What is the connection between TMJ and dizziness? Can TMJ cause lightheadedness? Discover the underlying mechanisms and treatment options for TMJ-related dizziness and vertigo.

Understanding the Relationship Between TMJ and Dizziness

Temporomandibular joint (TMJ) disorders are a common source of various symptoms, including dizziness and lightheadedness. The close proximity of the temporomandibular joint to the inner ear structures, as well as the potential impact on the Eustachian tube, contribute to the connection between TMJ problems and balance-related issues.

Mechanism of TMJ-Induced Dizziness and Lightheadedness

When the temporomandibular joint and its surrounding muscles, blood vessels, and ligaments become strained or inflamed, the inflammation can spread to the middle ear. The inner ear, which is responsible for balance and body position, can become affected, leading to a loss of balance and the sensation of lightheadedness or dizziness. Additionally, dysfunction in the Eustachian tube, which connects the middle ear to the back of the throat, can also contribute to balance-related symptoms.

Common Symptoms of TMJ-Related Dizziness

Patients with TMJ disorders may experience a range of symptoms, including jaw clicking and popping, headaches, sore jaws and cheeks, back and neck pain, worn teeth, tooth sensitivity, earaches, and a locked jaw in an open or closed position. Dizziness and lightheadedness are also commonly reported, often described as a feeling of imbalance or a sensation of the surroundings moving, even when standing still.

Diagnosing the Cause of Dizziness: TMJ or Other Conditions

Determining the source of dizziness is crucial for proper treatment. While TMJ disorders can be a contributing factor, other conditions, such as ear infections, may also cause similar symptoms. A thorough examination by an experienced dentist or healthcare provider is necessary to identify the underlying cause and develop an appropriate treatment plan.

Treatment Approaches for TMJ-Related Dizziness

Treatment for TMJ-related dizziness often involves addressing the underlying TMJ disorder. This may include correcting and realigning the bite, using a custom-made mouth guard to prevent teeth grinding, or restoring damaged teeth. In some cases, physical therapy or other conservative therapies may also be recommended to alleviate muscle tension and inflammation in the TMJ region.

Seeking Professional Care for TMJ Symptoms

If you are experiencing persistent dizziness or lightheadedness, it is important to consult with a healthcare provider who specializes in TMJ disorders. They can perform a comprehensive evaluation, identify the underlying cause, and develop a tailored treatment plan to alleviate your symptoms and restore your overall well-being.

Can TMJ Cause Lightheadedness?

Yes, TMJ disorders can indeed cause lightheadedness or a sensation of dizziness. The close proximity of the temporomandibular joint to the inner ear structures, as well as the potential impact on the Eustachian tube, can contribute to balance-related issues.

How are TMJ and Dizziness Connected?

The connection between TMJ and dizziness lies in the inflammation and dysfunction that can occur in the temporomandibular joint. This can lead to the spread of inflammation to the middle ear, affecting the inner ear structures responsible for balance and causing the sensation of dizziness or lightheadedness.

What are the Signs and Symptoms of TMJ-Related Dizziness?

Individuals with TMJ disorders may experience a range of symptoms, including jaw clicking and popping, headaches, sore jaws and cheeks, back and neck pain, worn teeth, tooth sensitivity, earaches, and a locked jaw. Dizziness and lightheadedness, often described as a feeling of imbalance or a sensation of the surroundings moving, are also common TMJ-related symptoms.

How is TMJ-Related Dizziness Diagnosed?

Determining the cause of dizziness is crucial for proper treatment. While TMJ disorders can be a contributing factor, other conditions, such as ear infections, may also cause similar symptoms. A thorough examination by an experienced healthcare provider, such as a dentist specializing in TMJ disorders, is necessary to identify the underlying cause and develop an appropriate treatment plan.

What are the Treatment Options for TMJ-Related Dizziness?

Treatment for TMJ-related dizziness often involves addressing the underlying TMJ disorder. This may include correcting and realigning the bite, using a custom-made mouth guard to prevent teeth grinding, or restoring damaged teeth. In some cases, physical therapy or other conservative therapies may also be recommended to alleviate muscle tension and inflammation in the TMJ region.

Can TMJ Cause Lightheadedness? | Austin, Bee Cave, Texas

Dr. John Schmid is an LVI-trained TMJ dentist, who can determine if symptoms you are experiencing are caused by temporomandibular joint disorder. Call our practice in Austin, at 512-329-5967, to arrange a consultation with Dr. Schmid.

Yes, TMJ Disorders Cause Dizziness and Lightheadedness

In general, yes, the answer is that TMJ disorders may cause symptoms that a person would describe as “lightheadedness.” You may also describe it as dizziness or feeling like you are about to fall. For the most part, patients characterize their lightheadedness as feeling as though they will lose their balance, and not as though they will faint. A fainting sensation may be unrelated to TMJ disorder, although Dr. Schmid can determine if your jaw joints are playing a role.

How TMJs are linked to Lightheadedness

The temporomandibular joints are very close to the inner ear, perhaps an inch or so away. When these joints and their surrounding muscles, blood vessels and ligaments are strained or stressed, then inflammation may arise. This inflammation may grow, eventually spreading to your middle ear. Your inner ear is involved in your balance and body position. When it becomes inflamed, you can lose your sense of balance, which may be causing the feeling of lightheadedness.

Another possible cause is an ear infection. It causes the same type of inflammation. Getting a diagnosis means you’ll soon be on your way to relief from this sensation, assuming it’s a treatable source of lightheadedness.

Other Signs and Symptoms of TMJ Disorder

In addition to lightheadedness, you may experience one or more of the following problems:

• Jaw clicking and popping
• Headaches
• Sore jaws and cheeks
• Back, neck and shoulder pain
• Worn teeth
• Sore teeth or toothache
• Earache
• Jaw that locks in an open or closed position

Dr. Schmid formulates the best treatment for you, if you are in fact experiencing a TMJ disorder. It may involve correcting and realigning your bite, using a mouth guard to block teeth grinding, or restoring damaged teeth. These issues are often the root cause of TMJ disorders.

Dr. Schmid is an LVI Fellow. LVI is the Las Vegas Institute for Advanced Dental Studies, and it is known worldwide as one of the most prestigious institutes for the advanced study of dentistry. Dr. Schmid’s intensive LVI training in neuromuscular dentistry taught him how to treat each case of TMJ disorder individually. He tailors the treatment recommendations to your dental health, bite and specific symptoms. His goal is to restore your wellness by eliminating these symptoms. TMJ disorders are not only inconvenient when they cause lightheadedness, but they can also be painful. Chronic headaches and facial pain can interrupt your daily life. The first step to relief is a proper diagnosis.

Get Relief from TMJ Symptoms in Austin

Ready to find out if a TMJ disorder is the source of uncomfortable symptoms like dizziness and lightheadedness? To arrange a consultation with experienced dentist Dr. John Schmid, please call our team at 512-329-5967. Our practice is located in Austin, Texas, and our patients visit us from across the surrounding areas, including Bee Cave and Lakeway.

TMJ Dizzy Spells | Michigan Head & Neck Institute

As you may recall from other blogs you have read here on my website, TMJ dysfunction (TMD) is known as “The Great Impostor” because its symptoms mimic those of many other conditions. One that we will focus on this week is Vertigo, which is a sensation of dizziness that can cause postural imbalances. In other words, your surroundings seem to be moving even though you are standing still. Read on to find out what the connection is between TMJ and dizziness; in some cases, vertigo. These spells are also known as TMJ dizzy spells.

Balance comes from the brain integrating data from the inner ears (vestibular system) and eyes (visual system). The vestibular system also includes nerves and joints. The inner ear contains the labyrinth, which is a small structure, which is a crucial to the body’s balance. The labyrinth has fluid, which moves around as you move, and that sends messages to the brain about balance. When any of this gets disrupted, the brain can misinterpret the signals and that gives off the feeling of vertigo or dizziness.

An interesting fact about the labyrinth is that it is located in your temporal bone in your head. Your TMJ (temporomandibular joint) also attaches to the skull at the temporal bone. The TMJ may move the temporal bone just enough to move the labyrinth housed inside to be moved out of position as well. So, whenever any misalignment or inflammation occurs in the TMJ, this is how the fluid gets disrupted.

Alternatively, if any hyperactivity in the masticatory muscles (chewing muscles) is present, this can cause dysfunction of the Eustachian tube, also leading to imbalance, dizziness and vertigo. The Eustachian tube is a part of the middle ear that equalizes pressure.

The following are some of the many symptoms associated with vertigo:

1. Dizziness/Lightheadedness
2. Confusion
3. Nausea/Vomiting
4. Pain in the eyes
5. Perception that objects are moving
6. Imbalance
7. Feeling of being pulled down towards the floor
8. Hot flashes
9. Light sensitivity
10. Headache/Migraine

If you have ever experienced a ride at an amusement park that goes round and round in a circle, then you are most likely familiar with this feeling. It seems like you are still moving when you get off the ride, because there is still movement within your semi-circular canals. But, your visual cues alert the body that you are standing still. This very disconnect between the signals gives your body that feeling of nausea and dizziness.

When your lower jaw (mandible) is not properly aligned to your upper jaw (maxilla), then there are certain pressures exerted on the jaw joint (TMJ). These pressures are transmitted, and in that process, the balance organs are moved out of alignment. Once misaligned, balance is naturally thrown off.

Take your pinky finger and put it inside your ear canal, and then move the jaw by opening and closing. You will be able to feel the movement of the mandible and realize how close it is to your inner ear.

Aligning (normalizing) the jaw joint often corrects the balance organs and equilibrium. Unfortunately, many people are placed on medications such as Antivert or Zofran to treat the symptoms of vertigo rather than treat the underlying problem (joint dislocation). While these medications can provide temporary relief, they will never provide a permanent solution to a joint problem.

If you or someone you know is experiencing any of the symptoms listed above, please call our office at 586-573-0438 to talk to Dr. Klein about a possible TMJ disorder.

References

Marchiori, Luciana Lozza de Moraes et al. “Probable Correlation between Temporomandibular Dysfunction and Vertigo in the Elderly.” International Archives of Otorhinolaryngology. 18.1 (2014): 49–53.

Chole RA, Parker WS. Tinnitus and Vertigo in Patients With Temporomandibular Disorder. Arch Otolaryngol Head Neck Surg. 1992;118(8):817-821. doi:10.1001/archotol.1992.01880080039010

Weber, PC. Vertigo and disequilibrium: a practical guide to diagnosis and management. 1961.

Parker WS, Chole RA. Tinnitus, vertigo, and temporomandibular disorders. Am J Orthod Dentofacial Orthop. 1995 Feb;107(2):153-8.

Probable Correlation between Temporomandibular Dysfunction and Vertigo in the Elderly

Int Arch Otorhinolaryngol. 2014 Jan; 18(1): 49–53.

Luciana Lozza de Moraes Marchiori

¹Universidade Norte do Paraná–Unopar, Londrina, PR, Brazil

Paula Vanessa Pedron Oltramari-Navarro

¹Universidade Norte do Paraná–Unopar, Londrina, PR, Brazil

Caroline Luiz Meneses-Barrivieira

¹Universidade Norte do Paraná–Unopar, Londrina, PR, Brazil

Juliana Jandre Melo

¹Universidade Norte do Paraná–Unopar, Londrina, PR, Brazil

Julya Macedo

²Faculdade Global de Umuarama–Paraná, Umuarama, PR, Brazil

Juliana Ribeiro Zuculin Bruniera

¹Universidade Norte do Paraná–Unopar, Londrina, PR, Brazil

Vanessa Cristina Gorres

¹Universidade Norte do Paraná–Unopar, Londrina, PR, Brazil

Ricardo de Lima Navarro

¹Universidade Norte do Paraná–Unopar, Londrina, PR, Brazil

¹Universidade Norte do Paraná–Unopar, Londrina, PR, Brazil

²Faculdade Global de Umuarama–Paraná, Umuarama, PR, Brazil

Address for correspondence Luciana Lozza de Moraes Marchiori, PhD Campus Universitário de Londrina, Clinica de Fonoaudiologia Av. Paris, 675–Jd. Piza CEP 86041-140–Cx. P. 401, Londrina, PR, Brazil, [email protected]

Received 2013 Jun 3; Accepted 2013 Jul 23.

This article has been cited by other articles in PMC.

Abstract

Introduction Temporomandibular disorder (TMD) covers a variety of clinical problems, and some epidemiologic studies have tried to indicate mechanisms of interaction and association between vertigo and TMD, but this topic still is controversial.

Objective To assess the presence of vertigo in elderly patients associated with TMD.

Methods A cross-sectional study was conducted with the inclusion of elderly individuals who lived independently. TMD was assessed by dental evaluation and vertigo was verified by medical history. Statistical analysis was performed using the chi-square and relative risk.

Results There was a significant association (p = 0.0256) between the TMD and vertigo (odds ratio = 2. 3793).

Conclusion These results highlighted the importance of identifying risk factors for vertigo that can be modified through specific interventions, which is essential to prevent future episodes, as well as managing the process of rehabilitation of elderly patients in general.

Keywords: dizziness, aged, temporomandibular joint dysfunction syndrome

Introduction

Temporomandibular joint (TMJ) disorder covers a variety of clinical problems involving the masticatory muscles, the joint itself, and associated structures to the ear region. Temporomandibular disorder (TMD) is a general term for the clinical problems that involve the masticatory muscles, the TMJ, and associated structures.¹²³

Vertigo is dizziness and may be associated with several comorbidities⁴ such as TMD. Some epidemiologic studies have tried to indicate mechanisms of interaction and association between vestibular and otologic symptoms and TMD, but this topic still is controversial. ^{1234567891011}

The otologic symptoms related to TMD most cited in the literature are tinnitus, ear pain, ear fullness, hearing loss, and vertigo.^5678910 In the literature, there are some hypotheses regarding the relationship between otologic symptoms and TMD.^{34567891011121314}

Manni⁸ hypothesized that the neurologic signs and symptoms of TMD are correlated based on three theories: (1) the possibility of transmitting mechanical power from the TMJ to the middle ear through the discomaleolar ligament; (2) direct irritation of the mandibular condyle auriculotemporal nerve; (3) hypertonicity of the muscles and the tensor tympani velum, based on common trigeminal innervation of these muscles and masticatory muscles in the jaw. In addition, the poor positioning of the mandibular condyle could cause earache, tinnitus, and vertigo. Another hypothesis explains the occurrence of hyperactivity in the masticatory muscles, which can lead to contraction of the tensor tympani muscle and the tympanic membrane or muscular contraction of the soft palate. This scenario can cause eustachian tube dysfunction leading to ear fullness, imbalance, and hearing loss.³¹⁵

Vertigo is a kind of roundabout dizziness, a loss of body balance, observed in many diseases. This condition mainly affects the elderly, and etiologic factors should be investigated to increase the efficiency of treatment.⁴⁷¹⁰ Thus, this study aimed to investigate the association between vertigo and TMD in elderly patients.

Materials and Methods

The study sample consisted of 199 physically independent elderly (mean age: 69.23 ± 5.70 years) subjects of both sexes (127 women and 73 men), from a population of 43,610 elderly subjects enrolled in 38 Basic Health Units in the urban area of Londrina. Individuals were randomly selected, taking into account gender and the five regions of the county, as follows: 15% of the central region, 27% in the northern region, 23% in the southern region, 19% of eastern region and 16% in the western region. This study is part of EELO Project, developed by the Universidade Norte do Paraná – UNOPAR, of the ethics committee number 00135/12.

The EELO is a multidisciplinary project aimed at integrating a wide variety of topics and health assessments, including economic and psychosocial problems, that enable a comprehensive understanding of the aging process. The data were only collected after the volunteers were informed the objectives of the study and signed the informed consent for any clinical procedure.

Only elderly subjects with natural teeth or prostheses with a functional occlusion were included. Individuals who were toothless and not duly rehabilitated by prostheses were excluded from the study. In addition, patients should have participated in the anamnesis of the audiological evaluation. Only experienced examiners performed all reviews of this research.

The diagnostic evaluation of vertigo consisted for audiological anamnesis based on the Katz protocol used in routine audiology care.¹⁶

The evaluation of the presence of painful symptoms in the TMJ started with an explanation to the patients on the difference between pressure and discomfort, to obtain reliable answers. This test was performed with bilateral palpation, with the index fingers placed 10 to 20 mm ahead of the external auditory canal. The lateral aspect of the TMJ was palpated with the patient’s mouth closed, and the posterior aspect was palpated with the patient’s mouth opened. These regions were pressed continuously and delicately, with a force of ∼450 to 900 g, according to Austin and Pertes.¹⁷ For muscular palpation, patients received the same orientations regarding the difference between pain and discomfort. The palpation of the masticatory muscles involved the anterior, medial, and posterior temporal and origin, body, and insertion of superficial and deep masseter, which were bilaterally palpated, with a constant pressure of 1,500 g. ¹⁸ The presence of pain was checked through the eyelid reflex and/or by questioning patients. Cervical muscles (posterior digastric muscle, sternocleidomastoid, and superior trapezius) were palpated by clipping one’s fingers like pincers on both sides.

The presence of joint noises based on right and left TMJ inspection was also evaluated. This evaluation was performed by placing the pointer fingers lightly upon the region corresponding to the lateral pole of the condyle, facing the external acoustic meatus, while the patient performed mandibular movements of opening and closing.

Statistical analysis was performed by chi-square tests and odds ratios to determine possible correlations between dizziness and TMD. In the univariate analyses, p < 0.01 was considered p < 0.001 highly significant; and p < 0.05 was used for the inclusion in the final model for the chi-square test and the relative risk value, with 95% confidence.

Results

This study showed that there is a significant association between TMD and vertigo. Moreover, the studied elderly people with TMD showed 17.61% more chance of presenting vertigo than those without TMD (). However, there was no significant association between TMD and vertigo when the genders were observed separately ( and ).

Table 1

Complete distribution of TDM in relation to vertigo complaint

TMD	Vertigo complaint				Total
	Yes		No
	n	%	n	%
Yes	54	27. 14	87	43.72	141
No	12	6.03	46	23.11	58
Total	66	33.17	133	66.84	199

Table 2

Complete distribution of female patients with TMD and vertigo

TMD	Vertigo complaint				Total
	Yes		No
	n	%	n	%
Yes	45	35. 71	53	42.06
No	7	5.56	21	16.67
Total	52	41.27	74	58.73	126

Table 3

Complete distribution of male patients with TMD and vertigo

TMD	Vertigo complaint				Total
	Yes		No
	n	%	n	%
Yes	9	12. 33	34	46.57	43
No	5	6.85	25	34.25	30
Total	14	19.18	59	80.82	73

By multiple logistic regression, using the factor “vertigo” as intercept and TMD and gender as independent variables, it was observed that the TMD is a predictor for vertigo but not gender. The result of this regression can be seen in .

Table 4

Multiple logistic regression between vertigo, TMD, and gender

Multiple logistic regression
Intercept: Vertigo
	Odds ratio	I95% CI	p value
TMD	2.3950	1.16–4.93	0.0178
Gender	1. 3954	0.74–2.63	0.3024

Discussion

Pathology of the TMJ affects an important part of the population, though it is not viewed as a public health problem. Between 3 and 7% of the population seeks treatment for pain and dysfunction of the temporomandibular joint (TMJ) or related structures. The literature reports great variability in the prevalence of the clinical symptoms (6 to 93%) and signs (0 to 93%), probably as a result of the different clinical criteria used. Age is a risk factor, though with some particularities. In elderly patients, there is an increased prevalence of clinical and radiologic signs, though also a lesser prevalence of symptoms and of treatment demands than in younger adults. Approximately 7% of the population between 12 and 18 years of age is diagnosed with mandibular pain/dysfunction.¹⁹

The association of vertigo with TMD has been debated for many years. The observation that patients with TMD have otologic symptoms is confounded because vertigo is a common symptom in the normal population. The mechanism of the association of TMD and otologic symptoms is unknown.⁵

From literature studies, it appears that several distinct mechanisms and comorbidities may be present in the pathophysiology of otologic symptoms, and more specifically, especially of vertigo in relation to TMD, causing its interaction.^{182021222324252627}

According to D’Antonio et al,²⁰ symptoms commonly associated with TMD are headache, tinnitus, ear pain, TMJ noise perception and balance disorders, and problems of malocclusion and painful palpation of temporomandibular structures. In some movements, the mandibular condyles exert pressure on the auriculotemporal nerve near the TMJ capsule, working as a trigger to the painful process along the temporal region.

Williamson²¹ hypothesized that vertigo can result from painful stimuli caused by harmless peridiscal TMJ tissue, which produces arterial constriction in the temporal region and decreases the blood supply to the inner ear vestibular region. In the current study, there was an association between TMD and TMJ palpation, masticatory muscles, and cervical muscles.

TMDs are a form of musculoskeletal pain of the TMJ and/or masticatory muscles of nonspecific etiology. Therefore, the relationship must be found between embryonic and anatomic-topographic similarities of the TMJ and the ear and secondary otologic symptoms that can be closely connected to TMJ disorder. Nonspecific otologic symptoms are not primary diagnostic symptoms of TMD but may cause diagnostic confusion due to patients’ inability to correctly locate the origin of pain. The most common otologic symptoms that can be related to TMDs are otalgia, tinnitus, and vertigo.²⁴

Middle ear muscles have a common embryologic and functional origin with masticatory and facial muscles. Symptoms referred to the ear may originate from the stomatognathic area. When a primary otologic cause is discarded in the diagnostic workup for tinnitus, vertigo, hypoacusis, hyperacusis, ear pain, or sensation of occluded ear, TMD may be the cause of these symptoms. Among patients with this dysfunction, the prevalence of ear pain, tinnitus, and dizziness varies between 33 and 76%.²⁵

To determine the prevalence of aural symptoms in patients with orofacial pain and a potential association between TMD and aural health, while controlling for covariates known to be associated with TMD or auditory dysfunction, a retrospective study was performed with charts of 776 patients. Of the 344 subjects who had TMD, 59.9% complained of aural symptoms (tinnitus, vertigo, and hearing loss complaints) versus 29.2% of the 432 patients without TMD. Of the subjects with otalgia, tinnitus, vertigo, or perceived hearing loss, 67, 64.1, 65.2, and 62.2% had TMD, respectively. Subjects with aural symptoms were significantly more likely to be female, to consider themselves in poor health, to smoke, or to have TMD, orofacial pain, headaches (temporal, occipital, or frontal), neck and shoulder pain, altered vision and sensation, sleep disturbances, loss of appetite, memory loss, or low energy. Clinical findings indicated that pathognomonic signs of TMD were associated with an increased risk of aural complaints in this patient population. A significantly greater negative impact on normal life functions was found in subjects exhibiting aural symptoms versus those who only had TMD complaints.²⁶

The prevalence and rank of order of vertigo and other otologic complaints in 200 TMD patients were investigated and compared with an asymptomatic control group. No subjective otologic complaints were reported by 45 (22.5%) TMD patients; the remaining 155 (77.5%) patients had at least one otologic complaint. Vertigo was reported by 50% of the subjects with myofascial pain and dysfunction, by 32.5% of the patients with internal derangement, and by 41.6% of the patients with both myofascial pain and dysfunction and internal derangement. However, the incidence of vertigo (14%) was found to be lower for the control group. Statistically, the control group had fewer vertigo complaints. Patients in the TMD groups had high incidences of vertigo complaints compared with the control subjects without TMD signs or symptoms.²⁷

A study was conducted to determine if vertigo is actually more prevalent in patients with TMD than in age-matched controls. One control group was recruited from patients seeking care for health maintenance and the other from patients seeking routine dental care. We surveyed 1,032 patients: 338 had TMD and 694 served as two age-matched control groups. Vertigo was significantly more prevalent in the TMD group than in either of the control groups.⁵

The results of the present study have shown that 27.14% of the elderly population with vertigo complaints has TMD. According to all studies cited in this research, there was an association between TMD and TMJ palpation, masticatory muscles, and cervical muscles and between TMD with vertigo. The significant association between TMD and vertigo in the studied population demonstrated the importance of identifying risk factors for vertigo that can be modified through specific interventions.

Conclusion

This research demonstrated a significant association between TMD and vertigo. However, there was no significant association between TMD and vertigo when the genders were observed separately. This significant association in the studied population demonstrated the importance of identifying risk factors for vertigo that can be modified through specific interventions.

References

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[Otological symptoms among patients with temporomandibular joint disorders] Rev Med Chil. 2007;135(12):1582–1590. [PubMed] [Google Scholar]26. Lam D K, Lawrence H P, Tenenbaum H C. Aural symptoms in temporomandibular disorder patients attending a craniofacial pain unit. J Orofac Pain. 2001;15(2):146–157. [PubMed] [Google Scholar]27. Tuz H H, Onder E M, Kisnisci R S. Prevalence of otologic complaints in patients with temporomandibular disorder. Am J Orthod Dentofacial Orthop. 2003;123(6):620–623. [PubMed] [Google Scholar]

TMJ and Dizziness – NYC Physical Therapy Clinic

Dizziness, clinically called vertigo, is a feeling of being off-balance as the world around you seems to spin. When your jaw is poorly aligned and inflamed, it can put pressure on your inner ear, disrupting the organs that help you balance.

Your inner ear’s vestibular system is located in your temporal bone, where your jawbone attaches to your skull. Pressure from a poorly aligned jaw can throw your vestibular system off, confounding the signals sent to your brain about your body’s position in space and leading to feelings of vertigo.

Your temporomandibular joint (TMJ) is located directly beneath your eustachian tube, or ear canal, and connects your jawbone to your skull. It is a sliding hinge joint that allows you to talk and chew. Because of its proximity to the ear canal, pain that originates in the TMJ is often mistaken for ear pain.

Problems with the TMJ have been linked to several seemingly unrelated conditions, including:

• back pain
• shoulder pain
• neck pain
• migraine and general headaches
• problems swallowing
• facial pain
• jaw pain
• popping sounds in the jaw
• tinnitus
• congestion in the ears
• hearing loss and disorders
• pain when chewing
• pain behind the eyes
• lightheadedness and dizziness

TMJ syndrome may arise due to postural issues in the upper body that cause the joint to misalign. Texting and computer use may be primary contributors. The condition may also be caused by stress that makes you grind or clench your teeth at night.

TMJ syndrome is often associated with pain and dizziness due to a heightened vestibular response to jaw inflammation. A Korean study (Chung et al. 2012) was conducted on rats whose jaws were injected with an inflammatory agent. The experimental group subsequently displayed heightened vestibular nuclei activity, compared to controls that were injected with a neutral substance.

Another study (de Toledo et al. 2017) found that 40.8 percent of TMJ patients experienced vertigo associated with the syndrome, and 55.1% experienced otalgia (ear pain). While vestibular issues are not always caused by TMJ syndrome, it should not be ruled out as a potential cause of chronic dizziness.

Dizziness associated with TMJ syndrome can be effectively treated with chiropractic care and physical therapy. The first step is accurate diagnosis, to ensure that other issues are not affecting the vestibular system.

Conventional medical treatments for TMJ syndrome include bite devices, Botox injections, orthodontic care and surgery. However, there is little scientific evidence that any of those approaches are effective, and most are costly.

Effective conservative treatment options for TMJ syndrome include:

• Specialized physical therapy
• Ultrasound guided dry needling
• TMJ mobilization techniques
• Myofascial relaxation techniques
• Cranial osteopathy
• Craniosacral therapy
• Cervical stabilization
• Biofeedback therapy
• Surface electromyography (SEMG) feedback retraining for chewing and neck muscles

Once the TMJ is restored to proper function, dizziness symptoms should subside. If you still experience vertigo, your dizziness may have another underlying cause.

If you are experiencing ear and jaw pain with dizziness, you may have TMJ syndrome. The clinical director at NYDNRehab, Dr. Kalika, is a world-renowned chiropractor with extensive experience treating TMJ patients. Chiropractic care combined with physical therapy can resolve the root causes of TMJ syndrome and eliminate headaches and dizziness.

Our state-of-the-art clinic features:

• High resolution diagnostic ultrasound
• SEMG
• Physical therapy exercises
• Advanced real-time feedback training
• Ultrasound guided dry needling
• Innovative treatment approaches for TMJ

NYDNRehab now offers TeleHealth services to patients who prefer remote treatment. Contact us today, and let our team of TMJ experts resolve your pain and discomfort, so you can get back to your active pain-free life.

Resources

Chung, Sung-Won, et al. “Inflammation of temporomandibular joint increases neural activity in rat vestibular nucleus.” Neuroscience Letters 528.2 (2012): 126-130.

De Toledo, Isabela Porto, et al. “Prevalence of otologic signs and symptoms in adult patients with temporomandibular disorders: a systematic review and meta-analysis.” Clinical oral investigations 21.2 (2017): 597-605.

If You Are Dizzy, It Could Be TMJ

When it comes to the most complicated systems in the body, the inner ear is towards the top of the list. This complex, fragile system is instrumental not just in detecting sound, but also in your sense of balance and spatial orientation. And when something is “off” about your inner ear, it can be very difficult to determine the cause and find the best solution.

Inner Ear 101

Your inner ear contains the vestibular system, which exists to coordinate balance and movement, keeping you upright. It does this via a network of canals filled with fluid. The hairs that line these canals are stimulated by the fluid, and relay information to your brain when the fluid moves. Your brain then correlates this information with data from other sources, such as your eyes and your proprioceptors–message cells that tell your body how its various elements sit in relation to each other. This is how your brain knows when you’re turning, falling, or upside down.

When those systems aren’t functioning as they should, your brain might be receiving or interpreting those signals incorrectly. Vertigo is a clear sign that something is being lost in translation between the inner ear and the brain–it usually occurs when messages from the inner ear don’t match messages from the other sources.

Vertigo refers to the feeling of being dizzy or off-balance. It can be caused by anything from trauma to stroke to infection — it could even be a side effect of prescription medication. Sometimes it’s accompanied by other symptoms, like nausea, headache, or tinnitus.

Due to the wide variety of potential causes, hunting for the root cause of vertigo can quickly start to feel like a fruitless task. But there’s one common cause of vertigo that is often overlooked: TMJ.

TMJ and the Inner Ear

The jaw and the inner ear may seem totally unrelated. But when you see the location of the vestibular system and the temporomandibular joint in relation to each other, the relationship becomes evident: They’re right on top of each other! And in our evolutionary ancestors the bones of the inner ear were actually jawbones. Muscle connections still remain from this ancient heritage.

This means that any misalignment or tension in the jaw joint can easily translate to problems with the inner ear. That’s why 50% of TMJ sufferers experience vertigo, 59% experience tinnitus, and 36% even experience hearing loss as a side effect of TMJ.

Simply put, TMJ is the misalignment of the jaw, leading to pressure and pain that can start in the jaw itself and stretch all the way down the back and even to the fingertips. When the jaw is forced into a position of tension, the entire body strains to compensate for it. The resulting disorder can cause symptoms like jaw pain, back and neck pain, headaches, and yes, inner ear problems.

To treat TMJ, the jaw needs to be brought back to its natural position, where it experiences the least tension. For some people, periodic TENS treatments (a sort of electric massage to relax the muscles of the head and face) might be enough to correct the issue. For others, a bite splint (similar to a mouthguard) can retrain the jaw muscles. For those who want a long-term solution, orthodontics or reconstruction dentistry can permanently correct the bite.

Do you think you might have TMJ? Call (303) 691-0267 or contact us online today to make an appointment and speak with an experienced TMJ dentist about what treatment would be best for you.

The Connection between Stress and TMJ

Temporomandibular joint disorder, also known simply as TMJ or TMD, is a condition that affects the hinge or joint connecting the upper and lower jaw. Chronic pain and other issues are common when this joint is not working as it should. People who suffer from this disorder often face depression, anxiety and stress as well. Here’s what the research says about TMJ:

• A 2002 study by the National University of Singapore found that people with myofascial joint pain had higher levels of depression than those with only disk displacements.
• An International Journal of Prosthodontics study from 2006 found that patients with TMD had higher levels of depression, and psychological factors play a role.
• According to a Journal of Pain article from 2013 (based on a German research study), there is a moderate to strong link between depression and TMJ disorder.

What is the relation between stress and TMJ?

Severe teeth grinding or Bruxism, headache, muscle pain or tension are all symptoms of stress. Jaw pain or tenderness, jaw locking or popping, pain in and around the ear etc., are some of the symptoms of temporomandibular joint dysfunction.

When you are stressed, your muscles including those in your temporomandibular joint or TMJ get tight and sore. Your muscles stay overworked and cause pain and stiffness. Similarly, if you are experiencing TMJ symptoms, it affects your routine activities and can induce stress. This creates a cycle between TMJ and stress.

Can TMJ Induce Anxiety Attacks?

Studies have shown that people suffering from TMJ disorder are more prone to developing anxiety as well. Even for those with anxiety, the sleep disorders like teeth grinding and sleep apnea that accompany TMJ make matters worse.

Also, in case of people experiencing chronic pain such as jaw pain, neck pain, headaches and other symptoms of temporomandibular joint dysfunction, it affects every aspect of their lives such as eating, working, socializing and sleeping. Scientists have found that chronic pain and depression go hand in hand. Understanding the correlation of TMJ and depression or TMJ and anxiety can help you deal with your TMJ pain better.

How do

TMJ symptoms cause or increase anxiety?

1. Dizziness– TMJ affects blood vessels and nerves that go through the back of your jaw, and this can lead to neurological symptoms such as dizziness. This often happens suddenly and with no warning, causing significant amounts of anxiety or stress.
2. Headaches– TMJ can cause morning headaches in many cases, which affects the way you start your day. In addition to the discomfort caused by TMJ or TMD headaches, studies suggest that starting your day on the wrong note raises anxiety levels as well.
3. Chronic Pain– A common symptom of TMJ disorder is frequent and consistent pain in the jaw, temples or other parts of the face. Research shows that chronic pain, caused by your body’s attempt to deal with constant stress, could be a trigger for anxiety.
4. Clicking Jaw– Temporomandibular joint disorder often causes a popping or clicking sensation in the jaw, which can lead to emotional distress if you don’t know what it is. You may also be blinking too often, which can be disturbing and even frightening.
5. Tinnitus– Most people tune out the “ringing” sound in their ear, but this becomes more difficult to do if it’s loud or constant. Tinnitus caused by TMJ can lead to loss of sleep, distraction and anxiety, even though we don’t yet understand why this happens.
6. Other TMJ Symptoms– Since TMD disorder affects nerves, it can lead to various other neurological symptoms linked to anxiety. Examples include involuntary muscle movements, numbness in limbs, tingling in extremities, and even impaired thinking.

TMJ can make existing symptoms of these conditions worse. Chronic pain and inflammation have been known to trigger anxiety-like symptoms in many cases, and other TMJ symptoms may also lead to increased stress, depression and anxiety.

How reducing stress can help you ease your TMJ symptoms?

Stress can start a vicious cycle with your temporomandibular joint dysfunction. TMJ pain can cause stress and anxiety. On the other hand, stress can cause or aggravate the TMJ symptoms, especially jaw pain.

The key here is to manage your stress and make efforts to reduce or eliminate it. Consult a TMJ specialist to learn about what type of relaxation techniques can help your case. Exercise, meditation, laughing out loud, getting some fresh air, etc., can help you handle stress effectively. Similarly, if you are grinding your teeth or are experiencing other symptoms of TMJ, consult a TMJ specialist who can help you relax your muscles, protect your teeth and address other TMJ symptoms.

How to get relief from TMJ pain due to stress?

Here are a few effective ways to ease or relieve TMJ pain due to stress:

• Exercise, meditation, laughing out loud, getting some fresh air, etc., can help you handle stress effectively.
• Simple, quick stress relief practices such as breathing exercises, calming aroma therapy, relaxing your jaw if you notice yourself clenching it etc., can help you ease TMJ pain.
• Don’t eat chewy things. If you have recently discovered that you have a TMJ disorder, eating chewy things can cause jaw locking, dislocation of the disc, clicking or even serious jaw pain. In case of a TMJ disorder, your jaw becomes extra sensitive, hence it’s best to avoid sticky or chewy foods.
• Making conscious efforts to calm down especially before bed time will help you ease TMJ pain. Simple, quick stress relief practices such as breathing exercises, calming aroma therapy, relaxing your jaw if you notice yourself clenching it etc., can help you ease jaw pain.
• Consult your orthodontist to learn jaw stretches. The results aren’t immediate, but with dedicated efforts, you will start noticing positive outcomes. Some of the pain may go away completely and you may start noticing that your jaw clicks less than it used to before you did the stretches.
• A slightly expensive treatment option is getting jaw massages from an experienced massage therapist. Massaging the muscles helps relieve pain in individual muscles which in turn helps you relax more. The advantage of this treatment is that it can prove beneficial in addressing both physical and physiological aspects of the pain.
• Ask a TMJ specialist to fit you with a mouthguard since it hinders teeth grinding and protects the teeth. A mouthguard is perhaps one of the most expensive but also the most effective treatment options for addressing TMJ pain. This oral device is customized to fit perfectly on your jaw. It hinders teeth grinding and protects the teeth.

If you’re suffering from temporomandibular disorder and anxiety, stress or depression, it’s a good idea to seek treatment. Controlling your TMJ symptoms can help reduce other secondary symptoms as well. Even if the disorder isn’t actually the main cause of your anxiety or depression, it can make these issues worse.

You may need to seek medical advice for severe anxiety or depression, but an experienced dentist can help you with TMJ treatment. If you think TMD is causing stress or making existing issues worse, visit Dr. Joshua Hong’s clinic in Goodyear AZ for evaluation and treatment today!

Ear Symptoms & TMJ – John M. Korolewski, D.D.S.

UNSTABLE JAW JOINT POSITION and EAR SYMPTOMS – IS THERE A RELATIONSHIP?

TMJ disorders can also cause a number of ear symptoms, including dizziness, ear ringing, stuffed Eustachian tubes, and difficulty hearing.  Although we don’t always understand the mechanism, these ear symptoms are often part of a TMJ disorder, because they increase along with the other TMJ symptoms when the TMJ disorder becomes more severe, and they decrease along with the other TMJ symptoms when the TMJ disorder is relieved.

The balance mechanism, located in the inner ear, may be affected. Severe injury to the balance mechanism results in dizziness and nausea.  Mild injury to that same system produces feelings of disorientation, inability to concentrate, a tendency to bump into things, and “spaciness”. Tinnitus (ringing, roaring, or buzzing sounds in the ears) has been shown to respond to TMJ treatment in about half of the patients studied.

One cause of ear symptoms in TMJ disorders is probably sterile inflammation of the retrodiscal tissues. Anatomical studies of TMJs with dislocated disks have shown that most of the tissue bruising occurs at the extreme back end of the TMJ, located only 1.5 millimeters from the front of the middle ear.  The increased fluid pressure that results from inflammation there can transmit pressure across the thin membrane bones separating the ear from the TMJs.

Increased fluid pressure can push closed the Eustachian tube, which passes very close to the back of the TMJ.  If it has been pushed closed for long, it can become narrowed in that area.  Subsequently it can be blocked by a cold, allergy, or anything else that causes inflammation of the inner lining of the tube and thereby further narrows its lumen. Blockage of a Eustachian tube can prevent it from equalizing pressure between the middle ear and the outside air and thereby create a stuffy feeling in the ear and difficulty clearing it after changes in altitude.

Another cause of ear symptoms in TMJ disorders may be loss of proper resting tonus in the two tiny ear muscles (the tensor tympani and the tensor veli palatini) which are controlled by the same motor nerve that controls the jaw closing muscles.  Increased tension in that motor nerve triggered by reflex protective bracing in response to TMJ tissue damage may cause increased tension in both ear and jaw muscles.  Increased resting tension in the tensor tympani muscle, the muscle that tightens the ear drum, may cause the subjective hearing loss that causes TMJ disorder patients to complain they often miss things people say, even though hearing tests show normal results.  Increased resting tension in the tensor veli palatini muscles, which pull open the Eustachian tube during swallowing, can interfere with the health and function of the Eustachian tubes.

Some researchers believe that still another cause of ear symptoms in TMJ disorders may be Pinto’s ligament, a fibrous continuity between the sphenomandibular ligament and the anterior malleolar ligament of the middle ear.  The petrotympanic fissure between these structures appears to close at about the age of three, but some fibers may continue to pass through it and exert some pressure across it.

90,000 To the question of pain relief in case of dysfunction of the temporomandibular joint :: DIFFICULT PATIENT

To the question of pain relief in temporomandibular joint dysfunction

Journal number:
May 2012

L.N. Maksimovskaya, N.M. Fokina, E.N. Dudnik
Moscow State Dental University
First Moscow State Medical University named after I.I.Sechenov
P.K. Anokhin Research Institute of Normal Physiology, Moscow

Pain syndrome caused by dysfunction of the temporomandibular joint is relieved by the non-steroidal anti-inflammatory drug Nimesil®. The effectiveness of the drug has been proven in 69.05% of cases.
Keywords: temporomandibular joint dysfunction, pain, treatment, nimesulide.

Relieving pain due to temporomandibular joint dysfunction
L.N. Maximovskaya, N.M. Fokina, E.N. Dudnik
Moscow State Dentistry University I.M. Sechenov First Moscow State Medicine University
P.K. Anokhin Normal Physiology SRI

Pain caused by temporomandibular joint dysfunction could be relieved by non-steroidal anti-inflammatory drug called Nimesil®. The efficiency of this drug was proven in 69.05% cases.
Keywords: temporomandibular joint dysfunction, TMJ, pain, nimesulide.

Information about the authors:
Maksimovskaya L.N. – Doctor of Medical Sciences, Professor, FPO MGSU
Fokina N.M. – Ph.D., First MGMU im. THEM. Sechenova
Dudnik E.N. – Candidate of Biological Sciences, Associate Professor, Research Institute of Normal Physiology. PC. Anokhina RAMS

Facial pain is one of the most common complaints of patients visiting the dentist. At the same time, about a third of the patients who applied can be attributed to primary facial pain, while secondary facial pain caused by the pathology of the ENT organs, ophthalmological problems and dental disorders make up the vast majority of cases. These pains have no specific characteristics, but are always localized in the middle and lower third of the face.It should be noted that one of the main nosological forms is the temporomandibular joint dysfunction (TMJ) syndrome – one of the most difficult and controversial diagnoses. About 57% of patients seeking help from a dentist have some kind of complaints about dysfunction of the temporomandibular joint [1]. From 14 to 29% of children and adolescents suffer from this disease [2].
Temporomandibular joint dysfunction means that the joint connecting the upper and lower jaw is not functioning properly.This joint is one of the most difficult joints in the human body, it is responsible for the movement of the lower jaw forward, backward and from side to side. Any disease that prevents this complex system of muscles, ligaments, cartilage and bones from working properly forms its dysfunction.
Pain dysfunction of the TMJ (TMJ pain dysfunction syndrome) has synonyms: Kosten’s syndrome, pain dysfunctional TMJ syndrome, myofascial pain dysfunctional syndrome, TMJ dysfunction, craniomandibular dysfunction, dysfunction of the lower jaw, muscular-articular dysfunction of the TMJ and TMJ.
In 1934, J.Costen described the symptomatic complex, which was observed in edentulous patients and in persons with a low bite. The symptom complex was characterized by the following: dull pain in the joint area; headache; dizziness; pain in the cervical spine, occiput and behind the auricle, worsening towards the end of the day; clicking in the joint while eating; hearing loss; tinnitus; burning in throat and nose [3]. The described complex of symptoms was later called Kosten’s syndrome.Some other symptoms were later added to this syndrome: paresthesia, xerostomia, glossodynia, a feeling of pressure in the ears, soreness of the auricle, etc. [4].
Thus, the most common symptoms of TMJ dysfunction are:
• headache (frontotemporal-parietal localization), ear pain, as well as pain and pressure behind the eyes;
• clicking or clicking sound when opening or closing the mouth;
• pain when yawning and wide open mouth;
• if the jaws “jam”, they do not open or “pop out”;
• weakness of the jaw muscles;
• Suddenly the upper and lower jaws begin to close differently.
A variety of clinical manifestations of temporomandibular joint dysfunction is determined by the polyetiology (multiple determining factors) of pathological changes developing in it, which complicates diagnosis and treatment [5].
In this regard, the purpose of our work was to detail the clinical and painful manifestations of TMJ, as well as the possibility of its treatment using the nonsteroidal anti-inflammatory drug (NSAID) Nimesil®.
Material and methods
42 patients of the dental clinic (28 women, 14 men) aged from 28 to 52 years with complaints of pain in the facial area lasting from 6 months (chronic pain syndrome) were examined.
For the diagnosis of pain syndrome, a comprehensive examination was carried out:
1. Clinical and neurological (detailing the involvement of the pericranial muscles).
2. Clinical and dental (assessment of occlusion and integrity of the dentition, myography of the temporal and masticatory muscles).
3. Psychometric testing: YOUR pain and quality of life assessment.
In order to eliminate pain and anti-inflammatory action in the TMJ, all patients were prescribed NSAIDs – the drug Nimesil®, in a dosage of one sachet (100 mg) 2 times a day (morning / evening), after meals.The course of drug treatment was 10 days.
Statistical processing of the obtained indicators was carried out using the program “Statistica for Windows 6.1”, the calculation of standard statistical indicators was carried out using parametric statistics methods (standard deviation, mean value, mean error, mode, mode amplitude, etc.). To assess the reliability of the differences in the mean values ​​of the parameters, the differences were analyzed using the Student’s t-test for paired samples.
Study results
Clinical and neurological examination did not reveal the primary pain syndrome of the facial localization in all patients.
External dental examination revealed asymmetry of the lower part of the face due to lateral displacement of the lower jaw. At the same time, an assessment of the lateral movements of the lower jaw to the sides of the median sagittal plane revealed the limitation of these movements by less than 8 mm. Palpation of the muscles involved in the movements of the lower jaw revealed muscle hypertonicity and the presence of myofascial seals.
At rest, the severity of pain according to the VAS was 3-4 points, with active movements (opening-closing the mouth, lateral displacement) – 9-10 points.
Electromyography data indicated dysfunction of the masseter and temporal muscles proper. The asymmetry of the activity of the masticatory and temporal muscles was revealed, as well as the blurring of the change in the phases of bioelectric activity and periods of rest. In 76.1% of patients, a unilateral increase in the muscle tone of the masseter muscle was revealed, bilateral – in 22.90%. Unilateral increase in temporal muscle tone was detected in 59.45% of the examined, bilateral –
in 40.55%.
When choosing a treatment, we were guided by the leading pathogenetic mechanism.Practical experience shows that NSAIDs are most often used to relieve subjective pain. The main effects of NSAIDs are associated with the mechanism of suppression of the activity of cyclooxygenase (COX), an enzyme that regulates the conversion of arachidonic acid to prostaglandins, prostacyclin and thromboxane. The analgesic and anti-inflammatory effects are mainly associated with the inhibition of COX-2, and the development of side effects is associated with the suppression of COX-1. Therefore, we considered it appropriate to use a drug with a predominant effect on COX-2 – Nimesil®.
It should be noted that when taken orally, the drug is well absorbed. The time to reach the maximum concentration of the active substance in the blood plasma is 2-3 hours. In the elderly, the pharmacokinetic profile of Nimesil® does not change significantly.
After the treatment (pain relief), 29 patients were able to carry out further necessary dental treatment. Thirteen patients showed a significant reduction in pain. These patients (according to indications) were recommended additional drug therapy, depending on the severity of emotional disorders – anti-anxiety phytotherapeutic drugs [6].
Thus, the results obtained indicate the effectiveness and feasibility of using the drug Nimesil® for relief of pain manifestations in TMJ dysfunction, which makes it possible to recommend its use in dental practice.

Literature
1. Arsenina OI, Oskolsky G.I. et al. Prevalence of secondary deformities of the dentition and pathology of the temporomandibular joint in the population of the Far East. Dentistry. 2010; 6: 59–61.
2. Zakrzewska JM. Diagnosis and treatment of orofacial pain without dental. Dent Update. 2007; 34 (3): 134-6, 138-9.
3. Costen J.B. J. Am. med. Ass. 1936; 107.
4. Syrup C.O. Initial management of temporomandibular disorders. Dent Today. 2002; 21 (8): 52-7.
5. Potapov V.P., Potapov I.V. et al. Clinical picture and methods of treatment of patients with arthrosis of the temporomandibular joint caused by chronic microtrauma. Russian dental journal. 2011; 1: 26-28.
6.Fokina N.M. Treatment of episodic tension headache in young people. Doctor. Special issue. 2007; 55-56.

Question to a specialist | Medical center “Kutuzovsky”

Resume doctor-endoscopist Laganin Artem Alexandrovich. Own customer base.
Full name: Laganin Artem Alexandrovich

Contacts: tel. +79506160776, e-mail [email protected]

Date of birth: 09/10/1976

Vacancy: endoscopist.

Work experience in the specialty – 14 years.

Experience in commercial medicine – Yes (as a doctor, as a co-founder of a medical center).
Education – higher medical (Nizhny Novgorod State Medical Academy, 1999).
A valid specialist certificate – Yes.

Professional skills: All types of flexible intraluminal endoscopy of the gastrointestinal tract – EGDS, colonoscopy, bronchoscopy, removal of neoplasms (polypectomy, endoscopic mucosal resection, submucosal dissection), stenting of the esophagus, colon, endoscopic surgery on the organs of the pancreatobiliary zone, EST, stenting of the common bile duct and Wirsung’s duct), endoscopic hemostasis, endoscopic vacuum ligation and sclerotherapy of esophageal veins, capsule endoscopy.Knowledge of the regulatory framework for organizing the work of the endoscopic room and processing equipment.

Professional activity:
– Nizhny Novgorod Scientific Research Institute of Pediatric Gastroenterology, Junior Researcher, Surgeon 2002-2003.
– State Budgetary Healthcare Institution of the Nizhny Novgorod Region “City Clinical Hospital No. 30”, surgeon 2003-2004.
– GBUZ Nizhny Novgorod region “City Clinical Hospital No. 30”, endoscopist 2004-2011.
– GBUZ Moscow “Research Institute of Emergency Medicine named after N.V. Sklifosovsky Department of Health of Moscow “2011-2011.
– GBUZ of the Nizhny Novgorod Region “City Clinical Hospital No. 30”, endoscopist 2011-2014.
– State Budgetary Healthcare Institution of the Nizhny Novgorod Region “City Clinical Hospital No. 30”, Head of the Department of Radiation Diagnostics and Endoscopy from 2014 to the present.

Desirable work schedule: Shift (part-time), office rent (work using our own equipment – capsule video endoscopy system).

Dear colleagues! If you are interested in introducing a modern technique of video capsule endoscopy (small bowel and guided capsule gastroscopy) in the clinic without the cost of purchasing equipment and consumables, I look forward to your response. Capsule endoscopy system available. I have extensive experience, including in this type of research. Working conditions are being discussed. We have our own client base. Thank you for your interest in my resume and proposal.

90,000 Dizziness and TMJ.- Info TMJ

“Oh, I fell and I can’t get up” – this is what we all joked about in childhood, but as we matured, we understand that this is actually a very serious question. Balance is one of the major health problems in people over 65, but it can affect young people as well. If you do not have good muscle strength and joint mobility, then most likely you do not have a good balance. Balance is defined as a state of equilibrium characterized by the suppression of all forces by equal opposing factors.In other words, maintaining an upright posture while standing or moving.

Loss of balance caused by temporomandibular disorder is often not addressed by our healthcare professionals. After all, one of the muscles under tension can touch the Eustachian tube and cause dizziness or loss of balance. This is easier to understand by imagining a game of constructor in front of you, when neighboring parts begin to strain, in which one of the parts of the tallest constructor tilts to the side, and then gradually begins to drag other parts along with it, and so on until the constructor finally breaks down.

At this point in time, there have been many studies concerning the relationship of the temporomandibular joint and their positive or negative influence on the patient’s posture when changing the correct body position.

Several decades ago, it was recognized that TMJ may be associated with episodes of loss of balance in humans and the material was published in Arch Otolaryngol Head Neck Surg 1992, Chole Ra, Parker WS (https: // www.ncbi.nlm.nih.gov/pubmed/1642833).

Vertigo can also be caused by a disturbance in a specific part of the inner ear, which is an important part of the vestibular (equilibrium) system. Our ear, or rather its labyrinth, interacts with other body systems such as the visual (eyes) and skeletal (bones and joints), which helps maintain the position of the body in space. In addition to the visual, vestibular, and skeletal systems, which can contribute to imbalance, the dental system can also contribute to imbalance.It is when all four of these systems are in coordination with each other that balance will properly maintain correct gait and body position.

Now, dizziness , is the most common complaint in younger patients. Vertigo is defined as a sensation of movement, including feeling unsteady, dizzy, and unsteady. People may feel that they are spinning, swinging, bending, or spinning. These sensations occur even when standing or lying down.

What are other common causes of imbalance?

1. Tinnitus – Buzzing or ringing in the ears (a common symptom of TMJ dysfunction discussed in previous articles), which may also be accompanied by dizziness.

2. Inflammation of the inner ear , usually caused by various viruses that can cause dizziness or imbalance.

3. Benign paroxysmal positional vertigo is a short, intense feeling of dizziness that occurs due to a specific positional change in the head, possibly caused by a problem in the vestibular system of the inner ear.

4. Post-traumatic dizziness – dizziness caused by a head injury, concussion or whip.

5. Meniere’s disease – a condition of the labyrinth fluid balance in the inner ear, causing repeated attacks of dizziness and accompanied by pressure in the ears, vomiting, buzzing or ringing, as well as partial hearing loss.

Determining the cause of imbalance and the appropriate treatment options is always challenging. Ear infections , changes in blood pressure , vision problems and medications in turn contribute to imbalance. Medical conditions such as multiple sclerosis, stroke and Parkinson’s disease, as well as temporomandibular joint disorders a, can also contribute to imbalance.

If you experience any of the above symptoms, the first thing you should do is visit your PCP.They will most likely refer you to an otolaryngologist (ENT) who specializes in ear, nose and throat conditions. You may be assigned a audiometric (auditory) test to test your ability to follow visual objects with your eyes and how your eyes respond to different types of information entered into the vestibular system. Also, the doctor, if necessary, will refer you to an MRI of the brain, cervical spine or computed tomography in order to see the structures of the inner ear and the neural connections of these organs with the brain.If a doctor directs you for the above MRIs, then you will need to visit a neurologist to rule out various neurological diseases.
If all the results are completely normal and the ENT doctor, as well as the neurologist, cannot find the cause. It is worth taking a closer look at your TMJ and trying to find a doctor who can tell you about the connection between TMJ dysfunction and vertigo.

One thing I can tell you for sure, I have never suffered from dizziness. But when the ALF device was activated for me , I got dizzy several times.And once – it was very strong, and it’s good that I was sitting on the couch at that moment. Having visited my attending physician, I told about my symptoms. She explained that this is by the fact that the body is undergoing colosal restructuring, and this is not only a gradual movement of the bones of the skull, muscles, nerves, blood vessels, arteries, veins, etc. move along with this. In my case, this is a kind of side effect of the treatment. The main thing is that this phenomenon is of a short-term nature. Otherwise, I will need the help of an osteopath.
Summing up this article, I would like to note that in it I tried to explain to you as much as possible what causes dizziness and how to deal with it. Well, and I, in turn, hope that you will get rid of this serious illness and achieve balance in everything.

90,000 On the issue of pain relief in case of dysfunction of the temporomandibular joint

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To the question of pain relief in case of dysfunction of the temporomandibular joint

L.N. Maksimovskaya, N. M. Fokina, E. N. Dudnik Moscow State Dental University I. M. Sechenov First Moscow State Medical University P. K. Anokhin Research Institute of Normal Physiology, Moscow

Pain syndrome caused by dysfunction of the temporomandibular joint is relieved by the non-steroidal anti-inflammatory drug Nimesil®. The effectiveness of the drug has been proven in 69.05% of cases.

Keywords: temporomandibular joint dysfunction, pain, treatment, nimesulide.

Relieving pain due to temporomandibular joint dysfunction

L.N. Maximovskaya, N.M. Fokina, E.N. Dudnik Moscow State Dentistry University I.M. Sechenov First Moscow State Medicine

University

P.K. Anokhin Normal Physiology SRI

Pain caused by temporomandibular joint dysfunction could be relieved by non-steroidal anti-inflammatory drug called Nimesil®.The efficiency of this drug was proven in 69.05% cases.

Keywords: temporomandibular joint dysfunction, TMJ, pain, nimesulide.

Facial pain is one of the most common complaints of patients visiting the dentist. At the same time, about a third of the patients who applied can be attributed to primary facial pain, while secondary facial pain caused by the pathology of the ENT organs, ophthalmological problems and dental disorders make up the vast majority of cases.These pains have no specific characteristics, but are always localized in the middle and lower third of the face. It should be noted that one of the main nosological forms is viral dysfunction syndrome.

of the temporomandibular joint (TMJ) is one of the most difficult and controversial diagnoses. About 57% of patients seeking help from a dentist have some kind of complaints about dysfunction of the temporomandibular joint [1]. From 14 to 29% of children and adolescents suffer from this disease [2].

Temporomandibular joint dysfunction means that the joint connecting the upper and lower jaw is not functioning properly. This joint is one of the most difficult joints in the human body, it is responsible for the movement of the lower jaw forward, backward and from side to side. Any disease that prevents this complex system of muscles, ligaments, cartilage and bones from working properly forms its dysfunction.

Pain dysfunction of the TMJ (TMJ pain dysfunction syndrome) has synonyms: Ko-wall syndrome, pain dysfunctional TMJ syndrome, myofascial pain dysfunctional syndrome, TMJ dysfunction, craniomandibular dysfunction, mandibular dysfunction, muscular-articular dysfunction of the TMJ and etc.

In 1934 J.Costen described the symptomatic complex, which was observed in edentulous patients and in persons with a low occlusion. The symptom complex was characterized by the following: dull pain in the joint area; headache; dizziness; pain in the cervical spine, occiput and behind the auricle, worsening towards the end of the day; clicking in the joint while eating; hearing loss; tinnitus; burning in throat and nose [3]. The described complex of symptoms was later called Kosten’s syndrome.Some other symptoms were later added to this syndrome: paresthesia, xerostomia, glossodia, a feeling of pressure in the ears, soreness of the auricle, etc. [4].

Thus, the most common symptoms of TMJ dysfunction are:

• headache (frontotemporal-parietal localization), pain in the ears, as well as pain and pressing sensations behind the eyes;

• clicking or clicking sound when opening or closing the mouth;

• pain when yawning and wide open mouth;

• if the jaws “jam”, they do not open or “pop out”;

• weakness of the jaw muscles;

• Suddenly the upper and lower jaws begin to close differently.

A variety of clinical manifestations of temporomandibular joint dysfunction is determined by the polyetiology (multiple determining factors) of pathological changes developing in it, which complicates diagnosis and treatment [5].

In this regard, the goal of our work was to detail the clinical and painful manifestations of TMJ, as well as the possibility of its treatment using the nonsteroidal anti-inflammatory drug (NSAID) Nimesil®.

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Information about the authors:

Maksimovskaya L.N. – Doctor of Medical Sciences, Professor, FPO MGSU Fokina N.M. – Ph.D., First Moscow State Medical University named after I.I. THEM. Sechenov

Dudnik E.N. – Candidate of Biological Sciences, Associate Professor, Research Institute of Normal Physiology. PC. Anokhina RAMS

Material and methods

42 patients of the dental clinic (28 women, 14 men) aged 28 to 52 years with complaints of pain in the facial area lasting from 6 months (chronic pain syndrome) were examined.

A comprehensive examination was carried out to diagnose pain syndrome:

1.Clinical and neurological (detailing the involvement of the pericranial muscles).

2. Clinical and dental (assessment of occlusion and integrity of the dentition, myography of the temporal and masticatory muscles).

3. Psychometric testing: YOUR pain and quality of life assessment.

In order to eliminate pain and anti-inflammatory action in the TMJ, all patients were prescribed NSAIDs – the drug Nimesil®, in a dosage of one sachet (100 mg) 2 times a day (morning / evening), after meals.The course of drug treatment was 10 days.

Statistical processing of the obtained indicators was carried out using the program “Stati-stica for Windows 6.1”, the calculation of standard statistical indicators was carried out using parametric statistics methods (standard deviation, mean value, error of the mean, mode, mode amplitude, etc.). To assess the reliability of the differences in the mean values ​​of the parameters, the differences were analyzed using the Student’s t-test for paired samples.

Research results

Clinical and neurological examination revealed no primary pain syndrome of facial localization in all patients.

External dental examination revealed asymmetry of the lower face due to lateral displacement of the lower jaw. At the same time, an assessment of the lateral movements of the lower jaw to the sides of the median sagittal plane revealed the limitation of these movements by less than 8 mm.Palpation of the muscles involved in the movements of the lower jaw revealed muscle hypertonicity and the presence of myofascial seals.

At rest, the severity of pain according to the VAS was 3-4 points, with active movements (opening-closing the mouth, lateral displacement) – 9-10 points.

Electromyography data indicated dysfunction of the masseter and temporal muscles proper.The asymmetry of the activity of the masticatory and temporal muscles was revealed, as well as the blurring of the change in the phases of bioelectric activity and periods of rest. In 76.1% of patients, a unilateral increase in the muscle tone of the masseter muscle was revealed, bilateral – in 22.90%. Unilateral increase in temporal muscle tone was found in 59.45% of the examined, bilateral – in 40.55%.

When choosing a treatment, we were guided by the leading pathogenetic mechanism. Practical experience shows that most often for actually

I am nimesupid

Nimesil

An informed approach to pain management in dentistry

Accuracy

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on target!

Granular form – fast results1

Pronounced anti-inflammatory and analgesic effect2

-f- Low risk of gastrointestinal complications

1.Alessandrini A, Ballarin E, Bastianon A, Migliavacca C.

Comparison of the bioavailability of 2 different equal-dosage oral pharmaceutic forms of nimesulide in healthy volunteers. Clin Ther 1986; 118 (3): 177-182.

2. Rainsford KD. Inflammofarmacology 14 (2006): 120-137; Bianchi M, Broggini M. Drugs 2003; 63 Suppl. 1: 37-46.

3.Laporte JR et al. Drug Safety 2004; 27 (6): 411-420.

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Per. ud .: P No 011439/01 dated 08/18/2010

NSAIDs are used to relieve subjective pain. The main effects of NSAIDs are associated with the mechanism of suppression of the activity of cyclooxygenase (COX), an enzyme that regulates the conversion of arachidonic acid into prostaglandins, prostacyclin and thromboxane.The analgesic and anti-inflammatory effects are mainly associated with the inhibition of COX-2, and the development of side effects is associated with the suppression of COX-1. Therefore, we considered it appropriate to use a drug with a predominant effect on COX-2 – Nimesil®.

It should be noted that when taken orally, the drug is well absorbed. The time to reach the maximum concentration of the active substance in the blood plasma is 2-3 hours. In the elderly, the pharmacokinetic profile of Nimesil® does not change significantly.

After the treatment (pain relief), 29 patients were able to carry out further necessary dental treatment. Thirteen patients showed a significant reduction in pain. These patients (according to indications) were recommended additional drug therapy, depending on the severity

emotional disorders – anti-anxiety phytotherapeutic drugs [6].

Thus, the results obtained indicate the effectiveness and feasibility of using the drug Nimesil® for relieving pain manifestations in TMJ dysfunction, which makes it possible to recommend its use in dental practice.

Literature

1. Arsenina OI, Oskolsky G.I. et al. Prevalence of secondary deformities of the dentition and pathology of the temporomandibular joint in the population of the Far East.Dentistry. 2010; 6: 59-61.

2. Zakrzewska JM. Diagnosis and treatment of orofacial pain without dental. Dent Update. 2007; 34 (3): 134-6, 138-9.

3. Costen J.B. J. Am. med. Ass. 1936; 107.

4. Syrup C.O. Initial management of temporomandibular disorders. Dent Today. 2002; 21 (8): 52-7.

5.Potapov V.P., Potapov I.V. et al. Clinical picture and methods of treatment of patients with arthrosis of the temporomandibular joint caused by chronic microtrauma. Russian dental journal. 2011; 1: 26-28.

6. Fokina N.M. Treatment of episodic tension headache in young people. Doctor. Special issue. 2007; 55-56.

About

Product information

PHARMACOLOGICAL PROPERTIES Pharmacodynamics

Nimesulide is a non-steroidal anti-inflammatory drug (NSAID) from the sulfonamide class.It has anti-inflammatory, analgesic and antipyretic effects. Nimesulide acts as an inhibitor of the cyclooxygenase enzyme responsible for the synthesis of prostaglandins and inhibits mainly cyclooxygenase 2.

Pharmacokinetics

After oral administration, the drug is well absorbed from the gastrointestinal tract, reaching maximum plasma concentration in 2-3 hours; connection with plasma proteins – 97.5%; the half-life is 3.2-6 hours.P) 2C9. The main metabolite is the pharmacologically active parahydroxy derivative of nimesulide – hydroxynimesulide. Hydroxy-nimesulide is excreted in the bile in a metabolized form (found exclusively in the form of glucuronate – about 29%).

Nimesulide is excreted from the body, mainly by the kidneys (about 50% of the dose taken). The pharmacokinetic profile of nimesulide in the elderly does not change with the appointment of single and multiple / repeated doses.

NIMESIL® (Laboratorios Menarini S.A., Spain)

Nimesulide

Granules for suspension preparation 100 mg

According to an experimental study conducted with the participation of patients with mild to moderate renal failure (creatinine clearance 30-80 ml / min) and healthy volunteers, the maximum concentration of nimesulide and its metabolite in the plasma of patients did not exceed the concentration of nimesulide in healthy volunteers.The area under the concentration-time curve (ANC) and the elimination half-life in patients with renal insufficiency were 50% higher, but within the pharmacokinetic values. With repeated administration of the drug, cumulation is not observed.

INDICATIONS FOR USE

• Treatment of acute pain (back pain, lower back pain; pain syndrome in the musculoskeletal system, including injuries, sprains and dislocations of joints; tendenitis, bursitis; toothache).

• Symptomatic treatment of osteoarthritis with pain syndrome.

• Algodismenorrhea.

The drug is intended for symptomatic therapy, reducing pain and inflammation at the time of use.

Sections: Pharmacokinetics, Contraindications, Dosage and Administration, Side effects, Overdose, Interaction, Special instructions – see.in the instructions for use of the drug.

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90,000 Orthodontic treatment – “Medline Lux” Clinic of functional and aesthetic dentistry at VDNKh

Congratulations on the start of your orthodontic treatment! Today you have taken the first step towards healthy, even teeth and a beautiful smile.

For the first week, it is recommended to eat soft, semi-liquid foods until you get used to the braces (yogurt, cottage cheese, porridge, puree, twisted meat, fish, etc.). Further see ORTHO-MENU.

If the bracket rubs the lips or cheeks, a piece of protective wax should be glued to it or covered with a cotton swab. After 3-10 days, the oral mucosa will adapt and the discomfort will pass. Use wax as needed.If you swallow it, it doesn’t matter, it is bioinert. If a wound has formed on the mucous membrane, first treat the damaged area with hydrogen peroxide, dry it with a cotton swab and apply Metrogyl Denta ointment. But if this is the tip of an arc or ligature, you need to make an appointment.

During the alignment process teeth may hurt – on their own and when chewing. This is a normal process, and the severity and duration of pain is individual for each patient. If necessary, you can take an anesthetic drug in an age-specific dosage (solpadein, baralgin, ketans, etc.). In a few days, the pain will surely go away!

Around the braces on the teeth, food debris, plaque, bacteria accumulate intensively, which can lead to the development of caries. Caries never develops under braces! But around the braces – it can. Excess carbohydrates (sweets, soda, buns, cookies) increase the risk of tooth decay! Therefore, it is necessary to reduce the intake of carbohydrates and pay special attention to hygiene of the oral cavity and orthodontic apparatus.

After each meal, you should brush your teeth and orthodontic appliance with a toothbrush and fluoride toothpaste. Before going to bed, special brushes and dental floss, the most convenient and effective “Superfloss” (Oral-B), will help to clean hard-to-reach places between teeth and braces. After brushing, teeth and braces should shine! You can use an electric or ultrasonic toothbrush. We also recommend using anti-caries and antibacterial dental rinses.

It is very useful to use the home irrigator (eg Waterpic, Braun Oral-B). Under pressure, a thin stream of water washes away plaque, food debris, and due to the water micromassage, the blood supply to the gums is improved. You can use herbal decoctions, antiseptic solutions.

For the best hygiene control, we recommend that you carry out a professional preventive dental cleaning every 3 months.

If the bracket comes off , fix it as soon as possible.And, in general, it is not as harmless as you might think.

Firstly, the treatment time is increased by several months, since when the braces are peeled off, the teeth very quickly move to their original position and you have to return to the weaker arches that were set at the very beginning of the treatment.

Secondly, an appointment with a doctor can be scheduled for a whole month, and it is not always possible to find free time (15-30 minutes) to re-fix the bracket.

Thirdly, you have to waste your time on unplanned visits and buy new braces, which increases your expenses for orthodontic treatment. To avoid all this, carefully read the ORTHO-MENU and follow the treatment regimen prescribed by your doctor.

Braces do not come off by themselves! Avoid excessive stress on the orthodontic appliance !!! You must remember that the effectiveness of treatment does not depend on the doctor, but also on the patient.We sincerely hope that you will follow all of our recommendations for an excellent result!

Ortho – Menu

Today you have a bracket system fixed. Each bracket is firmly and securely glued to the tooth using a special orthodontic glue. It must be remembered that a bracket system is a fragile and delicate orthodontic appliance that requires careful and careful handling. Eating hard and sticky food can cause the braces to come off and break the bows.

Remember that braces do not come off by themselves! Re-fixation of the bracket is not a planned procedure and requires additional time !!!

We have compiled a special ortho-menu that will minimize your food intake and allow you to keep all the braces for the entire treatment period.

What cannot be eaten during orthodontic treatment?

Everything is hard – crackers, bagels, nuts, seeds, chips, popcorn, puffed rice, kozinaki, chocolate with nuts, bread with seeds, corn. Braces come loose from excessive load .

Everything is viscous – toffee, gum, jelly candies stick to braces and with great difficulty are cleaned of teeth and orthodontic apparatus.

Cola and other carbonated drinks weaken the fixation of braces and increase the cariogenic situation in the oral cavity.

Do not get carried away by very cold and hot ones. Ice cream can only be eaten with a spoon.

Be very careful when eating pitted berries (cherries, apricots, grapes, peaches, watermelon, melon, pomegranate).

Do not gnaw ice, caramels, nails, etc.

When treating with ceramic or sapphire braces, in order to reduce the staining of the ligatures, limit the use of strong black tea, juices, red wine, blueberries and other coloring products.

All solid food products must be cut into small pieces or broken off, but not bite or gnaw !!!

Very soon you will find that you can eat almost anything with braces, observing the above rules.Good luck to you.

90,000 What is the connection between TMJ and ear pain?

The temporomandibular joints are the joints in front of each ear that connect the lower jaw to the skull. These joints are responsible for all possible jaw movements, movements that allow you to perform actions such as eating, talking, and facial expressions. When the temporomandibular joint is not working properly, it is called a disorder of the temporomandibular joint (TMJ).The connection between the temporomandibular joint and ear pain is primarily related to location.

TMJ and ear pain can go hand in hand, and pain in the jaw, ear, or both is one of the most common characteristics of TMJ. Others include ringing or buzzing in the ear, feeling like the ear is clogged, headaches, aching facial muscles, noises such as cracking when opening or closing the mouth or chewing, hearing loss, dizziness, feeling like someone has up and down teeth do not occur, and even vision problems.The inclusion of the ear in suffering TMJ symptoms results from the location of the temporomandibular joint close to the ear.

Doctors do not fully understand what causes TMJ, and research in the early 21st century is investigating whether TMJ is associated with other diseases or is part of a larger but as yet unidentified syndrome. Jaw disorders are part of the dentist’s care, but TMJ and ear pain are so often associated that many patients with undiagnosed TMJ often see an ear, nose, and throat (ENT) doctor rather than a dentist.Many patients with TMJ undergo costly testing and ear treatment – treatments that often fail – before being diagnosed with TMJ

Some conditions that can cause TMJ include injuries to the jaw or face; joint inflammation, such as arthritis; dental work; teeth grinding during sleep or stress; bacterial or viral infection; and disorders of the autoimmune system such as fibromyalgia, lupus, and rheumatoid arthritis.There may also be a genetic component to the disorder. TMJ mainly affects women from teens to 50, but it can also affect men.

Treatment of TMJ and ear pain tends to try to limit the stress on the joints by avoiding opening the mouth too wide, avoiding foods that are difficult to chew, taking over-the-counter anti-inflammatory drugs such as ibuprofen, applying ice or heat directly to the affected joint and wearing the bite of the guard while sleeping.Other treatments may include prescription muscle relaxers and, as a last resort, surgery. Simple home care treatments often relieve ear and tinnitus pain.