|
Chronic headache and facial pain sufferers experience a silent segregation from the world around them. Their plight is often invisible to the outside world, save those who would read their pain.From mild to severe, occasional to relentless, symptoms vary widely from one person to another. Often patients have sought answers far and wide. There now exists an accurate method to determine, in a large number of cases, the cause of such pain - cases previously undiagnosed by the Medical and Dental professions. Today's ability to non-invasively and quickly determine the source of the pain in these cases often allows professionals to deliver predictable, almost immediate relief. To the "future chronic sufferer", who today has only early signs, yet no symptoms, we hope the information to follow will help you comprehend the scope of things to come before you realize that "hindsight is 20:20."
HOW COULD PROBLEMS WITH THE TEETH CAUSE HEAD AND NECK PAIN? - IIA Problem:
Muscle incoordination occurs if and when any back teeth touch while the jaw is forward or chewing side to side. As soon as any premolar or molar contact occurs, the dentin and periodontal neural networks signal the brain, which instructs the powerful chewing muscles to clamp down. But the jaw is not centered to close straight down on the back teeth! The lateral pyterygoid muscle, fully aware, "fires" to try to shift the jaw right or left, in an attempt to "go around" the spot that shouldn't be allowed to hit! This spot is called an "interference."
 When one has even the slightest improper contacts or "interferences," the lateral pterygoid muscle will fire -- all day long! Every time we chew, every time we swallow, in fact every time our teeth touch. The muscle becomes hyperactive, and the pain begins. Like in any other overworked muscle in the body, lactic acid builds up; the muscle can't get enough oxygen to wash it away, and the pain cycle commences.Not only is the lateral pyterygoid muscle painful from constant hyperactivity (overuse), it is equally sore from the "antagonistic workout" it gets when fighting the closing muscles, which kicked in when a back tooth came into contact. Try making a muscle with your biceps by pulling your clenched fist up toward your shoulder. Now have a friend pull the fist back away from the shoulder while you try hard to oppose his action. This type of antagonistic, spastic muscle incoordination is at the heart of the chronic pain experienced with TMJ problems.
HOW COULD PROBLEMS WITH THE TEETH CAUSE HEAD AND NECK PAIN? - III
A comfortable position for your joint, and a comfortable place for your bite must occur simultaneously. Muscle harmony, jaw joint and teeth stability and comfort depend on this relationship.The most comfortable position for any joint is within its normal range of motion. Once pulled forward or forced even slightly out of joint, the associated muscle groups will be signaled into action.If you've ever had a filling or other type of dental restoration placed, you already know the most comfortable position for your bite. Immediately after placement of a new restoration, your dentist checks for "high" spots; until they are eliminated, the bite is extremely uncomfortable. The most comfortable place for your bite allows simultaneous, even contact of all teeth.
Rear tooth premature contact acts as a pivot:
 The joint is still comfortably seated, but the teeth are not. Note that the early contact on the rear molar is the pivot point around which the jaw will rotate. The majority of patients with Temporoman-
dibular Joint (TMJ) Syndrome exhibit a discrepancy between the comfortable position of the jaw joint and that of their teeth. That is, the teeth cannot all meet simultaneously when the jaw joint is within its normal range and hinged closed. Typically, one of the back teeth hits first. The incredibly sensitive nerve system recognizes the premature contact, and calls for the powerful closing muscles to continue their contraction until the majority of teeth are in contact. The lower jaw pivots about the tooth in premature contact. The top of the jawbone pulls down away from the skull, as the front lower teeth rise up toward contact.
 When the teeth are comfortably closed, the joint is dislocated downwards. Note that while the muscles were able to bring all the teeth into contact, the joint suffers, having been dislocated downwards. This occurs hundreds of times daily, during chewing or swallowing.Once the teeth reach their comfortable destination, the joint complex is significantly stressed. Muscle hyperactivity occurs for several reasons: first, the lateral pterygoid fires in an effort to avoid the interfering contacts, instantaneously shifting the jaw imperceptibly to the right or left based upon its memory of the contact. Second is the stretch receptor reflex. Tendons attach muscle to bone; when the jaw joint is stressed (or dislocated), the tendons' stretch receptors become activated. They signal the brain that a potential injury is in progress.The third source of muscle hyperactivity occurs once the teeth contact comfortably. Now the jawbone is stretched down from its comfortable position, and the closing muscles fire by reflex. Most TMJ treatment is focused on harmonizing a comfortable bite while the jaw joint, too, is in its comfortably seated position.
THE ANATOMY OF PAIN SITES IN TMJ Another source of pain occurs when the intra-articular disc is unable to do its job properly. The lateral pterygoid muscle is responsible for guiding the disc forward. In cases of hyperactivity it may pull the disc forward so that the disc slips in front of the jawbone -- even when the jaw joint is not in its forward sliding mode. When you open your mouth, the jawbone "pops" back onto the disc, which is waiting out in front. This is the "click" or "pop" some patients experience.
The ligament attached to the back of the disc is very sensitive, making it a potentially severe source of pain. Unlike the disc's cartilage, ligaments have many nerves and blood vessels, which cause severe pain if compressed. When the disc is forward, the top of the jawbone sends chewing forces against this sensitive retrodiscal ligament. Some patients suffer severe pain when chewing or yawning, for example.The jaw joints are immediately in front of each ear. The muscles for chewing span from the temple to the bottom of the jaw, forward to the cheekbone. Understanding human anatomy makes it is easy to comprehend how hyperactivity, followed by lactic acid buildup in muscles of the jaw joint, could cause significant facial pain and headaches. Stress was once thought to be the cause of TMJ disorders. Our current understanding classifies stress as one contributing factor, but certainly not the cause.
"BUT I'VE NEVER HAD ANY PAIN OR OTHER SY MPTOMS... "Today, we have advanced diagnostics in many areas of Medicine that afford us forewarning of problems to come. For example, a simple blood test can tell us of cholesterol levels today, which may lead to tomorrow's stroke or heart attack. Similarly, routine screening mammography today can prevent the heartache of undetected untreatable cancer tomorrow. Severe consequences can be avoided with proactive diagnostics and preventive intervention. Ninety-five percent of TMJ problems are caused by an imbalance in the relationship between the teeth, muscles, nerves and jaw joint. Similar to the silent problems mentioned above, TMJ problems, left untreated, lead to degeneration of bone, muscle, ligaments, or all three. Eventually one or more of the following is possible:
- Limited range of motion of the jaw (such as the inability to open wide enough, even to brush properly);
- Severe pain when chewing;
- Frequent episodes of grinding, extreme muscle tension and constant head, neck, and facial pain;
- Severe (destructive) premature, abnormal teeth wear.
Early treatment is easier, faster, less costly and more predictable than ever. The longer you wait, the more complex the degeneration and less predictably stable the outcome of treatment. We cannot predict the pace of degeneration nor the possible eventual level of derangement or dysfunction for any given individual. But, predictable long-term correction is highly likely for those patients fortunate enough to identify a TMJ disorder before the degeneration is allowed to decrease their quality of life. We can achieve a harmonious, peaceful and balanced masticatory system.
METHODS of CORRECTIVE TREATMENT "If a diagnosis of a TMJ disorder is made, what are the possible treatments I could expect?"
Careful analysis and diagnosis leads to the most conservative, effective treatments possible. There are six categories of potential non-surgical therapies. Surgical intervention is required less than 5 % of the time. Occlusal Splint Therapy: An occlusal splint is a clear plastic guard that fits over the upper (or occasionally lower) teeth. Although it may look like the common "niteguard", there is a dramatic difference: an occlusal splint will simulate the perfect bite pattern. All teeth will touch with even, simultaneous contact as the jaw moves straight up and down. At the beginning of any grinding motion ( toward the front or either side), all of the molars and premolars come out of contact. In the majority of cases, a well-made splint will relieve most or all pain from TMJ muscle hyperactivity - usually within the first 24 hours
.When would the dentist suggest a splint?
A) When immediate relief is critical. Anyone suffering from acute or chronic TMJ headaches and pain is fully aware of the debilitating nature of their problem. In an emergency, a splint can be constructed and placed in a matter of hours.
B) Delta-Stage Bruxers. Although most grinding occurs during lighter stages of sleep, some patients do their most destructive grinding during Delta stage sleep. If grinding continues after reconstruction, or originally was severe enough to extensively wear of the natural teeth, a night splint may be required.
C) Unable to "Load Test." Chapter 8 discusses the "Load Test" and its sources as either an Intracapsular Disorder (degenerative structural joint problem) or muscle hyperactivity. In most cases, muscle hyperactivity can be relieved sufficiently by the splint to allow normal load testing. If still unable to load, further diagnostics may be required, including TMJ x-rays and/or MRI (Magnetic Resonance Imaging).Although splints are extremely effective, they are usually an adjunct or precursor to proper bite rehabilitation. If the involved teeth are not treated properly, the cycle of excessive wear, muscle hyperactivity, spasm, pain and eventual jaw joint degeneration will continue.
The Precision Bite Adjustment ( PBA ) : The Precision Bite Adjustment (or "equilibration") is the simplest and most conservative method of perfecting the bite to eliminate the interferences. PBA is the selected option when the dentist determines that removing the interfering contacts will not appreciably compromise the anatomy of the teeth, and will not remove enamel to the extent that dentin is exposed. Often; analysis of the bite simulation models (see Chapter 8) helps determine the extent of adjustment necessary . The PBA usually requires two or more appointments, with the first as much as an hour long; sufficient time is required to perfect the bite during every functional movement of the jaw. Rather than creating a "new bite, " we are only re-enabling what once was. An anesthetic is not required, as the amounts of tooth structure removed are minimal -- similar to adjusting a high spot on a filling, with the drill.
Restorative Treatment: Restorative treatment consists of procedures normally performed to rebuild broken, decayed or missing tooth structure (or teeth), such as onlays, crowns, bridges or partials. Because the stability of the newly perfected bite and patient's health are compromised by older fillings with broken or leaky edges, decay or fracture, these may be removed during the restorative process.
Orthodontic Treatment: It may not be possible to perfect your bite with Precision Bite Adjustment (PBA) and/or selective, restorative treatment. Occasionally, one or more teeth may not be able to achieve a stable position without first being slightly moved. Orthodontics, in many instances, may be limited to "minor tooth movement." A simple removable retainer, or a temporarily bonded wire or rubber band may be used to gently move the tooth in question. Only in severe cases of malalignment would full braces be considered.
Orthognathic Treatment: Although rare, there are situations that necessitate moving a segment of bone along with the teeth. In these unusual cases, growth and development have not allowed for proper facial configuration: the size and shape of the jaws do not adequately match the teeth. In these rare cases, surgical intervention is required for proper realignment
Combination Therapy: In most instances,
some combination of the above treatments is employed. Most frequently,
Precision Bite Adjustment is performed along with necessary restorative
care.More severe cases require combinations of treatments, as well.
Skeletal developmental problems, as well as traumatic accidents, may
require combination therapy that could span the entire spectrum of
care.
|
