What Patients Should Know
Before Seeking Treatment for a Jaw Problem
Who do you turn to when seeking answers for jaw problems and related headaches or neck pain? It can be very challenging to obtain reliable information, especially when seeking answers using the Internet. Finding a clinician you can trust can also be difficult.
Knowledge is power. The more the patient knows about the nature of jaw disorders and related head and neck pain, the better equipped they will be to make an informed choice about where to seek help. Unfortunately, there is very little consensus among doctors about how to diagnose or treatment these problems. Patients can seek answers from five different doctors claiming expertise in this field, and get five very different diagnoses and treatment recommendations. It is our hope that the following information will assist you in cutting through the confusion surrounding this field.
As you may know, “TMJ” is a common term used to describe problems related to the jaws and associated structures. TMJ is not a disease or disorder. Rather, it is the name of the jaw joint. This joint is called the Temporo-Mandibular Joint. The term comes from the two bones that form joint—the Temporal bone in the skull, and the lower jawbone, known as Mandible. The term “TMJ” has been associated with a variety of symptoms and complaints, some of which have nothing to do with the jaw itself. The currently accepted term for jaw disorders is “TMD”, which stands for Temporo-Mandibular Disorders.
Fundamentally, a jaw problem is just like any other orthopedic condition. It involves disorders and pain within the jaw joint or associated muscles, ligaments, and nerves. However, because of some unique characteristics associated with jaw problems, orthopedic physicians do not treat these patients.
Common symptoms associated with jaw disorders include:
- Jaw pain
- Facial pain
- Clicking or grinding noise in the jaw
- Jaw restriction
- Neck pain
- Jaw locking
- Ear pain
- Muscle tightness or fatigue
- Shoulder pain
- Bite problems
- Difficulty chewing
It is estimated that 40 million Americans suffer from these varied symptoms in the head and neck region. It is important to point out that jaw disorders do not present the same symptoms in every patient. In fact, no two TMD patients have exactly the same combination of complaints. This is because the causes of TMD can be highly varied.
There are dozens of causes of jaw problems. However, most of these causes can be placed in one of three broad categories. These categories include the following:
Structural Disorders include damage within the jaw joints or abnormal growth of the jaw bones. The damage can include torn or stretched ligaments, a dislocated disc within the joint, abnormal growth of the bones forming the jaw, arthritis, or scar tissue formation within the joint. In addition, recent research has shown that certain deficiencies in minerals, vitamins, or hormones within our bodies can cause destruction of the bone within our jaw joints. These include low levels of calcium, vitamin D, and estrogen.
Structural disorders also include bite problems, which can stress the entire jaw system, by forcing the jaw out of alignment. These bite problems may involve genetic factors, which cause the jawbones to grown abnormally. Bite problems are also caused by bone loss in jaw joints, which alters the hinge axis of the jaw.
Trauma is one of the primary causes of structural damage in the jaw. In many cases, the traumatic injury occurred years before the onset of jaw symptoms. Childhood injuries usually do not manifest as a jaw disorder until the teenage years. Jaw damage can also occur in eating disorders such as bulimia, or repeated vomiting during a pregnancy. Some people are born with a genetic predisposition to having TMD. For example, weak joint ligaments can be inherited.
This category includes problems within the muscles and associated nerves, which control the muscles and bones of the jaw and neck. This category also includes changes in the sensory nerves of the head and jaw, causing abnormal pain sensations. Muscle pain and dysfunction can be caused by harmful habits, such as clenching or grinding the teeth. The same muscles we use to move our jaw are also used in positioning the head and neck. Because of the intimate relationship between neck and jaw function, neck problems can often induce muscle problems in the jaw. Most patients with a jaw disorder also have neck symptoms. If jaw treatment is attempted without addressing the cervical component, the symptoms will often persist. Arthritic muscle conditions, such as fibromyalgia, can also cause pain in the face and jaws.
Emotional stress is what sets jaw problems apart from every other orthopedic condition in the body. It is well known that emotional stress induces tension in the muscles. Some people respond to stress by developing ulcers; others develop chronic headaches, neck pain, or jaw pain. For many people, this emotional stress is simply a reaction in the body to their lifestyle. This includes inadequate or poor quality sleep, poor eating habits, job-related stress, or family stress. It is often a combination of these. Conversely, anyone who is in chronic pain for more than 3 months can experience depression or anxiety. This can cause a “vicious cycle” of muscle tension and harmful habits which perpetuates the pain. Stress is the primary cause of clenching and grinding the teeth.
Each TMD patient is different
Each person has a different combination of all the causes within these three broad categories. Therefore, it is very important that a thorough examination and diagnosis be performed before considering any type of treatment. If the treatment recommended does not address all the components that are causing the symptoms, the treatment is unlikely to provide lasting relief.
Obviously, there are other causes of headaches, ear pain, or neck pain, besides jaw problems. It may therefore be appropriate to refer you to another specialist for further evaluation, if necessary.
How are TMD problems treated?
Because no two TMD patients have exactly the same problems or causes, the treatment must be customized to address each patient’s unique needs. If it is confirmed that you have a jaw disorder, the treatment is generally conservative (non-invasive) in nature.
Treatment may include a jaw splint, to stabilize the jaw, and reduce the harmful effects of clenching or grinding. These devices can also be very effective in reducing headaches and arthritic jaw pain. Specialized orthopedic physical therapy can be very helpful, and can teach many techniques to avoid these problems. Medications are sometimes prescribed for a brief period—usually a few months. If emotional stress is found to be a contributing factor, you may be referred for stress reduction training or counseling.
Treatment can vary from a few weeks to six months. Treatment time can be considerably reduced if the patient cooperates fully with all recommendations.
Probably the best source for a referral to someone you can trust is your general dentist.
Today, many people seeking help for these problems turn to the Internet. Using the Internet as a referral source can lead to unnecessary treatment and expense.
The National Institute of Health has issued a statement that treatment for jaw disorders should be “reversible,” if possible. This means, in most cases, no treatment should be performed that cannot be undone. For example, surgery, crowning or capping of the teeth, grinding on the teeth, or orthodontic treatment should be avoided (See page 9 in the NIH brochure “TMJ Disorders”). In addition, a well-documented article in the New England Journal of Medicine states that 90% of jaw problems can be treated with “non-invasive, nonsurgical, and reversible interventions.” The irreversible jaw treatment described above may result in thousands of dollars in unnecessary expense.
In Dr. Guinn’s practice, 95% of his patients are successfully treated with conservative reversible procedures. He performs no dental or surgical procedures himself. Identifying all of the causes of a patient’s symptoms and addressing them can often avoid the need for extensive dental treatment or surgery.
Therefore, before seeking treatment for these disorders, it would be wise to investigate all the procedures a particular dentist performs in his or her practice. Some dentists attempt to portray themselves as “experts” in a number of different disciplines, not just jaw problems. If you look on the doctor’s web site, you might click on their “Home” button, to see what the primary focus of their practice is. Alternatively, you might look for the services this dentist performs. There may be a cause for concern if these services include cosmetic dentistry, orthodontic treatment, or capping of the teeth as part of the jaw treatment.
However, many general dentists are certainly qualified to treat uncomplicated jaw problems. For additional information on this subject, please see Choosing A Doctor.