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Home > Dental Conditions > TMJ & TMD > TMJ & TMD Symptoms  > TMJ Syndrome and Referred Pain
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TMJ Syndrome and Referred Pain

TMJ syndrome refers pain to the head and face.

Temporomandibular joint disorder, or TMJ syndrome, can cause chronic, severe head and facial pain: pain so severe that often a victim cannot get out of bed for days. The syndrome is not new -- the first surgery on the temporomandibular joint was performed in 1858 and the first known article about these disorders was written in 1934 -- but it is a complex problem that is still frequently misdiagnosed.

Most head and facial pain involves contraction and spasm of muscles of the head, face and neck. The spasms produce pain in the head, face, neck, in or around the eyes, ears and throat, as well as difficulty swallowing, blurring vision and dizziness. The most common symptom is a chronic, severe headache. The TMJs, or temporomandibular joints, are located in front of the ear on each side of the head. When the TM joint is injured, many ligaments, tendons, muscles, nerves, blood vessels, discs and fascia are injured simultaneously. An injury to the TM joint does not always involve pain at the site of the joint itself. The pain may be located at almost any part of the head or face.

Most TMJ dysfunctions are due to trauma. When TMJ problems are suspected, muscles and joints are evaluated through X-ray and physical examinations. Tests to evaluate TMJ disorder might include tomography, EMG, thermography, Doppler sonogram or arthroscopy.

Most patients find that pain is relieved through physical medicine procedures -- orthopedic appliances, electronic devices to stimulate blood flow and healing, and joint mobilization techniques. Some patients require injection of trigger points, tendons or ligaments. In those cases where the pain does not abate, or recurs, radio frequency cautery procedures, in which the pain-producing structure is denervated, may be considered.

The majority of TMJ disorder patients, however, do not require surgical intervention. And nearly all of them find relief from the chronic, debilitating pain they've been suffering from for years.

Tinnitus and TMJ Dysfunction

Recent studies have shown that close to half of the people suffering with tinnitus have a dysfunction of the muscles and joints of the head and face, commonly referred to as "TMJ." The Temporomandibular Joint (TMJ) is the joint in front of the ear which allows us to speak, chew, swallow, kiss, smile and exhibit normal facial expressions. Almost half of the patients who have TMJ dysfunction have tinnitus as one of their symptoms and in these patients, success rates in eliminating these ear sounds approach 90 percent.

In certain cases, tinnitus may be a result of a spasm of a tiny muscle, called the stapedius, in the middle ear. This spasm may cause a slight vibration which is heard within the ear as a ringing, buzzing or hissing sound. In addition, dysfunction of other muscles, such as the tensor veli palati, may prevent the Eustachian tube--an air passage connecting the middle ear to the throat from functioning normally, causing fullness and pressure behind the ear drum.

Conditions commonly referred to as "TMJ," "TMD" and "TM Joint Dysfunction Syndrome," are complex dysfunctions of muscles, ligaments and joints involving the head, face and neck. These conditions are typically caused by injuries such as falls, automobile accidents and trauma at birth. It is very common for the onset of symptoms to be delayed for months or years, thereby leading the individual to believe that the symptoms merely started on their own.

For many patients, tinnitus is accompanied by other symptoms such as:

  • Headaches
  • Face pain
  • Eye pain
  • Ear aches
  • Dizziness
  • Pressure in the ears
  • Clicking noises or pain when opening or closing the mouth
  • Difficulty swallowing
  • Burning tongue
  • Frequent sore throats

We have found that patients who have tinnitus as one of their symptoms experience an elimination of their ear sounds following treatment in the vast majority of cases. However, patients who have tinnitus without any other symptoms are relatively unlikely to experience improvement with treatment of the type discussed below. Since approximately half of the people who experience tinnitus also have other symptoms, a major proportion of tinnitus sufferers can eliminate the source of their frustration.

Many assume that stress is the cause of these conditions. However, stress makes virtually any dysfunction worse. If a person has a heart problem, under stress they are more likely to have a heart attack. Similarly, a person with a stomach ulcer, dysfunction of the muscles of the head or even a broken leg, are likely to feel worse stomach pain, headaches or leg pain respectively, as a result of stress. Certainly, this does not mean that stress was the cause of these conditions.

Treatment commonly employs procedures which help stimulate muscles and joints to function normally, decrease spasm, remove toxic waste products, and increase blood flow and nutrition to the affected areas. In rare cases, surgery to the affected tissues not involving the ears may be employed.

Over the last few decades, we have come a long way in diagnosing and treating temporomandibular joint dysfunctions and accompanying symptoms such as tinnitus.

If you have chest pain and also experience headaches, this section may be of interest.

First of all, please understand that we do not under any circumstances diagnose or treat chest pain. In fact, chest pain can be a symptom of very serious conditions involving the heart, lungs and other organs. Failure to properly diagnose and treat those conditions may lead to death. Consequently, if you or a loved one have chest pain but have not yet been fully evaluated by a medical doctor and followed all of his or her recommendations, please do not read further. Go back to your physician, or preferably a cardiologist, immediately.

However, if you have already been evaluated extensively and the source of your chest pain has not been found, and you also experience frequent headaches or face pain, the following information may be helpful.

Over the past 25 years, many of our patients whom we were treating for headaches or face pain remarked that not only were the problems we were treating being resolved, but their chest pain was disappearing as well. It wasn't long before we added chest pain to the history and discovered that approximately one-sixth of the patients had this problem. Many had been to cardiologists and most had been to their physicians or hospital emergency rooms. Yet in almost every case we saw, a specific cause for the pain could not be found. That is not to say that the source can never be found, and that is why it is critically important for everyone who has chest pain to seek medical evaluation and treatment, which is not something which we can do.

Several years ago, we began a statistical study. We discovered that of the last 3,000 patients whom we treated for headaches or face pain, several hundred also had chest pain. Over 90 percent of these patients reported that their chest pain almost always resolved before the head or face pain went away.

How can this be possible? While we cannot tell you with certainty that we know the reason why, we can tell you that it has long been known that pain can be "referred" from one structure to another. Many people are aware that pain felt in the left arm can result from a heart attack often due to spasm of a very important muscle in the chest. It is also well known that a heart attack can result in pain referral to the jaw. Consequently, you won't be surprised to know that in 1988 when a patient called us complaining of severe face pain, I spoke to him for a few seconds and said, "I'll be glad to see you--but first go to the hospital. You're having a heart attack." He had a triple bypass operation two days later to replace the arteries that were blocked. His cardiologist pointed out that had I not insisted that the pain in his face was actually referred from his chest, he probably would not be alive today. There are physical reasons for pain referral, involving specific aspects of the spinal cord and brain. With this understanding in mind, it seems less surprising that the same brain that can cause pain in the chest to be felt in the face; can also cause pain in the face or head to be felt in the chest. Let us remind you once again that pain in the chest can result from a serious problem in the chest, which must be evaluated by your medical doctor as early and completely as possible.

Our patients have reported that the pain can be felt in any area of the chest--the quality being sharp or dull--of varying intensities from mild to severe, and lasting from moments to hours at a time. Some patients say that it feels as if an elephant is sitting on their chest, while others say that it feels like a knife is stabbing them. Others describe the pain as much milder.

However, if you have chest pain and your physician or cardiologist cannot find the cause after extensive efforts, and you also experience headaches or face pain, it may be appropriate to seek evaluation to determine whether you are likely to benefit from our treatment for the headaches or face pain. While we cannot and do not diagnose or treat chest pain, extensive past experience demonstrates that in the vast majority of cases, both will ultimately resolve.

Do you think you might have a problem with TMJ? Don't wait until it gets worse -call us at 1-866-970-0441 to find a great dentist today.

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