Help for the often misdiagnosed condition TMD

May 24, 2023 – Toothache is the worst. It can come on seemingly out of nowhere and interfere with eating, drinking, and daily activities. But what happens when the pain is not necessarily in your teeth, but in your face, jaw and neck?

Shane G., a 40-year-old financial manager in Austin, TX, is painfully aware of this difference. After sitting through a highly stressful meeting in his office one day, he decided to take his laptop to a bar and finish his work over a basketball game and a beer.

“I took a sip of beer and it was like the corner of my mouth was on fire,” he said. “It was a sharp, sharp pain, accompanied by heat; something was clearly wrong.”

The pain that Shane felt is more commonly known as orofacial pain and includes over 30 types temporomandibular disorders (TMDs) – conditions affecting the two joints that connect the jaw to the skull (temporomandibular joint), as well as the muscles and tissues of the jaw.

From Between 5% and 12% The US population has TMD. Because they are difficult to diagnose and can overlap with other conditions, patients often embark on a seemingly endless quest to find relief.

Fortunately for Shane and others like him, there are self-directed strategies that can help alleviate the misery.

He was able to make an emergency appointment with a knowledgeable dentist who suspected the problem was in the jaw muscles. After taking x-rays and measuring the night guard to rule out possible grinding and tightness, Shane was referred to a massage therapist. Not only did she identify the root of her pain, but she was able to find some relief after just one session.

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Not everyone is so lucky.

There are “practitioners who don’t know the diagnosis and jump on the trigger a little too quickly to provide irreversible treatment,” said Clifford Chow, DDS, an orofacial pain specialist and associate professor at the Orofacial Pain and Dental Sleep Medicine Center. . at the University of California-San Francisco School of Dentistry.

“Unfortunately, with delay, circumstances can change and things can get worse and more difficult to manage,” he said.

It is often misdiagnosed

Although not rare, orofacial pain disorders are often left out or dentists and doctors confuse it with other conditions. And TMDs are often associated with other conditions, such as fibromyalgia and migrainewhich makes diagnosis even more difficult.

“We have a saying in dentistry: When you hear hooves, think horses, not zebras,” said Lisa Crafton, DDS, a dentist in private practice in Columbia, MD.

“For most people who present with facial pain, most of them are muscular,” he explained. “And I feel like most people have it after a stressful episode. Or for some it can happen 2 weeks after a stressful incident and then suddenly the jaw is killing them.”

“If you think about a skull, the lower jaw is held in place by muscles,” Crafton said. “So I always start by saying, OK, let’s try muscle release.”

Katie Pudhorodsky, an Austin, Texas-based licensed massage therapist who focuses on the head, neck, and jaw, has treated Shane and countless others with TMD pain. Pudhorodsky has become a favorite of many dentists who, like Crafton, recognize the muscle component certain TMDs immediately.

Massage can often help treat two of the most common pain conditions associated with TMD: 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 muscles of mastication, which make it possible to chew food).

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Pudhorodsky explained that TMD pain comes in many forms and is often referred to as pain in areas other than the exact location of the muscles, joints and tissues of the jaw. Symptoms include headache, neck pain or stiffness, toothache, sinus pain, ear fullness, ringing in the ears (tinnitus), numbness and/or tingling.

The universal experience is that most of the patients Pudhorodsky sees in his practice are looking for relief.

“They’ve brought up this conversation with their dentist or doctor, that they’re in pain, and it’s running away.” They move them from specialist to specialist until someone says, “Hey, those muscles are tight! maybe that’s a piece of the puzzle,” he said.

Nataly S., a 32-year-old researcher from Austin, said she landed in Pudhorodsky’s office after experiencing sudden pain in her jaws and what she called “jaw cramps.”

“I went through a particularly stressful time emotionally,” she said, reflecting on the experience. “I went to my dentist, who suggested I get a mouth guard. But he also asked me what my symptoms were, how long they had been going on, and said TMJ-specific massage would be helpful.”

Nataly got relief after a treatment with Pudhorodsky and continued to do her exercises twice a day.

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

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The four pillars of relief

Pudhorodsky sees patients personally, but provides detailed education and exercises online. Much of his work is focused on helping people achieve and maintain muscle relief and rests on four pillars:

  • “The first pillar is to relax the muscles and reduce the trigger points. And that’s done with massage and stretching,” he explained. “This can be done by a professional or by yourself at home.
  • The second pillar is the retraining of attractive muscles; these exercises are also used to stabilize the bite.
  • The third pillar is the maintenance of the correct oral resting posture. “This is the correct oral resting posture. We want our tongue to come up to the top of our mouth, and our lips to touch and slightly apart,” Pudhorodsky said.
  • And “the fourth pillar is dealing with bad usage habits; that’s when you start to stop these bad patterns from continuing.”

Managing expectations

Like other pain conditions, TMDs are complex and present differently in different patients. Massage is not a solution for all types and not all people. But by releasing tight muscles and retraining joints to move in a more balanced way, massage can help remedy some of the problem, relieve pain and, as Pudhorodsky explained, “open space for healing.”

Chow says patients should be proactive and ask whoever is treating them what their diagnosis is.

“Just saying they have TMD is not a diagnosis; it’s a broad term for disorders, and often those are the ones that might miss something,” he said. “They need to be more specialized in diagnosis and more specific in treatment.”