The Ultimate Guide to TMJ Dysfunction and TMJ Symptoms & Treatment
How do we begin speaking about a topic like Temporomandibular Joint (TMJ) Dysfunction? It’s probably best to share a real-life example. I want to tell you about a TMJ patient named Sharon. When Sharon came to our practice, she had been suffering from TMJ symptoms for years. From the very moment I met her, it was obvious she was downtrodden for a very long time. After getting to know her, I learned she has a wonderful family, twin daughters, and a dog. She has an incredibly passionate career as a professor with numerous patented inventions. She and her husband own two homes, one in the city and one by the ocean. Her life should be a symbol of success and happiness by all measures, yet she described her life to me as …miserable.
Sharon explained to me that although she considers herself as a happy person, her TMJ symptoms have limited her ability to fully enjoy life. Sharon’s TMJ symptoms are a constant burden. This is a serious problem. At the point when I met Sharon, she had seen over 20 different dentists, physical therapists, orthopedists, neurologists, and primary care physicians. You name it, she saw them. She had daily jaw fatigue, headaches, ear ringing, and muscle soreness…everyday, all day. Some days are better than others, but the condition was weighing on her physically and emotionally.
Over the past 20 years, Sharon explained she had tried several treatments, all of which seemed to provide minimal relief. She was frustrated, depressed, and losing hope. How could her jaw cause such unhappiness in her life? Why hasn’t any provider been able to help relieve her TMJ symptoms? The goal of this e-book is to help you understand how TMJ treatment can be life-changing for a patient like Sharon. It is my hope to prevent other patients from suffering unnecessarily for so many years.
Introduction to TMJ Dysfunction
As anyone looking into the topic probably notices, TMJ treatment is a convoluted and often misunderstood field even by professionals. The name is even said incorrectly. Is it properly called TMD or TMJ? You may wonder, why can’t the facts of TMJ be clear?
With so many varying philosophies and conflicting opinions, it is often frustrating for patients to feel confident in selecting the best path to resolve their discomfort. There are several pitfalls that patients must avoid, and several key points patients must understand to achieve success. I will share these points over the next few pages to demystify TMJ pain, TMJ symptoms, and TMJ treatment.
Figure 1: Understanding TMJ symptoms can be disorienting. It’s time to demystify the subject of TMJ
There is Hope
Pain is something that we all share. At some point in each of our lives, we all cope with overcoming physically, emotionally, or psychologically painful experiences. If you are suffering from chronic TMJ pain, you understand how the condition can encompass all of the above forms of pain.
TMJ symptoms weigh on you. TMJ patients often say that their symptoms have become a large burden on their daily lives. As a demographic, TMJ patients are often intelligent, professional people. They actively learn about their condition and seek out for the proper resolution. Unfortunately, many patients suffer from TMJ pain for far too long. The condition is very complex and is not often thoroughly understood by many dental and medical providers. Do not give up. There is hope. Unburdening yourself of TMJ pain can be life-changing.
What is TMJ?
The temporomandibular joints (TMJ) are the two joints that connect the jawbone to the skull. The TMJ primarily functions in a hinge motion as the mouth opens, but it also can slide back and forth as well as side to side which is called translation or excursive motions, respectively. The TMJ is a unique joint because of the two identical joints on each side of the head function as one unit. In addition to the joint, each of the right and left side have accessory components essential to its function. The accessory TMJ components are a joint capsule, articular disc, mandibular condyle, articular surface of the temporal bone, temporomandibular ligament, stylomandibular ligament, sphenomandibular ligament, and the following muscles: lateral pterygoid, temporalis, medial pterygoid, and masseter.
Figure 2: The anatomical source of TMJ Symptoms. TMJ dysfunction can originate from the bones, muscles, ligaments, and/or teeth of the head and neck
The Secret to Understanding the Cause of TMJ Dysfunction
As you see, the TMJ is complex. Because the jawbone connects the two joints, the right and left joints must function together. Thus, the right and left joints are not independent of one another. The lack of independence of the two sides of the jaw is very important to understand. The secret to treating TMJ dysfunction is to properly identify which part (or parts) of the joint anatomy are out of harmony.
For a moment, I want you to think of the TMJ complex as a canoe. Think of a canoe full of people each paddling. When everyone is paddling in the same direction and with the same rhythm, the canoe moves effortlessly. But what if even one person is paddling against the rest of the group? Suddenly the team becomes disorganized and tires sooner. Each of the other paddlers must exert significantly more energy to overcome the negative force. As the canoers reach exhaustion, the canoe may even move erratically, turn off course, or require constant correction by the proper paddlers to keep it moving in the right direction. The development of TMJ pain is similar. If even a single part of the anatomy (the joint, the teeth, the muscles, or the ligaments) is out of harmony from the rest, it begins a domino effect that can lead to very, very powerful TMJ related symptoms for the patient.
Figure 3: TMJ Pain is like a crew team when one teammate is paddling against the group. If one part of the TMJ Anatomy is out of harmony it causes excessive soreness, fatigue, and erratic movement of the entire complex
So What is Proper Harmony of the TMJ complex?
Now that we understand the canoe analogy, let’s see how TMJ pain plays out with human anatomy. TMJ symptoms are most often created by a lack of harmony between the patient’s bite, muscles, and/or temporal-mandibular joint. Each of these structures has a position in which they are comfortable functioning. The teeth fit together in a very specific way, similar to a puzzle. If the position of the teeth puts tension on the temporomandibular joint or the muscles around it, the strain causes pain and vice versa.
Because the teeth, joints, and muscles are connected to fixed structures in the skull, the TMJ complex creates a tug of war effect. For example, if the teeth restrict the jaw in a backward position when closed, but the temporomandibular joint is more comfortable forward, that is a problem. The teeth, muscles, and joint have no choice, but to battle for their ideal position of comfort. Just like canoers paddling to overcompensate a canoer paddling the wrong direction, the muscles of the jaw begin exerting unnecessary energy. The muscles become strained and sore. As the condition becomes more chronic, body parts that typically have nothing to do with jaw function begin to try to overcompensate for the strain. The concept of over-compensation is why TMJ symptoms like headaches or neck pain can arise even though they appear to have no connection to jaw function.
Figure 4: The physics of TMJ dysfunction are caused by tension between the temporomandibular joint, the muscles, and the teeth. The muscles essentially act as a rope being pulled between the Temporomandibular Joint and the Teeth
Do I have TMJ? What are the Symptoms?
To simplify your understanding of TMJ dysfunction symptoms, I want you to consider symptoms in two different ways:
1) When the symptoms develop: either acutely short term (weeks to months) or chronically long term (months to years)
2) The source of the pain: TMJ symptoms are caused by one (or any combination) of five categories. The cause of TMJ dysfunction may be from the Occlusion of the teeth, the temporomandibular joint itself, the Muscles, Neurological in nature, and/or Psychological).
Thus symptoms evolve based on how much time has progressed, and the symptoms are originated by five main sources of TMJ pain. Let’s look at the symptoms in terms of general categories to develop an understanding of what are TMJ symptoms. Some of these symptoms may affect some patients and not others, depending on their specific situation.
Figure 5: TMJ symptoms are derived from many parts of the anatomy. There may be numerous types of symptom presentations.
Short Term TMJ Symptoms
Muscle pain: Muscle pain of the jaw is the most common complaint patients suffering from TMJ have. It is important to understand that muscle pain may feel vague. Often when patients feel pain on the side of their jaw they assume it is an issue with the jaw bone or the temporomandibular joint. However, the pain they feel is the most common strain, soreness, and/or tension of the muscles.
Muscle fatigue of the jaw when chewing: An early sign of temporomandibular dysfunction is fatigue when chewing, talking, or smiling. Often patients will note that they have difficulty chewing their meals fully or their mouth gets tired easily when eating. It can feel similar to muscle fatigue when lifting weights near the end of a workout. However, unlike lifting weights, the muscles of the jaw generally should not be noticeably fatigued while completing normal meals or snacks throughout the day.
Figure 6: The etiology and physiology of muscle soreness during TMJ pain
Grinding and clenching of the teeth: Patients with TMJ dysfunction often will not feel their teeth have a comfortable “home”. The teeth will never truly feel at rest when the jaw is open or closed. When the teeth do occlude together, the patient subconsciously shifts their jaw around, trying to find an improved position. The increased muscle activity creates soreness of the muscles and joints.
Awareness of the mouth, jaw, and teeth: A patient suffering from Temporomandibular Disorder will often be aware of their jaw a significant portion throughout the day. Because of the discomfort and inability for the jaw to properly rest, the patient often says they find themselves constantly thinking of their jaw or teeth multiple times an hour throughout the day. The jaw position can begin to become a large distraction in their ability to concentrate or enjoy happy moments in their lives.
Psychological stress: Stress and anxiety have a bit of a chicken and an egg relationship to TMJ. Psychological stress can often contribute to Temporomandibular Dysfunction and vice versa. Patients going through heightened times of stress will often note their jaw discomfort increases, or that they notice they are grinding or clenching more often during the day or night which further causes muscle fatigue.
Pain at the Temporomandibular joint: The joint space itself can be the source of TMJ pain. It is interesting to note that this is one of the less common symptoms of TMJ pain, but it is common for patients to incorrectly believe the dysfunction is created from the joint space. The joint space may become inflamed by the improper position of the teeth which forces the head of the condyle improperly into the retrodiscal tissues, displaces the articular disc, arthritis, or inflammation of the joint capsule known as synovitis. Trauma is also another cause of true joint space pain. After an impact to the jaw or from opening the jaw excessively, joint space issues may develop.
Headaches and Migraines: Patients are often surprised that the headaches and migraines that they have been suffering with for years may be reduced by improving their jaw function. When I explain to them the concept, it makes perfect sense. You see, if the muscles of the jaw are stained and fatigued, what happens is the muscles of the head and neck begin to try to compensate. Suddenly muscles on the sides and back of the head which typically have minimal contribution to opening and closing the jaw, begin working overtime. When the muscles of the head begin working when they really shouldn’t be… it leads to the sensation of tension headaches or increases the trigger of neurovascular migraines.
Long Term TMJ Symptoms
Wear of teeth: The most common result of TMJ dysfunction that has been present for years is the teeth become worn or flattened. Wear of teeth is known as attrition. Attrition is the body’s natural response to try to equilibrate the teeth to place the jaw into a better position to achieve harmony. Over time, the muscles subconsciously create patterns of clenching or grinding to wear down interferences in the teeth which are inhibiting the jaw from sitting into a more comfortable position for the anatomy. Worn teeth can create the appearance of premature aging of the smile, or make the teeth appear shorter than ideal.
Figure 7: Years of grinding and clenching create deterioration of the Temporomandibular Joint and also the Teeth. Here we see an advanced progression of wear from years of TMJ disharmony.
Fracture of teeth: The teeth serve as the final stop for the force of the jaw. When jaw force is abnormal, or in an abnormal position, over time, the teeth absorb more force than ideal. The increased force begins to cause microfractures of the teeth. Over time the microfractures begin to spread on the tooth surface similar to a crack on a car windshield. At a certain point, the fracture lines may progress to lead to fractures of the teeth under normal chewing force.
Flattening of the condylar head: If the joint space of the TMJ is left inflamed for years without treatment, the immune response of the body is to begin recontouring the shape of the top of the jaw bone, known as the condylar head. The flattening of the condylar head is an irreversible osteoarthritic change to the jaw.
Diffuse face, head, or neck pain: When a patient has suffered from pain in the head and neck for a long period of time, the nerve pain may become ingrained into the ganglions of the central nervous system. What happens is the nerve tissues begin to respond abnormally. The patient feels pain in areas where no painful stimulus exists. The pain has become trapped along with the nerve tissue of the central nervous system. Centralized nerve pain is one of the most difficult TMJ symptoms to treat, and it is always the hope to avoid the progression of pain to this level of neuralgic pain. This pain embeds over the years or even decades, so there is a good chance centralized neurological pain may be avoided.
Tinnitus: Ear ringing has been reported by patients suffering from Temporomandibular Disorder. The correlation is not currently well documented, but it is believed that altered hearing can be caused by a protective co-contraction of the tensor tympani muscle of the ear which can become hyperactive after long term fatigue of the muscles of the jaw and head from TMJ symptoms.
Depression: Psychological depression is a common finding in chronic pain patients. Patients who suffer for a long time with TMJ dysfunction or myofascial pain will often become depressed. Elimination of the source of pain frequently improves the symptoms of depression. However, because depression can result in an independent psychological problem, it must also be properly managed to enable overall patient success.
Figure 8: Psychological Effects of TMJ dysfunction. Studies have shown a link between TMJ symptoms and Depression
History of physical or sexual abuse: It is important to note that studies have linked the history of severe physical or emotional abuse to the development of centralized neurological pain and myofascial pain. This is not necessarily a symptom, but more a link that should be thoroughly understood. A TMJ specialist should understand the importance of this link and should be empathetic toward this topic if the patient chooses to disclose it. Most TMJ specialists will have an understanding of the psychological aspects of pain and will have a referral for a psychologist or psychiatrist who specializes in treating the psychological component of TMJ and neurological pain.
How is TMJ Dysfunction Properly Treated?
The Secret to TMJ Treatment
If you forced me to simplify TMJ treatment into one word…the word would be, comprehensive. What I mean is the TMJ specialist must thoroughly understand the patient’s history, anatomy, and symptoms. It doesn’t necessarily mean the treatment has to be complicated. It doesn’t mean numerous treatments are always essential. Comprehensive means that the patient must always be thoroughly understood before selecting the treatment sequence.
TMJ pain is caused by several different factors. There can be varying symptoms, all of which manifest in a variety of clinical presentations. Many providers may have an understanding of a few of the treatments available, but it is rare to have a provider who understands the entire fleet of treatment available, let alone which ones are most appropriate for the specific case. This is why patients can see several different providers, and each doctor or dentist may give different recommendations. It is also the reason why some patients receive TMJ treatment but have minimal improvement. The treatment itself isn’t ineffective…it’s just the wrong treatment that was selected for the patient’s specific case.
Let’s discuss some of the TMJ treatments presently available. Keep in mind that sometimes if the case is severe two or more of these treatments might be recommended. The sequence of treatment is equally important to the treatment itself. Okay, here we go:
TMJ Remedies You Can Begin At Home
If you’re reading this ebook, there’s a good chance you may have not been able to seek treatment yet. You’re probably at home wrestling with jaw soreness, pain, or headaches. A good place to begin discussing treatment is what you can do at home to help treat TMJ pain. Here are some helpful tips to get you by for now.
Just like you would stretch before and after a gym workout to help maintain muscle elasticity and reduce soreness, the same principles apply to the muscles of the jaw. A particularly useful stretch is to place your tongue on the roof of your mouth, then slowly open your mouth without your tongue leaving the roof of your mouth. You will feel a stretch at the back of your jaw just before your tongue is pulled off the palate. Hold in that position for about 30 seconds and repeat 4-5 times each day.
Warm Compresses and Cold Packs
If you are having an amount of TMJ pain and jaw muscle soreness, warm or cold compresses can help. Most people find warm compresses soothing for TMJ. The warm compress increases circulation to the area which reduced inflammation and helps to remove lactic acid. Try heat first. If that has no effect, there are some situations where a cold compress can reduce TMJ symptoms. I know, the exact opposite treatment, but sometimes things don’t make perfect sense. Try warm compresses first for a few days, and if there is minimal relief try a bag of frozen peas to help temporarily soothe your symptoms.
The muscles of mastication are influenced by the muscles of the head, neck, and upper back. Poor alignment and tension in surrounding muscles can cause pain in other areas and vice versa. Maintain proper head, neck, and back posture to reduce stress throughout the day. Focus on sitting up straight. Be aware if there are tasks in your daily life that are forcing you to maintain straining positions of one side of your body versus the other. Take breaks while at a computer or desk, and gently stretch your neck periodically.
In times of TMJ pain, the muscles and bones of the jaw develop inflammation. Anti-inflammatory medications are the first line of defense to reduce TMJ pain due to inflammation. A good option for over the counter medication to help with TMJ symptoms is Ibuprofen. Most healthy adults may take 400-600mg every 6 hours. The key is to maintain the dosing around the clock consistently for 2-3 days.
Treatment a TMJ Specialist May Recommend
A customized orthotic or occlusal guard is an appliance that fits over the teeth. The purpose of the appliance is to reposition the jaw into a more favorable position in an attempt to reduce symptoms. The teeth serve as a puzzle piece that limits the jaw position. The occlusal guard allows the jaw position to be modified by temporarily eliminating the need to accommodate the position of the teeth. In our practice, the occlusal guard is typically used as a test to work out how the symptoms respond when the jaw is shifted into a different position. It helps us to verify our assumptions about what is causing jaw pain. Once we see improvement with the occlusal guard, it allows us to move the jaw into the proper position via orthodontic, occlusal equilibration also called disclusion time reduction (DTR), or restorative treatment. The goal of the final treatment is for the patient to eliminate their symptoms without needing to wear an appliance their entire life.
The alignment of how the top and bottom jaw come together is incredibly important to improving muscle pain and headaches. For a moment, I want you to think of a lion living in an enclosure at a zoo. The fence cannot be too small. It also cannot be unstable or with gaps. If the fence is too small, the lion will begin forcefully trying to destroy the enclosure. If the fence is the proper size but unstable, eventually the lion will knock it down or escape just from normal use. The requirements for properly housing a lion are surprisingly similar to TMJ pain. The top jaw (maxilla) is a fence, and the lower jaw (mandible) is a moving lion living within the stationary top jaw. There cannot be a size discrepancy or instability between the upper jaw and lower jaw, otherwise, severe consequences happen. If there is size discrepancy or instability, it creates a strain on the teeth, muscles, and jaw joints. The strain ultimately causes pain, fractured teeth, and joint deterioration. To alleviate the size discrepancy between the top and bottom jaw, orthodontics is a common solution. It allows movement of the teeth into a better position so that the upper jaw is in a proper position to counterbalance the force of the lower jaw.
As we discussed previously, the top and bottom jaw positions are important. Sometimes when a patient is orthodontically in a stable position, there are areas of their mouth that are hitting unevenly. Think of this situation like a stiletto high heel. The teeth may look beautiful and properly aligned, but they can still be incredibly unstable. For a stiletto high heel, the front of the heel is flat and has stability, but the back heel is a spike as thin as a pencil. If you were to walk on a hardwood floor with a stiletto heel, the force of the front would be light but the back heal would be so powerful that it could puncture a hole through the floor. It looks beautiful and delicate. No one would expect that much force to be generated, but that’s what happens when the force is concentrated in one location. The same happens with the teeth. Some spots of the mouth may hit with pinpoint precision, and so much force is generated it ultimately begins to cause severe tension of the muscles, jaw, and skull. To correct these excessive points of occlusal force, the TMJ specialist will equilibrate the bite by thoroughly checking and balancing the bite manually. The process is similar to adjusting a tall spot on a filling that is too high. The procedure is often called occlusal equilibration, T-scan equilibration, or DTR (disclusion reduction time).
Restorative Dentistry, Veneers, and Crowns
Severely worn or broken teeth create uneven forces on the bite and jaws. Sometimes the teeth are too short which is causing the jaw to close into an excessively closed position. In cases like this, the recommendation may be to reestablish the jaw position by increasing the height of the teeth. If the teeth were to prop the jaw into a more satisfactory height, then the jaw position is prevented from entering into the strained collapsed position. In this situation, the TMJ specialist would take impressions of your mouth to produce study models. The TMJ specialist will discuss with you the findings, and can even simulate the proposed change to explain to you how the improvement will be achieved before doing any of the treatment. Some of the restorative treatment that may be discussed to achieve an improved vertical position of the jaw are dental crowns, bridges, implants, or composite fillings.
Removal of Third Molars
The third molars, known as wisdom teeth are the teeth farthest back in the mouth. Wisdom teeth are the last teeth to develop. Because their development is so late, often the growth of the jaw has completed when the third molars erupt. The lack of space for third molars can potentially disrupt the position of the other teeth which can disrupt jaw function. The wisdom teeth may also be wedged in a tight space along the jaw bone which can cause interference as the jaw hinges to open and close. If wisdom teeth appear to be a potential interference, your TMJ specialist may recommend having your wisdom teeth removed before further treatment to rule out and eliminate their contribution to the disruption of the proper TMJ function.
During bouts of TMJ pain, the muscles of the jaw, face, head, and neck often become overly tense and strained. The strain begins similarly to normal muscle soreness you would feel if you worked out at the gym, but as the strain begins to overwhelm the muscle over time, it leads to tension which does not easily relieve or heal. Muscle relaxers work as a therapy to help reduce tension of the muscles to give them more opportunity to heal. There are several types and categories of muscle relaxers that may be prescribed by your TMJ specialist, but muscle relaxers generally work either via the central nervous system or at the location of the muscle itself. Some common prescription muscle relaxers used in temporal mandibular dysfunction therapy are Robaxin, Flexeril, Skelaxin, and Soma.
A large proportion of TMJ patients are ultra-successful people that are balancing the weight of several personal and professional endeavors all at the same time. It’s not coincidental. Studies show TMJ symptoms are more common in people who have high expectations for themselves. TMJ symptoms and type-A personalities are linked because TMJ pain, jaw soreness, and headaches all have an emotional component. In times of stress and anxiety, TMJ symptoms can be exacerbated. A TMJ specialist may want to rule out an anxiety component to the symptoms by prescribing an anti-anxiety medication such as valium or lorazepam. The goal is to test if symptoms of muscle tension or jaw clenching fade as anxiety is reduced.
Trigger point injections
Muscle strain from TMJ causes the muscles to develop knots, also known as trigger points. Trigger point injections can reduce pain and relax the muscles. During trigger point injections for TMJ, small quantities of an anesthetic such as lidocaine and anti-inflammatory medication such as Kenalog are injected directly into the inflamed and stiff muscle groups to relieve them of their pain. Over time the treatment allows the trigger points to heal and no longer produce symptoms. For trigger point injections to be successful, it is important to utilize a series of injections. Treatment sessions can be spaced weekly, with about three to four total sessions to take place for proper relief from TMD pain. Trigger point injections are often a finishing technique for TMD that is used after the jaw position is first improved by orthodontics, occlusal equilibration, or restorative dentistry.
Sometimes the teeth, and jaw position are perfectly normal. In this situation, the TMJ symptoms are derived solely from a muscle problem. The muscles are overly developed and are overpowering the other components of the TMJ complex. When some muscles are identified as being overpowering, we may consider Botox to reduce the overcompensating muscles which ultimately reduces the tension and pain. It is important to note that Botox should rarely be used as the first line of treatment for TMJ symptoms. There is often an underlying problem that is causing the muscles to be tense and overdeveloped. Typically Botox is most successfully used as a finishing technique of TMJ treatment to eliminate any residual symptoms after other sources of the pain have been treated.
Psychological TMJ Treatment
Studies have shown there is a link between TMJ symptoms and psychology. Some psychological conditions such as anxiety, stress, obsessive-compulsive, Type-A personality, and depression have all been linked to TMJ. It is important for the TMJ specialist to recognize if and when an underlying psychological pattern may be contributing to the TMJ pain. Studies have also supported that patients who have undergone a history of physical or emotional abuse have a significant increase in risk for developing TMJ pain or myofascial pain. A TMJ specialist will be understanding to this history if the patient chooses to share, and can help coordinate a referral to a psychologist experienced with the patient’s psychological history and how it relates to the treatment of myofascial pain and myalgia.
Surgery is typically the least common treatment needed for TMJ dysfunction, but in some limited cases, it is the only option. Surgery is typically indicated for three primary indications:
1) If the patient experiences major trauma to the joints or jaw from an accident.
2) If the maxilla and mandible are developmentally so far out of proportion that surgery is the only way to align the upper and lower jaw properly.
3) Internal derangement of the TMJ from conditions such as arthritic changes, severe flattening of the condyle, and deterioration of the articular disc.
Fortunately, the need for surgery is relatively rare. Greater than 95% of TMJ patients can successfully be treated with other methods before considering surgery.
Top 7 Reasons to Treat TMJ Pain You Never Considered
- Escaping TMJ Pain Begins with One Step Forward. Most people think TMJ pain requires invasive jaw surgery with long term healing. This is rarely true. Sometimes a significant improvement of a patient’s jaw pain can be observed after one appointment.
- Say Goodbye to Stomach Pain. When the muscles of the jaw are sore and fatigued, the patient cannot chew thoroughly. Patients find themselves swallowing food whole, which then puts a strain on the stomach and intestine to digest the under chewed food. This is the reason why TMJ patients often complain of chronic stomach and intestine pain.
- Turn that Frown Upside Down. Studies have shown chronic temporal mandibular dysfunction has a link to depression. The constant soreness and discomfort weigh on patients. TMJ pain places patients at a significantly higher risk for depression, sleep deprivation, and chronic exhaustion.
- Make It Easier On Yourself. The duration a patient allows TMD symptoms to fester increases the difficulty of treatment. A patient who has had progression of TMJ symptoms over decades is significantly more complex to treat than the patient who identifies their temporal mandibular dysfunction sooner.
- Prevent the Progression of Centralized Pain. When muscle and jaw pain are allowed to persist chronically, the pain can become ingrained to the central nervous system. Centralized myalgia is when a site of the body has no painful stimulus applied, but the pain is still felt. What happens is the nerve has been inflamed for so long that it can no longer distinguish normal sensation from painful sensation. A peripheral pain no longer exists but the pain has become centralized, trapped in the nerve.
- You need a TMJ Quarterback. Because TMJ treatment is so complex, you need a TMJ specialist who serves as your treatment quarterback. Just like football TMJ treatment always starts with the quarterback. This usually begins with an experienced TMJ dentist in your area. The TMJ dentist should be accountable for your treatment. He or she may be able to treat your case exclusively, or at different times during your treatment, they may refer you to supporting professionals such as a physical therapist, ENT, psychologist, neurologist, chiropractor, or oral surgeon.
- Gosh, golly…start Living Again. Above all, you deserve to live the best life you can. No one should allow physical or emotional stress to ever persist long term. Unburdening yourself of TMJ discomfort can be life-changing. Be the best you can be. We believe in you.
Putting It All Together: How to Begin Overcoming TMJ Pain Today
The goal of this ebook is to demystify the symptoms, treatments, and the hard facts of TMJ dysfunction with the hope that it will launch you on a path toward healing. In closing, I’d like to leave you with a story.
Let me tell you the Egg story of Christopher Columbus. During the time when Columbus lived, it was already well understood that the Earth was round. The fear of falling off the side of the Earth had already been overcome years prior. Days after Columbus returned from America, he went to a dinner party one evening. At dinner, some gentleman teased Columbus. They questioned whether he thought he accomplished something important by discovering the New World. They joked that his discovery was something that anyone probably could have done. A gentleman even reminded him, “All you did was sail directly west until hitting land right?”
Columbus responded by handing an egg around the room. He challenged everyone to stand the egg on its head. One by one, they tried, and each failed. The round egg rolled around each time they tried to stand it up. When the egg made it’s way back to Columbus, he tapped the top of the egg on the tabletop to flatten it. It stood up perfectly. “What could be simpler, he asked? The impossible always appears simple after someone explains it.”
Figure 9: The Christopher Columbus Egg as related to TMJ. Don’t Lose hope in what is possible.
The point I want to leave you with is… Don’t lose hope in what is possible. If you have been suffering from TMJ pain and headaches for years, it can be incredibly frustrating. You may even have reached a point of depression. If you have had several failed attempts to treat your condition, it’s even more disheartening. Don’t lose faith. TMJ is a complex subject, which is why many patients are left in discomfort for far longer than they should, but it is not impossible. Successful TMJ treatment begins with a TMJ specialist thoroughly understanding the patient, and then systematically simplifying their treatment to progress toward improvement. If you are feeling depressed by your TMJ pain, remember the story of Christopher Columbus. Things always seem impossibly complex at the start, but very obvious after they are correctly accomplished.
About the author
Dr. Charles Sutera is one of the nation’s leading TMJ specialists in Waltham, MA. He is the owner and founder of Aesthetic Smile Reconstruction, a reconstructive and TMJ practice in Waltham, MA.
Dr. Sutera has completed renowned TMJ training at Tufts University, a residency at the University of Kentucky with the acclaimed Dr. Jeffrey Okeson, and numerous post-graduate courses at the Pankey Institute. Dr. Sutera believes in a comprehensive philosophy to TMJ treatment and understands the entire scope of all TMJ treatment modalities available. He is most proud of his empathy for patient symptoms, and comprehensive understanding of the entire maxillofacial anatomy.