Dr. George: Your Aching Jaw and Aching Head Need Dentist’s Attention and Corrective Action (part 1 of 2)

Dear Dr. Meinig:

We always enjoy your informative articles. Now I have a problem! A serious jaw hinge ache and headache that will not stop. A call to my dentist of 30 years said, “Call your doctor.” My good doctor said, “All of the classic symptoms of TMJ…see your dentist!”

After being told that had been my first call, he said that perhaps I should find another dentist with an interest and knowledge pertaining to this particular problem and, meanwhile, try Advil to tame my headache, eat only soft foods, etc.

I know you will be able to offer me some information regarding local knowledgeable help. Is this something you attend to perhaps? Thank you. – R. K.

 

Dear R. K.:

In a way, you are somewhat fortunate that you have had the “jaw hinge ache,” inasmuch as headaches not accompanied by jaw pain do not reveal the cause of the problem.

I am embarrassed that your dentist for over 30 years would send you to a physician to solve a well-known and common dental problem. On the other hand, you are fortunate to have a physician who suggested that you see another dentist and that he held off giving you a shot of cortisone, as these cases are much more difficult to treat after such injections.

Headaches and pain in the jaws are but two of many symptoms of what are technically called the Temporomandibular Joint Dysfunction (TMJD). Pain can be present in the back of the neck, top of the head, shoulders, face, temporal muscles and ears. The jaws can experience popping, clicking, crepitation, grating, grinding, and spasms and patients frequently grit or grind their teeth.

You can imagine that numbers of causes are involved in TMJD cases. The jaw joints can be damaged because of accidents, arthritis, osteoporosis, sinusitis and other diseases, but 90 percent of cases are a result of dental problems.

These, too, can be numerous but mainly they deal with the engineering relationship each of our teeth is supposed to have to each other at the moment they meet in the act of masticating food and swallowing. Teeth may look beautifully straight and well-aligned and still be out of proper interdigitation of lower ones to upper ones.

When you consider the thousands of times our teeth meet in chewing a meal you can better visualize how their malpositions could transfer stress to the joint of the jaw. The resulting changes are not unlike those that joggers suffer in ankles, knees and hips.

Because the pain can be quite severe, patients are initially advised to avoid clenching and grinding their teeth, as such actions are part of the cause of the pain they are experiencing. Instead, they are told to let the jaw fall open loosely, of its own accord, or to lie down on their back and just let it flop open.

Another pain reliever is to have the patient clench the teeth together as tightly as possible for a count of ten. That sounds contradictory but after the count is over and the pressure is relaxed, the jaw automatically loosens up and falls open of its own volition. After a careful examination and history taking, most dentists who treat these cases initially make a plastic splint to fit over the teeth that does away with the traumatic tooth contacts. This usually relieves the pain rather promptly.

After the jaws and facial muscles have had a reasonable rest period, the oral problems that are present must be corrected. This may mean the judicious shaping up of the teeth to remove tooth contacts that meet prematurely. If too much reshaping would be necessary, teeth may need to be straightened orthodontically or rebuilt with inlays and crowns so they meet properly the way intended by nature.

It was my good fortune to be involved in the early research in the TMJD problem as I suffered with headaches for 15 years with this affliction. One of the things I miss in the practice of dentistry since my retirement is the treatment of such cases.

If the recommendation of your physician to go on a soft diet and take Advil have not controlled your symptoms, I would be happy to recommend one. Just drop me a line at the Ojai Valley News, P.O. Box 277, Ojai 93024.

Space limitations prevent going into important home treatment considerations. Patient home care proved so successful in controlling TMJD pain for numbers of patients that sought my care that they were able to put more formal dental treatment on hold.

I will cover home treatment in next week’s article.