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 Temporomandibular Joint Dysfunction Syndrome, which, by itself, 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).

Comparing Your Options

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.

Long-Term Results

The second patient had been completely debilitated by severe headaches 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 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 headaches 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 cannot state all of her problems.

Conclusion

Dr. Marlin’s 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 and, clearly, many different courses of therapy. These three cases illustrate the range: the first had a slight malocclusion contributing to overall pain; the second had a problem that was primarily neurologic without a TMJ component; and the last was primarily a TMJ problem.

If you are experiencing jaw pain, headaches, or neuromuscular discomfort, schedule a consultation with Dr. Marlin for a comprehensive evaluation.