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tmd and its symptoms

TEMPORO-MANDIBULAR JOINT DISORDER/DISEASE (TMJ/TMD):  A collective term used to describe a group of medical disorders causing TMJ pain and dysfunction, and is estimated by The National Institute of Dental and Craniofacial Research of the National Institutes of Health to affect 10.8 million people in the United States at any given time.

When normal relationships between the condyle, the disc, the fossa and the eminence are altered or distracted for whatever reason, the result is called “Internal derangement of the TMJ”.  Internal derangement includes disc displacements, clicking, popping, stretched or torn ligaments, perforated discs, infection/ inflammation of the capsule or tissues, and adhesions of the cartilage to the socket of the jawbone.  Joint noises, especially clicking, popping and crepitus (grinding sound in the joint) are excellent indicators of internal derangements. 

When pain and dysfunction develop to the surrounding muscles and tissue, this is called “Myalgia/Myofascial pain dysfunction syndrome”.  This is usually due to persistent contraction of the chewing muscles as they attempt to keep from excessive movement.  Symptoms commonly associated with TMD include pain at the TMJ, generalized orofacial pain, chronic headaches and neck pain, earaches and ringing in the ear, dizziness and vision problems, jaw dysfunction including limited movement or locking of the jaw, painful clicking or popping sounds with opening or closing of the mouth, and difficulty chewing.  

At TMJ, Head & Neck Pain Center, clinical statistics show that both symptoms of “internal derangement of the TMJ” and “myofascial pain” are improved or relieved significantly after established the bite and TMJ to its physiologic functional position, over 90% of the time.

HEADACHES: Headaches is the number one cause of pain in the United States and there are numerous medications and treatment modalities for headaches.  However, millions of people still suffer from various types of headaches every day.

“Are headaches really an incurable disease?”

An American Medical Association study illustrates that muscle contraction headaches comprise about 90% of all headaches.  When neck and jaw muscles become dysfunctional or tight due to injury, dental distress, chronic stressful situations, abnormal habitual positioning, or whatever the cause is, this compresses the occipital and trigeminal nerve, both of which are distributed to the head, neck, face, jaw and teeth.  The occipital nerve is the most common nerve to cause headaches.  It is connected to the trigeminal nervous system, which in turn directly innervates the TMJ and teeth.

One of the most common causes of dental distress is a bad bite. Bad bites induce TMJ dysfunction which in turn compress nerves within the joint space, making neck muscles tighter, resulting in headaches. 

Another known cause of headaches is viral/bacterial infection, heavy metal deposits, and nutritional imbalance.  Through detoxification, proper nutritional supplementation, and control of viral/bacterial infections, various types of chronic headaches have been relieved in the absence of complicating medical problems. 

The Resultant Force Vector Technique provides the unique ability to reduce abnormal muscle tension and to restore balance within the body by correcting bite and establishing physiological functions.

Most headaches can be treated effectively by utilizing intra-oral appliances, eliminating infection and heavy metal deposits, and maintaining a proper airway during sleep at night.

If you suffer from weekly or daily headaches, are taking medications, injections or various treatments without knowing when the headaches will cease, or your doctor can’t give you a reasonable answer, it might be worthwhile to get a second opinion by Dr. Uparika Sharma. There is no need to continue living in constant frequent pain from headaches when in most cases, headaches can be treated fairly easily.

MUSCULOSKELETAL DISORDER:  Our body is the ultimate living machine.  But it needs a well maintained bone structure, muscle tone, nutrition, and emotional environment to function and perform properly. 

The musculoskeletal system is the master system in our body. It controls posture, breathing, gait, and body movement.  It is the system that allows you to enjoy golf, dancing, sports, working out, and sexual performance.  If you have a TMJ-musculoskeletal disorder you may experience fatigue easily, loss of balance, unstable gait, curved posture, a hunched back, tilted neck, discomfort standing/sitting, muscle pain on the  neck/shoulder/low back, shortness of breath, difficulty taking deep breaths, limited range of movement, chronic fatigue, and indigestion etc.

If you are experiencing such chronic symptoms as described above, have tried various treatment modalities  without satisfying results, you should seriously consider having a TMJ/Bite evaluation.  If the bite can be corrected,  the TMJ balance can be established in a physiological position, and the force of occlusion can be adjusted according to the direction of the muscular and bio-mechanical movement.  Most musculoskeletal originating pain can be eliminated or reduced faster than by taking pills or exercising.  

FIBROMYALGIA (FM):  This is one of the most prevalent rheumatic disorders affecting women between the ages of 25 and 55.  Most FM patients complain of generalized pain that is difficult to pinpoint which leads to the statement:  “It hurts all over” (11 out of 18 pain points).

Hundreds of prominent researchers and clinicians have spent their time, effort, and millions of dollars (maybe multi-billions around the world), to find the cause of FM and pain mechanisms.  So far, they have recognized the following as possible causes of fibromyalgia:  physical trauma, chronic pain conditions, arthritis, chronic mechanical stress, psychological distress, significant emotional stress, repetitive environmental stimuli, genetically decreased threshold, mechanical stress in the spine, automobile accident, infection, sleep deprivation, insomnia, psychosocial factors, stress, depression, anxiety, childhood trauma, irritable bowel syndrome, headaches (migraine, tension type), restless legs syndrome, periodic limb movement disorder, temporomandibular pain and dysfunction, myofascial pain syndrome, primary dysmenorrhea, chronic fatigue syndrome, female urethral syndrome, neuroendocrine dysfunction, nutritional deficiencies, hormone imbalances, chronic enzyme deficiency, central sensitization (sensitive central nervous system caused by continuous irritation of chemical, heat, touch etc), and much more. 


So called “fibromyalgia experts” have recommended the following treatment/management modalities:  exercise, muscle strengthening, aerobic fitness, pool exercise, spa therapy, ultrasound therapy, cardiovascular program, mineral bath, acupuncture, massage, nutritional supplement, chiropractic therapy, physical therapy, pain pills, muscle relaxants, and sleeping pills.  Also large pharmaceutical companies are engaged in a race to discover effective drugs for treatment.  You may soon be bombarded with “new drugs”.  

“What are you going to do for the treatment and whom are you going to seek for help?” 

Will you visit every healthcare professional or are you going to have a shot at one pain site after another?  Will you go on taking all types of pain pills?  What are you going to do about the side effects from these medications?  Or are you going to join a Fibromyalgia support group and spend time feeling sorry for yourself learning how to live with it?  

Fibromyalgia is not an intractable or incurable disease.  It is a symptom of the broken circuit in the Autonomic Nervous System (ANS) inside your body and can be cured by simply resetting it again.  “Dental Distress Syndromes” is one of the major causes of a broken circuit to ANS.  Teeth are related to the ANS via the Trigeminal Nervous System.  If we can remove the causative dental distress scenario and, re-establish physiological functions to the ANS, this can alleviate fibromyalgia within a few weeks without medication, painful stretching, exercises or any unfavorable treatment. 

The Resultant Force Vector Technique is the key for the treatment of fibromyalgia.

TRIGEMINAL NEURALGIA:  Trigeminal neuralgia is also referred to as tic douloureux, which means unbearable, painful twitch.  The symptoms of trigeminal neuralgia include a very sharp, short, electric-type pain.  Pain is triggered by touching a specific area of the skin by washing, shaving, applying makeup, brushing the teeth, kissing or even by cold air.

Because of the complexity of treatment modalities and the unpredictable treatment outcome, not many healthcare practitioners are willing to challenge this unusual symptom and only  a few  highly educated and trained individuals or hospital level of program ready facilities are available for this treatment.  Commonly, drugs such as neurontin, tegretol or injections are used to quiet nerves.  Occasionally, very  aggressive treatment modalities are implied, such as brain surgery, to separate blood vessel from nerve to relieve pressure to the trigeminal nerve (www.cedars-sinai.edu/mdnsi). 

The main nerves distributed in the face and the jaw are Trigeminal nerve and Facial nerve.  Specially, branches of trigeminal nerve are directly related to TEETH and TMJ.  Because trigeminal neuralgia caused by irritated and triggered trigeminal nerves, and malocclusion and TMJ disorder are the main nerve distressing factors, if we are able to establish bite and TMJ to its physiological functional position and, balance the teeth to various jaw movement, it can quiet the trigeminal nerve and the pain will be successfully relieved.

Resultant Force Vector Technique is the key knowledge and technique for the treatment of trigeminal neuralgia and Dr. Uparika Sharma has treated many trigeminal neuralgia patients successfully without medication or surgery.  If you are suffering from  Trigeminal neuralgia, have attempted various treatment modalities and, surgery is the only option left it will be worthy to have a second opinion by Dr. Uparika Sharma.

WHIPLASH:  Whiplash trauma involves a rapid displacement of the TM joint, neck, and upper shoulder girdle as the result of a vehicular collision or other jarring event (such as a fall).  Neck pain is the most commonly reported symptom, headache is the second.  It is not uncommon for pain and dysfunction to appear several days, weeks, months or even years after the injury.

There are various effective treatment modalities such as:  chiropractic therapy, physical therapy, massage therapy, acupuncture therapy, etc.  However, if symptoms remain after a certain number of months of therapy, the internal force vector of the incident may be perpetuated into the TMJ and alter the occlusion relationship.  This remains as a foci of dysfunction of the altered mandibular-cervical relationship, which changes the tone of the  masticatory muscles.  Until the altered TMJ-Bite relationship is corrected, some degree of symptoms may persist despite various treatment modalities.

Dr. Uparika Sharma is Certified in “Soft Tissue Injuries Resulting from Motor Vehicle Accident:  Biomechanics, Diagnosis and Testimony Preparation” from the American Academy of Craniofacial Pain and is qualified to be an expert witness, if legal issue are  involved.

UN-RESOLVED CHRONIC PAIN:  If any pain does not go away within a reasonable period of time (i.e. 3-6 months), it becomes chronic pain, and requires different modalities of treatment.  Chronic symptoms are controlled by the Autonomic Nervous System, consisting of the sympathetic and parasympathetic nervous system, which may demand long term care without the promise for progress or cure.

Traditional medicine does an excellent job with acute pain, but performs poorly with chronic pain.  Pills, injections, physical therapy, surgical intervention, applied psychophysiology, psychiatric evaluation/counseling, and “learning to live with it” are the standard treatment options for chronic pain patients. 

Alternative treatment modalities can be:  periodic chiropractic therapy, long lasting pain drugs, biofeedback, relaxation technique, behavioral assessment to cope with anxiety and distress, a healthy life style, good nutrition, sufficient sleep, acupuncture and acupressure, ice, adequate fluid, exercise etc.  This may force life style changes that were previously enjoyed and, can cause one to easily fall into depression.

The relationship between the Teeth/TMJ and abnormal muscle tension, pain, and body function is frequently ignored by the medical establishment because they cannot over-ride the influence of the teeth/TMJ on the muscle pain.  The RFV Technique identifies this relationship, and is able to correct abnormal relationships between the muscles and teeth, relieving chronic pain and dysfunction relatively easily in a short period of time.

         “Masking symptoms will not cure chronic pain.  Elimination of pain generating source will”.

If you are under a long-term pain management plan and do not know what your prognosis will be, you may be barking under the wrong tree.  It may be worthy for you to have a second opinion by Dr. Uparika Sharma.  Numerous people are freed from various pain and, are enjoying a new life after undergoing this very conservative and simple treatment.

CHRONIC FATIGUE/LACK OF ENERGY:  Many people blame their age.  Aging may be one of the factors, but there are multi-factors which cause chronic fatigue.  Improper nutrition, continuous un-resolved stress, structural imbalance, including TMJ imbalance, and chronic illness such as; diabetes, cancer, allergies, hypoglycemia, hypothyroid, poor circulation, taking multiple drugs, all have to be considered as well.  Maintaining a peak energy level requires multidisciplinary attention. 

Balancing the body structure and establishing proper body chemistry is the most effective proven chronic fatigue syndrome treatment modality.  If you have Dental Distress Syndrome, which perpetuates into TMJ, further influencing the mastication, digestion, enzyme production, and this can cause inadequate absorption/assimilation, leading to a lack of energy production and chronic fatigue. 

Dr. Uparika Sharma has extensive education and training in nutrition, food supplement, toxic element evaluation, oriental medicine, sleep medicine, compatible dental material in addition to holistic dentistry.  The majority of patients regain their energy and improve their function, regardless of age, by establishing the proper treatment protocol from these modalities and then by applying them effectively.

POST TMJ SURGERY SYMPTOMS:  25-30 years ago, various surgical methods and techniques were developed for TMJ treatment.  It was one of the most popular treatment modalities for patients whose symptoms could not be relieved by splint therapy or other conservative treatments.  However, despite some experiencing symptomatic relief, the majority of patients suffered more after surgery. 

Surgical procedures are irreversible and if a patient experiences post-surgical pain,  there is nothing much he/she can do except to go back and medicate in order to control the pain.   Because of the severity of pain and the side effects of the drugs, both patients and doctors struggle. 

These days, better non-surgical techniques and drugs are utilized, and both surgeons and non-surgeons consider surgery as the last treatment modality option.  Dr. Wesley Shankland, past President of the American Academy of Craniofacial Pain recommends, in his book, three criteria be satisfied before TM Joint surgery is attempted.  These criteria are:

All conservative treatments were a failure.  If splint therapy is a failure once, it should be repeated, with a different splint design, or by a different doctor.
There has to be a demonstrable physical or structural explanation for the patient’s complaints.  A physical problem can be seen with an MRI, x-rays, or with dye injections into the joint (arthograms).  Make certain that this is not an exploratory surgery or that the surgeon “thinks” surgery will help.
Patients must be suffering so much that they must take strong pain medication, greatly altering their life-style.  In other words, the patient must be desperate and at the “end of their rope” before surgery is attempted.

Do not permit the doctor to proceed with any invasive or irreversible procedure too soon.  Instead, insist on a referral to other practitioners who are trained to analyze symptoms, observe signs, and are adept at placing these findings into comprehensive packages.  By doing so, a correct diagnosis can be performed and a treatment determined which will include a conservative non-invasive modality. 

Post surgical symptoms are categorized into “chronic pain symptoms” and must be treated/managed accordingly because of irreversible structural changes.  If you have already undergone surgical procedure, and are experiencing prolonged post-surgical symptoms that now require prolonged medication/therapy,  and were told to live with it, contact TMJ, Head & Neck Pain Center. Dr. Uparika Sharma may be able to identify the possibility of reducing the pain level through his unique examination and assessment method.

Dr. Uparika Sharma has not referred any patients for surgery for many years, and is currently treating patients who have already had surgery, or have post-surgery complications, such as continuous pain, limited mouth opening, and limited range of motion. 

TMJ disorders are frequently unexplained, misdiagnosed, and mimic many other symptoms.  Because of this, healthcare practitioners  call it  “The Great Imposter”.  Chronic fatigue/lack of energy, stiff neck, dizziness, ringing in the ear, light headedness, blurred vision, pain behind the eye, muscle twitching, numbness or tingling, swallowing difficulty, attention deficit disorder (ADD), attention deficit hyperactivity disorder (ADHD), seizure, inability to fall into deep sleep, snoring, difficulty breathing, constant changing of position while sleeping, nasal stiffness, allergies, unstable walking, falling down often, head forward posture, unparallel shoulder height, un-corrected scoliosis, pain in the hip/leg/foot/heel, restless leg syndrome, carpal tunnel syndrome, Parkinson’s Disease, irritable bowels, may all be a part of TMJ disorder symptoms.

Some may consider these symptoms as a field outside of dentistry.  However, the fact is, many patients experience a relief or reduction of these symptoms in both intensity and/or duration after TMJ/Craniofacial treatment.