HEAD, NECK, FACIAL PAIN & TM DISORDERS
The majority of temporormandibular disorder (TMD) have head, neck and facial pain.
The most common symptom of TMD is noise in the joint. This noise is usually related to the rapid reduction of the fibrous disc malpositioned between the condylar head and the glenoid fossa. The sound is often accompanied by a restricted mandibular range of motion.
Pain is usually localized in the muscles of mastication.
Many of these patients complain of:
- Chronic headaches
- Limited mandibular movements or locking open/closed
- TMJ sounds; clicking, popping, grating
- Ear fullness or pain with no apparent other etiology
- Facial pain
- Neck pain or stiffness
Trauma, disease and developmental disorders can lead to internal derangement of the TM joint. This occurs when the normal physiologic relationship of the condyle, disc and fossa have been altered and compromised. Discomfort in the jaw joint can be the result.
It is becoming clear that a dentist who is specially trained in treating these disorders, can best direct this care.
THE BIOMECHANICAL RELATIONSHIP
Symptoms that are seen by various health care professionals include:
Otolaryngologists may see patients with unexplained ear pain, tinnitus, fullness in the ears, hearing loss or hyperacusis, nose/sinus complaints, headaches, equilibrium, and/or swallowing difficulties.
Neurolosists may see patients with unexplained chronic head pain/severe headaches, dizziness, shoulder pain or stiffness, pain behind eyes or at the base of the skull and sometimes numbness in the fingers or arms.
Primary care Providers may see patients with unexplained headaches, cervical discomfort or arthritis. These signs may be related to a temporomandibular disorder and are commonly seen in conjunction with medical conditions such as Fibromyalgia and Chronic Fatigue Syndrome.
Chiropractors may see patients with cervical symptoms of pain and/or limited range of motion. There is a direct relationship between TMD and cervical disorders.
Rheumatologists may see patients with cervical osteoarthritis, rheumatoid arthritis, Sjogren Syndrome or other auto immune disorders. This is because the TM joints, like other joints in the body, are affected by these disorders.
The conditions listed here are very commonly associated with the TM joint. In any differential diagnosis for head and neck pain, TM disorders should always be considered.
Causes of TMD can be multifactorial. However, they often involve treating the relationship between the upper and the lower teeth and the teeth to the TM joints, as well as supporting ligaments and associated musculature. Just as nutrition affects teeth and joints, other contributing factors may include:
- Trauma: Direct and indirect trauma to the masticatory structures and upper quadrant can lead to TMD, head, neck and facial pain. Strains, sprains and injuries can lead to both pain and dysfunction. Either micro or macro traumas may be etiologic factors.
- Improper occlusion: When teeth do not fit together properly, it causes sustained microtrauma to the joints. When this condition is prolonged, the body begins to compensate by involving muscles in other areas: the neck, throat and upper back.
- Muscle Hyperactivity: This goes hand-in-hand with internal jaw joint problems. Any condition that prevents the complex system of muscles, bones and joints from working together in harmony can contribute to TMD. Various ways this system can be disrupted include trauma, connective tissue disorders, arthritis or skeletal malformation.
- Posture: Poor posture places unnecessary wear and tear on all the joints including the jaw joints. Over time, consequences of postural neglect can be as damaging as an injury.
- Stress: Increased physical and emotional stress is another factor that impacts patients with TMD as it reduces the adaptive capabilities of the jaw. Some patients unconsciously brux and/or clench their teeth in response to increased stress. Chronic clenching and bruxing creates strain on the TM joints and muscles which can exacerbate TMD problems.
THE ROLE OF DENTISTRY IN MULTIDISCIPLINARY CARE
When an occlusion problem or tissue damage to the head, neck and facial area is diagnosed, it is important to have an evaluation by a trained and qualified TMD dentist. Our office performs a full examination of the TM joints, head, neck & facial region, as well as x-rays and occasionally MRI evaluation. We are able to objectively determine the pathological nature and extent of joint sounds, injuries to the TM joint area and arrive at a realistic prognosis. Frequently, a custom-made orthotic (“splint”) is prescribed for orthopedic and musculoskeletal stabilization.
While many of the symptoms are temporarily improved with pharmacological agents such as analgesics, muscle relaxants, anxiolytics and anti-depressants, additional adjunctive therapies may include:
- Physical therapy
- Massage therapy
- Hot/cold therapy
- Spray & stretch
- Various injections
- Stress counseling
- Relaxation therapy
- Nutrition counseling
Patients benefit from the non-surgical, conservative treatment our office provides. Once pain is controlled and the jaw joint is stabilized, the bite is balanced so the teeth, muscles and joints all work together without strain or pain. Initially, treatment addresses the pain. Secondly, function is restored. Thirdly, the patient is stabilized. Occasionally surgery is necessary, but in less than 3% of all patients. Because problems associated with the jaw joints can be progressive, accurate and immediate diagnosis and treatment is crucial.
It is easy to see why the role of dentistry is essential in successful diagnosis and treatment of TM disorders, head, neck and facial pain. Of course, interdisciplinary management with supporting health care professionals results in the most effective treatment.