TMJ Center, Dr. Louis R. Vita, D.D.S.

Q: I had TMJ surgery about 8 years ago. I had anterior disc displacement and could not open my mouth. After surgery and up until about a year ago I felt good.I started having pain again and am wearing a nightguard sporadically. I just had a panorex today and the condylar head is very worn and it looks like there is little to no meniscus. What can I do? My dentist recomends an occlusal equilibration but will this be enough?

A:Dear Kenda, I would require more specifics to properly respond. What kind of surgery did you have and what type of night guard are you wearing? Please note that a lack of pain does not indicate a lack of continual problem. A Panorex is not specific for TMJ analysis although condylar anatomy and size can be viewed. The position, quality and quantity of the disc is impossible to determine from a radiograph. In my practise, I would stongly recommend an MRI of the TMJs and possibly a CAT scan to determine the appropriate diagnosis and treatmnet considerations. If I can be of any other assistance to you please contact me.

Q: Dear Dr Vita, I have had pain in both my teeth and face. Over the past several months, I have had 2 root canals and even had a tooth pulled out. The pain remains even where the tooth was pulled. Now my dentist said I have TMJ. Is this possible?

A:Pain that originates from the TMJ area can and often does refer sensations to other areas. This is especially true for referral patterns into the teeth because the areas are covered by the same nerve branches. Many times areas within your muscles can be overactive and knotted. These are called trigger points and they often refer pain and sensations to areas distant from their location.

Q: I am a 78-year-old man who has been suffering with Trigeminal Neuralgia for the past 20 years. I have tried so many different medications and have had gamma knife surgery without help. The pain is burning, constant, and mainly under my top denture which I cannot use due to the pain. I am at a loss and need your help.

A: Perhaps the most challenging situations we in the health field need to address is that of neuropathic (nerve) pain. First, we must properly evaluate and address any and all contributing factors. In your case, to assure you have a properly fitting denture made of non-irritating material not to traumatize the injured (trigger) area and induce pain. There are newer medications that can be considered along with newer topical medications that are applied directly to the pain areas. Please continue to pursue all possible treatment options.

Q: I have been grinding my teeth and having headaches for most of my life. I also noticed my teeth are getting smaller. I was given a nightguard which helped at first, but now the pains returned and there are holes in my guard. It was very expensive and now it doesn't work. I cannot afford to buy a new guard if it doesn't work. Do I need surgery?

A: Patients often present for second opinions after being told that they need surgery because the bite guard failed to provide relief. Just placing a piece of plastic between one’s teeth does not necessarily address the person’s specific problem. Each patient has a different diagnosis and treatment must be specific for that diagnosis. Typically, if the guard is not “working”, the design of the guard needs to be evaluated and often it is not specific for their problem. Improper guards can actually increase muscle force, spasm, and pain. I suggest that you do not consider surgery until you are first given an appropriate diagnosis and with such, an appropriate treatment plan. You should be treated by a dentist who actually treats patients with TMJ dysfunction.

Q: I have left sided face pain starting at the cheekbone to my chin. The pain is low during the daytime and gets extremely worse when I lie down and try to sleep. My doctor put me on Neurontin which does not help. My dentist said I do not grind my teeth and I agree. What could this be?

A: Pain that intensifies with positional changes, as in your case when you lie down, are usually associated with structural impingements. Something is out of place or pressing on a muscle or nerve. There are many conditions where the symptoms mimic each other. I would first suggest a comprehensive medical evaluation to include proper imagery with an MRI. Should all medical testing be inconclusive or negative, I would then investigate in more detail the TMJ and neck status for compression of the nerve, artery, and muscle.

Q: I have been diagnosed with migraine headaches by several different neurologists. Presently, I take nine pills per day with little to no relief. I am a 38-year-old mother of three and need to function for my family. My headaches begin when I wake up and are at the temples. As the day progresses, the headaches develop at the back and top of my head. This happens every day and my hair even hurts. Can you help me?

A: It is not uncommon for patients to be diagnosed with migraine headaches because the headaches are perceived as “severe” and there is nausea and/or aura. Typically, when medications do not relieve the headache, when they are located at the temples, the TMJ and bite of the teeth may contribute. Headaches located at the back and top of your head may be associated with a neck problem. I would suggest that you be examined for these areas and if properly treated, a reduction in the intensity and frequency of your headaches may occur.
Dr. Louis R. Vita

Q: I have been grinding my teeth for many years and I purchased a bite guard at the local pharmacy. Since using it, my face pain has been worse and I cannot open my mouth when I wake up. What should I do?

A: The over the counter bite guards are not specific for an individual’s problem and they cannot possibly be customized as the instructions may suggest. This also includes the sports guards purchased at a sports store. Typically, these types of guards do increase muscle spasm and strain to the TMJ, increase muscle tightness and a “Charlie Horse” feeling. I suggest that you do not use these guards and be evaluated and treated by a specially trained dental specialist for an appropriate bite guard based on your diagnosis. If you do not improve, then you must continue to seek care and pursue different opinions.
Dr. Louis R. Vita