TMJ and TN - The Orofacial Pain Center

04/25/2024

Hi all,
I have been so busy with our new information page, I have neglected our office page! If you don't already know, I am an Orofacial Pain Specialist and I have seen a lot of significantly damaged jaw joint patients in the past 25 years. I have developed a treatment philosophy and don’t plan on changing it. I have had 25 years of successful diagnosis and treatment. I disagree with most of the information found online about “TMJ” and take my personal time to try to educate anyone who wants to hear it. I have an information page called "TMJ" support and information, where I answer specific questions

We are still here and seeing lots of new patients and this is why I never get any work done! Jack jack is our adorable office "kitten". We think he is about 1 year old now and he is a lovebug!❤️

When we aren't cuddling him, CIndy and I are talking to and seeing patients with all kinds of facial pain and headaches. CIndy would love to explain how we do things. Just give us a call. 904-296-1990.

01/27/2024

Sorry I haven't updated in a while. Cindy and I are doing well and the office is busy. School just started and I have new freshman students needing patients to see. If you need a dental cleaning, xrays and exam for $10.00, FSCJ Dental Hygiene School is the place!
I started a new information page called "TMJ" support and information on Facebook. It is a place for people to come and get true information regarding diagnosis of jaw joint damage, share their stories and ask questions. We would love to have you join!

09/27/2023

I always see posts saying Never have jaw joint surgery. I get scared when I see posts advocating for NEVER doing surgery on temporomandibular joints. Saying that is like saying never do surgery on any joint (knees, hips, shoulders, wrists, etc), which is done all the time in medicine. I find the “Never Have Surgery” statement too broad and the misconception that all surgery fails goes back 50 years. In the 1970’s, we didn’t have MRI and CT, so we had no way of knowing what was wrong in cases of facial pain that might be related to the temporomandibular joints. Because of this, they did temporomandibular joint surgery on everyone with “TMJ” and since 80% of “TMJ” patients don’t have anything wrong inside the joints, 80% of surgeries failed. That was 50 years ago, though. Now, we have MRI and CT and can see inside a joint and know exactly what is wrong, if anything. It is easy to find out. The field has been slow to follow, though. In general, I see doctors choosing to diagnose without MRI, so they can’t know what is wrong. I see them doing outdated surgical procedures, such as arthrocentesis. Arthrocentesis is a flushing out procedure. If the joint is healthy and stable, you don’t need any kind of surgery. If the discs are displaced (geenral finding), arthrocentesis does nothing to correct the damage (disc displacement) and generally makes the damage inside the joint worse. It is 100% guaranteed to fail. They also seem to make the patients feel crazy to be in pain and generally ignore the problem.
One of the main problems is calling facial pain “TMJ”. It is way too vague. TMJ stands for temporomandibular joint. Getting a diagnosis of “TMJ” for facial pain is like getting a diagnosis of “KNEE” for leg pain. You would say to the doctor, “What is wrong with my knee?”. They would do a thorough exam and get an MRI. Then they would give a diagnosis of a torn ACL, torn MCL or torn meniscus and tell you can wear a knee brace, take ibuprofen, decrease use of the knee or have surgical correction. If they said you did or didn’t need surgical correction due to “KNEE”, you would think it was strange. Jaw joints should be the same. A thorough exam, MRI specifically of the jaw joints, explain the MRI and give a diagnosis such as osteochondrosis (lack of growth of the jaw joint), disc displacement, torn ligaments, avascular necrosis, etc, should be done. Then develop a treatment plan such as wear a bite guard, decrease use of the jaw, take ibuprofen, or correct the damage.
I had a similar situation with my sister. She suffered from terrible migraines and facial pain for many, many years. When the doctor told us she needed to see a psychiatrist, I decided to figure the problem out. I did and now it is my mission to educate anyone and everyone who will listen to me about how to correctly diagnose jaw joint damage. I found a surgeon who was taking MRI’s in the 1990’s. When we saw her joints, it was obvious what was wrong. Because we didn’t get to her in time, her joints were damaged beyond repair and had to be replaced. The original disc displacement was caused when she broke her collarbone. The disc being out of place, blocked the blood flow to the condyle and caused the growth discrepancy. The surgeon corrected her damage and gave her life back. She has been stable for 25 years. So, I have personal knowledge that the correct diagnosis and treatment does work and I have hundreds of patients who can attest to that.
I have been referring to her surgeon for over 25 years and have had no surgical failures. The surgeon does a procedure called disc removal and fat graft transfer. If you don’t have an MRI, have a doctor who can explain it, does the correct procedure or doesn’t do many procedures, you should not have surgery. But if you do have those things, surgery can save a life. Don’t be scared of fixing it. Surgery is a viable option to prevent further damage, dysfunction and pain. Chronic pain is a huge drain on people’s lives and the medical system.
It is my goal to educate enough people so that there are no more Facebook groups dedicated to this particular chronic pain issue. Some chronic pain is not fixable, like nerve pain, but joint damage is fixable. I am more than happy to answer any questions.

08/10/2023

I saw a patient yesterday that reminds me of a lot of cases I see posted on the TN and ON sites. Mr. Smith presented with constant, severe, dull, aching, burning, pain and intermittent, sharp, shooting, pain in his left occipital area and to a lesser degree in the left side of his face. He had a main diagnosis of ON and a probable diagnosis of TN. SInce TN is a diagnosis of exclusion, the other 9 causes of facial pain need to ruled out, first. One that had not been ruled out was jaw joint damage. I see a lot of patients diagnosed with TN when they actually have damaged jaw joints that are the source of their pain. This is because there is a branch of the trigeminal nerve called the auriculotemporal nerve that only goes through the jaw joints. if the joints are damaged, it can cause TN pain. It often gets overlooked for two reasons, one, we use the term "TMJ" which is a woefully inadequate term for facial pain diagnosis that doesn't actually take into account the health and stability of the jaw joints themselves and two, because doctors rarely look inside the joints for the cause of facial pain. "TMJ" stands for temporomandibular joint. Getting a diagnosis of "TMJ" for facial pain is like getting a diagnosis of KNEE for leg pain. It doesn't take into account the many sources inside the knee (joint) that could be causing the pain. You could have a torn ACL, torn MCL, torn meniscus, etc. You have to know which is the cause of the pain in order to know how to fix it. "TMJ" is the same way. We have to know what, if anything, is wrong inside the joints to know how to fix it. That can only be done with an MRI specifically of the jaw joints. Also, if the joints are damaged, they are unstable. This joint instability can cause neck pain, shoulder pain and occipital pain. I ordered an MRI of Mr. Smith's joints and he did have damaged joints. To prove if the joints were the cause of his facial and occipital pain, I did an auriculotemporal nerve block. Since the auriculotemporal nerve only goes through the jaw joints, if you numb it and the pain goes away, it is 100% diagnostic that the jaw joints are the cause of the pain. What totally surprised me was that when I did the block, not only did his facial pain go away 100%, but the occipital pain went away 100%, also! That tells me that if we correct the damaged jaw joints, not only will his "TN" pain go away, but his ON pain will go away, also. This situation happens quite frequently in my practice and I am hoping that by posting this story, it will help someone else get a correct diagnosis and treatment. I would be happy to answer any questions.

06/18/2023

We had the cutest visitors at the office last week!

05/03/2023

02/17/2023

Valentine's Day love from a patient. Cindy and I have THE best patients!!!!

02/13/2023

I met a 12 year old facial pain patient in my office many years ago. She had significant pain and headaches I got an MRI of her temporomandibular joints and she had significant jaw joint damage. Luckily, she was able to have successful, corrective temporomandibular joint surgery. After her surgery, I didn't see her again, which is the goal of my office!
Fast forward about 14 years to the Dental Hygiene school where I teach. It was during COVID, so everybody was wearing masks. This shy young lady told me she had been my patients many years ago. After racking my old brain cells, I recognized her. 😊 She told me she was still pain free since her surgery!
She was an excellent student for the whole rigorous program and graduated to become a Certified Registered Dental Hygienist 2 years ago.
Last night, I went to her wedding. I saw a beautiful, happy young lady marry the man of her dreams.
This is what makes me keep going, educating people about the correct way to diagnose facial pain, get a TMJ MRI and correct the damage, if need be. No other doctors would have corrected her damage at such an early age. They would have let her damage just keep progressing. She would have been in so much pain by this point, I doubt she could have completed a college degree, let alone another degree in Dental Hygiene. She is proof this procedure works and has been working for many. many years.