Another approach, however, vastly different, is to use medications to calm the pain and at least get some degree of relief almost immediately. In some of these cases, the practitioner would prescribe Cymbalta to alleviate the anxiety often associated with the pain. Cymbalta is a well-known drug used to treat depression and anxiety. Admittedly, many TMD patients are hurting so badly that they become depressed, and anxiety sets in as they worry about how their future is looking. Unfortunately, this drug has a host of side effects that may make it not so worthwhile, but as a temporary measure, it might help for now. Some practitioners use Xanax along with the Cymbalta since it takes time for the Cymbalta to activate the desired response.

In other cases, something like Cymbalta is used in conjunction with injections into the muscles of the head and neck region to calm those muscles that have been irritated from the slipped discs. Injectables like Botox®, cortisone, prolotherapy and stem cell therapy have been documented to reduce muscular tension. This also provides some degree of temporary relief and may even help to ‘reset’ the muscles into a better pattern.

Of course, there are the surgical approach options. The least desired surgical treatment entails breaking the jaws and resetting them into a more ideal position, however, this approach may not work very well. Cutting apart the bones of the skull may be more risky than other modalities. A more conservative approach to dealing with the displaced discs in the jaw sockets entails simply putting the discs back on top of the condyles. A 20-minute surgery called plication. By far, this is more conservative and simpler than the other surgeries.

So as a patient, you have a choice: try to figure out the underlying issues and deal with them accordingly, or mask over the symptoms and hope things settle down. As I tell our people, it is up to you and I am simply here to guide you on the journey.

Read more about TMD.

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In most cases, when the MRI is ordered of the TM joints, it is patently clear when there is cortical erosion of either the condyle or the fossa (socket for the condyle). The radiologist will most likely indicate that the articular disc (that protects the condyle) is displaced and thus the condyle is now exposed and is bone on bone in the fossa. This is not a good situation and can lead to all sorts of pain, asymmetry, and other problems in the head/neck region. Think of it like this: If the disc is slipped off the top of the condyle, it can no longer protect your condyle from banging into the socket bone-on-bone. Diagnosis: OUCH!

The cortical erosion of the condyles and fossas can also be diagnosed with the X-ray called CBCT (Cone-Beam Computed Tomography). The CBCT allows the dentist or the radiologist to look very precisely at the condyle and fossa and if erosion has begun it can be clearly seen in the images. Even though some people do not like taking the CBCT due to the radiation, it is really important to do these images every few years to follow up on the cortical erosions.

So, what does one do when cortical erosions are present? Well, in most cases it’s called ‘watchful waiting’ where the doctor checks the range of motion on a regular basis to make sure the erosions are not doing more obvious damage. You should wear your mouth appliance(s) accordingly to protect the joints. And every few years, just re-take the images and compare them to the previous images.

Unfortunately, if things worsen, surgery is sometimes all that is left to offer to a person with severely damaged joints. There are several types of surgery. The simplest surgery is called plication of the articular discs. This means just moving the slipped discs back into the proper position to reduce the risk of bone-on-bone damage to the condyle and fossa. The next level of surgery entails what is called menisectomy – removal of the damaged discs. If the discs are fully removed, this enhances the risk of bone-on-bone, condyle to fossa, banging or pounding. As long as the appliance (splint) is worn, this is not a problem. Unfortunately, if things get worse, then TJR (Total Joint Replacement) is indicated. This is a big surgery but very rarely indicated.

As with most health issues: Treat early and keep a careful watch on your health!

The post So, What Is Cortical Erosion? first appeared on Sleep & TMJ Therapy.

Another factor with women experiencing more TMD is that the disease process known as EDS (Ehler Danlos Syndrome) is far more common in women than men. In fact, the most common subtype of EDS (hEDS- hypermobile EDS) shows that 90% of the patients are women. This number is staggering. And with the more common forms of EDS, it turns out that the prevalence is roughly 70% women and only 30% men have it. Again, this is a remarkable difference that exists in a disease process that greatly affects TMD. With EDS the ligaments and joints are all looser than they should be so the discs on top of the jaw bones (the condyles) are far more likely to slip off or become displaced…

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The post TMD From a Woman’s Perspective first appeared on Sleep & TMJ Therapy.

The other day I walked into our consultation room to meet a new patient and I could tell right away what was going on. The lady sat there with huge circles under her eyes. Her face appeared sunken and sullen. Her shoulders were slumped forward, and it was obvious she did not sleep well. Her pain was overflowing. As I did the palpation exam, I barely touched the muscles, and she winced every time as a few tears came out. I wanted to cry with her. She was on the edge, and I could tell she had dark thoughts in her head. She finally admitted that if I could not help her, she would not survive much longer. How sad that a person had to suffer so much and so long.

As you all know, dear readers, I ordered the MRI to figure out what is really going on. The MRI is the key to our understanding of her situation. Unfortunately, she had never had an MRI done in the past. To me, this seemed like such an obvious path to take. It was what I learned so long ago. Never assume. Do an MRI to know where your discs are located. This concept was ingrained into me many years ago and I have not wavered from it since. Obviously, the MRI can only show the soft tissue and along with the CBCT X-ray, we can come to a good diagnosis.  (This is another blog about what I am measuring and looking for.)

This lack of imaging and analysis seems to be missing in the world of TMD treatment. (I am making headway teaching and explaining this, but so much more is needed.) An X-ray most certainly will not provide the required views of the discs – the X-ray is good for looking at the hard tissue – the bone. Don’t get me wrong, the bone view is very important, however, it’s equally important to know what the soft tissue – the discs – are doing. So, let me pose it this way: if you went to your orthopedist with knee pain, would an X-ray suffice for a diagnosis? We all know the answer to that one…No Way! You definitely would need an MRI before treating the knee joint, especially if there was any need to consider surgery.

So why is it that most dentists out there who are treating TMD are not doing the MRI? Because of inconsistencies in treatment, this is likely why patients do not get relief with other types of TMD treatment. If all dentists did like all orthopedists do – take a good  MRI to diagnose their patient’s condition, then maybe the patient might not have to go from healthcare provider to healthcare provider, spending money and not knowing what is really going on.  It’s quite a conundrum, isn’t it?

The post The Case of The Missing MRI first appeared on Sleep & TMJ Therapy.

Now, let’s explore the implications of exercise and its impact on the effectiveness of TMD treatment. Engaging in activities such as running can subject the neck to significant impact, leading to compression of the spinous processes. Consequently, this compression can adversely affect the temporomandibular (TM) joints. Therefore, it is generally not advisable to engage in running while undergoing TMD treatment. An alternative to running is the use of an elliptical machine. This low-impact device provides an excellent cardiovascular workout without putting strain on the neck. It is crucial to prioritize the well-being of the TM joints and cervical spine during the exercise routine.

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TMJ Disorder and Exercise

The post TMJ Disorder and Exercise first appeared on Sleep & TMJ Therapy.

What occurs in TMD is the articular disc that sits on the condyle (the cartilage that sits on top of the jawbone) has slipped off and is now pinching nerves and blood vessels in that region. Think of it like this: your doctor tells you that you have a disc slipped in your lower back. You then understand why the back and legs hurt and understand why there is numbness in that area. When the articular disc slips off the condyle, it can actually displace not in just one direction, but it can be a double displacement (in two directions) and since there are two TMJs in the skull, such displacement can hurt terribly and cause tremendous inflammation.

Sometimes the warning signs are there: popping/clicking of the jaw joints, head/neck pain, ringing in the ears, vertigo, and even tremors. These warning signs can occur at all ages and can lead to other health complications as well. Frequently, young children report ear problems but not the pain, clicking and popping, teeth grinding and clenching and headaches. Typically, the ear is treated and or the ears are irrigated.  If this persists the source of the problem is likely a slipped disc in the jaw joint. That slipped disc can actually push the condyle backward and into the area of the ear canal causing the “clogged feeling”. This is actually quite common.

Another very important facet of TMD is how the slipped discs cause either outright pain or even a low-grade irritation/ inflammation that prevents us from getting good sleep. Too many people just get used to the discomfort and learn to live with it. This lack of good sleep correlates to cardiovascular problems, diabetes and cancer. The human body requires good quality sleep in order to allow the cells to rejuvenate and for the body to heal from injury. So, if you are not sleeping all that well, it may just be a TMJ problem that should be analyzed. Part of that analysis includes looking at your Vitamin D-3 levels, because without proper D-3, there is no way to sleep well (but that is a whole other discussion).

So, whether you are young, old, or in between, it is really important to know a little about TMJ disorder and how it affects your wellbeing. The earlier in life that we recognize the problem, the easier it is solved. For your good health, reduce high stress or anxiety in your life, deal with the signs presented, and pass the word on.

The post The Case Of How TMD Can Affect Both Kids And Adults Or Why Should I Know About Such Things? first appeared on Sleep & TMJ Therapy.

The truth of the matter is that if you work with an experienced TMD (Temporomandibular Disorder) specialist, then such an advanced procedure is rarely necessary. The path toward surgery should always try to be avoided, but sometimes it is simply necessary.

When a patient first begins treatment, they must do an MRI to figure out how damaged the discs in the jaw joints really are. This gives the specialist a good baseline to begin with so that a comparison MRI 12-18 months later will help to determine if enough healing has occurred so that surgery is not needed. It’s all relative- if after the 12–18-month appliance therapy period, the patient just feels great, yet the discs are not quite perfect position, then no surgery is indicated. If there is still substantial discomfort, then there would be a discussion about the type of surgery and how to finish the case.

In almost all cases that require surgery, the process is either plication (put the discs back into proper anatomic position) or meniscectomy (remove the remnants of the damaged discs). In either case, the surgeon makes an incision that is only one inch long at the little crease just in front of the ear. He then goes into the joint and will fix the problem either way. Sutures are done internally to keep the discs where they should be, and external sutures are done to seal the area. These two surgeries are considered simple and logical and when done will last a lifetime in almost all cases. The key factor is having a surgeon who has done many cases over the years. It should also be mentioned that TRJ (Total Joint Replacement) is only done when the top of the jawbone (the condyle) is severely eroded beyond any reasonable chance of repair. This is a rather heavy-duty surgery because you are in full braces and the jaws are wired shut for a few months. Eating through a straw is no fun, but there are few other options.

Because TMD treatment is so misunderstood and mismanaged, there are many opinions coming from many practitioners about the proper course of treatment. Some surgeons will ONLY perform TJR while others would do arthrocentesis (flushing the joints) before considering plication or meniscectomy. For these reasons, insurance companies are hesitant to pay for a procedure and call it all ‘experimental’ which it most certainly is not. So please be well informed and understand the options!

The post The Case of the Misunderstood Surgery first appeared on Sleep & TMJ Therapy.