Learning with Laughter

TMD – Who to refer

• Key point “ TMD patients treated with conservative and reversible modalities on the whole responded as well as patients treated with more aggressive regimens, both short terms and long term assessment of outcomes”.

Reference: Greene CS p224 Chap14 “concepts of TMD etoliogy. Effects on Diagnosis and Treatment” in TMD’s an evidence-based Approach to Diagnosis and Treatment, Laskin, Green, and Hylander, eds Quitnessence 2006

• Early intervention is Key as passage of time is a major factor in development of chronic pain problems: any pain that lasts longer than 3-6 months is considered chronic. Patients tend to treat their symptoms after 6 months as if acute and this can lead to escalating psychosocial issues, for example (frustration, anxiety, depression, relationship conflicts),

 

TMD and occlusion

“…there is a relatively low association of occlusal factors in characterizing TMD. Skeletal anterior open bite, overjets greater than 6 to 7 mm, retruded cuspal position/intercuspal position slides greater than 4mm, unilateral lingual crossbite, and five or more missing posterior teeth are the five occlusal features that have been associated with specific diagnostic groups of TMD conditions.

Reference: Occlusion, Orthodontic treatment and TMJ disorders: a review. McNamara JA Jr, Seligman DA Okeson JP. J Orofac Pain 1995 Winter;9 (1) ; 73-90

• 70% of patients with TMD present with neck pain, more prevalent with myogenous than arthrogenous TMD 

• All patients with neck pain, headaches, ear aches, sinusitis and facial pain because with TMD often a central pain phenomenon-region of primary lesion excites neighbouring areas in Central Nervous System to produce heightened sensitivity

 

• Referred pain-pain arising from a trigger point, which refers pain to another area. Most common example would be when patient comes in complaining of upper tooth pain. This could be from a trigger points in Temporalis muscle.

Other contributing factors are behavioural, (forward head posture, parafunctional habits, muscle tension), and widespread pain like fibromyalgia. All these factors aggravate symptoms.

• All patients who have been in car accidents, any presumed innocuous hit on the head. Recent one I had patient had hit head on car roof /boom of a boat etc.

TMD SELF CARE

In our fast paced lifestyles and communications it is hard to make time for self. Meditate –take time for your self

 

Try to something you love every day –aim for greater heights, because time spent now will ensure healthy retirement

After 100 who cares!

Make time to have fun and be able to laugh at your self!

Laughter is best medicine and can improve perspectives of challenging situations in every day life

BASIC SELF CARE FOR PATIENTS

Awareness of habits or jaw use patterns

• Teeth should only make contact during eating and swallowing, otherwise they should be apart

- Bite… Restful jaw position is when tongue tip is behind the maxillary central incisors, lips together and the teeth slightly apart

DIET MODIFICATIONS

 Softer foods place less stress on the jaw muscles

   Cut foods into small bites-

 No hard food like nuts/carrots or chewy food

Do NOT chew gum

 

 Avoid wide jaw opening

 Support your jaw with your hand when yawning

 Do not sleep on your stomach or with your jaw resting on your hand or arm

 Avoid leaning on your chin or jaw

Apply moist heat on muscles for 15-20 minutes

 Apply “ice cube’ massage to joint /muscles for 5 minutes

-  Do not test jaw

 Jaw movement that elicits pain may prolong recovery

- Exercise to maintain good health –best exercise is one you love. Do 4 times a week for at least half hour.

- Mindful breath based exercise like Yoga

Pilates, tai chi, Qi gong are excellent for chronic pain sufferers

- Yoga Stretching Whatever works for you!

Why is it important? With aging and a sedentary lifestyle muscles lose their flexibility. This leads to muscle imbalances and adaptations causing some muscles to become strong and short and others muscles to become weak. These imbalances place abnormal forces around joints and can lead to common overuse injuries such as tendonitis, plantar fasciitis, jaw, neck and back pain.

Overtime tight muscles can compress nerves, resulting in tingling and numbness; muscle weakness and pain. When you improve your flexibility you improve posture, decrease tension and increase circulation in the muscles.

Alternate nostril breathing (see December newsletter)

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