Disorders of the Temporomandibular Joint and Facial Pain

TMD and Trigeminal Neuralgia

Facial pain can be a common but oftentimes complex condition to treat. The most common facial-related disorder that affects Canadians today and that Vancouver physician Dr. Ali Ghahary sees in many patients is a condition that is known as Temporomandibular Disorder, also known as TMD. TMD refers to a number of different disorders that affect the temporomandibular joints (TMJ), muscles, as well as the facial nerves.

The temporomandibular joint connects the mandible to the temporal bone. If you apply a bit of pressure just in front of your ears with your fingers and open your mouth, you will usually be able to feel these joints. As a result of these joints being flexible, we are able to speak, chew and yawn. There are also muscles around these joints that also help with jaw movement. However, when these joints or muscles become inflamed or painful, the ability to speak and chew becomes limited. This is known as myofascial pain, which is the most common disorder of the jaw. Myofascial pain can be mild to severe, with symptoms such as aching or throbbing, neck pain, and even headaches, and it is most noticeable when opening and closing the jaw. One of the most common causes of this kind of pain is clenching of the jaw — usually while sleeping. If you are experiencing jaw pain or unexplained tooth pain, this may be a sign that you are clenching your jaw and your dentist will be able to fit you for a mouth guard which should significantly reduce the pain you’re experiencing if worn on a regular basis. Other factors of myofascial pain include possible environmental conditions, generalized muscle pain disorder, as well as trauma to the jaw (i.e. from a car accident or contact sports.)

The best way to treat myofascial pain is with anti-inflammatory medications such as Ibuprofen, Aleve or Naproxen. Anti-depressants and sedatives have also been used to treat jaw-related pain. However, they must be used carefully as they are known to cause drowsiness and other side effects. A physiotherapist may also be able to help you with stretching exercises for your jaw, and applying heat to the affected area can also relieve muscle tension and help reduce pain. Some have also found relief with acupuncture.

Another condition, known as Trigeminal Neuralgia, is a much more severe type of facial pain and can be difficult to diagnose and treat. It occurs when the function of the trigeminal nerve — which is responsible for transmitting sensations to the face — becomes disrupted. Classic symptoms of TN include facial pain that is described as a jabbing or shooting type of pain, in addition to pain that feels like an electric shock on the side of the face. It can be triggered by things as simple as brushing your teeth, touching the face, chewing or even speaking. Episodes of TN pain can last for several hours to several days, weeks or months at a time.

Trigeminal Neuralgia is commonly treated with medications that are used to treat neurological conditions, such as anti-convulsant medications, in addition to anti-depressants. Studies have also shown Botox injections to be beneficial in those who have not had success with medication, and it may reduce the number of TN attacks that a patient experiences.

As facial pain can be the result of a number of different factors, it is important for Dr. Ali Ghahary to rule out any other medical causes. In some cases, an MRI may be ordered to determine if things like multiple sclerosis or tumours are a cause of the pain that the patient is experiencing. A referral to a neurologist may also be necessary.