Dr. Shapira's Chicago Headache Blog

All patients with TMJ disorders especially if they get morning headaches or are tired during the day should be evaluated for sleep apnea. Sleep apnea (see www.ihatecpap.com) is a collapse of the airway during sleep.

Patients with clicking or popping TM joints will frequently have resolution of the TM Joint (temporomandibular joint) clicking if they wear a sleep apnea oral appliance.

The appliance stabilizes the condyle of the TMJ forward and if the disc is reduced allows time for the soft tissues to heal and stabilze the disc.

This stabilization will require the use of a daytime neuromuscular (splint) orthotic to maintain joint stability during the day.

Labels: CGRP neuromuscular dentistry, chronic daily headaches, facial pain TMJ, improving quality TMD, morning headache, temporomandibular joint, TMJ clicking, TMJ pain, TMJ popping

Brenda comments : I HAVE HAD AN ANTERIOR DISC DISCPLACEMENT A YEAR AGO AND HAVE BEEN IN CONSTANT PAIN EVER SINCE. NOW BOTH SIDES HURT AND I AM VERY DISCOURAGED. HAD AN ARTHROCENTESIS THAT DID NOT WORK, I AM ACTUALLY WORSE. IS THERE ANY HOPE? I WEAR A BITE GUARD AT NIGHT AND SLEEP ON MY BACK. JUST STARTED TAKING LYRICA WHICH DOESN'T SEEM TO WORK. PLEASE PLEASE HELP ME. THIS HAS CONSUMED MY LIFE FOR THE PAST YEAR.


Dr Shapira Response:

Dear Brenda,

Yes there is hope, but there are no magic cures.

It is often thought that all the pain is from the joint but that is rarely the case. Many times we can eliminate the pain but reduced motion due to internal derangement continues. Does it only hurt when you move your jaw or is the pain continuous? You stated it was constant. Joint pain is almost always associated with jaw movement. Costant pain is usually from many different areas.

You mentioned you wore an appliance at night. If you have major instability wearing an appliance only a night is not sufficient. 24 hour wear of an neuromuscular orthotic is essential especially during the healing process. I never have patients undergo invasive procedures like arthrocentesis without a stabilizing neuromuscular orthotic. You did not say what caused the dislocation but usually patients are predisposed to dislocation due to their bite. I feel correcting the bite with a 24 hour orthotic should precede surgical intervention.

When I treat patients we work thru their pain, we initially shoot for a 50-80% pain reduction and that is usually relatively easy, We then try to relieve 50-80% of remaining pain. I like to describe my onion analogy. Treating pain is like peeling an onion, when you take away one layer you find a similar but different layer. Some layers may belong to the orthotic, some to trigger point injections etc. You work yourself thru the layers until you reach the hard white center, You without pain.

Unfortunately when you first dislocated the disk it wasn't immediately reduced. There are many techniques to reduce pain however it is impossible to determine what the best treatment is without a complete examination and history.

i would be happy to have you come for an evaluation. We have many patients who come from long distances (much farther) for treatment. You probably would have approximately a 2 1/2 hour drive to get here. Contact my office at 800-TM Joint for an appointment if you would like to have me evaluate the problem. In many cases we can give significant pain reduction at the consultation appointment. We are relatively close to the Milwaukee airport and very close to (private)Waukegan airport. We have a hotel at the country club that gives my patients discount rates.

If that is impossible I will try to find a neuromuscular dentist closer to you but many doctors do not have the experience and knowledge to treat more difficult cases. I can also work with a doctor in your area.

Labels: constant pain, consumed my life, ever since, TMJ getting worse, TMJ pain, TMJ worse after arthrocentesis

Patients with morning headaches usually have either TMJ disorders or Sleep Apnea. Sleep Apnea can be treated with CPAP or an Oral Appliance. Patients who have TM Joint clicking and are undergoing treatment for headaches or TMD can benefit in several ways from having a night-time apnea appliance and a daytime neuromuscular orthotic.

A problem that is sometimes encountered with oral appliances for sleep apnea are undesired bite changes. These changes can actually be helpful when treating TMJ clicking and popping and headaches. The bite changes that occur are actuallly the healing of the TM Joint. The jaw usually postures forward unloadding the retrodiscal lamina of the TM Joint that is compressed in patients with clicking. The retrodiscal lamina rehydrates and does not let the condyle go into retrusive pathology which serves to stabilize the disk.

The Daytime appliance allows this position to stabilize and heal. In patients who are not undergoing treatment exercises are done to prevent this healing from occuring. The joints will frequently heal if placed in a healthy position. A recent paper showed no damage to the joints with sleep appliances.

The American Academy of Sleep Medicine recommends that dentists fitting patients with oral appliances for sleep apnea be well versed in treating TMJ disorders. There are many good reasons for this recomendation. Dentists who do not uderstand how bite changes affect the joints and the muscles as well as head posture can create difficult problems they do not have the expertise to treat. Please check my I HATE CPAP website (http://www.ihatecpap.com) for more information about the dangers of sleep apnea and on how oral appliances are used in treating sleep apnea.

Labels: AASM, American Academy of Sleep Medicine, bite Changes, cluster headaches, headaches, neck pain, SLEEP APNEA, TMD, TMJ, TMJ clicking, TMJ pain, TMJ popping, TMJD