Eye Pain, Swelling and Twitching

Dr. Shapira Blog 32 Comments

Has eye pain, swelling or twitching just become too much of a strain?

tmj-eye-painDo you sometimes feel a ‘stabbing’ sensation behind your eyes or do they swell up or twitch unexpectedly making it difficult to concentrate on everyday things? Have you tried everything to relieve these painful sensations and haven’t yet come up with a solution?

When you have ruled out organic causes of eye pain with your ophthalmologist it is likely your pain is related to jaw, muscle  and TMJ function.

These sorts of symptoms could be due to a dental problem related to your jaw and neck muscles and your temporomandibular joint (TMJ). These  are  the joints that act like a hinges on both sides of your face. These joints allow you to speak, chew and yawn, amongst other things.

Some problems with the joint can lead to referred pain behind the eyes and the eyebrow area via the Trigeminal Nerve.  The TMJoints  are some of the most complicated joints in your body.  Each TMJ joint is actually two joints in one, a ball and socket joint and a sliding joint.  The entire ball and socket portion can slide forward and back as well as side to side.

The nerve that just might be behind your eye pain

If your bite is not properly lined up, you have what is often called a ‘bad bite’. This can cause friction or uncoordinated motion in one or both of your  (TMJ) TMJoints.

If it stopped right there you would probably never know about it, but unfortunately a nerve runs right past the joints, called the trigeminal nerve.  The Trigeminal Nerve goes to the teeth, the jaw muscles, the jaw joints as well as to the sinuses especially directly behind the eye.  Retro-orbital or behind the eye pain is mediated by the Trigeminal Nerve. This nerve is responsible for passing the message about friction through to the brain and somehow the message is transferred right on through to the eyes as well. The result is that you feel pain behind the eyes and sometimes they cause swelling and twitching because of the pain.

The trigeminal nerve is a cranial nerve, or actually made up directly of brain cells. The impulses of the trigeminal nerve ultimate are more than 50% of all input to the brain after they are amplified in the reticular activating system.  This is similar to music coming out of an amplifier at a concert.  Good input can be amazing but bad input is intolerable noise.  In this example the bad input or noise is what patients percieve as pain. What we call eye pain is nociceptive input perceived as eye pain.  The pain is absolutely real but the cause is often different than expected.  This is called refered eye pain.  Pain that is perceived in the eye but is actually from elsewhere.

These eye pain symptoms are common in the disorder known as temporomandibular disorder or TMD.  Myofacial Pain and Dysfunction (MPD) refers to the pain coming from trigger points in the muscles.  90-95% of all pain is actually muscular in origin.  The muscles work overtime to protect us from problems.  When they are overworked we have myofascial pain and TMD, both repetitive strain disorders.  More commonly known repetive strain disorders include carpal tunnel and tennis elbow.

There are many other symptoms  of TMD and MPD as well so it’s not surprising that it’s hard to work out exactly what is behind all these varied pains and sensations.  Physiologic dentists are experts in understanding patterns of referred pain in the head and neck .

The ‘bad bite’ that causes the problem in the TMJ is actually a poor alignment of the upper and lower teeth. When they don’t match up properly it puts extra pressure on the jaw and the muscles are used incorrectly causing repetitive strain injuries  like a chain reaction.  These problems affect head position posture and the body as a whole. The bad bite affects the muscles and the TMJ (TMJoints) which triggers the trigeminal nerve causing referred pain that eventually makes your eyes hurt.

The swelling around the eyes and dark circles under the eyes are actually secondary results of unhealthy muscles blocking normal drainage creating venous back-ups.  The dark area under the eyes is due to blood that is not receiving enough oxygen.

Dental treatment may be pain resolution

By now you will be wondering if anything can be done to help relieve the symptoms of eye pain, swelling and twitching. Fortunately, we might be able to provide a solution through the use of a diagnostic physiologic orthotic placed in your mouth that realigns your bite and allows your healing.  The orthotic is used to eliminate the impediments to healing. Doctors who allow the body to heal understand the process of health far better than those who promise magic cures.

An ultra low frequency TENS machine (MYOMONITOR) is used to create minute electrical impulses to stimulate your jaw and neck muscles so they  relax and the jaw and TMJ joint takes up a better position. This makes it easier for a dentist who specializes in physiologic treatment of TMJ and other jaw disorders to pinpoint where your bite should be.  Once the bite is idealized postural changes occur in the neck and throughout the entire body.  The diagnostic orthotic is corrected to reflect these postural changes.

When your bite is kept in the correct place then your TMJoints and jaw muscles will not be triggering the trigeminal nerve and resultant  pain will not be referred to  your face and neck. Effective dental treatment may eliminate or improve your eye pain and allow you to reclaim your normal life.

It may be time to seek TMJ relief

tmj-reliefYou shouldn’t miss out on enjoying life because eye pain is distracting you and painkillers have become a way of life. As it is possible that your TMJ is causing your eye pain, then it may be time for you to take the next step.

A diagnosis of TMD will be required, and we will need to make a thorough examination and eliminate any other potential causes of your eye pain. From there, we can determine what the best step would be for you. TMJ relief may be possible if you have bad bite and it can be realigned successfully.

TMJ Surgery

Dr. Shapira TMJ is a painful condition 0 Comments

Think twice about non-emergency TMJ surgery

tmj-surgeryTMJ is a painful condition, and there are a variety of treatment options. While surgery is one of them, going under the knife comes with risks. That’s why dentists typically only suggest TMJ surgery as a last resort for patients who tried other TMJ treatment without success.

Surgical procedures use unique methods of supporting the jaw and cartilage and removing the factors that cause pain and discomfort. Before choosing surgery, your doctor will talk with you about the risks and rewards, and some potential TMJ surgery risks include problems swallowing, difficulty talking and issues with eating.

TMJ treatment comes in three distinct phases

Phase 1

This phase is all about relieving pain and restoring physiological health to your jaw. Typical treatments include:

  • relaxing your jaw muscles with a TENS machine
  • a diagnostic physiologic orthotic sometimes called a bite splint to correct jaw function
  • practicing simple exercises
  • changing your behavior (putting and end to habits like nighttime teeth grinding, jaw clenching and pencil gnawing).
  • This is the most important phase of treatment.  The orthotic is utilized to correct the jaw position so the muscles and nerves can function ideally. This will properly load the TMJoints to prevent damage.   This is the DIAGNOSTIC Phase of treatment.  This is a preview for the patient as to what can be accomplished during phase 2 treatment.   Do not proceed to phase two treatment unless you are happy with the results of phase 1.

Phase 2

The objective of phase 2 treatment is to bring longer-term stabilization to your jaw. This involves the use of:

These treatments straighten, replace, repair or rebuild teeth in order to stabilize your bite in a balanced, healthy position.

Phase 3

It’s only when none of the aforementioned, less-invasive treatments help, that surgery should be considered an option.

Though temporomandibular joint (TMJ) surgery is a last resort, some patients find that they cannot improve their symptoms with the use of other remedies. Surgeries can involve:

  • an arthroscopic procedure
  • arthrocentesis
  • microsurgery
  • open surgery

tmj-location

Arthocentesis is the least invasive procedure to the TMJ.  It involves washing out the joint and removing adhesions.  It is often done with hydraulic pumping movements   While this is listed in Phase three it can also be considered a phase 1 treatment for some joint issues.  Dr Shapira does arthocentesis on awake patients in his office.  Other patients are referred to Oral Surgeons to have the procedure done with OV sedation.

With an arthroscopic procedure, the dentist will insert needles straight into the infected joint and use enough saline or another liquid to force the jaw open and loosen the cartilage.   Microsurgery uses tools and equipment that let the doctor repair damaged cartilage inside your mouth.

Open surgery surgery is a much more complex and dangerous surgery.  It is usually best avoided.

Is surgery right for you?

The effects of TMJ surgery on patients before and after varies from person to person. The popping or clicking noise that you might hear generally dissipates after a surgical procedure, but some patients still experience headaches, muscle pain and other symptoms.

Before committing to surgery, it’s important to weigh the pros and cons of all TMJ treatments carefully. It’s also critical to involve a dentist like Dr. Shapira, one who understands the principles of physiologic dentistry. If you have questions and concerns about the treatments for TMJ, please come in for a consultation.

TMJ Pain and Sleep

Dr. Shapira Jaw Problems, Sleep Problems, TMJ Pain and Sleep 0 Comments

TMJ Pain and Sleep: Why do I have trouble sleeping?

tmj-pain-and-sleepDo you find trouble sleeping and at the same time have jaw pain? A lot of Americans suffer from one sleep disorder or another but the most common is something called sleep apnea. Sleep apnea occurs when the airways become blocked and you find that you keep waking up as your body reacts to the lack of oxygen.

There are other reasons that can help to stop you sleeping well and these are related to your temporomandibular joint (TMJ). The jaw joints that connect the lower jaw to the skull are the TMJ Joints.  When they do not function smoothly you may hear clicking, popping or grinding noises in your joints or experience mild to severe pain when using your jaw.  This is the part of the face that allows you to move your jaws up, down or sideways.  When the TMJ is not working you may experience locking of your jaws or experience pain with movement.

If your ‘bite’ becomes misaligned you might experience symptoms such as face, ear, neck and jaw pain, because a ‘bad bite’ can affect your TMJ. A problem with the TMJ may then also cause snoring and sleep problems.  Your bite and your two TMJ joints act like a three-legged stool, if the legs are even the stool is stable.  If one or more of the joints or the bite is not correct you will have instability resulting in problems.  Muscle pain, neck pain and headache are some of the most common results of instability.

A jaw joint disorder could be causing your sleep problems

If you have a problem with your TMJ, then the pain could cause a TMJ related sleep disorder. The link between your TMJ and some sleep disorders like sleep apnea is crystal  clear, but just the jaw pain may still prevent you from getting a proper night’s sleep.

TMJ problems are often caused by a misaligned bite, which can put your tongue in the wrong place so that it readily blocks your airways. If you snore a lot and cannot sleep because of your TMJ, you do need to find a remedy because it could lead to more serious health issues, including heart disease and high blood pressure. A sleep disorder is more than a lack of sleep as it is a warning that further health problems are possible if treatment does not start.

The National Heart Lung and Blood Institute of the NIH published a report on “THE CARDIOVASCULAR AND SLEEP-RELATED CONSEQUENCES OF TEMPOROMANDIBULAR DISORDERS”  I  wrote a paper for Cranio Journal titled “TMJ, The Great Imposter has a Co-coconspirator Poor Sleep”   I  was requested to write the editorial for Cranio by Riley Lunn, the editor and owner when the Journal  changed it’s name from  the Journal for Craniomandibular Practice to the Journal for Craniomandibular Practice and Sleep.

Sleep problems can cause a multitude of pain Disorders including Fibromyalgia

It does not matter if jaw pain or airway problems are causing your disturbed sleep.  Once you sleep is disturbed it creates a host of new problems with widespread muscle pain.  There is a very specific sleep finding in Fibromyalgia, Alpha Intrusion into Delta Sleep or in simple English you wake or have disturbed deep sleep.  Studies have shown that many patients have Fibromyalgia symptoms if you disturb their sleep.  The disruption in sleep also alters our endocrine system affecting insulin resistance, cortisol levels, growth hormone, adrenal function, sexual hormones and thyroid hormone.  All of these factors can increase the pain and dysfunction associated with TemporoMandibular Disorders.

Dental treatments for your jaw problems and sleep disorder

This may be the right time to consider dentistry to correct the TMJ problem and any sleeping disorders, too. We will first ensure that no other health problems are causing your TMJ problem and any other sleep disorders. The first test we might use is an ultra low-frequency electronic device which will relax the muscles in your face.  Many patients have comorbid conditions or health problems that contribute to their TMJ disorder but there are also many patients who experience a host of medical problems because of their TMJ disorder.   One study showed that patients with TMJ disorders have a 300% increase in spending in every field of medicine.

If your TMJ is the culprit, then a special orthotic appliance is put in place which prevents the bite misalignment. If teeth grinding (bruxism) seems to be the main reason for the TMJ disorder, fitting a night guard is quite likely. This is a custom-made mouthpiece that you will wear when you sleep. These treatments can lead to less pain and better breathing.  Many patient who grind their teeth have sleep apnea and the bruxism helps to stiffen and open their airways.  Sometimes, a troublesome behavior can have both  positive and negative  consequences.  It is extremely important that patients with sleep problems and/or TMJ problems always see an expert in both fields.

Dr Shapira is a Diplomat of the American Board of Dental Sleep Medicine, A Diplomat of the Ameican Academy of Pain Management and a Felllow of the International College of CranioMandibular Orthopedics.

Stop the pain and get back to sleep

If you have been experiencing jaw pain and find it hard to get to sleep you may have a problem with your TMJ which could be helped by physiologic dentistry combined with Dental Sleep Medicine. We will need to make a thorough examination and eliminate other possible causes of the pain and any sleeping problems you have been experiencing. By utilizing advanced clinical and diagnostic protocols available in modern dentistry techniques, Dr. Shapira will be able to help you find a night filled with better sleep and a reduction or elimination of your daytime pain.