TMD & Headache
Dr. Dukes has been treating TMD patients in Santa Barbara for decades. He is a Diplomate of the American Board of Orofacial Pain and is recognized as a specialist in this discipline by the American Dental Association. He received his specialist training at UCLA School of Dentistry where he subsequently taught for ten years.
WHAT IS TMD AND HOW IS IT RELATED TO HEADACHES?
The jaw joint is one of the most complex joints in the body is located just in front of the ear opening. It is named after the Temporal bone that is a part of the skull located on the side of the head in front and above the ear. This bone has a socket at the base that the head of the mandible fits into, so it is called the Temporomandibular Joint, or TMJ. When this joint and/or the associated muscles do not work properly or cause pain, this condition is called Temporomandibular Disorder or TMD. TMD is part of a constellation of painful conditions called Orofacial Pain and headache is the most common symptom. In fact, research studies have shown that TMD is the root cause of most headaches.
TMD SYMPTOMS
- Headache
- Earache
- Jaw pain
- Jaw locking, catching, difficult jaw opening.
- Painful joint noises, popping, grating or clicking.
CAUSES OF TMD
- Joint Diseases – Arthritis
- Abnormal Habits of the jaw – Clenching, grinding, fingernail biting, and chewing gum are major causes of headache and TMD pain.
- Jaw Injury – Blows to the jaw, over-stretching from wide opening during eating and long dental appoints.
- Psychological Factors – Research studies show that emotional stress, depression and anxiety increase pain.
- Prescription Medications – Prescription medicines taken for other conditions can have side effects that increase pain.
UNDERSTANDING TMD
NORMAL TMJ ANATOMY
The TMJ is a joint that can allow the mandible to move up and down and side to side. There is a meniscus, or shock absorbing disc, between the mandible and the base of the skull. This disc moves with the jaw and protects the bones as you use your mouth.
TMJ ARTHRITIS
Arthritis is an inflammatory condition of the joints where the tissues and bone break down. This condition is characterized by crunching sounds, restricted range of motion and pain. Arthritis can be caused by wear and tear on the joint such as from sleep bruxism (tooth grinding).
JOINT TMD
The tissues inside the TMJ can become injured and cause pain when you move your jaw, talk or eat. Sometimes it can be continuously painful. Often the meniscus (shock-absorber disc) in the TMJ gets displaced or damaged. When this disc doesn’t move normally it can cause pain and joint noises. This can lead to jaw sticking or locking.
MUSCLE TMD
The chewing muscles are large and cover side of the head connecting the jaw to the skull. These muscles open and close the mouth and provide chewing movements. When using jaw muscles, you also use the muscles of the neck that support the head and neck.
Like other muscles of the body, these muscles can become fatigued, tense and painful from overuse. Sometimes the brain confuses these pain signals, and you might feel the pain in other places. This can lead to widespread jaw pain, neck pain or headache.
Chronic daily headache is most often caused by Muscle TMD. Many patients suffer for years with chronic headaches and try multiple medical procedures to no avail. TMD therapies are generally very effective at treating headache while being reversable, noninvasive, drug free and long-lasting.
TREATMENT OF TMD
Your TMD symptoms may be temporary and self-limited without serious long-term effects, or you may have suffered for years. TMD therapies have proven to be very effective in the vast majority of cases. Most researchers agree with Dr. Dukes that your treatment should be conservative and reversible.
The goals of treatment are to decrease pain, to increase jaw function and limit the impact of TMD on your daily life. TMD is managed like other joint and muscle problems in the body.
TREATMENT MODALITIES
- Self-Management Behaviors – Stop self-destructive habits that perpetuate pain.
- Stress Management – Studies have shown that managing stress and anxiety helps relieve TMD symptoms.
- Physical Therapy – Simple, self-administered, home PT is effective in relieving joint and muscle pain when used in conjunction with orthotic treatment.
- Medications – Many medicines are available for discomfort. Some of these are traditional pain-relievers while others work in different ways to treat pain. Dr. Dukes will provide you with a specific treatment plan to fit your needs.
- Orthotic – Also known as a stabilization splint. The design will depend on your condition. These orthotics work to deprogram nighty tooth grinding, relieve pressure on your TMJ’s and teeth, and relax the jaw muscles. They have a well-researched and clinically proven record of success with headache pain and jaw musculoskeletal disorders.
- Surgery – Rarely required for our TMD patients.
