Deciding where to go for headache treatment or TMJ treatment is no easy task. The internet provides too much information and can lead to many roads. When someone has debilitating headaches the following are often professionals that patients seek:
- Family practitioner
- ENT (ear, nose, throat medical professional)
- General Dentist
- TMJ Specialist
- Physical Therapist
- Massage Therapist
The problem is that headaches from TMJ are most often overlooked. Family practitioners usually do not diagnose headaches or migraines from TMJ issues, rather refer to other medical specialist or prescribe medications to try and relieve pain.
Unfortunately, many referrals to other medical professionals also leads to more tests and more medications. For dizziness, however, an ENT can often run certain test to see if there is something wrong with the crystals in ear. I have found that some ENTs do actually understand that headaches and ear pain are very often TMJ related.
Some patients ask their family dentist about their headaches who most likely will recommend a night guard to see if that helps you. A night guard is designed to keep you from grinding and wearing down your teeth. It is not designed to treat or correct TMD issues such as popping, headaches, migraines, facial pain, ear pain, ringing of ears, or neck pain.
Sometimes a dentist will use an NTI appliance. This is popular, as it requires no training or advanced studies to use them. Most general dentist do not treat complex TMJ cases and this NTI appliance is what they often try to use or refer cases out to TMJ specialist (dentists with special interest and training in TMJ). If you do have an NTI, it is important to only use it very short term as it can cause an open bite, meaning you will not be able to get your front teeth together as it moves these teeth. It is often a quick fix and can cause problems with long term use.
Having a dentist “equilibrate” your teeth, or re-contouring the biting surfaces of the teeth. This unfortunately can further compress your jaw joints backwards and make the problem worse.
Patients can also see a neurologist. This is often a common choice. Most neurologist are very thorough and the good news is they can rule out a medical issues such as tumors, cyst, etc. At the end, even after all testing is performed; many often wind up with more prescription drugs for headaches. A common complaint we see is these drugs make them feel drowsy or offbeat.
This has led the medical profession to try Botox for headaches. Botox has helped some patients, however, actually acts as a band-aid, masking the true problems. It requires repeated having multiple injections every 3 months. Does it make true sense to keep injecting botox into your head and neck? The other issue is the fact that not correcting the underlying problem can lead to further damage of joints, ligaments, etc…
What if there was a way to find out what was making these muscles to be unbalanced and cause headaches in the first place?
Other patients might seek out the help of orthodontists. Most orthodontist do not treat true TMJ, however, some do. The real question is does your orthodontist find the correct physiologic position for your jaw, joints, and muscles or move teeth until they are straight? It the pain is caused by muscles and joints, it is imperative to treat them first and then find where to move the teeth too and not vice versa.
Finally, some patients are referred to Oral Surgeons. Oral surgeons do surgery, most TMJ patients are non-surgical cases, or should be. Although, there are some surgical procedures that can be used such as arthrocentesis, condylectomy, and arthroscopy, these should be last resort and not the starting place.
Chiropractors and physical therapists do a great service for many people and can help them feel better. The problem is that the TMJ and the jaw is the top of the chain. If the head, neck, and jaw are not properly aligned any adjustments will not last or hold. To treat TMJ related headaches and problems, one must get to the true problem. Often chiroprators and physical therapists are used in conjunction with TMJ treatment.
These are common scenarios often seen with chronic TMJ patients seeking relief.
Dentists who have advanced training in TMJ should be focused on treating the underlying cause and not the symptoms. Physiologic or Neuromuscular dentistry focuses on finding, diagnosing and treating the underlying cause of the pain, usually overworked muscles and damaged or compressed jaw joints caused by this unnatural strain. There are many ways to diagnosis this. Along with a through exam, a 3D scan of the head and neck can show the problems and help with the diagnosis.
Very briefly, underlying treatment is geared to finding the correct physiologic position for your teeth to meet in when the facial and neck muscles and jaw joints are relaxed and not strained. This is not done by laying the patient back in the chair and taking an arbitrary bite. Several methods can be used to relax the muscles such as ultralow frequency TENS for at least an hour along with other ways to relax the neck muscles too. Sophisticated computerized EMG’s like EKGs can be used to help find this position for the patients as well. Once this position has been found, an orthotic, fixed or removable (preferably fixed) can be used to “test drive” your bite and allow the muscles and joints to heal and to be sure the headaches resolve. This herein gives you direction as where the teeth need to be for long term health and stabilization which is the next phase of treatment.
In short, it is important to know where you are going with the diagnosis before treatment begins.
Be sure to ask questions about the treating dentists training and experience in treating these complex TMJ issues before beginning treatment.
If you have any questions regarding Houston TMJ Pain, please feel free to contact our office, Ronald W. Konig DDS, FAGD, LVIF 713-668-2289