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By Lina Garcia, DMD, DDS
TMJ pain, and or migraine headaches
tend to have some or all of the following signs, and symptoms.
Observable signs include:
1 - Locking or clicking of
one or both lower jaw joints (TMJ), with or without pain.
2 - Limited jaw opening.
3 - Facial asymmetry with one side puffier than the other.
4 - A protruded lower jaw - this compromises the airway so the head
is held forward (the forward head posture strains the cervical vertebrae
- the thoracic, and lumbar vertebrae must compensate, and now either
one shoulder or hip is lower than the other).
The primary symptoms include:
1 - An intolerance of light,
requiring sunglasses during the day, and difficult driving at night.
2 - Headaches preceded by warning signs minutes to hours before the
pain begins. The signs are in the form of colors, blurred vision, or
dots in one or both of the eyes, or dizziness, and light - headedness;
the pain is restricted to one side of the face, and head - usually in
the temples, back, or top of the head.
3 - The pain may travel to unusual areas such as in front, or behind
the ears, and jaws, or in the sinuses; and there is chronic neck, shoulder,
and lower back pain.
The jaw, and headache pain
is the result of chronic compression of one, or both jaw joints. The joint
becomes displaced posteriorly, and effects the circulation of the external
carotid artery.
The muscles, and ligaments
supporting the joints attempt to protect the compressed joint by splinting,
or restricting the movement (similar to limping after spraining an ankle).
If the compression is chronic, the muscles ultimately fatigue, and pain
occurs.
The joints may become compressed
from a variety of causes; however, three causes comprise the majority,
and the most easily recognized:
1 - Accidents which tear,
or stretch the ligaments, and muscles supporting the joints;
2 - Untreated malaligned teeth, or jaw size discrepancies, which prevent
symmetrical closure of the jaws. (Ultimately, one jaw becomes compressed
because of the uneven pull of the muscles, which close the jaw).
3 - Orthodontic treatment with a headgear to correct an overbite, in
conjunction with removing the upper premolars (not lower premolars).
This creates an upper jaw smaller in circumference than the lower jaw.
The arc of closure of the lower jaw is now restricted, resulting in
compression of one or both joints.
Treatment is essentially directed
at decompressing the joints, and allowing the ligaments, and membranes
to relax, allowing the muscles to stop the splinting process, thereby
allowing unstrained movement of the TM joints
Since the spine helps splint
the other joints of the body, Cranial Osteopathy is the treatment of choice
before and after the TMJ appliance is fabricated.
In 1874 Dr. Still founded a
new profession and named it Osteopathy. The word "Osteopathy"
is derived from the words "osteo," meaning bone, and "pathos"
meaning disease or suffering.
This does not entirely describe
the true nature of our profession. Traditional Osteopaths do not focus
exclusively on bones. Rather, we focus on recognizing an inherent intelligence
that perfectly, and with precision, is working to establish wellness in
the patient at all times.
This higher intelligence, which
we call the "Health," is conscious, precognitive, omnipresent
and is a direct reflection of the Divine The Health does not diminish,
and is not affected by disease. Dr. Still recognized this innate wisdom,
and guided by it, in addition to a strong understand of Anatomy and physiology,
developed the science of Osteopathy.
Dr. Sutherland, a student of
Dr. Still's, expanded the osteopathic concept by developing the cranial
concept and he described a series of phenomena that work in response to
the Health. These phenomena are an integral part of our teaching and a
major focal point of our research.
Depending on the chronic nature,
and severity of the TM joint compression, and the causes, improvement
of the symptoms will vary from weeks to months. The body's healing tempo
will dictate how long the healing process will take.
Once the symptoms are alleviated,
a decision will be made on how to stabilize the joint in its unstrained
position. This can vary from splints to orthodontics, to crowns, and bridges.
Prior to beginning treatment,
a complete examination with appropriate tests must be completed to rule
out that the symptoms are not due to tumors, aneurysms, circulatory diseases,
or nutritional deficiencies. It is essential that we are certain the symptoms
are of dental, and joint preexisting conditions, and not other origin.
TMJ Cranial Osteopathy Sequence
Treatment
1. First Phase Treatment-
Comfort phase:
The primary purpose is to eliminate
the pain, clicking, popping, locking, headaches, neck aches, backaches,
and other symptoms that are frequently related to a condyle that is improperly
positioned in the fossa, and discs that are frequently displaced forward
in the fossa.
The TMJ appliance repositions
the mandible in such a position that the condyles are centered in the
fossa, and any impingement of the tissues is reduced. The treatment time
usually takes at least 6 to 12 months.
You will usually start to notice
improvement of at least some of these symptoms within three days to three
weeks after treatment is started; however, it usually takes at least 6
to 12 months for the injured tissues in the joint area to heal.
When TMJ dysfunction is due
to displaced condyles; where the teeth used to fit together, no matter
how good the occlusion looked, the Temporomandibular joints were not in
the proper position, and when the temporomandibular joints are in the
right place, the teeth will on longer fit properly.
This new mandibular position
usually creates a more prominent chin, and a posterior open bite - the
degree of which is related to the original depth of the overbite, and
to the degree that the mandible had to be brought forward.
2 Second Phase Treatment:
From the comfort phase of TMJ
treatment, you will move into one of the following two categories of Second
Phase treatment:
A. TMJ recall - If you feel
fine, and have no symptoms when the splint is out, and can move your
mandible back to its original bite position, you will be placed into
"TMJ Recall", and no further treatment is planned.
You should be checked on a
periodic basis for a year, or two to make sure you remain symptom free.
B. If TMJ symptoms return,
Osteopathic treatment, and reevaluate the TMJ appliance will be necessary.
It is important to understand
that once clicking or trauma to the TM joints is present, the TM disorder
is considered a permanent dysfunction because torn, or stretched ligaments
will not completely heal (similar to knee and elbow joint injuries). Since
the injury to the ligaments is permanent, occasional flare-ups are not
unusual, and can be expected to recur during, or after treatment.
TMJ Cranial Osteopathy treatments
are supporting the whole patient (Physically, Mentally and Spiritually)
to learn the necessary tools to overcome the challenges of life. The true
commitment of the Practitioner is to synchronize with the Health and treat
the patient as a whole being.
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