The Best Treatment for TMJ is still an open question. Surgery is rarely a first choice of treatment.

The New York Times recently reported that "the best treatment for TMJ disorders may be nothing" The New York Times has done a disservice to the public by ignoring the effect on TMJ disorders on overall health and sleep in particular.
By: Ira L Shapira DDS, FICCMO,D,ABDSM, DAAPM
 
 
Feb. 8, 2009 - PRLog -- TMJ disorders are often called The Great Imposter because the symptoms can vary widely.  The Times  quoted  scientists at the National Institute of Dental and Craniofacial Research who  recently wrote , “Less is often best in treating TMJ disorders.”  This is contrary to important work done at the NHLBI.

The National Heart Lung and Blood Institute (NHLBI) of the NIH (National Institute of Health) considers sleep apnea to be a TMJ disorder. TMJ problems are often called the Great Imposter because the symptoms mimic many other problems.

Fibromyalgia, headaches, sinus pain, jaw pain, migraines, and ear aches and are just a few of the more common symptoms of TMJ disorders. The NHLBI has a excellent report that is a must read for every patient with TMJ/TMD disorders or who has symptoms of daytime sleepiness. The report "CARDIOVASCULAR AND SLEEP-RELATED CONSEQUENCES OF TEMPOROMANDIBULAR DISORDERS" can be found at the NHLBI site at: http://www.nhlbi.nih.gov/meetings/workshops/tmj_wksp.pdf. According to the NHLBI "Reproductive age, female gender and to some extent trauma are the major risk factors for TMD" and "there are reasons to suspect that TMD patients are at greater risk for cardiovascular diseases. Many patients exhibit sleep dysfunction associated with persistent pain and inability to sleep on their side, but sleeping supine increases the risk for sleep disordered breathing. The effects of acute and persistent pain upon autonomic and motor control of these systems would be expected to impose further cardiovascular risk to these patients based upon what is already known about the effects of sleep disordered breathing."

Patients who wake with morning headaches, dry mouths or who just never feeling well rested should read "SUFFER NO MORE: DEALING WITH THE GREAT IMPOSTOR" in Sleep and Health Journal. Sleep and Health Journal is the only medical journal that covers all aspects of sleep and is specifically directed to patients. "Suffer No More" can be found at: http://sleepandhealth.com/modules.php?name=News&file=arti....

Shimshak et al published two of the most striking articles on TMJ disorders in Cranio a few years ago that showed that patients who had TMJ disorders had a 200-300% increased utilization of health resources across all fields of medicine except obstetrics.  In a period of time when the economy is in turmoil and health care costs are hurting business it is easy to be short sighted when considering TMJ disorders.  The signs and symptoms of TMJ disorders may be an early warning of sleep related problems that can lead to coronary disease, strokes, chronic pain and autonomic disruptions.

The article  the American Academy of Orofacial Pain, the disorder “usually involves more than one symptom and rarely has a single cause.”  This is absolutely true but it certainly is not a reason to avoid treatment and in fact is probably a reason to consider phase one reversible diagnostic orthotic treatment that has been shown to be very effective in reducing symptoms though it is not a cure.  It is very effective at reducing the myofascial pain component of the problem.  

There are several dental  organizations involved in treating TMJ disorders.  ICCMO, The International College of CranioMandibular Orthopedics focuses on neuromuscular dentistry and normalizing physiology.  Their website is http:// www.iccmo.org has a directory to help you find a neuromuscular dentist.  The American Academy of Orofacial Pain believes that the problem is best treated with drugs and is primarily a psychosocial disease.  It is that group that was quoted in the New York Times article.  Another major group involved in TMJ  treatment is the AACFP or the American Academy of Craniofacial Pain (formerly the American Academy of Head Neck and Facial Pain).  

The TMD Alliance represents the major TMD organizations.  ICCMO and  AACFP are among the members as well as the Academy of Pain Management.  The AOP is conspicuously absent from this group.

The American Academy of Sleep Medicine (AASM) has declared that oral appliances are a first line treatment for snoring and mild to moderate sleep apnea and an alternative treatment to CPAP for severe apnea when patients do not tolerate CPAP.  The treatment of sleep apnea with oral appliances is a specialized type TMJ treatment.  The AASM states that dentists treating sleep apnea with oral appliances should be well versed in treating TMJ disorders.  This makes perfect sense when you read the NHLBI report that considers sleep apnea to be a TMJ disorder.  Read the whole report at:  http://www.nhlbi.nih.gov/meetings/workshops/tmj_wksp.pdf.

The American Academy of Dental Sleep Medicine and DOSA (Dental organization for Sleep Apnea) are two organizations dedicated to treating sleep apnea.  Other TMJ treatment organizations including ICCMO and AACFP teach treatment of Sleep Apnea and Snoring as part of a global approach to treating TMJ disorders.

Dr Shapira a Chicago, Illinois dentist with 30 years experience in treating TMJ and Sleep disorders has created http://www.ihatecpap.com the premiere site for information on treatment alternatives for sleep apnea and snoring.  He is currently working on an extensive new site highlighting Neuromuscular Dentistry that will be found at http://www.ihateheadaches.org. That address currently leads to information on neuromuscular dentistry at his dental site. He is best known for his website http://www.ihatecpap.com that has a directory of sleep apnea dentists who treat snoring and apnea with intraoral appliances.I HATE CPAP LLC is a company dedicated to the diagnosis treatment of sleep apnea and snoring and supplies extensive information at its website www.ihatecpap.com which has a directory of dentists treating sleep apnea utilizing oral appliances.

The majority of patients diagnosed with TMJ disorders are women while the majority of patients diagnosed with sleep apnea are men.  According to the NHLBI these are just different faces of the same underlying condition which explains why TMJ disorders have the moniker "The Great Imposter"  

According to the National Heart Lung and Blood Institute TMJ disorders effect the autonomic nervous system and are intimately related with nocturnal breathing as well as daytime coughing and choking. Many patients feel as if there is a foreign object in their throats or they complain of frequent sinus pressure and/or pain but examination does not reveal any signs of infection. The entire report from the NIH (National Institute of Health is available at: http://www.nhlbi.nih.gov/meetings/workshops/tmj_wksp.pdf  .   These are some of the most common symptoms that cause patients to seek treatment of their TMJ disorders.

The reason TMJ disorders have been dubbed the great imposter is because most patients suffer long term problems and numerous physician visits without relief. The patients seek symptomatic relief of the symptoms but often are never properly diagnosed. Neuromuscular Dentistry is often the key to proper diagnosis and treatment of TMJ disorders. Information on Neuromuscular Dentistry is available at http://www.ihateheadaches.org . This web address will soon have a directory of neuromuscular dentists across the U.S.

The best Neuromuscular dentists belong to ICCMO, the International College of CranioMandibular Orthopedics. This group was founded by Dr Barney Jankelson or Dr J the father of Neuromuscular Dentistry. Their website is http://www.iccmo.org/ and they have an extensive directory of neuromuscular dentists on their site.

LVI or the Las Vegas Institute is another major institution teaching treatment of TMJ disorders as well as treatment of sleep apnea and snoring.  They teach neuromuscular dentistry as the underlying physiologic basis for all dental treatment.  It is the neuromuscular philosophy that has turned them into the premier provider of post graduate dental education.

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information on sleep apnea, sleep apnea treatment and cpap alternatives are available at http://www.ihatecpap.com This is the premiere site for the promotion of Dental Sleep Medicine and Sleep Apnea Dentisits. Sleep and Health Journal http://www.sleepandhealth.com is the premiere patient oriented journal on sleep and health issues.
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Tags:Tmj, Tmd, The Great Imposter, Aadsm, Iccmo, Lvi, Neuromuscular Dentistry, New York Times, Sleep Apnea, Snoring Treatment, Mpd, Tmjd
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