Sunday, July 23rd, 2017

TMJ Treatments and Nerve Repair

Read the first article describing how TMJ occurs – click here.

TMJ Treatments and How Nerves Play a Role

About one-half of all the nerves of the brain go to the mouth, jaws and lower face. Did you know that? No wonder jaw pain is so common!

Types of Nerves and How TMJ is Affected

There are three types of nerves: sensory, motor and autonomic. Quick definitions so you can understand your TMJ association with nerves.

1. Sensory nerves
Conduct sensations – touch, heat, cold, pressure, pain, etc.
2. Motor nerves
Motor nerves cause the muscles to contract for movements of the lips, tongue, jaw, palate, larynx, etc.
3. Autonomic nerves
Autonomic nerves are part of the subconscious control system. They turn on and select secretion of saliva, tears, nasal secretions, etc. They also connect to the rest of the body; the digestive system, the heart, reproductive organs, etc. to get the rest of the body ready for what’s going to happen next.

These nerve systems are complex. Medical science cannot explain all we would like to know about how the nerves function in health and disease. Fortunately, (in the last ten years) much has been learned about pain, muscle control, nerve reflexes, etc.

Consequently, more patients are being helped. More importantly, it has been learned that patients with chronic pains have real physical problems and aren’t suffering because of emotional instability.

Jaw Joints and Nerves and TMJ

Abnormalities of the jaw joints and nerves are major causes of disease and illness in our society – probably causing five to ten percent of the population to suffer headaches, pain and/or abnormal body function. Typically, the pain begins in the region of the ear.

Pains tends to grow from the ear and becomes a headache radiating through the temple perhaps behind the eye and then down the back of the neck. Some patients describe feeling extreme jaw tightness or “lock jaw.”

Often TMJ is misdiagnosed by primary physicians as a vascular migraine headache, when in reality many so-called vascular problems and neuromuscular contraction problems are secondary to the derangements of the TMJ.

TMJ problems also cause neck, back, shoulder and arm pains – and vice-versa.
It is not uncommon for TMJ patients to have arm pain, numbness or weakness.

If the neck vertebrae get out of line, pain may radiate through the back of the head into the region of the TMJ and temple. Therefore, it is sometimes important to have an examination and treatment for neck problems for these can contribute to painful symptoms.

What is a TMJ Headache? How to Know if you Have One!

The TMJ headache symptoms vary because TMJ is called the “The Great Imposter” with symptoms appearing like traditional migraines or sinus, ear, eye and neck problems.

Generally, pain begins in and around the ear or jaw portion near that area and is sometimes accompanies by stuffiness, buzzing, ringing, fullness and even a sensation of water dripping in the ear.

TMJ pain migrates into the temple across the side of the head and down the back of the neck. In severe cases, the pain radiates behind the eye, causing a deep pressure pain in the retro-orbital region.

These TMJ headaches are like a deep ache and last for hours and sometimes days. Some patients have ported nausea.

There is an old saying “if you assume that a person is neurotic you can use his symptoms to support your diagnosis.” So if you are told by a physician the pain is in your head – they are right but it is in your jaw not your mind!

Whereas most people with jaw joint problems don’t seem to suffer much and are able to cope with TMJ problems there are others whose lives are devastated by these problems. There are literally millions suffering headache and other physical and emotional disturbances because of jaw joint problems.

The Jaw’s Disc Joint, TMJ and Degenerative Joint Disease/h2>
The disc, a small cushion in the jaw joint, frequently gets out of place, causing clicking and/or locking at first. This may not always cause pain.

As the joint begins to wear out because the disc is displaced, it can make a crunch or grinding noise. This is called Degenerative Joint Disease (DJD) or Degenerative Arthritis. It is usually limited to the jaw joints and may or may not be painful.

When the disc is out of place it usually will go back in place by itself. This requires jaw repositioning with appliances called bite planes or splints which are commonly used by TMJ patients even if they do not have DJD. T

Treatment of TMJ Options

Treatment of jaw joints is divided into several phases depending on the nature of the problem and the age of the patient.

Youth TMJ
In young patients, if the disc is out of place, jaw re-positioning therapy is recommended to put it back in place even if it is not painful. Generally this is done with appliances that gradually move the joint back together and prevent grinding of the teeth at night.

Adult TMJ
If an adult has a disc out of place for a long period repositioning may not be possible. It is best not to treat this if the patient has no headaches or pain.

However, if it hurts or causes pain, relief can be achieved in 80-85% of the cases by bite splints (bite planes, muscle relaxation jaw appliances, etc.) supported by muscle relaxation therapy; mild muscle relaxant medication, anti-inflammatory medication, and physical therapy, biofeedback, etc. Of all the different treatment programs, the bite splint (jaw repositioner) has proven most effective.

Length of treatment
Stressed individuals who grind their teeth always at night may find the need for an appliance their entire life, while others may simply need an appliance to move the jaw over a period of weeks or months.

Usually the first phase of treatment lasts 8 to 10 weeks, however, it may last a year or more. The second phase depends on what needs to be done to get the teeth to fit together after the jaw joints have calmed down. Sometimes the patient may simply wear the bite splint at night or whenever the jaw becomes uncomfortable.

In other cases, orthodontics or restorative dentistry such as crowns and bridges may be required.

The case of TMJ problems is complex. The tendency to have TMJ problems may be inherited. Childhood injuries are often a factor.

Sometimes TMJ problems lie dormant, then suddenly begin to cause pain for little or no reason. Usually it is impossible to treat the cause – it is best simply to treat what is actually wrong and try to make it better.

Conclusion to TMJ Treatment

Jaw joint problems are broadly classified as developmental abnormalities, diseases and dysfunctions.

Also there are other problems such as dental infections, split teeth, sinus and ear problems, etc., which cause similar symptoms. Nerve inflammations called neuralgia also cause craniofacial pain.

A thorough examination including a review of the patients history, clinical examination, x-rays and laboratory tests provide the basis for the diagnosis.

TMJ treatments are highly variable and based on the nature of the problem, how long it has existed, the patients age, etc.

There is no way to use a cookbook philosophy of TMJ treatment. Each patient is different from the others and the treatment must be based on individual needs. Make an appointment with Smith Family Dentistry for a TMJ evaluation with TMJ specialist Dr. Garry Smith.