Pearls of Wisdom

TMJ: Temporomandibular Joint

The Real “Jaws”

 

 

 

Image result for no sharks allowed Image result for tmj

 

What is TMJ?

 

  The temporomandibular joint (TMJ) is a loose joint connecting the condyle of the mandible also known as your lower jaw to the temporal bone. Muscles of the mouth allow movement of this hinge joint so that the jaw can move in the upward, downward and side to side directions so that we can open and close our mouth for such tasks as but not limited to chewing/swallowing, speaking, laughing, talking, smiling, kissing and yawning ¹. Our facial expressions are attributed to the muscles of the jaw influencing the TMJ.

 

What causes TMJ Disorder?

 

  When dysfunction occurs at this joint, it can cause pain, limited jaw mobility or deviations, and even headaches. Disruption of the TMJ can be caused  by trauma whether do to poor dental work or a blow to the face, degenerative changes/arthritis, poor neck and jaw posture/alignment, excessive jaw use from bad habits of gum chewing and nail biting or the more common reason stress². Stress can lead to habitual grinding of teeth and clenching which affects the biomechanics of the jaw and muscle dysfunction due to overuse.

 

Signs and Symptoms of TMJ

 

   Some of the signs and symptoms associated with TMJ disorders include clicking and/or popping in the jaw upon opening and closing, difficulty biting or chewing, headaches/migraines, tinnitus, pain in the face including the jaw, behind the eye or front of ear, neck pain, dizziness and/or blurry vision ². Temporomandibular disorder can also cause limited jaw mobility upon opening accompanied with pain.

 

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How is TMJ Disorder diagnosed?

 

  Upon noticing these signs and symptoms, going to your doctor or dentist, they can further assess the mechanics of your jaw while listening to the sounds when opening and closing, observe your jaw mobility and press on areas you might deem as sensitive. “If your doctor or dentist suspects a problem with your teeth, dental X-rays may be recommended. Also,  a CT scan can provide detailed images of the bones involved in the joint, and MRIs can reveal problems with the joint's disk ³.”

 

Who does TMJ Disorder affect?³³

 

  It has been estimated that about 75% of the general population has at least one sign of TMJ disorder ⁴. Roughly 33% have one symptom that causes them to seek medical help ⁴. The prevalence rate is higher among those 20-40 yrs of age and are 3x as likely to be affected among women than men ⁴. Also people with high anxiety or stressful environments, persons who undergo frequent dental work and/or spend an excessive amount of time on the computer all seem to be linked to higher risk factors for having TMJ disorder ⁴.

 

Who can treat TMJ Disorder?

 

  Various health care professional scan help with TMJ disorders including Dentist, Orthodontist, Ears Nose and Throat doctors, Physical Therapist, Psychologist and Chiropractors¹. Dentist and Orthodontist can typically  provide mouth guards for you to protect against bruxism (teeth grinding) and any noted stress on the joint ¹. Ear Nose and Throat doctors can prescribe pain medication/muscle relaxers as well as provide means of treatment for any ear related symptoms as a result of your TMJ disorder. Psychologist can help reduce the stress and reduce bad habits related to cause of poor posture and teeth grinding. Chiropractors can provide joint mobilizations of the neck and jaw to help with proper alignment. Physical Therapist can help reduce pain and improve alignment by assessing and treating the muscular imbalances causing malalignment of the jaw and any cervical related issues impacting poor posture and any impaired balance/dizziness associated with your TMJ disorder.

 

Is there a cure for TMJ Pain?

 

  Yes! Depending on the healthcare provider you seek, certain treatments will be rendered. Myofascial release and gentle stretching  of the tight muscles of the jaw and neck can significantly improve posture and decrease tension of the jaw and minimize inflammation. Electrical stimulation and other modalities such as heat can reduce inflammation. Certain exercises prescribed by either your Physical Therapist or Chiropractor may help restore tongue position and improve muscle strength for areas of the neck or jaw where muscle imbalances are causing dysfunction of normal TMJ mechanics. Joint mobilizations can also help with restoring proper alignment especially if you have decreased mobility in jaw either with opening or shifting to the side. Modifying your diet initially to softer fews can provide less stress on the jaw joint and reduce unnecessary clicking and popping. Also, eliminating parafunctional habits such as gum chewing, nail biting, jaw clenching can help decrease tension on the jaw and help lessen inflammation.


 

References

 

  1. Do You Have Jaw Pain? Read This. (2016, March 14). Retrieved from https://fullpotentialpt.com/do-you-have-jaw-pain-read-this/

 

  1. Mohl, N. Functional Anatomy of the Temporomandibular Joint. Chapter 1 The President’s Conference on the Examination, Diagnosis, and Management of Temporomandibular Disorders. Published by American Dental Association June 1-4, 1982

 

  1. TMJ disorders. (2017, August 16). Retrieved from https://www.mayoclinic.org/diseases-conditions/tmj/diagnosis-treatment/drc-20350945

 

  1. Rugh, J., Solberg, W. Oral Health Status in the United States: Temporomandibular Disorders. Journal of Dental Education. Vol. 49 pgs 398-404, 1985

By Mark T. Brown
January 23, 2018
Category: Sinus

 

What are Nasal Polyps?

    Nobody wants to hear they have polyps in their nose. This is not your garden variety nasal issues. Most of the time caused by allergy, polyps are a chronic condition that is not often cured with surgery. Usually an allergist is going to provide the best long-term control. But there are times when surgery is needed, even repeatedly in the most extreme cases.

    Polyps grow in response to nasal inflammation. They are relatively discrete mounds of incredibly swollen nasal mucosa (lining). Most of the time it is something in the air that stimulates them to grow. At times, it is a sinus infection that provides the impetuous for their existence. No matter the cause, polyps are disruptive to nasal airflow and tend to cause secondary sinus infections.

 

Epidemiology and differential diagnosis of nasal polyps.

Chaaban MR, Walsh EM, Woodworth BA - Am J Rhinol Allergy (2013 Nov-Dec)

 

    Surgery is needed for polyps if medical management can’t keep them at bay and an allergist can’t help you control the environmental reaction that started them in the first place. It is by no means the first choice of treatment unless they are, sometimes quite literally, hanging out of your nose.

 

Adult-onset woakes' syndrome: report of a rare case.

Schoenenberger U, Tasman AJ - Case Rep Otolaryngol (2015)

 

The problem with surgery is it is not a permanent fix most of the time. Think about mowing the grass – it just keeps coming back.

    When someone has a significant enough polyp issue to require an ENT to take them to the OR, the surgery should be a part of the process. Combining surgery with aggressive medical management pre- and post-op is often the best way to keep you and your nose healthy.

 

 

 

Mark T. Brown, MD, FACS

 

 

 

 

 

 

 

Dr. Mark Brown is an Otolaryngologist (Ear, Nose and Throat) specialist at Great Hills ENT in Austin, TX who is double Board Certified in Otolaryngology and Sleep Medicine. Dr. Mark Brown, MD is the author of Smarter Sleep: Real Answers, Science Based Solutions, Healthier Sleep. Dr. Brown treats sinusitis, nasal congestion, nasal fractures, dizziness/vertigo, ear infections, tonsilitis, sleep apnea and insomnia for both adults and pediatrics. Great Hills ENT serves the greater Austin area including Georgetown, Cedar Park, Lago Vista, Jonestown, Steiner Ranch, Lakeway, Spicewood and Point Venture. We are proud to provide excellent care to our patients for general Ear, Nose and Throat (ENT) services, hearing loss, dizziness/vertigo and sleep disorders.

 
By Mark T. Brown, MD FACS
October 16, 2017
Category: Sinus
Tags: Untagged

 When is Sinus Surgery Appropriate?

 

 

    The official name of this sort of procedure is Functional Endoscopic Sinus Surgery (or FESS to those of us in the biz.) If you have tried everything from sinus yoga to big time antibiotics and steroids and you are still sick, it may be time to consider a more invasive but remarkably effective approach.

 

Neti Pot Austin, TX

 

    The “Functional” part of this surgery indicates that we are helping your sinuses aerated and drain properly, the way they are supposed to. Normally the sinuses are connected through small but efficient openings into the nose. If, for whatever reason (cold, allergy, distorted anatomy), those are not able to allow air in and mucous out you are set up for infection. Mucous pools, bacteria have a playground in which to grow, the infection induces swelling, and the drainage is further blocked. We give all sorts of medications to try to reverse this process. If those meds fail surgery physically unblocks the drainage. Properly draining sinuses are happy sinuses. They function normally again and your chronic infection goes away. For most people, this is a permanent fix too. It is rare that we need to go back in to reopen operated sinuses.

 

Case Report: retained gutta-percha as a cause for persistent maxillary sinusitis and pain.

Hodnett BL, Ferguson B - F1000Res (2014)

 

    The best news is what patients tell us. The vast majority of patients undergoing FESS have a real improvement in the quality of their lives. And they see their doctors a lot less often.

 

 

 

Mark T. Brown, MD, FACS

 

 

 

 

 

 

 

 

 

 

 

 

Dr. Mark Brown is an Otolaryngologist (Ear, Nose and Throat) specialist at Great Hills ENT in Austin, TX who is double Board Certified in Otolaryngology and Sleep Medicine. Dr. Mark Brown, MD is the author of Smarter Sleep: Real Answers, Science Based Solutions, Healthier Sleep. Dr. Brown treats sinusitis, nasal congestion, nasal fractures, dizziness/vertigo, ear infections, tonsilitis, sleep apnea and insomnia for both adults and pediatrics. Great Hills ENT serves the greater Austin area including Georgetown, Cedar Park, Lago Vista, Jonestown, Steiner Ranch, Lakeway, Spicewood and Point Venture. We are proud to provide excellent care to our patients for general Ear, Nose and Throat (ENT) services, hearing loss, dizziness/vertigo and sleep disorders.

 

 
By Mark. T. Brown, MD
October 10, 2017
Category: ENT
Tags: Mark Brown   Parotid Tumor  

What is a Parotid Tumor Anyway?

 

    So you have a lump on your jaw near the ear. Everybody freaks out when they have a lump somewhere, so your concern is justified. Rest assured that your ENT will figure out what is going on and help you take care of this.

 

The parotid gland is one of the salivary, or spit, glands that help lubricate your mouth and begin the process of digesting the food you are chewing. It is one of 6 major glands that provide saliva on demand when you eat – or when you are thinking about going to your favorite Italian place and your mouth starts to water.

 

Parotid Gland, Best ENT Doctor Austin, TX, Dr. Mark Brown, MD

 

Just like with any organ in the body, parotid tumors may grow. Usually (>90% of the time) these are benign. But they can be malignant so concern is appropriate. And the most common tumor, called a pleomorphic adenoma, has a 10-15% chance of becoming malignant if not removed.

 

    If you have one of these seek the advice of a professional. Better to get it taken care of than to worry about it.

 
 
 
Mark T. Brown, MD, FACS
 
 
 
 
 
 
Dr. Mark Brown is an Otolaryngologist (Ear, Nose and Throat) specialist at Great Hills ENT in Austin, TX who is double Board Certified in Otolaryngology and Sleep Medicine. Dr. Mark Brown, MD is the author of Smarter Sleep: Real Answers, Science Based Solutions, Healthier Sleep. Dr. Brown treats sinusitis, nasal congestion, nasal fractures, dizziness/vertigo, ear infections, tonsilitis, sleep apnea and insomnia for both adults and pediatrics. Great Hills ENT serves the greater Austin area including Georgetown, Cedar Park, Lago Vista, Jonestown, Steiner Ranch, Lakeway, Spicewood and Point Venture. We are proud to provide excellent care to our patients for general Ear, Nose and Throat (ENT) services, hearing loss, dizziness/vertigo and sleep disorders.
By Mark T. Brown, MD, FACS
October 04, 2017
Category: Sleep Medicine
Tags: Mark Brown   Sleep Challenge  

Dr. Mark Brown's Sleep Challenge

 

    I am going to challenge you to prove to yourself that sleep really is important to good health and well-being. I ask for 1 week of your life, Sunday through Friday. Follow these 10 recommendations and if you are not better rested, more productive, in a better mood, and feeling better in general by the weekend I want to hear about it. Really. Send me an email or letter to let me know what didn’t work. If you follow my suggestions I am confident you will understand the power of sleep.

  1. Prepare for bed every night thoughtfully. Make sure that you have time to wind down for bed every night this week. No last minute disruptions. When it is time to sleep, start getting ready and go!
  2. Follow the Eight Hour Rule. Every night, go to bed AT LEAST 8 hours before your alarm clock is set to go off. Don’t worry this week about what you are missing on TV. Record it and watch on the weekend if you must!
  3. Be cozy in your bed. Make sure that your mattress is comfortable, the sheets are clean, the pillows are fluffed, and your PJs are pressed.
  4. Your bed is sacred ground. This is your oasis from the stresses of the day. Sleep and sex and the only 2 activities allowed. Make a conscious effort to leave the day behind before you get ready to sleep.
  5. Keep the room as cool or as warm as you like it. Find the temperature that is conducive to your sleep and set it. Let your bed partner adjust to your temperature this week if they need to.
  6. Nap wisely. No naps late in the day. If you catch a little shut-eye, do it before 3 PM and make it short (less than 30 minutes).
  7. Eat smart. Have the last meal of your day at least two hours before bedtime. Going to bed with a stomach full of food is a recipe for indigestion and Insomnia.
  8. Exercise at the right time: early in the day. Exercising within an hour of bedtime can be stimulating, not relaxing.
  9. Caffeinate early (if you must). Caffeine is a stimulant. Avoid having it after 3 PM.
  10. Drink early (if you so choose). While alcohol makes you sleepy, it also interferes with healthy, regular sleep cycles. No alcohol after dinner. Water is your friend before bed.

 

    Follow these 10 steps every night Sunday through Friday. By Saturday morning, you will be better rested. Honest. And as a result, you will perform better at home and at work and be in a better mood.

    When you prioritize sleep, you will be happier, healthier and more productive. It just happens. If you do this Challenge and DO NOT feel better, there is likely more to your sleep problem than not taking care of yourself. Talk to your primary care doctor to make sure that there are no health problems looming that impact sleep.

 

Dr. Mark Brown's Smarter Sleep: Real Answers. Science Based Solutions. Healthier Sleep

 

Mark T. Brown, MD, FACS

 

Read More from Smarter Sleep

 

 

 

 

 

 

Reprinted by permission from Mark T. Brown, MD from Smarter Sleep, Clear Answers, Science Based Solutions, Healthier Sleep. Old Wives Tales Publishing, 2015.

 

Dr. Mark Brown is an Otolaryngologist (Ear, Nose and Throat) specialist at Great Hills ENT in Austin, TX who is double Board Certified in Otolaryngology and Sleep Medicine. Dr. Mark Brown, MD is the author of Smarter Sleep: Real Answers, Science Based Solutions, Healthier Sleep. Dr. Brown treats sinusitis, nasal congestion, nasal fractures, dizziness/vertigo, ear infections, tonsilitis, sleep apnea and insomnia for both adults and pediatrics. Great Hills ENT serves the greater Austin area including Georgetown, Cedar Park, Lago Vista, Jonestown, Steiner Ranch, Lakeway, Spicewood and Point Venture. We are proud to provide excellent care to our patients for general Ear, Nose and Throat (ENT) services, hearing loss, dizziness/vertigo and sleep disorders.





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