Dr. Howard Liss treats disorders that cause pain and disability by providing consultative services and soft tissue and joint injections when needed. When medically appropriate, he makes specific referrals for diagnostic testing (lab work, imaging, electrodiagnosis), physical and occupational therapy, interventional procedures (epidurals and facet joint injections), and surgery.
When it comes to eating, talking, breathing and expressing feelings and emotions, the temporomandibular joint (TMJ), or jaw joint, is of significant importance. Therefore, when the most used joint in the body becomes damaged or impaired, it is referred to as TMD, or temporomandibular joint dysfunction. However, many use the terms TMJ and TMD interchangeably.
Individuals may or may not experience pain with TMD, yet common manifestations include clicking, popping, grinding, difficulty opening the jaw fully and the inability to close or clench the jaw completely. On the other hand, for TMD sufferers that do have pain, headaches, earaches and upper neck pain are common. Pain is often made worse when individuals grind or clench their teeth with achiness and soreness in the bones and muscles in the face. Even so, severe cases of temporomandibular joint dysfunction (TMD) may result in dizziness. Sufferers may also have an inability to eat or speak (due to intensity of pain and muscle stiffness) and tinnitus (ringing in the ears).
For TMJ dysfunction, causes generally point to a muscular condition or increased pressure in the TMJ, leading the individual to “brux,” or grind their teeth. Specifically, masticatory muscle dysfunction, or myofascial pain syndrome, is one source of TMJ problems. Marked by tension, fatigue and spasm of the masticatory muscles, symptoms include bruxism, pain that may refer to the head and neck and impaired jaw function. It’s important to understand that nocturnal bruxism, which causes the jaw to move and shift, can lead to a poor bite or weakened teeth (occlusal dental condition). In addition, when the articular disc in the jaw joint is displaced, individuals may experience jaw pain and popping.
Other factors that contribute to TMD include mandibular misalignment, prolonged mouth opening, wisdom teeth removal, poor or weak cervical posture, neuropsychological concerns, stress, injury from whiplash, infection, arthritis or anatomical abnormalities.
Treatment and Rehabilitation for TMJ, TMD
Causes of temporomandibular joint dysfunction (TMD) can stem from congenital or acquired behaviors and jaw mechanics. A comprehensive treatment approach is necessary to classify this multifaceted musculoskeletal disorder, effectively treat jaw pain and improve mobility.
Physiatrists remain in a unique position to identify and discern disorders and conditions of many kinds. While favoring conservative, nonsurgical methodologies for pain relief and improved function, physiatrists also consult with other physicians, therapists, neurologists and surgeons as needed.
Case by case, physiatrists examine TMJ disorders through a full investigation into craniofacial structures, jaw range of motion, resting muscle tension and strength and movement patterns of the jaw. Initial treatment will center on reducing pain or discomfort. This may be accomplished through rest (keeping the jaw slightly open, so as to avoid the tendency to grind or clench), pain relievers, anti-inflammatory medication, ice or heat therapy, gentle massage or jaw realignment. Once pain and inflammation are managed and the patient’s TMD condition is determined as an “opening” issue or “closing” issue, physiatrists direct and manage treatment accordingly.
Specific problems related to an opening issue may include hypermobility of the joint (stiffness, arthritis), displacement of the TMJ disc, locking of the jaw or a spinal posture problem. In turn, TMJ joints with a closing problem are often attributed to an occlusion condition, in which the individual’s bite will need to be assessed by a dental professional.
Treatment and exercises for TMJ and TMD include:
- Biomechanics training, including posture correction and neck treatment
- Relaxation exercises
- Massage (to reduce tension and lengthen muscles)
- Joint mobilization
- TMJ timing and movement pattern correction
- TMJ stabilization exercises
At the Howard Liss, M.D. Rehabilitation Institute in Tenafly, patients can rely on Dr. Liss to put together the right treatment, therapy and rehabilitation plan to ensure the most optimal outcome. Dr. Liss works closely with other specialists required to rehabilitate patients suffering from chronic pain or serious injuries, and Dr. Liss will refer patients as needed to ensure appropriate treatment. With extensive education and exposure to a variety of conditions that affect the cervical and lumbar spine, bones, nerves, joints, ligaments, tendons, muscles, brain, and spinal cord, Dr. Liss is uniquely positioned to help patients manage their pain and maximize their functioning.
If you are suffering from symptomatic pain from TMJ or TMD, contact the Howard Liss, M.D. Rehabilitation Institute in Tenafly today.