As you are well aware, head, neck and orofacial pain affects a very large percentage of the population who presently seek care for both acute and chronic pain, most of which are temporomandibular joint disorder sufferers. Although most of these patients are women, some men as well as children and, increasingly, adolescents also suffer from this condition.

Signs and Symptoms:

The most common symptom of TMD is noise in the joint, which is usually related to the rapid reduction of the cartilage disc malpositioned between the condylar head and the glenoid fossa. Many patients, however, suffer from symptoms that do not include joint noise. One major symptom is pain, usually localized in the muscles of mastication, the accessory muscles of mastication in the posterior cervical area, the temporomandibular joints and the area around the ears.

Many motor vehicle accident/trauma/whiplash patients have a range of signs and symptoms and signs, which could include craniomandibular pain dysfunction with cervical shoulder and lumbar involvement. Without initiating treatment of the TMJ, the syndrome, as a whole, cannot be treated.

Many of these patients may present with complaints of the following:
• Chronic tension-type headaches possibly leading to a “true” migraine.
• Limited mandibular movements or open/closed locking
• TMJ sounds; clicking, popping, grating - all of which may require stethoscope and/or doppler auscultation to detect.
• Vertigo and general balance problems.
• Facial pain which is often confused with such conditions as trigeminal neuralgia
• Neck, shoulder and back pain or stiffness.
• Ear congestion or pain with no apparent etiology. Many children have had “tubes” placed for mistaken ear pain with no investigation of TMJ. Often times, children will be treated for chronic ear infections when they actually suffer from TMJ symptoms.

 

Causes:

Causes of TMD are usually multifactorial and therefore involve treating the relationships of the upper teeth to 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 (eg: whiplash) to the masticatory structures and upper body can lead to TMJ, head, neck and facial pain. Strains, sprains and other injuries can lead to both pain and dysfunction.

Malocclusion: 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 such as the neck, throat and upper back.

Muscle spasms: Any condition that prevents the complex system of muscles, bones and joints from working together in harmony can result in 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.

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.

General Systemic Medical Conditions:
(Eg:rheumatoid arthritis, psoriatic arthritis): Dr. Thompson has an established network of medical specialists eg: neurologists, ENT, rheumatologists that we refer to in such cases on an as-needs basis.

Generally Dr. Thompson’s goal is to provide a multifactorial solution to a multi-etiological problem. He does not wish to see patients (who unfortunately can only find whatever help is available in a chronic pain clinic - using potent, lifestyle detracting medications often with limited success and limited prognosis for any realistic recovery) condemned to a lifetime of dysfunction and pain

Treatment:

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 (usually a specialist). Dr. Thompson performs a full examination of the TMJs, head, neck and facial region as well as radiographs and if required, he will occasionally request an MRI evaluation. With these diagnostic tests, Dr. Thompson is able to objectively determine the pathological nature and extent of joint sounds and injuries to the TMJ area thereby arriving at a realistic diagnosis. Frequently, a custom made appliance is prescribed for orthopedic and musculoskeletal stabilization.

While many of the symptoms are improved with pharmacological agents such as analgesics, muscle relaxants, anti-depressants, additional adjunctive therapies may also be required. These could include:

• Stress counselling • Hot and cold therapy
• Nutrition counselling • Pulsed radiofrequency
• Ultrasound • Iontophoresis with dexamethasone
• Infrared laser • TENS and MicroStim
• Referral to other clinicians: ie: chiropractor, neurologist, rheumatologist
• Injection therapy eg: depo-medrol and occasional therapeutic Botox
• Massage therapy – Dr. Thompson has a registered massage therapist on staff specifically educated to a higher level in the area of TMJ.

Treatment usually requires two phases, the first being pain relief and restoration of function and the second being stabilization. Once pain is controlled and the jaw is stabilized, the bite is balanced so the teeth, muscles and joints all work together without strain or pain.

Dr. Thompson believes in conservative treatment first, however, it is not always possible to treat a patient conservatively, and occasionally surgery is necessary. Dr. Thompson practices with a group of specialists which includes an oral and maxillofacial surgeon who is very familiar and highly skilled in this area. He is fully trained in the area of endoscopy which is the usual “first line of attack” if surgery is required, being the most conservative of treatment regimes in the surgical arsenal.