The Case of the Confused Craniofacial Case

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When it comes to treating your craniofacial pain, there are actually a number of diverse ways to go about it. When a person lands at my office, the first step is really to try and figure out the underlying cause of the pain by doing an in-depth analysis of the problem. This process (in most cases) will entail an MRI to look at the discs that cover and cushion the condyles (top of the jaw bones). The second diagnostic tool is a good CBCT X-ray to look at the cervical spine and the cranial bones, not just the jaw area. In almost all cases of craniofacial pain, the articular discs in the jaw joints are displaced. This displacement will then affect the position of the condyles and cause the bite to be uneven. It may seem to the patient that the muscles are the problem when the real source of the problem is the slipped discs. The treatment involves wearing a splint on the lower jaw and most likely an appliance on the upper jaw. The lower splint provides spacing for the disc to move back into place while the upper splint helps level the asymmetry of the cranial bones.

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.

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