In the last 2 issues we covered typical clinical problems that we encounter with TMJ patients. We have received many questions regarding how to diagnose subclinical TMJ patients (the ones who show no obvious sings of TMJ problems such as popping, clicking, or pain.) Subclinical TMJ patients can present with many clinical problems and make dental treatment difficult for the practitioner. In order to help you recognize some of these patients, we recommend that first you ask your patient if they have a history of Headaches. We find that 95% of Headache patients have an underlying TMJ problem!!! Here is a guide for your reference that you can use to help discern these patients:
1. No signs of any TMJ problems?
Patient is having absolutely no jaw pain or muscular pain. NO signs of a TMJ or jaw problem whatsoever! These patients visit their dentist, physician, and many other specialists who cannot detect a TMJ problem due to the fact that the jaw joint exhibits no noises or signs of pain. This is very common with chronic pain patients, especially migraine sufferers. These patients are often found to have joints that have slowly “plasticized” over time due to compression. The protective disk slowly resorbed, over time, with no apparent signs of pain or problems. The joint itself adapted to the dysfunction by smoothing out the skull bone and the head of the lower jaw (the condyle). The “hyalinized” bone (smoothed bone) makes no noise or causes no pain within the joint itself because it has polished itself in an effort to protect the area. The problem, however, comes with time as the surrounding tissues, muscles, nerves, blood vessels, and brain sense the dysfunction and start to cause head pain. This is the most commonly misdiagnosed and missed problem in today’s headache war and these patients can have difficulties when getting regular dental work done. Unless TMJ treatment is done, Sedation may be the only option for achieving anesthesia but be careful because the patient can have many post-op issues, especially “ghost toothaches,” jaw pain and worsening headaches.
2. Do you grind or clench your teeth or chew gum?
This is one of the most common and widespread problems affecting a large segment of the population. As the teeth wear down from continuous use, grinding and/or clenching, so do the joints. The teeth lose their ability to support the proper jaw to jaw balance. As the teeth wear down they lose the ability to support the jaws and the jaw joints. Some of these patients also chew gum which is a big contributing factor to Headaches. Remember to check their Medication regimen and look out for psych drugs.
3. Undiagnosed tooth pain or unpleasant dental experiences?
We see a large number of patients who experience tooth aches that are in fact not tooth related. This is called “ghost tooth aches.” Often, these patients receive root canals or extractions in vain. The problem persists or gets worse. The underlying issue is neurologic and not tooth borne. Proper diagnosis requires skill and experience.
4. Chronic neck and shoulder pain?
The jaws and your neck/shoulder work in tandem. If one is out of alignment, the other cannot be balanced. Proper treatment can only be accomplished by taking into consideration all working parts. Physical therapy and chiropractic may work temporarily, but they will not provide any long term healing without functional jaw treatment.
5. History of accidents or trauma?
Whiplash or trauma can cause neck and jaw dysfunction. Often, the symptoms are not felt for months or years. Proper diagnostic tests and XRays must be performed in order to determine the extent of any injury. Treatment must be done with close cooperation with physical medicine specialists.
In the next newsletter we will cover more additional identifiers.