77 year old white male came to the office for the routine treatment. His main complaint was an old broken removable partial denture that needed replacement. No other pain or discomfort in the face or the neck. Severe attrition was immediately noticed and the patient was advised accordingly. The patient chose not to address it at this time and proceeded directly to the restoration of interest, in this case the upper partial denture. It was completed in the conventional manner without any complications, and the bite was comfortably adjusted.
However, a week later the patient returned with the complaint about an uncomfortable bite on the left and the problem was addressed and the patient was happy for a week after numerous bite adjustments at weekly intervals. Possible TMD and TMJ was suspected, and patient was examined and questioned with this disorder in mind.
This questioning revealed that he had severe headaches since he was 19 years old. Those headaches started after the severe stress caused by the death of his mother. He was hospitalized for a few weeks and headaches were only partially controlled by the medication. For years he woke up with headache every morning, and it lasted to about 4pm. Headaches were in the frontal area, behind the eyes, in the temples. Severity was 4-6/10. He was light and sound sensitive. This was followed by the period of depression (1989-1996), and headaches became less severe after that, but never completely stopped.
On April 9 2009, he had an attack by an excruciating headache again. Oxicodon 5/325 3/4 times a day was the only medication that helped. Tylenol made pain tolerable, but did not make it go away completely.
Examination of the neck and the head did not reveal any painful muscles; however some tension was noticed in the masseter and temporalis. Mouth opening was within normal limits, and no pain or clicking of the TMJ was noticed. Neurological exam was wnl.
TMD and TMJ treatment was initiated with the diagnosis of tension type headache triggered by TMD and TMJ. Pain was dramatically reduced within a month of the start of treatment, and currently patient is completely pain free.
Please note 3 main symptoms that lead to the diagnosis in this case: severe attrition of teeth, constant bite change on the partial denture and constant headaches.
2 of these symptoms may be easily noticed in the PCP office: severe attrition and constant headache.
A 74 year-old black female was a patient in the office for the past 10 years. She had been seen regularly for her hygiene appointments and routine dental treatments. The patient never complained about any unusual pain in the orofacial area. She did have a slight clenching habit which did not bother her and was never addressed, She appeared for the routine hygiene appointment with a complaint of tender gums on the lower left. Exam did not reveal any signs of a problem. Patient admitted that this pain is not confined to just the one area, but is moving, and is in a different location every day. At the point she was examined and questioned with regards to possible TMD and TMJ: this questioning revealed that the patient had history of chronic headaches for the past 30 years. Her headaches were daily, and mostly in the morning. They were dull, lasting for hours. They were partially controlled by advil, partially would go away on their own. Frequently, her ears would clog and sometimes hurt. ENT specialist did not find anything wrong. She also experienced frequent sinus infections. Recently she had severe vision change, and increases in headaches.
Exam revealed severe painful tissue joints in the masseter,and temporalis with lots of pterygoid. Both joints had a slight click, no restriction on opening, and no deviation. TMD and TMJ treatment was instigated and pain non-drastically reduced within 2 weeks. Her headaches were completely gone within 2 months. Eyesight was dramatically improved, and as an added bonus her hair started growing again (she had to go to the hair dresser which she hadn't had to do for the last year.) Total treatment lasted 12 months from start to completion. She is being seen for something at the joint.