Happy October!

The month of September was interesting for weather in Minnesota, but it was devastating in other parts of the country.  Torrential rains, hurricanes, earthquakes, and a possible Mt. St. Helen's eruption all visited the U.S. this past month. I hope that all is well where you live. 

The October ENews is focusing exclusively on Temporomandibular joint (TMJ) dysfunction and the problems associated with it.  

Several years ago I anticipated that TMJ would be a focus of future treatment for neck and head injuries.  I wondered why physical medicine was ignoring the pain and disability that accompanied a TMJ injury or imbalance.  It can be extremely painful and long-term.

I think that the reason TMJ took a back seat to other traditional injuries is that TMJ is very difficult to treat with success.  No one likes failure, especially doctors!  Insurance companies also don't like to recognize and pay for therapies that have a poor outcome at best!

TMJ, also called Temporomandibular disorder (or TMD), however, did not go away and the large number of people suffering with this disorder began to become more vocal.  This forced doctors and researchers to beginning looking more closely at why acute and chronic jaw problems exist, modes of treatment and possible preventative measures.

I hope that you enjoy this issue of ENEWS and share it with those people who may suffer with TMJ.

Dr. Frisch 

"Let's Chew the Fat"

If someone is under the age of thirty, this may seem like an odd statement to make.  Primarily, because it is not likely part of their normal every day conversation lingo.  The term "chew the fat" comes from the Inuit Eskimos.  They would chew whale blubber like chewing gum.  It dissolved very slowly so it passed the time during the longer winters, and it also provided the needed energy and immune boosters to fight the cold weather and illness.

'Chewing the Fat" nowadays means to sit and converse, often times about nothing serious or important.  Talking is an important part of every culture.  some cultures rely exclusively on the spoken word, rather than the written word.  Speaking allows us to casually mingle, share thoughts and ideas, but also to bond with those around us.

There are some unique qualities involved in the act of talking.  Those of you who have read my newsletter on the conversion of Sound-to-Thought understand what an incredible process is involved while talking and listening..  Talking, however, is not only neurological and chemical.  It is also a physical activity that involves unique mechanical properties.

The simple act of opening your mouth involves muscles to move the jaw up and down, different muscles to hold the jaw stable, and still others to maintain the neck and head in positions favorable to speaking and being heard.  This means that in order to even speak at all, the muscles controlling head, neck and jaw function must work properly and in unison.  When injury occurs or a neck/skull/jaw imbalance exists, we are unable to properly open and close our mouth to speak or chew.  Because of the involvement of the cranial nerve #5, which lies in close proximity to the jaw, there is pain when the jaw motion is 'out of sync'.  Sometimes this motion comes back on its own, but more often than not, the imbalance remains, resulting in a process called TMJ or TMD.

A Temporomandibular joint (TMJ) that does not work right results in a Temporomandibular Disorder/Disease (TMD).  Traditional fixes for this problem are:

• Do nothing

• Inject the cranial nerve to kill the pain (can result in paralysis)

• Make a night-time mouth guard to decompress the TMJ ($ 1000's)

• Shave the tooth enamel down to try and 'balance the bite'.

• Surgical remove the cartilage between the temporal bone (skull) and the mandible (jaw).

The problem with all of the theses therapies is that they rarely work!  They are attempting to correct an actively created problem with passive therapy!  I understand that they are sincerely trying to do something to relieve the pain and dysfunction, but these accepted approaches to 'fixing' a TMJ/TMD are becoming unacceptable.  I think that you may see why as you read on......

TMJ Pain & Trauma

Many patients complain of jaw-related pain after trauma to their head or neck.  It may result from an automobile accident and the thrusting forces that accompany a crash, but it can also happen as the result of a fall or even repeated motions of the head and neck as would be associated with working on a computer, reading with the head bent forward and let's not forget about head positioning during sleep (Propping up on 2-3 pillows is never a good idea!).

The key thing to remember when you are experiencing jaw pain is that the pain is a symptom of a dysfunction!  The pain itself isn't the problem.  It is merely letting you know that there is a problem, somewhere!

A Swedish study investigated the topic of jaw pain as a result of trauma to the neck, rather than an exclusive result of trauma to the jaw.  What they found was that the neck and jaw are not independent of each other.  Function of both the neck and jaw are related to and depend upon each other to function properly!  That means that the picture above should also have an arrow that points from the neck to the head to indicate a true relationship.

The authors reported:

"Many individuals suffer from TMJ pain after a rear-end collision.  Unfortunately, many professionals are unaware of how common this problem is and many cases of TMJ goes undiagnosed for months or years.  The longer the problem goes undetected, the more difficult it is to treat.  Screening for TMJ pain is a very important part of whiplash treatment.  And, from this study, it seems that treating the cervical spine injury directly may be the most effective way to prevent and treat TMJ pain." 

Hoggman-Henrikson B, Zafar H, Ertiksson PO. Disturbed jaw behavior in whiplash-associated disorders during rythmic jaw movements.  Journal of Dental Research 2002;81(11):747-751.

This all means that the 'clicking and popping' that someone feels with jaw movement, with or without pain, may be an indicator that both the neck and jaw should be evaluated for imbalance and dysfunction.

*  There was also another study noting long-term pain with neck and TMJ dysfunction  that increased the rate of true clinical depression after 2 years.

What's the Big Deal?

"My jaw clicks and pops, but it rarely hurts, so what is the big deal with TMJ and why should I care?"

If this sounds like something that you would say, then you need to read this column.

TMJ is more involved than just being a joint that makes noise or occasionally 'locks' on you.  Think of a gyroscope that moves in many different planes of motion at the same time.  You neck, head and jaw are very similar.  They all work independently, but they are all interrelated and must work in unison.

There is an extensive supply of nerves that encompass and run in the area of the jaw joint.  A blow to the jaw, grinding your teeth

and injury can upset the nerve signals and cause muscle spasm and improper opening and closing of the jaw.  There is also glandular supply to the area around the jaw.  That is why your mouth can hurt when you have an infection or are ill.  This can all help to create long term imbalance.  Detecting and stabilizing a TM joint that is out of 'sync' is key to limiting the degeneration and arthritic changes that can occur from long-term neglect.

Even the chewing and swallowing mechanisms are upset by a dysfunction of the TM joint.  If you have heard someone say, "It feels like my food is getting caught in my throat when I swallow.", they likely have a component of TMJ.  

The muscular reflex of chewing has a rebound effect when the jaw is fully opened.  If the jaw is unable to be fully opened due to pain, this rebound effect doesn't occur and it may be difficult to chew your food properly.  If the TM function is impaired, the ability to close the mouth and initiate the swallowing reflex of the esophagus may also be impaired.

The chewing mechanism is also responsible for initiating the digestive process.  Digestive enzymes and other processes begin to prepare your whole body to digest and use the food you are chewing.  

I will let you ponder what digestive imbalances may occur from not initiating the digestive sequence properly. 

(Hint: Think stomach acid and bowel contraction!)

Eileen's Corner

Apple Brownies

"I think that you will like these!"

2/3 Cup Butter

2 Cups Brown Sugar

2 Eggs

2 Cups Flour

2 tsp. Baking Powder

1/4 tsp. Salt

1 tsp. Vanilla

3/4 Apples, chopped

Cream the butter and sugar.  

Add the eggs and vanilla.

Mix well.

Add flour, baking powder, and salt.

Stir well.

Next, stir in the apples.

Bake in a 9x13 pan that is pre-sprayed with Bakers Joy.

Bake at 350 degrees for 30 minutes.

These brownies will be a light brown when done.

When cooled, sprinkle with powdered sugar.

Have a great Fall Season!

Eileen

Activator Methods Technique^®

* If you are wonder if there is a doctor in your area who is qualified to use the Activator Technique^®, you can call Activator Methods, Inc at 1-800-598-0224.  

To be rated to use the instrument and understand the analysis requires education and testing.  

Doctors who are 'Proficiency Rated' or 'Advanced Proficiency Rated', which I am, will be proud to tell you so!  They will also know what they are doing when treating your TMJ.

How Common is TMJ ?

To say that Temporomandibular Disorders (TMD) are common is an understatement.  The American Dental Profession has estimated that the cost for treating this disorder and the symptoms of pain, headache, and vertigo that go with it exceed $34 billion dollars yearly.  

The problem to this point has been that there are costs for treatment, but what is that treatment really doing?  Testing has gone high-tech with laser diagnostic and physiology modeling, as well as other ways to tell that a jaw is not functioning properly.  This is all well an good, but what are the successful measures used to treat TMJ? (Everyone knows how a bad dog acts, but who knows how to train it right?)

Even though TMJ is a skull/mandible joint disorder, the dental profession has embraced TMD as their own and have come up with quite sophisticated remedies.  This includes night-time mouth guards (up to $4000 each) that try to decompress the TM joint at night to relieve pain, shaving down tooth enamel to 'balance a bite', and surgery to replace  degenerated jaw cartilage.  The problem is that none of these work to 'stop the process' or 'fix the problem'.  TMJ is an active problem that requires an active fix, not a passive Band-Aid. 

The Medical Profession, unfortunately, ignores TMJ as a problem or tries to alter the pain with chemicals.  They may give the patient muscle relaxers or analgesics to kill the pain.  I have even seen them use 'nerve blockers' to try and interrupt the nerve signals of pain or inject the area to numb the nerve.  These attempts to fix a TMJ problem are also futile.  Why?  Again, because TMJ is an active process and will not be fixed through a passive sedation.  

What then is the best approach to fix this disorder?  

How about Chiropractic?

That is right!  Chiropractic is based on structure and function of the human frame (including the jaw) as it relates to neurology!  The gyroscope mechanism of the neck/skull/jaw must work in unison and be properly positioned according to gravity.  This again is controlled by neurology, not mouth guards, surgery or sedative injections!

Those of you who are patients at my clinic have heard me talk countless times about the two parts of the Chiropractic adjustment: The mechanical thrust and the resonant frequency of that thrust.  The Activator Instrument not only aids in correcting the structural injury or imbalance that contributes to TMJ, but it also helps to reinstruct the neurology what to do with the joint!

Here is another gem for you:

The Activator Methods Technique^® of Chiropractic Adjusting is the ONLY therapy for TMJ dysfunction that has research supporting what it does!

If that surprises you, don't be alarmed.  It surprised me too!  I thought that all of the other treatments had research to support their claims for treatment, but they don't.  They merely apply models of therapy that they thought might help the symptoms.  Even other chiropractic techniques fail at proving their outcomes for reproducible care based on solid, objective, research methods.

The topic of TMJ dysfunction and correction is a favorite of mine and again, as many of you already know, I have been in contact with product developers and research laboratories to help me develop what I feel will be the icing on the cake for TM stabilization.  In addition to the Activator Methods Technique^® for stabilizing the TMJ, my clinic will have a means to prevent reoccurrence of the problem.

Developing medical technology is expensive and time consuming. I must thank Dr. Arlan Fuhr and the research team at Activator Methods, Inc., for their extensive work and I hope that my contribution to treating TMJ will be as significant and successful!

Take care,

Dr. Frisch