are frequently unrecognized by the physicians who's standard training has not equipped them to understand the relationship between teeth, the jaw bones and the subsequent alignment of the jaws and the rest of the body. Many dentists are also unaware of how closely their work is linked to a patient's general health and their subsequent head and neck pain.
Consequently, thousands of chronic sufferers go from one medical specialty to another taking potent drugs which fail to bring relief and even having needless surgery when the pain becomes unbearable or being referred to psychiatrists who cannot help them because these experts are concentrating on the symptoms without recognizing the cause.
Temporomandibular joint disorders cause strained facial muscles and leads to tension discomfort and pain. Almost 92 percent of all recurring headaches come from a TMJ problem according to recent research. Also, according to this recent research, almost one quarter of the population suffers some form of craniomandibular (TMJ) disorder. If you have recurring headaches or jaw pain, the chances are better that you would get relief from a dentist rather than a neurologist, surgeon, or a psychiatrist. If you suffer from frequent headaches, please tell us. We can perform an extensive, thorough examination to see if this head pain is related to your teeth, mouth, jaw or misalignment.
If you are one of the millions of people who suffer from headaches, dizziness, popping or clicking of the jaw joint, facial tension, neck or back problems or other symptoms caused by TMD syndrome, we can usually help. Some of the various types of clear plastic splints can be used.
The temporomandibular joints are joints located on either side of the face that connect the lower jaw to the skull. The joints work in synergy with the facial bones and multiple pairs of muscles to allow opening and closing of the mouth and the forward, backward, rotational, and side-to-side movements of the lower jaw. Any disturbance of the perfect facial balance can trigger the cycle characteristic of TMJ disorders, which affect muscles and joints on all areas of the Face, neck, and back. When muscles and joints are not working together correctly, muscle spasm can result which produces pain and dysfunction.
Jaws either in opening or closing position and having to wiggle the jaws to get them closed are a symptom. Also, in many instances a limited jaw opening will generally signify a TMJ condition.
The TMJ is called the "impostor" since it can mimic other diseases. Because TMJ disorders can mimic so many other conditions diagnosis can be complicated. Many people spend a great deal of time and money searching for the source of their symptoms. If your physician cannot find any underlying conditions, you should consider the possibility of TMJ and recommend that you consult a dentist that specializes in the diagnosis and treatment of TMJ disorders. For this very reason, our scheduling of patients with TMJ disorders is very lengthy and extensive. It takes us more than an hour-and-a-half to sometimes as long as 2 or 3 hours to adequately examine and diagnose anyone with a TMJ disorder in order to pinpoint the exact cause of their problem and not be continually chasing symptoms, but actually get to the cause of their problem.
Recurrent chronic headaches, as well as facial and neck pain, are common occurrences in millions of Americans. In addition, people frequently suffer from ear symptoms, including pain, ringing, buzzing, loss of hearing, clicking and popping of the jaw joint noises, pain upon chewing, speaking and sneezing. These symptoms, appearing unrelated, were previously, frequently undiagnosed or misdiagnosed as migraine headache, pain due to tension, neuritis, neuralgia, or stress headaches. When standard treatments for these types of disorders proved unsuccessful, patients were frequently labeled as hypochondriacs, or it's all in your head. It is well recognized by practitioners in the health care community and those practicing in the area of TMJ disorders, that those often unexplained, undiagnosed and therefore untreated symptoms are related to a group of problems called temporomandibular joint disorders. With the proper training and diagnostic skills and adequate equipment, practitioners working in the area of TMJ Dysfunction's are able to pinpoint the cause of these symptoms and provide (many times miraculous to the patient), relief of symptoms which may have been present for years. if you suffer from one or all of these symptoms, we are here to help you. Both the web site and our office have much information including videos, that will explain the cause of the treatment and help that is available to you. The American Academy of Head, Neck, and Facial Pain desires to provide you with information about your disorder and help guide you in a selection of a health care professional, who has received advanced training in the diagnosis and treatment of head, neck and facial pain and TMJ disorders. We refer you to their web site, in which you can gain even more information.
There are various ways in which the system of jaw balance can be disrupted, such as accidents involving a blow to the face, or a whiplash injury due to a car accident. The most common cause of craniomandibular dysfunction relates to your teeth and how your bite comes together. When your bite is not right, it can effect both the muscles and the joints. By a bad bite, we mean that your upper and lower teeth do not come together in a stable way that provides the proper bracing support for your jaw against the skull, in which no teeth hit harder than any other teeth. This might result from a missing tooth, misaligned teeth, misaligned back teeth, or teeth which are too short. A bad bite is called a malocclusion and needs to be "fixed" by one treatment modality or another.
Before prescribing the proper treatment for your particular problem, a variety of diagnostic procedures may be necessary. A detailed head and neck physical examination is usually necessary and is so detailed as to require one or more hours of time. Sophisticated radiographs, such as tomographs or CT scans may be taken of your jaw joints. In some instances, MRI's may be necessary. These radiographs are used as a means of detecting disease and the position of the jaw joint. A medical and head and neck history is also carefully reviewed, as is a psychometric testing to determine the degree the pain has affected your life. Other electronic and computer aided studies may also be used, such as sonographic joint vibration analysis and EMG recording.
TREATMENT MODALITIES
Structural stress from a misaligned TMJ is the worst kind of physical stress because there is no way the body can find relief for it. Any injured limb can be rested, but it is impossible to leave the TMJ inactive. Without realizing it, we swallow hundreds of times each day, and at night we may clinch or grind our teeth. Every time those teeth meet in incorrect occlusion, there is stress. To compensate for it, the jaw muscles begin to hold a tense and unnatural position and before long the tension travels by chain reaction throughout the body.
Muscle Spasms
Upper and lower teeth and jaws must come together firmly and without any stress every time you swallow. Swallowing can happen over a few thousand times a day and night, so, therefore, if your bite is unstable or certain areas of your bite have more stress on them than others, the muscles must work extra hard. In fact, they work so hard that sometimes some of the muscle groups fail to get any rest. The extra work makes muscles shortened and results in stiffness and pain in these muscles. Because of the strain, it is possible that all the muscles in your head and neck may feel very painful. Thus a vicious cycle begins of increased muscle tension, tissue damage, and stressful pain that is almost impossible to eliminate. There again, the cycling of this pain makes you feel very tense, uptight and irritable. This in turn again cycles and worsens the muscle spasms, which in turn increases the pain to another level.
Treatment Modalities
After diagnosing the problem of a TMJ dysfunction, a variety of treatments may be recommended. Initial or Phase I treatments are aimed to eliminate the TMJ pain or the symptoms that are resulting from the actual problem whether it be a bad bite or malocclusion or the result of trauma or injury. In the second stage or Phase II, the actual treatment to correct the causing problem is implemented. Various TMJ treatments that are used in our office are now outlined: however, it must be remembered that the treatment is tailored to the diagnostic finding and the actual cause of the problem.
TMJ Scale
A psychometric test which is given to determine the quality of pain and level of pain and also to differentiate what portion of head and neck pain is directly related to a TMJ disorder versus some other non-TMJ disorder and also what is stress related.
Orthopedic Repositioning Appliances
These allow muscles to obtain a relaxed, unstained position and also positions he temporomandibular joints in an unstained position. These are commonly referred to al splints, and mention of those has been made in the article above.
Ultrasound
Reduction of joint inflammation and muscle inflammation and any other inflammatory responses that occur in the head and neck area.
Ionophoresis
The application of medication through electronic pads or patches to reduce pain, both in joints and muscles.
Electrogalvanic Stimulation
Electrogalvanic stimulation causes reprogramming of tense and stiffened muscles and also caused relaxation and reduction of pain in those muscles.
Trigger Point Injections
Trigger point injections cause pain reduction and relaxation in muscle groups, particularly those muscle groups that refer pain from one specific area to other areas of the head, neck and even upper shoulder and is obtained by injecting small quantities of anesthetic and anti-inflammatory medication directly into painful, sore, tense and stiff muscle groups.
Moist Heat
Causes muscles muscle relaxation by applying deep heat to muscle groups and also the joint area by a hydrocollator.
Pharmacological Agents
Prescription of all types of anti-inflammatory and antigenic agents for the temporary reduction of pain and inflammation, primarily non-steroid in nature. Heavier pharmacological agents, including steroid agents can be used if there is severe pain and inflammation.
Coolants
Vapo-coolants can be introduced to achieve pain reduction and reduce spasming of muscle tension.
Bio-Feedback
Electronic bio-feedback introduces relaxation and reduction of pain in many muscle groups that are affected by tension, soreness, and spasms.
Nutritional Therapy
Assessment of nutritional needs and addition of proper nutritional support can raise immune response and also decrease muscle tension and spasms and cause reduction of pain and muscle tenderness.
Muscle Exercises
Increases range of motion and is able to reprogram muscles into a normal, proper function.
Functional Exercises
Strengthens opposing muscle groups and actually strengthens muscles so as to reduce muscle tension and muscle spasms to obtain normal muscle functioning.
Occlusal Equilibration
Eliminates physical stress by balancing out the way teeth come together, so that all teeth hit optimally in a stress-free closure without any teeth hitting any other teeth prematurely. Results in a stress-free or normal bite relationship.
Comprehensive Prosthetic Crown and Bridge
Eliminates dental stresses by balancing out the bite and obtains a stress-free dental relationship, in which all teeth hit simultaneously without any other teeth hitting prematurely and corrects a bad bite or malocclusion, achieved by placing crowns or inlays on teeth.
Orthodontic Therapy
By use of functional appliances, orthodontic therapy moves teeth into a more ideal position so that again, a malocclusion or bad bite can be eliminated and teeth will meet together in a stress-free environment without any undue stresses in any specific areas of teeth. Orthodontic therapy may be used in conjunction with other forms of therapy, such as crown and bridge treatment, or occlusal equilibration.
Cranial Sacral Therapy
Eliminates jammed cranial sutures and jammed cranial areas of bony stresses that can occur in the skull as the result of severe muscle tension and spasms.
Myofascial Therapy
Reduces muscle tension and stress, and muscle pain by manual manipulation.
Neural therapy
Allows muscles to relax and eliminates painful muscles and stresses as a result of toxicity's that may be present in the body.
The treatment that can be obtained in our office is provided as a result of a very thorough and comprehensive examination. Following a diagnosis and a consultation with you about what treatment modalities would best work in your individual case, we schedule structures appointments with adequate time for the best level of care. However, if you have an emergency or are in severe pain, we do have emergency time available and can treat your problem on an emergency basis.
Usually, our staff is available to answer any questions that you have during the course of treatment and we always welcome any questions or clarification that you may have at any time. It is usually not possible for the doctor to come to the phone to answer questions, but the staff that we have is certainly very capable and can answer most of the questions or address any problems that you may have. However, there are certain times of the day that the doctor is available to return phone calls, and we will be glad to do so if you will leave your telephone number and a statement of why you need a return phone call. If any questions or problems require a lengthy conversation, it may be necessary to schedule a consultation appointment. Referrals to other practitioners who may be able to provide additional levels of care may be made at any time during treatment.
Medical reports are routinely available, and are prepared based on your examination and diagnosis and are sent to a referring physician or dentist and to any other attending physician or dentist, who you have been in contact with prior to your visit with this office. Medical reports to non-physicians, i.e. insurance companies, will be sent only on written requests from the insurance company with a records release. There is a charge for this service to a non-physician. It is highly important to maintain a sequence of appointments to ensure steady improvement as proper healing takes place over time and is progressive. From time to time, we will also send progress reports to physicians or referring sources of record.
Will Surgery Help?
Our mission is to treat everyone to a pain-free daily living level, without the use of prolonged drug therapy, or certainly surgery. However, from time to time, surgery is a distinct possibility in some advanced cases of TMJ dysfunction. These cases represent less than 5 percent of the patient population that we see statistically. We have a few well-qualified oral surgeons that we work with in those few cases, and we do not hesitate to refer for surgery when the diagnosis and treatment indicates it. However, surgery by itself is usually not a complete answer to treat head and neck pain. Surgery plus the above mentioned modalities that we offer, are sometimes necessary.
