TMJ 'dysfunction' - Health implications

“Only those who attempt the absurd can achieve the impossible” - Albert Einstein

It was interesting to come across a patient who had been diagnosed with Polymyalgia Rheumatica. Here is the patient completed responses: (Please click on the image to enlarge)

After 30 years of experience, the symptoms listed above are typically related to TMJ dysfunction. The extraction of wisdom teeth as per the above list is a crucial contributory factor in worsening the symptoms in patients.

I had never treated any patient with this condition before, so I did some more reading on the subject.

According to Wikipedia, Polymyalgia Rheumatica encompasses a wide range of symptoms classically:

• Pain and stiffness (moderate to severe) in the neck, shoulders, upper arms, thighs, and hips, which inhibits activity, especially in the morning/after sleeping. Pain can also occur in the groin area and in the buttocks. The pain can be limited to one of these areas as well. It is a disease of the "girdles" meaning shoulder girdle or pelvic girdle. [Here please note that we come across hip asymmetry and pain in most patients.]
• An overall feeling of illness or flu-like symptoms.
• Low-grade (mild) fever or abnormal temperature is sometimes present.
• In most people, it is characterized by constant fatigue, weakness, and sometimes exhaustion.
• Headache.
• Tenderness and sensitivity on the scalp
• Jaw claudication (pain in the jaw when chewing)
• Tongue claudication (pain in the tongue when chewing)
• Reduced visual acuity (blurred vision)
• Acute visual loss (sudden blindness)
• Diplopia (double vision)
• Acute tinnitus (ringing in the ears)[/color]

All these symptoms also occur in patients who have any asymmetries around the jaws or who suffer from jaw dysfunction.

About 15% of people who are diagnosed with Polymyalgia rheumatica also have temporal arteritis, and about 50% of people with temporal arteritis have polymyalgia rheumatica.

Symptoms of temporal arteritis are also caused by a retruded bite, inflaming the temporalis muscle every time one swallows! This was the exact experience of one of my patients suffering from Palatal Myoclonus. He experiences a flaring of his temporalis regions on palpating the region where temporal arteritis emanates by retruding his lower jaw and biting the teeth together.

Causes:
Medically, the cause of Polymyalgia Rheumatica is not well understood. Reading carefully through the explanation below, it sounds neither scientific nor evidence-based, but please read on:

"Pain and stiffness result from the activity of inflammatory cells and proteins that are normally a part of the body's disease-fighting immune system, and the inflammatory activity seems to be concentrated in tissues surrounding the affected joints. During this disorder, the white blood cells in the body attack the lining of the joints, causing inflammation."

This type of justification is strategically designed to attract more patients into the profitable "autoimmune disease model," enabling the prescription of medications that can amount to $100,000 annually. In numerous countries, those who prescribe these treatments also receive substantial kickbacks for participating in this charade.

"Inherited factors also play a role in the probability that an individual will develop PMR. Several theories have included viral stimulation of the immune system in genetically susceptible individuals." [This is another typical ruse - blame a virus or genetics and sell the drugs for the rest of the lives of the patients!]

Tests available:
One blood test usually performed is the erythrocyte sedimentation rate (ESR) which measures how fast the patient's red blood cells settle in a test tube. The faster the blood cells settle, the higher the ESR value, which means inflammation is present. Many conditions can cause an elevated ESR, so this test alone is not proof that a person has Polymyalgia Rheumatica.

Another test that checks the level of C-reactive protein (CRP) in the blood may also be conducted. CRP is produced by the liver in response to an injury or infection, and people with polymyalgia rheumatica usually have high levels. However, like the ESR, this test is also not very specific.

Please note that both these tests do not test for pain and stiffness, which are the main features of this illness as far as the patient is concerned.

Medical treatment:
"Prednisone is the drug of choice for PMR, and treatment duration is frequently greater than one year. If the patient does not experience dramatic improvement after three days of 10–20 mg oral prednisone per day, the diagnosis is reconsidered."

Please note that steroid use can cause serious complications - one of which is damage to the femoral head, which would make the pelvic girdle pain much worse and possibly lead to serious incapacity and a need for hip replacement. Also, treatment with Corticosteroids can have widespread undesirable effects such as osteoporosis, type 2 diabetes, hypertension, glaucoma and cataracts. These occur because steroids can affect the gut (and nutrient absorption) and cause weight gain. The high blood pressure and eye conditions may be related to fluid retention.

"Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are ineffective in the initial treatment of PMR, but are used with the steroid maintenance dose."

Patients are also prescribed PPI drugs such as Omeprazole, with their serious adverse effects.

Regarding my patient, after I had taken evaluations of jaw position and checked for body symmetry and studying fully his responses to the questionnaire, it all pointed to a primary jaw problem. I embarked on treating the obvious first - the treatment to correct the jaw asymmetries.

The patient rapidly recovered. Here is what he wrote after recovery:

"I booked a consultation with Dr. Amir, initially for dental purposes, which led to a discussion regarding very challenging physical symptoms I was experiencing. I had received a diagnosis of Polymyalgia and Fibromyalgia, both discovered/confirmed via numerous scans under consultation with a Cardiologist and Respiratory Consultant.

I was experiencing muscle weakness and pain and was unable to do basic functions such as lift a moderate weight above chest height. Following several scans and consultations, I was prescribed a high dosage of steroids and advised I may need to remain on steroids on a long-term basis.

I did not take the steroid medication, but instead discussed an alternative plan with Dr. Amir, which involved wearing a dental appliance, for the purpose of achieving cranial symmetry. Considering the remarkable improvement I had seen in my children, I chose to work with Dr. Amir. After 3 months of wearing and adjusting the mouth brace, my symptoms were dramatically reduced and within 6 months, I had completely regained my strength, and I was pain-free.

I went for another series of scans, the results of which showed a reversal of the opacification of the lung deposits, providing physical evidence that I was indeed getting better (despite not having taken any medicinal intervention). I am now completely well and healthy, much of which I attribute to Dr. Amir’s remarkable treatment!

Throughout all of our family’s treatment, Dr. Amir has been both gracious and professional. He is a humble, yet brilliant man, doing great work. We are sincerely grateful to him and would highly recommend his practice to everyone we know.

I think Dr. Amir should be praised for the remarkable work he is doing and sincerely hope his work is indeed given the recognition and praise it deserves, and that more aspiring dental professionals would follow in his footsteps. Indeed, I have suggested to my children that they may want to consider being trained by and working with Dr. Amir."

The patient also pointed out that physical signs of lung damage had completely disappeared, as was demonstrable on radiographs and to the bafflement of his rheumatologists a few months into treatment.

Surprisingly, his baffled clinicians never looked into this modality of care, nor did they refer any patients for evaluation or treatment. This is the imprisonment of patients into chronic illness perpetrated by conventional medicine almost right across the spectrum, as this forum will show you throughout.

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