digital illustration of facesThis is a different kind of opera than everyone is thinking about.  This topic relates to TMD (temporomandibular joint disorders).  Each person has a left and right temporomandibular joint (TMJ) and can experience a problem or dysfunction on one or both sides. A TMJ Disorder is typically referred to as a TMD, although TMJ is a more commonly used term. There are different problems that can be categorized as a TMD. Sometimes a TM Joint can be dislocated or move improperly because of tightness in the surrounding muscles, and looseness of the TMJ disc. Although two people could have a TMD, they might have different things that are wrong with their TMJ.

TMD involves the muscles of mastication (chewing muscles), the temporomandibular joint (TMJ), and/or associated orofacial structures (mouth, face, jaws, neck, ears and eyes).  Symptoms can include headaches, migraines, jaw pain, eye pain, hearing loss, ear ringing, ear pain, dizziness, clicking/popping noises in the jaw, blurred vision, light sensitivity and trouble swallowing.  TMD affects quality of life and produces significant disability.  It is proven that more women than men are affected, and the most affected age group is 40-50.
The first large population-based study designed to identify the risk factors of TMD – The original OPPERA Study – was launched in 2006.  At 4 different US study sites, 3,258 “TMD-free” adults were evaluated. During follow-up 5 years later, 4% of participants per year developed TMD.  Click this link to read more about the 7-year study.



Evaluation &


Assessment Study

As some of you remember from my previous postings, one of the most prevalent symptoms of TMD is headache and/or facial pain – sometimes referred to as Cephalgia.  Unfortunately, this comorbidity is not well understood.
-Is it the headache that causes TMD?
-Is it the TMD that causes the headache?
-Is OSA (Obstructive Sleep Apnea) a factor?
I have treated over 10,000 TMD and OSA patients, and throughout the years have seen TMD symptoms that have been misdiagnosed as anything from Migraine to Trigeminal Neuralgia.  It is in my experience that once the TMJ dysfunction is controlled, the TMD caused headaches and migraines diminish.

Whether or not headache can predict the onset of TMD has not been determined at this point.  However, clinical findings do suggest that appropriate and timely treatment of headache/migraine may reduce the risk for developing or exacerbating TMD.
OPPERA was the first large study specifically intended to identify genetic factors, social factors and environmental factors that are associated with TMD.

It wasn’t always acknowledged in the past, but now the association between psychological factors (depression, stress, anxiety, etc.) and the physical symptoms of TMD are widely recognized.  These psychological factors can induce fatigue, muscle spasms, muscle hyperactivity, internal disturbances and degenerative arthritis. Masticatory function can be disrupted, changing a person’s stable occlusion to one that is unstable.
Many studies have found that symptoms of TMD can be a root cause of depression and other psychiatric diseases.  If not the cause, then the symptoms (PAIN) ear or eye can exacerbate the problem.  It certainly doesn’t help that so many TMD patients are told that “it’s all in their head” and nothing is wrong with them physically.  Patients begin to believe that after so many misdiagnoses.

If you feel that you have been misdiagnosed or have questions about different treatment options, please contact our office at (586) 573-0438. Some of the treatments offered at Michigan Head & Neck Institute include wearing an adjustable, corrective orthotic (mouthpiece), physical therapy, massage, use of the tens unit, heat application, pain-relieving injections and guidance to understand your condition. For more information, please visit our website.
Goncalves DA, Bigal ME, Jales LC, Camparis CM, Speciali JG. Headache and symptoms of temporomandibular disorder: an epidemiological study. Headache. 2010;50(2):231–241.
Maixner W, Diatchenko L, Dubner R, et al. Orofacial Pain Prospective Evaluation and Risk Assessment Study – The OPPERA Study. The journal of pain: official journal of the American Pain Society. 2011;12(11 Suppl):T4-T11.e2. doi:10.1016/j.jpain.2011.08.002.
Tchivileva IE, Ohrbach R, Fillingim RB, Greenspan JD, Maixner W, Slade GD. Temporal change in headache and its contribution to risk of developing first-onset TMD in the OPPERA study. Pain. 2017;158(1):120-129.
Dworkin, Samuel F. The OPPERA Study: Act One. J Pain. 2011 Nov;12(11):T1 – T3.
Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders: 2nd edition. Cephalalgia : an international journal of headache. 2004;24(Suppl 1):9–160.
Maixner W, Fillingim R, Booker D, Sigurdsson A. Sensitivity of patients with painful temporomandibular disorders to experimentally evoked pain. Pain. 1995;63:341–351.
Slade GD, et al. Preclinical episodes of orofacial pain symptoms and their association with health care behaviors in the OPPERA prospective cohort study. Pain. 2013;154(5):750–760.
Ohrbach R, et al. Clinical findings and pain symptoms as potential risk factors for chronic TMD: descriptive data and empirically identified domains from the OPPERA case-control study. J Pain. 2011;12(11 Suppl):T27–45.
Bair E et al. Study Protocol, Sample Characteristics, and Loss to Follow-Up: The OPPERA Prospective Cohort Study. J Pain. 2013 Dec;14(12 Suppl):T2–T19.