Understanding TMJ Disorder

TMJ disorder affects the joints and muscles that control jaw movement. This can lead to symptoms like pain, difficulty chewing and even locking of the jaw. Despite these clear indicators, TMJ disorder often goes undiagnosed. In a study by Johansson et al. (2002), it was found that 6.7% of males and 12.4% of females experience TMJ-related pain. Additionally, data from the National Health Interview Survey in 1993 revealed that 3.5% of males and 6.9% of females reported experiencing pain in the jaw joint or in front of the ear on multiple occasions over six months. These statistics highlight a gender disparity in TMJ disorder prevalence that underscores the need for better understanding and treatment options.

The Role of Medical Training in TMJ Awareness

The limited awareness of TMJ disorder can be traced back to the training of healthcare providers. Very few dentists and medical professionals receive adequate education on TMJ disorders, which contributes to the lack of comprehensive care available for sufferers. This lack of training means the condition is often misdiagnosed or not recognized at all. As a result, many patients do not receive the specialized care they need, leading to ongoing pain and discomfort. Increasing TMJ-specific training in medical and dental programs could significantly improve diagnosis and treatment outcomes for patients. Many physicians tell their patients that it is not something they can see and refer them to other healthcare providers like an ENT, PT or Osteopath doctor.

Common Misdiagnoses and Overlapping Symptoms

TMJ disorder is frequently mistaken for other conditions due to its overlapping symptoms, such as headaches, ear pain and neck tension. For instance, the Osteoarthritis Initiative (2007) discovered that 3.8% of males and 10.9% of females aged 45-79 with a history of knee pain also reported jaw joint or ear pain in the past 30 days. This finding suggests that TMJ pain can easily be confused with other joint disorders, leading to inappropriate or delayed treatment. Educating healthcare providers to recognize these overlapping symptoms can help differentiate TMJ disorder from other conditions and prevent unnecessary treatments.

These overlapping symptoms often result in TMJ disorder being misdiagnosed as more common conditions like migraines, ear infections or even dental issues unrelated to the temporomandibular joint. Headaches caused by TMJ disorder can mimic migraines, making it difficult for both patients and doctors to identify the root cause without specialized knowledge. Ear pain, a common TMJ symptom, is often misattributed to ear infections, particularly in the absence of visible signs of ear problems. Neck tension and pain can lead to a misdiagnosis of cervical spine issues, diverting attention away from the actual problem in the jaw.

Tinnitus — hissing, buzzing and/or ringing in the ears — is often a TMJ problem. This is why an MRI is so critical in determining what the problem is. If the articular disc has slipped forward of the jaw bone (the condyle), this can readily push the condyle back and into the region of the ear. This is where so much ear pain and tinnitus can come from. The problem is that it requires an early enough diagnosis before nerves are damaged badly enough that they cannot be repaired. The TM joint is heavily innervated, meaning if the discs are slipped, they could readily damage the nerves surrounding the joints.

Healthcare providers’ limited training in TMJ disorders compounds these misdiagnoses. Very few dentists and doctors (not all) have the expertise needed to identify TMJ disorder accurately, leading to a cycle of incorrect diagnoses and ineffective treatments. Patients may undergo multiple consultations and treatments for symptoms that never fully resolve because the underlying TMJ disorder remains unaddressed. I have personally heard many stories of patients going on antibiotics for months on end to treat ear problems, or having tubes placed, when the real problem was simply a slipped disc.

Improving the education of healthcare professionals about TMJ disorder is crucial for better diagnosis and management. When doctors and dentists can more accurately identify TMJ disorder, they can provide appropriate treatment plans tailored to alleviate the specific symptoms associated with the condition or refer to a specialist. Addressing this educational gap can significantly reduce the incidence of misdiagnoses and ensure that patients receive the care they need for lasting relief. It is our mission within our practice to do so.

The Impact of Public Awareness Campaigns

Public awareness campaigns are essential for bringing TMJ disorder into the public eye. Increasing awareness can help individuals recognize symptoms early and seek the appropriate care they need. Currently, TMJ disorder has not been prominently featured in widespread public health campaigns, leaving many people unaware of its existence and impact.

Raising awareness can lead to several positive outcomes. Firstly, it can prompt individuals to seek medical advice sooner, potentially leading to earlier diagnosis and treatment. Early intervention can prevent the condition from worsening and improve the quality of life for those affected. Secondly, heightened public awareness can create a demand for more specialized care, encouraging healthcare providers to develop expertise in TMJ disorders. This, in turn, can lead to more comprehensive and effective treatment options.

Public campaigns can also help dispel myths and misconceptions about TMJ disorder. Many people might dismiss their symptoms as insignificant or believe that jaw pain is a normal part of life. Educating the public about the seriousness of TMJ disorder can help people understand that their symptoms are valid and treatable. By providing clear information about the symptoms, causes and available treatments, public health campaigns can empower individuals to take control of their health.

Additionally, increased awareness can foster a sense of community among those who suffer from TMJ disorder. People may feel isolated or misunderstood because their symptoms are not widely recognized. Public awareness initiatives can connect individuals with support groups and resources, offering a network of understanding and shared experiences.

Moreover, raising public awareness can influence policymakers and funding bodies to allocate more resources toward TMJ research and treatment. Increased funding can lead to breakthroughs in understanding the disorder and developing new, more effective treatments. By spotlighting the issue, public campaigns can drive systemic changes that benefit everyone affected by TMJ disorder.

Public awareness is a great beginning. This is a big reason we reach out to our referring providers to provide educational classes on how to screen. In addition, with our practice, we educate the patient as well. We show on models how the disc behaves and how it is affecting the patient and causing their symptoms. In addition, Dr. Brown participates as a guest speaker at seminars for healthcare providers to share cases and show how the symptoms relate to the rest of the body. The goal is always to educate and share screening techniques. This translates to how we help these patients with their craniofacial pain.

The Importance of Specialized Care

Managing TMJ disorder effectively requires specialized care from professionals who understand the condition’s complexities. TMJ disorders often involve a variety of symptoms that can be influenced by hormonal factors, especially in women. Research has shown that women who use either supplemental estrogen or oral contraceptives are more likely to seek treatment for TMJ disorders. This suggests that hormonal changes could exacerbate TMJ symptoms, making it even more crucial for healthcare providers to consider these factors when diagnosing and treating the disorder.

Additionally, TMJ disorders can be interconnected with other conditions such as fibromyalgia, rheumatoid arthritis and sleep apnea. A specialized approach can help identify these connections and tailor treatment plans accordingly. This is why a multidisciplinary approach often proves beneficial, involving dentists, orthodontists, rheumatologists and other specialists to provide comprehensive care.

In-depth knowledge of TMJ anatomy, pathophysiology and the latest treatment options is crucial for creating effective treatment plans. This includes understanding the role of physical therapy, occlusal appliances and surgical interventions when necessary. Specialized care can also focus on pain management techniques tailored specifically for TMJ-related pain, which may differ from standard pain management approaches.

By seeking care from professionals trained in TMJ disorders, patients are more likely to receive accurate diagnoses and effective treatment plans. This specialized care can lead to significant improvements in quality of life, reducing symptoms such as chronic pain, headaches and jaw dysfunction. Given the complexity and the broad impact of TMJ disorders, specialized care is not just beneficial but essential for those affected.

The actual treatment for people with TMD usually involves wearing some small appliances in the mouth that allow room for the discs to go back into place if they can. If they are unable to return to their proper position, it may be possible to manage them or do surgery to finally fix the problem. In almost all cases, surgery can be avoided and the patient can live a very normal lifestyle with displaced discs. This is why it is important to meet with a TMJ doctor who understands all the various issues.

The Future of TMJ Research and Treatment

The future of TMJ research and treatment is filled with potential advancements that could revolutionize care for those affected by this disorder. Ongoing research aims to uncover the underlying causes of TMJ disorders, which could lead to the development of more targeted and effective treatments. One promising area of research involves genetic studies, which may help identify individuals at higher risk and facilitate early intervention.

Advances in imaging technology, such as MRI and 3D CT scans, are improving our ability to diagnose TMJ disorders accurately. These tools allow for a more detailed understanding of the joint’s structure and any abnormalities present, leading to more precise treatment plans. Additionally, innovations in minimally invasive surgical techniques offer new options for patients who require surgical intervention, potentially reducing recovery times and improving outcomes.

Interdisciplinary collaboration is becoming increasingly important in TMJ research. By bringing together experts from fields such as dentistry, rheumatology, neurology and physical therapy, researchers can develop a more comprehensive understanding of TMJ disorders and create holistic treatment approaches. This collaborative effort can also lead to the discovery of connections between TMJ disorders and other conditions, such as sleep apnea and chronic pain syndromes, allowing for more integrated and effective care.

Telemedicine is also emerging as a valuable tool in the management of TMJ disorders. Virtual consultations can make specialized care more accessible, especially for patients in remote areas or those with mobility issues. This technology enables continuous monitoring and follow-up, ensuring that treatment plans are adjusted as needed to achieve the best outcomes.

The role of patient education and self-management is gaining recognition in the treatment of TMJ disorders. By providing patients with the knowledge and tools to manage their condition, healthcare providers can empower them to take an active role in their care. This approach can include techniques such as stress management, dietary modifications and exercises to improve jaw function.

As awareness of TMJ disorders increases, so too will the availability of funding for research and treatment development. This financial support is crucial for driving innovations that can ultimately improve the quality of life for those affected by TMJ disorders. With continued effort and investment, the future holds promise for more effective, accessible and comprehensive care options.

We Are Here To Help!

At Sleep & TMJ Therapy, Dr. Jeffrey Brown and the team are here to help you get the care you need for TMJ disorder symptoms in Falls Church, Virginia. Call 703-821-1103 to learn more or schedule a consultation.

The post The Mystery of TMJ Disorder Explained! first appeared on Sleep & TMJ Therapy.

Another approach, however, vastly different, is to use medications to calm the pain and at least get some degree of relief almost immediately. In some of these cases, the practitioner would prescribe Cymbalta to alleviate the anxiety often associated with the pain. Cymbalta is a well-known drug used to treat depression and anxiety. Admittedly, many TMD patients are hurting so badly that they become depressed, and anxiety sets in as they worry about how their future is looking. Unfortunately, this drug has a host of side effects that may make it not so worthwhile, but as a temporary measure, it might help for now. Some practitioners use Xanax along with the Cymbalta since it takes time for the Cymbalta to activate the desired response.

In other cases, something like Cymbalta is used in conjunction with injections into the muscles of the head and neck region to calm those muscles that have been irritated from the slipped discs. Injectables like Botox®, cortisone, prolotherapy and stem cell therapy have been documented to reduce muscular tension. This also provides some degree of temporary relief and may even help to ‘reset’ the muscles into a better pattern.

Of course, there are the surgical approach options. The least desired surgical treatment entails breaking the jaws and resetting them into a more ideal position, however, this approach may not work very well. Cutting apart the bones of the skull may be more risky than other modalities. A more conservative approach to dealing with the displaced discs in the jaw sockets entails simply putting the discs back on top of the condyles. A 20-minute surgery called plication. By far, this is more conservative and simpler than the other surgeries.

So as a patient, you have a choice: try to figure out the underlying issues and deal with them accordingly, or mask over the symptoms and hope things settle down. As I tell our people, it is up to you and I am simply here to guide you on the journey.

Read more about TMD.

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Diagnosis of the problem is paramount. A really well-done MRI is critical in determining the path of treatment, and many times getting good imaging is quite difficult. So here is the first ‘delay’ in fixing the problem, getting an appointment for a well done and well-read MRI. It can take several weeks to get that appointment and quite honestly some people just do not want to wait. I can’t blame them either. Let’s get it done now!

The next delay is just getting an appointment at the office to discuss all the issues. This is where we look at the bone from the CBCT X-ray and the soft tissue from the MRI. In most cases, people want their insurance to pay at least something and that in turn creates the next delay. Next on our list is the fact that with TMJ appliances, they are custom-made. This takes time. They are not something sitting on the shelf, ready to put in the mouth. It takes weeks to make them since they are custom made for each person.

Now let’s get to the next big delay. You have to wear the devices for 12-18 months to give the discs a chance to move back into the proper position. That’s right folks, it takes that long, especially if the discs have been displaced for several years. The discs don’t just fall back into place instantly. It will take time and patience. Of course, some are not willing to devote such time (and patience) to their health, so they do not do anything. That is OK as not everyone is experiencing the same level of pain or discomfort. When it gets really bad, the patient will pursue treatment but generally now the problem is harder to fix, costs more, and takes more time. This is like most things in life.

Finally, the biggest time consumer of all – finishing after the discs are back in place. In most cases, orthodontic work is needed to grow the teeth taller to protect and support the TM joints (the jaw joints). Orthodontics can take 1 ½ -3 years, easily! So here you are, having spent all this time on appliances only to realize it’s going to take another couple of years. You are basically dedicating up to 4-5 years of your life toward fixing a TMJ problem. This is why we always tell our patients phase one is appliance therapy and phase two is finishing. Thus, the question has been answered. Now you know why TMJ treatment can take so long!

The post The Case of: “Why Does This Take So Long?” first appeared on Sleep & TMJ Therapy.

Another aspect of having a tooth pulled out is that upon removal of the tooth, the bite on that side will experience an almost immediate collapse in which the jawbone (condyle) will now go more deeply into the socket. This is where a TMJ problem begins. When that condyle jams further up into the jaw socket, it will impinge on the articular disc that covers the condyle. This can cause a gradual displacement of the disc and subsequent TMJ disorder. If multiple teeth are removed this can readily lead to the discs being pushed way out of proper placement and this can be quite painful for so many people.

With periodontal disease, the bone and gum support around the tooth becomes weaker over time. This can lead to the tooth getting loose in the socket and it can no longer be a good vertical support for the jaw joints. Just like the foundation of a house, if it starts to rot away, the whole house can tip sideways. The jaw is similar. If the teeth become looser due to periodontal disease, this can destabilize the jaw joints and the discs in those joints can become damaged more readily. By maintaining good periodontal support for your teeth, this will help the jaw joints stay healthier and stronger.

Unfortunately, oral cancer should be mentioned in this blog. Cancer in the mouth can lead to loss of teeth and bone which of course can lead to loss of TMJ support. This is why it is so important to keep up with your dentist and at least yearly have them do an oral cancer screening. This screening only takes a few minutes, yet it could save your life and your health. So many people are very afraid of cancer but if detected early enough it is fairly easy to treat.

As Dental Health awareness month is April, be smart and reach out to your dentist about your dental health. Ask questions. Ask if they are checking for periodontal disease. Ask about cavities. And most importantly, ask if they are checking for any signs of oral cancer or other diseases.

The post How Oral Health Affects the TM Joints first appeared on Sleep & TMJ Therapy.

Why is sleep important? When the body does not sleep well, it is far more likely that disease processes can begin. As anyone knows, when your body is just tired all the time, it is far more likely you will catch the flu and infections are far more likely to set in. This is the case with cancer as well. When your body is debilitated from lack of sleep it is easier for cancer to set in.  There is now plenty of research to support this. If you simply Google ‘cancer from sleep apnea’ you will find that with moderate to severe sleep apnea, you are two and a half times more likely to develop cancer and three times more likely to die from cancer. This is a serious statement. What this means is that if you are not sleeping well, you are far more likely to contract kidney cancer, melanoma, breast cancer, and uterine cancer. Even though the risk of lung or colorectal cancers is less, it is just not worth the risk when you do not sleep well. TMJ disorder affects not only your joints but impacts the quality of sleep. A confirmation from UVA hospital’s research is that good sleep has been confirmed to be key to good health. With good sleep, the lymphatic system is regulated, and in turn, helps regulates many immune systems.

So, what is the message of this little blog? The message is to pay attention to your body. If the jaw joints are causing pain – headaches, neck or back pain, or even dizziness and tremors – then pay attention and have it looked at by someone who understands the situation. And this has now opened up another proverbial can of worms: Who do I see? TMJ disorder is so poorly understood that there is no consistency in diagnosis or treatment. So please stay tuned as the next blog will delve into the devious world of diagnosis and treatment.

The post Oral Cancer and TMD- Coincidence or Correlation? first appeared on Sleep & TMJ Therapy.

But now let’s be realistic.  If a potential patient reports that they have ‘TMJ,’ they really are just trying to say that their jaw is a problem, and it might need some help. The way to help such a person is to measure how big they can open their mouth, and then palpate the various muscles that attach to the TM joint. This goes a long way in diagnosing the problem. In many cases, it is necessary to further that diagnosis by ordering an MRI to determine what the articular discs are doing in the jaw joints. The articular discs are the cartilage that covers the top of the jaw bones and protects the joints from going bone on bone, which really can hurt badly.

In addition, a specialty X-ray called a CBCT must be done to further determine if the bones of the skull are out of alignment. So first, the MRI, then the CBCT to figure out what is really going on in the joints. At this point, a discussion must be done about how best to treat the problem(s). Each person has unique symptoms and determining the best appliance is critical. Often, wearing an appliance or an appliance for each arch in the mouth works to ‘decompress’ the joints. This is very effective. The appliance(s) must be worn for a year or more in order to be effective. Then a new MRI and X-ray must be done to see if the discs have moved or are moving back where they should be.

Sometimes,  unfortunately, the disc is either damaged or is not moving back. At this point, it may be necessary to do surgery to help move the discs back into place or remove the damaged disc. Other therapy options to help with the symptom management are prolotherapy, BOTOX®, or even stem cell therapy to help. Surgery is always the last-ditch option because it is more invasive than any other choice. It is, however, very effective and can provide much needed relief to that person who has suffered for many years. The other options, often called the ‘injectables’, help to lubricate the joints so the displaced discs have a chance to move back where they need to be. Sometimes this works quite well, other times not so much because they are not actually fixing the underlying problem.

So, if you do indeed have ‘TMJ’ problems then you most likely have other body pain or symptoms as well. The TM joint can be a problem and you will want to fix it. If so, see the right doctor, analyze the problem, and treat this before it becomes more difficult.

The post “I Have TMJ” What Does That Really Mean? first appeared on Sleep & TMJ Therapy.

The truth of the matter is that if you work with an experienced TMD (Temporomandibular Disorder) specialist, then such an advanced procedure is rarely necessary. The path toward surgery should always try to be avoided, but sometimes it is simply necessary.

When a patient first begins treatment, they must do an MRI to figure out how damaged the discs in the jaw joints really are. This gives the specialist a good baseline to begin with so that a comparison MRI 12-18 months later will help to determine if enough healing has occurred so that surgery is not needed. It’s all relative- if after the 12–18-month appliance therapy period, the patient just feels great, yet the discs are not quite perfect position, then no surgery is indicated. If there is still substantial discomfort, then there would be a discussion about the type of surgery and how to finish the case.

In almost all cases that require surgery, the process is either plication (put the discs back into proper anatomic position) or meniscectomy (remove the remnants of the damaged discs). In either case, the surgeon makes an incision that is only one inch long at the little crease just in front of the ear. He then goes into the joint and will fix the problem either way. Sutures are done internally to keep the discs where they should be, and external sutures are done to seal the area. These two surgeries are considered simple and logical and when done will last a lifetime in almost all cases. The key factor is having a surgeon who has done many cases over the years. It should also be mentioned that TRJ (Total Joint Replacement) is only done when the top of the jawbone (the condyle) is severely eroded beyond any reasonable chance of repair. This is a rather heavy-duty surgery because you are in full braces and the jaws are wired shut for a few months. Eating through a straw is no fun, but there are few other options.

Because TMD treatment is so misunderstood and mismanaged, there are many opinions coming from many practitioners about the proper course of treatment. Some surgeons will ONLY perform TJR while others would do arthrocentesis (flushing the joints) before considering plication or meniscectomy. For these reasons, insurance companies are hesitant to pay for a procedure and call it all ‘experimental’ which it most certainly is not. So please be well informed and understand the options!

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