M
igraines; pain in the jaw, head, neck or shoulder; ringing or congestion in the ears – these symptoms could be caused by dysfunctions of the temporomandibular jaw joints. In the common vernacular, these dysfunctions are often mistakenly called “TMJ,” but are actually a cluster of disorders called temporomandibular disorders (TMD). Dysfunction can occur within the jaw joint complex or may be due to dysfunction of the muscles attached to and surrounding the jaw joint which control the position and movement of the jaw. This includes musculature of the head, neck, face and shoulders. This musculature dysfunction can be characterized by muscles not working in pairs as they normally do and also by muscles on one side working harder in an attempt to achieve balance in the musculoskeletal system. As a result, the overworked muscles may develop spasms and/or trigger points, which appear as a localized spot of tenderness in a nodule that is a palpable taut band of muscle fibers. Trigger points can also be felt as painful lumps of hardened fascia tissue. Fascia is a sheath of connective tissue surrounding a muscle. Unlike tender points, trigger points can and do refer pain to other parts of the body, making the source of the pain obscure. When trigger points are present, muscle strength becomes unreliable. Trigger points may form when a nerve passes through a muscle between the ropey bands of muscle or when a
Could That Pain Be From TMD?
Temporomandibular Disorders Explained by Kurt A. Le Jeune nerve lies between the band and bone, where the pressure on a nerve can produce numbness, but only in the area of compression. For example, muscle inflammation and trigger points within the neck musculature that attaches to the base of the skull at the back of the head can entrap or compress the greater or lesser occipital nerve resulting in pain radiating from the base of the skull upward across the side of the head to the forehead and sometimes resulting in pain behind the eye. Treatment for trigger points range from trigger point injections with medication to dry needling and cold laser therapy. However, trigger point injections usually result in a longer lasting relief of pain. Dysfunction inside the jaw joint complex may involve inflammation or stretched or torn ligaments holding the articular disc, an oval cartilage that separates the bones of the jaw joint that is involved in opening and closing movements. There may be remodeling of the bony surfaces that make up the jaw joint
complex or tears or holes in the articular disc itself. Stretched or torn ligaments result in slippage or movement of the disc as the mouth is opened or closed. When the disc slips in and out of place a clicking or popping sound may be heard with or without accompanying pain. Initial treatment for dysfunction inside and outside the jaw joint complex most likely would include a thorough examination and diagnosis, a treatment plan formulated to improve or restore proper function of the jaw joint complex and musculature, therefore reducing pain and inflammation. According to the National Institute of Dental and Craniofacial Research, over 10 million Americans may suffer from TMD, with a greater prevalence in women than men. Kurt Le Jeune, DDS has a dental practice located in Baton Rouge. He is a Diplomate of the American Board of Craniofacial Pain – Craniofacial Dental Sleep Medicine. His office may be contacted at administration@cypressdental.com or 225-248-8400. See ad on page 25.
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