TMJ DISORDERS | HOLMES DENTAL ASSOCIATES

Headache pain

There are many causes of headaches and they can be very challenging problems for a clinician to diagnose and treat. TMJ problems are a major source of headaches, especially of the temporal region. If a patient presents with pain of the facial, temporal, masseter, or occipital region it is often myogenic in nature and caused by a hyperactivity of these muscles due to a TMJ disorder.

Masticatory myalgia can mimic the location, manifestation, and intensity of true vascular migraine headaches. The important point is that the two differ in etiology and more importantly treatment. Unfortunately, there is a tremendous amount of false advertising by dentists who claim to treat migraines by the use of bite splints or TMJ therapy.

Myogenic head pain is usually caused by a discrepancy in one’s dental occlusion related to their condylar position which then results in hyperactivity of the masticatory muscles. Habitual clenching of one’s jaws can also cause severe pain of the muscles of mastication.

Internal derangements of the temporomandibular joints can cause pain of the joint area itself or refer pain to regions of the head. The internal joint problem most often found is displacement of the meniscus (disc) to varying degrees. Condylar head pathology can also be a source of pain in a small percentage of patients.

The differential diagnoses for head pain can be a lengthy list. Cervical, dental, neurological, vascular, and auricular sources are common problems that create pain in the head. We have the ability to determine if a patient’s headache is caused by the most common source of a TMJ disorder. We have the most systematic, effective, and modern diagnostic methods and treatment options available for TMJ patients.

Botox

Botulinum injections can be an effective treatment option for chronic myogenic head pain that is unresponsive to primary treatments. We use this option with remarkable success.

It is important that Botox NOT be administered prior to the establishment of a TMJ diagnosis or as a primary treatment option for headache pain because most patients have an underlying occlusal or joint problem that should be corrected first.

Many people have some degree of damage to their temporomandibular joints that manifest as popping, clicking, or grinding noises. The noises are caused by an anterior displacement of the cartilage disc that is normally interposed between the condylar head and the glenoid fossa. The ligaments that position the disc can become stretched or torn from even a very minor injury which can then allow the TMJ disc to become displaced. The popping noise that is heard is from the disc reducing back onto the condylar head during opening or from it slipping off when closing. The direction and degree of a displacement as well as the shape and integrity of the disc determine the diagnosis, prognosis, and treatment.

All popping TMJs are not the same and are therefore not treated the same! There are 8 different classifications of internal derangements and additional subcategories. Although their signs and symptoms may appear to be the same, the treatment and prognosis of the stages are significantly different.

It is imperative that it be determined whether a disc displacement occurs at the lateral or medial pole of the condylar head before providing any type of irreversible dental treatment, including equilibration, orthodontics, prosthodontics, or jaw surgery. The prognosis of a medial pole displacement is much poorer than one at the lateral pole due to the fact that the loading of the joint occurs at the medial pole. In addition to which portion of the disc is displaced, the medial or lateral direction of the displacement is also important to know.

Locking jaws are caused by a displaced disc that does not reduce. This locking can occur with the mandible open or closed. Closed locks usually represent a more severe problem and need aggressive early intervention.

We know how, when and why to properly treat TMJ problems.

Occlusal equilibration
may be performed for patients with an unbalanced bite when orthodontics is not needed.

Full Mouth Rehabilitation can be performed when severe attrition or malocclusion is present.
Teeth

Splints are sometimes utilized. However, many patients can be treated without a splint. When necessary, we use a single splint that is thin and comfortable which results in a high degree of patient compliance. Soft splints are contraindicated for muscle pain. Partial splints are contraindicated for internal derangements.

OPEN LOCK The patient should have the lock reduced and should be seen within 7 days of the incident.

CLOSED LOCK The patient should be seen within 1 day of the incident. Proper early management of this problem dramatically increases the success rate of treatment.

Less than 5% of our patients require surgical intervention to relieve their symptoms.

There is arguably no other area in medicine with more confusion and disagreement than TMJ disorders in not only the treatment but the diagnosis. It may be acceptable to have differing opinions on how to treat any condition of the body but there should be only one correct
diagnosis.

With the litigious nature of today’s society, why burden yourself with the responsibility of this complex problem? Although the all-too-common recommendation of “soft diet” and “no gum chewing” may provide acute relief in some cases, it is not sufficient anymore. We have the experience necessary to treat TMJ disorders and complex dental problems.

Whether it is the initial manifestation of a problem, a patient that is unresponsive to treatment, or an acute injury, we are here to help you and your patient.

Dr. Dennis M. Holmes