Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
How are patients evaluated and diagnosed when TMJ problems are suspected?
A complete dental and medical evaluation is often necessary and recommended to evaluate patients with suspected TMJ disorders. One or more of the following diagnostic clues or procedures may be used to establish the diagnosis. Damaged jaw joints are suspected when there are popping, clicking, and grating sounds associated with movement of the jaw. Chewing may become painful, and the jaw may lock or not open widely. The teeth may be worn smooth, as well as show a loss of the normal bumps and ridges on the tooth surface. Ear symptoms are very common. Infection of the ear, sinuses, and teeth can be discovered by medical and dental examination. Dental
X-rays and computerized tomography (CT) scanning help to define the bony detail of the joint, while magnetic resonance imaging (MRI) is used to analyze soft tissues.
What is the treatment for TMJ disorders?
The mainstay of treatment for acute TMJ pain is heat and ice, soft
diet, and
anti-inflammatory medications.
1. Jaw rest: It can be beneficial to keep the teeth apart as much as possible. It is also important to recognize when tooth
grinding is occurring and devise methods to cease this activity.
Patients are advised to avoid chewing gum or eating hard, chewy, or
crunchy foods such as raw vegetables, candy, or nuts. Foods that
require opening the mouth widely, such as a big hamburger, are also not
recommended.
2. Heat and ice therapy: These assist in reducing muscle tension and spasm. However, immediately after an injury to the TMJ, treatment with cold applications is best. Cold packs can be helpful for relieving pain.
3. Medications: Anti-inflammatory medications such as aspirin,
ibuprofen (Advil and others), naproxen (Aleve and others), or steroids can help control
inflammation. Muscle relaxants, such as diazepam (Valium), aid in
decreasing muscle spasms. In certain situations, local injection of cortisone preparations (methylprednisolone [Depo-Medrol], triamcinolone [Kenalog], Celestone) into the TMJ may be helpful.
4. Physical therapy: Passively opening and closing the jaw, massage, and electrical stimulation help to decrease pain and
increase the range of motion and strength of the joint.
5. Stress management: Stress support groups, psychological
counseling, and medications can also assist in reducing muscle
tension. Biofeedback helps people recognize times of increased
muscle activity and spasm and provides methods to help control them.
6. Occlusal therapy: A custom-made acrylic appliance which
fits over the teeth is commonly prescribed for night but may be
required throughout the day. It acts to balance the bite and reduce
or eliminate teeth grinding or clenching (bruxism).
7. Correction of bite abnormalities: Corrective dental
therapy, such as orthodontics, may be required to correct an abnormal
bite. Dental restorations assist in creating a more stable bite.
Adjustments of bridges or crowns act to ensure proper alignment of
the teeth.
8. Surgery: Surgery is indicated in those situations in which
medical therapy has failed. It is done as a last resort. TMJ
arthroscopy, ligament tightening, joint restructuring, and joint
replacement are considered in the most severe cases of joint damage
or deterioration.
Temporomandibular Joint Disorder (Tmj) - Symptoms ExperiencedQuestion: For temporomandibular joint disorder (tmj), what were the symptoms and signs you experienced?
Headaches can be divided into two categories: primary headaches and secondary headaches. Migraine headaches, tension headaches, and cluster headaches are considered primary headaches. Secondary headaches are caused by disease. Headache symptoms vary with the headache type. Over-the-counter pain relievers provide short-term relief for most headaches.
Dizziness is a symptom that is often applies to a variety of sensations including lightheadedness and vertigo. Causes of dizziness include low blood pressure, heart problems, anemia, dehydration, and more. Treatment of dizziness depends on the cause.
Muscle spasms are involuntary muscle contractions that come on suddenly and are usually quite painful. Dehydration, doing strenuous exercise in a hot environment, prolonged muscle use, and certain diseases of the nervous system may cause muscle spasms. Symptoms and signs of a muscle spasm include an acute onset of pain and a possible bulge seen or felt beneath the skin where the muscle is located. Gently stretching the muscle usually resolves a muscle spasm.
Tinnitus is a ringing or swishing that seems to originate in the ear or head. Most of the time it is not a serious problem (it is however, a nuisance to those that suffer from the condition). Causes of tinnitus include loud noise exposure (firearms, loud music), medications, and other diseases (Meniere's disease). Treatment options are limited for tinnitus. Tinnitus can be prevented by wearing hearing protection when exposed to loud noises.
Stress occurs when forces from the outside world impinge on the individual. Stress is a normal part of life. However, over-stress, can be harmful. There is now speculation, as well as some evidence, that points to the abnormal stress responses as being involved in causing various diseases or conditions.
Toothache usually refers to pain around the teeth or jaws. In most instances, toothaches are caused by tooth or jaw problems, such as a dental cavity, a cracked tooth, an exposed tooth root, gum disease, disease of the jaw joint (TMJ), or spasms of the muscles used for chewing. A toothache can also be caused by a problem that does not originate from a tooth or the jaw, like diseases of the heart (angina or heart attack), ear infections, and sinus infections. A thorough oral examination, which includes dental X-rays, can help determine the cause.
Bruxism is the medical term for teeth grinding. Bruxism may be caused by stress or anxiety and often happens during sleep. Symptoms and signs include jaw pain, headache, and abnormalities in your teeth. Treatment may involve practicing stress-management techniques, cutting back on caffeine and alcohol, avoiding gum chewing, training oneself not to grind the teeth, and wearing a mouth guard.
Stress may be considered as any physical, chemical, or emotional factor that causes bodily or mental unrest and that may be a factor in disease causation. An important goal for those under stress is the management of stress in our lives. Elimination of stress is unrealistic, since stress is a part of normal life. We can however, learn to manage stress through techniques such as exercise, relaxation, meditation, time management, and support systems so that we have control over our stress and its effects on our physical and mental health.
Oral health problems in children include thumb sucking, tongue thrusting, lip sucking, tooth decay, and early tooth loss. Get tips on how to prevent these problems in your child.
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