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New NIH Funding Opportunity on the Biology of the Temporomandibular Joint

New NIH funding opportunity announcements (FOA) on the Biology of the Temporomandibular Joint in Health and Disease (R01/R21). The intent of these FOAs is to support research that will provide a better understanding of total joint structure and mechanics

Let’s hear it for Mindfulness Meditation!

The National Institutes of Health re-established a cross-institute Pain Consortium about a decade ago to increase pain research and promote inter-institute collaboration. The consortium holds annual symposia and invites young investigators to submit post

Is Botox Safe and Effective for TMD?

As TMJ patients search for alternative treatments to manage their pain, a doctor may have suggested the possibility of trying Botox injections directly into the chewing (masseter and temporalis) muscles to relax these muscles.

Seventh Scientific Meeting of The TMJ Association

The Seventh Scientific Meeting of The TMJ Association - Genetic and Epigenetic Basis of Temporomandibular Disorders and Related Chronic Overlapping Conditions Federation of American Societies for Experimental Biology, Bethesda, MD, September 7-9, 2014

Social Security Disability Benefits and Temporomandibular Disorders

Those who suffer from Temporomandibular Disorders also referred to as TMJ or TMD, may find it impossible to maintain the responsibilities associated with full-time work activity. Some of the symptoms associated with Temporomandibular Disorder, such as vertigo, light sensitivity, and severe pain in the neck, head, and ears, can make it impossible to earn an income. The resulting lack of income can lead to significant financial stress. Fortunately, in some cases, Social Security Disability benefits can help alleviate some of the financial strain associated with this condition.

TMD WE GET QUESTIONS...AND COMMENTS

  • Jun 18, 2014

This section was developed to address questions of general interest. Should your question not appear, it may certainly be answered elsewhere on the website.

Use the drop down list to view questions and comments.

ACUPUNCTURE

Question: Does acupuncture help a TMJ problem?

Answer: At the present time, the therapeutic efficacy of acupuncture for chronic TMDs, including those exhibited by multiply-operated patients, is equivocal. Acupuncture may produce, at least, short-term pain relief for some patients. Acupuncture could serve as an adjunct to a comprehensive pain management program. While acupuncture may be a viable treatment option for some patients, it should be recognized that many variables may contribute to the success or failure of acupuncture. Furthermore, careful consideration should be given to the selection of a skilled acupuncturist who is familiar with the management of chronic craniofacial pain conditions.

BIOESTHETIC DENTISTRY

Question: I recently was referred to Bioesthetic dentist from my TMJ problem. What is bioesthetic dentistry and will this help me?

Answer: Bioesthetic dentistry is another name for bite modification. It is based on the idea that such diverse signs and symptoms as worn or cracked teeth, gum recession, a history of multiple root canal treatments, headache, TMJ problems, ringing in the ears, equilibrium problems, fibromyalgia, etc. are all related to a disharmony between the way the teeth meet and the correct position of the temporomandibular joint. The bioesthetic dentist has patients wear a bite appliance called a MAGO (Maxillary Anterior Guided Orthotic) for six to twelve weeks, which is supposed to get the bite to match the correct jaw position. This position is then maintained by tooth grinding, bonding, crowns or braces. There is no scientific evidence to support the claims made by the bioesthetic dentists, and patients should be wary of having such irreversible changes made to their teeth and bite without such evidence. (Response by Dr. Daniel Laskin)

CAUSES

Question: I recently had my tonsils and adnoids removed and a little over a month later I started experiencing jaw pain. I have since been diagnosed with TMJ and was wondering if the surgery could possibly cause TMJ?

Answer: Intubation during surgical procedures has been known to cause jaw joint disorders. The patient's mouth must be opened quickly, and very widely, to insert the respiration tube, and the jaw may remain fixed in place for a prolonged period of time.

Comment: I have some information that you might want to pass along to your constituents. I am a transgendered person who used an external estrogen gel for about two years. Toward the end of the second year I developed TMJ. I found your website and did a lot of reading. I noted that women on hormone replacement therapy were reporting a higher incidence of TMJ and that the jaw joint seemed to be a place where estrogen concentrated. TMJ is also much more prevalent in women. It was becoming clear to me that my use of the estrogen gel may be causing my TMJ. I stopped using the gel and in two months the TMJ was gone. That happened a year ago and no symptoms have returned. It seems clear to me that estrogen levels have something to do with TMJ. I have tried to put the word out in the TG community but I think you ought to call attention to my experience on you website.

Question: I was diagnosed with TMJ in March of this year. I have never had symptoms in my life except a couple of days after I received a meningitis vaccine. Since then I have been suffering with this awful jaw pain, difficulty opening and chewing with my jaw, facial pain, and pretty much all of the general symptoms. The only time I had anything like this was a year ago in the hospital. I had a systemic reaction to Reglan and Compezine. My jaw clenched down and I grinded my teeth and back gums so hard I bled. Only with benadryl did my symptoms go away after a few days. My jaw symptoms didn't return until after the vaccine in spring 2006. I tried benadryl this year and nothing seems to help. Ibuprofen seems to do little help also. Have you heard of any links to the meningitis vaccine and jaw/facial pain?

Answer: The patient’s first experience sounds like a classic phenothiazine-induced myotonia. On occasion, these reactions can persist over long periods of time. The patient’s current condition could reflect a persistent dystonia induced by Reglan or Compazine. I am unaware of any association between a meningitis vaccine and a temporomandibular disorder, though some vaccines can certainly produce neurological complications. (Response by Dr. Stephen Milam)

Question: I had a general anaesthetic using a laryngeal mask and awoke to a very stiff jaw that continued to get more painful as time went on. I have been told by the insurer that because I was not intubated there is no way that my TMJ could have been damaged and there is no research to prove otherwise. Is this correct?

Answer: The laryngeal mask is used in a very similar manner as an endotracheal tube except that it does not involve use of a laryngoscope. Therefore there is less need to open the mouth widely and thus less chance of stretching the TMJ. However, it is not impossible. If you had an oral surgical procedure the stretching could have been done during the procedure. Usually the use of a mild pain medication, applying heat to the joints, staying on a soft diet for a few weeks, and avoiding excessive use of the jaw usually results in resolution of the problem.

Question: I just returned from a scuba diving trip and have been experiencing headaches, pain in my jaw and ringing ears. Could TMJ problems be caused by scuba diving?

Answer: Because conventional scuba mouthpieces are typically poorly fitted, small and only support a few teeth, divers can experience jaw joint stress and inflammation. As a diver swims, the hose between the mouth and the air tank creates a small amount of drag, pulling on the mouthpiece. The resulting twisting motion can lead to TMJ dysfunction. A customized scuba mouthpiece that adapts to an individual's teeth and provides better jaw support is recommended. Like other joint injuries, TMJ problems caused by diving may get better with rest, relaxation, hot or cold compresses, and aspirin or anti-inflammatory drugs.

Question: I recently had a crown put on my left molar. A week later, I woke up one morning and could not close my left jaw. The pain has been with me for about two weeks and I have yet to see a doctor for this for fear that it is TMJ. Is it normal to wake up and have a TMJ problem so suddenly or does it usually creep up on you?

Answer: There are a number of complications that can occur in the context of preparing and placing a crown. Sensitivity of the tooth, aches and pain are the most common observations. Some patients report the onset of a TMJ condition after dental work. Manipulation of the jaw, including overt trauma to the jaw is to be expected to cause pain and dysfunction. We suggest you contact the dentist who crowned your tooth and have it evaluated with respect to the cause of the complaint.

Question: I would like to know if you have ever heard of anyone having TMJ like symptoms after a bad car accident? I never in my life had these problems until my auto accident. I did not hit my head on anything. I was in so much pain after the accident that I was unable to eat anything for three days. Now, four months later it's getting worse and worse. I can't stand the pain. I will be seeing a dentist soon, but I want to be sure that he is going to be treating me correctly. Any suggestions?

Answer: Yes. It is possible that your TMJ problems were caused by trauma from your auto accident. You point out that your face did not come into contact with a hard surface; however, injury to deep tissue of any body part can result from any high velocity impact. Soft tissue injuries often remain undetected during the E.R. visit because matters of immediate treatment need, superficial tissues and bone, get all the attention. We advise you to follow up with your primary care physician to determine what next steps he/she considers appropriate for you at this time. Although you may be led to believe otherwise, there are no recognized TMJ specialists by either the American Medical Association and American Dental Association.

The purpose of the information we provide in the treatment section of our website is to help you to become a discriminating TMJ health care consumer. Read it before your appointment with the dentist so you can formulate questions and then again after your appointment so you can assess the scientific validity of the treatments being recommended to you.

Question: For years it has been recommended to me to get my wisdom teeth removed. About a year ago I noticed popping and clicking in my jaws when I open wide or yawn. There is no pain, but it is bothersome. My dentist is very emphatic that I get my wisdom teeth removed and says that they are causing these TMJ symptoms. My previous dentist said she did not think my wisdom teeth needed to be removed. I have read that wisdom teeth extraction can actually worsen TMJ symptoms. I am very confused about what course of action to take.

Answer: Wisdom teeth do not cause TMJ problems. These teeth only need to be removed when local events justify their extraction. This includes inflammation of the gums around the wisdom teeth, or their negative impact on the neighboring teeth. They should not be extracted as a treatment for TMJ problems.

Question: I am 18 years old. A few months ago I was diagnosed with TMJ. I never had any problem with my jaw locking, clicking, or making grinding noises until I had my wisdom teeth removed. My jaw was in perfect condition, but now I have to press on my joint just to be able to open my mouth all the way. Could something have gone wrong during the removal of my wisdom teeth that could have caused these problems?

Answer: Certain dental procedures appear to cause TMJ symptoms in some people. To avoid causing or exacerbating an existing problem, dentists should not apply too much pressure on the jaw, push the jaw posteriorly (back), or build caps up too thick or fillings too high. Lengthy dental work requiring the patient's mouth to be open very wide for extended periods of time can cause or aggravate a TMJ problem. We frequently hear from patients who experienced their first symptoms after having their wisdom teeth extracted. Although many doctors remove wisdom teeth in adolescent patients to prevent future problems, according to a prior study, most wisdom teeth do not cause trouble. Some patients suffer jaw spasms, along with other surgical complications, after extraction of their third molars.

CHIROPRACTIC/PHYSICAL MANIPULATION

Question: Can chiropractic treatment help a TMJ problem?

Answer: There is insufficient scientific evidence of safety and/or efficacy of the various chiropractic treatment methods recommended for treating TMJ problems. However, we are aware of some cases in which the patient's condition was improved. On the other hand, we also heard from patients for whom such treatment did not provide relief, patients whose TMJ problem was actually  caused or worsened by chiropractic treatment or physical manipulation of the jaw.

COMORBID CONDITIONS

Question: How does TMJ disorders relate to other broad-spectrum syndromes, such as Fibromyalgia, Chronic Fatigue Syndrome, Multiple Chemical Sensitivity Syndrome, Myofascial Pain Syndrome and others?

Answer: An interesting point to note is that many TMJ patients also experience symptoms outside of the TMJ area. Research as been done on the frequent "overlap" of nonspecific broad-spectrum syndromes in a large number of patients. Muhammad Yunus, M.D., of the University of Illinois College of Medicine has studied a group of syndromes as being part of a larger spectrum of conditions, which he calls Dysregulation Spectrum Syndrome or DSS.

The following syndromes are considered to be part of DSS, according to Dr. Yunus:

"Other studies are being conducted on the occurrence of overlapping syndromes in patients. The exact cause of such a wide range of syndromes and symptoms in a patient is not yet clear, but it does seem to be the cause that a patient with one particular syndrome on the above list is much more likely to have symptoms of one or more other syndromes on the same list."

Question: I was just diagnosed with TMJ and also have pectus excavatum. One website I found claims these two conditions are correlated in a general way with connective tissue disorders. Is there any truth to this and any evidence that these two conditions are somehow related?

Answer: We have not been previously asked about a relationship between TMJ disorders and pectus excavatum*. In researching pectus excavatum on the web, we found it very interesting that it is a musculoskeletal disease which also has a connection to Mitral Valve Prolapse. The same can be said about TMJ disorders. Certainly there maybe a connection between pectus excavatum and TMJ problems but we are not currently aware of any research on their relationship.

The TMJ Association is dedicated to improving the basic and clinical research on TMJ disorders to provide greater understanding and safer and more effective methods of diagnosis and treatment, based on scientific evidence. We will be holding our fourth scientific meeting this September with the focus on co-morbid conditions common in TMJ patients. Certainly pectus excavatum is one that needs further investigation. We appreciate you bringing this to our attention.

*Pectus excavatum, also known as sunken or funnel chest, is a congenital chest wall deformity in which several ribs and the sternum grow abnormally, producing a concave, or caved-in, appearance to the anterior chest wall. The exact mechanism involved in this abnormal bone and cartilage overgrowth is not known, and, to date, no genetic defect is known that is directly responsible for the development of pectus excavatum.

Question: My 24-year-old daughter has been diagnosed with Cervical & Oromandibular Dystonia. She really suffers from TMJ pain yet specialists see no TMJ problem, it is all muscular. Do you have any information on Dystonia affecting the jaw and facial muscles; she has lost 45 lbs from not being able to eat and is in a lot of pain. Using Fetonal patch for pain, she now suffers from depression and chronic fatigue from all of this.

Answer: The National Institute of Neurological Disorders and Stroke (NINDS) has online information about Dystonia at the following websites: http://www.ninds.nih.gov/health_and_medical/disorders/the_dystonias.htm and http://www.ninds.nih.gov/health_and_medical/pubs/dystonias.htm These materials include specific information about cervical dystonia (also known as spasmodic torticollis) and oromandibular dystonia. Because of the pain the young woman is experiencing, materials at these sites may also be useful: http://www.ninds.nih.gov/health_and_medical/disorders/chronic_pain.htm and http://www.ninds.nih.gov/health_and_medical/pubs/pain.htm.

There are voluntary health agencies that provide information and services to people coping with Dystonia. A list of these agencies can be accessed at the following NINDS site: http://www.ninds.nih.gov/health_and_medical/disorders/the_dystonias.htm#Organizations.

Additional sources of information can be found at the National Library of Medicine's (NLM) Medline Plus website, which is designed to assist people in identifying resources that will help them with their health concerns or questions. Materials on Dystonia and pain, respectively, are available at the following Medline Plus sites. Because the requestor mentioned that her daughter suffers from depression and fatigue, these Medline Plus sites may also be useful to her.

Your requestor may also wish to search for more detailed information about treatment using PubMed, which provides free access to an online bibliographic database of published biomedical literature from the NLM. She can access PubMed at http://www.ncbi.nlm.nih.gov/PubMed. The search strategies "oromandibular dystonia AND treatment AND English" and "torticollis/therapy" are possible starting points to find articles. Anyone wishing to obtain copies of articles identified by a search may need the assistance of a librarian at the nearest university or medical library. Alternatively, the NLM offers a service called Loansome Doc that allows PubMed users to order a copy of any article they locate in the database directly from the Internet.

If the young woman would like to learn about clinical research studies on Dystonia, she may wish to search the National Institutes of Health online clinical trials database, which has information about more than 7,900 federally and privately funded clinical research studies on a wide range of diseases and conditions. Studies listed in the database are being conducted at more than 96,000 locations worldwide, primarily in the United States and Canada, but include sites in about 90 other countries. This database can be accessed at the following website: www.clinicaltrials.gov/.gov. The database offers an easy way for people to learn about research studies in need of participants and includes information about the location of clinical studies, their purpose, and criteria for patient participation. There are also links to the individuals responsible for recruiting study participants. The database is expanding, and references to the many clinical trials being supported by other organizations and pharmaceutical companies are being added all the time. She may wish to search the database periodically for studies of interest.

This question was answered by the Office of Communications and Public Liaison, National Institute of Neurological Disorders and Stroke

Question: What is Trigeminal Neuralgia? How is it different from TMJ? Is there any relationship between the two?

Answer: According to the Trigeminal Neuralgia Association, http://www.fpa-support.org/, TN is a disorder of the fifth cranial nerve that causes episodes of intense, stabbing, electric shock-like pain in the areas of the face where the branches of the nerve are distributed. While some of the same kinds of pain may be experienced by TMJ patients, it is not yet clear what the specific cause or causes are of TMJ disorders. To date, no scientific evidence has established a relationship between the two. However, we have heard from some TMJ patients they have separate diagnoses for both conditions.

COLD LASER THERAPY (LOW LEVEL THERAPY)

Question: What is cold laser therapy and is it effective for treating TMJ problems?

Answer: Cold laser therapy (also known as low level laser therapy) is another of the many scientifically unsupported treatments that have been promoted to patients with chronic pain conditions who are desperately seeking relief. The fact that it has been recommended for such diverse conditions a back and neck pain, musculoskeletal pain, arthritis, fibromyalgia, tendonitis, bursitis, neuropathy, migraine headaches, sprains and strains, carpal tunnel syndrome and temporomandibular disorders suggests the nonspecificity of its effects and several systematic reviews of the scientific literature support the fact that any positive results are most likely a placebo response. (Response by Dr. Daniel Laskin)

COSTS

Comment: My orthodontist has diagnosed me with having a TMJ problem and wants to put braces on my teeth in an effort to help correct the problem. It will cost approx. $5,000 so I wanted another opinion before I spent that much money.

Comment: I have been to a dentist who said that I was grinding my teeth and gave me a mouth guard and then said I needed to be fitted with a special splint to fix my jaw for $1,000.

Comment: I have been diagnosed with TMJ by a "specialist" who has warned me that my insurance will not cover the TMJ mouthpiece needed to correct my bite (which I never knew I had a problem with). The mouthpiece will cost $3,000 out of pocket.

Comment: I have had TMJ since 1984. When I first got it no one knew what it was. As of this date I have spent approximately $30,000 over the years having my splint adjusted.

Comment: I was just diagnosed with TMJ and my dentist recommended a customized acrylic nightguard to relieve the pressure of my nightly teeth grinding. I was shocked at the quoted price of $1,400 for the nightguard and five follow-up visits to monitor my progress and make adjustments to the guard.

Question/Comment: An oral surgeon wants to perform arthroscopic surgery on our daughter's jaws. Her rheumatologist feels she should get the inflammation down and warns even if she gets the surgery ($7,200 cost) she still might have pain. What should we do? Who is right?

Comment: I have already spent $500 for splints which do not work. I am in almost constant pain. I don't have a life anymore compared to how it used to be.

Question/Comment: I would like to receive some guidance, if possible, on the practicality of these recommendations to see if the cost is in line with this type of treatment. 1. Initial consultation with oral surgeon (including a panoramic X-ray) $345. 2. Prescribed anti-inflammatory medication and muscle relaxers (to be paid by patient). 3. Fitting of an oral appliance with 2-3 follow-up visits $2,300 to be paid up-front prior to insurance submission. 4. Additionally an evaluation with a sleep disorders specialist with the possibly of an MRI. I would like to receive a second opinion from another oral surgeon, but this will cost me $200. I can look into the reputation of a particular doctor, but how do I evaluate the cost of TMJ treatments?

Comment: The dentist I've seen recommended physical therapy, saying all may pain, etc. was muscular. I've spent over $1,000 and am improved, but not pain free. The dentist told me his splint costs $800, which I don't have.

Comment: Over a years time I have watched my mother severely suffer from this evil disease. She actually under went surgery in which they replaced the disc or at least tried to on the left side of her face in March of 2001. In my opinion this destroyed her life and only made things worse. She is in and out of the hospital at least twice within a month and even then she is in there for at least a week. I have had to stand by and watch people tell her that the pain she feels is all in her head and that it can't be that bad. She no longer is able to work due to this. I feel that I am watching her slowly give up. Now they told her she has to go through a complete joint replacement and that is going to cost at least $67,000+ and her insurance does not cover a dime if those three little letters are mentioned "TMJ".

Question/Comment: I believe I was overcharged for my orthotic appliance. Are there any cost price guidelines available? Is there anything like a "usual or customary charge?" Does the American Dental Association or other similar groups include these appliances in there cost review/reports? What can I do If I was overcharged? I paid approximately $4,000 for an appliance, TMJ evaluation, and X-rays. I have no pain, only clicking noises. I don't expect this device to work.

Comment: A dentist convinced me I needed to have all my teeth capped for $75,000 and then after that he said my teeth were perfect and I should go see a shrink and I did. She and I both couldn't figure out why if this was the problem he didn't tell me to see a shrink the three years he was working on my teeth. Now I live my life with a bite guard on most of the time. I don't know who to trust or where to go.

Comment: I have gone to a TMJ specialist who gave me an appliance, after learning that my insurance will not cover this I am $3,500 in the hole and making payments but have not gone back. I AM IN PAIN all the time.

Comment: My 21-year-old daughter has suffered from TMJ since she was 12. We have tried many treatments, but she suffers terribly. We recently came upon an oral surgeon in our area who says he is the only one in the south doing a procedure in which he puts computer sensors on her pressure points. He now has now informed us she needs her teeth totally redone in porcelain at a cost of $25,000. We have wasted over $50,000 already in treatments that have not worked.

DENTAL CARE NEEDED

Question: I need dental care but I'm unable to have the work done because of my TMJ problem. What can I do?

Answer: TMJ patients frequently have difficulty receiving general dental care and hygiene. We suggest you interview several dentists to obtain information about what care they provide to orally compromised patients. We are aware that some dentists accommodate the patient's difficulty in breathing and swallowing when placed in a reclining position and do the work in a more upright position. To prevent neck and back muscle pain, pillows are placed at the neck and back. Dental work is carried out with minimal mouth opening and a dentist can be sensitive to a TMJ patient's jaw tiring and will ask the patient for a sign when she needs to close the mouth. Frequent rest periods are also recommended.

DISEASE RECOGNITION/EDUCATIONAL PROGRAMS

Question: I work for a TMJ specialist. We are engaged in a verbal war with the State Department of Insurance regarding TMJ. They are attempting to tell us that TMJ is a dental concern. Under the PIP fee schedule they can pay us less for our services if it is truly a dental dysfunction. The State District Attorney legal counsel stated he felt TMJ is a medical dysfunction and should be treated as such. The insurance carriers of course don't want to hear this so the State Insurance Commission wants "proof positive" that TMJ is medical. I bill CPT (medical codes). My question is this: Is TMJ dental or medical?

Question: How long will it be before patients can expect TMJ to be a specialty among the medical/dental community?

Answer: It is impossible to predict when TMJ disorders will become a specialty. TMJ disorders refer to a complex medical condition and we are in the infancy of scientific research which will tell us the causes and yield treatments based on scientific standards. Complex diseases have many aspects, and the future may see several specialties involved in the science and treatment of TMJ disease/disorders. Until that time, what is important is that all health care professionals be educated about the realities of this condition and current treatment limitations.

Question: Why is it taking the medical and dental community so long to recognize TMJ as a disorder and develop educational programs for effective treatments?

Answer: TMJ had been turned over to the dental community over 50 years ago and from that time there have been an incredible number of dental approaches to solving the problem. The lack of sound scientific evidence for the causes, criteria for diagnosing TMJ and treating it has created chaos and controversy in the field which continues to this day. Since TMJ was regarded as a dental problem, the medical community has been reluctant to take it on. Hence, TMJ is not included in most medical schools curriculum. Given the research reported at international meetings organized by the TMJ Association, TMJ problems can relate to a broad range of multidisciplinary medical specialties, such as chronic pain, neuromuscular disorders, bone and joint disease, chronic immune and inflammatory disease and digestive disorders. Since the majority of TMJ patients are women in their childbearing years, study of the part reproductive hormones play in TMJ is essential. As research in this area progresses, the medical community will see their role in solving this problem and treating the TMJ patient.

The NIH sponsored Technology Assessment Conference indicated there are insufficient data to support any form of treatment. This is the information which should be the focus of ALL healthcare educational programs and as evidence-based treatments evolve that information should be added to the educational programs for the public and professionals.

DISLOCATED DISC

Question: I have been diagnosed with "disc displacement without reduction" following an MRI. I can't seem to open my mouth beyond 25mm (except the time the dentist took his two hands and stretched it to 31mm). I don't have any pain normally, and only mild pain when: (1) I eat hard foods (eg. almonds, large uncut carrots) or (2) when I perform the dentist-recommended stretching exercises (try to pry open my mouth further with popsicle sticks and chewing gum for 30 minutes), which the dentist suggested as a way to get the muscles back into shape. Aside: Having read through your website, I will review with my dentist the wisdom of the exercises he has given me (and I will seek a second opinion).

 

What is not clear from your (very helpful) website is what are the non-invasive treatments I could consider to allow me to gain greater mobility (without leading to the pain/suffering I have been reading about)? Also, I find it strange that my pain is minimal. Do people with my condition normally experience pain (or more pain, as the case may be) with time? Put differently, should I expect that if my non-reducing displaced disc does not correct itself, then it will wear out and I will eventually start to feel the pain? Thank you for your response.

Answer: Given state of science in this area it is difficult for us to tell you how to increase your jaw mobility at this time. Jaw exercises may be helpful, however we caution you from forcing the jaw beyond what is comfortable. You may want to consider some of the self-help techniques listed in our treatment section.

The use of MRI and the arthroscope has been shown in research to not only reveal displaced discs in symptomatic patients, but also in asymptomatic volunteers. So in other words, many people without TMJ problems have displaced discs. Research has also shown that repositioning splints and disc repositioning surgeries in many cases actually caused the disc to further be displaced, even in patients who had been considered cured. "The accumulated scientific evidence in the 1990's appears to be showing that the disc, by itself, is not the sole culprit in TMJ and facial related pain, even when it is positioned off the condyle. In fact, quite the opposite appears to be true, that is, the further anteriorly displaced the disc is, the better the patient feels." (Source: Mercuri, L. (Speaker). "Practical Reviews in Oral and Maxillofacial Surgery" entitled Fixation on the Disc. Audiotape, Vol. 5, No. 10, July 1991.)

Question: I just found out that I have a dislocated disc in my TMJ. Is this common? Is there anything that can be done for this, if so will it relieve the pain?

Answer: Yes, a dislocated disc is common. A diagnosis of a dislocated disc isn't an indication for treatment. If your disc restricts movement and causes pain, then you may require treatment, however, the two can be totally unrelated. If you have a dislocated disc but experience no pain, then no treatment is needed. If you have a dislocated disc with pain, your pain may subside with or without treatment.

Question: I was diagnosed with internal derangement of disc. What does this mean?

Answer: An internal derangement refers to a displacement of the disc that is located in the temporomandibular joint between the condyle and the articular fossa. If the displaced disc returns to its normal position when the mouth is opened, it is accompanied by a clicking and/or popping sound, and is referred to as anterior disc displacement with reduction. If the disc is so displaced that it does not return to the normal position during attempted mouth opening, there is locking and the patient generally cannot open more than 20-25 mm. This is referred to as anterior disc displacement without reduction. Both conditions are usually accompanied by TMJ pain.

Question: I was diagnosed with a dislocated TMJ disc, but have no pain. Should I proceed with treatment to reposition my disc?

Answer: Many people suffer from a dislocated disc and don't even realize it. You're fortunate that you have no pain. Since you have no pain, we caution you to be discriminating should you seek future treatment. If the dislocation has recently occurred, your jaw may accommodate itself. Many times we hear from people whose TMJ symptoms improve with time and without treatment.

There are many opinions regarding the clinical significance of displaced discs and, not surprisingly, treatments vary among practitioners. Although some claim they are able to capture a disc, or to replace the failed tissue, others question whether it can be done. On the other hand, there is good data that the physical displacement as such is not the cause of pain, and that any restriction in range of motion will improve with time. There is also evidence that articular tissue will undergo fibrotic changes, leading to the formation of a pseudo-disc.

DOCTOR REFERRALS

Question: If someone suspects they have TMJ, what steps should they take?

Answer: Know that many people with TMJ problems get better without treatment. Often the problem goes away on its own in several weeks to months. Some self-help therapies, such as eating soft foods, use of over-the-counter analgesics according to manufacturers' instructions may provide relief. Should the symptoms persist, consult a medical doctor to rule out other diseases. If you are diagnosed with TMJ problems and are referred to a dentist, obtain several independent opinions before agreeing to any treatments. Educate yourself! Be sure to read through our website. Informed patients are better equipped to ask the questions vital to making important health care decisions.

Question: Who would I need to go see if I think that I may have TMJ? Do I go to see my primary care physician or dentist?

Answer: Neither the American Dental Association nor the American Medical Association recognizes treatment of TMJ diseases as a specialty. As a result, there is no established standards for dental/medical school education. Treatments are based largely on professional beliefs, not scientific evidence. Today there are more than 50 different treatments available, often reflecting the type of provider seen.

The TMJ Association does not provide doctor referrals. As stated above, there is no specialty in TMJ disorders. Diagnosis and treatment are usually based on the doctor's preference. The field of TMJ disorders suffers from an extreme lack of basic and clinical science. We recommend that you first consult with a medical doctor to rule out any other disease that may be causing your symptoms. If your physician does not diagnose a problem that is routinely treated by physicians, you may be referred to a dentist. Whether you seek health care from a medical or dental practitioner, we suggest obtaining multiple independent opinions to confirm your diagnosis and then proceed with caution.

EAR/EYE PROBLEMS

Question: I read on the website that TMJ disorders can cause visual problems. Can you elaborate on that?

Answer: Many TMJ patients tell us they have trouble focusing at times or experience snowblindness.

Question: I have had an earache and am hard of hearing since my TMJ problem began. Is this problem reversible?

Answer: Earache and perceived hearing loss are symptoms we hear frequently from TMJ patients. In individual cases the problems may or may not be related to TMJ disorders. It's possible that the TMJ ear-related pain is caused by inflammatory processes in the back parts of your mouth or the tissues close to your middle ear. We suggest an appointment with an Otolaryngologist (ear, nose and throat doctor) to rule out any problem treated by that professional. Most earaches are effectively treated by relatively simple means and should for this reason be excluded prior to engaging in any TMJ treatment by the professional responsible for your care. A substantial portion of TMJ patients report pain in and around the ear which is the result of referral of deep pain to that particular location and not the consequence of a problem with the ear itself.

Should the earache and hearing loss be related to your TMJ disorder, we are unaware of safe and effective remedies.

Most patients tell us that these symptoms wax and wane, meaning they come and go.

Question: What is Ernst Syndrome?

Answer: Ernest syndrome, also known as Eagle Syndrome, is named after the person who first described it in 1983, Edwin A Ernest III, DMD. According to the author, it is characterized by pain below the earlobe that radiates to the ear, jaw joint, temple, cheekbone, posterior teeth, eyes and throat. Its cause has been attributed to either inflammation or weakness in the stylomandibular ligament (which extends from the styloid process of the temporal bone to the region of the angle of the mandible) due to an automobile accident, a blow to the head, a fall, prolonged mouth opening or surgical removal of wisdom teeth. The recommended treatment is cauterization of the area under local or general anesthesia in a procedure termed radiofrequency thermoneurolysis.

There are several issues regarding the etiology and treatment of this syndrome. First, is the question of how inflammation can occur in a relatively avascular structure such as a ligament? Moreover, the stylomandibular ligament plays only a minor role in lower jaw function and therefore looseness should not have a major role in causing painful symptoms. Finally, there have been no good controlled scientific studies to either establish the role of this ligament in causing the described pain symptoms or in its ablation resulting in their elimination. 

EVER FATAL?

Question: Can TMJ disorders be fatal?

Answer: TMJ disease is not a fatal condition. However, there can be serious problem conditions due to secondary factors related to TMJ problems.

Anyone undergoing surgical procedures is at risk for complications of surgery. Any surgical procedure poses a risk of infection and other complications, including reactions to anesthesia.

Another serious issue faced by TMJ patients is the lack of understanding and social support from families, friends, and health care providers. Because TMJ problems have often been mislabeled as a psychological problem, rather than a medical condition, patients often feel that they have to live "in the closet." Many people with TMJ try to hide their disease because others doubt what they are experiencing. A mix of pain, dysfunction, fear, doubt, and frustration is likely to lead to isolation, hopelessness, and depression. These secondary psychosocial effects of TMJ, when severe, have even led to suicide in some cases.

FACIAL DISFIGURATION

Question: Does the TMJ problem cause facial distortions in the masseter muscle? I've had this problem for about a year and I have noticed a muscle "loss" in my masseter muscles. It also causes my cheek bones to stick out more visibly. If it does this, will my facial muscles be restored as it heals? Will my face appear healthy again and more "filled" under my cheekbones?

Answer: TMJ problems do not directly cause changes in the jaw muscles. However, if one has a TMJ problem and does not use the jaw normally, such as occurs with use of a soft or liquid diet, then the jaw muscles can atrophy from disuse. They should return to normal when normal function returns.

Question: Is there ever any disfiguration of the face if it TMJ problems get too bad?

Answer: Yes, TMJ patients may experience some retrusion of the mandible and may develop an open bite if the jaw degenerates severely. Please keep in mind this occurs only in extreme cases.

IDIOPATHIC CONDYLAR RESORPTION

Question: My doctor just diagnosed me with idiopathic condylar resorption. What does this mean?

Answer: Idiopathic condylar resorption is a condition of unknown specific etiology characterized by a progressive decrease in condylar shape and mass. However, it has been associated with a number of systemic medical conditions including rheumatoid arthritis, systemic lupus erythematosus, and scleroderma as well as with the use of systemic steroids. It has also been reported following trauma, orthodontic treatment and orthognathic surgery. It has a predilection for females in the 15-35 year age range. The condition is generally bilateral and ultimately results in a retruded lower jaw and an anterior open bite. Although it usually causes pain, it can sometimes occur painlessly. Since the condition is eventually self-limiting, it is generally recommended to do periodic bone scans until the process stops and then do either orthognathic surgery or costochondral grafts to correct the malocclusion. At the present time, however, there are no evidenced-based studies to substantiate the effectiveness of these procedures. (Response by Dr. Daniel Laskin)

IMPLANTS

Question: Is silastic sheeting approved by the FDA for use in the TMJ?

Answer: In 1999 the FDA called for PMAs (pre-market approval) on all TMJ devices. premarket Approval documents contain testing and clinical data on safety and efficacy of a product. Not one silicone manufacturer submitted a PMA on Silastic sheeting to be used in the TMJoint. Therefore, FDA has not approved any company's silicone products for use in the TM Joint. If a surgeon implants any silicone material into a jaw joint the surgeon is using it "off label" and according the "practice of Medicine." This simply means, the surgeon is practicing without FDA or manufacturers recommendation for use.

INJECTIONS

Question: A physician is injecting a patient with anesthetics for TMJ problems. Are anesthetics a common treatment? Is it FDA-approved?

Answer: Local anesthetics are sometimes injected into the TMJ for diagnostic purposes to see if the pain is of joint or muscle origin. They are also used therapeutically to inject trigger points in the muscles. Such procedures would not need FDA approval as long as the anesthetic agent is an approved drug. (Response by Dr. Daniel Laskin)

Question: I am seeing a surgeon and his initial treatment was to inject steroids into my TM joints and Botox into the muscles of the jaw and neck. I have experienced difficulty with swallowing since the injections and I have had difficulty holding my head as well. Is this a common following these injections?

Answer: Steroid injection is one of the many treatments offered to TMJ patients. We know of no scientific or clinical studies that show long-term benefit for a majority of patients. Botox is not FDA-approved for use in the TMJ. Patients should be advised that off-label use of products is not approved by FDA and that FDA has not evaluated the safety or efficacy of the off-label use.

Question: Have hyaluronic acid injections or supplements been approved for TMJ use? I have seen some heavy marketing of this new supplement for joint problems.

Answer: According to the FDA hyaluronic acid has not been approved to treat TMJ disorders.

A reported study in the 2010 found that " The superiority of HA injections was shown only against placebo saline injections, but outcomes are comparable with those achieved with corticosteroid injections or oral appliances. The available literature seems to be inconclusive as to the effectiveness of HA injections with respect to other therapeutic modalities in treating TMJ disorders. Studies with a better methodological design are needed to gain better insight into this issue and to draw clinically useful information on the most suitable protocols for each different TMJ disorder."

Question: I met with a maxillofacial surgeon who recommended that I have an injection of steroids in my joint. I am scared and want to know if this is a typical treatment for TMJ disorders?

Answer: Steroid injection is one of the many treatments offered to TMJ patients. We know of no scientific or clinical studies that show long-term benefit for a majority of patients. More research is needed to determine if this treatment has a predicable beneficial effect for TMJ patients. We recommend that you ask your doctor for the basis for recommending the treatment and be sure to ask about the potential risks.

Question: Do Botox injections work for TMJ?

Answer: (This answer was written by the FDA's Center for Biologics Evaluation and Research): There are only 4 FDA-approved indications for Botox. They are: cervical dystonia (neck spasms), blepharospasm (involuntary eye contractions), strabismus (abnormal squinting) & more recently, glabellar lines (cosmetic).

Botox is not only used to treat these approved labeled conditions, but also to treat off-label conditions for which it is not FDA-approved. FDA does not endorse off-label use. Patients should be advised that off-label use of products is not approved by FDA and that FDA has not evaluated the safety or efficacy of the off-label use. Botox to treat TMJ is off-label & not FDA-approved. The FDA, however, accepts reports to its MedWatch system of any adverse events involving Botox, regardless of whether it is used in accordance with the approved label or off-label.

The only way a product can be FDA-approved for a specific condition is for the manufacturer to submit a request, called a supplement, to the FDA with data to support that new indication, which the FDA then must review and may or may not approve. Unfortunately, only Allergan can tell you if they have submitted such a request to the FDA.

Question: My doctor suggested cortisone shots in my TM joint. Will this help me?

Answer: Controversy still exists regarding cortisone shots as a TMJ treatment. A cortisone injection can be of help in reducing inflammation in cases of an acute flair-up of degenerative joint disease or rheumatoid arthritis. However, it is only a temporary palliative measure and does not address the cause of the problem. Also, if given too often, the injections can actually cause degenerative joint changes. Therefore, if used, it should not be done more than three times a year with at least three month intervals.

Question: My daughter's dentist is recommending prolotherapy to reduce bilateral TMJ pain and improve range of motion for her jaw opening (now at 37). She had various splints for two years, and had a right ramus osteotomy, had injections into the TMJ joints to dissolve scar tissue build-up and still experiences the initial pain and bilateral dislocation. Any info on prolotherapy in regards to TMJ would be helpful.

Answer: Prolotherapy (also known as sclerotherapy) is a technique in which an irritating solution is injected into a ligament or muscle tendon near a painful area with the intent of inducing the proliferation of new cells and thus strengthening these structures, supporting the weakened muscles, and eliminating the pain. Although it has been used mainly to treat chronic low back pain, it has also been recommended for patients with temporomandibular disorders (TMD). However, there is no scientific evidence to show that weakened ligaments and tendons are the cause of pain in TMD patients or substantiate the effectiveness of this procedure in eliminating the pain. Moreover, there are no studies to show what these solutions actually do to the tissues. Therefore, prolotherapy should be avoided. Additional information can be found on Mayo Clinic's website. (Response by Dr. Daniel Laskin)

INSURANCE

Question: I don't see any change in the status of TMJ improvements in terms of getting the insurance provider to cover treatments for patients suffering from TMJ. In fact, some of the insurance companies have pulled coverage for TMJ. What is the TMJ Association doing regarding this matter?

Answer: Insurance companies will continue to eliminate TMJ coverage as long as we lack treatments that have been scientifically evaluated. Insurance companies have been burned over the years for paying for TMJ treatments that in fact made the problem worse. Hence, they had to pay many times over for what was to be a one time procedure.

The fact that insurance companies still agonize over whether this is medical, dental, or even cosmetic also demonstrates the incredible lack of information regarding the "whole" TMJ patient. This problem appears to be one aspect of a complex of conditions, and hopefully, we will be on the way to understanding the comorbid conditions TMJ patients have as well as the mechanisms, which trigger these disorders.

The TMJ Association has contributed to the insurance issue by advocating for quality clinical and basic research so that insurance companies can be assured that the treatments they pay for will not contribute to the problem but will actually be proven safe and effective.

We understand your frustration and welcome your help in this very difficult fight to bring quality science and respectability to this problem and those who suffer.

Question: Why are TMJ treatments not covered by most insurance companies?

Answer: One of the most frustrating problems faced by people with TMJ disorders is trying to obtain insurance coverage. Many medical and dental insurance plans do not provide coverage for the treatment of jaw joint and muscle disorders. Some offer very limited coverage, perhaps on an individual, case-by-case basis, or with strict stipulations, such as annual or lifetime fee limits. Still others will pay for surgery, but refuse to cover medical management or even palliative care.

Without consensus on definitions or standards of care, insurance companies claim to be protecting themselves from exorbitant costs. Much controversy exists about the causes and treatment of TMJ problems and few treatments have been scientifically validated. Indeed, some treatments appear to cause new TMJ problems or exacerbate existing ones. Disagreements continue regarding whether TMJ treatments should be categorized as dental, medical, or even cosmetic.

INTUBATION

Question: I have a limited mouth opening and am unable to be intubated for general anesthesia. What can be done?

Answer: Those of us with TMD present unique problems when having to undergo general anesthesia for surgery. Since we generally cannot open our jaws properly or keep them open for an extended period of time, the anesthesiologist has great difficulty trying to sedate us. But we have options for mitigating the situation. First and foremost, we need to be our own patient advocate. Next, consider the following suggestions:

  • If you are not already wearing a MedicAlert® bracelet or pendant, go to http://www.medicalert.org/ or call 1-800-432-5378 to obtain an application.
  • Alert your family and/or friends to your oral disability.
  • Obtain and make multiple copies (so that you always have one with you) of the Anesthesia & Me© Checklist at http://www.asahq.org/patientEducation.htm from the American Society of Anesthesiologists or call 1-847-825-5586. This checklist enumerates every possible problem that can interfere with your intubation.
  • To determine if your surgeon and anesthesiologist are board-certified, go to www.abms.org or 1-866-ASK-ABMS.
  • If you are having elective surgery, discuss with your surgeon all the medical issues that might affect your intubation.
  • Prior to surgery, arrange a phone call or visit with the anesthesiologist to discuss your anesthisia options and alert him or her to your TMD problems.
  • As an alternative, and depending upon the length of your surgery, you may want to discuss spinal or epidural anesthesia. However, these alternatives may cause more serious problems than throat intubation. For a discussion in layman’s terms of general anesthesia go to http://health.allrefer.com/health/endotracheal-intubation-info.html.
  • In teaching hospitals residents who are going to specialize in anesthesiology may actually do the intubation. If you would prefer not to have a resident anesthesiologist assigned to your case, add that requirement to the surgical consent form.
  • Some community hospitals employ nurse anesthetists and board-certified anesthesiologists are not available. If you are having major surgery, consider having your operation in a larger hospital with board-certified anesthesiologists.
  • If you are asked to sign additional paperwork in the pre-op area, make sure you fully understand the terms of what you are signing. If possible, ask that a family member be allowed in the pre-op area to be your health care advocate.

(Response by Nancy Bernhard, a fellow TMJ patient)

JAW JOINT PROBLEMS

Question: Are both TM joints always involved or is it possible that only one side can be affected?

Answer: Certainly TMJ disorders can affect only one of the TM joints. Conditions that routinely affect other joints in the body, such as arthritis and trauma, also affect the TM joint.

Question: Every time I open my mouth to yawn or to eat a sandwich, my jaw on my right side makes a popping sound. My dentist says that since I don't have any pain there's really nothing I can do for it. Is this still considered TMJ

Answer: Jaw noises are one of the most controversial subjects in the TMJ field. Some experts claim that many perfectly healthy joints make noise. In some cases, the clicks disappear over a period of time without treatment. Many people with clicks have no complaints, whereas others are in absolute agony. Although most doctors feel that, if you have no other symptoms, a click or popping sound in the jaw joints is nothing to worry about, others are anxious to begin treatment and get rid of even the slightest sound. Jaw noises unaccompanied by pain or decreased mobility typically mean you do not have a problem.

It is important to get several independent opinions before agreeing to treatment designed to eliminate a click or other noise in the joints. Repositioning splint therapy is unproven, irreversible and expensive and possibly harmful. A click without other symptoms is usually nothing to worry about.

LEGAL ISSUES

Question: My TMJ symptoms occurred following a dental procedure. Should I take legal action?

Answer: Certainly we've heard from patients who have taken legal action against dentists after a treatment or procedure that allegedly caused or triggered a TMJ problem. Unfortunately we rarely are advised of the outcomes of these cases. As with many settlements, gag orders are imposed to prevent the information from being released. A medical malpractice attorney should be able to assess your situation and advise you on whether to pursue action.

MASSAGE THERAPY

Question: Is massage an effective TMJ treatment?

Answer: We are not aware of any clinical trials on TMJ disorders and massage therapy so we are unable to comment on the effects of massage therapy on the TMJ. We do hear that massage can be helpful for some patients, and painful for others. It is important to keep in mind that there are various types of massage and each TMJ patients symptoms vary.

MEDICATIONS

Question: What is Theraflex and is it effective for TMJ disorders?

Answer: Theraflex-TMJ is a topical cream containing a blend of herbs and minerals that have been recommended for treating masticatory muscles and joint pain.  Although it may provide some pain relief, it does not treat the cause and therefore is palliative rather than therapeutic.  In the one study that was done about 7 years ago it was more effective than the placebo and the only side effects were skin irritation and a burning sensation in two patients. However, there have been no subsequent studies.

Question: I was recently diagnosed with a TMJ problem in which I have ear and jaw pain. Can a side effect of the drug Accutane taken by adolescents for acne cause a TMJ problem to occur? Muscle and joint pain has been a serious side effect for me.

Answer: We are not aware of this issue in TMD patients and researched your question. The Food and Drug Administration's website does list bone, muscle and hearing problems as side effects of taking Accutane. This information can be found online at: http://www.fda.gov/downloads/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm094315.pdf on page 44. We encourage you to contact the FDA's drug division as well as your medical physician about these symptoms.

Question: I'm wondering if my TMJ or teeth grinding maybe a side effect of an antidepressant that I take. Has nortriptlyne (a tricyclic) been linked to TMD? I'm about to spend $4,000 on a splint and would like to treat it more conservatively if possible.

Answer: The causes of clenching are debatable as little research exists. One recent scientific study by Ellison JM and Stanziani P found SSRI (serotonin selective reuptake inhibitors) medications to cause tooth clenching and/or grinding during sleep. It is possible that other medications may cause clenching as well. You may want to consider discussing this possibility with your medical doctor.

Question: I am very worried about FDA recommendations that have resulted in several pain medications being removed from the marketplace. Should I just stop taking my pain medicines?

Answer: No! This is the time to have a conversation with your health care professional. Review the risks and benefits that you achieve with your pain medications. Be sure you are aware of how to take your medications safely. Also, take responsibility for how you take your medication.

  • Do you take them as recommended or do you take then as you wish?
  • Most medications should not be taken with alcohol. Are you aware of what can happen either to the potency of the drug or the potential internal organ damage that can result, if you ignore those warnings?

Once you have discussed your medication management and the decision to stop taking your medication has been made, slow tapering of your medication may be required, particularly if opioids are used. Abrupt removal can cause withdrawal symptoms, which can be harmful. To lessen the degree of pain and suffering, pain management options, such as companion medications, complementary methods and/or progressive treatments should be considered for your pain management plan.

Answered by Micke A. Brown, BSN, RN, Director of Advocacy, the American Pain Foundation

"Ask a Nurse", 2005, by the American Pain Foundation. Used by permission. All rights reserved.

Question: My physician, who has been treating my pain for years, is closing his practice and moving out of town. How do I go about finding someone who will continue treating my pain?

Answer: By law and ethics, your physician cannot abandon you. Your health care provider is obligated to arrange for the transition of care for his/her established patients. Often, as a practice is closed, other providers may either purchase that business practice or make an agreement to accept those patients into their practice. Patient records are then transferred to that new practice. This implies that the medical relationship is transferred as well. You should be provided official notice of those arrangements and given the option to continue care with that new practice or directed to other providers to arrange for transfer of care. Many times a list is provided or can be obtained through area hospitals or the medical licensing board in your state.

If the new provider is unable or unwilling to manage your pain, a referral to a pain specialist or another primary care provider should be arranged. Referrals to pain specialists most frequently require a physician request and transfer of medical information.

Continued care, until a referral has been completed and you have been accepted into a new practice, remains an obligation of your medical provider. When this does not occur it is equivalent to medical abandonment. Further action may be a necessary next step, such as filing reports to:

  • State Board of Medicine
  • Hospital Ethics Committee (if that practice is part of a hospital system)
  • State and Federal Legislators

Answered by Micke A. Brown, BSN, RN, Director of Advocacy, the American Pain Foundation

"Ask a Nurse", 2005, by the American Pain Foundation. Used by permission. All rights reserved.

Question: Is the drug Neurontin effective for the pain caused by TMJ? Is there another reason why this drug would be prescribed for TMJ?

Answer: Neurontin (gabapentin) is a drug that has been found to be effective in the management of neuropathic pain such as that associated with postherpetic neuralgia, trigeminal neuralgia and diabetic neuropathies. However, most patients with temporomandibular disorders have pain that is arthritic or muscular in origin and not neuropathic. Therefore, it will not be effective in these patients. However, in patients with long-standing, chronic pain, there can be central changes that may have a neuropathic component and the drug may be worth trying in such patients. (Response by Dr. Daniel Laskin)

The following information was provided by the FDA's Center for Drug Evaluation & Research (CDER) for our website.

INDICATIONS AND USAGE:

  • Postherpetic Neuralgia Neurontin® (gabapentin) is indicated for the management of postherpetic neuralgia in adults.
  • Epilepsy Neurontin® (gabapentin) is indicated as adjunctive therapy in the treatment of partial seizures with and without secondary generalization in patients over 12 years of age with epilepsy
  • Neurontin is also indicated as adjunctive therapy in the treatment of partial seizures in pediatric patients age 3-12 years.

Neurontin is not only used to treat these approved labeled conditions, but also to treat off-label conditions for which it is not FDA-approved.

The FDA is empowered by law to review drug products for safety and effectiveness. Once approved, a drug product may be prescribed by a licensed physician for any use that, based on the physician's professional opinion, is deemed to be appropriate. This action is considered to be part of the practice of medicine, which FDA does not regulate. The FDA cannot comment on, or recommend, a course of treatment for any individual. The best protection as a consumer/patient is to educate yourself about any drug that your doctor prescribes.

Patients should be advised that off-label use of products is not approved by FDA and that FDA has not evaluated the safety or efficacy of the off-label use. Neurontin to treat TMJ is off-label and not FDA-approved. The FDA, however, accepts reports to its MedWatch system of any adverse events involving Neurontin, regardless of whether it is used in accordance with the approved label or off-label.

The only way a product can be FDA-approved for a specific condition is for the manufacturer to submit a request, called a supplement, to the FDA with data to support that new indication, which the FDA then must review and may or may not approve. Unfortunately, only Pfizer can tell you if they have submitted such a request to the FDA.

Question: Please provide me with information on Serenitol for treatment of TMJ symptoms.

Answer: The TMJ Association has received a number of inquiries from TMJ patients about the use of Serenitol. We contacted the Federal Drug Administration (FDA) for information about the use of Serenitol for those who suffer from TMJ disorders. The FDA informed us that Serenitol is classified as a health food supplement and therefore is not under their control. At this time The TMJ Association is not aware of any clinical studies with Serenitol in patients who suffer from TMJ disorders.

MIGRAINE HEADACHES

Question: What is the relationshiop between TMJ problems and migraine headaches?

Answer: Although headaches associated with TMJ and masticatory muscle problems is either a referred type of pain that the patient interprets as a headache or it can be a true muscle contraction (tension) headache. As far as I know, nobody has shown any relation between TMJ disorders and actual migraine headaches. (Response by Dr. Daniel Laskin)

MUSICIANS/INSTRUMENTS

Question: Will playing a saxophone make a musician's TMJ condition worse?

Answer: We don't have the scientific studies to tell us about the relationship of TMJ problems and playing of brass and wind instruments. However we have heard from some patients whose symptoms were triggered or exacerbated by playing musical instruments or singing. A small group of musicians support and communicate with each other via the Internet. If you would like us to connect you with this group, please email us at info@tmj.org.

A resource that was brought to our attention by a musician who was misdiagnosed with TMJ is Dystonia and Embouchure Dystonia. (Embouchure dystonia is a term used to describe a type of dystonia that affects brass and woodwind players. The term embouchure refers to the adjustment of the mouth to fit the mouthpiece of a wind instrument. The anatomy of this form of dystonia includes muscles of the mouth, face, jaw, and tongue.) Perhaps this information will be of some help.

NEUROMUSCULAR DENTISTRY

Question: Can neuromuscular dentistry help relieve a TMJ problem?

Answer: Neuromuscular dentistry is a technique that is intended to treat your jaw muscles and produce a balanced bite. However, there is no evidence that a patient's bite contributes to TMJ problems.

  • Sonography - measures vibrations from the joint during opening and closing of the mouth. The joint sounds are analyzed by the computer in terms of amplitude and frequency in the opening and closing cycles.
  • Electromyography (EMG) - involves placing surface electrodes over the jaw muscles which pick up electrical impulses and sends them to the recording instrument. It is used to measure the activity in the muscles during various movements.
  • Jaw Tracking (Electrognathograph, Kinesiography) - analyzes mandibular movements three dimensionally. A headset is placed on the patient and a magnet is attached to the lower front teeth. Recording of the lower jaw movement is then made.
  • and TENS - produces ultra low frequency electrical stimulation of the muscles to relieve muscle spasms and pain.

As with many other TMJ dental treatment groups that have their own standards, those who practice neuromuscular dentistry have their own standards for what are normal and abnormal readings so that patients may be told they have a TMJ problem when they really don't, leading to unnecessary treatments.

There is no specialty in TMJ disorders because this area lacks the science necessary for the American Dental Association and American Medical Association to establish a specialty. Although a variety of health care providers advertise themselves as TMJ specialists, treatments available today are based largely on beliefs, not on scientific evidence.

At present, there are no widely accepted, standard tests to correctly identify all TMJ conditions. In most cases, however, a complete evaluation, including a detailed medical history, the patient's description of symptoms, physical examination of the head, neck, face and jaw, and radiographs and magnetic resonance imaging (MRI) provide information useful for making a diagnosis. Tests that are recommended are often intended to rule out other possible medical conditions. A diagnosis of TMJ disorders should be made only after every other possibility has been considered and eliminated. (Response by Dr. Daniel Laskin)

NUMBNESS

Question: Does facial numbness occur with TMJ?

Answer: We do not list facial numbness as a symptom of TMJ disorders on our website, however, we are hearing from a number of people who are experiencing facial numbness. At this time, we cannot cite any published quality scientific studies that would answer this question. You may wish to consult a neurologist to see if there is anything other than TMJ causing the numbness.

NUTRITION/FOOD

Question: What are your thoughts on the use of herbal supplements?

Answer: The National Center for Complementary and Alternative Medicine advises: "If you use herbal supplements, it is best to do so under the guidance of a medical professional who has been properly trained in herbal medicine. This is especially important for herbs that are part of an alterative medical system, such as the traditional medicines of China, Japan, or India. Herbal supplements can act in the same way as drugs. Therefore, they can cause medical problems if not used correctly or if taken in large amounts."

Question: Are you aware of any non chew cookbooks? I have TMJ and cannot chew this week!

Answer: There are several cookbooks for preparing good-tasting, non-chewing foods. Check out the following:

  • Pureed Foods with Substance and Style by J. William published by Aspen Publishers, Inc. It is expensive, so you might want to get a copy from your library first to see if it is useful to you.
  • Easy-To-Chew and Easy-On-Salt - Pureed Foods for a Sodium Controlled Diet by Rosalie N. Norris published by Cornwall books
  • Ease-To-Swallow, Easy-To-Chew Cookbook by Donna L. Weihofen, published by John Wiley & Sons
  • Dinner Through a Straw and Let's Do Lunch (and other meals) by Becky R. Dethero, published by Dethero Enterprises. P.O. Box 332574, Murfreesboro, TN 37133, 1-800-842-3841, email: dinnerthroughastraw@yahoo.com, www.dinnerthroughastraw.net
  • The Healing Jaw Guidebook by Susan Beaudette RN, published by Zip-N-Squeeze (714) 997-7146 or www.zip-n-squeeze.com/book.html
  • Soft-Sipp Bottles and Zip-N-Squeeze feeding systems designed by Susan Beaudette, RN P.O. Box 575, Yorba Linda, CA 92885-0575 or (714) 997-7146, email: zipnsqueeze@earthlink.net, www.zip-n-squeeze.com

The first three books are available from Amazon.com and probably other merchants. They may also be available from your local library.

A number of TMJ patients have had success with a straightforward approach that does not require a cookbook. Make your normal dinner and puree it in a blender. You may wish add a broth to thin the consistency. For a dinner item, the taste is quite good.

OCCLUSAL (BITE) ADJUSTMENT

Question: I am a 42-year-old woman who has had TMJ for probably 20 years. Although I cannot open my mouth wide and I must exercise my jaw every morning before breakfast, I thankfully do not suffer from the intense pain some people have. I have a strong overbite and overjet, and my mouth does not open vertically straight; the lower jaw opens far to the right. I've wanted braces for a long time to correct the overbite and to close up the spaces between some teeth. I saw an orthodontist yesterday who recommended the following treatment plan:
•    I'll be fitted with a Herbst appliance for several months.
•    After 4-6 months, braces will be added, while the appliance is still in place.
•    After the braces and appliance come off, I'll be fitted with permanent retainers for the upper and lower front teeth. I'll also wear a removable retainer at night.

I read on the TMJ website and on the website for the National Institute of Dental and Craniofacial Research that irreversible treatments are not recommended. I'm guessing that braces and the Herbst appliance fall into the irreversible category??

Answer: The treatment plan suggested by the orthodontist is acceptable. However, there are two things you  must understand. First, orthodontics is not a treatment for TMJ problems. If it is done, it should be merely to correct a malocclusion and not a TMJ problem.  Second, orthodontics is not a reversible procedure. That is OK if it is to correct a bad bite.” (Response by Dr. Daniel Laskin)

Question: I have a cross-bite and was prepared for braces as a child but never got them. I have struggled with TMJ problems off and on since college. I am now 38 and the orthodontist has given me a bite plate to help with my cross-bite and TMJ. He has cautioned me that it is a temporary fix to be worn only for six months or less, and given the results so far he thinks I am a good candidate for braces. After reading your site, I am confused and concerned. Will braces fix the cross-bite, which could be the cause of my TMJ problem?

Answer: Most so-called TMJ problems are not caused by a malalignment of the teeth, but rather by what a person does with the teeth, e.g. clenching and grinding (bruxism). If that is your situation, the bite appliance should help eliminate the problem. The decision to have orthodontic treatment should be based on your desire to eliminate the crossbite and properly align any other malposed teeth, and not as a cure for your TMJ problem, which literature shows is not a likely possiblity. (Response by Dr. Daniel Laskin)

Question: I'm 35 years old and am in need of help. At age 16 I started TMJ treatments which involved filing teeth for repositioning and splint therapy. This treatment didn't work and in my opinion made my TMJ problems worse. I saw an orthodontist who wanted to fit me for braces. I sought another opinion from a "TMJ Specialist" who did more filing and splinting. Again this didn't work. I was then referred to a rehabilitation medical specialist center and was diagnosed with Fibromyalgia and underwent many treatments. I recently made another appointment with a new dentist who wants to do more filing and repositioning. At this point I cannot close my jaw or open very wide. When I bite my teeth together my jaw slides forward and over to the left and is very painful. All previous years of filing and repositioning did not work and I need some sound advice before going through all of this again.

Answer: A recently reported study in the Autumn 2003 issue of Cochrane Oral Health Group Newsletter found "no strong evidence of benefit from occlusal adjustment (adjusting the teeth's biting surfaces) for problems associated with the TM joint." Specifically, the review reported there is "no evidence from trials to show that (bite) adjustment can prevent or relieve temporomandibular disorders." Koh H, Robinson PG, Source: Cochrane Oral Health Group, August 2003, Issue 8, To view abstract click here.

(The Cochrane Collaboration is an international organization that aims to help people make well-informed decisions about health care by preparing, maintaining and promoting the accessibility of systematic reviews of the effects of health care interventions. The main work of the Collaboration is done by approximately fifty Collaborative Review Groups, within which Cochrane Systematic Reviews are prepared and maintained. The Cochrane Oral Health Group aims to produce systematic reviews which primarily include all randomized control trials (RCTs) of oral health. Oral health is broadly conceived to include the prevention, treatment and rehabilitation of oral, dental and craniofacial disorders.)

According to The National Institutes of Health, National Institute of Dental Research TMD Temporomandibular Disorders brochure,  ("Other irreversible treatments that are of little value - and may make the problem worse - include orthodontics to change the bite; restorative dentistry, which uses crown and bridge work to balance the bite; and occlusal adjustments, grinding down teeth to bring the bite into balance" pg. 11).

Question: If I have braces on my teeth, will I be able to undergo an MRI of my TMJ or will the metal interfere with this type of imaging study?

Answer: Orthodontic appliances do not interfere with MRI imaging.

Question: Will braces help my TMJ problem?

Answer: There is no scientific basis for orthodontic treatment of disorders of the temporomandibular joint. According to the National Institutes of Dental and Craniofacial Research Brochure: "Other irreversible treatments that are of little value - and may make the problem worse - include orthodontics to change the bite; restorative dentistry, which uses crown and bridge work to balance the bite; and occlusal adjustment, grinding down teeth to bring the bite into balance... Even when the TMD problem has become chronic, most patients still do not need aggressive types of treatment."

The 1996 National Institutes of Health Technology Assessment Conference Statement booklet states that "evidence is insufficient to warrant prophylactic modalities of therapy. Additionally, available data are not persuasive that orthodontic treatment prevents, predisposes to or causes TMD. Therapies that permanently alter the patient's occlusion cannot be recommended on the basis of current data."

PHYSICAL THERAPY

Question: Would physical therapy be helpful?

Answer: There is insufficient scientific evidence of safety and or efficacy of the various physical therapy treatment methods for TMJ. A study released in April 2001 by the Agency for Healthcare Research and Quality reported, "Available research on behavior modification and physical therapy suggests that some types of intervention can be helpful in reducing pain and increased function. However, interventions studied range from physical self-regulation to posture correction to ambiguously described cognitive therapy. This area of the literature has few studies involving non-treatment control groups, long-term follow-up data, or direct comparisons of alternative methods of behavioral modifications and physical therapy".

PREVENTION

Question: Our dentist told us that our 16-year-old daughter has a "bite problem" that will lead to TMJ problems if not treated. He recommended us to an orthodontist for braces to realign her bite and eliminate stress on her joints. She has worn braces and had them off about a year before the dentist noticed her "bite problem." She wasn't complaining of symptoms but now says that sometimes her jaw hurts. We don't know whether or not to pursue treatment or see how it plays out. Any thoughts on "pre-TMJ" treatment?

Answer: At present there is insufficient evidence to support the prevention of TMJ disorders through treatment. According to the National Institutes of Health there are no data to support some commonly held beliefs. For example, evidence is insufficient to warrant prophylactic modalities of therapy. Additionally, available data are not persuasive that orthodontic treatment prevents, predisposes to, or causes TMJ. Therapies that permanently alter the patient's occlusion cannot be recommended on the basis of current data.

SCIENCE BEHIND TMJ TREATMENTS

Question: Why is the jaw so much harder to treat than any other joint in the body?

Answer: The temporomandibular joint is one of the most complex joints in the body. Despite the tremendous patient population and the significant morbidity related to a plethora of TMJ disorders, the TMJ has been poorly studied in comparison to joints of interest to the orthopaedic community. Unlike the orthopaedic community, there is no organized continuity between engineers, scientists and clinicians in the TMJ research community.

Question: Are there any updated reports on TMJ disorders by the NIH? The one we are reading Management of Temporomandibular Disorders from the 1996 NIH Technology Assessment Conference seems outdated.

Answer: The Agency for Healthcare Research and Quality (AHRQ) contracted with The Lewin Group to conduct a study of the per-patient cost and efficacy/effectiveness of treatment for TMJ. This study was carried out at the request of the Senate Appropriations Committee to further clarify the TMJ issue and to followup on relevant developments since the 1996 NIH Technology Assessment Conference. The report prepared by the Lewin Group, April 30, 2001, confirms certain findings of the 1996 NIH Technology Assessment Conference. and of certain other reviews of this subject. Their findings reinforce previous conclusions that few randomized clinical trials or other types of rigorous studies exist for determining the effectiveness of treatments for TMJ. Published reports of clinical research on TMJ consist primarily of non-randomized uncontrolled trials, case series, case reports, and anecdotal descriptions of treatment techniques. Among the factors affecting the body of evidence on TMJ treatments are insufficient understanding or consensus regarding the etiology, course of disease, and diagnosis of TMJ. This report is available below:

Another study, conducted by the Emergency Care Research Institute (ECRI), a nonprofit Pennsylvania organization, found that most treatments for TMJ disorders lack sound research support for the surgeries, injections, splints, and other procedures for joint problems which TMJ patients undergo each year.

"The available evidence suggests that approximately half of the patients who initially develop TMD symptoms will experience significant improvement or spontaneous resolution of their symptoms within a period of weeks or months," ECRI researchers concluded. "Although noninvasive procedures may provide an additional benefit for some patients, the evidence of benefit for splint therapy is weak." The institute, formerly an emergency medicine research agency, has since the 1970s served as an independent organization committed to advancing the quality of health care.

The ECRI study found these conclusions:

  • Roughly half the patients with disc displacement without reduction in clinical trials of splints will improve within weeks or months without treatment. Stabilization splints appear to provide little if any additional benefit over no treatment for patients with disc displacement without reduction.
  • Available evidence fails to address whether stabilization splints provide benefit to patients with disc displacement with reduction. Only one clinical trial was available.
  • In general, patients with disc displacement with reduction might benefit from arthroscopy (closed-joint surgery using a small incision). There is insufficient evidence to determine whether patients with disc displacement with reduction will benefit from disc repair and repositioning procedures.
  • In general, patients with disc displacement without reduction benefit from arthroscopy and will benefit from arthrocentesis (a relatively noninvasive procedure using hypodermic needles to irrigate the joint).
  • In general, patients with disc displacement without reduction might benefit from disc repair and surgical repositioning procedures. The small number of studies made it difficult to determine statistical significance.

The ECRI Technology Assessment Report "Temporomandibular Articular Disorders: Selected Treatments" is available for purchase from ECRI at 5200 Butler Pike, Plymouth Meeting, PA 19462-1298. Telephone: (610) 825-6000. Unfortunately the ECRI report is very costly to obtain, costing several thousands of dollars.

Question: Why are irreversible TMJ treatments being performed if the National Institute of Dental and Craniofacial Research has concluded that most irreversible treatments show little value and may, in fact, aggravate the problem?

Answer: The Technology Assessment Conference and two independent studies published in 2001 (Agency for Healthcare Research and Quality and ECRI) found little scientific information to support the effectiveness and safety of TMJ treatments and in many cases the most commonly prescribed treatments were found to be ineffective or minimally effective. Even with this compelling evidence, most dentists treating TMJ problems continue to do so because of their belief that their treatments work. Until we understand more about TMJ and have scientifically based treatments, this will continue. That fact alone underscores the need for the patients to adhere to the adage, "buyer beware."

SINUS PROBLEMS

Question: I am experiencing sinus-like symptoms along with my TMJ. Is this typical?

Answer: Yes

SLEEP APNEA

Question: I have sleep apnea and use a Continuous Positive Airway Pressure (CPAP) device. Can the mask that covers my nose cause or the airway pressure aggravate a TMJ problem?

Answer: The nasal mask and the positive pressure should not cause or aggravate a TMJ problem. (Response by Dr. Daniel Laskin)

SPLINTS

Question: Does the NTI-tss (Niciceptive Trigeminal Inhibition Tension Suppression System) work to relieve bruxism and TMJ disorders? Are there any concerns regarding treatment with NTI-tss? What is its effectiveness?

Answer: The basic theory behind the NTI appliance is correct in that it prevents clenching and grinding by separating the back teeth, which is the site where such activities generally take place. A full-coverage stabilization appliance can prevent grinding, but does not prevent clenching because there is posterior tooth contact. However, since the NTI appliance fits on only two teeth, it can place a great deal of stress on these teeth and that can be harmful. Also, because of its small size, if it comes off during the night, there is danger that it could be swallowed or aspirated. Finally, because of the small contact area between it and the lower teeth, it cannot be used in patients with certain types of malocclusion. (Response by Dr. Daniel Laskin)

Question: I have a flat plane splint that I have been wearing close to two years. I wear it every night when I go to sleep. I just read on this site that you should not wear a splint longer than six months. Why and at this point what should I do about wearing my splint? I have been wearing it for so long that it has changed my bite, but I rarely have pain anymore. I am nervous to stop wearing it because I might still clench and grind my teeth at night and the pain might come back.

Answer: The National Institutes of Dental and Craniofacial Research brochure states, "An oral splint should used only for a short time and should not cause permanent changes in the bite" p9. The reason the NIH suggests wearing a splint no longer than six months is because it can affect the position of the teeth. We understand your concern. You may want to discuss the length of time you are wearing the splint with your dentist and if you'll need to deal with a change in your bite.

Question: I recently had an orthodontist recommend a repositioning splint. The research I have done so far indicates that this treatment is often unnecessary and can even cause more damage. However, I have suffered from a painful popping jaw for years, experience eating difficulty and wake up with a headache and sore jaw from grinding my teeth almost daily. These symptoms continue to worsen. I do not want to simply get rid of the pain. I want to fix the problem! Is the repositioning splint really a bad idea in this case?

Answer: There are many TMJ treatments. They may yield no change, improvement, or may worsen the condition. Without evidence based research it is up to you, the consumer, to decide on the course of treatment. According to the National Institutes of Dental Research, "Other irreversible treatments that are of little value - and may make the problem worse - include orthodontics to change the bite; restorative dentistry, which uses crown and bridge work to balance the bite; and occlusal adjustment, grinding down teeth to bring the bite into balance. Although more studies are needed on the safety and effectiveness of most TMD treatments, scientists strongly recommend using the most conservative, reversible treatments possible before considering invasive treatments... Even when the TMD problem has become chronic, most patients still do not need aggressive types of treatment" (National Institutes of Health brochure).

Question: My new bite splint smells and tastes bad. I've tried soaking it in mouthwash, putting it in baking soda, but nothing seems to work. What can be done to correct this problem?

Answer: This problem is almost certainly out gassing/leaching of acrylic monomer. The device should be reprocessed or remanufactured with careful attention to getting a complete "cure" of the polymethacrylate material. If you are still sensitive to the more completely cured splint, it's recommended that the splint to subjected to an extensive period (48 hours) of vacuum out gassing, followed by extensive (48 hours) water rinsing.

Question: I was told I should have a TMJ splint made. Are there different types of splints and how will a splint help me?

Answer: We caution patients to be careful before beginning any TMJ treatment that is irreversible, or can produce irreversible changes, and non-conservative such as crowns, braces, surgery and repositioning splints. Be sure to ask your doctor what the intent of the splint is (flat plane or repositioning), what happens if this doesn't improve your condition, what happens if it worsens your condition, what further treatment will be needed if any, what kind of splint and how much will it cost.

Splints are the most universal type of treatment for TMJ and many types of splints are in use. The one that is considered to be the most benign is called a flat plane or stabilization splint, which is intended to allow your muscles to relax and help reduce clenching and grinding. It should not cause any change in your bite.

Another type of splint is a repositioning splint. It is intended to put your jaw into a position other than where it is, therefore, causing permanent changes in the bite as well as repositioning muscles and ligaments.

The National Institute of Dental and Craniofacial Research says an oral splint should be used only for a short period of time and should not cause permanent changes in the bite. If a splint causes or increases pain, stop using it and see your practitioner. See the National Institutes of Health brochure in our publication section for more information. The maximum amount of time you should wear a splint is six months.

Ask your dentist what the intent of the splint is, how long you are to use it, what will be the outcome, what happens if this doesn't improve your condition, what happens if it worsens your condition, what further treatment will be needed if any, and what kind of splint and how much will it cost.

Question: My nightguard (flat plane splint) helped relieve my pain in the beginning, but now the pain has returned. Why has this happened?

Answer: Though the flat plane splint is intended to reduce clenching and grinding, in some patients, it actually increases clenching and grinding. It may be explained by the brain telling the teeth to go where they used to be. This is called proprioception. In other words, the teeth are trying to get to where they feel they should go but the splint is in the way; therefore, you are clenching harder in order to get the teeth to that position. Recent studies have shown that sham splints (placebo) evoked a similar response as the therapeutic ones. Other patients mention that the splint helps to reduce pain for a while, but then problems may arise, such as the development of an "open bite" (meaning when the mouth is closed, there is a gap between the upper and lower front teeth). Remember, your splint is custom made, which makes you dependent upon the expertise of your dentist.

TINNITUS (EAR RINGING)

Question: Can medications I'm taking for TMJ problems cause ear ringing?

Answer: One cause of tinnitus can be medications. Over 200 different drugs can cause ear ringing, including aspirin - especially when taken in high doses. The American Tinnitus Association has printed a list of medications which can cause tinnitus. TMJ patients are often prescribed medications which appear on this list. Certainly it is something to rule out should you be experiencing tinnitus. To view the listing of medications click here.

Question: Did you ever hear of Tinnitus being caused by TMJ?

Answer: Tinnitus is a sound in one or both ears or in the head when no external sound is present. It is often referred to as "ringing in the ears," although some people hear hissing, roaring, whistling, chirping, or clicking. We do not list it as a symptom of TMJ disorders on our website, however we are hearing from a number of people who are experiencing tinnitus. At this time, we cannot cite any published quality scientific studies that would answer this question. You may wish to consult an Ear, Nose, and Throat (ENT) doctor to see if there is anything other than TMJ causing the tinnitus.

The National Institute on Deafness and Other Communication Disorders of the National Institutes of Health hosted a workshop on tinnitus December 5-6, 2005. The purpose of the workshop was to advise the National Institute on Deafness and Other Communication Disorders about research and training opportunities in the area of tinnitus. Linda Parkin, a TMJ patient who also experiences tinnitus, as do many TMJ patients, participated in the meeting. The meeting summary is available online at http://www.nidcd.nih.gov/funding/programs/wkshp_tinnitus.htm.

TMJ FLARE-UPS

Question: What is the length of time between TMJ flare-ups?

Answer: Many pain-related conditions tend to wax and wane. We do not have any information regarding a predictable way to ascertain when a flare-up will occur. Many TMJ patients tell us weather conditions can affect their pain and swelling. There are still many other factors that may influence flare-ups.

WEIGHT LIFTING & THE TMJ

Question: Does lifting weights affect the TMJ?

Answer: Lifting weights can sometimes aggravate a TMJ problem because in order to lift a heavy weight the teeth have to held together and that results in a form of clenching.

WHO GETS TMJ DISORDERS

Question: I'm 18 years old and having jaw problem. Are TMJ problems common at adolescence?

Answer: TMJ disorders can affect young adolescents. In fact, such conditions are observed in puberty much more often than in years prior to it. The condition can often affect a young person's ability to participate in school and many extracurricular activities. Far greater education is needed in schools about TMJ problems and its impact on those being affected by it.

WISDOM TEETH EXTRACTION

Question: I have been told that I do have a disorder called TMJ. I was asymptomatic and feeling fine. That was until I had all four of my wisdom teeth removed last week. Since then my jaw has become worse. I experience pain when biting and talking. Can wisdom teeth removal exacerbate TMJ?

Answer: It is too soon after the wisdom teeth extractions to determine where the pain is coming from. Masseter muscle pain is not unusual following the removal of lower impacted third molars. It is also possible when a patient has pre-existing TMJ problems that there can be some stretching of the joint when lower third molars are moved under sedation or general anesthesia. Both of these conditions are generally temporary. Symptoms may subside with a soft diet, moist head, a mild pain medication and limited jaw function for 1-2 weeks. You may wish to consult your primary physician should you symptoms persist.

Question: My dentist recommended I have my wisdom teeth removed, saying that they are causing my TMJ symptoms. My jaw pops and clicks when I open wide or yawn but there is no pain. I have read tooth extraction can actually worsen TMJ symptoms. I am very confused about what course of action to take.

Answer: Wisdom teeth do not cause TMJ disorders. These teeth only need to be removed when local events justify their extraction. This includes inflammation of the gums around the wisdom teeth, or their negative impact on the neighboring teeth. They should not be extracted for a TMJ problem.

The TMJ Association would like to thank Dr. Robert Baier at the University of Buffalo, Dr. Ronald Dubner at the University of Maryland, Dr. Julie Glowacki at Brigham & Women's Hospital, Dr. Stephen Gordon at Gordon Biomedical Consulting, Inc., the late Stephen Milam who was at the University of Texas Health Science Center in San Antonio, Dr. Christian Stohler at Columbia University and Dr. Daniel Laskin at Virginia Commonwealth University for their contributions to this page.