Expert: Susan Tannenbam - 11/16/2008

Question
Hello Susan! I read through many of your other answers, and I wanted some advice about my condition. About 3 months ago, I started get sharp pains near my ear, where I believe the jaw joint is. I thought it was an ear problem, but after a few regular doctors, I finally decided to go to an ENT. She's the one that told me she believed the pain was being caused by tmj. She suggested I take advil or alieve to make inflammation go down, but I refuse to live my life on pain killers. I went to my dentist who believes it could be tmj or an impacted wisdom tooth. So, she reccomended I go to an oral and maxillofacial surgeon. His name is Jonathan Kameros. Have you heard anything about him? I am scared he will suggest the wrong treatment and make things worse. What do you recommend I agree to and what should I not allow him to do? I hope he will be able to make the diagnosis. Do xrays give the diagnosis or do you know if there are other ways they can tell? I am just so frustrated and depressed about these spontaneous pains. They come and go as they please. They don't really hurt when I open my mouth or chew; I'm not really sure what triggers the pain. Also, how can I tell if I am clenching or grinding my teach? Will the oral surgeon know the cause? Any advice would be greatly appreciated. I just want this pain to go away and not get any worse! Its interfering with my life and relationships. Thank you!

Answer
Stephanie,
IT's really better if you try to relax about this.  Pain feeds on anxiety, and really there is no reason to panic at all.  TMJ is simple:  we clench/grind our teeth in our sleep (almost everyone does it but to different degrees), and this makes the muscles around the jaw tighten up.  The pain originates in these muscles but it can travel into other areas such as the teeth, gums, neck, head, upper back.  Many times there is nothing wrong with the tooth that hurts, and the dentist might not realize the pain has just travelled from the tight muscles into the teeth.

ANyway, there are various things you can do to alleviate the pain, as you can see in past questions I have answered on this site.  THe most important thing is to get a hard custom fit nightguard.  Mine fits on the bottom teeth and is very comfortable.  I wear it every night.  You'd be surprised how much it helps.  I rarely if ever get any pain anymore.

My dentist does not think surgery is the way to go, and I feel that is much too extreme, especially for someone that hasn't tried other things.  My pain was horrible and constant, and I did not get surgery.

I do not know the doctor you mention, but if you do have an impacted wisdom tooth he can see it on an X ray, and it should be taken out. I personally wouldn't have any surgery for TMJ, EVER (but of course I'm not a doctor/dentist so I can't advise you either way).  

As far as how you can tell if your pain is caused by clenching,  a dentist can tell by your symptoms and an examination (not by Xrays)..  I did have a hard time finding a good dentist for this, but I finally found someone that is excellent.  He treats a LOT of these cases.  He is in NY and his name is Dr. Barry Rozenberg.

Hope this helps.