| TMD/TMJ |
The temporomandibular joint connects the lower jaw (the mandible) to the temporal bone at the side of the head. Place your fingers just in front of your ears and open your mouth and you can feel the joint on each side of your head. These joints are flexible, allowing the healthy jaw to move smoothly up and down and side to side. This enables us to talk, chew and yawn. Muscles attached to and surrounding the jaw joint control its position and movement. When the mouth is opened, the rounded ends (the condyles) of the lower jaw glide along the joint socket of the temporal bone. The condyles slide back to their original position when the mouth closes. A soft disc is positioned between the condyle and the temporal bone. This disc absorbs shocks to the temporomandibular joint (TMJ) from chewing and other mouth movements.
TMJ disorders are problems related to your jaw joint. TMJ stands for Temporomandibular Joint, which is the name for each joint TMJ disorders are problems related to your jaw joint.ned to help you maintain your smile's health and beauty. Keep your teeth and gums strong and disease-free.
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| Sleep Apnea & Snoring Therapy |
People with obstructive sleep apnea (OSA) have disrupted sleep and low blood oxygen levels during apnea episodes. When obstructive sleep apnea occurs, the tongue is sucked against the back of the throat. This blocks the upper airway and air flow stops. When the oxygen level in the brain becomes low enough, the sleeper partially awakens the obstruction in the throat clears and the flow of air starts again, usually with a loud gasp.
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Headaches |
There have been many advances in the diagnosis and treatment of headache over the past decade. Research in pain management and the development of specific medications for the treatment of headache attacks allow physicians and orofacial pain specialists to help even the most frustrated patients. The following provides you with information about common types of headaches and the newest treatments available.
Remember, this information is not a substitute for careful evaluation by a physician or orofacial pain expert. Numbness, paralysis, disorientation, double vision or inability to talk accompanying headaches are symptoms that demand immediate evaluation. Experiencing a first, worst, more intense or different kind of headache is also cause for concern.
Headache is one of the most common maladies. There is scarcely anyone who has not had a headache at some point in their lives. For many, a headache is an occasional painful inconvenience easily controllable with an over-the-counter medication. But for others, the headache is frequent and can disable them and cause missed work or damage social and family aspects of life. There are about three hundred causes of headaches but only the most common ones will be discussed here.
The International Headache Society (IHS) broadly divides headache into two categories: primary and secondary headaches. Primary headaches are a constellation of clinical symptoms and not a result of another disorder. Primary headaches include:
- Migraine headache and its variants
- Cluster headache
- Tension type headache
Secondary headaches are headaches caused by an underlying medical condition such as sinus disease, brain tumor, or stroke. There are numerous causes that could be listed for secondary headaches. A thorough evaluation by a trained professional is aimed at investigating causes for the headache.
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| Trigeminal Neuralgia |
Of the neuropathic pain disorders, perhaps the best known is Trigeminal Neuralgia (TN). It often appears suddenly as a sharp, shooting, lightning-like pain lasting a few seconds. There may be a specific trigger area that, when touched, causes the pain to occur. Patients are often unable to shave, comb their hair, or touch their face for fear of triggering the pain. Sometimes the pain is triggered by slight movement of the affected part of the face. The disorder is more common after age 50 but can occur at any age.
The trigeminal nerve is the main nerve that provides sensation to the face. The nerve is divided into three branches on either side of the face and the pain of TN usually follows one or more of these branches. The cause of TN is often unknown, but many doctors and researchers feel that at least in some patients, there may be a compression of the trigeminal nerve by an artery or vein within the brain. Also, patients with tumors in the brain and with Multiple Sclerosis may suffer from TN-like pain. Therefore, all patients need to be carefully evaluated before starting therapy. There are also several other, less common neuralgias involving other nerves of the face.
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| Tooth Aches of Non Dental Pain |
Some patients experience persistent toothaches without having an apparent dental problem, such as tooth decay, that could explain their pain. These patients may visit several dentists and specialists in the search for a solution, and may have root canal therapy, dental extractions and other procedures without relief.
Thus, toothaches of non-dental origin encompasses a group of conditions in which pain is due to problems in structures other than a tooth. Since the pain still feels like a toothache, the cause can be difficult to identify and puzzling for the dentist and patient.
What Patients Experience
The pain from a toothache of non-dental origin can present in many different ways. Some patients have a low-grade, bothersome ache and others experience an excruciating pain, described as throbbing, sharp or shooting. The pain can be present all the time or come and go. It is usually felt in the teeth or in the surrounding areas such as the gums and bone. Unexpectedly, the pain can migrate from one tooth to another and even change sides of the mouth. The pain may be present from weeks to several years. The similarity to a classical toothache will cause some patients to undergo dental treatments in multiple teeth before a diagnosis is established. It is important to exercise caution in having irreversible procedures performed, such as a root canal or an extraction, in these situations.
Disorders that Cause Persistent Tooth Pain
Toothaches usually occur as a consequence of dental problems such as an inflammation in the dental pulp ("the nerve") due to deep decay, gum problems or periodontal disease. These dental problems can cause pain and inflammation in the tooth pulp and supporting gums and bone. Your dentist can treat the tooth or gums, and the pain will disappear after the treatment.
A toothache of non-dental origin, however, has other causes for the pain. Previously, when the cause of persistent toothache was unknown, it was often labeled as atypical tooth pain or atypical odontalgia. As the actual cause of this type of pain becomes better understood, this term will be used less often.
To determine the source of persistent tooth pain, several conditions have to be considered. These include conditions that are due to dental problems and frequently go unnoticed, as well as conditions due to non-dental problems. These can include: Muscle Pain, Headache, trigeminal neuralgia, nerve damage pain, , heart attack, sinus pain, tumors, salivary gland dysfunction and psychological disorders.
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| Tooth Ache |
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"Toothache" usually refers to pain around the teeth or jaws. In most instances, toothaches are caused by tooth or jaw problems, such as a dental cavity, a cracked tooth, an exposed tooth root, gum disease, disease of the jaw joint (temporo- mandibular joint), or spasms of the muscles used for chewing. The severity of a toothache can range from chronic and mild to sharp and excruciating. The pain may be aggravated by chewing or by cold or heat. A thorough oral examination, which includes dental x-rays, can help determine the cause, whether the toothache is coming from a tooth or jaw problem.
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| Movement Disorders (Facial Ticks) |
Unusual, spontaneous movements of parts of the face are often called tics.
These are usually called Dyskinesias or Dystonias.
They come about spontaneously as in Parkinsons Disease, or often as a result of taking certain medications that are used for severe depression or psychiatric disorders like psychosis or schizophrenia. (Tardive Dyskinesia)
Some other common tics are Blepharospasm (Eye Tic) and Torticollis (Wry Neck). These are often treated with injections of Botox.
Specially trained dentists can identify and treat many of these disorders, or refer you to a movement disorder specialist.
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| Facial Pain |
Neuropathic Orofacial Pain
Of the many pains that can affect the head and neck, perhaps the most confusing and difficult to diagnose are a group of the maladies called Neuropathic Orofacial Pain Disorders. These neuropathic pain disorders are often chronic and arise from the brain and nerves of the head, face and neck.
If you have experienced the frustration of having a toothache or face pain and, after seeing many doctors, still don't know where the pain is coming from, you may be suffering from a neuropathic pain disorder. In the past, many patients were told that these types of pain were of psychological origin, but recent research has shown that most of these pains have physical origins and can be managed effectively when properly diagnosed.
The nervous system can be divided into two general parts: the central portion, which includes the brain and spinal cord, and the peripheral part, which includes the nerves that go to such outlying areas of the body as the arms, legs, trunk, face and teeth. The peripheral nerves involved with neuropathic pain provide sensations from various stimuli, such as touch, heat, chemicals or pain, from a particular area of the body. The pain nerves course their way back to the spinal cord where they connect to a second nerve which extends up the spinal cord where the information is processed. In the brain, a different nerve continues to carry the message to other parts of the brain where the message is actually interpreted as pain. The brain has many complex chemical mechanisms to either increase or decrease the pain-related information streaming into it.
If a peripheral nerve is injured, for example a tooth has a nerve injury from decay and subsequent root canal treatment, one might correctly expect that teh tooth would be sore for several days. Sometimes, however, the tooth continues to hurt for months and even years. Even more perplexing, the tooth may be extracted and can continue to hurt as if it were still there.
Science has shown that after a peripheral nerve is injured, there can be permanent changes in the area where that nerve was first injured, in the area where it meets the spinal cord, and further up the chain of nerves into the brain. These changes can result in continued pain, despite normal healing in the area of the tooth. Research has also shown that the nervous system can undergo changes both in the peripheral portion and even more surprisingly, in the central portion so that the pain may come from either one or both parts. This is a phenomenon called "plasticity" which means that the nervous system can be altered so that non-painful signals such as touch and pressure are interpreted by the brain to be painful. The brain then continues to perceive that the area that was first injured is the area that is painful even though it has healed.
The pains that result can vary, but often times will have several qualities that distinguish them from other pains. Often the patient complains that the pain just happens by itself, or that light touch, or hot or cold stimulation triggers it. Sometimes it is difficult for the patient to figure out just where the pain is coming from. It may seem that there is a general area that is painful. The pain can vary from a general nagging dull ache to a sharp, stabbing, shock-like pain; we call this kind of sharp pain "paroxysmal".
In Conclusion
Treatment of neuropathic pain disorders may require considerable patience to eventually control the pain because the first method of treatment, or even the second, may not be successful. Through careful scientific research we are discovering new treatments all the time and more doctors are learning about Neuropathic Pain Disorders. Try to avoid being discouraged if you don't get well immediately. Maintain close communication with your doctor in a cooperative manner in an effort to obtain the most effective results.
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