#143 Is It a toothache or TMD?

It is not unusual for a patient to present to our office for Temporomandibular Joint Disorder (TMD) consultation missing a few posterior teeth in an otherwise totally healthy mouth. No other areas of decay or periodontal disease.  Just a few missing posterior teeth.  Most of the time they are missing lower first and second molars.  Sometimes they are missing maxillary molars. Sometimes on one side, and sometimes on both sides.  Observing this, I get very suspicious and always ask the patient, “Why did you lose your back teeth?”  Often, I hear, “I thought my pain was a toothache and the dentist removed the teeth that were hurting.   

These histories usually follow the same pattern.  The patient presents to the dental office complaining of a toothache.  X-rays and examination of the offending tooth or teeth are done. The dentist tells the patient there is no  problem detected.  At that point, one of several outcomes occur.  One, the patient leaves in a huff, thinking the dentist needs to go back to school.  Two, the patient talks the dentist into removing a perfectly healthy tooth or teeth.  Three, the dentist tells the patient he will not take out a perfectly healthy tooth, (The preferred decision), but has no other recommendation.  Or four,  the dentist has been to one of our lectures or seen some our literature describing the incidence of dental pain being confused with TMD and refers the patient to us. 

The concept of TMD being confused with toothache is not new.  Dentists have been aware of this phenomenon for decades.  But the explanation of how and why it occurs is a new discovery.  Prior to the discovery of how chronic inflammation within the temporomandibular joint, (TMJ) creates all the disparate symptoms, the dentists and physicians used the term, “Referred Pain” to explain this phenomenon.  But no one could explain how “referred pain” worked.  They could not explain the mechanism of “referred pain”.  They just used a term because it sounded good but had no basis in science.  Such is the history of the dental establishment dealing with TMD.  They just threw things at the wall to see if they stuck. 

My discovery of how chronic inflammation within the TMJ creates all the disparate TMD symptoms of headache, earache, jaw pain, dental pain, neck pain, tinnitus, subjective hearing loss, vertigo, upper back and shoulder pain and tightness, arm/hand/finger tingling and numbness, various types of jaw locking is new.  This discovery has changed the paradigm of how TMD should be treated.   

Instead of trying to treat symptoms by throwing things at the wall hoping they will stick, the emphasis is on treating the cause, chronic inflammation, and being able to predict the outcome. 

As in life, the truth, once known, is simple, not complicated.  The TMJ operates like all the other joints in the body.  Dentists are all taught that the TMJ is very complicated and unique.  This was the big lie that kept the entire dental profession from solving the problem.  If the dentists had asked the orthopedic surgeons about how joints operate, they would have learned that Tennis Elbow and TMD are the same disease and should be treated the same way.  Just rest the joint.  Tennis Elbow is treated with a sling and TMD is treated similarly. 

Once damaged, a joint sends a signal through the autonomic nervous system to the brain, announcing it is damaged.  The brain, responds by sending a signal back down the autonomic nervous system to the muscles that move the damaged joint to constrict holding the joint motionless in an attempt to assist healing.  When the muscles tighten up, they pull on the covering of the bone, (Periosteum) stimulating the pain receptors located there, which return to the brain as the sensation of pain. 

When the TMJ becomes damaged and inflamed, the signal to tighten can be sent to the muscle that pulls on the periosteum next to the posterior teeth and the patient swears they have a toothache when the tooth is actually healthy.   

 It’s not a toothache, it’s TMD.  And the solution is simple.