Aurora Press, Santa Fe, New Mexico USA

 


TMJ: THE JAW CONNECTION
THE OVERLOOKED DIAGNOSIS

By Greg Goddard. D.D.S.

—CONTENTS—
 

 

 

Acknowledgements

ix

 

 

Forward by Patricia Rudd, R.P.T.

xi

 

 

Introduction

1

 

 

CHAPTER 1: THE CONTROVERSIAL TMJ

3

 

 

    What Is the TMJ?

5

 

 

    The TMJ Controversies

5

 

 

CHAPTER 2: HOW DO I KNOW IF I HAVE A TMJ DISORDER?

7

 

 

    How Common Are the Problems?

10

 

 

    What Tests Can I Do?

11

 

 

      l. FeeI Your TMJ Joint

11

 

 

      2. Press on Your TMJ Muscles 11

11

 

 

      3.Watch Your Jaw Open

14

 

 

      4. Listen for Noise

14

 

 

      5. Check for Pain

16

 

 

    What Other Med. Problems Can Be Confused with TMJ Problems?

16

 

 

      Headaches

16

 

 

      Ear Infection

18

 

 

      Sinusitis

18

 

 

      Temporal Arteritis

19

 

 

      Carotidynia

19

 

 

      Neuralgias

19

 

 

      Lyme Disease

20

 

 

      Arthritis

21

 

 

      Osteoarthritis

21

 

 

      Rheumatoid Arthritis

22

 

 

      Other Types of Arthritis

22

 

 

CHAPTER 3: HOW SHOULD A TMJ DISORDER BE DIAGNOSED?

23

 

 

    TMJ Specialists

28

 

 

    X-Raysand MRIs

28

 

 

    Other Tests

30

 

 

      Electromyography

30

 

 

      Thermography

30

 

 

      Sonography

31

 

 

      Doppler Auscultator

31

 

 

      Jaw Recordings or Gnathogram

31

 

 

CHAPTER 4: HOW DOES THE TMJ WORK?

33

 

 

CHAPTER 5: WHAT CAUSES TMJ DISORDERS?

43

 

 

    Muscle Injuries

43

 

 

    Joint Injuries

45

 

 

    Whiplash

47

 

 

    Bad Bites

47

 

 

    Sudden Bite Changes Through Loss Of Teeth

51

 

 

    Arthritis and Other Diseases

52

 

 

    Stress and Distress

52

 

 

    Bruxism

60

 

 

      Treatments

63

 

 

      Bruxism in Children

63

 

 

    Sex

65

 

 

CHAPTER 6: WHAT CAUSES TMJ SYMPTOMS?

67

 

 

    Joint Noises and Joint Pain

67

 

 

      Structural Abnormality

67

 

 

      Over-opening

69

 

 

      Displaced Disc

69

 

 

      Sticking Disc

69

 

 

    Headaches

70

 

 

    Earaches

70

 

 

    Muscle Aches

70

 

 

      Distress

72

 

 

      Pain

72

 

 

      Poor Posture

72

 

 

      Overuse

74

 

 

    What is Pain?

74

 

 

      Emotional and Psychological Effects of TMJ Pain

77

 

 

CHAPTER 7: SELF-CARE TIPS FOR TMJ DISORDERS

81

 

 

    1. Rest

83

 

 

    2. Soft Food Diet

83

 

 

    3. No Gum

83

 

 

    4. Relax Your Facial Muscles

84

 

 

    5. No Clenching

85

 

 

    6. Yawn Against Pressure

85

 

 

    7. Moist Heat

87

 

 

    8. Ice

87

 

 

    9. Heat and Ice

91

 

 

    10. Good Posture

91

 

 

    11. Sleeping Position

91

 

 

    12. Jaw Exercises

93

 

 

    13. Exercise

93

 

 

    14. Acupressure

96

 

 

    15. Over-the-Counter Medications

96

 

 

    16. Yoga and Meditation

99

 

 

    17. Good Nutrition

102

 

 

    18. Massage

103

 

 

    19. Athletic Mouthguard

105

 

 

    20. Avoid Long Dental Appointments

106

 

 

    21. Avoid General Anesthesia

108

 

 

    22. Telephone Use

108

 

 

    If Your Jaw Locks Open

108

 

 

    If You Can't Open Your Mouth

109

 

 

    Herbal Medicines That Can Help

110

 

 

CHAPTER 8: DENTAL TREATMENTS FOR TMJ

113

 

 

    Splints

113

 

 

      How Long Will I Need to Wear the Splint?

116

 

 

      Dental Checkups

116

 

 

      Difficulties Wearing a Splint

117

 

 

      Cleaning and Maintaining Your Splint

117

 

 

    Trigger Point Therapy

118

 

 

    Dr. Travell Illustrations

119-21

 

 

    Prescription Medications

121

 

 

    Dental Work

125

 

 

    Surgery

127

 

 

CHAPTER 9: TREATMENT BY OTHER HEALTH CARE PROVIDERS

133

 

 

     Physical Therapy

133

 

 

    Chiropractic Treatment

141

 

 

    Acupuncture

143

 

 

    Counseling and Support Groups

146

 

 

    Biofeedback

147

 

 

    CraniaI Osteopathy

149

 

 

    Alexander Technique

149

 

 

    Feldenkrais Method

150

 

 

CHAPTER 10: COSTS AND INSURANCE

151

 

 

CHAPTER 11: PREVENTION OF TMJ PROBLEMS

155

 

 

GLOSSARY

159

 

 

APPENDIX

163

 

 

    Suggested Foods for Soft Food Diet

164

 

 

    Sample Soft Food Diet Plan

165

 

 

    Quiz

166

 

 

    Answers to Quiz

167

 

 

SUGGESTED READINGS

168

 

 

INDEX

171

 

 

ABOUT THE AUTHOR

174

 

 

 

CHAPTER 1

THE CONTROVERSIAL TMJ

A few years ago the rumor was going around that Burt Reynolds had AIDS: he looked ill, he wasn't able to work, he had lost a lot of weight. It turned out that he had a TMJ disorder as a result of getting hit in the jaw while filming City Heat. In a newspaper interview (San Francisco Chronicle, May 24, 1987), he described his symptoms: "When your jaw, your bite, goes off, your equilibrium goes off too. You're in a kind of brain pain that comes up and whips your eyeballs out. Then the nausea starts. It's like being seasick all the time. You throw up, can't lie down, can't take any light. If the phone rang, I'd fall on the floor with a pillow over my head because of the pain. I had tubes in my ears and I didn't eat - just drank soup. I kept getting thinner and thinner. It was scary." He saw thirteen dentists before he found one that could alleviate the pain.

Normal TMJ With Disc as a Cusion

What Is the TMJ?

TMJ is the abbreviation for temporomandibular joint (also called the cranio-mandibular joint). A joint is where two bones join together. You have two TMJs - one in front of each ear connected to the horseshoe-shaped jawbone that has your lower teeth in it. The TMJ is a ball-and-socket joint. The jaw has rounded ends that fit into a socket and slide on a disc, or pad, as your mouth opens for chewing, biting, eating, talking, yawning, kissing, or making various facial expressions. Your lower teeth need to mesh in a very precise way with your upper teeth when your jawbone opens and closes. Your TMJ can give you problems for many different reasons, and we'll discuss each of them in Chapter 5.

The TMJ Controversies

Burt Reynolds' story illustrates the two kinds of controversy surrounding TMJ: its symptoms can be confused with a lot of other illnesses, and its cure is far from agreed upon. The reason for the difficulty diagnosing TMJ disorders is that pain in one part of your body can be referred to other parts through the connecting nerves and muscles. The reason why the treatment of TMJ disorders is controversial is that the causes are still not fully understood.

The controversy over treating TMJ disorders was evident at a workshop of the American Dental Association in late 1989. A lawsuit had been filed to stop eleven experts from discussing the treatment and diagnosis of TMJ disorders, but it was not successful, and 700 dentists signed up for this workshop that had originally been scheduled for a 225-person auditorium. The main source of conflict over TMJ disorders in the dental profession is the role of a bad bite, or malocclusion. A large segment of the dental profession believes that bad bites cause TMJ disorders, and therefore the treatment is bite correction at prices that can range from a few thousand dollars up to $15,000 or $20,000 if every tooth has to be capped. The accumulated scientific evidence doesn't substantiate this expensive treatment, however. It favors a more conservative and cost-efficient therapy that includes a soft diet, use of heat and ice, medications, stress management, and splint therapy. For a small percentage of the cases, surgery may be recommended.

The experts at the ADA workshop reported that a survey of the scientific literature showed that TMJ problems may lead to bad bites, but not the reverse, and that TMJ problems may be self-limiting and go away by themselves: This second conclusion was derived from research that showed that most TMJ disorders occur in people between the ages of 24 and 44 and that they rarely occur in people over 65. Because many dentists still believe that malocclusion is the major cause of TMJ disorders and that untreated TMJ problems can lead to permanent degenerative disease, these conclusions were hotly debated at the ADA meeting.

The final word is not yet in, but in the chapters that follow we'll look at various causes of TMJ disorders and the latest scientific evidence about their treatments. This information should help you become an informed consumer of dental treatment and help you to manage your TMJ problem over the long term.

  • Cranial Mandibular Disorders, Guidelines for Evaluation, Diagnosis & Management by American Academy of Cranial Disorders, Charles McNeill DDS. (Quintessence Publishing, 1991).

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