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Home > Dental Conditions > TMJ & TMD > TMJ & TMD Treatment > TMJ and Related Headache Treatment Guidelines
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TMJ and Related Headache Treatment Guidelines

 
TMJ can cause headaches and facial pain.

Millions of dollars are spent each year to diagnose and treat headaches and facial pain--much of this expenditure is wasted.

Treatment outcomes are often very limited, with a high probability that the sufferer will seek yet another doctor, take more expensive tests, and purchase more medications in an effort to obtain relief. The true costs are elevated even further by the millions of hours lost from work or school as a result of ongoing pain.

In our experience, approximately 90 percent of the total pool of headache patients can be treated in the fashion described below, with a 90 percent probability of success. This success rate determination is based on my 26 years of experience with approximately 16,000 patients.

Certainly, the procedures described below are not applicable to those suffering from headaches with neurological and other causes such as tumors, infections, hypertension, and the like. However, less than three percent are believed to suffer from pain for these reasons. An additional 7-10 percent of headache patients have pain often described as vascular or neurogenic. This small group benefits to a lesser extent, or not at all.

Diagnosis requires evaluation by a dentist or physician with extensive training and experience in treating the physical causes of head and facial pain. Unfortunately, most doctors do little more than prescribe aspirin, Tylenol, NSAIDS, codeine related compounds, or medications with even worse potential side effects when they are confronted by chronic headache patients. However, this is far from ideal. Faculty at the University of Pennsylvania Headache Center have stated, "The bottom line is this--there is really no role for use of chronic pain medication in the management of headaches."

Other practitioners assume that chronic pain complaints are "due to stress", and refer the patient for costly diagnostic testing, psychotherapy or biofeedback without dealing with the treatable organic source of the pain.

This regrettable approach was brought to us a few years ago, when a woman was referred two years after severe daily headaches developed following child birth. Throughout the years that followed, she underwent psychotherapy to help her "understand" and "deal with the resentment" she was told that she had toward her newborn baby. After examining the woman, I suggested that the cause of her pain was probably a neck and TM joint injury. "Have you ever had a car accident?" I asked. "Yes", she replied, "on the way to the hospital when I gave birth." Minimal treatment relieved her suffering, and her relationship with her baby was no longer in doubt. How much misery could have been prevented, and how many thousands of dollars could have been saved if she had been examined sooner, after the onset of pain?

An even more dramatic case is described in the following letter written by a patient who was in pain for 32 years:

"I was in an automobile accident at the age of 14 years and have had severe headaches several days a week since then. I also developed serious face, neck and shoulder pain in recent years. At the age of 45, I am almost totally without any of the pain mentioned and am thrilled not to be plagued with this discomfort anymore." Following TMJ treatment, she has remained virtually pain free for the past 10 years.

Our approach to diagnosis and treatment of head and facial pain is based on the following protocol:

Diagnosis

A detailed history is taken of the patient's complaints and general medical condition. Evaluation by a physician with appropriate neurological training is often also appropriate, especially for children and patients with headaches of sudden onset associated with difficulty moving the head, vomiting or a drooping eye lid. Until proven otherwise, all such cases should be presumed to be due to a tumor or aneurism, or "blister" on a blood vessel in the brain.

Symptoms may include one or more of the following:

  • Headaches (in any part of the head)
  • Dizziness
  • Face pain
  • Ringing in the ears
  • Eye pain
  • Pressure or blocked sensation in the ears
  • Ear pain
  • Blurred vision
  • Difficulty swallowing
  • Frequent sore throats or a sensation that something is stuck in the throat
  • Burning tongue

Clearly, each of the above symptoms can also be caused by a variety of causes. However, dysfunctions of the craniocervical musculoskeletal system (e.g. temporomandibular joint and related muscles, ligaments and tendons in and around the head, face, neck and shoulders) should be ruled out, especially when the patient complains of two or more symptoms, or if routine medical tests prove negative.

The examination includes: physical examination of the muscles of the head, face, neck and shoulder (commonly described as the upper quarter), beginning with manual palpation. The doctor should feel for muscle spasm and rule out "trigger points" which can refer pain to other areas. Also included should be range of motion studies--measurements of jaw movement when moving side to side and on full opening of the mouth.

In certain cases, additional objective tests may be required. These might include one or more of the following:

  • Radiographs may be taken from various angles as an aid in diagnosis. These can often be used to assist in ruling out tumors, cysts, fractures, infections and developmental abnormalities.
  • In some cases, specific projections or "slices" called tomographs are taken. This allows a more detailed evaluation of the skull or its various sections.
  • A Doppler sonogram--High-tech testing device which allows the doctor to hear blood flowing through the arteries and recognize the presence of stretched ligaments and perforated or displaced discs.
  • EMG using surface electrodes -- Is a computerized system for determining electrical activity within specific muscles of the head, face, neck and shoulders. Surface electrodes are employed rather than needles, making this a totally painless procedure. Objective numerical and graphic readings are provided by the EMG's computer.

If surgery is considered, then an MRI, CT Scan or Arthrogram is taken to visualize the location and condition of the TM joint discs. Unlike MRI's of the brain, which can be relied on to an enormous extent in making treatment decisions, MRI's of the TM joint should provide only a fraction of the total diagnostic input needed before considering surgery, and are practically unnecessary as a diagnostic aid prior to non-surgical treatment.

If you're interested in TMJ treatment, call us at 1-866-970-0441. We'll put you in touch with a great dentist today!

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