Expert: Scott F. Gillman, DC, DACBSP - 1/3/2009

Question
QUESTION: Hello! I have a severe case of TMD.  It causes dull pain and pressure in what feels like my left ear.  It does not go away easily.  It has been recommended to me to see a chiropractor.  I have also seen a few dentists and orthodontists and they recommend jaw surgery.  My ear has been looked at by a few ENT's and there are no ear infections.  I have TMD.  I am 31 and the pain just seems to get worse.  Is there any hope of relieving the pain? What course of treatment do you suggest?

Thank you kindly!
Sheila

ANSWER: Hi Sheila,

If you do not have osteoarthritis of the TMJ, and you do not have a deranged or torn disc (there is a little fibrocartilage disc in the jaw joint), then I wonder about the reasons for surgery.  Surely the DMD's have a good reason for it.  I'm assuming you have tinkered with oral appliances, too.   You've given me little information, so it is hard to give you any specific advice.   Nevertheless, some people with TMJD get relief with the manual methods performed by a chiropractor.   Make sure the chiropractor has experience with TMJ disorders and is skilled in performing hands-on joint manipulation as well as soft tissue therapy.  Also, low level laser therapy should be considered, too.  Lots of providers have these devices and you should call around.   I would recommend a laser that has 635nm through about 850nm wavelengths (you can read about low level laser therapy at the following address:   http://www.laser.nu/index.htm    If the chiropractor has good skills, then you should notice pain reduction within a few treatment sessions.   Be sure to fill out a TMJ pain index questionnaire prior to treatment and again after a few weeks to note if treatment is working (you can do it on line at: http://www.clinicalhealthservices.com/Lenoir/      If treatment shows no changes in your TMJ index after a few weeks or a half dozen sessions, then odds are it is not likely to help IMHO.  

'Good luck.  

Dr. G

---------- FOLLOW-UP ----------

QUESTION: Hello! The reason for the jaw surgery and braces is that I have a severe open bite and the braces alone will not correct it.  As I am sure you know, jaw surgery could help with the TMD, make it worse, or leave it the same.  The TMD I have has been happening for over four years and occurs in the left side, about where my ear is and feels like a very bad ear infection and can last several days.  The worse part of the pain is the dull pain and pressure I feel against the left ear.  I saw the chiropractor yesterday and she is recommeding the following:
Chiropractic adjustments 3 times a week for 3 weeks, then 2 times a week and for two weeks, and once a week for one week and the re-assess.
Then craniosacral once a week for the next few weeks.
I had my craniosacral evaluation yesterday and a few moves were perfomed on my neck but I am still feeling no relief to the dull pain and pressure against my left ear.  How soon before I should have some kind of relief?

I hope this provides more information for you.  Please let me know your sincere thoughts.  I just want the dull pain and pressure to be relieved or better, go away.

Answer
Sheila:

1) if you are not making progress at three weeks, why continue treatment until a re-assessment?  That does not make clinical sense.  
2) craniosacral therapy is generally ineffective and its rationalle of tinkering with cerebrospinal fluid mechanics has never been proven.  It is, in my opinion, a weak and poorly substantiated treatment procedure.  
3) Since joint mechanics and range of motion can improve rather quickly with skilled joint manipulation and skilled soft tissue mobilization, then you should notice some improvements in a few visits, not a few weeks.   I am not saying that you will be 100% alleviated in a few visits, but you will know that the treatment may be working.   
4) Did you fill out that TMJ questionnaire?  That's how everyone stays honest.   
5) Soft tissue therapy requires the doctor to get a finger into your mouth and agains the inside of your jaw.  Also, from the outside of your jaw, pressing against the cheek and temple areas, there are methods of massaging while you move your jaw in different ranges, into and out of painful ranges, all while the doctor strips, debrides (if they are using Graston Technique), releases (active myofascial release techniques) or massages these areas.   If your chiropractor has not taken courses in these methods, then odds are you are not getting the best of care.  

Good luck,

Dr. G