TMJ Dysfunction

(Can help be more than a mirage?)

From the perspective of a person suffering from the ravages of temporomandibular joint dysfunction, it must be one of the most perplexing and frustrating medical problems one could possibly have.

The symptoms are unbelievably diverse, both in nature and in severity. The most common symptoms are migraine-like headaches, which seem to come from behind the eyes or the side of the head. Also, there are the headaches or neckaches, which occur at the back of the head right where the neck attaches to the skull. People usually describe these neckaches as "tension headaches." The pain often radiates down into one or both shoulders.

Slightly less frequent, but occasionally more severe symptoms include vertigo (dizziness), ringing in the ears, lancing pain in one or both ears, hearing difficulties, stuffiness in one or both ears, ulcer-like pains in the stomach, low back pain, and poor posture.

More obvious, but less severe TMJ symptoms include clicking, popping, and/or grinding (crepitus) in the jaw joint; tenderness or pain in the jaw joint; sore or painful muscles in the head, face, or neck; difficulty in chewing; fatigue of the jaw muscles after prolonged chewing or talking; limitations of the range of motion of the lower jaw; locking of the jaw in either the open or closed position; clenching or grinding the teeth; and deviation of the jaw when opening or closing the mouth.

When people develop one or more of the above mentioned symptoms and decide to seek medical or dental help, they are often beginning a journey fraught with frustration and danger. A typical scenario goes something like this: Because most often the symptoms seem unrelated to their teeth or jaws, most people usually first seek the help of their family doctor or primary care physician. When he/she recognizes that they can not help the patient, they often refer the patient to an allergist or ENT specialist to have the sinuses and ears checked out. When these specialists can't come up with a good diagnosis or a beneficial therapy, they most often refer the patient to a neurologist. After the neurologist has run exhaustive tests, like MRI's, cat scans, and nerve conduction test, and still not been able to come up with a definitive diagnosis or helpful treatment, the patient is often told the symptoms are psychosomatic (just in your head) and that they need to see a psychiatrist or go to a chronic pain clinic.

In my practice, we sometimes see two or more people in a day, who come to us telling the above story with very little variation. They are often distraught and frequently have a feeling of hopelessness and helplessness. On one recent day, I saw both a young man who had not been able to go to work for a year because of the pain, dizziness and associated nausea caused by a TMJ problem and a young lady, only 23 years old, who had dropped out of college because of the pain from head aches and neckaches associated with her TMJ problem. Both of these young people had already seen all the doctors described in the scenario in the above paragraph to no avail. What a sad series of events for these two young people? Unfortunately, there are only a handful of professionals in this country who truly understand gnathologic orthopedics as it relates to the cranial-mandibular-cervical complex and the temporomandibular joint.

The ravages of TMJ dysfunction pay no heed to social or economic status. Burt Reynolds was hit on the jaw. He didn't work for three years. His weight dropped to 140 pounds. People thought he had AIDS which kept him from making movies. What he actually had was TMJ dysfunction. Here is how Mr. Reynolds described his problem. "When your jaw, your bite, goes off, your equilibrium goes off, too. You're in a kind of brain pain that comes up and whips your eyeballs out. Then the nausea starts. It is like being seasick all the time. You throw up, can't lie down, and can't take any light. If the phone rang, I'd fall on the floor with a pillow over my head because of the pain. I had tubes in my ears and I didn't eat, just drank soup. I kept getting thinner and thinner. It was scary. I got real carved cheekbones. Friends suggested I see a psychiatrist."

When asked if TMJ disorder was a rare disease? Mr. Reynolds said, "No, lots of people have it but there are thousands of dentists who don't know how to treat it. I saw 13 of them. Finally, I found a guy in Florida and spent weeks.......... Asked when he finally decided to take control of life again, he said, "The moment I woke up and was no longer nauseated."

Albeit, most professionals have good and honorable intentions for helping their patients, almost no medical doctors and only a precious few dentists have a comprehensive enough understanding of TMJ dysfunction to offer anything more than an attempt to control symptoms. I once heard the statement, "When you have a hammer, a lot of things start to look like a nail." I suspect that statement accurately explains the treatments most often recommended for TMJ patients. The "hammer" of many medical doctors is drugs and/or surgery. Because the symptoms of TMJ dysfunction are so diverse and often poorly defined, some of them certainly look like a "nail." Maybe this explains why so many TMJ patients have had tubes put in their ears and have been given drugs for migraines. The "hammer" of a general dentist may be an acrylic occlusal splint, trigger point injections, or occlusal equilibration. The "hammer" of an oral surgeon, of course, is surgery, which in my opinion, is only very rarely warranted. The "hammer" of the orthodontist is to straighten the teeth. The "hammer" of the chiropractor is adjustments, or physical therapy, or electrical stimulation. What is truly lacking are practitioners with eclectic enough backgrounds to have a comprehensive understanding of how the teeth, temporomandibular joint, the bones of the skull, the cervical vertebrae, and the muscles of mastication interface with each other. With that understanding, non-surgical, non-chemical therapy can be rendered which may yield health, comfort and vitality that is with in reach for all those who suffer from TMJ dysfunction.