nanos gigantium humeris insidentes

Temporomandibular Joint (TMJ) Disorder

Harrison YaNoe — Wed, 14 Mar 2012 17:06:18 +0900

By Lori Montgomery, MD, CCFP and Kate Gerry, BSc, PT, BPE

Introduction

The temporomandibular (say: tem-puh-ro-man-DIB-yuh-ler) joint is the place where your lower jaw (mandible) attaches to your skull. It is the joint that allows you to open and close your jaw. There is a shock-absorbing disc between the two parts of the joint (similar to the discs in your spine). There is also a set of specialized muscles that control movement of the joint. Pain and abnormal function in this joint can cause problems with eating and speaking, and make it difficult to sleep.

Signs and symptoms

pain over the temporomandibular joint on one or both sides
headache
neck pain
burning, shooting, electric-shock-like facial pain
numbness or tingling around the jaw
pain with chewing, clenching, or yawning
clicking or locking of the jaw
reduced range of motion (either when opening the mouth or when moving the jaw from side to side)
a change in the way the upper and lower teeth fit together

Causes

There are a number of reasons to have symptoms of temporomandibular joint (TMJ) disorder. They fall into three main groups, although many patients have two or three of them at the same time:

myofascial
structural
degenerative arthritis
congenital

Myofascial

Myofascial changes in the muscles of the jaw that cause pain and changes in function. This type of pain is similar to the pain of fibromyalgia, and the two conditions often go together. We do not know what causes this to happen, although it sometimes happens after a trauma such as a motor vehicle collision, especially one that involves a whiplash-type injury. Sometimes these patients have a history of clenching the jaw, or grinding the teeth - but sometimes the symptoms start with no clear reason at all.

Structural

Sometimes a disc is displaced, the joint is dislocated, or one of the bones is broken. This happens most often after a significant trauma, like a serious motor vehicle collision.

Degenerative

Degenerative arthritis can happen in this joint, in the same way that it happens in other joints in your body. This happens as you age, although it is more likely to happen if the joint has been injured in some way.

Congenital

Some syndromes can cause facial deformities, which affect the joint.

Diagnostic tests

The best way to diagnose TMJ disorder is not clear. The way that you describe your symptoms and the results of a physical exam of the jaw, neck, and shoulders by a doctor or physiotherapist are likely the most important parts of the diagnosis. Some tests may be done, such as an X-ray to make sure that there are no fractures or other problems with the bones of the jaw. If you are referred to a dentist or other provider with a specialized approach to TMJ disorder, magnetic resonance imaging (MRI) may be done to guide treatments like injections or surgery.

Treatment approach

Sometimes, the pain will settle with simple things like eating soft foods for a while, or putting ice or heat on the joints. When it becomes more persistent or disabling, more invasive treatments may be required. There is no clear evidence to tell us which treatment is best. However, so most experts recommend using treatments that do not cause irreversible changes to the teeth or the bite (i.e avoid surgery, if possible).

Splints

Splints are often used to stabilize the jaw in TMJ disorders. These should be worn for a limited period of time, and should not cause permanent changes to the bite. They are intended to relieve symptoms of TMJ (not to cure it), and so should never cause or increase pain.

Non-drug therapies

There is a strong link between neck pain and TMD, so strengthening and stretching of the neck muscles is also important. There are physiotherapists with expertise in treating TMD. They can provide exercises to strengthen the muscles around the jaw. Some patients find the following things helpful as well:

intramuscular stimulation (IMS)
acupuncture
biofeedback
nutritional therapy
transcutaneous electrical nerve stimulation (TENS)

Non-drug therapies

Studies have shown that non-drug therapies can help to reduce pain levels and enhance pain coping. These include:

relaxation
meditation
activity pacing
cognitive behavioural therapy

These self-management strategies can help you to improve your function so you can do more and enjoy life more.

Medicines

Medicines are sometimes helpful to reduce pain levels, improve sleep, and help you to function better. These may include anti-inflammatories, acetaminophen, or weak opioids. Some of the Medicines that can help fibromyalgia may also help TMJ pain. These include:

tricyclic antidepressants (such as amitriptyline or nortriptyline)
gabapentin or pregabalin
tramadol or other opioid-like Medicines (such as morphine)
serotonin-norepinephrine reuptake inhibitors (such as venlafaxine or duloxetine)

Botox (botulinum toxin type A) has been used at times to treat TMJ disorder. It is the subject of intense research, and may prove to be useful for some people. It has not been officially approved for use in TMJ disorder, however.
Sometimes a combination of local anaesthetic and steroid can be injected into the joint. There are not many providers who perform this procedure.

Surgery or splints

Surgery or splints that permanently alter the bite are available in many centres. They are appropriate for a small number of patients with TMJ disorder. There are no long-term studies that evaluate the safety and usefulness of these approaches, however. They have the potential to make pain worse, so they should be approached with caution. Research is ongoing into how to develop invasive techniques that are most effective with the least potential to cause harm.

For more information

Web sites

Web MD
www.webmd.com

The TMJ Association, Ltd.
www.tmj.org

American Pain Foundation
www.painfoundation.org

Pain.com
www.pain.com

TRIP Database (Resources for Evidence Based Medicine)
www.tripdatabase.com

National Institute of Neurological Disorders and Stroke
www.ninds.nih.gov

References

National Institute of Dental and Craniofacial Research/Office of Research on Women’s Health. TMJ Disorders., National Institutes of Health, NIH Publication No. 06-3487. Updated December 05, 2008.

Dimitroulis, G. The role of surgery in the management of disorders of the temporomandibular joint: a critical review of the literature. International Journal of Oral and Maxillofacial Surgery. 2005;34(2)107-13.

video clip

Harrison YaNoe — Wed, 14 Mar 2012 13:06:38 +0900

sinus graft
http://youtu.be/uRZTJ1lm-kg

Medications Used to Treat TMJ Disorder

Harrison YaNoe — Wed, 08 Feb 2012 09:14:23 +0900

Medications Used to Treat TMJ Disorder

There are no specific medications made for TMJ disorder, so drugs can only be prescribed to treat the symptoms. Symptoms of TMJ disorder vary widely from person to person, and because of this, a variety of medications can be used in treatment. Here is a list of medications that are commonly used to treat the symptoms of temporomandibular joint disorder:

Acetaminophen - Tylenol

Non-Steroidal Anti Inflammatory Drugs (NSAIDs)
Ibuprofen - Advil, Motrin
Nabumetone - Relafen
Meloxicam - Mobic
Naproxen - Aleve

Muscle Relaxants
Carisprodol - Soma
Cyclobenzaprine - Flexeril
Diazepam - Valium
Lioresal - Baclofen
Metaxalone - Skelaxin
Tizanidine - Zanaflex
Alprazolam - Xanax

Anti-Depressants
Amitriptyline - Elavil
Nortriptyline - Pamelor
Imipramine - Tofranil
Escitalopram Oxalate - Lexapro
Setraline - Zoloft
Bupropion hydrochloride - Wellbutrin

Topical Analgesics
EMLA cream
Lidocaine patches - Lidoderm
Capsascin

Nerve Pain Medications
Gabpentin - Neurontin
Topiramate - Topamax
Levetriacetam - Keppra
Pregabalin - Lyrica
Duloxetine - Cymbalta

Pain Medications
Hydrocodone & APAP (APAP=acetaminophen) - Vicodin, Lortab
Oxycodone & APAP - Percocet
Propoxyphene & APAP - Darvocet, Darvon
Morphine Sulfate - MS Contin, Kadian, Avinza
Fentanyl - Duragesic, Fentora, Actiq

열어줄 때

Harrison YaNoe — Sat, 28 Jan 2012 03:27:37 +0900

열어줄 때 확실히 열어주어야한다. 나이가 50 60을 먹어도 아직도 시행착오중일 수 있다. 부모라도 항상 오른 선택만 하고 사는 건 아니다. 사는게 항상 불확실의 연속이다. 죽는 그날까지 계속 이런 느낌이겠지. 난 안그럴거라 다짐 또 다짐해본다.

iPhone 에서 작성된 글입니다.

Don't give up

Harrison YaNoe — Tue, 04 Oct 2011 14:05:37 +0900

당신에게 남은 건

Harrison YaNoe — Wed, 28 Sep 2011 16:05:56 +0900

낙망하지 말고 슬퍼하지 말고 아파하지 말고 좌절하지 말고

at imaging lab. Stanford

Harrison YaNoe — Wed, 14 Sep 2011 07:55:31 +0900

이제 슬슬 끝나갑니다. 다시 이제 일생에 이런 시간들이 올까요??

Kickbacks Virgin Mobile

Harrison YaNoe — Tue, 13 Sep 2011 08:40:09 +0900

참 좋은 세상이다. 망은 별로 안 좋긴 한데

어쩌다 다 돌아갈 때 되서야 이걸 알게 된 걸까??

한국에선 있을 수 없는 시스템이다.

Comcast

Harrison YaNoe — Mon, 12 Sep 2011 04:19:33 +0900

Foster City Address: Hours: 999 Edgewater Blvd Suite E Foster City, CA 94404 800-945-2288 Monday-Saturday 9:00am-6:00pm
with modem

진정 바라는 것

Harrison YaNoe — Sat, 10 Sep 2011 09:37:01 +0900

** 진정 바라는 것 **

소란스럽고 바쁜 일상 속에서도 침묵 안에 평화가 있다는 사실을 기억하십시오.

포기하지 말고 가능한 모든 사람들과 잘 지내도록 하십시오. 조용하면서도 분명하게 진실을 말하고, 어리석고 무지한 사람들의 말에도 귀를 기울이십시오. 그들 역시 할 이야기가 있을테니까요.

목소리가 크고 공격적인 사람들을 피하십시오. 그들은 영혼을 괴롭힙니다. 자신을 다른 사람과 비교하면 자신이 하찮아 보이고 비참한 마음이 들 수도 있습니다. 더 위대하거나 더 못한 사람은 언제나 있기 마련입니다.

당신이 계획한 것뿐만 아니라 당신이 이루어 낸 것들을 보며 즐거워하십시오. 아무리 보잘것없더라도 당신이 하는 일에 온 마음을 쏟으십시오. 그것이야말로 변할 수 밖에 없는 시간의 운명 안에서 진실로 소유 할 수 있는 것이기 때문입니다.

사업 상의 일에도 주의를 쏟으십시오. 세상은 속임수로 가득하기 때문입니다. 그러나 세상에 미덕이 있다는 것을 모르고 지나치지는 마십시오.

많은 사람들이 높은 이상을 위해 애쓰고 있고, 삶은 영웅적인 행위로 가득 차 있기 때문입니다. 당신 본연의 모습을 찾으십시오. 가식적인 모습이 되지 마십시오! .

사랑에 대해서 냉소적이 되지 마십시오. 아무리 무미건조하고 꿈이 없는 상태에서도 사랑은 잔디처럼 돋아나기 때문입니다. 나이 든 사람들의 충고는 겸손히 받아들이고, 젊은이들의 생각에는 품위 있게 양보하십시오.

갑작스러운 불행에서 자신을 보호하려면 영혼의 힘을 키워야 합니다. 그러나 쓸데없는 상상으로 스스로를 괴롭히지 마십시오. 많은 두려움은 피로와 외로움에서 생겨납니다.

자신에게 관대해 지도록 노력하십시오. 당신은 나무나 별들과 마찬가지로 우주의 자녀입니다. 당신은 이곳에 머무를 권한이 있습니다. 그리고 당신이 느끼든 느끼지 못하든 우주는 그 나름의 질서대로 펼쳐지고 있습니다.

그러므로 하느님과 평화롭게 지내십시오. 당신이 그분을 어떻게 생각하든, 당신의 노동과 소망이 무엇이든 시끄럽고 혼란한 삶 속에서도 영혼의 평화를 간직하십시오.

서로 속이고, 힘들고, 꿈이 깨어지기도 하지만 그래도 세상은 아름답습니다. 늘 평안하고 행복하려고 애쓰십시오.

- 著者: by Max Ehrmann (맥스 어만 1872~1945).

전 교황 요한 바오로 2세 (출생/사망 : 1920년 05월 18일 / 2005년 04월 02일) 집무실에 걸려 있던 글

내용이 좋아서 임창준교수님 페북에서 퍼왔음
두고 두고 읽어봐야겠다. 힘드네 사는게..쉬운게 없네

nanos gigantium humeris insidentes

Temporomandibular Joint (TMJ) Disorder

Temporomandibular Joint (TMJ) Disorder

By Lori Montgomery, MD, CCFP and Kate Gerry, BSc, PT, BPE

Introduction

Signs and symptoms

Causes

Myofascial

Structural

Degenerative

Congenital

Diagnostic tests

Treatment approach

Splints

Non-drug therapies

transcutaneous electrical nerve stimulation (TENS)

Non-drug therapies

Medicines

Surgery or splints

Web sites

References

video clip

Medications Used to Treat TMJ Disorder

Medications Used to Treat TMJ Disorder

열어줄 때

Don't give up

당신에게 남은 건

at imaging lab. Stanford

Kickbacks Virgin Mobile

Comcast

** 진정 바라는 것 **

진정 바라는 것