Help with an often misdiagnosed TMJ condition

May 24, 2023 – Toothache is the worst. It can appear out of nowhere and interfere with eating, drinking, and daily activities. But what happens when the pain isn’t necessarily in the teeth, but rather around the face, jaw, and neck?

Shane G., a 40-year-old money manager from Austin, Texas, is painfully aware of the difference. One day, after sitting in his office for an extremely stressful meeting, he explained, he decided to take his laptop to the bar and finish his work over a basketball game and a beer.

“I took a sip of beer and the corners of my mouth seemed to be on fire,” he said. “It was a sharp, sharp pain with heat attached to it; something was clearly wrong.”

The type of pain Shane felt is better known as orofacial pain and includes more than 30 types of temporomandibular disorders (TMJ), conditions that affect the two joints that connect the jaw to the skull (TMJ), as well as the muscles of the jaw. and fabrics.

ABOUT from 5% to 12% the US population has TMDs. Because they are difficult to diagnose and can overlap with other conditions, patients often undertake what may seem like an endless search for relief.

Luckily for Shane and his ilk, there are self-help strategies that can alleviate the pain.

He was able to make an emergency appointment with a knowledgeable dentist who suspected the problem was in his jaw muscles. After X-rays and night guard measurements to eliminate possible grinding and squeezing, Shane was referred to a masseur. She not only identified the root of his pain, but he was able to find some relief after one session.

Not everyone is so lucky.

There are “practitioners who are simply not familiar with the diagnosis and pull the trigger too quickly to provide irreversible treatment,” said Clifford Chow, MD, orofacial pain specialist at the Center for Orofacial Pain and Dental Sleep Medicine and assistant professor. at the School of Dentistry at the University of California, San Francisco.

“Unfortunately, with a delay, conditions can change and the situation can worsen and be more difficult to treat,” he said.

Often misdiagnosed

Although not rare, orofacial pain disorders often missed or mistaken by dentists and doctors for other conditions. And TMJs are often accompanied by other conditions, such as fibromyalgia and migraine, making diagnosis even more difficult.

“We have a saying in dentistry: if you hear hooves, think horses, not zebras,” says Lisa Crafton, MD, a private dentist in Columbia, Maryland.

She explained that “most people who come in with facial pain are mostly muscle related.” “And I feel that for most people it happens after an episode of stress. Or for some it might be 2 weeks after a stressful incident and then all of a sudden the jaw kills them.”

“If you think of the skull, the lower jaw is held together by muscles,” Crafton said. “So, I always start with the thought: OK, let’s try muscle relaxation.”

Katie Pudgorodsky, a licensed head, neck, and jaw massage therapist in Austin, Texas, has treated Shane and countless others with DNR pain. Pudgorodsky has become a favorite of many dentists who, like Crafton, recognize the muscular component in the teeth. some TMDs straightaway.

Massage can often help with pain associated with the two most common TMJs: myofascial pain (discomfort or pain in the connective tissue and muscles that control the jaw, neck, and shoulders) and myalgia (muscle pain associated with jaw movement). – for example, in the masticatory muscles that allow you to chew food).

Pudgorodsky explained that TMD pain manifests itself in many ways and is often cited, meaning that it hurts in areas other than the exact location of the muscles, joints, and tissues of the jaw. Symptoms include headaches, neck pain or stiffness, toothache, sinus pain, a feeling of fullness in the ears, tinnitus (ringing in the ears), numbness and/or tingling.

Worldwide experience shows that most of the patients that Pudgorodskaya sees in her practice are looking for relief.

“They brought up this conversation with their dentist or their healthcare provider that they have pain and they are getting excuses. They are taken from specialist to specialist until someone says, “Hey, those muscles are tense; maybe it’s part of the puzzle,” she said.

Natalie S., a 32-year-old Austin researcher, said she entered Pudgorodsky’s office after experiencing a sudden pain in her jaw and what she described as “jaw clicking”.

“I was going through a particularly emotionally intense period,” she said, reflecting on the experience. “I went to my dentist who recommended that I get a mouth guard. But he also asked me what my symptoms were, how long they lasted, and said that I would benefit from a TMJ massage.”

Natalya felt relieved after one session with Pudgorodsky and continued to do the exercises twice a day.

“By the end of the week, the pain was gone,” Natalie said.

Four Pillars of Help

Pudgorodsky sees patients in person, but also offers detailed training and exercises online. Much of her work is focused on helping people achieve and maintain muscle definition and is based on four pillars:

“The first pillar is to relax your muscles and reduce trigger points. And this is done through massage and stretching,” she explained. “This can be done by a professional or by yourself at home. The second pillar is to overtrain the muscles involved; these exercises are also used to stabilize the bite. The third pillar is to maintain the correct resting posture in the mouth. “It’s about the right posture for resting your mouth. We want our tongue to be in the palate, the lips to be closed and slightly apart, ”said Pudgorodsky. And “the fourth pillar is the fight against bad habits of use; that’s when you start to stop making those bad patterns.”

Expectation Management

Like other pain conditions, TMJs are complex and present differently in different patients. Massage is not the answer for every type or every person. But by relaxing tense muscles and retraining joints to move in a more balanced way, massage can partially solve the problem, relieve pain and, as Pudgorodsky explained, “make room for healing.”

Chow said patients should take the initiative to ask their caregivers what their diagnosis is.

“If they just say they have TMD, it’s not a diagnosis; it’s a broad term for disorders, and often they’re the ones who can miss something,” he said. “They need to be more specific in diagnosis and more specific in treatment.”