How does temporomandibular disorder affect headaches and ear pain. What are the common symptoms of TMD. Can TMD be mistaken for sinus or ear infections. How is temporomandibular disorder diagnosed and treated. Why is TMD often underdiagnosed in primary care settings.

Understanding Temporomandibular Disorder (TMD): A Common but Overlooked Condition

Temporomandibular disorder (TMD) is a condition affecting the jaw joint and surrounding muscles that is often misdiagnosed or overlooked in primary care settings. Despite its prevalence, many patients suffering from TMD symptoms are mistakenly treated for other conditions, leading to unnecessary antibiotic use and prolonged discomfort.

TMD affects approximately 10-15% of adults, with peak incidence occurring between ages 20-40. The condition can manifest through a variety of symptoms, often mimicking other common ailments.

Key Symptoms of TMD:

• Facial pain
• Ear discomfort
• Headaches
• Jaw pain
• Restricted jaw movement
• Clicking or crepitus when opening the mouth

Many patients with TMD report a history of recurrent ear infections, sinus infections, or migraine headaches. However, upon closer examination, these diagnoses often do not align with the patient’s symptoms and physical findings.

The Intricate Connection: TMD, Headaches, and Ear Pain

TMD’s ability to mimic other conditions often leads to misdiagnosis and inappropriate treatment. Understanding the relationship between TMD and other common complaints is crucial for accurate diagnosis and effective management.

Is there a link between TMD and primary headache disorders. Research suggests that TMD is often comorbid with primary headache disorders, contributing to the complexity of diagnosis. Additionally, otolaryngologists have found that TMD can be a significant contributing factor in cases of “sinus headaches.”

How does TMD affect ear pain. The temporomandibular joint’s proximity to the ear can cause referred pain, leading patients and clinicians to mistakenly attribute the discomfort to ear infections. This misdiagnosis can result in unnecessary antibiotic prescriptions and delayed appropriate treatment.

Diagnosing TMD: Key Physical Examination Findings

Accurately diagnosing TMD requires a thorough physical examination focusing on the jaw and surrounding structures. Physicians should be aware of the following key findings:

1. Tenderness over the temporomandibular joint
2. Restricted jaw movement
3. Crepitus or clicking sounds when opening the mandible

These physical signs, combined with the patient’s reported symptoms, can help differentiate TMD from other conditions with similar presentations.

TMD Treatment: Effective Management Strategies

Once diagnosed, TMD can often be managed effectively with conservative treatments. What are the primary treatment options for TMD.

• Short-term use of nonsteroidal anti-inflammatory drugs (NSAIDs)
• Muscle relaxants
• Anxiolytics
• Referral to an oral surgeon for an occlusive splint in severe cases

Many patients experience significant relief with NSAIDs alone, with symptoms typically resolving within about two weeks. However, some cases may require additional interventions or specialist referral.

The Hidden Epidemic: TMD in University Students

Recent observations from a university student health center highlight the prevalence of TMD among undergraduate and graduate students. Many of these young adults present with chronic recurrent headaches that can be attributed, at least in part, to TMD.

Why is TMD common in university students. The high-stress environment, coupled with long hours of studying and potential poor posture, can contribute to increased jaw clenching and muscle tension. This demographic may be particularly susceptible to developing TMD symptoms.

The Role of Stress and Posture in TMD Development

Increased stress levels and poor postural awareness can significantly contribute to TMD symptoms. How do stress and posture affect TMD.

Stress often leads to unconscious jaw clenching, which can result in muscle tightness and faulty joint mechanics. Additionally, poor posture, particularly while working at a computer, can exacerbate TMD symptoms.

Is there a connection between tongue position and TMD. Interestingly, proper tongue positioning can help alleviate TMJ stress. When sitting with good posture, the tongue naturally rests on the roof of the mouth, reducing tension in the jaw. Conversely, slouching often causes the tongue to drop, potentially increasing jaw stress and promoting teeth clenching.

Preventing TMD: Ergonomics and Postural Awareness

Given the increasing prevalence of remote work and the associated ergonomic challenges, understanding how to prevent TMD through proper posture and workspace setup is crucial.

Tips for TMD Prevention:

• Maintain proper sitting posture with the spine aligned
• Ensure your workstation is ergonomically optimized
• Take regular breaks to stretch and relax jaw muscles
• Practice stress-reduction techniques
• Be mindful of tongue position – aim to keep it resting on the roof of your mouth

By implementing these preventive measures, individuals can reduce their risk of developing TMD symptoms and improve overall oral and physical health.

The Importance of Accurate Diagnosis: Reducing Antibiotic Overuse

One of the most significant concerns regarding TMD misdiagnosis is the potential for antibiotic overuse. Many patients report repeated treatments with antibiotics for presumptive ear and sinus infections, which are ineffective for TMD and contribute to the growing problem of antibiotic resistance.

How can healthcare providers improve TMD diagnosis. By considering TMD in the differential diagnosis when patients present with headache, sinus pain, or ear pain without clear alternative explanations, physicians can reduce unnecessary antibiotic prescriptions and provide more targeted, effective treatments.

Accurate diagnosis of TMD not only leads to more appropriate pain management but also plays a crucial role in antibiotic stewardship efforts.

Future Directions in TMD Research and Management

As awareness of TMD’s prevalence and impact grows, what areas of research and clinical practice should be prioritized.

• Improved diagnostic criteria and tools for primary care settings
• Development of targeted therapies for different TMD subtypes
• Investigation of the long-term effects of chronic TMD on overall health
• Exploration of the relationship between TMD and other chronic pain conditions
• Assessment of preventive strategies, particularly in high-risk populations like university students

Advancing our understanding of TMD will enable healthcare providers to offer more precise, effective treatments and improve patient outcomes.

In conclusion, temporomandibular disorder represents a significant but often overlooked cause of headache, sinus pain, and ear pain. By increasing awareness of TMD’s varied presentations and improving diagnostic accuracy, healthcare providers can ensure patients receive appropriate, timely treatment while avoiding unnecessary antibiotic use. As research in this field progresses, we can expect to see more targeted, effective management strategies for TMD, ultimately improving the quality of life for millions of affected individuals.

The complex interplay between TMD, stress, posture, and overall health underscores the importance of a holistic approach to diagnosis and treatment. By considering the broader context of a patient’s symptoms and lifestyle factors, healthcare providers can offer more comprehensive care and empower patients to take an active role in managing their condition.

As we continue to navigate the challenges of modern life, including increased stress levels and ergonomic issues related to remote work, understanding and addressing TMD becomes increasingly crucial. By raising awareness among both healthcare providers and the general public, we can work towards earlier detection, more effective treatment, and improved prevention strategies for this common but often misunderstood condition.

The journey to better TMD management is ongoing, but with continued research, education, and clinical vigilance, we can significantly improve outcomes for those affected by this challenging disorder. As our understanding of TMD evolves, so too will our ability to provide targeted, personalized care that addresses not just the symptoms, but the underlying causes of this complex condition.

Temporomandibular Disorder: An Underdiagnosed Cause of Headache, Sinus Pain, and Ear Pain

P. HUNTER SPOTTS, MD

Am Fam Physician. 2017;95(3):142

Author disclosure: No relevant financial affiliations.

to the editor: Headache, sinus pain, and ear pain are common chief complaints in the primary care setting. In 17 years of working in a community urgent care practice, I routinely encountered patients who reported a history of recurrent ear infections, sinus infections, or migraine headaches; yet, the history and physical examination did not correspond with the chronic recurrent diagnoses they reported. In many cases, examination of the jaw revealed they were most likely experiencing temporomandibular disorder (TMD).

TMD affects as many as 10% to 15% of adults (peak ages 20 to 40 years) and presents with symptoms that include facial pain, ear discomfort, headache, and jaw pain.¹ Physical examination findings include tenderness over the temporomandibular joint, restricted jaw movement, and crepitus or clicking with opening the mandible.^1,2 TMD is often comorbid with primary headache disorders and is found to be a contributing cause of “sinus headaches” in otolaryngology practice.^3,4

In my experience, most patients feel much better with short-term use of nonsteroidal anti-inflammatory drugs; symptoms typically resolve within about two weeks. Some patients also may need muscle relaxants, anxiolytics, or referral to an oral surgeon for an occlusive splint.¹

Of particular concern, many patients I saw over the years in community urgent care reported repeated treatment with antibiotics for presumptive ear and sinus infections. Some were skeptical of the new diagnosis and thought they did not need to take antibiotics. During the past year, I have worked in a university student health center where I have seen several undergraduate and graduate students with chronic recurrent headaches that, at least in part, could be attributed to TMD.

Physicians should consider TMD in the differential diagnosis when a patient presents with headache, sinus pain, or ear pain and no other diagnosis that readily explains the symptom. Accurately diagnosing TMD can not only lead to more appropriate treatment to relieve the patient’s pain but also reduce unnecessary antibiotic prescriptions.

Email letter submissions to [email protected]. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors. Letters submitted for publication in AFP must not be submitted to any other publication. Letters may be edited to meet style and space requirements.

This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

Ear/Jaw Pain, Headaches & Dizziness / Balance Solutions PT

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Ear/Jaw Pain, Headaches & Dizziness From Clenching Your Teeth?

Ear/Jaw Pain, Headaches & Dizziness Can Come From Clenching Your Teeth?

Recently in the clinic we are seeing more and more patients with complaints of ear/jaw pain as well as headaches and a sense of dizziness.  Your jaw, also known as your temporomandibular joint (TMJ), can be a significant source of these symptoms if there is a joint dysfunction or a muscle imbalance.

Women experiencing ear/jaw pain due to TMJ dysfunction.

Increased stress, decreased postural awareness and/or a poor ergonomic work station setup can contribute to increased clenching of the jaw, which can result in muscle tightness and faulty joint mechanics. With more people working from home and additional stresses placed on individuals during these times of social distancing, it’s important to increase awareness on how stress, posture and ergonomics can contribute to headaches, ear/jaw pain and dizziness.

If you are slouching while you are sitting you will notice that your tongue is not resting on the roof of your mouth, this causes stress in your TMJ and often results in clenching your teeth. If you correct your posture and sit up straight, your tongue will rest on the roof of your mouth alleviating the tension in your jaw.  If your tongue is touching the roof of your mouth, is the proper resting position of your tongue.  Try it!

This is just another reason why your posture and ergonomics (how you set up your computer or work station) at home is so important. Poor posture and ergonomics contributes to so much more than low back and neck pain!

A Few Symptoms Associated with TMJ Dysfunction Include;

Temporomandibular Joint Pain

• Headaches or ear pain upon waking in the morning
• Temporal headaches – ranging from mild ache to stabbing pain
• Tension type headaches – begin at the base of the skull radiating to the forehead
• Restricted or painful motion in your jaw
• Clicking with opening and closing of your jaw
• Jaw, ear, or facial pain
• Dizziness, headaches, or jaw/ear pain with chewing

Helpful Tips

1. Be aware of your posture – don’t slouch
2. Don’t grind your teeth or clench your jaw
3. Don’t chew gum
4. Learn relaxation techniques to decrease clenching during stressful periods
5. Adjust your computer or work station so that you are not reaching for your keyboard or mouse; in order to assist with good postural habits and no slouching!

Specialized physical therapy intervention can assist in alleviating symptoms associated with TMJ dysfunction. A few key techniques and methods that may be utilized during intervention include the following:

Therapist Performing Myofascial Release To Woman With TMJ Dysfunction

Soft Tissue Mobilization/Myofascial Release: Increased muscle tone (tightness) or muscle spasm resulting from clenching the jaw may compress small nerves; contributing to symptoms of temporal pain/headaches. Mal occlusion of the jaw may result in abnormal nerve stimulation, which causes certain muscle in your neck to get tight.

Headaches may then begin at the base of your skull and radiate into your forehead. Muscles in the front of your neck that connect behind your ear may get tight, resulting in ear fullness or pressure as well as ear pain. There are multiple techniques utilized to decrease muscle tightness and improve flexibility in these muscles.

Joint Mobilization/Muscle Energy Techniques: Decreased joint mobility or altered joint mechanics in your neck or jaw may result in pain or headaches. Treatment for this is achieved through gentle joint mobilizations and muscle energy techniques.  Joint mobilizations are pain free, non-aggressive techniques that improve the joint mechanics.  Joint mobility is promoted throughout the jaw and cervical spine, as restrictions in these areas may contribute to your problem.  Muscle energy techniques are a gentle way to influence your jaw mechanics and increase mobility by having you contract and relax  muscles in a specific way.

Strength & Cervical Stabilization: Proper joint mechanics in the cervical spine and jaw depend on muscle strength and tension relationships. When muscles are too weak or too tight more stress is placed on the jaw as well as cervical ligaments and joint capsules. Tightening or shortening of the neck muscles can result in faulty jaw mechanics, which may cause pain and wearing away of the joint surfaces.

Education is provided on postural correction, proper ergonomics, body mechanics and exercises related to TMJ dysfucntion and cervical issues.

Evaluation by an oral surgeon may be required if the problem is complex and not manageable with physical therapy.

Physical Therapy Rehabilitation Services

If you are searching for relief of jaw/ear pain, tension or cervicogenic headaches or dizziness then skilled Physical Therapy intervention is a highly effective non-surgical treatment option to improve or resolve your condition. Physical therapists are like body mechanics and can help to find the mechanical cause of your pain. A skilled therapist will perform a comprehensive evaluation to assess all factors contributing to your condition.

It’s time to act and reduce or eliminate your pain, call to schedule an appointment with a physical therapist today. Your therapist will develop a personalized treatment plan based on your evaluation findings to target your specific needs. Balance Solutions Physical Therapy is here to help, offering advanced physical therapy and manual therapy intervention for pain relief.

Balance Solutions Physical Therapy is located at Commerce Park in Beachwood Ohio, just on the outskirts of Cleveland. Services offered include physical therapy, massage, myofascial release, Integrative Dry Needling, as well as Pilates mat and reformer private and class lessons.

Kelly Beaudoin2020-10-20T12:54:06+00:00

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Causes of pain in the head and jaw

According to doctors, pain in the head and jaw can occur simultaneously. Similar symptoms are provoked by dental pathologies. Sometimes the problem can be caused by pathologies of the organs of vision, blood vessels and ENT organs. The article will describe the reasons for this phenomenon.

• Malocclusion

Pain in the jaw and head may be due to a violation of the closure of the jaws and the functioning of the masticatory muscles. Bite pathologies can lead to scoliosis.

• Advanced caries

Pain caused by inflammatory diseases of the teeth (caries, pulpitis, granuloma) is felt in the jaw and the area of ​​the affected unit. Initially, discomfort occurs due to thermal or mechanical effects. At the advanced stage, sharp pain occurs on its own and radiates to adjacent zones.

• Adentia or damaged parts

Partially edentulous adjacent teeth and nearby muscles are subjected to intense stress. The patient has to adapt and chew food on the healthy part of the jaw.

• Availability of orthodontic and orthopedic products

Pain may occur after the installation of bite correction devices. This is a normal condition when the dentition gets used to the new position. Unpleasant sensations arise due to the pressure of the structure on the teeth. The discomfort goes away within a few weeks.

Prosthetics should be free of pain and discomfort. This indicates a low quality of treatment.

• High galvanic currents

The occurrence of galvanosis is due to the movement of galvanic currents in the mouth and their intense influence. The anomaly is characteristic of patients with metal prostheses in the mouth. The reaction occurs due to an allergy to metal alloys, non-compliance with production technology.

• Bruxism

Involuntary occurrence at night. Manifested by excessive clenching of the jaws. People learn about pathology from relatives. Patients experience fatigue, tension headaches in the morning. Teeth are brittle and have worn enamel.

• Dental treatment

Patients report similar adverse events immediately after treatment. Discomfort occurs after therapeutic manipulations and surgical interventions. This is due to stress, prolonged stay in an open mouth position, and the traumatic nature of the doctor’s actions.

• Erupting wisdom tooth

The third molar, when passing through the jawbone, exerts pressure and irritates the nerve endings. Pain sensations are blurred and spread to the entire jaw, radiating to the temples and head.

It is worth going to the dentist and having an x-ray. Third molars may be impacted or dystopic. Such elements provoke crowding of the jaw row, bite defects, pericoronitis, accompanied by pain and discomfort.

• Complications after operations

Surgical procedures are accompanied by pain, swelling and other manifestations. Gradually, the discomfort subsides. If acute pain persists 3-4 days after treatment, this indicates complications. Alveolitis develops – inflammation in the diseased hole. In the absence of timely treatment, there is a risk of developing flux, abscess and osteomyelitis.

Doctors are sure that sometimes pain in the head or jaw is mistaken for a toothache.

• Subluxations and dislocations

Develop due to arthritis or joint disease. The problem can be provoked by excessive opening of the mouth and displacement of the articular head of the lower jaw. Soreness is felt in the head, temples and cheeks.

• Trigeminal neuralgia

If the trigeminal nerve is affected or inflamed, acute pain is felt like a migraine. The patient experiences discomfort in the jaw.

• Diseases of the ENT organs

Sinusitis, tonsillitis and other ENT diseases masquerade as dental problems. Otitis causes intense pain in the head and jaw. Identical symptoms are characterized by sinusitis and sinusitis. This is due to the close location of organs and the spread of pathogens through the bloodstream.

• Cluster headache

Characterized by pain in the area of ​​the upper jaw. Acute pain is mistaken for manifestations of inflammation of the pulp or periodontitis.

• Viral, infectious diseases, hypothermia

Hypothermia or SARS can provoke a migraine. There are accompanying symptoms characteristic of infectious diseases: hyperthermia, rhinitis, cough.

• Angina pectoris

Discomfort in the heart capable of shooting into the arm or shoulder on the left side of the body. Occasionally, pain is felt in the head or lower jaw.

Only a doctor can determine the cause of a headache and choose the right treatment. If symptoms occur, contact your dentist.

Relationship between headache and malocclusion

Headache can be provoked by pressure surges, lack of fresh air, lack of water, as well as prolonged eye strain. In addition, there is another reason for the appearance of migraine, which is associated with the health of the dental system.

Headache can be provoked by pressure surges, lack of fresh air, lack of water, as well as prolonged eye strain. In addition, there is another reason for the appearance of migraine, which is associated with the health of the dental system.

Headache and malocclusion

In case of malocclusion, the jaws meet loosely and crookedly. Because of this, some jaw muscles are in constant tension, while others, on the contrary, are always relaxed. That is, there is an imbalance in the jaw muscles. Normally, the muscles should tense up only while chewing food, and not constantly. Prolonged muscle hypertonicity is transmitted to the entire jaw, which causes a spasm of blood vessels and nerve endings.

Hypertonicity of the jaw muscles can go further, moving to the muscles of the skull and the muscles of the neck-collar region. In addition to pain, stiffness and numbness of the muscles appear. The range of motion in the cervical region is limited, while the source of pain and discomfort is very difficult to identify. In this situation, there may be a spasm of large vessels, which are responsible for the access of blood flow to the head.

Anomalies of bite can be observed not only at an early age, violations can develop later. The final formation of the bite, the appearance of wisdom teeth can cause displacement of the dentition and malocclusion.

Consequences of abnormal occlusion

In case of malocclusion, the ligaments in the articulation of the lower jaw and the skull are overloaded, while the second cervical vertebra may also suffer, its position may change. The result of this is nerve compression, which is the main cause of severe and persistent headaches. In addition to migraine, problems also arise in the work of the temporomandibular joint.
In addition to pain and discomfort, the accompanying symptoms of malocclusion are:

• gnashing of teeth during sleep;
• inability to fully open the mouth;
• the appearance of ringing in the ears;
• Regular dizziness.

The appearance of such symptoms is a reason to immediately contact a specialist. It will not work to drown out the symptoms with painkillers, they will occur again and again.
Dentistry is constantly evolving, and orthodontics also does not stand still. To correct bite pathologies, various methods and technologies are now used. In addition to metal braces, highly aesthetic sapphire and ceramic braces are used, which are hardly noticeable on the teeth. You can hide the ongoing orthodontic treatment from prying eyes with the help of lingual braces, which are installed on the inner surface of the dentition.