TMJ---A Pain in the Neck

(Both literally and figuratively)

Often TMJ (short for tempromandibular joint, the jaw joint) disguises itself as a very different problem. I even refer to it as "the Great Impostor". Literally, one of the most common symptoms is a neckache at the back of the head just where the neck and skull are joined. Very often, this neckache is described as a tension headache, and frequently, the pain even radiates down the neck into one or both shoulders, and the muscles in those areas do, in fact, become filled with tension and become "tight". That may seem like a strange place for pain to occur which is associated with the TMJ, located just in front of each ear. However, a more complete understanding of the problem makes it very logical.

Let's review the myriad of other symptoms, which can be associated with TMJ dysfunction. One of the most common is headaches, which frequently are located behind the eyes or sort of fan out over the side of the head. People often believe these are sinus headaches.

Other symptoms which lead to the elusiveness of TMD include: stuffiness in one or both ears, ringing in one or both ears, dizziness (vertigo), hearing difficulties, low back pain, poor posture, and occasionally ulcer-like symptoms in the stomach.

Symptoms, which are not so illusive, include:

  1. clicking, popping, and/or grinding (crepitus) in the jaw joint2
  2. tenderness or pain in the jaw joint
  3. sore or painful muscles in the head, face, or neck
  4. difficulty in chewing
  5. fatigue of the jaw muscles after prolonged chewing or talking
  6. limitations of the range of motion of the lower jaw
  7. locking of the jaw in either the open or closed position
  8. clenching or grinding the teeth
  9. deviation of the jaw when opening or closing the mouth.

Figuratively, TMJ dysfunction can be "a pain in the neck" because of the difficulty a person may have in having the problem correctly diagnosed and properly treated.

A typical scenario is one where a person goes to their family physician complaining of one or more of the above mentioned symptoms. Often after trying prescription drugs to no avail, the physician refers the person to an ENT specialist. The ENT pronounces the ears free of fluid and the sinuses clear and recommends a neurologist. The neurologist often does MRI and X-rays or cat scans and comes up with nothing, other than maybe some more drugs to try. If the patient hasn't given up by now, he/she may even be referred to a psychiatrist.

Lets assume one of the medical doctors along the way did, in fact, make the proper diagnosis, and suggest the person see a dentist. The problem may still not be over. The methods of treatment may be about as varied as the symptoms. Precisely, most treatment protocols are symptom directed. The dentist or physician may prescribe pain medication and/or muscle relaxants. The dentist may grind the teeth to "correct" the bite or construct an acrylic occlusal splint. The dentist or orthodontist may even straighten the teeth to treat the problem.

The "good news" of all this is that it is very likely that any of the above mentioned approaches will cause some or possibly complete cessation of the symptoms, at least for a little while. The "bad news" is all the above mentioned approaches could be likened to having the engine light come on while driving your car. You pull into the mechanics garage to get it checked out. He says, "No problem." and cuts the wires going to the light. Sure enough, the engine light is not on any more. But did he resolve the problem, or did he merely treat the symptom?