MISDIAGNOSED MEDICAL CONDITIONS
Diagnosing TMJ Disorders can be difficult as it can mimic any type of head, neck, and facial pain, so often times a TMJ Disorder can be misdiagnosed as certain medical conditions.
Also, TMJ Disorders can be present at the same time as other medical conditions in the same person, this is known as comorbidity. For example, someone with a
TMJ Disorder can also have comorbid medical conditions such as migraines, headaches, neck pain, shoulder pain, tinnitus, dizzy spells, and vertigo.
TMJ Disorder Treatment can be completed for patient's with comorbid conditions such as:
-
Oromandibular Dystonia
-
Blepharospasm
-
other Motor Movement Disorder conditions
MENIERE'S DISEASE & TMJ DISORDER
Ménière's disease describes by the American Academy of Otolaryngology-Head and Neck Surgery as a set of episodic symptoms including:
-
vertigo (attacks of a spinning sensation)
-
hearing loss
-
tinnitus (a roaring, buzzing, or ringing sound in the ear),
-
a sensation of fullness in the affected ear.
MENIERE'S DISEASE SIGNS AND SYMPTOMS
-
Episodes typically last from 20 minutes up to 4 hours
-
Hearing loss is often intermittent, occurring mainly at the time of the attacks of vertigo
-
Loud sounds may seem distorted and cause discomfort
-
Usually, the hearing loss involves mainly the lower pitches, but over time this often affects tones of all pitches.
-
After months or years of the disease, hearing loss often becomes permanent.
-
Tinnitus and fullness of the ear may come and go with changes in hearing, occur during or just before attacks, or be constant
(American Academy of Otolaryngology-Head and Neck Surgery website)
TMJ DISORDERS IN PATIENT’S WITH MENIÈRE’S DISEASE
A study (Bjorne, 1996) of 31 patients who were diagnosed with Menière’s disease and were compared to 31 control subjects. TMJ Disorder symptoms of pain in the face or jaw; tenderness over the TMJs (temporomandibular joints), tenderness over the masticatory (chewing muscles), pain on movement of the mandible; fatigue of the jaws; and pain located in the vertex area, the neck/shoulder area, and the temples were evaluated in the patients with Menière’s disease and the control group.
TMJ Disorder symptoms occurred significantly more often with the patients with Menière’s disease.
Their conclusion was: “The findings indicate a much higher prevalence of signs and symptoms of craniomandibular (TMJ Disorder / TMD) disorders in patients diagnosed with Menière’s disease than in the general population.”
TMJ DISORDER TREATMENT AND MENIÈRE’S DISEASE
A study (Bjorne, 2003) of 24 Menière’s disease patients who underwent temporomandibular joint (TMJ) Disorder (TMD) and Cervical Spine Disorder (CSD) treatment.
The results of the TMJ Disorder (TMD) treatment and Cervical Spine Disorder treatment caused highly significant decreases in the intensities & frequencies of:
-
vertigo
-
non-whirling dizziness
-
headache
-
complete disappearance of pain located in the vertex area
It also caused a highly significant reduction in the intensities of:
-
tinnitus
-
feeling of fullness in the ear
-
pain in the face and jaws
-
pain in the neck and shoulders
The results showed that a coordinated treatment of TMJ Disorders (TMD) and Cervical Spine Disorders (CSD) in patients with Meniere’s disease is an effective therapy for symptoms of this disease.
REFERENCES:
-
American Academy of Otolaryngology-Head and Neck Surgery website (http://www.entnet.org/content/menieres-disease)
-
Bjorne A, Agerberg G. Craniomandibular disorders in patients with Menière’s disease: a controlled study. J Orofac Pain. 1996 Winter;10(1):28-37.
-
Bjorne A, Agerberg G. Symptom relief after treatment of temporomandibular and cervical spine disorders in patients with Meniere’s disease: a three-year follow-up. Cranio. 2003 Jan;21(1):50-60.
-
Seppo Kuttila. Secondary aural symptoms in relation to cranio-cervical and general disorders. ANNALES UNIVERSITATIS TURKUENSIS. SARJA- SER. D MEDICA-ODONTOLOGICA, OSA-TOM. 2003)
PRIMARY HEADACHE
Primary Headaches are classified as:
-
Migraines with or without Aura
-
Tension-Type Headaches
-
Chronic Daily Headaches
-
Trigeminal Autonomic Cephalalgia (TAC)
-
Cluster Headaches
Patient’s suffering from Headaches (migraines, chronic daily headaches, tension type headaches) can also be affected by TMJ Disorder (TMD).
The definition of Comorbid is: existing simultaneously with and usually independently of another medical condition (http://www.merriam-webster.com/dictionary/comorbid)
There are several comorbidities that increase the risk of headaches:
-
TMJ Disorders (TMD)
-
Snoring
-
Sleep Apnea
-
Other: Obesity, Stressful life events, Psychiatric comorbidity
Individuals with TMJ Disorders were more likely to have migraines, chronic daily headaches, and tension-type headaches as compared to individuals without TMJ Disorder symptoms according to Dr. Gonçalves (2010) large study of 1,230 individuals who were surveyed for the comorbidity of headaches (migraines, chronic daily headaches and tension type headaches).
PROGRESSION OF MIGRAINES
The AMPP (American Migraine Prevalence and Prevention) did a study on the 1-year evolution of migraine (Lipton 2007). The results showed that over a 1 year period:
-
84% still had a migraine
-
10% had 1-year complete clinical remission
-
3% had partial remission,
-
3% developed chronic migraines (15 or more days per month)
TMJ AND HEADACHE TREATMENT
Temporomandibular disorders and headaches should be treated together but separately according to Dr. Graff-Radford (Director of the Program for Headache and Orofacial Pain at the Pain Center at Cedars-Sinai) and Dr. JP Bassiur (Director of the Center for Oral, Facial, and Head Pain at the Columbia University Headache Center). According to their article, they wrote “If there is marked limitation of opening, imaging of the joint may be necessary.
The treatment should then include education regarding limiting jaw function, appliance therapy, instruction in jaw posture, and stretching exercises, as well as medications to reduce inflammation and relax the muscles. The use of physical therapies, such as spray and stretch and trigger point injections, is helpful if there is myofascial pain.”
REFERENCES:
-
Gonçalves D. A. G., Bigal M. E., Jales L. C. F., Camparis C. M., Speciali J. G. Headache and symptoms of temporomandibular disorder: an epidemiological study: research submission. Headache. 2010;50(2):231–241.
-
Graff-Radford, Steven & Bassiur, Jennifer. (2014). Temporomandibular Disorders and Headaches. Neurologic clinics. 32. 525-537.
-
Lipton RB, Bigal ME, Diamond M, Freitag F, Reed ML, Stewart WF. Migraine prevalence, disease burden, and the need for preventive therapy. Neurology. 2007;68:343‐349.
VERTIGO, HEARING LOSS, TINNITUS
SENSATION OF FULLNESS IN THE EAR
Tinnitus sensation and other otologic symptoms have been linked to the presence of TMD(s):
-
Ear Pain (Otalgia) (Peroz, Keersmaekers et al, Seedorf and Jüde, Tuz et al, Badel, Pereira et al);
-
Badel found otalgia in 51.2% of patients with TMJ articular disk displacement using magnetic resonance imaging (MRI)
-
-
Decreased Hearing (Hypoacusis) (Ramirez et al., 2008)
-
Tinnitus (a roaring, buzzing, or ringing sound in the ear) (Pereira et al, Parker and Chole, Tuz)
-
Ren and Isberg determined a significant connection between anterior disk displacement and tinnitus in patients with TMJ disorder.
-
-
Ear fullness (Pereira et al)
-
Vertigo (Parker and Chole)
WHY EAR SYMPTOMS CAN BE CAUSED BY THE TMJ
The explanation of the cause of the otologic (ear) symptoms and signs in TMJ Disorders (TMJ) (Ramirez, 2008):
-
Embryological
-
Muscular
-
Bone communication
-
Neural network.
EAR SYMPTOMS CAUSED BY TMJ STUDY OF 2131 PATIENTS
According to a study (Kuttila, 2003) study of 2131 adults with ear symptoms in relation to TMJ Disorders (TMD), the author concluded that patients with ear pain (otalgia), tinnitus or fullness of ears, it is important to first rule out otologic and nasopharyngeal diseases that may cause the symptoms. If no explanation for otologic (ear) symptoms is found, temporomandibular and cervical spine disorders should be ruled out.
REFERENCES:
-
American Academy of Otolaryngology – Head and Neck Surgery website (http://www.entnet.org/content/menieres-disease)
-
Bjorne A, Agerberg G. Craniomandibular disorders in patients with Menière’s disease: a controlled study. J Orofac Pain. 1996 Winter;10(1):28-37.
-
Bjorne A, Agerberg G. Symptom relief after treatment of temporomandibular and cervical spine disorders in patients with Meniere’s disease: a three-year follow-up. Cranio. 2003 Jan;21(1):50-60.
-
Parker WS, Chole RA. Tinnitus, vertigo and temporomandibular disorders. Am J Orthod Dentofac Orthop. 1995 fev;107(2):153-158.
-
Pereira KNF, Andrade LLS, Costa MLG, Portal TF. Sinais e sintomas de pacientes com disfunção temporomandibular. Rev CEFAC. 2005;7(2):221-8.
-
Peroz I. Otalgie und Tinnitus bei Patienten mit kraniomandibulären Dysfunktionen. HNO 2001;49:713-8.
-
Keersmaekers K, De Boever JA, Van Den Berghe L. Otalgia in patients with temporomandibular joint disorders. J Prosthet Dent 1996;75:72-6.
-
Seedorf H, Jüde HD. Otalgien als Folge bestimmter kraniomandibulärer Dysfunktionen. Laryngorhinootologie 2006;85:327-32.
-
Badel T. Temporomandibularni poremećaji i stomatološka protetika. Zagreb: Medicinska naklada, 2007.
-
Tuz HH, Onder EM , Kisnisci RS. Prevalence of otologic complaints in patients with temporomandibular disorder. Am J Orthod Dentofacial Orthop 2003;123:620-3.
-
Ramirez et al. Topical review: temporomandibular disorders in an integral otic symptom model. Int J Audiology. 2008;47(4):215-27.)
-
Ren YF , Isberg A. Tinnitus in patients with temporomandibular joint internal derangement. Cranio 1995;13:75-80.
-
Seppo Kuttila. Secondary aural symptoms in relation to cranio-cervical and general disorders. ANNALES UNIVERSITATIS TURKUENSIS. SARJA- SER. D MEDICA-ODONTOLOGICA, OSA-TOM. 2003)
EAGLE'S SYNDROME
Eagle’s Syndrome is an elongation of the styloid process and is also known as stylohyoid syndrome, styloid syndrome, styloid-carotid artery syndrome. The diagnosis is made by radiographic imaging and clinical signs.
EAGLE’S SYNDROME SYMPTOMS:
-
pain over the TMJ area
-
referred pain to the ear
-
tinnitus
-
a foreign-body sensation in the throat (pharynx)
-
throat / pharynx pain
-
trouble swallowing (dysphagia)
-
neck pain
-
craniofacial especially the retrogoniac area
-
migraines
-
headaches
-
dizzyness
-
reduced ability to open the mouth
DIAGNOSIS OF EAGLE’S SYNDROME AND TMJ DISORDERS (TMD)
“When treating patients affected by temporomandibular disorders (TMD), complaining of atypical orofacial pain, and with a concomitant radiographic finding of a bilaterally elongated styloid, the possible coexistence of Eagle’s syndrome should always be considered. When the clinician is faced with a patient complaining of chronic orofacial pain, the diagnostic pathway may be difficult. Considering that the clinical manifestations of Eagle’s syndrome resemble those of numerous other diseases, the patient often comes to the dental office after having visited other dentists or specialists, such as otolaryngologists (ENT), neurologists or maxillofacial surgeons, who have sometimes treated the symptoms without focusing on the diagnosis. Furthermore, Eagle’s syndrome may coexist and overlap with a TMD.”
REFERENCES:
Costantinides, F. et al. Eagle’s Syndrome: Signs and Symptoms, Cranio, Vol 31, No. 1, January 2013
Casale M et al. Atypical chronic head and neck pain: don’t forget Eagle’s syndrome. Eur Rev Med Pharmacol Sci. 2008 Mar-Apr;12(2):131-3.
Guo, B. et al. Correlation between ossification of the stylohyoid ligament and osteophytes of the cervical spine. J. Rheumatol., 24(8):1575-81, 1997.
Al-Nuamee, S. The role of 3-dimensional multi-detector computed tomography in the diagnosis of Eagle’s syndrome and correlation with severe headache and migraine. J Bagh Coll Dentistry 2013; 25(Special Issue 1):72-76
Carro LP, Nunez MP. Fracture of the styloid process of the temporal bone. A case report. Int Orthop1995; 19: 359- 60.
Chourdia V. Elongated styloid process (Eagle’s syndrome) & severe headache. Indian J Otolaryngol Head Neck Surg 2002; 54: 238-41.
Buchaim RL et al. Anatomical, clinical and radiographic characteristics of styloid syndrome (Eagle syndrome): a case report. Int. J. Morphol., 30(2):701-704, 2012.
* OASIS DENTAL EXCLUSIVELY TREATS AND/OR MANAGES THE MALOCCLUSION (BAD BITE), MAXILLO-MANDIBULAR MALRELATIONSHIP AND/OR TEMPOROMANDIBULAR JOINT (TMJ) DISORDER (TMD) THAT OUR PATIENTS EXPERIENCE
* NOTHING ON THIS WEBSITE OR ANY OF THE CONTENT CONTAINED HEREIN IS MEANT TO IMPLY OR STATE THAT OASIS DENTAL, DR. RICK SOORDHAR AND/OR DR. VICK SOORDHAR CURE OR TREAT ANY MOVEMENT DISORDERS OR MEDICAL CONDITIONS.
