A few weeks ago a new patient wandered into my office with severe facial pain. For convenience lets call him Jim. Ever since a surgery to remove infected tonsils more than eleven months ago Jim has visited three other dentists who each made a mouth guard but none has resolved his discomfort. They all agreed that he has “TMJ”.
The term “TMJ” refers to the Temporomandibular Joint, which connects the lower jawbone to the skull. Everyone has two, one on the left and one on the right. When it does not function correctly the condition is termed “Temporomandibular Dysfunction” or “TMD”. TMD actually encompasses a total of nine or more possible problems that are grouped into either capsular (pertaining to the joint itself) or muscular (affecting one or more of the muscles involved in the chewing process). These other dentists tried their best to help Jim with his pain, however their dental training did not fully cover these types of problems, and there is not any one good place in our area to refer these patients. Fortunately, problems like Jim’s are quite infrequent.
Long before Jim arrived in my office I had already taken advanced training in dealing with TMD. I immediately ran him through a few simple tests which suggested that his problem was partially capsular and partially muscular. However, his severe pain went beyond what one would expect from TMD alone. I suspected that his problem had progressed into a condition termed CRPS (pronounced Crips), which stands for Complex Regional Pain Syndrome. CRPS can develop whenever a source of pain is not resolved in a reasonable period of time and the autonomic nervous system becomes stimulated. The autonomic nervous system controls all of those subconscious responses such as touch, sweat and reflexes. In Jim’s case he feels pain radiating from the corner of his jaw up the side of his face to his temple, which is so intense that he has not been able to work as a welder in months. The process of simply opening his mouth to run my tests was enough to trigger this severe pain.
Most forms of TMD can be resolved in a few weeks if caught early. Waiting nearly a year limits success of treatment and complicates matters with another layer of pain. CRPS is treated differently than TMD. As of this writing, treatment is only in its third week. Thus far anti-inflammatories such as Aleve and Advil, warm compresses, rest, corticosteroids, and another night guard have had little improvement.
Recently Jim’s father shared the enormous amount of stress that he is under. Stress is yet another component of CRPS and TMD which needs to be addressed and resolved.
So facial pain involving the Temporomandibular Joint and its associated muscles can become quite complicated. As with most health issues early intervention limits the amount of treatment and expedites its resolution. Time will be the judge of Jim’s outcome. Hopefully his pain resolves and his life returns to normal.