In many cases, people suffering
from jaw pain and/or headaches are told that they have “TMJ”.
However, “TMJ” is short for “Temporomandibular
Joint” which is the technical name for the jaw joint
in front of the ear. Could you imagine what you would think
if you consulted your physician for pain in your arm, and
were told,
“You have elbow”
You’d probably be
shocked because “elbow” is not a diagnosis.
It’s the name of a joint just like “TMJ”
is the name of a joint.
The term “TMD”
or "Tempormandibular Dysfunction” is not much
more meaningful. Using the previous comparison, would an
orthopedist diagnose a condition as “elbow dysfunction”?
In each case, a specific diagnosis must be made. Whether
the problem is in the head, the face, the arm, or most any
other joint, the diagnosis can include arthritis of various
types, tendonitis, ligament sprains, tumors, etc. Specific
to the TM joint, the ligaments which hold the disc in place
may be stretched causing the disc to be displaced and locked
outside the normal position permanently or temporarily.
Curiously most (but certainly not all) people who suffer
from “TMJ” have a muscle or ligament dysfunction
which is the primary source of pain with the TM joint dysfunction
being far less important or even insignificant. Now you
can see why less than one percent of our patients require
joint surgery yet over 90% report that pain is gone when
we discharge them from treatment. This includes numerous
patients who came to us for a second opinion after being
told that their only hope was surgery -- yet none was needed.
The TM joint is the most
complicated joint in the body. First of all, the right and
left joints are connected to each other by a rigid bone
called the mandible or lower jaw. Consequently, any movement,
swelling, or disc displacement on one side affects the opposite
side. Surprising as it may seem, we have seen many patients
who had significant injuries and advanced arthritis on one
side but only felt pain on the opposite
side.
Secondly, each of the two
joints is composed of two separate joints. The lower joint
consists of the condyle or ball at the top of the lower
jaw, and a disc which is held in place by small threads
called ligaments. Rotation of the condyle inside of the
disc allows for opening of the mouth partway – to
approximately the width of a finger. To open fully, the
combined disc and condyle slide forward out of the socket.
The most common reason
which one can hear “clicking” or “popping”
sounds coming from the TM joints is a result of stretching
of the ligaments which normally hold the disc in place.
The condyle is incorrectly sandwiched between the opening
for the ear and the disc (which is no longer on top of the
condyle where it belongs). When a person with this condition
opens his or her mouth, the condyle pops back into its correct
position. When the mouth is closed, the disc moves in front
of the condyle once again. This is diagnosed as “Anterior
Displacement of the Temporomandibular Joint Disc with Reduction”
because the disc “reduces” or goes back into
place.
In certain cases, the ligaments
which hold the disc in place stretch even further thereby
making it impossible for the condyle to get under the disc.
In this case, the disc is jammed or stuck in front of the
condyles. The person is unable to open his or her mouth
wider than the width of a finger (approximately 1 inch).
This is diagnosed as “Anterior Displacement of the
Temporomandibular Joint Disc without Reduction”.
As you can imagine, some
patients can diagnose their own “anterior displacement
with reduction” because of the clicks
or pops which the joint produces. However, this is not always
true. In certain cases clicks which are detectable with
MRIs and sonograms are silent to the patient themselves.
In addition, limited mouth opening (for example, to the
width of a finger or 27 millimeters) can be due to “anterior
displacement without reduction” but
can also result from muscle spasm and other conditions which
occasionally include tumors. Obviously, proper treatment
requires a correct diagnosis.
Fortunately, the comments
from physicians and patients included on this web site suggest
that we have the knowledge, experience, and concern not
only to make the right diagnosis, but to properly treat
our patients and return them to a pain free, functional
condition. Further advances in medicine have made it possible
for us to treat these conditions without surgery in the
vast majority of cases (click here
for information regarding treatment). However, time
remains a significant factor. Consequently, the earlier
treatment is complete after the onset of symptoms the better.
For
Family and Friends
Hundreds
of times each year patients tell us that their family and
friends simply don’t understand how they can be in
so much pain and yet look completely normal. In 1991, a
new patient added this perspective to his medical history.
It may be useful for you to show this to your loved ones:
“I
am 32 years old. Over the past years, I have had open
heart surgery to close an atrio-septal defect. This required
cutting my ribs, pulling them apart, and then wiring them
back together. The wires subsequently broke when I fell
out of a tree, at which time I also broke a rib and my
back in three places, and displaced several discs in my
spine. I was told that one of the bones in my back will
never heal. In addition, I have agonizing cluster headaches
and passed kidney stones, which is an excruciatingly painful
experience.
I
used to assume that TMJ problems were minor, unimportant
afflictions. However, now that I have injured my temporomandibular
joints, the head pain, ear pain, face pain, and throat
pain which I am experiencing are far more severe than
any of the above pains which I have had. In fact, this
is the first time in my life that I have showed up at
a doctor’s office on an emergency basis asking for
relief from the pain.” - Steven
This also makes the point:
“I had kidney and
pancreas transplants, but nothing caused as much excruciating
pain as my headaches and my face pain. The treatment here
gradually reduced the pain and now it’s all gone.
Everyone here was great, professional, and nice to me.”
- Gladys W.
Please click here for information regarding other sources of pain in the face and jaw.
“Pain in my jaw when I was eating or yawning was so bad that it made my neck pain worse. It’s all gone now, and I don’t have to be careful about what I do anymore. Dr. Klemons and his staff are really wonderful, and I recommend them to everyone.” - Mary Anne M.
"When I first came here my jaw pain was excruciating, and I couldn't open my mouth. I'm all better now and can do anything. The doctors and staff were excellent!" - Dezmin W.
“When I had eye and jaw pain, I had to come home and just lie on the couch. I couldn’t play with my kids, do the laundry, or take care of normal things that needed to be done. Now I can function as the mother of a two year old. The eye pain and jaw pain are gone.” - Johnna S.
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