TMJ

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I found this post on immunesupport.com

Wallace

*What is Fibromyalgia?* TMJ & NICO connection 11/15/03 04:02 AM

Sorry guys, another long article which I have pieced together from

several articles which explains Fibromyalgia, TMJ & NICO Lesions, -

a connection for some.

I have a friend with fibro that developed after a road accident.

Also an interesting piece on root canal and jaw infection at the

end.

Happy reading...

What is Fibromyalgia?

(Fibrositis, myofibrocytis) is a chronic, painful muscle condition

characterized by pain in the skeletal muscles, tendons (which

attatch muscles to bones), ligaments (which attach bones to bones)

and bursa (sac-like structures which are filled with synovial fluid

and provide lubrication and nutrition to joints). Recently, much has

been written about this disorder in health magazines and newspapers.

Although Hippocrates first described fibromyalgia, it has been only

in the last few years that much attention (and credence) has been

given to this syndrome. Controversy and disbelief by the medical

profession has been associated with fibromyalgia simply because

objective evidence in the form of x-rays or biopsies can't be found.

However, with the use of thermography, or the measuring of heat

produced by areas of the body, this syndrome is now more widely

accepted by many, but not all, doctors.

SYMPTOMS. Fibromyalgia is characterized by generalized muscle

soreness and stiffness lasting more than three months, poor sleep

with morning fatigue and stiffness, tenderness at 11 of 18 specific

sites, and normal blood test results. The more common painful areas

are the low cervical spine, the shoulder, the second rib, the arm,

the buttocks and the knee. These symptoms are often worsened by

stress or a change in the weather. Depression, which may be due to a

chemical imbalance in the brain or the development of chronic pain,

is common with fibromyalgia. Virtually all physical activity not

only increases the patient's pain complaints, but also makes the

next few days miserable, producing intense muscle pain.

11 of 18 specific tender points are required for the diagnosis of

fibromyalgia to be made.

CAUSES. Fibromyalgia may be caused by physical trauma (such as a

motor vehicle accident, a sudden fall, or even the trauma of surgery

with a general anesthetic). This terrible disorder may also begin

after an illness like the flu. Often, women experience the effects

of fibromyalgia due to hormonal changes after a hysterectomy or

around the time of the beginning of menopause. Also, the sudden

emotional trauma of the loss of a loved one may trigger

fibromyalgia.

Many " experts " feel that fibromyalgia effects only those people

with " Type A " personalities, but this notion has not been

demonstrated either by statistics or by scientific experimentation.

It may plague people with all types of personalities and life

styles, all age ranges, and those in all states of health. However,

many of those suffering with fibromyalgia also suffer with TMJ.

CONDITIONS ASSOCIATED WITH FIBROMYALGIA.

Many other physcial conditions are found frequently along with

fibromyalgia. Each of these can and do occur separately; however,

they are also quite commonly associated with fibromyalgia.

TMJ. Many patients suffering with TMJ problems alsosufferer with

fibromyalgia. Unfortunately, many doctors (1) don't recognize either

TMJ or fibromyalgia or (2) fail to see the connection of these two

pain syndromes. Fibromyalgia almost always intensifies the painful

symptoms of TMJ and when one or both temporomandibular joints are

dislocated, the pain of fibromyalgia in the neck and upper back is

greatly magnified. Both TMJ and fibromyalgia produce similar painful

symptoms in the muscles of the neck, shoulders, back, face and head

as well as often causing dizziness.

Chronic Fatigue Syndrome.

This debilitating disorder, just like fibromyalgia and TMJ, is often

misdiagnosed and at best, misunderstood by many medical

professionals. In addition to chronic fatigue, CFS, just like

fibromyalgia, produces muscle pain and weakness.

Irritable Bowel Syndrome. Nearly half of all patients with

fibromyalgia have frequent bowel cramping, severe diarrhea, and

severe abdominal pain.

Depression. As with most conditions which produce chronic pain,

depression is a common problem with fibromyalgia. Common depression

symptoms include a feeling of low self esteem, helplessness,

hopelessness, poor appetite, loss of sexual drive, sleeplessness,

frequent crying, and basic lack of interest in life.

Anxiety Disorder and Panic Attacks. Often, those aflicted with

fibromyalgia also experience extreme anxiety and panic attacks,

especially at nighttime. They may awaken in terror with their heart

beating rapidly, their chest feeling tight with a feeling as if

breating is impossible. The patient will be convined that they are

going to die. There are many causes of such attacks, and perhaps

alterations in certain body chemicals produced in excess with

fibromyalgia may be one cause.

Concentration and Memory Problems. Like those suffering with severe

TMJ, patient with fibromyalgia often report difficulty in thinking

and even remembering. They often forget where they've parked the car

at the mall, for example. Simple facts and numbers are often

forgotten. Understandably, great frustration often accompanies these

memory problems.

Irritable Bladder. Those with fibromyalgia often complain of

frequent, painful urination. Although they feel as if their bladder

is infected, urine and blood tests are negative.

Mitral Value Prolapse. There may be a statistical correlation with

those suffering with mitral value prolapse (a weakness in the mitral

value of the heart) and fibromyalgia. Since the mitral value is

mostly fibrous connective tissue, perhaps the same process that

effects other connective tissue of the body (eg, musles, ligaments,

tendons and bursae) also damages the mitral value of the heart.*

Fibrocytic Breast Disease and Endometriosis. Although there is no

known explaination (yet!), both fibrocystic disease of the breast

and endometriosis are often seen in women with fibromyalgia.*

TREATMENT.

Treatment of fibromyalgia is physical therapy, trigger point

anesthetic injections, stress management, non-steroidal anti-

inflammatory drugs, dietary changes and antidepressant drugs,

especially at bedtime. Recently, there has been a lot of research

concerning the use of herbs and homeopathic remedies (eg, Vitamin C,

Rhux Tox 6x, melatonin, magnesium, and many others) in the treatment

of fibromyalgia.

Physical exercise, preceeded by stretching and followed by

application of ice, is very beneficial. One of the worse things a

sufferer of fibromyalgia can do is to become sedentary and inactive.

You'll only gain weight, become depressed, and lose all desire to

participate in life.

TMJ and FIBROMYALGIA. Many sufferers of fibromyalgia also suffer

with TMJ problems. In fact, each of these disorders make the other

far worse than they'd be alone. When one or both TMJs are injured,

the muscles in the head and neck automatically tense-up, develop

trigger points, and, among other symptoms, intensify the symptoms of

fibromyalgia. Unfortunately, many doctors who effectively treat

fibromyalgia do not understand or recognize TMJ and visa versa.

Also, many patients suffering with TMJ have been misdiagnosed as

having fibromyalgia.

What is TMJ?

Many people, even doctors, nurses, and insurance companies, use the

term TMJ. But what does this abbreviation mean? The term TMJ is an

abbreviation for Temporo-Mandibular Joint, or the jaw joint. In

fact, there are really two TMJs, one in front of each ear. The TMJ

is the joint formed by the temporal bone of the skull (Temporo) with

the lower jaw or mandible (hence, mandibular). These joints move

each time we chew, talk or even swallow. The TMJ is actually a

sliding joint and not a ball-and-socket like the shoulder. This

sliding allows for pressures placed on the joint to be distributed

throughout the joint and not just in one area. The TMJ is the most

complex joint in the human body. Placed between these two bones is a

disc, just like the one between your back bones. This disc is

primarily made of cartilage and in the TMJ acts like a third bone.

The disc, being attached to a muscle, actually moves with certain

movements of the TMJ.

The nerve to the TMJ is a branch of the trigeminal nerve and

therefore, an injury to the TMJ may be confused with neuralgia of

the trigeminal nerve. The two bones of the TMJ are held together by

a series of ligaments, any of which can be damaged, just like any

other joint. A damaged TMJ ligament usually results in a dislocation

of the disc, the lower jaw, or both. Also, the bones are connected

by two main muscles: the temporalis, the masseter, and a muscle just

discovered by Dr. Shankland, the zygomandibular. Any or all of these

muscles may be painful and produce pain in the TMJ or at the very

least, abnormal movement of the lower jaw.

Because many different symptoms of TMJ exist, discovering a proper

diagnosis is difficult. However, there are a few classic symptoms

which involve the TM joints, ears, head, face and teeth.

TMJ CLICKING

The most common symptom of TMJ is jaw joint clicking (popping,

snapping). This clicking sound may be so loud that it can be heard

by others while you chew. There may or may not be pain in the joint

itself with the sound of a click or pop. But one thing is for sure:

if there is a displaced disc, as is usually the case when a click

occurs, then the muscles that move the jaw while chewing are more

tense than normal. This tenseness can and does cause muscle, facial,

head and neck pain.

TMJ LOCKING

Locking of the TMJ may be noticed simply by catching of the lower

jaw as it opens. Sometimes, the person with a locked joint must move

the jaw to one side or another in order to open wide. Or, a person

might have to open until he hears and feels a loud pop, at which

point the jaw actually unlocks.

CHANGE IN BITE

A dislocated TMJ may also be noticed by a change in the dental

occlusion, or bite. If the TMJ disc goes out of place, the bones and

disc do not fit together properly and therefore, the bite of the

teeth changes.

EAR SYMPTOMS

Due to the close anatomical relationship of the TMJs to the ears, an

injury to the TMJ often causes various ear symptoms. Some of the

symptoms may be ear pain, fullness or stuffiness, and even a loss of

hearing. That's why so many TMJ sufferers first see their family

doctor and an ear specialist before even considering seeing a

dentist for a possible TMJ problem

HEADACHE

Headache is one of the most common symptoms of a TMJ problem.

Usually the TMJ headache is located in the temples, back of the

head, and even the shoulders. Clenching and grinding of the teeth,

both of which may be TMJ symptoms, produce muscle pain which can

cause headache pain. Also, a displaced disc in the TMJ may cause

pain in the joint which is often referred into the temples, forehead

or neck. These headaches are frequently so severe that they are

confused and treated (with little success) for migraine headaches or

abnormalities in the brain.

SENSITIVE TEETH

The teeth may become sensitive because of jaw activities such as

clenching of the teeth or grinding of the teeth when the disc of the

TMJ is displaced. Patients often see their dentist with the

complaint of pain in the teeth and usually the doctor can find no

cause. Frequently (and very unfortunately), unnecessary root canals

and even tooth extractions are performed in an attempt to help a

suffering person. What's worse, after these invasive and non-

reversible procedures, patients still have their pain, only now it

has increased!

OTHER SYMPTOMS

Many other symptoms may be associated with TMJ. Often, pain will be

felt in the shoulders and back due to muscle contraction, a

condition called myofascial pain dysfunction syndrome. Dizziness,

disorientation and even confusion are also seen in some people who

suffer with TMJ.

Depression is common with TMJ. This may be due to the fact that no

one really believes there is a problem causing such pain and

suffering. Also, plenty of scientific evidence shows that chronic

pain patients (which nearly all TMJ patient can claim) have changes

in chemicals in the brain (termed neurotransmitters) as result of

the pain. These chemicals can and do produce depression. Along with

depression comes an inability to get a good night's sleep. This may

be due to TMJ pain itself or, changes in the brain's

neurotransmitter chemicals which produce stimulation even though the

TMJ sufferer is asleep. Sufferers usually wake feeling like they

never slept or at least, did not sleep well. This lack of sleep not

only makes their pain seem worse, but also adds fuel to the fire of

depression.

TMJ patient may also suffer with photophobia, or light sensitivity.

A dislocated TMJ may produce pain in and behind the eye which can

cause sensitivity to light. Blurred vision and eye muscle twitching

are also common in TMJ patients.A final common symptom is ringing

(termed tinnitus) in the ears. This sound may be caused by many

different problems (such as, working around loud noises or taking

too much aspirin or ibuprofen).

Common complaints following a CAD or Whiplash injury may include:

Neck pain

Neck stiffness (difficulty in turning the head)

Headaches (especially, temporal and occipital --where neck attaches

to head)

Back pain

TMJ symptoms (joint pain, limited opening of the mouth, change in

bite, TMJ noises, pain in face and TMJs with mouth opening, ear

pain)

Dizziness

Visual changes (light sensitivity, blurred vision, etc.)

Swallowing difficulties and even hoarseness

Air Bag Deployment--

Direct trauma to the mandible in auto accidents, like indirect

trauma in whiplash injuries, are both known to produce TMJ injuries.

Recently, however, the advent of air bags, which no doubt have saved

numerous lives, has been implicated in causing TMJ problems.

Personally, I've seen several patients in the last couple of years

who have been hit only with air bags which deployed when the car was

impacted in an accident. Patients who've been injured with air bags

often have the following symptoms:

Burned or abraded skin on the chin, face and even the nose

Almost immediate TMJ pain

Swelling of the TMJs

Limited mouth opening

Lateral and cervical neck pain

Change in the dental occlusion (bite)

Opening Too Wide

All joints have limitations to movement and the TMJ is no exception.

If you open wide for a long time, or if your mouth is forced wide

open, ligaments again may be torn. Swelling and bruising develop and

disc dislocation may occur. For example, if your mouth is open for a

long time at the dental office while having a tooth prepared for a

crown, the joint can dislocate. This rarely happens without a prior

history of trauma; however, it does happen. Also, this type of

injury may occur if someone's mouth is opened too wide when they are

being put to sleep for surgery. Again, both of these examples are

accidental and consequences of the given procedures.

Bruxism

Bruxism is the abnormal grinding of the teeth. If grinding

continues, TMJ may develop. Bruxism usually occurs during sleep.

That is why so many people do not realize that they are bruxers. One

indication that a person is a bruxer is sore jaw muscles when waking

in the morning. Some researchers feel that the constant grinding of

the teeth causing pressure on the TMJs may injure the ligaments,

thus allowing for the disc to dislocate. At the very least, bruxism

produces muscle pain, sensitive and worn teeth.

Malocclusion--

Malocclusion is simply a bad bite. Malocclusion may be produced by

poor development of the jaws or removal of teeth without

replacement, a high dental restoration, a poor fitting denture or

partial denture, or a displaced TMJ disc.

Orthodontics

Some dentists feel that orthodontic treatment, or braces, might be a

cause of TMJ. By moving teeth with orthodontic appliances,

malocclusion is produced during treatment. Also, people undergoing

orthodontics do report sensitive teeth, pain in the jaw muscles and

even bruxism. However, as with malocclusion, there has been no

scientific controlled study to prove that orthodontic treatment

produces a TMJ problem.

Ligament Laxity

People who appear to be double-jointed actually suffer from a

problem termed Aligament laxity. If this occurs, then the joint

appears to be double or, loose. This definitely can happen to the

TMJ's. Ligament laxity is a fairly common problem in active young

women who suffer with TMJ (and injuries to other joints).

Stress

Stress has many effects on our bodies: some good and some bad.

Stress, being both physical and psychological. Physiological changes

can produce muscle tightness and pain and if you are subjected to

chronic stress, these physical changes may produce harmful effects.

For example, people subjected to chronic stress develop ulcers,

diarrhea, tension headaches, muscle tightness and other physical

symptoms. Stress is just like throwing gasoline on an existing fire:

the fire is a TMJ problem and the gasoline is stress. The gasoline

causes the fire to flair up and burn widely for a time, but the gas

did not produce the fire (or, TMJ), it just made it worse. This is

how it appears that stress acts in conjunction with a TMJ problem.

Muscles tighten, teeth clench, abnormal pressure is forced against

the TMJ disc, and if the ligaments are weak or if the patient is one

that has ligament laxity, then the disc may dislocate.

Systemic Diseases

Various diseases can cause or aggravate TMJ problems. Immune

disorders such as rheumatoid arthritis, psoriatic arthritis, and

systemic lupus erythematosus can produce inflammation in the TMJ. In

addition, viral infections such as mononucleosis, mumps and measles

can cause damage to the surfaces of the TMJ, which ultimately can

lead to an internal derangement.

Systemic Problems Associated With NICO Lesions

The term NICO -- Neuralgia Inducing Cavitational Osteonecrosis-- has

been used when pains such as severe facial pain, neuralgia,

headache, or phantom tooth pain accompany NICO lesions. Although

bone cavitations (hole in a bone where progressive disease process

in the jawbone, which kills bone cells and produces a large

cavitation area or areas within the jawbones) can be common, only a

small percentage (we think) suffer with pain. However, even those

who have cavitational lesions with no apparent pain complaints may

very well suffer from unknown systemic problems. Researchers early

in the 20th century and now recently have been concerned with

systemic diseases caused by a primary problem (a focus of

infection). The focal theory of infection fell out of favor with

medical and dental doctors after the advent of antibiotics, but many

researchers today believe that in spite of antibiotics, the focal

theory of infection is alive and well. Ask and veterinarian doctor,

and he or she will immediately agree that the focal theory of

infection is a great concern of theirs.

In other words, many researchers today believe that NICO lesions are

the focus of various infections which may spread throughout the

body. In the last year or so, some of the most surprising medical

news has been the discovery that bacteria from the mouth appear to

be very influential in causing various heart problems. Could NICO

lesions be associated?

Occurence of NICO Lesions

With the use of an experimental device (the CAVITAT), cavitational

lesions of various sizes have been discovered in 94% of wisdom tooth

sites! Worse yet, the Cavitat found cavitations under 100% of teeth

treated with root canal therapy in both males and females of various

ages from several geographic areas of the United States. Do root

canals also cause NICO lesions?

Initiating, Predisposing, and Risk Factors for NICO

There are many initiating, predisposing, and risk factors associated

with cavitational lesions. It's likely that a combination of these

factors present in a someone may influence the occurrence, type,

size, progression and growth patterns of a cavitational bone lesion.

Initiating Factors: Probably the major initiating factors are dental

trauma, which produce physical, bacterial, and toxic components.

Wisdom Teeth Sites: Research findings indicate that 45% to 94% of

all cavitational lesions are found at wisdom teeth extraction sites.

These areas are anatomically predisposed to develop these bony

lesions because they contain numerous tiny blood vessels which are

apparently, easily damaged from trauma (oral surgery in these areas)

and osteonecrosis can easily develop. Also, many local anesthetic

injections are given in the wisdom tooth areas and many of the local

anesthetic solutions contain vasoconstrictors (especially

epinephrine) which is used to intensionally close or shut-down the

blood supply to the bone, teeth and gingiva to prolong the effects

of the anesthetic and reduce bleeding. The actions of closing down

the blood supply to these wisdom tooth areas may be a major cause

for NICO development.

The results of research in Germany indicate the jawbone may be a

holding tank for chemicals and heavy metals, especially at the

wisdom tooth sites. Clinical experience indicates it's sometimes

difficult for some patients to successfully detoxify mercury from

the body until both the bone cavitations AND mercury fillings are

removed.

A 44 year old lady had left lower jaw pain for a couple of years,

after the last two molars were treated with large fillings, then

root canals, and then removed. She also had a slow drainage into her

mouth which produced a sore throat. During her surgery, when I

removed the dead bone in this area, she surprisingly said: " My calf

pain is gone! My leg feels normal. " Among her many symptoms, one was

left leg and calf pain.

Imagine, a lesion in a jaw bone causing pain in a leg. These bony

lesions can and do cause remote and systemic pains.

Unfortunately, this lady saw at least 7 doctors (a dentist, 2 oral

surgeons, a periodontist, an endondontist, 2 ENT physicians, and a

family physician) and all could find nothing and even suggested she

consult a psychologist!

Recommended Treatment of Cavitational Lesions of the Jaws

The only treatment available at this time to removed cavitational

lesions is surgical removal. Some have attempted to inject

homeopathic remedies into these areas of dead bone, but

unfortunately, there's no blood circulation within cavitational

lesions, so any medications, drugs, or remedies can't get into and

permeate these lesions, let alone allow toxins and metabolic

products to be removed. Homeopathic remedies certainly have their

place in NICO treatment, especially in healing after surgical

removal of the lesions themselves.

The surgery basically consists of making an incision, exposing the

bony defects, and scraping them clean (termed debridement) to remove

all unhealthy bone and other pathological problems like abscesses

and cysts. It's not sufficient to simply punch a hole in the bone

and rinse the area out, like some doctors recommend. In fact,

treating these expanding bony lesions in such a conservative fashion

often makes the lesion and subsequent pain much worse.

After removing the dead bone and other pathological products, the

goal in healing is bone regeneration. But first, if possible, we

remove all predisposing and risk factors.

What Can A Patient Do?

If you think you might have a NICO lesion, what can you do? First,

find a doctor who understands this disease process; one who is

trained in effectively diagnosing and treating these bony problems.

Unfortunately, there are precious few such doctors in the world and

probably less than 10 in the United States at this time.

Don't allow anyone to operate without first proving where your pain

originates. This is done most effectively by closly evaluating x-

rays and using diagnostic anesthetic injections to actually turn-off

the suspected NICO areas to see if the pain is turned-off. There are

characteristic referred pain patterns of NICO lesions and there are

also characteristic responses to local anesthetic testing. Find a

doctor who knows about these characteristic patterns and realize

that most doctors who treat orofacial and TMJ pain know nothing

about NICO lesions.

You can also get good advice on the Internet at NICO and APS NICO &

Chronic Pain Forum. Here, you can talk with NICO patients and learn

probably a lot more than you want or need to know!

Dr. Shankland consults and treats NICO, orofacial, and TMJ patients.

If you have any questions, please call Dr. Shankland's office (614-

794-0033) and ask for the NICO Information Packett to be sent to you

free of charge. You can also consult with Dr. Shankland.

I gleaned this info from Dr Shrankland site if interested.