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Intracapsular TMJ Disorders
These are the most common type of TMJ problems comprising about 75% of people with craniofacial pain. Intracapsular disorders of the TMJ include dislocation of the disc inside the jaw joint or deformation of any structure inside the TMJ.
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Signs & Symptoms: Most commonly, this shows up as a popping, clicking, or locking jaw. Jaw pain, ear pain, eye pain, headaches, sudden & unexplained bite changes, and tooth pain (unrelated to cavities or infection).
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Treatments: Treatments depend on the cause of the disorder. Most often, an oral orthotic, such as a Gelb, is recommended.
Obstructive Sleep Apnea
The American Academy of Sleep Medicine (AASM) defines obstructive sleep apnea (OSA) as “a sleep-related breathing disorder that involves a decrease or complete halt in airflow.”
The blockage of the upper airway is most often caused by the tongue sliding back into the throat.
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Signs & Symptoms: waking up unrefreshed, snoring, gasping for breath while asleep, choking at night, obesity, large neck, daytime sleepiness, difficulty concentrating, depression, anxiety, ADD/ADHD, bedwetting, frequent urination at night, high blood pressure, clouded thinking.
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Treatment: A diagnosis must be made by a physician and a sleep study. Those people with mild to moderate obstructive sleep apnea can choose to use PAP therapy or oral appliance therapy (OAT) from the beginning. However, those with severe sleep apnea must first attempt PAP therapy for at least 3 months prior to attempting oral appliance therapy.
We, at Craniofacial Pain Relief Center, are providers of oral appliance therapy for OSA. We will work with you and your diagnosing physician to give you the best sleep possible.
Bruxism
Bruxism is excessive or abnormal grinding, clenching, or parafunction (dysfunction) of the lower jaw. It can happen during sleep or while awake. Bruxism can lead to tooth damage, jaw pain, headaches, and other symptoms. Bruxism is often a sign of other health problems affecting one or more parts of the teeth, jaw, upper airway, stress & psychological health, as well as the musculoskeletal and nervous systems.
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Signs: worn tooth enamel, jaw pain or soreness, and tension headaches.
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Treatments: may include a mouth guard, relaxation techniques, correcting misaligned teeth, Botox, behavioral health therapies, and medications.
Clenching
Clenching of the teeth involves forcefully holding the upper and lower teeth together, often unconsciously. It can be a habit or related to stress and anxiety. It may lead to jaw pain, headaches, and tooth damage over time. Clenching can be a sign of other conditions affecting the muscular and nervous systems throughout the body. Treatments can include a mouth guard, stress reduction, physical therapy, and correcting bite issues. Signs include jaw soreness, indentations on the tongue, tense facial muscles, tension headaches, extra sensitive teeth, receding gums, reduced mouth opening.
Myofascial Pain Disorders
Myofascial pain disorders involve chronic pain in the muscles and surrounding fascia. Causes include injury, jaw clenching and grinding, stress, and poor posture, just to name a few.
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Signs: localized pain, tenderness in the jaw and neck muscles, limited jaw mobility, tension headaches, migraines, muscle fatigue, and jaw pain when chewing.
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Treatments: may involve physical therapy, massage, moist heat, shockwave or ultrasound therapy, trigger point injections, and posture correction.
Dyskinesia
Dyskinesia of Muscles of Mastication and Mandibular Dystonia are conditions of involuntary contraction of the jaw muscles, causing repetitive movements. It can include a jaw tremor, teeth grinding or jaw clenching and deviating movements.
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Signs: uncontrolled jaw and tongue motions, jaw pain or spasms, difficulty chewing, and difficulty opening or closing the mouth.
Treatments: can include medications, botulinum toxin injections, stress reduction, and an oral orthotic.
Migraine
The definition by the American Headache Society is “Migraine is an episodic disorder, most commonly consisting of severe headache, usually with photophobia (light sensitivity), phonophobia (sound sensitivity) and/or nausea (at times vomiting).” The causes are various from genetic predisposition, trauma, stroke, tumors, and untreated health conditions to name just a few. Migraines should always be evaluated and diagnosed by a neurologist or migraine-trained physician. Migraines comprise only about 20% of all headache disorders. What we often see here at the Craniofacial Pain Relief Center, is that treating the underlying craniofacial disorders helps reduce the occurrence and intensity of our patient’s migraines. This allows the neurologist to fine tune their treatments.
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Signs: Pain in the head area, light sensitivity, sound sensitivity, aura prior to the migraine, nausea, vision changes, dizziness.
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Treatment: Good hydration, Botox, muscle deprogramming, massage therapy, low-impact exercise, physical therapy, stress reduction.
Ear Pain & Other Ear Symptoms
The TMJ and the inner/outer ear are very interconnected. If you are experiencing ear pain, we recommend you first go to your physician or ENT for an evaluation. If they find nothing wrong and you also have TMJ and craniofacial pains, the ear pain is likely to be secondary to other problems.
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Signs: pain in or around the ear, tinnitus, stuffiness in the ear, muffled hearing, dizziness.
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Treatments: diagnosing and treating the underlying craniofacial & TMJ causes. This often involves an oral orthotic for TMJ decompression & realignment, massage, physical therapy, sleep evaluation, sleep study, medications.