News for Physicians
Head, Neck, Facial Pain and TM Disorders
Head, neck and facial pain affects a significant percentage of the population (one in every four North Americans)
seeking care for both acute and chronic pain in the medical model we deal with every day. The majority of
temporomandibular disorder (TMD) sufferers are women, although men, young children and adolescents are also
affected. Too often, patients endure a frustrating doctor to doctor search for relief of these symptoms. These patients
may first seek help from their Primary Care Provider.
Symptoms
The most common symptom of TMD is noise in the joint, but it can also be present without noise. The noise is usually
related to the rapid reduction of the cartilage disc malpositioned between the condular head and the glenoid fossa.
The sound is often accompanied by a restricted mandibular range of motion.
Healthy
TMD
Pain is usually localized in the muscles of mastication in the posterior cervical area, the temporomandibular joints and
the area
about the ears. Many of these patients complain of:
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Chronic headaches
Limited mandibular movements or locking open / closed
TMJ sounds: clicking, popping, grating
Vertigo
Ear congestion or pain with no apparent etiology
Facial pain
Neck pain or stiffness
Trauma, disease and developmental disorders can lead to internal derangement of the TM Joint. This occurs when the
normal physiologic relationship of the condyle, disc and fossa have been altered and compromised. Discomfort in the
jaw joint is the result.
It is becoming more and more apparent that a dentist who is specially trained in treating these disorders may best
direct this care.
The Biomedical Relationship
Symptoms that are seen by various Healthcare professionals
include:
Otolaryngologists may see patients with unexplained ear pain, tinnitus, fullness in the ears, hearing loss or
hyperacusis, nose/sinus complaints, headaches, equilibrium and / or swallowing difficulties.
Neurologists may see patients with unexplained chronic head pain/migraines, vertigo, neck, shoulder pain or stiffness,
pain behind the eyes or at the base of the skull and numbness in the fingers or arms.
Primary Care Physicians may see patients with unexplained headaches, cervical discomfort, arthritis, or sleep apnea.
These signs may be related to temporomandibular disorder and are commonly seen in conjunction with medical
conditions such as Fibromyalgia and Chronic Fatigue Syndrome.
Chiropractors may see patients with cervical symptoms of pain and/or limited range of motion. There is a direct
relationship between TMD and cervical disorders.
Rheumatologists may see patients with cervical osteoarthritis, rheumatoid arthritis, Sjogren Syndrome or other auto
immune disorders. This is because the TM joints, like other joints in the body, are affected by these disorders.
The conditions listed here are very commonly associated with the TM Joint. In any differential diagnosis for head and
neck pain, TM disorders should always be considered.
Causes
Causes of TMD are usually multifactorial and therefore involve treating the relationships of the upper to the lower
teeth to the TM joints, as well as supporting ligaments and associated musculature. Just as nutrition affects teeth and
joints, other contributing factors may include:
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Trauma: Direct and indirect trauma to the masticatory structures and upper quadrant can lead to TM, head,
neck and facial pain. Strains, sprains and injuries can lead to both pain and dysfunction. Either micro or
macro traumas may be etiologic factors.
Improper Occlusion: When teeth do not fit together properly, it causes sustained microtrauma to the joints.
When this condition is prolonged, the body begins to compensate by involving other muscles in other areas:
the neck, throat and upper back.
Muscle spasms: These go hand in hand with internal jaw joint problems. Any condition that prevents the
complex system of muscles, bones and joints from working together in harmony can result in TMD. Various
ways the system can be disrupted include trauma, connective tissue disorders, arthritis or skeletal
malformation.
Posture: Poor posture places unnecessary wear and tear on all the joints including jaw joints. Over time,
consequences of postural neglect can be as damaging as an injury.
Stress: Increased physical and emotional stress is another factor that impacts patients with TMD as it reduces
the adaptive qualities of the jaw. Some patients unconsciously brux and/or clench their teeth in response to
increased stress. Chronic clenching and bruxxing creates stress on the TM joints and muscles which can
exacerbate TMD problems.
The Role of Dentistry in Multidisciplinary Care
Treatment
When an occlusion problem or tissue damage to the head, neck and facial area is diagnosed, it is important toi have an
evaluation by a trained and qualified TMD dentist, like Dr. Sharnell Muir. Our office performs a full examination of
the TM joints, head, neck and facial region, as well as radiographs and an
I-cat head and neck CAT scan through Dr. Muirs company, Dimensions Orofacial Digital Imaging. She is able to
objectively determine the pathological nature and extent of joint sounds, injuries to the TM joint area and arrive at a
realistic prognosis. Frequently, a custom-made Orthotic (splint) is prescribed for orthopedic and musculoskeletal
stabilization.
While many of the symptoms are improved with pharmacological agents such as analgesics, muscle relaxants,
anxiolytics and anti-depressants, additional adjunctive therapies may include:
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ultrasound
physical therapy
hot/cold therapy
spray and stretch
stress counselling
chiropractic
iontophoresis
massage therapy
TENS
Various injections
Relaxation therapy
Nutrition counselling
Patients benefit from the non-surgical, conservative treatment our office provides. Once pain is controlled and the jaw
joint is stabilized, the bite is balanced so the teeth, muscles and joints all work together without strain or pain.
Initially, treatment addresses the pain. Secondly, function is restored. Thirdly, the patient is stabilized. Occasionally
surgery is necessary, but in less than 3% of all patients. Because problems associated with the jaw joints can be
progressive, accurate and immediate, diagnosis and treatment is crucial
It is easy to see why the role of dentistry is essential in successful diagnosis and treatment of TM disorders, head, neck
and facial pain. Of course, interdisciplinary management with supporting health care professionals results in the most
effective treatment.
I-CAT 3D DIGITAL CAT SCAN
Dimensions Orofacial Digital Imaging is the only I-CAT 3D Cat Scan between Vancouver and Calgary. Captured in a
low dose 20 second scan, DODI offers a low cost and low radiation solution for physicians to assist in diagnosing
unexplained ear pain, headaches and sleep apnea.
Dr. Sharnell Muir, the owner of DODI, was a graduate of the UBC Faculty of Dentistry in 1987. She also attended
LVI (Las Vegas Institute) for the Full Mouth Advanced Restorative Program, the TMD program and the Orthodontic
Program and has achieved Fellowship status. Her article on E4D CAD/CAM Dentistry was published in the March
2009 issue of the Oral Health Dental Journal.
Dr. Muir uses the I-CAT as her standard of care for all existing and new patients in her dental practice. She uses it to
diagnose Airway Obstructions as she is also a member of the American Academy of Dental Sleep Medicine, as well as
diagnosing bone abnormalities, TMD, Implant treatment planning and numerous other areas involving the head and
neck. Many dentists refer their patients for these services as well. Dr. Muir works closely with a Certified Oral
Maxillofacial Radiologist who specializes in head and neck issues.
To refer a patient to have an I-CAT 3D Cat Scan, please fill out the referral form provided and fax it to 250-868-2171
or call the office at 250-860-1414.