The TMJ (temporomandibular joint) is a mystery in itself. Most doctors are not aware that the temporomandibular joint can wreak havoc with your life if it is not in the proper position. What this means is that if the discs that cover the top of the jaw bones (the condyles) have slipped off, then a person can indeed experience terrible pain in the head and neck region. It can be quite debilitating. The nerves can end up being pinched and pressure may also be placed on the blood vessels.
The first issue in identifying TMD (temporomandibular disorder) is to see someone who understands and can diagnose it. Often, this requires an MRI of the jaw joints to determine how displaced the discs are. If they are already torn or perforated, then surgery just might be needed, but even if they are that bad, surgery can usually be avoided by learning how to manage the damaged discs and allow for healing. In our office, the surgery rate is only one percent, so most issues can likely be managed non-surgically.
For almost all people, wearing appliances like an orthotic and an ALF (Advanced Light Force therapy) can greatly reduce the pain caused by the slipped discs. The orthotic is a device that fits on the lower teeth, and you would wear it 24/7. This is to ensure the condyles do not bang into the damaged discs. The ALF helps to reduce asymmetry of the cranial bones, allowing the jaw joint sockets to line up better. Together, these devices can greatly improve the pain management in the TM joints. You would wear these appliances for 12 to 18 months until the damaged discs can heal and move back into the sockets where they belong.
If a person is new to our practice and is suffering badly, we will often have them see our massage/laser provider, who is a certified massage therapist in the state of Virginia. She will use the laser to help stimulate blood flow, healing and reduce inflammation of the tissue around the TM joints. This has worked out very well for those cases in which a person needs immediate relief from the pain. This step allows time to complete the MRI, CBCT X-ray and discuss long-term treatment.
Another device that has proven very helpful for immediate relief is the Neubie machine. This device has sticky pads that go on the side of the neck, the traps (trapezius muscle responsible for shoulder and neck movements) and other areas to create a zone for the unit to pulse the muscles. The Neubie is a TENS machine on steroids! (TENS is a device that helps to vibrate the tissue to relieve pain; kind of like a fancy massage gun.) The stimulation goes to where the pain is being experienced to increase the limited range of motion, reduce spasms, increase blood flow and relieve pain.
Another adjunctive treatment we offer is BOTOX® therapy. This injection is used to relax the tension within the muscles and help alleviate the pain. The tightness or tension within the muscle creates these trigger points because the muscle has failed to relax. Prolonged irritation creates referred pain to other parts of the body as well. Keep in mind, the relief is not immediate in most cases, but within two to three days. This treatment can last up to three months or longer.
Another area to be looked at is the muscles around the head and neck. The palpation in this area is performed to see how tight the muscles are, and if very tight, this can cause tension to the airway. Most people with displaced discs have very tight neck muscles. This tightens the throat, hence the airway as well. If sleep is an issue, it just might be connected to a TMJ disorder. In other words, it is all connected!