Jaw pain

There are several types of jaw noises TMD patients may hear when opening and closing their mouth, such as clicking, popping, crepitus, and sand paper sounds.

When you open and close your mouth in a normal TMJ, the top part of the jawbone (condyle) can move frontward away from the ear or backward toward the ear. In a healthy joint, the disk is firmly held over the condyle by ligaments and should move smoothly along with the condyle. If the disk is not herniated, then the joint should not make a sound as the jaw is opened.

But if the ligaments responsible for tethering the disk over the condyle are torn or stretched because of trauma or disease, the disk may herniate when the jaw is closed. When the jaw opens a popping or clicking sound is heard by the patient as the condyle recaptures the disk. When the jaw closes again, the disk slips off of the condyle again, and a pop may be heard on closure.

Sometimes a click has been present for months or years. Then one day the click is gone. If the click is gone, then the disk has returned to normal alignment over the condyle or it has become locked in front of the condyle. It is more likely the disk has locked than returned to normal if a click as been present for a long time.

Ear Problems

Ear symptoms are important, but ear problems and temporomandibular joint disorders are not mutually inclusive or exclusive. Although it is not unusual for a temporomandibular joint patient to have ear pain, it still must be understood that the majority of ear pain patients do not have any TMD issues.

At Advanced Sleep and TMJ Centers, we look for a history of chronic ear symptoms that are not responsive to traditional medical therapies. When these treatments fail, we must consider the possibility that the temporomandibular joint may be referring symptoms to the ear, or that inner ear symptoms may be developing because of altered temporomandibular joint mechanics.

Patients with a TMD occasionally have a history of tinnitus. Tinnitus is a ringing sound that originates in the head of its owner. The exact cause for tinnitus is unknown. There are some patients who have tinnitus related to mandibular posturing, and these patients experience an increase or an elimination of symptoms with forward posturing or superior posturing of the mandibular condyle.

If your child is complaining about an earache and ringing in the ears, check with your family doctor. An earache and ringing in the ears, also known as tinnitus, are symptoms of TMD. A complete examination of the TMJs will rule out the causes of the ear problem.

Neck Pain

Neck pain is a very common problem that affects more than two-thirds of the population at some point in their lives. The causes of neck pain can be minor or severe. Most commonly neck pain is the result of an acute trauma or chronic stress (bad posture) that affects the muscles in the neck. Patients may or may not be able to adequately differentiate between headache, neck pain, jaw pain, ear pain and facial pain. We want to know about all of the painful areas so we can adequately determine where the pain originates.

In some cases, neck pain is caused by an out of place disk or vertebrae in the cervical spine causing cervical impingement of the nerves and blood supply. A common injury associated with neck pain and TMD is whiplash; however, TMD symptoms often don’t present themselves until after the cervical pain subsides. It is common to have symptoms consisting partially of TMD and partially of cervical pain, particularly in the patient who has suffered a whiplash type injury. Compression injuries against the vertex (top) of the skull can create cervical symptoms from cervical disk compression.

Neck pain can radiate to the midline of the skull extending from the base of the skull to the top of the skull to the forehead region and eyes. Patients who experience neck pain also find it difficult to rotate, extend or flex the cervical spine. If the head is held in a forward posture, cervical pain will increase.

The upper cervical spine may radiate pain into the front portion of the neck and across the jaw. The pain is contained in the fibers of the superficial cervical plexus as they course along the sternocleidomastoid muscle.

A local anesthetic injection midway down the sternocleidomastoid muscle will alleviate pain that radiates to the angle of the mandible, ear and mastoid regions.

Neck pain can radiate to the midline of the skull extending from the base of the skull to the top of the skull to the forehead region and eyes. Patients who experience neck pain also find it difficult to rotate, extend or flex the cervical spine. If the head is held in a forward posture, cervical pain will increase.

The upper cervical spine may radiate pain into the front portion of the neck and across the jaw. The pain is contained in the fibers of the superficial cervical plexus as they course along the sternocleidomastoid muscle.

Headaches

One of the more common complaints of patients with TMD or MFP are headaches. While there are many causes of headaches, muscle dysfunction, low oxygen levels, and cervical spine concerns can contribute.

MUSCLE TENSION HEADACHES: Tension Headaches comprise a high proportion of all headaches. The pain can range from dull and achy to pressure like and throbbing. These headaches are typically in the frontal or temporal region but can radiate from the back of the neck up to the top of the head. Pain is often experienced above and below the eye and can be accompanied by blurred vision. After evaluating the cervical region, the temporomandibular joint (TMJ), the muscles of the head and neck as well as the tendons and ligaments, all of which can produce tension type headaches, a source for the tension headaches can often be determined. 

MIGRAINE HEADACHES: Headaches that are throbbing in nature accompanied by nausea and vomiting, as well as phono- and photophobia, can be classified as migraines. Migraines are often vascular in nature. If you are a migraine sufferer you understand that this type of headache can be debilitating. An aura may or may not precede the migraine and there is often a dull headache following the migraine. There are some newer migraine medications as well as preventive medications for migraine headaches that can treat your pain at the onset of the migraine. Some of these migraine medications can also help relieve tension headaches. Most migraine patients are under the care of a neurologist or family doctor and have had a brain scan that is within normal limits. Some migraine headache suffers have low magnesium levels, have food sensitivities or may have other other triggers such as alcohol. Finally, low nocturnal oxygen may be a contributing factor so Obstructive Sleep Apnea should be ruled out. 

NECK PAIN BASED HEADACHES: Many headaches find their origin in the cervical spine where mis-alignment and compression of sensory or sympathetic fibers can trigger symptoms. There are many cross-over paths between the sensory nerves of the cervical spine and the branches of the Trigeminal nerve which can make it difficult to tell where pain is originating from. At Advanced Sleep and TMJ Centers we work with trained cervical spine specialists and physical therapy providers when the spine is contributing to the overall condition.

SINUS/CONGESTION HEADACHES: Upper respiratory congestion and sinus inflammation can also lead to headaches. Through a thorough exam and an evaluation of the sinus cavities with 3-D CBCT imaging, it can be determined if sinus congestion is a contributing factor. At Advanced Sleep and TMJ Centers we work closely with Ear, Nose and Throat specialists for our patients that require these services.