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TMJ and neck

Why Pain Can’t Tell You Where You Need Treatment: A TMJ Case Study

TMJ and neck

Jaw pain/TMJD is a very frequent problem we see in the office. It’s so frequent that I spend one day each week inside of a dental office in West Palm Beach doing consultations with a great local area dentist that specializes in pain syndromes of the jaw.

Most of the patients that see us with jaw pain have already seen a variety of jaw specialists. They’ve had MRI’s done, mouth pieces made, and various therapies done on the area of pain.

The problem of course is that pain, especially chronic pain, does a poor job of telling us what is wrong with you. Chronic pain is complex. Chronic pain is misleading. Chronic pain is also a poor locator for pathology.

Identifying the Pain Source

One of the common questions asked during a case history is to highlight or point to the area where you feel pain. It can be useful sometimes when pain patterns are reflecting specific nerve roots, and it also gives a general vicinity for a doctor to examine more closely. For most cases of chronic pain, examining the area of injury often leads to dead ends. There’s no damaged tissue to treat or remove that’s likely to explain why someone hurts.

Patients with TMJ pain frequently seek the treatment of these specialized dentists, and most of them do really well when in the right hands. However, sometimes jaw pain isn’t truly a problem in the jaw. Sometimes it’s a pain problem somewhere else in the body.

I recently took care of a patients who were was referred by another chiropractor. The patient had been to 6 different jaw and mouth specialists but could not get any form of relief from treating the jaw.

When we examined the patient, we didn’t pay much attention to the jaw itself. The patient already had imaging and tests done to their mouth already, so I wanted to spend my time elsewhere.

We found that the patient had poor motion in their shoulder and neck area on the right side. They were also showing a large amount of forward head posture characteristic of anterior head syndrome. Surprisingly, the patient’s jaw seemed to move pretty well. There wasn’t the clunky abnormal opening and closing of the jaw that you would usually see in a TMJ where the jaw displays a large side to side movement. From my view, the patient’s jaw movement looked really great, but the patient’s neck was moving poorly.

Correct the Neck and Pain Self-Resolves

We did our normal protocols with this patient. We did a gentle NUCCA correction to the patient’s neck. We post-x-rayed the neck to verify a neck improvement, and then we waited. You can see the x-ray results below.

Pre and Post X-ray shows a small shift, but an almost perfect correction.

Pre and Post X-ray shows a small shift, but an almost perfect correction.

3 days after her first appointment, we had our first follow-up appointment scheduled. The patient had gone 3 consecutive days without any jaw pain at all for the first time in 2 years!

Pretty good, but would it last?

3 months later, we re-examined the patient. The patient was now going 1 month between appointments because it would be important to see if the patient could go that long a distance between appointments without pain. The jaw was still moving normally, but now their head and neck could move in all ranges of motion smoothly. The patient also stopped showing a persistent right tilt of their head.

Most importantly, the patient could now talk with no restrictions, and had no more food limitations on what she could eat. For all intents and purposes, she became a normal teenager again.

Final Thoughts

Now if we had kept on trying to treat the jaw and identify pathology in the jaw, would she still have gotten better?

It’s hard to say, but after 2 years of doing every jaw therapy under the sun, it just seemed to make sense to look at other pieces of anatomy.

The complexity of chronic pain often means that we can’t look at things linearly. We have to know that someone has pain in one region, but we also have to think about all the different anatomy that shares a connection with the part of the body that hurts. This doesn’t mean that every person with chronic jaw pain will get better from a neck adjustment, because that’s not true either.

It means that we have to take care of people and see them for what they are globally instead of treating them as an object with a specific piece of meat that hurts today.

 

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TMJ and the Atlas

Research: Atlas Correction and TMJ Pain

TMJ and the Atlas

Read Time: [5 min]

Last month a study produced by the Upper Cervical Research Foundation was published that examined the effect that Atlas Corrections had on the function of the temporomandibular joint. It’s a first step towards solidifying our understanding on how the work we do in our office can be a powerful help to patients suffering from chronic jaw pian/TMJD.

The Study

Relationship between craniocervical orientation and center of force of occulsion in adults

The authors of the study are clinicians in active practice. They took 11 chiropractic patients who were presenting for regular check ups and showed signs of Atlas Displacement Complex. The patients were sent to a neuromuscular dentist to evaluate their bite patterns before and after performing an Atlas Correction. The bite evaluations were performed with a digital force analysis that is able to show unequal force on different parts of the bite.

This unequal force is known in dentistry as dental occlusion. The goal is to allow for equal distribution of the force from your bite throughout the teeth and jaw, which can help people with TMJ pain by decreasing abnormal tension in the jaw muscles.

The patients were tested 2 times before an adjustment and 2 times after an adjustment.

Results

Postural measurements were taken before and after the adjustment. As expected, patients experienced significant changes in their postural measurements after their adjustment.

With the jaw measurements…there’s good news and not so great news. The good news is that for most of the cases, there was a measurable and significant change in force and pressure coming from the jaw.

Force profiles of the teeth and jaw before and after Atlas Correction

Force profiles of the teeth and jaw before and after Atlas Correction

The not so good news is that the change didn’t necessarily lead to an evenly distributed force pattern, meaning that the change may or may not have been positive.

Important Points

  • Small sample size
  • The patients were used as their own control as opposed to having a control group
  • The patients were active chiropractic patients with no history of TMJ issues. We can’t say for sure if this effect is beneficial for patients with jaw pain.
  • The patients tested were current patients with a history of chiropractic care. Would the results look different using new chiropractic patients who have never had an atlas correction before?

 

What now?

While no definitive conclusions can be made about the benefits of correcting the neck, we now have some data that shows that affecting the neck can and does affect the function of the jaw.

Our experience working with hundreds of TMJ cases, as well as the experience of hundreds of doctors around the country suggest that correcting the neck can have a very powerful affect on cases of jaw pain and even popping and clicking.

Time will tell and with better studies how effective NUCCA can be for this debilitating pain condition.

 

TMJ Ruining

TMJ Pain is Ruining My Life

TMJ Ruining

Outline:

  • When treating TMJ pain seems hopeless
  • Surgery may not be your best solution
  • TMJ pain may not be a jaw problem

I’ve seen a lot of patients with TMJ in my Wellington office in the past couple of months.

Patients with TMJ often see a large drop in the quality of their life:

  • “I feel like a baby because I can’t eat solid foods anymore”
  • “There are times where I just have to stop talking because all I can think about is the pain”
  • “That popping sound creeps me out and drives me nuts”

A lot of people will experience jaw pain for a day or two if they bite into a hard/chewy piece of food, but imagine if your life was plagued with jaw pain every single day. We underestimate the importance of our jaw, but it’s the piece of anatomy that allows you to enjoy some of the finest pleasures in life. Everything from kissing, to chewing, to a casual conversation with friends becomes a burden when your jaw fails to function.

Desperate Times and Desperate Measures

Severe cases of TMD can make people reach their breaking point quickly. Many of the patients that come to see me are usually looking at surgery as their next and final option because they don’t know what to do.

Even worse is when a patient spends tens of thousands of dollars for surgery but the pain doesn’t go away. Procedures that help to remove or replace a degenerated disc in the joint is sometimes performed to eliminate this pain sensitive piece of anatomy. The problem is that a degenerated disc can show up on imaging, but it isn’t necessarily the cause of the pain.

Unfortunately this happens more often than you might think, and it’s something that can make a patient with TMD hopeless if even surgery couldn’t get the job done.

This isn’t to say that surgery is not the answer, or that surgery can’t help, but we have to remember that TMD is a problem that science has yet to reveal all of the answers, and dental surgery is still working on figuring out what works and when it’s appropriate. Source

TMJ Pain May Not Be A Jaw Problem

There are many different causes for TMJ pain. They can range from abnormal jaw movement, tight jaw muscles, and degenerated discs. These can all be problem areas for a TMJ patient, but  they all have something in common.

In fact, their commonality goes back to some of the same neurological mechanisms that contribute to neck pain and headaches. That’s why people with TMJ don’t just have jaw pain, they often have neck pain and headaches at the same time. It’s because almost all pain signals from the head and neck go through a small piece of spinal cord called the trigemino-cervical nucleus.

…..Trigemino what????

Sometimes Pain is a Computer Problem

So if you don’t have a medical background, some of that terminology might jump over your head.

Instead of thinking anatomy, let’s talk about it like a computer.

garbage in garbage out

Your brain and spinal cord are like a computer chip. The part of your computer chip that feels head and neck pain is the trigemino-cevical nucleus.

Just like all computer chips, the quality of information that comes out is dependent on the quality of information that comes in. If you put junk information in, you get junk information out.

The computer chip of your body relies heavily on information from the muscles and joints. These signals are like computer programs. Whenever these joints move poorly from bad positioning, then it’s like a bad program that gives faulty information about what’s happening inside the body. This can occur from malpositioning of the jaw, faulty jaw movement, neck positioning errors, and faulty neck movement.

It’s like a computer virus going into your system and scrambling important signals into the brain.

This tells the body to produce a junk signals including:

  • Tight and tense jaw muscles
  • Inappropriate inflammation
  • Central pain sensitivity

Can This Program Get Shut Off?

Fortunately your body’s program for pain can be re-written by changing the way these joints move.

A specialist like a neuromuscular dentist can use non-invasive methods to change the way your jaw moves and alter your bite with an orthotic.

Chiropractors that can correct the craniocervical region can create a dramatic impact on the pain programming in the brain.

That’s why both of these doctors frequently see similar patients, and will actually co-manage them between each other. Neck pain patients may get better relief from a dentist changing their bite, while some TMJ patients will get better relief from correcting their neck.

While we can’t say for certain which takes priority, but many patients can benefit from an interdisciplinary approach to care. Take the time to get a Complimentary Consultation to find out what method fits with you. You may even find that getting the entire jaw/neck complex fixed may be the key to solving your TMD.