Tinnitus, TMJ, Headaches, Neck Pain, Facial Pain, etc. — Possible Treatment

Serves me right for being dozy. Should have woken up and realised it wasn’t your story @just1morething ... I’ll go back to sleep now...

 

My noise came back when I woke up. I think I will try prolotherapy to left TMJ joint in addition to neck exercises. I had neck prolotherapy years ago.

According to the American Dental Association, more than 15% of American adults suffer from chronic facial pain.1 One of the most common causes is Tempomandibular Joint Disease (TMD), a collective term used to describe a group of medical disorders causing temporomandibular joint (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.2It occurs predominantly in women, with the female to male ratio ranging from 2:1 to 6:1, with 90% of those seeking treatment being women in their childbearing years.3,4

The TMJ is often predisposed to similar degenerative changes and pathologies seen in other synovial joints as a consequence of the frequent and repetitive stresses that the TMJ undergoes.5Symptoms commonly associated with TMD include pain at the TMJ, generalized orofacial pain, chronic headaches and ear aches, jaw dysfunction including hyper- and hypo-mobility and limited movement or locking of the jaw, painful clicking or popping sounds with opening or closing of the mouth, and difficulty chewing or speaking.6 While pain is the most common symptom, some people report no pain, but still have problems using their jaws. Sometimes the bite just feels “off.” Additional symptoms may include ringing in the ears, ear pain, decreased hearing, dizziness, and vision problems.7

The first-line approach to managing TMD typically includes resting the jaw, relaxing the jaw muscles, and doing jaw exercises as recommended by a physical therapist.8 Recommendations may also include eating a soft diet that minimizes hard repetitive chewing of crunchy or chewy foods, such as bagels and steak. All gum chewing must be stopped, talking minimized, and teeth clenching discouraged. Relaxation exercises that emphasize gentle range of motion of the joint are recommended. Application of warm compresses to the affected area twice daily, for 10 minutes, to decrease pain and increase joint movement are done. If this fails, then typically a short course of an anti-inflammatory medication such as ibuprofen is prescribed and often a dental consultation is given. The dentist then evaluates the patient for malocclusion and bruxism. Many times, a mouth splint used at night can completely resolve or control the problem.

When pain, clicking, and locking symptoms persist, TMD sufferers commonly seek out the advice of a myriad of TMJ dental and surgical specialists. Because the causes of TMD are varied and run the gamut from mechanical issues—such as disc degeneration and dislocation or erosion of the fibrocartilagenous surfaces of the condyle, fossa and articular eminence—to hormonal as well as psychological causes,9,10,11 the treatment approaches for the chronic TMJ case are also quite varied. As surgery is considered a last resort for TMD, it is common for sufferers to seek out alternatives and one of the treatments they may consider is prolotherapy.

This article presents a retrospective analysis of patients who received dextrose prolotherapy to their tempomandibular joints, and was conducted on a patient population from a charity clinic in rural Illinois. Patients were called by an independent data collector and asked numerous questions concerning their response to the dextrose prolotherapy they received. The data was analyzed in all TMJ pain patients, as well as a subset whose medical doctors told them there were no other treatment options for their TMJ dysfunction and pain.

Prolotherapy Modality
Prolotherapy, as defined by Webster’s Third New International Dictionary, is “the rehabilitation of an incompetent structure, such as a ligament or tendon, by the induced proliferatin of cells.” “Prolo” comes from the world proliferate. Prolotherapy injections proliferate or stimulate the growth of new, normal ligament and tendon tissue.12 In human studies on prolotherapy, biopsies performed after the completion of treatment showed statistically significant increases in collagen fiber and ligament diameter of up to 60%.13

Prolotherapy is based on the concept that the cause of most chronic musculoskeletal pain is ligament and/or tendon weakness (or laxity). Prolotherapy has been shown in one double-blinded animal study over a six-week period to increase ligament mass by 44%, ligament thickness by 27%, and the ligament-bone junction strength by 28%.14 Another animal study confirmed that prolotherapy induced the normal healing reaction that occurs when an injured tissue is healing itself. In this study, the prolotherapy caused the circumference of tendons to increase by approximately 25% after six weeks time.15

Prolotherapists have a long history treating TMD since the time of Louis W. Schultz, MD, DDS in the 1930’s. Dr. Schultz was unique in that he was both a dentist and a medical doctor. He was an Associate Professor in the Department of Surgery at the University of Illinois and Rush College of Medicine. He published several papers on the treatment of subluxation of the temporomandibular joint, including one in 1937 in the Journal of the American Medical Association.16 In this paper he described just how common TMJ syndrome was and that the traditional treatments of rest, appliances in the mouth, physical therapy, and surgery were only partially successful. He described a simple method of shortening and strengthening the TMJ capsule by injection (later termed prolotherapy). He tested various solutions in animals until he found one that caused a strengthening of the ligaments that support the TMJ but caused no injury to other structures.17 In regard to prolotherapy into the TMJ he found that:

• There was no alteration of the normal joint cavity; the proliferation occurred in the ligaments.
• There were no gross changes in the ligaments other than their thickening.
• Lymphocytes infiltrate the area injected within 30 minutes.
• Proliferation of tissue can be seen in four to six days.

He found that a series of three to five injections were required to often permanently stop the clicking, pain, and hypermobility of the TMJ joint. Dr. Schultz noted that over the course of his twenty years of doing prolotherapy for TMD, not only was it effective, but the treatment lacked significant side effects.

Dr. Schultz taught the technique of TMJ prolotherapy to Gustav S. Hemwall, MD. The primary author has worked with Dr. Hemwall and eventually assumed his practice upon his retirement from medicine in 1996. After acquiring Dr. Hemwall’s practice, Dr. Schultz’s son came to the clinic for a prolotherapy evaluation. He commented that in his father’s many years of practice as a dentist, medical doctor, and surgeon, the procedure that gave him the most amount of satisfaction in treating a TMJ case was prolotherapy.

 

Take a few minutes and read all 4 Blogs

https://www.medhelp.org/user_journa...in-and-head-and-neck-position-Elegant-ecology

 

Not sure if this is right place to put this. I woke up with basically a locked jaw this morning. When i woke up i noticed i was clenching. My jaw has been hurting for a while so um now wondering if its tmj.

Is it also possible a message to the neck can make the tinnitus worse by inflamming the jaw and neck?

 

@Fally Hit on my link above your post and continue to 'Dear Mark'. Read all 4 blogs. You may be doing more than just clenching. You may be twisting your jaw to one side to get it locked. There are several conditions (I have articles) that can be involved and most relate to dental - dental trauma and/or whiplash. Back posture and head heading will place more pressure on your jaw and neck. Stress or being upset is not a friend of the jaw.

Questions:
Any recent dental work?
Any neck injury or whiplash?
How is your posture?
Do you do a lot of forward head bending?
Do you move your tongue around during the day?

The neck sends messages to the jaw. The jaw can sent messages to the neck, but that's less common.

Treatment - Injections into the jaw. Sleep on side with face sideways to pillow with arms relaxed in any preferred position. A small soft pillow under neck.

 

I actually read it last night Greg ironically, and when i woke up i was like hmm. It was an interesting read and made sense. Ive had bad issues with my neck for as long as ive had my tinnitus which i thought was interesting. I also do have noise induced tinnitus but that came 8 months ago.
I havent had any dental work recently no, 2 years ago i did. I do have bad posture my physio told me as i get a lot of hip, neck and shoulder pain because of it. Not sure if i bend my head forward a lot. No it tends to stay on the top of my mouth a lot.

I ment to say massage not message lol. I had a massage two weeks ago for my neck and jaw and i feel like it might have inflamed everything because my tinnitus went haywire.

 

@Fally It's good to know that it's not dental related with no facial aspects as that would mean volumes of information - a hundred pages of possibilities would need to be considered.

I will only mention soft finger touch massage in my posts, but not based on my knowledge, but on neurologist findings. According to so many professionals (I have links) including the Back in the Game Wellness series, the occipital nerves and cervical facet roots cause necks problems, jaw problems and tinnitus. Stretching and posture exercises for the neck. Digastric muscle exercise is very important for the jaw - this can be found on YouTube.

 

Would it be worth going and getting my jaw checked by a dentist or is it better to go to my physio?

 

@Fally I would see a dentist for any structural considerations. I don't know if a mouth guard or a special appliance would be best for your locking jaw, but the dentist (link) recommends an appliance. I've read articles where other dentists recommend the same.

I would try gentle posture, stretching and digastric muscle exercises. Then maybe later some light gentle sternocleidomastoid and trapezius trigger point therapy - all from home. Your neck is part of your jaw problem, so you want to do only gentle treatments. I had tinnitus since April 2010 and the only thing that works for me and others that I talked too is posture training and gently stretching the neck upwards. Digastric light massage helps to relax my jaw.

 

If your jaw locked go in ASAP to an oral and maxiofacial surgeon. If that is what happened, you have a slipped disk and they can put it in rather quickly. If you waste your time with a mouth piece or dentist you will probably never get that disk back in place. No amount of stretching will put that disk in place unfortunately and a mouth guard is likely to mess up your bite.

 

The stretching and posture exercises are for his sore neck to relieve pressure that will associate to the jaw. Yes, he should see a dentist for any jaw structural changes. Then if he needs advanced care his dentist can get an appointment quick.

 

If it's locked jaw you really don't want to waste your time with the dentist and you don't want to be over stretching your neck if you have an acute closed lock. Otherwise you risk stretching the ligaments that keep it in place and they will never go back. You have about a two week window before the disc will never go back.

 

How do I know it is a slip disc though? I can open my mouth find now just pain, i only noticed it this morning that when i opened it was really painful.

 

One way is put your finger in your ear canal (just a very bit) and you can feel the disc slip or reduce back in place. The other option is to open your mouth in front of a mirror. Your top and bottom jaw should be perfectly aligned the whole way. You should be able to fit three fingers and your mouth should not deviate to either side during opening. If your disc has slipped it will deviate towards that side and you will most likely have to move your jaw ever so slightly to the side to reach full range of motion.

 

Healthtap - Jaw lock with neck pain and ringing
Dr. Lauren Elson
"The temporomandibular joint can get stuck from a variety of reasons." " The most common cause are tight muscles in your neck and jaw. When these muscles press on nearby nerves, you can get ringing in the ears".
Neck stretching is recommended as part of combined treatment.

We don't know for sure if he has a slipped disc problem, but again he should seek dental assistance. I can't get to see a specialized dentist the same day unless I'm in pain, but my regular dentist can send straight to an oral surgeon which in my case is in the same building.

 

I assumed the OP was American. In which case if you tell them it's a closed lock they will get you in within a week, at least I was able to at the Mayo Clinic. You can tell by how much range of motion you have. If it suddenly becomes around 30mm then a closed lock is very likely. According to the four TMJ surgeons at the Mayo Clinic, and multi day TMJ class they hold... You can wait and take your time but if it's muscle tension it is not closed lock. That is simple NOT how the anatomy of the TMJ works. Now a deranged disc that is partially reducing... this type of disc displacement with reduction can be affected by muscle tension since it is affecting the translation of your condoyle and your articular cartilage as your disc reduces (or not). But this would never prevent you from opening the jaw as the OP stated. It would just cause a shift or a deviation.

 

It all seems fine

 

I should point out im in Australia. Things work very differently here you often need referrals to surgeons and stuff. I would have to most likely have to see a dentist before going to a surgeon. I am going to the doctor in half an hour to talk to her about it and see what she recommends.

 

Agreed - from own situation and readings of professionals.

I started to get a partial locked jaw. My oral said nothing other than no treatment is needed.

I did digastric muscle massage, stretching occipital and deep fiber nerves and that helped with everything. Sternocleidomastoid treatment also helped. We're all different, but the areas that I focused on solved eye pain, blood shoot eyes, throat, headaches, partial tinnitus, partial facial and so much more. I don't use a mouth guard or other appliance as it was negative for me, but many others may receive benefit. TMJ is not solved as I have mouth nerve damage from dental which caused other mouth complications. Basically I received dental whiplash - lower jaw pressure with muscle spasms of neck - the short version.

 

Doctor said its definitely tmj said its from my clenching due to anxiety and has given me valium to see if i stop clenching and are more relaxed. If not after 2 weeks then we go ahead with another plan.

 

@Fally - Sound right. I would also consider the easy gentle ideas for posture and neck. Take care.

 

She wants to see how i go with the valium for two weeks to see if it calms it down. Then when i am taken off it we move onto what you just said about the posture and neck gentle ease.
thank you so much. You take care as well

 

Glad it worked out! I'm assuming when you said you had a locked jaw... that isn't what you meant?? A locked jaw has a hard stop, can open less than a finger width and you can't eat or get food in your mouth...

 

Just an FYI a closed lock is often considered an emergency and you don't need referrals. Like I said previously you must not have been experiencing a real closed lock scenario. Here's a nice article that explains this scenario in its most conservative treatment is unlocking with manual manipulation while your jaw is numbed so it releases. https://www.peertechz.com/articles/...losed-lock-of-the-temporomandibular-joint.pdf

If it is locked and you wait over three weeks it progresses into a degenerative disorder.

 

@kelpiemsp, Is this the TMJ Dr. you were going to see or have already seen at Mayo Rochester? My noise is really bad and think it's from my left TMJ. Do you take muscle relaxers? Thanks for any replies.

https://www.mayoclinic.org/biographies/reid-kevin-i-d-m-d/bio-20054311

 

Yes! He was the one I saw. He was excellent. However, he is not going to agree one iota with much of what is said by TMJ dentists or what you read here.

 

What do you mean by that? I wonder how I can see him. Did you need a referral? Did he say TMJD can cause loud noise in your ears/head?

 

@just1morething Sp5 receives input from the oral structures such as the temporomandibular joint. Susan Shore and others are all over this within this link. So many other articles discuss the temporomandibular complex and the many facial conditions that can also associate to the neck, dental and so many lifestyle habits - like oral care, posture and neck bending. Often with physical tinnitus there may be several things going on which could be started by just a primary or two.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2566901/#R60

 

@Greg Sacramento, I just need this tormenting noise gone ASAP. I'm going to try to see the TMJ Dr. from Mayo. If there is a fix I need it right now. Nobody would stand this noise I have atm. I would like to try muscle relaxers again but I had a auto accident in 2017 while on Robaxin so it's difficult to get prescribed.

 

I had to have my primary care doctor send a one to two page summary of all treatments etc that I had used for TMJ. Then I had to send them all imaging studies. After I sent everything over, and my Doctor sent the essay (it's funny thinking she had to write an essay) they contacted me and said they would see me. In my case, they determined that treatment (surgery) would be counter productive because my joint had adapted to its new position and if I learned to relax and stop fighting this new position it would heal. This is called adaptive change instead of degenerative.

I think if you mention tinnitus as the primary reason they won't see you. Tinnitus is a small fish the pond of chronic pain syndromes.

I have been taking small amounts of Valium and flexaril for the past 7 months for the muscle tension as well as 600mg of magnesium.