TMJ or Grinding Pain or Migraine Pain

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Select Your Current Condition:

• Signs and Symptoms of TM Disorders
• Causes of TM Disorders
• Treatment for TM Disorders
• Acupuncture + Chronic Headache
• Role of Massage Therapy & TM Pain
• Grinding Clenching vs TM Disorders
• Nervous Energy-Oral Habits vs TM Disorders
• TMJ -Migraine or Tension Head Ache Pain

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Intro

TMJ = Temporomandibular Joint
TMD = Temporomandibular Disorders

The bones of the TM joint are separated by a disk and are held together by muscles and ligaments. The temporomandibular joint connects the lower jaw, called the mandible, to the temporal bone at the side and base of the head. The anatomy of the TM joint is complex, especially because there are two joints working together and the alignment of both of the TM joints is set by the location of your teeth. If you place your fingers just in front of your ears and open your mouth, you can feel the joint on each side of your head. If you bite or clench you can palpate and determine the origin and insertions for many of the muscles that control jaw function. These muscles are located on the lower jaw and side of your head. Because TM joints are flexible, the jaw can move smoothly up and down and side to side, enabling us to talk, chew and yawn.

 
 
#1 Signs and Symptoms of TM Disorders

A variety of symptoms may be linked to TMD. Pain, particularly in the chewing muscles and/or jaw joint, is the most common symptom.

• Limited Movement or Locking Of The Jaw (Closed Lock), Decreased mouth opening (<20mm), Side to side jaw movements may be limited, Feeling of cramp or muscle tightness, Muscles rigid and painful to palpation
• Disc Malposition “Open Lock”: Severe discomfort. Patient is unable to close jaw (open lock). Anterior teeth will not contact. Patient may report incident of dental visit with prolonged opening of mouth or patient may report this as a recurring problem.
• Pain brought on by yawning, chewing or opening the mouth widely.
• Radiating pain in the face, neck or shoulders
• Tenderness of the jaw muscles.
• Painful clicking, popping or grating sounds in the jaw joint when opening or closing the mouth.
• A sudden, major change in the way the upper and lower teeth fit together.
• Symptoms such as headaches, earaches, dizziness and hearing problems may sometimes be related to TMD.

Common Symptoms Of Back Pain Can Help Patients To Understand Common Symptoms Of TM Pain.
Back pain is one of the most common medical problems in the U.S. It affects most people at least once in their lifetime and can be a good case in point. The most common form of back pain is due to muscle spasm and is very similar to the most common form of TM pain which is also from muscle cramping. An imbalance, strain of the joint, a history of trauma, or even something as slight as an awkward movement of the back or jaw, can lead to a muscle spasm. The muscle spasm can cause the back or jaw to lock, and can cause severe pain. This spasm can become part of a cycle that results in tissue damage, pain, muscle tenderness and more spasm. Back pain can reoccur from strenuous activities or imbalances, like weight gain in the abdominal area, which will increase demand and fatigue on spinal and pelvic muscles. Likewise, muscle strain from tooth grinding/clenching or imbalances of the jaw joint can trigger symptoms of TM pain.

Muscle spasm of the back and TM joint are similar but it’s important to note that the TM joint is one of the most complex joints in the body. The anatomy of the TM joint is unique, especially because there are two joints working together and the position of both of the TM joints is set by the location of your teeth. To better understand functionality of the lower jaw, try imagining the handling of a wheel barrel. A wheel barrel has one wheel (your teeth) and two handles (terminal ends of the lower jaw which rest at the base of your skull). If the wheel barrel is balanced, it’s easy to push and move heavy loads. If the load is slightly off center, your muscles will be strained to move even the smallest of loads. It’s important to note that over time an unbalanced load will wear at the jaw joint and muscles. Maligned TM joints in patients who grind have excessive degenerative forces on the muscles and the bones of the skull where these muscles are attached. While some cases of TM disorder may be clear-cut, such as trauma, arthritis, jaw imbalances, or grinding/clenching, most are due to a combination of factors.

 
 
#2 Causes of TMD

Depending On Your Signs And Symptoms, TM Diagnosis And Treatment Recommendations Can Vary From Person to Person. Many people may not experience TM symptoms to abnormal bites and other TM disorders for long periods of time. For this reason, TM diagnosis and treatment recommendations can vary from patient to patient. In general, any one or a combination of the following known causes of TMD will increase your likelihood of, or can increase the severity of TM Symptoms:

• Myofascial Pain, The most common form of TMD, which is discomfort or pain in the muscles that control jaw function.
• A History Of Or Current Symptoms Of Dislocated Jaw Or Displaced Disc (usually from an injury)
• Degenerative Joint Disease (Arthritis in the jaw joint itself) Arthritis may be a long term result of an injury.
• Post Dental Visit TM Pain: (See our section of post dental visit Emergencies)
  • DENTAL INJECTION TRAUMA
  • POST VISIT TRAUMA
    • Stress from surgical trauma to a muscle or ligament
    • Strain from over opening or prolonged opening of mouth
    • Jaw fracture
• Grinding Away -> Flattened Tooth Structure: It is very well documented that flattened tooth anatomy creates excessive lateral force on the TM joint. People who grind can and will eventually grind away nature’s protective biting surfaces. The loss of these natural tooth inclinations will result in excessive force on the TM joint and associated joints and muscles.
• Grinding Imbalance: People who grind on one side more then another will quickly create an imbalanced biting surface. Remember, if the jaw is forced out of alignment by the teeth, the muscles will be strained to accomplish everyday activities.
• Clenching or Grinding Related Muscle Strain: People with TMD often Clench or Grind their teeth at night, which can tire the jaw muscles and lead to pain.
• Family History Of TMD Or Grinding/Clenching
• Excessive Para-functional Habits: Excessive cheek biting, excessive gum chewing, etc.
• A Thought Or Awareness That Your Bite Is Uncomfortable Or Abnormal
• Occurrence of Tension or Stress: Some experts suggest that Stress, either mental or physical, may cause or aggravate TMD.
• Sleeping Disorders Oral habits such as clenching or grinding the teeth (Bruxism) may develop as a response to stress or as part of a sleep disorder.
• Sinus Pain (Treatment Without Long Term Relief)
• Migraine Headaches (Treatment Without Long Term Relief)
• Tension Head Aches (Treatment Without Long Term Relief)
• Any Treatment Of Head, Neck, Facial Pain (Without Long Term Relief)
• Jaw Clicking: There is no scientific proof that jaw clicking leads to serious TMJ problems. In fact, jaw clicking is fairly common in the general population. As long as the displaced disc causes no pain or problems with jaw movement, no treatment is needed.
• Occlusal Imbalances: If the teeth pull the jaw out of the socket during swallowing or biting, it destabilizes the jaw joint.
• An Abnormal Bite from Cracked, Chipped, Worn, Broken, Crooked or Missing Teeth.
• Abnormal Bite from Old Worn Dental Work. Remember all dental materials and tooth structure wear at a different rates. As an example, if you have porcelain crowns on your left side and the right side is healthy natural tooth structure. Over time, the porcelain crowns on your right will not wear as fast as your left side. The Crowns will end up higher then your right side.
• Orthodontic Treatment, such as braces and the use of headgear, has also been blamed for some forms of TMD, but studies now show that this is unlikely unless the final tooth position and bite is abnormal.
• Abnormal Bite from Age Related Wear of natural tooth structure.
• Abnormal Bite from Improperly Balanced Dental Work

 
 
#3 Treatment for TM Disorders

To the extent that the causes of your TM disorder can be identified, proper diagnosis is an important step before treatment. It can save time and money by ensuring that you receive the treatment appropriate for your particular problem.

There is no formal treatment sequence or “norm” for treatment of TM disorders. Treatments for TM disorders vary, based on your individual diagnosis. Dr. Landers may recommend a treatment involving a series of phases. This step-by-step plan is in your best interest because only minor corrective treatment may be needed. If pain and other symptoms persist, a more involved treatment will need to be considered.

Dr. Landers and our team of other health professionals (who provide treatment for TM disorders) care about your health and comfort. Please feel free to discuss your concerns openly with our team.

The Key Words To Keep In Mind About TMD Treatment Are:

• Start out with “conservative” and “reversible.”
• Pain is not a disease. It is a warning that something is wrong. No doctor would give you pain medicine as the only treatment for a broken bone. It’s our goal to find and treat the reason you have the pain. It’s important to understand that finding the cause of your TM Pain may take more than one visit.
• It is important to note that while many of the above factors are believed to cause TM disorders, the exact causes of the disorders are unknown and sometimes it is not possible to determine the causes of the symptoms. The symptoms should still be addressed and treated regardless of cause.

Patient Self-Care Practices for Active TMD Pain
Because most TMD problems are temporary and do not get worse, simple treatment is all that is usually needed to relieve discomfort. For example,

• Eating soft foods,
• Applying heat or ice packs, i.e. warm wash cloth on the jaw area
• And avoiding extreme jaw movements (such as wide yawning, loud singing and gum chewing)
• Learning special techniques for relaxing and reducing stress may also help patients deal with pain that often comes with TMD problems.
• Watch how you are sleeping (with your hands near your face?).
• Once pain is reduced: THERAPEUTIC EXERCISES AND STRETCHES: which focuses on gentle muscle stretching and relaxing exercises, muscles should be stretched passively to full length while patient gently opens and closes.
• Short-term use of muscle-relaxing and anti-inflammatory drugs such as Aspirin, Advil, Motrin or Naprosen.

Based On Dr. Landers’ Diagnosis, One or More Treatments May Be Recommended:

• Appliance that can be worn while sleeping
• Stress management suggestions
• Rule out fracture by radiograph
• Attempt pain management (massage, Vapo-coolant spray, ice, local anesthetic)
• Electrolytes or other lab work may be requested to rule out disorders (i.e. calcium/parathyroid disorders).
• Occlusal Equilibration – Reshape the teeth to fit in harmony with your jaw joints
• Even the bite or reconstructing the biting surfaces with inlays, crowns, or bridges
• Orthodontic Braces – Move the teeth with braces
• Jaw Surgery – Rare internal damage may require surgery
• Referral to other medical professional

Treatment Options From Other Medical Professionals

• Acupuncture to “trigger points.”
• Therapeutic Message Treatments soft tissue work – massage, trigger point work, soft tissue mobilization, etc.
  • Keep muscles relaxed and flexible
  • Reduces bouts of muscle aches and pains
  • Reduces TM stress
• Dietary And Nutritional Counseling
• as a last resort refer to Oral Surgeon to consider surgical treatment

How Dr. Landers Determines if Your Pain Is From Muscle Spasms Due To Occlusal Interference

At our office we can determine if your pain is related to an abnormal bite in less than five minutes:

Clinically it’s a Four Step Process:

1. Evidence that you are clenching or grinding your teeth
2. A conflict between the centered position of your jaw joints and your teeth
3. Pain and soreness in any jaw muscles
4. Pain relief using the Bite Discluder

If the Bite Discluder takes away your pain, you can expect substantial relief from bite treatment at our office. The combination of pain relief from a Bite Discluder and Dr. Landers’ diagnosis can indicate that a large percentage of your pain is due to muscle spasms that are caused by occlusal interference. Only a trained dentist can fix your bite.

 
 
#4 Acupuncture + Chronic Headache

Reuters – March 15, 2004

Acupuncture is a useful, cost-effective treatment for patients who suffer from chronic headaches or migraine, American researchers said on Monday.

In one of the largest randomized studies to assess the effectiveness of the ancient Chinese treatment, scientists found it worked better than just conventional treatments alone.

“People using acupuncture had fewer headaches, less severe headaches and they used less health resources over the course of the following year,” Dr Andrew Vickers, of Memorial Sloan-Kettering Cancer Center in New York, said in an interview.

The scientists compared acupuncture plus standard treatment to normal therapy alone in 401 patients in England and Wales who suffered from headaches several days each week. Their research is published online by the British Medical Journal.

Patients who had been assigned acupuncture plus standard treatment received up to 12 treatments over three months.

Initially there was not much difference between the two groups but at the end of the year-long trial the scientist noticed a big change.

Patients receiving acupuncture had 22 fewer days of headaches per year, used 15 percent less medication, made 25 percent fewer visits to their family doctors and took fewer days off sick than the other group.

There were not many side effects and Vickers and his colleagues also found that the treatment was cost effective.

Acupuncture was first used in China about 2,000 years ago, according to Vickers. It involves inserting very fine needles into the skin at specific points in the body. It is one of the most popular forms of complementary medicine and has been shown to relieve nausea and pain.

German researchers have also said it could help women undergoing fertility treatment to conceive.

 
 
#5 Role of Massage Therapy & TM Pain

Scientific research has proven the effectiveness of Therapeutic Massage as it applies to:

• Relaxing muscle tension
• Improving circulation of blood and lymph
• Enhancing overall relaxation
• Improved immune system functioning
• Improved flexibility

With proper application of Therapeutic Massage, oftentimes, the following symptoms of TMJ/D can be greatly reduced or even eliminated.

• Muscular tension and pain in head and neck
• Headaches
• Stress and anxiety

If you would like to discuss a treatment program or if you need an appointment, please contact:

Ed Kane
edkanecmt@comcast.net
(773) 818-5232

 
 
#6 Grinding Clenching vs TM Disorders

Bruxism can develop at any age. Many patients are unaware that they are grinding their teeth because it often happens while they sleep.

Classic symptoms of night grinding are:

• Waking Up With A Headache
• Toothache On Opposing Top And Bottom Teeth
• Earache
• Sore Face (Tightness Of Muscles Of The Jaw)
• Noticeable Tooth Wear

*Grinding sets the stage for TM pain

*Grinding can wear away or fracture tooth enamel and may eventually loosen teeth.

*The disorders appear to affect about twice as many women as men.

• Grinding Away -> Flattened Tooth Structure: It is very well documented that flattened tooth anatomy creates excessive lateral force on the TM joint. People who grind can, and will, eventually grind away nature’s protective biting surfaces. The loss of these natural tooth inclinations will result in excessive force on the TM joint and associated joints and muscles.
• Grinding Imbalance: People who grind on one side more than another will quickly create an imbalanced biting surface. Remember, if the jaw is forced out of alignment by the teeth, the muscles will be strained to accomplish everyday activities.
• Clenching or Grinding Related Muscle Strain: People with TMD often Clench or Grind their teeth at night, which can tire the jaw muscles and lead to pain.

Grinding and/or Clenching verses Root Surface Sensitivity
Grinding and root surface sensitivity commonly occur together. This is due to the fact that the pressure of grinding or clenching will cause bone loss and gum tissue recession with subsequent root surface exposure. In fact, patients who grind their teeth and have gum disease will lose bone 50% faster than those patients with gum disease alone.

Treatment of Grinding Habit

1. Check for abnormal bite and if necessary make adjustments.
2. Help the patient to recognize and eliminate the para-functional habit.
3. Fabricate a grinding appliance

Benefits of a grinding appliance:

• Prevent Tooth To Tooth Wear that occurs during grinding contact (attrition).
• Slightly hold mouth in an open position. This lengthens muscles and helps reduce muscle cramping.
• Covers and eliminates trauma from any unbalanced abnormal pathologic bite. A properly designed and professionally adjusted bite appliance will help patients move their jaw freely. Adjustment of an oral bruxing appliance is complex, and should be handled by a dentist who understands occlusion. Dr. Landers has been trained to equilibrate occlusion and oral appliances.
• The acrylic appliance relieves some of the pressure of grinding and clenching which can otherwise damage delicate jaw joints.

 
 
#7 Nervous Energy-Oral Habbits vs TM Disorders

We All Have Habits
All of us have a constant and basic metabolic rate or level of energy. Some inherently have more, while others have less. There is scientific research that suggests that we evolved with this energy because our ancestors needed this energy for grooming. In our modern day society there is less need for grooming and our lives are more sedentary i.e. desk work. As a result, we have extra energy. This energy manifests itself in one form or other. One such way to express this energy is fidgeting habits like: gum chewing, feet tapping, hair twirling, nail & cheek biting, and clenching/grinding, just to mention a few. Additionally, we know that some people allow their self corrective attention to be sidetracked due to an over focus on work or other interests (=stress!).

Did you know that our mouth hygiene is unique in that most of oral cleansing is maintained from the movement of your cheeks and tongue over our teeth? Observe this behavior next time you have finished a meal. This is an example of a self grooming habit.

Can an Oral Trigger Lead To Para-functional Habit?
There is no scientific evidence to support the theory that increased oral awareness from an oral trigger is linked to the establishment of an oral Para-functional habit. On the other hand, an abnormal bite from a dental restoration can be just enough to cause tremendous problems. Some patients will test & retest their new bite over and over. If the bite interference is not eliminated, this behavior could initiate a repeated action and theoretically may result in a Para-functional habit. Long term, and not in all patients, this habit can become excessive and ultimately create strain and wear on muscles, ligaments and the TM joint itself.

It’s important to note, it is most often difficult to “pin- point” the origin of many Para-functional habits including tooth grinding or clenching. Additionally, grinding is often familial in occurrence (i.e. runs in families). Because the occurrence is familial, this suggests that there may be genetic factors involved. Additionally, grinding and clenching occur more commonly with an undiscovered oral trigger and/or tooth to tooth interference. Finally, it should be noted that tooth pain can lead to oral triggers.

I Don’t Grind My Teeth… Do I?
Quite often, patients are not aware of their oral fidgeting type or Para-functional habits. Clinically, patients will present with obvious tooth to tooth wear that clearly suggests some current or past history of an oral habit. Most of the time on the patients subsequent visit and they will surprisingly inform me that they have discovered their Para-functional habit.

Treatment of Grinding Habit

1. Check for abnormal bite and if necessary make adjustments.
2. Help the patient to recognize and eliminate the Para-functional habit.
3. If habit is still present after bite is balanced, conservative treatment of a grinding-bruxing appliance is properly equilibrated.
   Benefits of a grinding appliance:
   • Prevent tooth to tooth wear that occurs during grinding contact (attrition).
   • Opens mouth which lengthens muscles and helps reduce muscle cramping.
   • Covers and eliminates trauma from any unbalanced abnormal pathologic bite. A properly designed and professionally adjusted bite appliance will help patients to move their jaw freely. This is a complex type of adjustment and should be handled by a dentist who understands occlusion. Dr. Landers has been trained to equilibrate occlusion and oral appliances.
   • The appliance relieves some of the pressure of grinding and clenching, which can damage delicate jaw joints.

 
 
#8 TMJ -Migrain or Tension Head Ache Pain

Pain is not a disease. It is a warning that something is wrong. No doctor would give you pain medicine as the only treatment for a broken bone. Our treatment goal is to help you cure the reason for your pain. The cause of headache pain must also be discovered and treated. However, often treatment only includes pain relievers, trapping the patient in an unending cycle of drugs and pain.

Tension headaches are one of the most common forms of headache and are often confused with migraine headaches. They may occur at any age, but are most common in adults and adolescents. If a headache occurs 2 or more times weekly for several months or longer, the condition is considered chronic.

Tension headaches result from the contraction of neck and scalp muscles. One cause of this muscle contraction is a response to stress, depression or anxiety. Some experts suggest that Stress, either mental or physical, may cause or aggravate TMD. People with TMD often tense muscles in the Jaw joint and Clench or Grind their teeth at night, which can tire the jaw muscles and lead to pain.

Is Jaw Pain Or TMJ Pain A Possible Reason For My Head Pain?

• Occlusal interference is a conflict between the teeth and jaw joints which is the cause of over 40 million people’s head, neck, or facial pain and dental damage
• A disease with symptoms that are commonly confused with migraine, tension, cluster and stress headaches
• A problem that can easily be treated by your dentist

In a landmark study, Dr. Jannet Travell, MD found that the pain from occlusal interference can radiate and refer to other areas of the head, neck and face with varying intensity and frequency.

How Dr. Landers Determines if Your Pain Is From Muscle Spasms Due To Occlusal Interference

At our office we can determine if your pain is related to an abnormal bite in less than five minutes:

Clinically it’s A Four Step Process:

1. Evidence that you are clenching or grinding your teeth
2. A conflict between the centered position of your jaw joints and your teeth
3. Pain and soreness in any jaw muscles
4. Pain relief using the Bite Discluder

If the Bite Discluder takes away your pain, you can expect substantial relief from bite treatment. The combination of pain relief from a Bite Discluder and Dr. Landers’ diagnosis can indicate that a large percentage of your pain is due to muscle spasms that are caused by occlusal interference. Only a trained dentist can fix your bite.

*Tension headaches are not associated with structural lesions in the brain as in Migraine headache pain.