New Palestine Craniofacial Specialist

Temporomandibular DisordersNew Palestine, IN

Health problems and the pain associated with disorders of the jaw joint (the temporomandibular joint) may seem to be mysterious and unexplainable to you, but there are growing numbers of health care practitioners who are qualified to diagnose and treat Temporomandibular Joint Disorders (TMD). While no amount of printed information can replace a complete examination by a qualified practitioner, it is often comforting to have some of your questions answered before taking that major step and making an appointment to consult "an expert".

Some patients live with TMD for years before it becomes painful enough to cause them to seek help. Others contract the problem suddenly -- usually by some trauma or blow to the head, face and/or neck region. But both types of patient can have very similar symptoms.

In some cases, TMD can be caused by, and may actually be part of, another disorder. These disorders may include: (click each topic for more information)

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  • Chronic Fatigue Syndrome

    In general, in order to receive a diagnosis of Chronic Fatigue Syndrome, a patient must satisfy two criteria:

    • Have severe chronic fatigue of six months or longer duration with other known medical conditions excluded by clinical diagnosis, and
    • Concurrently have four or more of the following symptoms:
      • Substantial impairment in short-term memory or concentration.
      • Sore throat.
      • Tender lymph nodes, muscle pain.
      • Multi-joint pain without swelling or redness.
      • Headaches of a new type, pattern or severity.
      • Unrefreshing sleep.

    * Post-exertional malaise lasting more than 24 hours.

    Source: Center for Disease Control

  • Chronic Regional Pain Syndrome
    • Severe burning pain,
    • Pathological changes in bone and skin,
    • Excessive sweating,
    • Tissue swelling, and
    • Extreme sensitivity to touch.
    • The syndrome is a nerve disorder that occurs at the site of an injury (most often to the arms or legs). It occurs especially after injuries from high-velocity impacts such as those from bullets or shrapnel. However, it may occur without apparent injury.
    • One visible sign of CRPS near the site of injury is warm, shiny red skin that later becomes cool and bluish. The pain that patients report is out of proportion to the severity of the injury and gets worse, rather than better, over time. Eventually the joints become stiff from disuse, and the skin, muscles, and bone atrophy.
    • The symptoms of CRPS vary in severity and duration.
    • The cause of CRPS is unknown. The disorder is unique in that it simultaneously affects the nerves, skin, muscles, blood vessels, and bones.
    • CRPS can strike at any age but is more common between the ages of 40 and 60, although the number of CRPS cases among adolescents and young adults is increasing.
    • CRPS is diagnosed primarily through observation of the symptoms. Some physicians use thermography to detect changes in body temperature that are common in CRPS. X-rays may also show changes in the bone.
  • Ernest Syndrome

    TMJ-like problem involves the stylomandibular ligament, at tiny structure that connects the base of the skull with the mandible, or lower jaw. If injured, this structure can produce pain in as many as seven specific regions of the face, head and neck: the temple, the TMJ, the ear, the cheek, the eye; the throat, especially when swallowing, and the lower back teeth and jaw bone.

    Treatment of Ernest syndrome, which is successful about 80% of the time, consists of injections of local anesthetic and medication (cortisone or Sarapin), physiotherapy, and at times, the use of an intraoral splint.

  • Fibromyalgia

    Fibromyalgia is a chronic disorder characterized by widespread musculoskeletal pain, fatigue, and multiple tender points. "Tender points" refers to tenderness that occurs in precise, localized areas, particularly in the neck, spine, shoulders, and hips. People with this syndrome may also experience sleep disturbances, morning stiffness, irritable bowel syndrome, anxiety, and other symptoms.

    Although the cause of fibromyalgia is unknown, researchers have several theories about causes or triggers of the disorder. Some scientists believe that the syndrome may be caused by an injury or trauma. This injury may affect the central nervous system. Fibromyalgia may be associated with changes in muscle metabolism, such as decreased blood flow, causing fatigue and decreased strength. Others believe the syndrome may be triggered by an infectious agent such as a virus in susceptible people, but no such agent has been identified.

    Fibromyalgia is difficult to diagnose because many of the symptoms mimic those of other disorders. The physician reviews the patient's medical history and makes a diagnosis of fibromyalgia based on a history of chronic widespread pain that persists for more than 3 months. The American College of Rheumatology (ACR) has developed criteria for fibromyalgia that physicians can use in diagnosing the disorder. According to ACR criteria, a person is considered to have fibromyalgia if he or she has widespread pain in combination with tenderness in at least 11 of 18 specific tender point sites.

    Source: National Institutes of Health

  • Gout (and Pseudogout)

    Gout is one of the most painful rheumatic diseases. It results from deposits of needle-like crystals of uric acid in connective tissue, in the joint space between two bones, or in both. These deposits lead to inflammatory arthritis, which causes swelling, redness, heat, pain, and stiffness in the joints

    The term arthritis refers to more than 100 different rheumatic diseases that affect the joints, muscles, and bones, as well as other tissues and structures. Gout accounts for approximately 5 percent of all cases of arthritis.

    Pseudogout is sometimes confused with gout because it produces similar symptoms of inflammation. However, in this condition, also called “chondrocalcinosis,” deposits are made up of calcium phosphate crystals, not uric acid.

    Source: National Institutes of Health

  • Lupus (SLE)

    Systemic Lupus Erythematosus (SLE) is a chronic, inflammatory, multisystem disorder of the immune system that mainly affects women of childbearing age.

    In SLE, the body develops antibodies that react against the person's own normal tissue. This abnormal response leads to the many manifestations of SLE and can be very damaging.

    The course is unpredictable and individualized; no two patients are alike.

    Lupus is not contagious, infectious, or malignant. It usually develops in young women of childbearing years, but many men and children also develop lupus. African Americans and Hispanics have a higher frequency of this disease than do Caucasians.

    SLE also appears in the first-degree relatives of lupus patients more often than it does in the general population, which indicates a strong hereditary component. However, most cases of SLE occur sporadically, indicating that both genetic and environmental factors play a role in the development of the disease.

    Common symptoms of SLE may include:・Painful or swollen joints,・Unexplained fever,・Skin rashes,・Kidney problems, and・Extreme fatigue.

    Source: National Institutes of Health

  • Migraine

    Migraine is a form of headache that is severe and usually one sided, and it is frequently associated with nausea and vomiting. This is sometimes preceded by warning symptoms, which usually affect the eyesight and are known as an "aura".

    People sometimes feel “not quite right” prior to a migraine (e.g., depressed, unusually happy or hungry), and in addition may suffer from visual changes (e.g., flashing, zig-zag lines, or a blind spot). Sometimes the symptoms are even more extreme.

    The headache is usually one sided although it is not invariably the same side. Quite quickly nausea and vomiting may follow. The bowels may also be affected, and in children sometimes there is no headache but abdominal pain instead.

    Each person is different but there are some "trigger" factors that are commonly involved:

    • Tiredness
    • Physical exhaustion
    • Stress
    • Climatic change
    • Hormones
    • Foods (e.g. caffeine, cheeses, chocolate, red wine)

    Source: Medinfo®

  • Occipital Neuralgia

    Occipital Neuralgia is a chronic pain disorder caused by irritation or injury to the occipital nerve located in the back of the scalp.

    There are actually two major types of occipital neuralgia: lesser occipital and greater occipital, with the lesser type being more common.

    Individuals with the disorder experience pain originating at the nape of the neck. The pain, often described as throbbing and migraine-like, spreads up and around the forehead and scalp.

    Occipital neuralgia can result from: Physical stress, Trauma, or Repeated contraction of the muscles of the neck.

    Treatment is generally symptomatic and includes massage and rest. In some cases, antidepressants may be used when the pain is particularly severe. Other treatments may include local nerve blocks and injections of steroids directly into the affected area.

    Source: National Institutes of Health

  • Arthritis

    Arthritis means "joint inflammation" and refers to a group of diseases that cause pain, swelling, stiffness, and loss of motion in the joints.

    "Arthritis" is often used as a more general term to refer to the more than 100 rheumatic diseases that may affect the joints but can also cause pain, swelling, and stiffness in other supporting structures of the body such as muscles, tendons, ligaments, and bones.

    Some rheumatic diseases can affect other parts of the body, including various internal organs. Children can develop almost all types of arthritis that affect adults, but the most common type that affects children is juvenile rheumatoid arthritis.

    Source: National Institutes of Health

  • Juvenile Rheumatoid Arthritis

    Juvenile Rheumatoid Arthritis (JRA) is arthritis that causes joint inflammation and stiffness for more than 6 weeks in a child of 16 years of age or less.

    Inflammation causes redness, swelling, warmth, and soreness in the joints, although many children with JRA do not complain of joint pain. Any joint can be affected and inflammation may limit the mobility of affected joints. The temporomandibular joint is one of the joints commonly affected. One form of JRA can also affect the internal organs.

    Doctors classify JRA into three types by the number of joints involved, the symptoms, and the presence or absence of certain antibodies found by a blood test. (Antibodies are special proteins made by the immune system.) These classifications help the doctor determine how the disease will progress and whether the internal organs or skin is affected.

    Source: National Institutes of Health

  • Osteoarthritis

    Osteoarthritis is the most common type of arthritis, especially among older people. Sometimes it is called degenerative joint disease or osteoarthrosis.

    Osteoarthritis is a joint disease that mostly affects the cartilage. Cartilage is the slippery tissue that covers the ends of bones in a joint. Healthy cartilage allows bones to glide over one another. It also absorbs energy from the shock of physical movement. In osteoarthritis, the surface layer of cartilage breaks down and wears away. This allows bones under the cartilage to rub together, causing pain, swelling, and loss of motion of the joint. Over time, the joint may lose its normal shape. Also, bone spurs--small growths called osteophytes--may grow on the edges of the joint. Bits of bone or cartilage can break off and float inside the joint space. This causes more pain and damage.

    People with osteoarthritis usually have joint pain and limited movement. Unlike some other forms of arthritis, osteoarthritis affects only joints and not internal organs.

    Source: National Institutes of Health

  • Psoriatic Arthritis

    Psoriatic Arthritis causes pain and swelling in some joints and scaly skin patches on some areas of the body. It is related to the skin condition psoriasis.

    About 95% of those with psoriatic arthritis have swelling in joints outside the spine, and more than 80% of people with psoriatic arthritis have nail lesions. The course of psoriatic arthritis varies, with most doing reasonably well.

    Symptoms include:

    • Silver or grey scaly spots on the scalp, elbows, knees and/or lower end of the spine.
    • Pitting of fingernails/toenails.
    • Pain and swelling in one or more joints,
    • Swelling of fingers/toes that gives them a “sausage” appearance.

    Source: Arthritis Foundation ®

  • Rheumatoid Arthritis

    Rheumatoid Arthritis (RA) involves inflammation in the lining of the joints and/or other internal organs. RA typically affects many different joints. It is typically chronic, which means it lasts a long time, and can be a disease of flare-ups.

    RA is a systemic disease that affects the entire body and is one of the most common forms of arthritis. It is characterized by the inflammation of the membrane lining the joint, which causes pain, stiffness, warmth, redness and swelling. The inflamed joint lining, the synovium, can invade and damage bone and cartilage. Inflammatory cells release enzymes that may digest bone and cartilage. The involved joint can lose its shape and alignment, resulting in pain and loss of movement.

    Symptoms include inflammation of joints, swelling, difficulty moving and pain. Other symptoms may include loss of appetite, fever, loss of energy, and anemia.

    Source: Arthritis Foundation®

Diseases Confused with TMD

In other cases, a disorder may simply mimic a TMD problem and cause no changes to the joint. Examples of unrelated medical conditions that can be confused with TMD include: (click each topic for more information)

  • Temporal tendonitis

    Symptoms: TMJ Pain, Tooth Sensitivity, Cheek Pain, Eye Pain, Temporal Headache

    Temporal tendonitis has been called "The Migraine Mimic" because so many symptoms are similar to migraine headache pain. Symptoms include: TMJ pain, ear pain and pressure, temporal headaches, cheek pain, tooth sensitivity, neck and shoulder pain.

    Treatment consists of injecting local anesthetics and other medications, a soft diet, using moist heat, muscle relaxants and anti-inflammatory medications, and physiotherapy. Only rarely (in approximately 4% of cases) is surgery needed.

  • Ernest Syndrome

    TMJ-like problem involves the stylomandibular ligament, at tiny structure that connects the base of the skull with the mandible, or lower jaw. If injured, this structure can produce pain in as many as seven specific regions of the face, head and neck: the temple, the TMJ, the ear, the cheek, the eye; the throat, especially when swallowing, and the lower back teeth and jaw bone.

    Treatment of Ernest syndrome, which is successful about 80% of the time, consists of injections of local anesthetic and medication (cortisone or Sarapin), physiotherapy, and at times, the use of an intraoral splint.

  • Occipital neuralgia

    Occipital Neuralgia is a chronic pain disorder caused by irritation or injury to the occipital nerve located in the back of the scalp.

    There are actually two major types of occipital neuralgia: lesser occipital and greater occipital, with the lesser type being more common.

    Individuals with the disorder experience pain originating at the nape of the neck. The pain, often described as throbbing and migraine-like, spreads up and around the forehead and scalp.

    Occipital neuralgia can result from: Physical stress, Trauma, or Repeated contraction of the muscles of the neck.

    Treatment is generally symptomatic and includes massage and rest. In some cases, antidepressants may be used when the pain is particularly severe. Other treatments may include local nerve blocks and injections of steroids directly into the affected area.

    Source: National Institutes of Health

  • Trigeminal neuralgia

    Trigeminal neuralgia is a terrible disorder of the trigeminal, or fifth cranial nerve. This is one of the most painful problems that plagues human beings. In fact, its description first appeared in the scientific literature in 1672.

    Another common name for trigeminal neuralgia is tic douloureux which literally means unbearably painful twitch. Far too often, when a person is suffering with severe facial pain with no apparent cause, the diagnosis given is trigeminal neuralgia. Because of this, the patient may be subjected to medications and even very serious surgical procedures which may not be necessary.

    The symptoms tic douloureux are very characteristic: sharp electrical pain which lasts for seconds. This pain is triggered by touching a specific area of the skin by washing, shaving, applying makeup, brushing the teeth, kissing, or even cold air.

    The second division of the trigeminal nerve (the maxillary division), which supplies feeling to the mid-face, upper teeth and palate, seems to involved most. The pain is so severe that the sufferer will do virtually anything to avoid touching the trigger zone, producing the pain.

  • Atypical trigeminal neuralgia

    In contrast to the typical type, atypical trigeminal neuralgia seems to cause pain constantly with the intensity increasing and decreasing.

    There are trigger zones with this type; however, there also is an area of dull aching which is intensified by touching the trigger zones. All three divisions of the trigeminal nerve seems to be affected equally.

    A common cause of this disorder is trauma, especially after a surgical incision or blow to the face.

  • Atypical facial pain

    Atypical facial pain is a disorder that also affects the trigeminal nerve. However, the symptoms are not as clearly defined as they are in typical and atypical trigeminal neuralgia.

    Atypical facial pain seems to affect people who are under a tremendous amount of stress and may even have a history of psychiatric problems. This does not mean that one suffering with atypical facial pain is mentally ill.

    We who treat this problem need to do much more research to understand this terrible disorder.

  • Neuralgia inducing cavitational osteonecrosis (NICO)

    As recently as 1979, a newly described pain disorder was reported. This disorder, which came to be known as osteocavitational lesions, produced pain similar to trigeminal neuralgia, both the typical and atypical types. In fact, usually these patients are diagnosed with trigeminal neuralgia. The diagnosis is complicated by the fact that the x-ray examination of the bone is usually normal.

    These bony lesions oftentimes develop in jaws and produce little or no pain whatsoever. They may lie dormant for years and sometimes never become painful or cause a problem. Those that produce pain are termed NICO (Neuralgia Inducing Cavitational Osteonecrosis) lesions.

    NICO lesions produce referred pain patterns which also serve to confuse both patient and doctor. However, just like trigeminal neuralgia, there are trigger areas that, when pressed, produce pain. These trigger areas develop directly over the areas of affected bone.

    The mandible, or lower jaw, is affected more often than the maxilla, or upper jaw.

    One important aspect of NICO is a history of tooth extraction usually years earlier. Any tooth area may be involved. However, lower back teeth seem to be most common. Small areas of bone actually die, producing neuralgia-like pain symptoms. It appears that after a tooth extraction, a NICO lesion may develop due to injury of the blood vessels in the area which ultimately results in poor circulation, resulting in bone death in some cases.

    Other common bones affected are the hips and knees.

Even though a headache can be a sign of many kinds of health problems, frequent headaches are the most common complaints of TMD sufferers. Other common complaints can include clicking or popping jaw joints, pain when chewing or yawning, grinding or clenching teeth, neck/shoulder pain, worn teeth, teeth that do not touch when biting, difficulty opening or closing mouth. Again, only a qualified health care practitioner can tell you for certain if any of these problems are a direct result of TMD.

Treatment of TMD

Methods for successful diagnosis and treatment of TMD vary from patient to patient and from office to office. Some problems may require a "team-approach" which means several different health care practitioners may be working with you concurrently to help alleviate your problem. Treatment can take time and even the amount of time varies from patient to patient. Sometimes it even takes time to get an appointment with a qualified health care practitioner.

Click here for a few suggestions you might follow to help yourself if there will be a lapse of time before you can get an examination appointment.

Temporomandibular Disorders (TMD) Self-Help Recommendations

For, at least, the first 12 weeks of your treatment in this office, we request that you attempt to comply with the following recommended changes in your nutrition habits. Many people need very restricted dietary changes to get well, while others require minor alterations. Your compliance can make a significant difference in the success of your treatment. After this 12-week period, you may make the decision as to whether you wish to continue with any of these changes or revert back to your old dietary habits. If you have found major success, you may wish to continue in a maintenance program.

Prolonged pain often indicates the body’s inability to completely heal or regenerate. Essential nutrients may be deficient or unbalanced. Therefore, during treatment for headache, neck or TMJ pain, certain dietary changes can be important. Certain foods and drinks may need to be increased, decreased or eliminated. Additionally, supplements may be added.

  • NUTRITIONAL
    • Eat a good balanced diet following guidelines to protect your TM joints.
      • Place yourself on a soft diet (not liquid, but soft), which would consist of foods such as cooked vegetables, eggs, chicken, ground meats, fruit, etc.
      • Avoid foods such as corn on the cob, large pieces of lettuce in salads, whole apples, very hard chips or snacks, tough meats, ice, etc.
      • No chewing gum!!
      • By cutting your food into smaller pieces, you can reduce the force of chewing, thereby, eliminating additional stress to your jaw joints. This also allows you to eat a greater variety of foods.
    • Attempt to avoid these seven items, which are prone to cause an increase in muscle irritability.
      • NutraSweet
      • Caffeine
      • Sugar
      • Alcohol
      • Nicotine
      • Excessive dairy products
      • Chocolate
    • Vitamins/Supplements
      • Will be thoroughly discussed and provided for your particular needs.
    • Dietary foods which can reduce stress to your muscles:
      • You may increase these foods in your diet:
        • Fresh fruits
        • Fresh vegetables
        • Salads — avoid most commercial salad dressings — use lemon or vinegar and oil
        • Whole grain cereals only (i.e., Shredded Wheat or Nutri-Grain Cereal by Kellogg, etc.
        • Chicken, fish and tender beef
        • Unsweetened vegetable and fruit jices and as much water as possible.
      • Attempt to avoid these foods:
        • Sugar
        • Alcohol
        • Hydrogenated fats
        • Coffee
        • White flour products (margarine, Crisco)
        • Cola
        • Processed carbohydrates
      • Reduce these foods:
        • Cheese
        • Milk/milk products
        • Salt (excessive)
      • Sweeteners and drinks:
        • Drink bottled or filtered water, herbal teas,weak iced or hot tea with lemon. If a sweetener is needed, a small amount of honey may be used or Splenda. Reduce the amount of artificial sweeteners in your diet, NO NUTRA-SWEET!!
        • Carbonated beverages – limit to the fewest per week as possible (nothing with NutraSweet). Soft drinks contain phosphoric acid that is harmful to teeth and several teaspoons of sugar are found in most of them.
      • Special Notes:
        • Frozen vegetables may be used with fresh vegetables, but not totally in place of them.
        • Try to avoid all foods in cans and box packages.
        • Corn products are often sources of food sensitivities. Try to reduce these products, as well as products containing corn syrup.
        • Drink, at least, 8 (8 oz.) glasses of bottled or filtered water daily.
        • Recognize the fact that smoking is deleterious to body tissues. Stop smoking as soon as possible.
        • Potatoes are complex carbohydrates. Baked potatoes are a good food source.
        • Butter in moderation, but not margarine.
  • LIFESTYLE
    • Avoid or reduce perfumes and scented products. These chemicals aggravate sensitive muscles.
    • Don’t sit or sleep directly under ceiling fans or vents.
    • Watch head / neck position (cradling phone between head and shoulder).
    • If you are able to tolerate aspirin products, take two tablets of Advil (or equivalent), an anti-inflammatory medication, four times daily. This is taken to reduce swelling and inflammation within the joint. If you are not sure of your tolerance to aspirin-like products or if you are taking any other medication, check with our office or your physician first.
    • Prioritize your activities. Be ruthless. Eliminate those things that are least important. This involves learning to say “no” to tasks that can be put off, so you can carefully parcel out your available energy among those things that need to be done.
    • Spare your family and friends. Pointing every detail of your illness out to close relatives can backfire. Family members and friends are not equipped to deal with the devastating nature of chronic pain over the long haul. It is okay to educate those close to you about it, but be careful to monitor the amount of personal details you burden them with. You don’t want to drive your most important network of social support away.
    • Get help. Patient support groups can be a great source of comfort for many on how to deal emotionally and functionally with the disease. Others have found counseling, massage therapy and physical therapy to be beneficial.
    • Continue living. If you can’t walk a mile, walk a block. If you can’t work full-time, work part-time. In other words, try to do the same things you use to do, even if you can only handle a fraction of the activity. It is important that you occupy yourself, both mentally and physically.
    • Maintain a positive attitude. Those who do seem to cope and recover the best.
  • EXERCISE
    • Exercise every day. Cardiovascular and therapeutic exercises are recommended. For cardiovascular, we recommend walking or water walking combined with a low impact aerobics or water aerobics. Additionally, swimming is beneficial. Running or more strenuous aerobics should be limited to those people who have the physical stamina to participate in such programs.
    • 6 x 6 x 6 – For therapeutic exercises, we have a standard set of exercises called the “6 x 6 x 6.” There are six exercises to be done six times a day and each movement is to be held for six counts, six times each.
      • There are three exercises for the shoulders. Please watch forward head posture on all of these.
        • Trapezius Squeeze – while holding arms like a runner, bring shoulder blades together.
        • Shoulder rolls – bring shoulders up for six counts back for six counts and down.
        • Pectoralis Stretch – place fingers by ears with elbows out, attempt to bring shoulder blades as close together as possible.
      • There are three exercises for the neck.
        • Neck Rotation – keeping eyes level to the floor.
        • Side Bending – face straightforward and ear toward shoulder.
        • Flexion – lower chin to chest.
  • POSTURAL
    • The goal of good posture is to maintain the natural curves of your spine in their normal, balance alignment. To keep your spine aligned, chest must be up, shoulders down, and head located over the body. Then, by learning how it feels to be in good posture, you will develop the body awareness that helps you stay in good posture throughout the day, no matter what you are doing.
    • Your sleep position is vitally important. If it does not interfere with your sleep, it is best to sleep on your back, perhaps, with a pillow under your knees if that is more comfortable. You may want to also use pillows to support your sides, which would discourage turning over while asleep.
    • A tubercle type orthopedic pillow is good, or a rolled bath towel placed under your neck may be preferred. If you sleep away from home, take your pillow (or towel) with you

Contact Us

Indiana Craniofacial Center PC is located at
4037 S. Arbor Lane Suite D
New Palestine, IN
46163

(317) 283-1900