Orofacial Pain Specialist in Glendora

The specialty of Orofacial Pain is the newest specialty in both Dentistry and Medicine. It includes the diagnosis, management and prevention of headache disorders, temporomandibular muscle and joint (TMJ) disorders, muscle pain, jaw and facial movement disorders such as clenching and grinding of the teeth, nerve pain, and sleep disorders.
Orofacial Pain (OFP) is the specialty of dentistry that encompasses the diagnosis, management and treatment of pain disorders of the jaw, mouth, face and associated regions.  The specialty of OFP is dedicated to the evidenced-based understanding of the underlying pathophysiology, etiology, prevention, and treatment of these disorders and improving access to interdisciplinary patient care.  These disorders as they relate to orofacial pain include but are not limited to temporomandibular muscle and joint (TMJ) disorders, jaw movement disorders, neuropathic and neurovascular pain disorders, headache, and sleep disorders. 

On March 31, 2020, the ADA National Commission for Recognition of Dental Specialties and Certifying Boards approved Orofacial Pain as the 12th dental specialty. This advancement of the profession of Dentistry will institute evidence-based treatments as the standard of care for all orofacial pain conditions including TMJ dysfunction. The term ‘TMJ specialist’ used by many general dentists who treat TMJ dysfunction will now be considered obsolete as it has never been approved as a true dental specialty.

Recognition of Orofacial Pain as a dental specialty will improve access to evidence-based treatments for patients as the American Academy of Orofacial Pain (AAOP) will be working with dental and medical insurers toward the goal of expanding coverage of care for patients. Specialty recognition will further expand the number of CODA-accredited advanced education programs in Orofacial Pain, training more dentists as Orofacial Pain Specialists and improving access to care. 

TMD / TMJ (temporomandibular joint)

TMJ Pain.

If you experience ongoing pain in the area near your ear, your jaw or the muscles on the side of your face, possibly accompanied by a clicking or popping sound or restricted jaw movement, you may be suffering from TMD — an abbreviation for Temporomandibular disorders. Sometimes people incorrectly use the term TMJ to refer to these problems, when in fact TMJ is the abbreviation for the temporomandibular joint — or jaw joint — itself. So while you definitely have a TMJ (two of them in fact), you may or may not have TMD.

TMD, then, describes a group of conditions characterized by pain and dysfunction of the TMJ and/or the muscles surrounding it. It's not always so easy to figure out exactly what's causing these symptoms, but the good news is that most TMD cases resolve themselves with the help of conservative remedies that you can try at home. In fact, it's important to exhaust all such reversible remedies before moving on to anything irreversible, such as bridgework or surgery.

The two TMJs that connect your lower jaw, the mandible, to the temporal bone of the skull on either side, are actually very complex joints that allow movement in three dimensions. The lower jaw and temporal bone fit together as a ball and socket, with a cushioning disk in between. Large pairs of muscles in the cheeks and temples move the lower jaw. Any of these parts — the disk, the muscles or the joint itself — can become the source of a TMD problem. If you are in pain, or are having difficulty opening or closing your jaw, a thorough examination can help pinpoint the problem area; then an appropriate remedy can be recommended. Some of the symptoms of TMD are:

  • Pain when opening or closing mouth 
  • Trouble chewing 
  • Jaw becoming stuck open or shut 
  • Headaches or ear pain 
  • Neck Pain
  • Clicking or popping sounds when opening your mouth 
  • Teeth Grinding

Causes of TMD

TMJ Joint.

As with any other joint, the TMJ can be subject to orthopedic problems including inflammation, sore muscles, strained tendons and ligaments, and disk problems. TMD is also influenced by genes, gender (women appear to be more prone to it), and age. Physical and psychological stress can also be a factor. In some cases, jaw pain may be related to a more widespread, pain-inducing medical condition such as fibromyalgia (“fibro” – connective tissues; “myo” – muscle; “algia” – pain).

Signs and Symptoms of TMD

Clicking Sounds — Some people with TMD hear a clicking, popping or grating sound coming from the TMJ when opening or closing the mouth. This is usually caused by a shifting of the disk inside the joint. Someone standing next to you might even be able to hear it. Clicking by itself is actually not a significant symptom because one third of all people have jaw joints that click, studies show. However, if the clicking is accompanied by pain or limited jaw function — the jaw getting “stuck” in an open or closed position, for example — this would indicate TMD.

Kids mouth anatomy.

Muscle Pain — This can be felt in the cheeks (masseter muscles) and temples (temporalis muscles), where the two big pairs of jaw-closing muscles are located. If you feel soreness and stiffness upon waking up in the morning, it's often related to habits such as clenching and/or grinding the teeth at night. If you have this type of nocturnal habit, a custom-made nightguard should be very helpful in decreasing the force applied to your teeth, which will in turn allow your muscles to relax and relieve pressure on your jaw joints. Other self-care remedies are discussed below (please see Relieving the Pain).

Joint Pain — Pain that's actually coming from one or both jaw joints technically would be described as arthritis (“arth” – joint; “itis” – inflammation) of the TMJ. Radiographs (x-ray pictures) show that some people have arthritic-looking TMJs but no symptoms of pain or dysfunction; others have significant symptoms of pain and dysfunction but their joints look normal on radiographs. There is no cure for arthritis anywhere in the body, but medication can sometimes help relieve arthritic symptoms.

Relieving the Pain

Once you have been examined, a strategy for treating your condition and managing your pain can be developed. Sometimes a temporary change to a softer diet can reduce stress on the muscles and joints. Ice and/or moist heat can help relieve soreness and inflammation. Muscles in spasm can also be helped with gentle stretching exercises. Non-steroidal anti-inflammatory medications and muscle relaxants can also provide relief.

Other Treatment Options

Severe TMD cases may require more complex forms of treatment, which might include orthodontics, dental restorations like bridgework, or minor procedures inside the joint such as cortisone injections or lavage (flushing) of the joint. It's rare for major surgery ever to be necessary in a case of TMD. Again, it's important to try the wide range of conservative, reversible treatments available, and give them enough time to work as they almost always prove effective. The first step is an examination at the dental office. To learn more about available treatment options, view this Chart on TMD Therapy

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Snoring & Sleep Apnea

Normal Anatomy and Function.

Obstructive Sleep Apnea.

You know it instinctively: A good night's sleep is essential for good health. It makes you feel rested and ready to take on the world. Yet many people don't get the sleep they need. Sometimes this is related to sleep-related breathing disorders (SRBD) — their own, or those experienced by their sleeping partners.

SRBD is characterized by recurrent episodes of reduced or interrupted respiratory airflow. This is caused by soft tissues near the back of the throat collapsing during sleep so that they partially close off the windpipe. These tissues — the tongue, for example — can vibrate as air passes by, causing snoring. Snoring is often worsened sleeping on one's back because this encourages the lower jaw to slip back, which in turn pushes the tongue in front of the airway.

Loud snoring often disturbs the person in the bed who isn't the one doing it, robbing him or her of vital sleep. The snorer, on the other hand, may seem to be slumbering peacefully, but this might not actually be the case. Chronic loud snoring is a common symptom of Obstructive Sleep Apnea (OSA; “a” – without; “pnea” – breath), which occurs when the upper airway is blocked to the point of causing significant airflow disruption, or even no airflow whatsoever for 10 seconds or more. This can be dangerous as reduced airflow into the lungs lowers blood-oxygen levels.

A person with sleep apnea may wake 50 or more times per hour — that's almost once a minute! — without having any memory of it. These awakenings, called micro-arousals, last just long enough to restore muscle tone to the airway so the individual can breathe. Unfortunately, all those micro-arousals preclude deep and restful sleep.

What to Look Out For

Sleep Related Breathing Disorders.

Obstructive Sleep Apnea is a serious matter as it can lead to heart problems and other health issues. It's possible you may have OSA if you snore and also suffer from any of the following:

  • Excessive daytime sleepiness
  • Irritability
  • Poor memory/confusion
  • Accident proneness
  • Night sweats
  • Morning headaches
  • High blood pressure
  • Obesity

How Dentistry Can Help

Oral Appliance Therapy.

By now you're probably wondering: What does my dentist have to do with all this? Here's the connection: Snoring or sleep apnea can sometimes be treated with an oral appliance available at the dental office that's designed to hold the lower jaw forward during sleep. This repositioning of the jaw moves the tongue away from the back of the throat, reducing the potential for obstruction. This treatment is backed by a great deal of scientific evidence; it's a good remedy to try before moving on to more complicated breathing devices or surgery to remove excess tissues in the throat.

Only a dentist can fabricate, fit, adjust, monitor, and treat complications associated with Oral Appliance Therapy used in managing SRBD. So if you or a loved one is experiencing any combination of the signs and symptoms mentioned above, a consultation with a dental professional is a good idea.

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Headaches & Migraines

Headache.

People don't generally think of a dentist as the healthcare professional to see for recurring headaches or migraines; yet dentists can play a role in diagnosing and even treating your condition. That's because quite often, recurring pain that is felt in the area of the temples on the sides of the head is actually caused by unconscious habits of clenching and/or grinding the teeth. These habits, which often manifest during sleep, put tremendous pressure on the muscles that work your jaw joint, also called the temporomandibular joint (TMJ).

The fan-shaped temporalis muscles located over your temples on either side of your head are two of several muscles involved in jaw movement. You can easily feel them working if you put your fingertips on your temples while clenching and unclenching your jaw. When temporalis muscles go into spasm from too much clenching, headache symptoms may result. This is not to say that headaches and migraines are always caused by TMJ problems, also known as temporomandibular disorders (TMD). But given the established link between them, it definitely bears looking into — especially if a diagnosis remains elusive in your case.

Sources of Relief

Custom-Made Nightguard.

The first thing you need is a thorough oral exam to determine if there is evidence of a clenching or grinding (also known as “bruxing”) habit or TMD. If so, there are things you can do for immediate and long-term relief. Sometimes eating softer foods for a few days can reduce stress on the muscles and joints. Ice and/or moist heat can help relieve soreness and inflammation. Gentle stretching exercises, non-steroidal anti-inflammatory medications such as ibuprofen, and muscle relaxants can also provide relief.

Finally, a custom-made nightguard to wear when you sleep might be recommended. This plastic oral appliance, which fits over the teeth, can control or even eliminate clenching and grinding, reducing pressure on the muscles that work the jaw and the jaw joint itself. Some users have reported that their headaches or even migraines are less frequent and/or less intense.

Will a nightguard or other TMD therapy relieve your headaches? It depends on the source of the problem. But living with chronic headaches or facial pain is no fun — so don't delay scheduling an exam and a consultation.

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TMD, or Temporomandibular Disorders, is an umbrella term for various painful conditions that affect the jaw joints. There are different treatment approaches to TMD problems, but not all are based on science. It's important to be up on the latest information and to be an educated consumer. In this comprehensive article, Dear Doctor magazine provides state-of-the-art information and guidance on what you should know, whom you should see, and what you should ask... Read Article

Sleep Apnea & Behavior Problems in Children Snoring 

Boy Sleeping.

The number of children diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) has been steadily increasing over the past decade. Yet according to a recent study, many children diagnosed with this condition don't really have it; their behavioral problems are actually related to sleep-related breathing disorders (SRBD), such as sleep apnea.

The 2012 study, published in the journal Pediatrics, followed more than 11,000 children for six years, starting when they were 6 months old. The children who had SRBD were 40 percent to 100 percent more likely than kids without breathing issues to develop behavioral problems resembling ADHD by the age of 7. So if your child is exhibiting ADHD-like symptoms — or has even been diagnosed with ADHD — it's worth considering whether interrupted sleep might be an issue.

It makes perfect sense when you think about it: A well-rested individual, young or old, can function a lot better on a good night's sleep. Yet a lack of sleep affects adults and children differently. While sleepy adults tend to act sluggish and drowsy, sleep-deprived kids are more likely to become hyperactive, uncooperative and unable to focus — just like kids with ADHD.

So what exactly is SRBD?

The condition is characterized by recurrent episodes of interrupted breathing during sleep. The child's airway becomes blocked by soft tissues near the back of the throat — tonsils or the tongue, for example — that partially close off the windpipe. These tissues can vibrate as air passes by, causing snoring. It's often worse while sleeping on one's back because this encourages the lower jaw to slip back, which in turn pushes the tongue in front of the airway.

Overweight children have a higher incidence of sleep apnea due to fatty tissue deposits in the soft palate, which decrease the size of the child's airway.

Does your child have a sleep-related breathing disorder? You can gather clues to report to your health professional by observing your child sleeping. Look for the following signs:

  • Snoring
  • Pauses in breathing
  • Chronic mouth breathing
  • Constant tossing and turning
  • Night panics
  • Bed-wetting

How is sleep apnea treated in children?

There are various treatments that can be very effective, depending on the cause. Enlarged tonsils and adenoids can be surgically removed. A therapy known as Continuous Positive Airway Pressure (CPAP) involves the use of a machine that delivers mild air pressure through a mask worn during sleep to keep the airway open.

How palatal expanders work.

Dentistry also can also play a role in treatment. For younger children who are still growing, the use of an orthodontic appliance called a palatal expander has proven helpful in some cases. A palatal expander gently widens the roof of the mouth (palate) over time by separating bones that don't permanently fuse together until puberty. It's most often used to create more room for crowded teeth, but the expansion can also increase airflow.

Older children who have stopped growing can sometimes benefit from Oral Appliance Therapy (OAT). This involves wearing a custom-made oral appliance designed to reposition the jaw during sleep so that the tongue is held away from the back of the throat, reducing the potential for obstruction.

The first step is to figure out what's keeping your child from getting the restful sleep that's so crucial to good health and well-being. For that to occur, and for your child to receive the best treatment, you will need to see a trained professional.

Related Articles

Snoring and Sleep Apnea - Dear Doctor Magazine

Sleep Disorders & Dentistry 

If my partner snores loudly, should I be concerned and what can be done to alleviate the problem? Why does my sleeping partner have lapses in breathing while sleeping and is it dangerous? Why do I wake up exhausted even though I get up to 10 hours of sleep at night? The answers to these and other questions — and how dentistry can help — are all revealed within... Read Article



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COME VISIT GLENDORA'S PREMIER DENTAL SPECIALTY GROUP

Office Location:

210 S Grand Ave, Suite 308 Glendora, CA 91741

Hours of Operation:

Peak Dental Specialists is open five days a week. Our hours of operation are:

Monday:

8:00 am-6:00 pm

Tuesday:

8:00 AM-5:00 PM

Wednesday:

8:00 AM-5:00 PM

Thursday:

8:00 AM-5:00 PM

Friday:

7:00 AM-4:00 PM

Saturday:

Closed

Sunday:

Closed