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Help for TMD, an often misdiagnosed condition

May 24, 2023 – Toothache is the worst. It can come from anywhere and can interfere with eating, drinking, and everyday activities. But what happens when the pain isn’t necessarily in your teeth, but around your face, jaw, and neck?

Shane Jie, a 40-year-old finance manager based in Austin, TX, is painfully aware of the distinction. One day after sitting in an extremely stressful meeting in his office, he decided to take his laptop to a bar and finish his work over a basketball game and a beer.

“I took a sip of beer, and it was like the corners of my mouth were on fire,” he said. “It was a sharp, sharp pain with heat attached to it; Something was clearly wrong.

The type of pain Shane was experiencing is commonly referred to as orofacial pain and includes more than 30 types of pain. temporomandibular disorders (TMDs) – Conditions that affect the two joints that connect the jaw to the skull (temporomandibular joint), as well as the muscles and tissues of the jaw.

About this 5% to 12% There are TMDs in the US population. Because they are difficult to diagnose and can overlap with other conditions, patients can often find what seems like an endless quest to find relief.

Fortunately for Shane and others like him, there are self-directed strategies that can help ease the suffering.

He was able to make an emergency appointment with a knowledgeable dentist, who suspected the problem was with his jaw muscles. After taking X-rays and measuring for a night guard to address possible grinding and clenching, Shane was referred to a massage therapist. Not only did she identify the root of her pain, but after one session she found some degree of relief.

Not everyone is that lucky.

“There are clinicians who are unfamiliar with the diagnosis and are too quick on the trigger to provide irreversible treatment,” said Clifford Chow, DDS, an orofacial pain specialist and an associate professor at the Center for Orofacial Pain and Dental Sleep Medicine. at the University of California-San Francisco School of Dentistry.

“Unfortunately, with delay, conditions can change and things can get worse and more difficult to treat,” he said.

often misdiagnosed

Although they are not rare, orofacial pain disorders are often missed or mistaken for other conditions by dentists and doctors. And TMDs often come with other conditions, such as fibromyalgia And migraineMakes diagnosis even more difficult.

“In dentistry, we have this saying: If you hear hooves, think horses, not zebras,” said Lisa Crafton, MD, a dentist in private practice in Columbia, MD.

“Most people who come in with facial pain, most of it is muscular,” she explained. “And I think most people have it after an episode of stress. Or for some, it can be 2 weeks after a stressful event and then all of a sudden, their jaw is killing them.

“If you think about the skull, the lower jaw is held up by muscles,” Crafton said. “So, I always start by thinking, OK, let’s try muscle release.”

Katie Pudhorodsky, an Austin, Texas-based licensed massage therapist who focuses on head, neck, and jaw work, has treated Shane and countless others with TMD pain. Pudhorodsky has become a favorite for many dentists who, like Crafton, recognize the muscle component. some tmd right away.

Massage can often help relieve the pain associated with the two most common TMDs: myofascial pain (discomfort or pain in the connective tissue and muscles that control the jaw, neck, and shoulders), and myalgia (muscle pain that limits jaw movement). relates to) – for example, in the masticatory muscles, which allow you to chew food).

Pudhorodsky explained that TMD pain appears in a variety of ways and is often referred to, meaning it hurts in areas other than the precise location of the muscles, joints, and tissues of the jaw. Symptoms include headache, neck pain or stiffness, dental pain, sinus pain, feeling of stuffiness in the ears, ringing in the ears (tinnitus), numbness and/or tingling.

The universal experience is that most of the patients Pudhorodsky sees in his practice are looking for relief.

“They have a conversation with their dentist or their medical provider that they have pain, and they go away. They go from specialist to specialist until someone says, ‘Oh yeah The muscles are tight; maybe that’s one piece of the puzzle,'” she said.

Natalie S., a 32-year-old researcher from Austin, said she came into Pudhorodsky’s office after experiencing sudden jaw pain and what she described as a “jaw click.”

“I was going through a particularly emotionally stressful time,” she said, as she reflected on the experience. “I went to my dentist, who advised me to get a mouth guard. But he also asked me what my symptoms were, how long it had been going on, and said I would benefit from a TMJ-specific massage.”

After one session with Pudhorodsky, Natalie found relief and continued to exercise twice a day.

“By the end of the week, the pain was gone,” said Natalie.

four pillars of relief

Pudhorodsky sees patients individually but also provides detailed education and online exercise, Much of his work is geared toward helping people achieve and maintain muscle relief and is based on four pillars:

  • “The column is meant to relax one’s muscles and reduce trigger points. And it’s done through massage and stretching,” she explained. “This can be done by a professional or by yourself at home.
  • Pillar two is to retrain the muscles that were engaged; These exercises are also used to stabilize the bite.
  • Pillar three is to maintain proper oral relaxation posture. “It’s looking at proper oral relaxation posture. We want our tongues to be on the roof of our mouths, with lips together and slightly apart,” Pudhorodsky said.
  • And “pillar four is to overcome bad habits of use; This is when you start to stop those bad patterns from continuing.

managing expectations

Like other pain conditions, TMDs are complex and present differently in different patients. Massage is not the answer for every type or for every person. But by releasing tight muscles and retraining joints to move in a more balanced way, massage can help heal part of the problem, reduce pain, and, as Pudhorodsky explained, “to treat Make room.”

Chow said patients should be proactive and ask whoever is treating them what their diagnosis is.

“If they just say they have TMD, that’s not a diagnosis; it’s a broad term for disorders, and they’re often the ones who may have missed something,” he said. “They need to be more specific in diagnosis and more specific in treatment.”

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