Melanie Asked:   Can severe TMJD cause burning/stinging-like pain in various places in the head/face/ears as well as  similar sensations in extremities? I also have an elevated ERthr.sed rate and heightened pain in several areas but am a little young for temporal arteritis, though am having blurred vision at times as well?

Dr Shapira response:

Melanie, never rule out Temporal Arteritis due to severe problems can be associated with it.  TMD can be related to pain, burning and stinging in head, neck and upper extremities but not directly responsible for stinging in lower extremities.

Indirectly it can be implicated due to autonomic nervous system.  An SPG block is a simple relatively non-invasive method to evaluate connection.  Lidocaine is applied topically over the sphenopalatine ganglion in the nose.  

When nociceptive inputs from the trigeminal nerve are amplified in the reticular activating system of  the central nervous system they can predispose the entire body  to lower pain thresholds.

TMD problems also have a strong correlation to anxiety disorders that also predispose patients to entire body symptoms.

Burning is a symptom that is associated with nerve irritation or neuritis.  Stinging is often seen both with myofascial pain as well as pain associated with irritated nerves.

Temporal Arteritis, Cranial Arteritis or Giant Cell Arteritis (Neck or upper quadrants) is an inflamatory condition that can lead to blindness and other serious consequences.  Being evaluated for Temporal Arteritis has no down side.  Temporal Arteritis usually affects vessels that are branches of the carotid arteries.  

These problems are considered Idiopathic or cause unknown but they are believed to be inflamatory in nature.

Common symptoms of Temporal Arteritis include unilateral throbbing headaches and tenderness of the scalp to touch.  It is not uncommon to experience flu like symptoms with Temporal Arteritis including fever, generalized aching, loss of appetite, weakness, severe tiredness and muscle pain in upper quadrants.

Vision problems include blurred vision, double vision and partial loss of vision or blindness.  An elevated Sed rate should be considered a warning sign.  While it is possible that most of these symptoms are from a TMJ Disorder it is essential that a complete medical diagnosis rule out organic disease.

Please visit my new website http://www.thinkbetterlife.com for more information on TMJ disorders and treatment of chronic pain utilizing Neuromuscular Dentistry as part of comprehensive diagnostic work up and treatment plan.

TMJ Locking: Acute Lock Versus Chronic Lock. Acute Close Lock of TMJoint Should be reduced ASAP before Permanent Damage Occurs

Below is a blog I wrote earlier today and published in Sleep and Health Journal.  The patient presented with an acute close lock and severe excruciating pain.  A reduction of the locked TMJoint was accomplished and she was fitted with a Neuromuscular Diagnostic Orthotic.  A follow-up call to check on progress and the patient was estatic, not only was the TMJ jaw joint gone but it was the first time she could remember being headache free.  Her jaw feels the best ever since orthodontics several years ago. 

Below is the original article in Sleep and Health Journal

A frequent occurrence in high school and college age women is an Acute Close Lock of the TMJoints. This usually occurs in patients who have a history of TMJoint clicking but it can also happen following trauma. There is a disc that divides the joint into an upper compartment and a lower compartment.

As I write this article I have a college student under high stress of midterms and papers due in my chair. She has been locked about 36 hours prior to her visit has 18 mm of interincisal opening and severe pain with movement. Opening past 18 mm her jaw deviated sharply to the right indicative of Right side. After reducing the dislocation it opened straight and to 31 mm. Prior to reducing the dislocation she could move her jaw to the right without pain but even slight movement to the left created sharp pain. Protruding her jaw forward was pailful and the jaw deviated to the right. Learn more about TMJ Disorders at www.thinkbetterlife.com

For this patient the diagnosis was acute close lock (medial anterior) of the Right TMJ. Following reflex reduction of the Right TMJ she could open (forced) to 41 mm without Joint pain but there was right masseter muscle pain. An orthotic was constructed to maintain the TMJoint position. This patient was seen a few months earlier and she declined treatment because she did not want to have to wear an appliance in her mouth at school. After experiencing the severe pain of a close lock she is very happy having an appliance in her mouth. Sometimes patients decide to quit their orthotics and often del fine for several days until the TMJoint locks again.

TMJoint Locking is different than being unable to open due to muscle spasm or myositis. The treatment for myositis is different than for a TMJ close lock. The best treatment for myositis is is nsaids, possibly muscle relaxers, icing and stretching and most important, time.

The same treatment for an acute close can be a disaster, ideally you want to reduce the close-lock as soon as possible. This can be difficult and sometimes is done under IV anesthetic or without and the oral surgeon manipulates the jaw to reduce the dislocation.

The alternative which is usually easier is to stimulate the opening reflex that instantly relaxes all of the elevators Mouth closing muscles) of the mandible and activates the opening muscles (supra hyoid muscles and infra hyoid muscles) This reflex gives instantaneous opening straight down like a snake and allows disc recapture. It is extremely important to have an emergency orthotic to prevent recurrence of dislocation. As soon as the disc dislocation is reduced the joint will begin healing, if your joint is in a closed lock continuing damage is occurring.

An open lock TMJ is completely different treatment. This occurs when there is a subluxation or movement of the condyle out of the joint and I will discuss in a future article. This is usually secondary to trauma, a wide yawn or over-opening to bite into sandwich or apple.

TENSION HEADACHE AND TMJ Disorders: Highland Park / Lake Forest NEW OFFICE OPEN December 2014

Tension Headaches are a type of Trigmeminal Nerve innervated muscle contraction headache. They are closely related to TMJ Disorders (TMD) and postural distortions like a forward head position. Tension Headaches and Chronic Daily Headaches are essentially variations of Muscle Contaction Headaches. Frequently severe muscle pain headaches are called Migraines or Atypical Migraines but are in reality primarily caused by muscle trigger points.  My new office dedicated to treatment of TMJ disorders and Sleep apnea  is opening in Highland Park in December 2014

It is important to remember that all muscle contraction headaches are a form of repetitive strain injuries. When there is a postural distortion or bite problem the muscles adapt to protect the whole If there is an acute injury Muscle Splinting will occur. This is where the muscle tighten to protect an injured site.

The good news is that Neuromuscular Dentistry can usually quickly and effectively correct these problems. My new Highland Park office dedicated to treating TMJ disorders, Headaches, Migraines and Sleep Disordered Breathing visitwww.thinkbetterlife.com for more information on TMJ Disorders and Neuromuscular Dentistry. WWW.ihateheadaches.org is another excellent site concerning chronic headaches and correction with Neuromuscular Dentistry.

Muscle Splinting is normal, in fact it is ideal on a short term basis to protect an injured joint, muscle or tendon. Problems arise when Muscle Splinting is no longer needed but Chronic Muscle Contracture occurs. This will often result in Tight Bands in the Muscle and Trigger Points in the tight bands.

Myofascial Pain and Dysfunction is when there is chronic muscle shortening with associated trigger points. It is similar, in many ways to Fibromyalgia but is more regional in nature. TMJ Dysfunction Patients (TMD) frequently have widespread myofascial Pain and Dysfunction throughout the Head, Neck, Shoulders and Upper Back.

Trigger points and muscle problems tend to spread from one area of the body to another as the muscles continually try to adapt to protect the whole. Unfortunately the muscles work past their Adaptive Capacity. When there is widespread muscle pain, taut bands and pain the condition is called Fibromyalgia and it is often treated as a Rheumatic Systemic Disease but frequently it is best addressed one area at a time, correcting function and eventually having the entire system working again as a single unit.

Patients with chronic pain often develop Alpha Intrusion into Delta Sleep which is the marker for Fibromyalgia. The deep sleep is disturbed resulting in increased pain and sympathetic nervous system activity.

Sleep disordered breathing greatly contributes to these problems. Patients may snore loudly or have sleep apnea where they periodically quit breathing but the female patients and younger, thinner heather males and females often have UARS or Upper Airway Resistance Syndrome that leaves them tired and sore and ruins their sleep but without the classic symptoms. Learn more about Sleep Apnea and UARS at www.ihatecpap.com that discusses sleep disordered breathing and comfortable alternatives to CPAP for treating these airway issues.

Sleep Well Illinois is a new company working to do universal sleep screening in Physicians offices to help identify these patients.

TMJ Help Sites; Creating a TMJ Support Group in Highland Park for Chicago and North Suburban TMJ sufferers.

I HATE Headaches.org is the ultimate TMJ Help site for patients with Chronic Headaches.  Patients in the Highland Park/ Lake Forest and Deerfield areas of North Suburban Chicago have a new resource www.thinkbetterlife.com

Dr Shapira would like to create a TMJ support group in the Highland Park Lake Forest area for patients with chronic headaches and/or TMJ disorders.

My new office is at 3500 Western Ave in Highland Park Illinois across from the Fort Sheridan Train Station.  It is dedicated to helping patients with acute and chronic pain problems including headaches, migraines, sleep apnea and TMJ disorders associated with the teeth, jaws, jaw joints and posture

This was originally published as a press release:

Highland Park, IL: Innovative Treatment Protocols for Fast Relief of TMJ (TMD) Disorders: You Deserve a Better Quality of Life

Improving the quality of life of patients from the North Shore and Chicago. You deserve a better life! Thinkbetterlife.com is your doorway to your better life.

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    CHICAGO, IL, October 15, 2014 /24-7PressRelease/ -- Patients who are living with TMJ disorders, TMD and Chronic Tension Headaches, Sinus Pain or Migraines want relief now. http://www.ThinkBetterLife.com is the new website dedicated to patients seeking quick relief and of TMD disorders and headaches. Long term correction of these disorders always starts with quick relief of the current pains.

Many patients think that TMJ (TMD) disorders are only treated with splints. Dr Ira Shapira utilizes a multifaceted approach to giving patients quick and lasting relief from their chronic pain. He utilizes Diagnostic Neuromuscular Orthotics and has over 30 years experience in Neuromuscular Dentistry. He trained with Barney Jankelson the founder of this field and with Bob Jankelson, his son. In addition to utilizing Neuromuscular Dentistry he is one of only a handful of practitioners to utilize SPG Blocks (Sphenopalatine Ganglion Blocks), Trigger Point Injections and Spray and Stretch techniques to treat Myofascial Pain and Muscle pain from Fibromyalgia. He trained with Dr Janet Travell who wrote the book Myofacial Pain and Dysfunction: A Trigger Point Manual.

Dr Shapira spent years doing research into sleep apnea and its connection to jaw position. His early research was done as a Visiting Assistant Professor in the 1980's at Rush Medical School in The Sleep Disorder clinic. He worked closely with Dr Rosalind Cartwright the acknowledged Mother of Dental Sleep Medicine. Dr Cartwright recruited Dr Shapira to return to Rush as an Asst Professor in the 1990's till early this century.

The connections between impaired nasopharyngeal breathing and development of ADD and ADHD in children was the topic of a recent lecture Dr Shapira gave in Buenos Aires, Argentina. The development of chronic TMJ disorders, headaches, migraines and postural distortions were all discussed at his lecture to members of ICCMO, The International College of CranioMandibular Orthopedics of which Dr Shapira is a Fellow and Secretary. Dr Shapira is a representative from ICCMO to the American Alliance of TMD Organizations.

In the 1990's Dr Shapira was a star lecturer for the A4M, The American Academy of Anti-Aging Medicine where he presented his work on the effect of TMJ disorders across ones lifetime. Premature aging and loss of memory and even dementia and Alzheimers disease are part of the same ongoing problem. Sleep Apnea and snoring are types of TMJ disorders according to the National Heart Lung and Blood Institute of the NIH in their report: Cardiovascular and Sleep Related Consequences of Temporomandibular Disorders.

Dr Shapira has been utilizing a multifaceted approach toward relieving chronic pain associated with TMJ disorders for over 30 years and is now bringing his expertise to the North Shore Communities of Chicago. He created www.IHATECPAP.com which addressed Sleep Apnea and snoring and utilizing oral appliances to treat these problems. He also created www.ihateheadaches.org that focuses on many types of headaches and the role of Neuromuscular Dentistry in providing relief of these problems.

The DNA Appliance is offering a possible cure for sleep apnea and TMJ disorders by growing the jaws utilizing Epigenetic Orthodontics. Until recently it was believed these changes could only be accomplished through extensive surgical procedures.

Dr Shapira has also studied Cranial Suture Release techniques and Chirodontics. He inroduced these concepts to a Chiropracter who is his friend and colleague, Dr Mark Freund . Dr Freund has embraced these concepts in totality and has become an expert in these techniques through immersive studying both in the US and Internationally. His primary office is in Lindenhurst but he also sees Cranial patients in Gurnee in Dr Shapira's office www.delanydentalcare.com.

Dr Freund will be treating patients in Dr Shapira's Highland Park office. These techniques treat not only TMJ Dysfunction but also postural distortion such as forward head posture that leads to headaches and neck pain. These postural distortions can have negative effects throughout the entire body.

Dr Ira L Shapira created the I HATE CPAP and I HATE HEADACHE websites to help patients find help with these difficult medical disorders that medicine can frequently not treat adequately without a dental collaboration. Dr Shapira did research in the 1980's as a visiting assistant professor at Rush Medical School where he worked with Rosalind Cartwright PhD who is primarily responsible for the entire field of Dental Sleep Medicine. He also studied with Dr Barney Jankelson who created the initial concepts that neuromuscular dentistry still uses today and created a company Myotronics that is the leading manufacturer of instrumentation used by Neuromuscular Dentistry.

Dr Shapira is a Diplomate of The American Board of Dental Sleep Medicine, a Diplomate of the American Academy of Pain Management, and a Fellow of the International College of CranioMandibular Orthopedics (ICCMO). He is a former national and International Regent of ICCMO, its current Secretary and the representative to the Alliance of TMD organizations or the TMD ALLIANCE has a general dental practice (http://www.delanydentalcare.com) in Gurnee, Il and has recently started Chicagoland Dental Sleep Medicine Associates with offices in Skokie, Schaumburg, Chicago, Vernon Hills and Bannockburn. Patients in Northern Illinois or southern Wisconsin can contact Dr Shapira by phone toll free at 1-8-NO-PAP-MASK OR 1-800-TM-JOINT or thru his websites at http://www.ihateheadaches.org orhttp://www.chicagoland.ihatecpap.com.

Dr Ira L Shapira is an author and section editor of Sleep and Health Journal, President of I HATE CPAP LLC, President Dato-TECH, and has a Dental Practice with his partner Dr Mark Amidei. He has recently formed Chicagoland Dental Sleep Medicine Associates. He is a Regent of ICCMO and its representative to the TMD Alliance, He was a founding and certified member of the Sleep Disorder Dental Society which became the American Academy of Dental Sleep Medicine, A founding member of DOSA the Dental Organization for Sleep Apnea. He is a Diplomate of the American Board of Dental Sleep Medicine, A Diplomat of the American Academy of Pain Management, a graduate of LVI. He is a former assistant professor at Rush Medical School's Sleep Service where he worked with Dr Rosalind Cartwright who is a founder of Sleep Medicine and Dental Sleep Medicine. Dr Shapira is a consultant to numerous sleep centers and teaches courses in Dental Sleep Medicine in his office to doctors from around the U.S. He is the Founder of I HATE CPAP LLC and http://www.ihatecpap.com Dr Shapira also holds several patents on methods and devices for the prophylactic minimally invasive early removal of wisdom teeth and collection of bone marrow and stem cells. He is currently working with Dr Tom Diekwisch at the University of Illinois to prove these stem cells can change peoples lives for the better. Dr Shapira is a licensed general dentist in Illinois and Wisconsin.