TMJ and Neuromuscular Pain

Many have heard of TMJ pain, but are unaware that, in many instances, the term TMJ pain is a misnomer.  TMJ stands for the Tempormandibular Joint Dysfunction Syndrome, which, by it self, implies that the pain is coming from the joints.  In our experience, the predominance of patients who are seeking pain relief when presenting for treatment do not have any pain in their joints.  The referred pain is usually emanating from trigger points in the muscles of mastication (for reference see the highly recommended text by Dr. Janet Travell Myofascial Pain and Dysfunction: The Trigger Point Manual.

Recently, we saw three patients for treatment of the “TMJ Syndrome”.  Each one had very different symptoms and causes of their problems.  The first one had been in a car accident five years before coming and was being treated for severe neck and back neuromuscular pain.  Her jaw pain was a contributing factor.  After treating the trigger points in her neck and back, her physician referred her to us to treat the jaw pain, as well.  In order to eliminate the primary jaw problems, an occlusal (bite) adjustment was done to ensure that she contacted evenly on all of her teeth.  She was then fitted for a night guard.  Now that we have eliminated the jaw as a secondary factor, her physician and physical therapist will continue to treat her neck and back.  The Jaw pain was contributing to her condition, but was not a primary factor.

The second patient had been completely debilitated by severe head aches and neuromuscular pain in the head and neck.  She was referred by her physician to rule out referred pain from the muscles of mastication or the TMJ.  Once a bite adjustment had been done and a night guard fitted for her, we had determined that her problem was not primarily as a result of the “TMJ Syndrome” or neck trigger points.  Ultimately she was treated at Johns Hopkins for treatment of a hyperactive nerve in her neck.  As of now, her pain problems have been eliminated.

The last patient also had severe head aches and pain in her jaws.  Unlike the previous two patients, we believe that a malocclusion of her jaws is the primary cause of her severe pain in the muscles of mastication.  This malocclusion is severe enough that she will most likely need to have orthodontic therapy to reposition her teeth to the proper places.  A bite adjustment will not be sufficient.  Since we are still in the early stages of analysis, we can not state all of her problems.

My Master’s Thesis, The Basis for Occlusal Rehabilitation, reaffirmed that there are many different Jaw positions, each one specific to each individual.  In addition, there are many different causes of the Temporomandibular Joint Dysfunction Syndrome, clearly, many different courses of therapy.  We have presented her three very different cases: the first one had a slight malocclusion that was contributing to her overall pain; the second had a problem that was primarily a neurologic and did not have a TMJ component; and the last one was primarily a TMJ problem.

About the Author

Dr. Gerald Marlin is a Washington D.C. specialist in implant, cosmetic, and restorative dentistry. Connect with him on Google+.