“You don’t have to live with headache pain.” (Middlesex County Healthcare Professionals), Ira Klemons, D.D.S., Ph.D.
Dr. Ira Klemons, director of The Center for Head and Facial Pain located in South Amboy, New Jersey, reports that numerous patients had virtually given up hope before they found help. “Many of our patients who thought that their headaches were due to brain tumors, were thrilled to have complete relief after treatment of what actually turned out to be a muscular injury which had been causing their pain,” says Dr. Klemons who has treated thousands of chronic pain sufferers from across the United States and abroad for over 20 years.
By far, the most common causes of headaches are muscle spasm and irritation of related structures. “It is not uncommon for headache sufferers to be told that there is nothing wrong neurologically and that all tests, including MRI’s are normal, regardless of the fact that pain is a frequent problem,” says Dr. Janet R. Crain, a co-director of the Center. Most of the Center’s patients find that pain is relieved through conservative, non-surgical procedures. “We have documented that 90% of our patients find that their pain is ‘gone’ or ‘almost gone’ at the completion of treatment,” says Dr. Klemons.
Lucy Berry, “Painful jaw disorder: a constant headache until doctor’s cure.” (The Messenger, Madison, North Carolina). Note: To date, twenty-eight patients from North Carolina have traveled to Dr. Klemons’ office in New Jersey, after failing to obtain relief locally. Numerous other patients have come from across the United States and abroad.
Mother and daughter, Janis and Sherri Hurd, thank Klemons for stopping a pain they thought incurable. Sherri began having severe headaches when she was 5. Following a treatment combining diet, exercise and a special orthopedic device that repositions the jaw bone and fits invisibly behind her bottom teeth, Sherri, now 21, is pain free. The routine 1,100 mile round-trips to his Family Dental Practice in Woodbridge, N.J., for six months, they say, was worth the 10-hour drive.
Roughly 30 percent of the population in this country suffer from headaches at least once a week, said Klemons. Most are women between 20 and 40 years of age. Eight times as many of his TMJ patients are women than men.
Just by accident, Janis Hurd found an article on TMJ in Women’s Day in the restroom of her office building. She told her sister, Debbie Tilley, a beauty shop operator, about Dr. Klemons. Tilley started having headaches three years ago. She went to see her dentist, thinking that she had an abscessed tooth. He told her to see a neurologist. Her condition kept getting worse. She blacked out at her office. She even tried biofeedback methods that help a patient deal with the constant pain. Nothing worked.
After she read the article on TMJ and saw Dr. Klemons’ name, she wrote to him. In 1981, he fitted her with a permanent orthopedic appliance. Her problem was more severe than most. Another patient, N.C. License Examiner, Gay Welch of Madison, also suffered for many years with TMJ, without knowing it. Last March she saw Klemons. In December he fitted her with a lightweight metal and clear acrylic orthopedic appliance that looks like a retainer dental patients wear after braces. “I’m a different person. I am me again,” Mrs. Welch said.
Ira Klemons, D.D.S., Ph.D., “TMJ syndrome causes pain.” (The Advocate). Temporomandibular joint disorder, or TMJ syndrome, can cause chronic, severe head and facial pain: pain so. severe that often a victim cannot get out of bed for days. The syndrome is not new–the first surgery on the temporomandibular joint was performed in 1858 and the first known , article about these disorders was written in 1934–but it is a complex problem that is still frequently misdiagnosed.
Most head and facial pain involves contraction and spasm of muscles of the head, face and neck. The spasms produce pain in the head, face, neck, in or around the eyes; ears and throat, as well as difficulty swallowing, blurring vision and dizziness. The most common symptom is a chronic, severe headache. The TMJs, ‘temporomandibular’ joints, are located in front of the ear on each side of the head. When the TM joint is injured, many ligaments, tendons, muscles, nerves, blood vessels, discs and fascia are injured simultaneously. An injury to the TM joint does not always involve pain at the site of the joint itself. The pain may be located at almost any part of the head or face.
Most TMJ dysfunctions are due to trauma. When TMJ problems are suspected, muscles and joints are evaluated through x-ray and physical examination. Tests to evaluate TMJ disorder might include tomography, EMG, thermography, Doppler sonogram, or arthroscopy.
Most patients find that pain is relieved through physical-medicine procedures–orthopedic appliances, electronic devices to stimulate blood flow and healing and .joint mobilization techniques. Some patients require injection of trigger points, tendons or ligaments. In those cases where the pain does not abate, or recurs, radio frequency cautery procedures, in which the.pain-producing structure is denervated, may be considered.
The majority of TMJ disorder patients, however, do not require surgical intervention. And nearly all of them find relief from the chronic, debilitating pain they’ve been suffering from for years.
Ira Klemons, D.D.S., Ph.D., “Volunteers.” (Journal of the New Jersey Dental Association). Dr.lra Klemons recently journeyed far from his Sayreville, NJ practice, limited to head and facial pain and TMJ disorder, to go to the Himalayan Mountains to treat needy Tibetan villagers. Although their makeshift clinic consisted of an operating table made from wooden planks, and instruments which were sterilized in big pots of boiling water, Dr. Klemons and the two trained Tibetans who guided him were welcomed by the villagers, who had heard in advance that men were coming to help the people in pain.
Working from sunrise to dusk, Dr. Klemons and his assistants often saw over 100 patients a day. Interestingly, few had ever heard of the United States, and none had ever seen a Western doctor or a Caucasian.
Although he has practiced in Appalachia and in some of the United States’ most depressed urban slums, Dr. Klemons reports that he has never seen so many unhealthy people as in the Himalayas. “It is hard to understand how these people live for so long with such pain,” Dr. Klemons says.
“It is quite clear that curative medicine (treating those who are already sick) will never provide the answer to these villagers’ health problems. Wherever we went, we trained villagers in proper nutrition and in preventive medical and dental care, but these practices require changes in customs which have existed for thousands of years.”
Ira Klemons, D.D.S., Ph.D., “Whiplash can injure jaw joint.” (New Jersey Law Journal). Severe head pain is a common and long-term consequence of the injury typically referred to as “whiplash.” The overall effect on an individual, his family and his employment can be devastating. Besides the physical suffering to which a patient is subjected for long periods, many patients suffer emotional stress, caused by their long but unsuccessful search for help. Until recently, the accurate diagnosis of Temporomandibular Joint (TMJ), or jaw joint, and related injuries was elusive, due to the inability to base the diagnosis on objective findings, rather than subjective complaints.
Most TM joint dysfunctions are due to trauma. In many cases, however, the onset of pain occurs so long after the accident that the patient does not relate the pain to the earlier injury. Shortly, you will see how initial awareness of symptoms can be delayed for months or years.
Injuries fall into three categories:
- I. Direct Impact;
- II. Ripping; and
- III. Latent Onset Due to Alterations in Posture.
Remember, referral for evaluation should not be based on the presence or absence of “clicks,” or on whether the injury victim specifically complains of “joint pain.” Patients complaining of any one of the following symptoms should be referred for evaluation as soon after injury as possible: headaches in any part of the head; pains of the eyes, ears, face, jaw and neck; blurred vision; swallowing difficulties; chronic sore throat; dizziness; ringing in the ears. (Patients suffering from cervical injuries, should also be evaluated by specialists competent in related fields, e.g. physiatry, neurology, orthopedics, chiropractic, etc.)
Although it is recognized that injuries to the temporomandibular joint and its related structures are permanent, the vast majority of sufferers can be helped to reduce their pain experience. Ira Klemons, D.D.S., Ph.D., “Successful Treatment of Tinnitus in Patients with TMJ dysfunction.” (Tinnitus Today – The Journal of the American Tinnitus Association)
The condition commonly referred to as “TMD” – temporomandibular joint disorder – is a complex dysfunction of muscles, ligaments, and joints in the head, face and neck. (The temporomandibular joint, or “TMJ”, is the joint in front of the ear which allows us to speak, chew, swallow, kiss, smile, and exhibit normal facial expressions.) TMD is typically caused by injuries that result from falls, automobile accidents, trauma at birth, etc. It is very common for the onset of symptoms to be delayed for months or years. the delay of onset occurs, in part, because these tissues progressively degenerate.
Close to half of the patients who have TMJ dysfunction have tinnitus as one of their symptoms, and in these patients, success rates in eliminating these sounds approach 90%. Recent research has found that TMD therapy improves tinnitus in 46-96% of patients who have TMD and coexisting tinnitus. A survey of patients taken two years after TMD therapy suggests that improvement is sustained over time.
The diagnosis of TMD requires evaluation by a dentist or physician with advanced training and experience in treating head and facial pain. Diagnosis begins by taking a detailed history of the patient’s (sometimes extensive) list of complaints. Symptoms can include headaches; pain in the face, eye, neck, or ear; blurred vision that comes and goes; hearing loss that comes and goes; frequent sore throats; dizziness; ringing in the ears; pressure or blocked sensation in the ears; difficulty swallowing; burning tongue; and tingling or numb sensations of the arms and hands. A physical examination of the muscles of the head, face, neck and shoulders is done using manual palpation to rule out “trigger points” and muscle spasms that can transfer pain to other areas. Range of motion tests, x-rays, sonograms, and painless EMG’s can also help in reaching an accurate diagnosis.
Treatment commonly employs painless procedures which help stimulate muscles and joints to function normally, decrease spasm, remove toxic waste products, and increase blood flow and nutrition to the affected areas. Therapies such as low current electric stimulation to reduce muscle spasm and stimulate healing, ultrasound for deep tissue heating, hydrocollator for moist heat, and cryotherapy (cold therapy) are used with a variety of removable orthopedic appliances aimed to correct the position of the condyle, or “ball” of the lower jaw within its socket. In addition, joint mobilization procedures, physical manipulation, and other procedures might be employed. Eighty-four percent of our last 1200 TMD patients who also had tinnitus reported that their ear sounds were “gone” or “almost gone” after treatment.
Treatment time and costs vary according to the extent of dysfunction, the simultaneous presence of related problems such as neck injury or thyroid disorders, patient compliance, and the patient’s age. Unfortunately, for reasons not yet explained, we have found a decreased success rate for elimination of tinnitus in patients over 60 years of age.
Many patients are given only home care instructions at a single visit, while others require an average of 4-6 months of care. Still others require much lengthier treatment and, in a small number of cases, even surgery. Approximately 1% of our patients require TMJ surgery and approximately 3% require radiofrequency thermoneurolysis -a surgical procedure that uses high frequency electrical energy to modify or eliminate pain impulses from injured structures. This technique in particular offers enormous promise for eliminating pain and tinnitus where other conservative procedures have failed to bring relief.
Wright and Bifano cite a study in which the relationship between tinnitus and TMD therapy resulted in the following: of 267 TMD patients who were evaluated, 101 reported co-existing tinnitus. Ninety-three of those agreed to participate in the study. Of the 93 subjects who were treated for TMD, 52 said that their tinnitus had resolved, 29 reported experiencing significant improvement, and 13 reported minimal or no improvement. No one reported experiencing a worsening of the condition. It’s been noted that patients who have tinnitus without any other symptoms are relatively unlikely to experience improvement with treatment of this type.
Over the last few decades, we have come a long way in diagnosing and treating TMJ disorders and the accompanying symptoms such as tinnitus. No doubt future research will provide greater knowledge regarding the relationship between tinnitus and temporomandibular joint dysfunction and consequently even higher success rates than are available at the present time.
Studies have shown that close to half of the people suffering with tinnitus have a dysfunction of the muscles and joints of the head and face, commonly referred to as “TMJ.” The Temporomandibular Joint (TMJ) is the joint in front of the ear which allows us to speak, chew, swallow, kiss, smile and exhibit normal facial expressions. Almost half of the patients who have TMJ dysfunctions have tinnitus as one of their symptoms and in these patients, success rates in eliminating these ear sounds approach 90%.
In certain cases, tinnitus may be a result of spasm of a tiny muscle (called the stapedius) in the middle ear. This spasm may cause a slight vibration which is heard within the ear as a ringing, buzzing or hissing sound. In addition, dysfunction of other muscles, such as the tensor veli palati, may prevent the Eustachian tube (an air passage connecting the middle ear to the throat) from functioning normally, causing fullness and pressure behind the ear drum.
Conditions commonly referred to as “TMJ,” “TMD,” “TM Joint Dysfunction Syndrome,” etc., are complex dysfunctions of muscles, ligaments and joints involving the head, face and neck. These conditions are typically caused by injuries such as falls, automobile accidents, trauma at birth, etc. It is very common for onset of symptoms to be delayed for months or years, thereby leading the individual to believe that the symptoms merely started on their own.
For many patients, tinnitus is accompanied by other symptoms such as:
- Face pain
- Eye pain
- Pressure in the ears
- Clicking noises or pain when opening or closing the mouth
- Difficulty swallowing
- Burning tongue
- Frequent sore throats
We have found that patients who have tinnitus as one of their symptoms, experience an elimination of their ear sounds following treatment in the vast majority of cases. However, patients who have tinnitus without any other symptoms, are relatively unlikely to experience improvement with treatment of the type discussed below. Since approximately half of the people who experience tinnitus also have other symptoms, a major proportion of tinnitus sufferers can eliminate the source of their frustration.
Many assume that stress is the cause of these conditions. However, stress makes virtually any dysfunction worse. If a person has a heart problem, under stress, they are more likely to have a heart attack. Similarly, a person with a stomach ulcer, dysfunction of the muscles of the head or even a broken leg, are likely to feel worse stomach pain, headaches or leg pain respectively, as a result of stress. Certainly, this does not mean that stress was the cause of these conditions.
Treatment commonly employs procedures which help stimulate muscles and joints to function normally, decrease spasm, remove toxic waste products, and increase blood flow and nutrition to the affected areas. In rare cases, surgery to the affected tissues (not involving the ears) may be employed.
Over the last few decades, we have come a long way in diagnosing and treating temporomandibular joint dysfunctions, and accompanying symptoms such as tinnitus.