TMD: RELATED DISORDERS

Due to the complex interaction between the jaw joint, its structures and other structures in the head and neck, patients with TMD often suffer from symptoms that are similar to a number of other related disorders, including the ones we have listed here. In some cases, TMD signs and symptoms simply mimic other disorders. In other cases, related disorders coexist with a TMD problem.

This is why we review your medical history and your dental history in detail. We also consult with your physicians as needed. With multiple board certifications and 50+ years of combined experience, we have found that this is the best way to provide you with superior care – and, more importantly – treatment that get results!

In general, in order to receive a diagnosis of Chronic Fatigue Syndrome, a patient must satisfy two criteria:

Have severe chronic fatigue of six months or longer duration with other known medical conditions excluded by clinical diagnosis, and
Concurrently have four or more of the following symptoms:

• Substantial impairment in short-term memory or concentration.
• Sore throat.
• Tender lymph nodes, muscle pain.
• Multi-joint pain without swelling or redness.
• Headaches of a new type, pattern or severity.
• Unrefreshing sleep.
* Post-exertional malaise lasting more than 24 hours.

Source: Center for Disease Control
To learn more about Chronic Fatigue Syndrome, click here.

Complex Regional Pain Syndrome (CRPS) is a chronic condition characterized by:

Severe burning pain,
Pathological changes in bone and skin,
Excessive sweating,
Tissue swelling, and
Extreme sensitivity to touch.

The syndrome is a nerve disorder that occurs at the site of an injury (most often to the arms or legs). It occurs especially after injuries from high-velocity impacts such as those from bullets or shrapnel. However, it may occur without apparent injury.

One visible sign of CRPS near the site of injury is warm, shiny red skin that later becomes cool and bluish. The pain that patients report is out of proportion to the severity of the injury and gets worse, rather than better, over time. Eventually the joints become stiff from disuse, and the skin, muscles, and bone atrophy.

The symptoms of CRPS vary in severity and duration. The cause of CRPS is unknown. The disorder is unique in that it simultaneously affects the nerves, skin, muscles, blood vessels, and bones. CRPS can strike at any age but is more common between the ages of 40 and 60, although the number of CRPS cases among adolescents and young adults is increasing. CRPS is diagnosed primarily through observation of the symptoms. Some physicians use thermography to detect changes in body temperature that are common in CRPS. X-rays may also show changes in the bone.

Ernest Syndrome arises when the stylomandibular ligament, which attaches to the jaw, becomes inflamed and produces feelings of pain in several areas of the head and neck.

This ligament grows from a bone under the ear floor and attaches to the back of the lower jaw, just about one-half inch beneath the ear lobe.

It limits jaw movement, keeping it from opening too wide or moving forward too much.

Fibromyalgia is a chronic disorder characterized by widespread musculoskeletal pain, fatigue, and multiple tender points. "Tender points" refers to tenderness that occurs in precise, localized areas, particularly in the neck, spine, shoulders, and hips. People with this syndrome may also experience sleep disturbances, morning stiffness, irritable bowel syndrome, anxiety, and other symptoms.

Although the cause of fibromyalgia is unknown, researchers have several theories about causes or triggers of the disorder. Some scientists believe that the syndrome may be caused by an injury or trauma. This injury may affect the central nervous system. Fibromyalgia may be associated with changes in muscle metabolism, such as decreased blood flow, causing fatigue and decreased strength. Others believe the syndrome may be triggered by an infectious agent such as a virus in susceptible people, but no such agent has been identified.

Fibromyalgia is difficult to diagnose because many of the symptoms mimic those of other disorders. The physician reviews the patient's medical history and makes a diagnosis of fibromyalgia based on a history of chronic widespread pain that persists for more than 3 months. The American College of Rheumatology (ACR) has developed criteria for fibromyalgia that physicians can use in diagnosing the disorder. According to ACR criteria, a person is considered to have fibromyalgia if he or she has widespread pain in combination with tenderness in at least 11 of 18 specific tender point sites.

Source: National Institutes of Health

Gout is one of the most painful rheumatic diseases. It results from deposits of needle-like crystals of uric acid in connective tissue, in the joint space between two bones, or in both. These deposits lead to inflammatory arthritis, which causes swelling, redness, heat, pain, and stiffness in the joints. The term arthritis refers to more than 100 different rheumatic diseases that affect the joints, muscles, and bones, as well as other tissues and structures. Gout accounts for approximately 5 percent of all cases of arthritis.

Pseudogout is sometimes confused with gout because it produces similar symptoms of inflammation. However, in this condition, also called “chondrocalcinosis,” deposits are made up of calcium phosphate crystals, not uric acid.

Source: National Institutes of Health

Systemic Lupus Erythematosus (SLE) is a chronic, inflammatory, multisystem disorder of the immune system that mainly affects women of childbearing age. In SLE, the body develops antibodies that react against the person’s own normal tissue. This abnormal response leads to the many manifestations of SLE and can be very damaging.

The course is unpredictable and individualized; no two patients are alike. Lupus is not contagious, infectious, or malignant. It usually develops in young women of childbearing years, but many men and children also develop lupus.

African Americans and Hispanics have a higher frequency of this disease than do Caucasians. SLE also appears in the first-degree relatives of lupus patients more often than it does in the general population, which indicates a strong hereditary component. However, most cases of SLE occur sporadically, indicating that both genetic and environmental factors play a role in the development of the disease.

Painful or swollen joints,
Unexplained fever,
Skin rashes,
Kidney problems, and
Extreme fatigue.

Migrain e is a form of headache that is severe and usually one sided, and it is frequently associated with nausea and vomiting. This is sometimes preceded by warning symptoms, which usually affect the eyesight and are known as an "aura".

People sometimes feel “not quite right” prior to a migraine (e.g., depressed, unusually happy or hungry), and in addition may suffer from visual changes (e.g., flashing, zig-zag lines, or a blind spot). Sometimes the symptoms are even more extreme.

The headache is usually one sided although it is not invariably the same side. Quite quickly nausea and vomiting may follow. The bowels may also be affected, and in children sometimes there is no headache but abdominal pain instead.

Each person is different but there are some "trigger" factors that are commonly involved:

Tiredness
Physical exhaustion
Stress
Climatic change
Hormones (e.g., the "time of the month" in women)
Foods (e.g. caffeine, cheeses, chocolate, red wine)

Occipital Neuralgia is a chronic pain disorder caused by irritation or injury to the occipital nerve located in the back of the scalp. Individuals with the disorder experience pain originating at the nape of the neck. The pain, often described as throbbing and migraine-like, spreads up and around the forehead and scalp.

Occipital neuralgia can result from:

Physical stress,
Trauma, or
Repeated contraction of the muscles of the neck.

Treatment is generally symptomatic and includes massage and rest. In some cases, antidepressants may be used when the pain is particularly severe. Other treatments may include local nerve blocks and injections of steroids directly into the affected area.

Arthritis means "joint inflammation" and refers to a group of diseases that cause pain, swelling, stiffness, and loss of motion in the joints. "Arthritis" is often used as a more general term to refer to the more than 100 rheumatic diseases that may affect the joints but can also cause pain, swelling, and stiffness in other supporting structures of the body such as muscles, tendons, ligaments, and bones. Some rheumatic diseases can affect other parts of the body, including various internal organs. Children can develop almost all types of arthritis that affect adults, but the most common type that affects children is juvenile rheumatoid arthritis.

Juvenile Rheumatoid Arthritis (JRA) is arthritis that causes joint inflammation and stiffness for more than 6 weeks in a child of 16 years of age or less. Inflammation causes redness, swelling, warmth, and soreness in the joints, although many children with JRA do not complain of joint pain. Any joint can be affected and inflammation may limit the mobility of affected joints. The temporomandibular joint is one of the joints commonly affected. One form of JRA can also affect the internal organs. Doctors classify JRA into three types by the number of joints involved, the symptoms, and the presence or absence of certain antibodies found by a blood test. (Antibodies are special proteins made by the immune system.) These classifications help the doctor determine how the disease will progress and whether the internal organs or skin is affected.

Osteoarthritis is the most common type of arthritis, especially among older people. Sometimes it is called degenerative joint disease or osteoarthrosis.

Osteoarthritis is a joint disease that mostly affects the cartilage. Cartilage is the slippery tissue that covers the ends of bones in a joint. Healthy cartilage allows bones to glide over one another. It also absorbs energy from the shock of physical movement. In osteoarthritis, the surface layer of cartilage breaks down and wears away. This allows bones under the cartilage to rub together, causing pain, swelling, and loss of motion of the joint. Over time, the joint may lose its normal shape. Also, bone spurs--small growths called osteophytes--may grow on the edges of the joint. Bits of bone or cartilage can break off and float inside the joint space. This causes more pain and damage.

People with osteoarthritis usually have joint pain and limited movement. Unlike some other forms of arthritis, osteoarthritis affects only joints and not internal organs.

Psoriatic Arthritis causes pain and swelling in some joints and scaly skin patches on some areas of the body. It is related to the skin condition psoriasis.

About 95% of those with psoriatic arthritis have swelling in joints outside the spine, and more than 80% of people with psoriatic arthritis have nail lesions. The course of psoriatic arthritis varies, with most doing reasonably well.

Symptoms include:

Silver or grey scaly spots on the scalp, elbows, knees and/or lower end of the spine.
Pitting of fingernails/toenails.
Pain and swelling in one or more joints
Swelling of fingers/toes that gives them a "sausage" appearance.

Rheumatoid Arthritis (RA) involves inflammation in the lining of the joints and/or other internal organs. RA typically affects many different joints. It is typically chronic, which means it lasts a long time, and can be a disease of flare-ups.

RA is a systemic disease that affects the entire body and is one of the most common forms of arthritis. It is characterized by the inflammation of the membrane lining the joint, which causes pain, stiffness, warmth, redness and swelling. The inflamed joint lining, the synovium, can invade and damage bone and cartilage. Inflammatory cells release enzymes that may digest bone and cartilage. The involved joint can lose its shape and alignment, resulting in pain and loss of movement.

Symptoms include inflammation of joints, swelling, difficulty moving and pain. Other symptoms may include loss of appetite, fever, loss of energy, and anemia.

Source: Arthritis Foundation ®
To learn more about Rheumatoid Arthritis, click here.