WHY IS THERE SO MUCH CONFUSION?
Much has been written on the topic of headaches, but very little has been said about the relationship between headaches, neck and ear pain, and TMJ syndrome, even though for more than fifty years research has shown it causes a high percentage of muscle contraction (tension type) headache pain and extensive damage to teeth and jaws.  Despite this objective evidence many well-trained caring professionals cannot detect or accurately diagnose TMJ-related headache pain.  TMJ dysfunction causes great suffering, yet patients who suffer with this disease remain confused and often are in a great deal of pain!

KEEP THIS IN MIND!

• Headaches are so common that people accept them as a part of life.
• Many people have been getting headaches for so long they don’t even know 
  what “normal” feels like anymore.
• Individuals usually self diagnose their headaches, as a result they often start 
  looking for answers in the wrong direction
• A large percentage of headaches diagnosed as stress and even migraines 
  can be due to TMJ dysfunction
• If the bite can be evened so there is no conflict between jaw joints, teeth, 
  and muscles, the pain will stop. 

JOHN HOPKINS REPORT
According to the National Headache Foundation (NHF) studies, headaches are an accepted part of life for more than 45 million Americans.

Recently, John Hopkins University Medical School researchers concluded in a report on chronic and episodic tension type headaches, in the journal of the American Medical Association, that these types of headaches were a highly prevalent condition having a significant functional impact at work, home, and school.  Forty-three percent of people in the John Hopkins study reported that their work suffered as a result of their headaches.  In addition eight percent of the people reported losing workdays due to headaches. 

The NHF estimates that employers lose $50 billion per year due to absenteeism and medical expenses caused by headaches and migraine sufferers lose more that 157 million workdays each year.  Headaches mean big business, especially when the underlying cause goes undetected and unsuccessfully treated, forcing patients to go from doctor to doctor in search for a diagnosis and relief from their pain.  People rarely consider that their headaches could be due to their bite.

YOUR HEADACHES COULD BE DUE TO TMJ DYSFUNCTION

• If you get frequent tension head and/or neck aches.
• If you wake up in the morning with head, neck or jaw aches
• If you get reoccurring ear pain or ringing and the ear doctor finds nothing wrong.
• If you get pain in the temples or forehead and you think it is due to eyestrain but your eyes have been checked and are fine.
• If your jaw feels sore or tired after chewing a lot
• If you hear popping or clicking or grinding sounds in your jaw or ears when you open or close your mouth.
• If you are aware that you sometimes grind or clench your teeth.
• If someone else told you that you grind your teeth.
• If there are any signs of damage from teeth grinding even though you are not aware that you grind your teeth
• If you get head, neck or facial pain and are uncertain of the cause.

TMJ dysfunction headaches can range from intense to mild and occur frequently.  While the more intense headaches demand attention, the more moderate headaches also have a negative affect on the quality of life of many people.  The more moderate to mild headaches that are due to TMJD are usually accepted as a part of life, and many don’t complain about them.  They accept some pain as normal and take medication when they need to.  These people often get little if any professional help. 

PAIN RELIEVERS ARE NO CURE
Pain relievers like aspirin, acetaminophen, and ibuprofen, take up miles of shelf space in stores in America.  More than $4 billion are spent annually on over-the-counter pain relievers for headaches.

If you get headaches, you are certainly not alone.  If you want to get an idea of just how common headaches are, ask your coworkers how often they get headaches.  If you survey includes mild stress headaches to severe migraines you will find that at least one in four people take some kind of pain reliever for headaches.

Pain relievers do not cure a headache.  Unlike antibiotics, which kill the germs that cause the illness, these drugs simply mask the symptoms of pain until it goes away by itself or until the drug wears off.  Pain relievers can cause new problems without curing the source of the headache. 

THE KEY TO THE CURE IS CORRECT DIAGNOSIS
Headaches caused by TMJ dysfunction syndrome can actually be diagnosed quickly and easily by a professional trained in the area of TMJ dysfunction syndrome.  Of course, not every head and jaw ache is due to TMJ dysfunction syndrome, 
but a surprisingly large number are.  The good news is that thousands of qualified dentists can accurately diagnose TMJ dysfunction syndrome and accurate diagnosis, which leads to correct treatment. 

SCREENING FOR TMJ DYSFUNCTION SYNDROME
KEEP THIS IN MIND

• Because TMJ related problems are so common, routine exams should include a brief screening exam to discover if symptoms of TMJ dysfunction syndrome are present.
• If there are head, neck, facial pain or dental symptoms present then a comprehensive TMJ-related evaluation should be done. 
• Since so many dental symptoms of TMJDS cause no pain, it is important to detect their presence before the damage becomes severe.
• When examining for TMJDS, the doctor must first determine if there is a conflict between the biting surfaces of the teeth and the jaw joints.

THE COMPLETE EXAM WITH A TMJ DYSFUNCTION EVALUATION
The routine examination for TMJDS as several elements:

• A medical and dental history that includes questions about pain in the head, neck, face and jaws.
• Examination of the teeth for any dental symptoms
• Examination of the bite and the muscles.
• If a patient tests positive in the initial exam, further tests such as study models, specific x-rays and ultrasound analysis should be done.

The initial examination should include checking for dental symptoms such as worn, chipped, broken, loose or shifted teeth.  In examining the bite, the dentist must guide the patient’s jaw in order to detect the difference between correct jaw position, muscle position, and the alignment of the teeth.  If the patient simply bites down the proper diagnosis will be missed.  If the biting surfaces of the teeth are in conflict with the correct position of the jaw joint, every time the person closes to swallow and the teeth touch, the jaw will be pulled off center, the muscles of the jaw will contract unevenly leading to muscles becoming cramped and painful, frequent headaches, and possibly severe wearing of the teeth and noisy jaw joints.  Patients can have one or all of these symptoms or a combination of each.

MORE ADVANCED TEST TO ANALYZE BITE PROBLEMS
If the results of the examination indicate a problem then further testing to gather more detailed diagnostic information is required.  One excellent option is to make impressions for models of the teeth.  These allow the doctor to study the bite relationship on an instrument that simulates the patients jaw movements.  Then the doctor can study the patient’s bite from angles that wouldn’t be possible by merely looking at the patient’s teeth. With these models, the doctor can check the effect of changing the shape or position of the teeth and determine what must be done to achieve a proper bite before working directly on the patient. If the changes work on the models, we feel confident that the recommended treatment will produce good results on the patient’s bite. The doctor may also take x-rays to study any possible damage to the jaw joint.  
They may also request MRI scans to discover if the disc is damaged or out of position.   One of the newest tests is an ultrasound examination.  This procedure is fast, inexpensive and noninvasive.  The procedure, known as Doppler auscultation, uses a very small ultrasound device to listen to abnormal joint sounds with the TM joint.  Based on whether the sounds heard when the patient opens and closes the jaw versus moving side to side, the doctor can tell where in the disc the  damage has occurred. 

SELF EXAMINE YOUR JAW JOINT
The key to early diagnosis and treatment for TMJD is to correctly educate the person who makes the first diagnosis, the patient.  Just as every woman has learned to understand breast cancer and the need to do a routine self-examination, 
every one can learn to do a self-examination of TMJDS.  Early detection may lead to more effective and less invasive treatment.

TEST YOUR BITE
Before you test your own bite remember that an uneven bite forces the body to try to compensate by overworking the jaw joint and complex muscles. As a result of this increased muscle activity, the muscles do not work properly. This imbalance 
can range from slight muscle fatigue to severe muscle cramping, pain and extreme limitation of movement.  As you test your own bite remember that existing muscle tension may make it difficult to position your jaw accurately.  In the dental office it may take a professional several minutes or much longer to do this.  Even though you are likely to position your jaw exactly, you will get a pretty good idea of how your bite lines up if you follow these simple instructions.

STEPS TO TEST YOUR OWN BITE

1. Sit in a relaxed position.  Tip your head up and back so you are looking toward the ceiling and touch the tip of your tongue to the back of the roof of your mouth.  This will help relax your jaw muscles.
2. Very slowly let your teeth start to come together.  Aim at your back teeth.  Notice if the right or left teeth touch first.
3. At the very first touch, stop and open your mouth again.  Slow motions are essential to allow the muscles to relax.  Repeat steps 1 and 2, but this time stop and freeze on the very first point that touches.
4. Pause on this spot for a moment.
5. Now squeeze all your teeth together without opening your mouth.  Squeeze from the spot you first touched to the place where all your teeth touch.

If your jaw had to move or if the teeth slid from the first place where only one or two teeth touched, then the biting surfaces of your teeth conflict with your proper  jaw position. 

TEST YOUR MUSCLES
Pain from TMJDS is due to muscle cramping of overworked jaws. Test your own jaw muscles to see if you have any soreness or discomfort. Place your fingers on the side of your head over the temples, eyebrows and above the ear.   Do you feel pain in these areas either with or without clenching your teeth?  Place your fingers on your cheeks and in front of your ears. Do you feel pain with or without clenching your teeth? Place your fingers on the back of  your head and down your neck. Do you feel pain?

LOOK AT YOUR OWN TEETH
In good light, use a magnifying mirror to discover any physical evidence that you grind or clench your teeth. 

Do you see?

• Broken teeth
• Worn teeth
• Chipped teeth
• Internal cracks
• Gum recession
• Shifting teeth
• Loose teeth
• Lost teeth
  

  Broken teeth:  Clenching and grinding forces can break a tooth.  Usually these teeth can be saved by capping them, but unless the grinding and clenching forces are controlled it is only a matter of time before the next tooth will break.

Worn teeth:  As a person grinds their teeth back and forth subconsciously, their teeth can become extensively worn.  It is important to note that by simply repairing the wear without first correcting the bite, the grinding will continue and the repair work will fail and the patient will naturally be very disappointed.

Chipped teeth:  Chipping is a combination of worn and broken teeth. Once the teeth are worn down the tooth structure can become fragile and easily chip. These chipped areas are often seen on the biting edges of the front teeth.

Internal cracks:   Severe clenching pressures can cause internal cracks and stress fractures in the teeth. They are not painful unless they go deep into the tooth.

Gum recession:   We generally blame brushing too hard for gum recession. But grinding can cause gum recession too.

Shifting teeth:   Grinding and clenching for us can cause considerable tooth movement.  Movement is first noticed when spaces develop or when teeth begin to overlap.

Loose Teeth:   Prolonged grinding or clenching can damage the bone around the teeth, causing teeth to loosen.

Lost teeth:   Except for decay, accidents, and gum disease usually lost teeth are caused by bone loss or tooth breakage beyond the point of repair. As you have seen grinding or clenching can cause both these conditions.

STRESS
Psychological stress is often mistaken as the cause of TMJDS. The truth is that the pain and dental symptoms of TMJDS are the result of tooth clenching or grinding due to an uneven bite, not the result of stress. 

Psychological stress, like other forms of stress, lowers your ability to tolerate unevenness in your bite.  But psychological stress, in the absence of a bite imbalance, will not cause dental or headache symptoms of TMJDS.

TREATMENT OPTIONS FOR HEADACHES AND DENTAL SYMPTOMS OF TMJDS
Any head, jaw or neck pain or dental symptoms that can be proven to be due to a conflict between the biting surfaces of the teeth and the jaw joints are TMJDS symptoms and should be treated as such.

For clarity, treatment options can be divided into temporary and long term solutions, but the underlying principles are the same.

TEMPORARY RELIEF:  THE BITE SPLINT
Patients can have temporary relief from TMJ related symptoms by using a bite splint made by the dentist. The bite splint is a hard plastic device that fits over the upper or lower teeth and creates an artificial biting surface that centers the jaw joints and evens the bite. 

In order to get as close as possible to a perfectly even bite, the dentist needs several appointments. However, this does not cure the imbalance.  When the bite splint is taken out, your bite is the same as before and any symptoms will return. Therefore long-term treatment is usually necessary.

LONG-TERM SOLUTIONS:
The bite splint is not a long-term solution. The main advantage, bite correction without permanent change, is also its main disadvantage. Long-term solutions involve permanent changes to the teeth, such as bite adjustments (equilibrations), orthodontics, bite reconstruction, jaw surgery, and surgery of the TM joint.

EQUILIBRATION : In this process, the dentist reshapes the uneven spots on the teeth until they meet evenly without throwing the jaw off. This treatment is the simplest, fastest, and least expensive long-term solution. This process typically 
takes several visits over a period of time.  

ORTHODONTICS :  More severe bite discrepancies require more than reshaping of teeth. Orthodontic treatment is designed to move the teeth into the proper position. This treatment may require one to two years or more. 

BITE RECONSTRUCTION : When a person’s teeth have been severely damaged from clenching or grinding, major repair work is required. This process of rebuilding extensively damaged teeth in combination with bite treatment is called bite reconstruction. 

This process will require capping many, or even all of the patient’s teeth.  Bite reconstruction combines the process of repairing teeth with an even bite in harmony with the TM joints. 

JAW SURGERY : In some extreme cases the bite may be so far off that a surgeon may need to surgically reposition the jaw into the proper relationship.  Orthodontics and equilibration are usually a part of the treatment.

SURGERY OF THE TM JOINTS :  Chronic TMJDS can lead to damage to the joint itself.  To correct this problem, surgical repair of the joint structure is necessary.  Fortunately, this degree of damage rarely happens, especially if more conservative treatment is initiated early.

ALWAYS REMEMBER!
The definition of TMJDS is that the total pain or dental problem can be proven to be caused by the bite being in conflict with the jaw joints. There are many other types of head pain that are not due to TMJDS. These other types of head pain such as arthritis, sinus, and true migraines are not due to a bite problem.  The key to success is to be able to determine what the proper diagnosis is and apply the proper treatment. 

GOOD NEWS: The good news is that the Dentistry of the Palm Beaches has had extensive training in the treatment of TMJDS at the Dawson Center for Advanced Dental Studies. Dr. Victor Martel, Dr. Bruce Ouellette, and Dr. Vincent McClane have spent hundreds of hours studying this topic.  


If you would like an initial exam and consultation please call:
Dentistry of the Palm Beaches 
(561) 659-5566
1309 South Flagler Drive
West Palm Beach, Florida 33401

Dr. Victor Martel, Dr. Bruce Ouellette, Dr. Vincent McClane

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