TMJ Disorders overview for Healthcare Providers

Dr. Holmes has treated over 10,000 patients TMD patients with 7,000 of them having severe internal TM joint disorders over his 29 years of practice. What makes his experience so rare is that he has ordered and correlated MRI scans on all 7,000 of these internal joint disorder patients. This has enabled him to provide an incredibly unique perspective and success rate for patients with this condition. Although the common recommendation of "soft diet" and "no gum chewing" may provide acute relief in some cases, with modern diagnostic tools at our disposal it is not sufficient anymore. Whether it is the initial manifestation of a problem, a patient that is unresponsive to treatment, or an acute injury Dr. Holmes has the experience necessary to treat TMJ disorders and complex dental problems and is here to help you and your patient. There is arguably no other area in dental medicine with more confusion and disagreement than TMJ disorders in not only the treatment but the diagnosis. Dr. Holmes has developed a logical, systematic and scientific approach to helping patients with this disorder.

Overview of TMJ headache pain

There are many causes of headaches and they can be very challenging problems for a clinician to diagnose and treat. TMJ problems are a major source of headaches, especially of the temporal region. If a patient presents with pain of the jaw, face, temporal, masseter, or occipital region it is often myogenic in nature and caused by a hyperactivity of these muscles due to some component of a TMJ disorder.

However, there can be many sources of pain in these area and the differential diagnoses can be a lengthy list. Cervical, dental, neurological, vascular, and auricular sources are common problems that create pain in the head. We have the ability to determine if a patient’s headache is caused by the most common source being a TMJ disorder or something else. We have the most systematic, effective, and modern diagnostic methods and treatment options available for TMJ patients.

Masticatory myalgia can mimic the location, manifestation, and intensity of true vascular migraine headaches. The important point is that the two differ in etiology but more importantly in treatment. Although masticatory muscle hyperactivity can trigger a migraine, there is unfortunately a tremendous amount of false advertising by dentists who claim to treat true migraines by the use of bite splints or TMJ therapy.

Myogenic head pain is usually caused by a discrepancy in one's dental occlusion related to their condylar position which then results in hyperactivity of the masticatory muscles. Habitual clenching and/or bruxing can also cause severe pain of the muscles of mastication and exacerbate underlying conditions.

Popping or crepitus of the TM joints represent internal derangements of the temporomandibular joints and can cause pain of the joint area itself or refer pain to regions of the head. The internal joint problem most often found is displacement of the meniscus (disc) to varying degrees. There are also various stages of condylar head pathology and this can also be a source of pain in a small percentage of patients.

Popping TMJs

Many people have some degree of damage to their temporomandibular joints that manifest as popping, clicking, or grinding noises. The noises are caused by an anterior displacement of the cartilage disc that is normally interposed between the condylar head and the glenoid fossa. The ligaments that position the disc can become stretched or torn from even a very minor injury which can then allow the TMJ disc to become displaced. The popping noise that is heard is from the disc reducing back onto the condylar head during opening or from it slipping off when closing. The direction and degree of a displacement as well as the shape and integrity of the disc determine the diagnosis, prognosis, and treatment.

All popping TMJs are not the same and are therefore not treated the same. There are 8 different classifications of internal derangements and additional subcategories. Although their signs and symptoms may appear to be the same, the treatment and prognosis of the stages are significantly different.

It is imperative that it be determined whether a disc displacement occurs at the lateral or medial pole of the condylar head before providing any type of irreversible dental treatment, including equilibration, orthodontics, prosthodontics, or jaw surgery. The prognosis of a medial pole displacement is much poorer than one at the lateral pole due to the fact that the loading of the joint occurs at the medial pole. In addition to which portion of the disc is displaced, the medial or lateral direction of the displacement is also important to know for establishing a prognosis.

Locking jaws are caused by a displaced disc that does not reduce or a subluxation. Closed locks, especially acute closed locks usually represent a more severe problem and need aggressive early intervention.

Because joint disorders are progressive, all popping joints should be properly evaluated regardless of whether they are painful. Ignoring early signs can prevent the opportunity to correct or stabilize a displacement and thus lead to a more serious problem.

Botox

Botulinum injections can be an effective treatment option for chronic myogenic head pain that is unresponsive to primary treatments. Dr. Holmes utilizes this option with remarkable success because he knows how, when, where, and how much to administer. It is important that Botox NOT be administered prior to the establishment of a TMJ diagnosis or as a primary treatment option for headache pain because most patients have an underlying occlusal or joint problem that should be corrected first to achieve the highest degree of efficacy of this costly medication.