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What is TMJ?
TMJ is an acronym for the temporomandibular joint. But TMJ has been used by
many people through the years to actually describe TMD, which is an acronym
for temporomandibular joint disorder. TMD describes many symptoms related to
the jaw and supporting structures. This disorder is a subgroup of orofacial pain
disorders that include many different types of pain in the head and neck. The
TM joint itself is located directly in front of the ear and is commonly
called the "jaw joint." Common symptoms of TM disorders are pain or
discomfort around the ear, jaw, jaw joints and facial muscles — headaches,
temple pain, throat pain, pain with opening, chewing, locking, limited
opening, clicking, popping and grating noises. If you have any of these
symptoms for more than a month, you should seek treatment from your dentist.
What causes TMD?
Usually several factors are involved, and there is rarely one single
symptom. Some factors include trauma to the face or jaw, arthritis, bruxism
or neck conditions. The most common cause is clenching of the jaw. There are
many causes of clenching, which is at the core of any treatment plan. Any or
all of these can perpetuate TMD symptoms and need to be addressed. TMD and facial
pain are a chronic, degenerative condition that must be managed to
reduce the aggravating factors. There is no "quick fix."
Does TMD cause my headaches?
It could be one possible contributing factor, but there are many causes for
headaches. The contracture of the facial muscles can produce a headache cycle
that is sometimes difficult to stop. TMD is but one possible cause of
headache, or it might be the effect of some other contributing factors, such
as migraine. If you suffer continually from headaches, chances are that you
are also developing a clenching habit that can put undue stress on the temporomandibular
joint.
How many headaches are normal?
Normal is about
one to two headaches per week, with a pain level of 3 out of 10. More
frequent or greater pain should be evaluated. Countless hours of work and
quality time with your family can be lost because of headaches, not to
mention how having headaches affects your quality of life. Your headaches are
treatable! Something else that you should consider is that all the medication
taken for headaches (Advil, aspirin, Motrin) can cause major stomach
disorders. Also, more than four to six Advil a day can lead to liver
disorders. Once your stomach becomes sensitive to these anti-inflammatories,
you will be severely compromised in your ability to deal with inflammation in
the future.
Will I have to have TMJ surgery?
Conservative, mainstream treatment for TMD does not include surgery as a first
line of treatment. Surgery is the very last treatment to consider. Non-surgical
treatment options for this condition are consistent with other orthopedic or
rheumatologic conditions, such as a painful knee or shoulder. The goals of
management are to decrease pain, loading of the joint and to restore function
of the joint (40mm opening between front teeth without pain) and normal
activity for the patient.
What do you do for TMD?
It depends on your symptoms and the different factors that are contributing
to those symptoms. Again, as with other musculoskeletal conditions,
medication, physical therapy, behavioral modification and orthopedic
appliances are all used in combination or alone (depending on the etiology )
to achieve good function and decrease pain. Long-term, the key to a healthy
joint is movement and lubrication (synovial fluid). Anything less can lead to
arthritis in the joints and internal derangement of the joints.
Does Dr. Prehn accept my insurance? Or is he a
participating provider on my insurance plan?
Even though Dr. Prehn is not a participating provider on your medical
insurance plan, we will assist you in filing your medical insurance
claims and provide you with all the documentation required to
process your claim. We will help you receive all the benefits of your
particular insurance plan by providing letters and various other
documentations of your particular medical condition. Your insurance company
will then reimburse you directly. This saves you time in receiving treatment
and cuts down on the costs that we would have to pass along to you.
What kind of doctor is Dr. Prehn?
Dr. Prehn is a dentist who has obtained additional training and education in
the medical field of orofacial pain, with a board certification from the
American Board of Orofacial Pain. He is also a member of the American Academy of Orofacial Pain. While orofacial
pain is still a proposed specialty of the American Dental Association, this
board exam will be the basis of all certification in this specialty requiring
two years of residency. Therefore, he no longer practices
general dentistry, as he has focused his practice on diagnosing and
treating facial pain, headaches and TMD only.
My jaw only clicks, but I have no pain. Can it get worse?
Clicking may or may not be a symptom of a future problem. If it is occasional,
with no pain, then it may not present a future problem. The key here is whether
there is a progression of clicking, changes in the click intensity or
frequency or if it has just started. However, if it clicks every time you
chew or open your mouth, or if it changes in nature, then it may be an early
symptom of a more severe problem. You should consult your dentist before it
progresses to a locked jaw.
My jaw locks occasionally, usually in the morning,
but I can work it open. Is this normal?
No! Even an occasional lock is cause for concern. Joints are designed to
move. A joint that locks up, even occasionally, is a joint under stress,
unstable and not being lubricated properly. Episodic locking is very
difficult to treat and should be treated as soon as possible. You could run
the risk of being permanently locked, which would diminish your treatment
options. Please see your dentist as soon as possible if you have this condition.
I already have a splint that does not work. What more
can be done?
The splint only addresses one contributing factor of your headaches or pain.
There may be others that need to be identified. Once they are identified,
they can be treated. However, during the treatment of these other factors, it
is critical that a good working splint is in place, because as
these other factors resolve themselves, the facial muscles will be affected,
and the splint needs to be changed in order to respond to these changes.
Are all splints created equal?
No! There are many different types of splints, all for different purposes.
There are soft splints (such as the ones you can purchase at drug or sporting
goods stores), which are designed to protect the teeth but in most cases
actually increase muscle activity and forces on the joint. There are
different types of hard, acrylic splints that are designed to accomplish
different results. A specialist like Dr. Prehn can determine which type is
the best for you.
What is the key to the long-term health of the TMJ?
Painless mobility of the jaw is the key. It is the lubrication in the joint
(synovial fluid) that keeps the joint healthy. Every time the jaw opens, it
lubricates itself, giving nutrition to the bone and soft tissues of the
joint. The jaw must open to at least 40 mm (distance between the front teeth)
in order to stay healthy. Less opening than that can lead to arthritis and
other internal derangements of the TM joint. This opening measurement of 40mm
would be the goal of any surgical or non-surgical TM joint therapy.
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