John R. Droter, DDS
Facial Pain Diagnosis and Treatments
There are over 190+ causes of head and neck pain, only some of which are caused by a damaged jaw joint. The Temporomandibular Joint is the joint between the temporal bone and mandible and is abbreviated “TMJ”.
Being told you have TMJ is the same as being told you have knee or you have elbow. TMJ is not a diagnosis on which you can base treatment. TMD is another term that is often misused. It stands for Temporomandibular Disorders, a very broad term referring to many different diseases causing pain in the head and neck area.
The TMJ is a synovial joint of the human body and will undergo the same diseases as any other joint. There are 40+ different diseases that can occur inside the joint. I use an orthopedic approach to diagnosing and treating damaged TMJs. Not all damaged TMJs need treatment, but some do.
85% of people with TMJ damage do not need any treatment what so ever!!!
Many people have damaged their TMJs (35% of the population), the disc is dislocated anteriorly, and the joint makes a clicking sound on movement. Most damaged joints adapt favorably and allow good jaw function (opening and closing), chewing, and eating pain free. As long as the clicking sound is not too annoying, these damaged joints can be well tolerated. A few people do however have jaw dysfunction and pain from a damaged joint that will need treatment. The TMJs did not adapt favorably to the damage. For them, there is treatment to help the TMJ damage readapt in a more favorable manor.
Three Types of Facial Pain
All pain in the human body is one of three types:
Nociceptive Pain- Pain from tissue
Neuropathic Pain- Pain caused from nerves not functioning properly
Centrally Mediated Pain- Pain from the brain not functioning properly
Overtop of all three types of pain is how the brain interprets pain. This is affected by stress and emotion. This is not the source of the pain, but affects the pain experience.
Different Beliefs: Different Treatments
There is not a consensus among professionals on which types of pain are the most prevalent. I find in my patients that sore muscles and joints in the head and neck are the source of the majority of facial pain (Nociceptive Pain). I find it invaluable to examine the muscles and joints by palpation (push on) , find out what is sore, and then figure out why it is sore. Therapies are then based on removing the cause of the sore muscles and joints. I do have patients who do have neuropathic pain and centrally mediated pain, but these are not the majority.
You can tell a doctor’s beliefs on the main causes of facial pain by which therapies they administer the most. I treat the physical causes of pain with an occasional treatment for the other types. (See slide below showing therapies I utilize). A doctor who believes neuropathic pain is the most prevalent, most likely will not palpate muscles and joints, but will write prescriptions for drugs like gabapentin, neurontin, and anti depressants. A doctor who believes most facial pain is caused by Psychosocial will recommend stress counseling, relaxation techniques, and anti-anxiety medication. They may recommend physical therapy for sore muscles, but believe the muscles are sore from emotional stress. While I agree that the brain’s interpretation of pain is a factor, I do not feel it is the cause of the pain. I have found if you remove the source of the pain, the pain goes away and most patients are no longer depressed.
Palpating muscles and joints and identifying which ones are sore must be part of any examination for facial pain, including headaches.
The Many Causes of Facial Pain, The Many Treatments
There are 190+ different causes of Temporomandibular Disorders/Facial Pain. The examination process, which needs to include muscle and joint palpation, will to lead to a working diagnosis on which you will be treated. A specific treatment is needed for each specific diagnosis. I utilize 70+ different therapies in my practice.