This practice is limited to the treatment of Temporomandibular Disorders (TMD) and Orofacial Pain (OFP). TMD manifests in a number of different ways including symptoms such as joint, ear and facial pain and clicking and locking of the jaw. OFP represents a conglomeration of pains associated with the teeth, face, head and neck and includes a large variety of headaches.
There are a number of contributing factors to TMD and OFP. Many people suffer with a combination of pain, anxiety and sleep disorders. Below is a brief description of how each of these various problems can influence TMD and OFP.
Sleep Disorders: Pain may lead to sleep loss and sleep loss may enhance pain. Insomnia, non-refreshing sleep and excessive daytime fatigue are common complaints in chronic pain patients. Snoring and obstructive sleep apnea are common in our patients and often can be successfully managed with various oral appliances.
Headaches: The prevalence of headache in TMD and OFP is substantial. Musculoskeletal pain from these disorders may contribute to changes in pain pathways to and within the brain that leads to this escalation of headache. Treatment of TMD and OFP often reduces or eliminates headache. Referral to a headache neurologist may be considered.
Neuropathic Pain: This disorder relates to a variety of nerve pains that can affect the head, face and neck. This is nerve pain that often has a burning, tingling, numbing and/or electrical shocking quality. These pains can be the result of dental or surgical treatment, trauma, and systemic conditions or may be spontaneous.
Bruxism: There are a number of oral behaviors that will influence the development and perception of TMD and OFP. Clenching and grinding the teeth; lip, cheek and tongue biting; chewing on foreign objects; tooth tapping; and smoking are all factors that can aggravate and perpetuate pain. Managing these behaviors can be critical in the management of TMD and OFP.
Systemic Disorders and Arthritis: Various forms of systemic disorders and arthritis can influence the development and perpetuation of TMD and OFP. The result can include developmental disorders affecting the face and jaw, dental malocclusions, limited jaw opening, popping and grinding sounds in the jaw and, of course, pain. Referral to a primary care physician or a rheumatologist is sometimes necessary.
Trauma: Trauma can be the consequence of both physical and emotional events. These circumstances can result in Post-Traumatic Stress Disorder (PTSD) which is another, common occurrence in patients suffering with TMD and OFP. Referral for oral surgery or an ear, nose and throat consultation may be necessary.
Stress: PTSD and anxiety are 2 to 3 times more common in patients with TMD and OFP. Acute stress can lead to increased muscle tension, but chronic stress can lead to long-term alterations in immunologic, neural and hormonal functions. Many patients who suffer with TMD and OFP are on medications which can contribute to clenching and grinding the teeth. Consultation with a primary care physician, a psychologist or a psychiatrist may be beneficial in some circumstances.