Tag Archive for: jaw pain

The Trigeminal Cervical Nucleus – Headache, Neck Pain, Facial Pain, and More

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This region of the brainstem and upper spinal cord is really important for our perception of our head, neck, and face. This is especially true in terms of pain.⁣
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Pain experienced in the head/neck/face have strong and fast connections to areas of the brain associated with autonomic and limbic consequences. That means that pain in these areas have a greater probability to have effects on emotions and organ function, which may explain why nausea and heightened distress and suffering are tied to chronic pain in these regions.⁣


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The reasoning is that these areas can have strong direct connections to pain modulating areas of the brain. They also have been shown to have strong effects on blood flow patterns in the arteries of the brain in animal models.⁣


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For practical purposes, we have to consider that pain in one part of the head/neck/face may be coming from another area with similar neurological origins. We should also consider that if someone has pain in one region, that we can treat another region to modulate the pain response as the actual source of injury may be too sensitized and makes the patient feel worse.⁣
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The important takeaway is that we don’t necessarily need to treat the exact site of pain in order to get a good outcome⁣
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Pain is tricky and can fool us, but an understanding of neurology can sometimes help us work around it.⁣

The Link Between the Neck and the Jaw

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Temporomandibular joint disorder (TMD) is a difficult condition to deal with. It is the most common non-dental cause of orofacial pain. It is characterized by a change to the joint of the jaw bone, which effects the chewing muscles involved and the person’s bite. TMD is a condition that causes a number of problems such as headache, neck pain, face ache, and ear ache. This condition affects more than 10 million people in the United States and is more common in women than men. Besides suffering from neck pain and jaw pain, people commonly report stiffness, popping, clicking, or locking of the jaw. This can make activities such as eating, singing, or talking difficult. [1]

The TMJ connects the jaw to the rest of your head. It’s purpose is to help guide the jaw, so that the bottom teeth are in alignment with the top teeth resulting in an even bite. When the misalignment of the TMJ occurs, the jaw muscles preform differently which causes the the muscles of the head and neck perform differently as well. If this happens, it will effect the person’s bite and possibly lead to an early break down of the joint.

How does the neck play into TMD?

The TMJ might not be the root cause for the disorder and research suggests that the structure of the head and neck plays a factor.  Evidence suggests that when there is an increase in cervical spine disorders it perpetuates factors for TMD. A cervical spine disorder being caused my repetitive motions and postural alterations of the head and neck. Another study showed that alterations in the TMJ can shift the vertebrae in the neck, especially the Atlas bone. This demonstrates their close relationship and when one of these structures shifts it can cause the others to shift as well. When this happens it puts abnormal stress on these structures where they’re connected effecting their proper function. That’s why it’s not too uncommon for a person to develop TMD after a traumatic event such as whiplash from a car accident.

The severity of TMD can vary from person to person. Some will find their TMD to be just an annoying click while others may feel a severe amount of pain and extremely limited ability to open or close their jaw. Patients who suffer with severe TMD are usually faced with the prospect of splints or surgery to fix their problem.

While some types of TMD may require surgery, many cases respond well to a structural approach to chiropractic using the NUCCA protocol. A gentle correction of the top vertebrae may be enough to decrease the jaw, neck, and headache pain as well as encourage some relaxation of the jaw muscles. When done in conjunction with a specialist in neuromuscular dentistry, many patients can experience a tremendous amount of relief.

If you are looking for conservative options to help address TMD, a Complimentary Consultation with our office can help you see if you a good candidate for this type of treatment.

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Why Pain Can’t Tell You Where You Need Treatment: A TMJ Case Study

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TMJ and neck

Jaw pain/TMJD is a very frequent problem we see in the office. It’s so frequent that I spend one day each week inside of a dental office in West Palm Beach doing consultations with a great local area dentist that specializes in pain syndromes of the jaw.

Most of the patients that see us with jaw pain have already seen a variety of jaw specialists. They’ve had MRI’s done, mouth pieces made, and various therapies done on the area of pain.

The problem of course is that pain, especially chronic pain, does a poor job of telling us what is wrong with you. Chronic pain is complex. Chronic pain is misleading. Chronic pain is also a poor locator for pathology.

Identifying the Pain Source

One of the common questions asked during a case history is to highlight or point to the area where you feel pain. It can be useful sometimes when pain patterns are reflecting specific nerve roots, and it also gives a general vicinity for a doctor to examine more closely. For most cases of chronic pain, examining the area of injury often leads to dead ends. There’s no damaged tissue to treat or remove that’s likely to explain why someone hurts.

Patients with TMJ pain frequently seek the treatment of these specialized dentists, and most of them do really well when in the right hands. However, sometimes jaw pain isn’t truly a problem in the jaw. Sometimes it’s a pain problem somewhere else in the body.

I recently took care of a patients who were was referred by another chiropractor. The patient had been to 6 different jaw and mouth specialists but could not get any form of relief from treating the jaw.

When we examined the patient, we didn’t pay much attention to the jaw itself. The patient already had imaging and tests done to their mouth already, so I wanted to spend my time elsewhere.

We found that the patient had poor motion in their shoulder and neck area on the right side. They were also showing a large amount of forward head posture characteristic of anterior head syndrome. Surprisingly, the patient’s jaw seemed to move pretty well. There wasn’t the clunky abnormal opening and closing of the jaw that you would usually see in a TMJ where the jaw displays a large side to side movement. From my view, the patient’s jaw movement looked really great, but the patient’s neck was moving poorly.

Correct the Neck and Pain Self-Resolves

We did our normal protocols with this patient. We did a gentle NUCCA correction to the patient’s neck. We post-x-rayed the neck to verify a neck improvement, and then we waited. You can see the x-ray results below.

Pre and Post X-ray shows a small shift, but an almost perfect correction.

Pre and Post X-ray shows a small shift, but an almost perfect correction.

3 days after her first appointment, we had our first follow-up appointment scheduled. The patient had gone 3 consecutive days without any jaw pain at all for the first time in 2 years!

Pretty good, but would it last?

3 months later, we re-examined the patient. The patient was now going 1 month between appointments because it would be important to see if the patient could go that long a distance between appointments without pain. The jaw was still moving normally, but now their head and neck could move in all ranges of motion smoothly. The patient also stopped showing a persistent right tilt of their head.

Most importantly, the patient could now talk with no restrictions, and had no more food limitations on what she could eat. For all intents and purposes, she became a normal teenager again.

Final Thoughts

Now if we had kept on trying to treat the jaw and identify pathology in the jaw, would she still have gotten better?

It’s hard to say, but after 2 years of doing every jaw therapy under the sun, it just seemed to make sense to look at other pieces of anatomy.

The complexity of chronic pain often means that we can’t look at things linearly. We have to know that someone has pain in one region, but we also have to think about all the different anatomy that shares a connection with the part of the body that hurts. This doesn’t mean that every person with chronic jaw pain will get better from a neck adjustment, because that’s not true either.

It means that we have to take care of people and see them for what they are globally instead of treating them as an object with a specific piece of meat that hurts today.

 

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