Doubting Your Diagnosis?

January 19, 2011No Comments

Doubting Your Diagnosis? Headaches & Oral Facial Pain Revealed

Submitted By: Illinois Institute of Dental Sleep Medicine

If you’re experiencing frequent headaches, back and neck pain, dull aching facial pain, or popping in your jaw you are not alone. Dawn had suffered from constant headaches her whole life. “My headaches never seemed to go away and I had to take aspirin every day just to mask the pain,” says Dawn. Another patient, Debbie also suffered from debilitating migraines. Even when one headache subsided, another would come unexpectedly. It hit her like a ton of bricks and she would be forced to stop all her plans, and wait. She visited her primary care doctor. She visited her neurologist. She tried numerous headache medications. But nothing worked for her. Then one day, she was visiting her dentist, Dr. Bill Costaras, of the Illinois Institute of Dental Sleep Medicine. He could tell she wasn’t feeling well and asked her if she had a headache. “I was so tired of my head hurting I wanted to cry,” says Deb. After a screening for Temporomandibular Joint Disorder (TMD) and Sleep Disordered Breathing (SDB), Dr. Costaras and Dr. Rod Willey started Deb down a path of answers and yes, relief from her headaches.

Approximately 35 million people in the United States suffer from TMJ problems. While both men and women experience TMJ disorders, the majority of those seeking treatment are women in their 20’s and 30’s. Many believe stress or a busy lifestyle is to blame but do not realize that these symptoms are often related to their jaw muscles and their jaw joint known as the temporomandibular joint or TMJ. Your bite can be a factor in many types of pain or functional problems because of the inter-relationship of the overall muscle and skeletal system.

What is Temporomandibular Joint Disorder?

TMD is a condition involving the temporomandibular joint, bone and cartiledge resembling a ball-and-socket that sits right above your ear canal on either side of your head. When the joint slips out of position, pain can result, and TMD is characterized by clicking or popping of the jaw when you open or close your mouth, persistent headaches, and sometimes chronic pain. “I have many patients who come to me complaining of headaches, jaw and facial pain as well as pain in the ears, never realizing that their pain was caused by a misalignment in their jaw,” says Costaras. Some people, however, report no pain, but still have problems using their jaws. View the diagram for additional signs and symptoms of TMD.

Causes of TMJ Disorder

The cause of TMD is not clear, but dentists believe that symptoms arise from problems with the muscles of the jaw or with the parts of the joint itself.

Macrotrauma to the jaw, temporomandibular joint, or muscles of the head and neck such as from a heavy blow or whiplash are common causes of TMD. Other possible microtraumas include:

Grinding or clenching the teeth, which puts a lot of pressure on the TMJ
Tooth loss, misalignment of teeth
Dislocation of the soft cushion or disc between the ball and socket
Presence of osteoarthritis or rheumatoid arthritis in the TMJ
Stress, which can cause a person to tighten facial and jaw muscles or clench the teeth
Chewing gum excessively or biting your nails can inflame your temporomandibular joint and may cause TMD.

Dental Treatment for TMD

Until recently, most dentistry was based on the assumption that wherever your bite was naturally was the correct position. However, the natural bite may not be comfortable or functional for the patient. In fact, malocclusion, or a ‘bad’ bite can be involved in pain and/or dysfunction of various areas of the body, which seem to have nothing to do with dentistry. Comprehensive Dentistry objectively evaluates the complex relationship between the teeth, nerves, muscles and jaw joints. Dentists who are trained to treat TMD are able to establish a harmonious relationship between these factors, resulting in a jaw position that achieves optimal occlusion and increased function and comfort for the patient.

Diagnosis & Treatment

“Because other conditions can cause similar symptoms including a toothache, sinus problems, arthritis, or gum disease we will conduct a careful patient history and clinical examination to determine the cause of the patient’s symptoms,” explains Costaras. “We then examine the temporomandibular joints for pain or tenderness, listen for clicking, popping or grating sounds during jaw movement, look for limited motion or locking of the jaw while opening or closing the mouth, and examine bite and facial muscle function,” he continues.

Diagnosis and treatment for TMD, utilizes advanced technologies such as Cone Beam Volumetric Tomography (a 3D Cat Scan of the head and neck with only 10% the radiation of a normal CT).

“After finding the optimum true rest position for the jaw a custom made appliance called an orthotic is created to promote healing and maintain the new, corrected bite position,” says Costaras. “While the orthotic will temporarily stabilize the jaw, permanent stabilization may be necessary,” Costaras continues. Options may include wearing a long-term orthotic, providing orthodontic treatment, placing crowns or veneers on the affected teeth, or creating a neuromuscular denture.

Tempormandibular joint disorder can cause a myriad of other physical problems. To provide optimal care for the patient the dentist may work with a variety of other specialists including: neurologists, rheumatologists, physical therapists, chiropractors, and others.

Dr. Bill Costaras has teamed up with Dr. Rod Willey of the Illinois Institute of Dental Sleep Medicine to provide comprehensive treatment for patients with TMD. To contact the Illinois Institute of Dental Sleep Medicine call 309-243-8980 or email them at info@illinoissleepdoc.com.

Sources: Jennifer Krahe, TMJ.org, WebMD

Signs & Symptoms of TMJ Disorder