Implants

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TMD (Temporomandibular Disorder) & Facial Pain

This is a very misunderstood part of medicine and dentistry and there are many factors that play into head and neck pain. Most patients arrive in our clinic looking for answers. Most have been to various other health care providers looking for some direction on what their problem is and how it can be fixed. And most leave those offices without any guidance or hope.

A diagnosis alone can be difficult to obtain and the treatment options can vary from simple to extensive. Our approach at The Dental Office starts with a thorough history of the patient. This will give us clues to the problem. Then we do an examination of the head and neck area and discuss the areas and levels of pain, and then we begin to look in the mouth for signs of TMJ problems. We will listen to the joints with a Doppler to hear what’s going on inside the joint. If we determine that there needs to be more information needed, we will obtain photos, X-rays, and impressions for plaster models of the teeth. For some patients, treatment from this point can be fairly straightforward and the results are predictable. For others with more compromised joints and/or severe pain, we will order an MRI and/or a CAT Scan of the head and neck region. From here, a very detailed evaluation of the joints takes place, looking for pathology, evaluating bone quality, determining joint damage, and evaluating the upper neck area. A complete work-up is followed by a detailed consultation where the patient and Dr. Brown sit down and go over the history, link the present condition of the structures to the history and then discuss where the situation might be headed, and ultimately options for treatment.

This is a very complex problem. It is typically multi-factorial in nature, with different systems of the body involved and symptoms show up in a lot of different ways and locations. There can be structural problems in the joints that show up in the mouth with altered tooth position and broken and worn teeth, but also manifests in multiple layers of pain that can be debilitating and life altering for a patient. Sometimes head and facial pain can be referred from the neck area, making a definitive diagnosis difficult. Understanding the source of the pain is the first step, determining what treatment is best to reduce as much of the pain as possible is second step, and lastly figure out the best long term solutions for managing and maintaining the involved systems. As mentioned before, it can range from fairly straightforward dental work, to very complex structural and neurological systems.

Dr. Brown is one of the few dentists who will look at the entire system, not just the teeth. The TMJ is a very unique, major joint in the body that is easily ignored but is absolutely the foundation for everything that happens inside the mouth. Ignoring this is like ignoring the foundation for a home. A castle built on sand only looks beautiful until the sand gives way. A breakdown of these structures can cause an avalanche of problems to the teeth, but also start a chain reaction of pain in the face area that can range from annoying to unbearable. From a dental perspective, the TMJ is where everything starts and ends. Damage to this joint is not a static problem, like say a broken bone, which generally heals and gets back to normal function in a relatively short time. Untreated or ignored, this damage can continue to get worse and cause a lot of structural and neurological problems.