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Orofacial Pain and TMJ Disorders

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Ortofacial Pain and TMJ Disorders

Abstract

Patients with orofacial pain (OFP) and/or temporomandibular disorders (TMD), may have several symptoms such as head, neck, facial, and ear pain. Other reported symptoms include dizziness, light-headedness, vertigo, tinnitus, loss of or difficulty in hearing, sinusitis, throat problems, difficulty eating, inability to or difficulty in opening the mouth wide, and blurred vision. Each of these symptoms may be caused by a number of other factors, not necessarily a disease, disorder, or injury to the temporomandibular joint (TMJ). Because, in many individuals, several overlapping head and neck pain and other symptoms may mimic the OFP and TMD, a differential diagnosis is needed to determine their origin and the probable cause. Hence, we integrate the knowledge gained from the patient’s history, the clinical examination, and the use of diagnostic aids to establish a proper diagnosis and tailor a suitable treatment plan.

TMJ Disorders

TMJ (Jaw Joint) disorder (TMD) is characterized by tenderness and pain in the joint on each side of your head in front of your ears, namely temporomandibular joint, where the lower jawbone hinges to the skull. This joint moves when we talk, chew and yawn. It combines a hinge rotation with gliding motions. The joint surfaces are covered with cartilage and are divided by a small disk, which maintain smooth movements. In addition, there are numerous muscles connecting the jaw and its joint to the head and neck. Therefore, disturbances in the joint or the associated structures cause head and neck pain and dysfunctions.

TMJ disorders (TMD) can be caused by diverse types of problems including: abnormal bite, jaw injury, facial or cranial muscle fatigue from teeth clenching or grinding. TMJ disorder may be associated with general systemic diseases such as fibromyalgia and arthritis. TMD symptoms may be as follows:
  • Pain or tenderness in or around the jaw joint that may radiate to the side, back or front of the ear or the neck areas.
  • Aching facial pain or tension headache.
  • An uneven or uncomfortable bite especially when teeth are making early contact.
  • Difficulty chewing or discomfort during or after chewing.
  • Locking of the jaw joint, making it difficult to open or close the mouth.
  • Clicking sound or grating sensation when you open your mouth or chew.

When to see a dentist:

It is advisable to seek professional attention as soon as you feel any of the above symptoms or signs. Persistent pain or tenderness in or around the TMJ or difficulty opening or closing your jaw may be an advanced stage of TMJ disorder.

Preparing for your appointment:

Preparing for your appointment:
You may want to bring a written paragraph of your medical history, chronological history of your current problem as well as a list that answers the following questions:

  • What type of symptoms are you experiencing?
  • When did your symptoms start?
  • Does any of your daily activities seem to trigger the pain?
  • Does your jaw click, pop or make noise when you move it?
  • Do you have problems sleeping?
  • Do you have any emotional stress?

What to expect at the first appointment:

You will be asked to answer a list of questions concerning your problems, then a review of your answers to these questions is done by the office staff and the doctor for more details and accuracy. An examination of the face, jaw joint, bite and mouth is performed. The doctor will prescribe a treatment plan that is suitable to your specific condition including taking some imaging studies to carefully diagnose your problem. The doctor may recommend treatment regimen to relieve your disorder including oral appliances, physical medicine modalities, and self-care remedies. In some cases, some medications may be prescribed depending on your specific case.

The majority of patients receive relief of their pain and discomfort with non-surgical treatments. Severe TMJ disorders may need to be treated with surgical interventions

Orofacial Pain

Orofacial pain is one of the many painful conditions that may affect the head and neck. This pain may be the most perplexing and tricky one to diagnose. The orofacial pain is composed of a group of the problems including muscular pain, arthritic pain, and neuropathic orofacial pain disorders. If you have experienced the annoyance of having a persistent toothache, face pain or have seen many health care providers without a real relief, you may be suffering from orofacial pain disorder. At one time, many patients were informed that their pain was of psychological origin; however current studies have revealed that most of these pains have organic origins and can be managed successfully when correctly diagnosed.
Persistent head and neck pain should be evaluated by specific health care providers dealing with such problem as well as an orofacial pain trained dentist. The doctor will perform a comprehensive evaluation, which may include a thorough history, careful examination, and diagnostics imaging.
The history should include recording accurate characters of the pain and other symptoms you may have, the history of the event that possibly caused the persistent pain, previously seen health care providers, past treatments and their results, and list of medications taken with their efficacy and/or side effects.
The examination may consist of touching different areas of the head, neck and inside the mouth, measurements of the jaw opening and evaluation of the jaw joint. Some pain provoking techniques may be employed to find the source of pain. This may be performed with touch, pressure on muscles or joint; or thermal application on the affected area. In some cases diagnostic injection may be needed.
Subsequently, the dentist may order diagnostic tests which could include magnetic resonance imaging (MRI), computer assisted tomography (CT) or other radiographs (X-rays). In addition, your primary care physician may refer you for blood tests, and other tests. These tests are used to make sure that there are no other factors that may be contributing to the pain. Depending on the complexity of the problem, the Orofacial pain dentist will decide which of the diagnostic tests are appropriate.
Subsequent to gathering the results of the history, examination, and diagnostic tests, the dentist will make a diagnosis and recommend a treatment approach. Occasionally treatment of difficult cases begins on a trial basis to select the most effective approach. In addition, we may refer you to other professionals to assist in managing other treatment that may be needed in conjunction with the treatment you receive in this office. Physical medicine, medications, and self-care may be prescribed depending on your specific case.

Common Orofacial Pain Disorders:

Facial Myalgia: pain in the facial muscles
Cranial Arthritis: pain in the skull bones
Neuropathic pain: pain from a nerve origin such as Trigeminal Neuralgia, Glossopharyngeal Neuralgia (burning mouth syndrome)

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