Judy Foreman

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If you can’t get help from doctors for chronic headaches and facial pain, should you see a dentist?

August 14, 2006 by

Absolutely. Roughly 15 million Americans suffer from a cluster of symptoms including jaw pain, ear pain, headaches (especially near the temples) and neckaches. This syndrome used to be called TMJ, for temporomandibular joint problems. It is now called TMD, for temporomandibular dysfunction.

“If a person has a severe headache, it’s considered a migraine, and the person is given a prescription and sent on his way,” said Dr. Robert S. Rosenbaum, a Boston dentist who specializes in orofacial pain dentistry and is past president of the American Academy of Orofacial Pain. “The problem is, most headaches are not migraines, so what happens is the patient flounders from physician to physician.”

There are several treatment options. One is a small, plastic device that is worn in the mouth like a retainer that helps reposition the jaw so that tense jaw muscles can relax, thus easing jaw and headache pain. The device can cost as much as $1,000.

Another is physical therapy, including ultrasound, massage and “myofascial release,” in which a therapist puts gentle pressure on the skin over the jaw muscle for about 10 minutes, until muscles relaxes. “This is probably the single most effective physical therapy technique,” said Rosenbaum. Prescription muscle relaxants also can help, as can antidepressant drugs (because many people with chronic pain also have depression). As a last resort, there’s surgery, but in rare cases, that can lead to permanent nerve pain.

Some dentists, like Dr. James Zonghetti of Braintree, use computerized images to assess the degree of misalignment of the jaw.

Although insurers typically pay for treatment of musculoskeletal disorders of other joints in the body — elbows, knees, hips – they don’t typically pay for TMD treatments, said Rosenbaum

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