Scott Webb: TMJ disorders cause symptoms such as face or neck pain, jaw stiffness, and clicking or popping noises in the jaw joint. TMJ can be complex and can overlap with other conditions while the cause of TMJ is a bit of a mystery. Our discussion today will uncover the answers to many questions about the disorder. And joining me today is Dr. Jack Annunziato. He's now patient, physiatrist with the Valley Health System. Welcome to Conversations like No Other presented by Valley Health System in Ridgewood, New Jersey. Our podcast goes beyond broad everyday health topics to discuss very real and very specific subjects impacting men, women, and children. We think you'll enjoy our fresh take. I'm Scott Webb.

Doctor, thanks so much for your time today. this is one of those topics like I've heard TMJ, I hear it on the news. I hear it maybe in social media, maybe my wife has said TMJ, and I sort of nod my head like, I know what TMJ is, but I'm not really sure that I do. So we're gonna get to that. But before we do, what is a physiatrist? What is that exactly? What do you do?

Dr. Jack Annunziato: A physiatrist is someone who's specialized, , in the field of physical medicine and rehabilitation. Obviously that's a mouthful. So we shortened it to physiatrists and we are physicians who basically focus on a patient's function and ability. We see lots of different patients for lots of different injuries and disabilities. You know, sometimes we treat brain injuries like concussions and strokes. Sometimes we treat musculoskeletal things like TMJ, but also back pain, neck pain, rotator cuff injuries, joint dysfunction. We focus on the whole patient. And one of the things that we try to focus on is their function and how an injury or an illness or a disability impacts a patient's quality of life.

Their ability to do things, to play sports, to spend time with family, , grocery shop, go out in the community. We really focus on the whole person and that. Ultimately, why I got into physiatry. It's a great field and I hope to educate people on what physiatry.

Scott Webb: Yeah, and like I said, I think I know what TMJ is. I think it's somethiung to do with the jaw stiffness, maybe some clicking, something like that. But from you here, , what does it stand for? What is TMJ and what is TMJ disorder?

Dr. Jack Annunziato: TMJ stands for temporal mandibular joint. It's the hinge joint in your mouth. As the jaw goes up and down, you can feel it if you put your fingers kind of just in front of your ears and then open and close your mouth. It has somewhat of a capsule and a disc, and there is all sorts of cartilage in it. And a temporal mandibular joint disorder, sometimes that's called TMD is a kind of broad term for any type of pain, discomfort, or inappropriate function related to the jaw in that area.

Scott Webb: And so when we think about, as you were saying, what physiatrists do, sometimes it's injuries, whatever it might be. So is TMJ typically the result of an injury? Is that more almost like a osteoarthritis, sort of like wear and tear, you know, how do people get TMJ disorder, I guess is what I'm asking?

Dr. Jack Annunziato: There's different types of reasons for TMJ and truthfully, no single person has the same reason. Some people get trauma to that joint. , think of a boxer getting punched in the face, or a slip and fall. Some people have somewhat of a cervicogenic or neck related postural thing, where basically the muscles that attach from around the head and neck lead to tightness, and it throws off your bite. Sometimes there is a psychological component to it. People really carry their stress in their face, in their neck, and sometimes that tightness over time builds to a point where you can feel a very strong muscle or it's very difficult to open your mouth wide. So there's a lot of different ways one could have a temporal mandibular joint dysfunction.

Scott Webb: Yeah, I see what you mean. And I'm sort of picturing in my head I was doing along with you. I was feeling for it. I was feeling in front of my ear. I was feeling the joint there and, you're so right. A lot of people carry stress in their faces and their mouths, and they c clench their jaws and their teeth. And you gotta get a sense of how we may do some of this to ourselves. Or some of it could be the result of some kind of acute injury or something. So generally then, what are the symptoms? Is it pain? Is it stiffness? Is it popping and clicking? Is it all the above?

Dr. Jack Annunziato: The overwhelming complaint that people have is pain. Usually it's one side versus the other. It is always there, but can come and go and we'll talk to patients about the things that definitely bring it up. Other patients will also complain of somewhat fullness in the ear. Sometimes ear pain is the symptom. Sometimes they can hear a ringing in the ear as their primary symptom. And then other patients get these types of headaches. Sometimes it runs to the front of their face, almost like a sinus pressure. Sometimes it runs to the top of the head. Almost to where like you would put a baseball cap.

It's more of a temporal headache and very rarely it could be in the back of the headache. Kind of feels , just like a vice gripp, like someone's just squeezing, basically between your ears, behind your neck. And those are simple more of the common things that we, as doctors hear from what our patients tell us about TMJ.

Scott Webb: Yeah. And you mentioned some ear symptoms and wondering just because I'm thinking, well, it's right by the ear and there could be some ear symptoms, some signs and symptoms from the ears. Is there any, , correlation cause and effect? Can TMJ cause an ear infection per se?

Dr. Jack Annunziato: So not necessarily an infection, , but definitely pain, a sense of fullness or a sense of dizziness often, sometimes patients will also know as hearing loss when there's a TMJ dysfunction as well.

Scott Webb: So let's talk then about what we can do to maybe avoid TMJ because it sounds. You know, innocuous enough, but it also sounds kind of unpleasant. And so I'm wondering, of course, well, what can we do to avoid that? So are there maybe certain foods we should avoid? Things, you know, just behavior, lifestyle things including eating that we can do to try to help ourselves avoid. TMJ?

Dr. Jack Annunziato: So I think the first thing is prevention. And with prevention, it's primarily working on the things that impact the jaw, which is usually neck tightness or stiffness. As part of a , whole body approach. You wanna make sure you exercise as part of a healthy lifestyle. That includes stretching, that includes neck stretching, being mindful of your posture, , making sure your computer is set up properly at a right height so you're not bending forward, looking down. You don't want to add to any areas which could develop further tightness and kind of picture the person who has kind of hunched down at their laptop, facing down.

You know that tightness, that frontal tightness could lead potentially to a temporal mandibular joint dysfunction. Then let's say you have it. Okay. The next thing that you want to worry about are eliminating factors that could contribute. And these are your very hard foods, like your nuts. Things that take a lot of time to chew. Think of a rubbery steak or very hard vegetable. Those things can contribute to this function that is gum chewing, habits that may not be necessarily what you're hoping to do, like chewing on a pen. Biting your nails. Sometimes those can contribute and serve as triggers to TMJ joint dysfunction.

Scott Webb: All right. So, yeah,,I think we as potential patients, of course, in doctors and nurses or patients too, we wanna know, can we prevent something? And then what do we do when we get something? So let's talk about the getting the, having TMJ, like once you've been diagnosed with TMJ, is it one of those things that you kind of always have and then working with someone like yourself, it's just more about managing it? Or is there treatment and potentially a cure if you will?

Dr. Jack Annunziato: So a lot of what we do are evaluating and kind of treating , the contributory factors, all the things that kind of work to, cause TMJ. And depending upon what the cause is, it may be neck pain and physical therapy is one of our first line agents. If there is a particular, grinding of the teeth, I might work with your dentist to help get you night guard. If there's a psychosomatic component, a caring of stress, we have patients who enroll themselves in some sort of talk therapy , which might be helpful. And sometimes, , an anxiety medication might be the treatment. There are also medicines for the pain itself. Think of your anti-inflammatories, your Advils, your Aleve's.

There are also some other types of medicines like muscle relaxants or nerve pain medications that we'll use. And the last thing that I do, which is a little unique, is I do manual therapy for the TMJ. I am specialized in something called osteopathic manipulative medicine, which is a style of manual therapy. And in the office a lot of my TMJ patients will come to me for treatments around the neck and intraorally.

Scott Webb: Yeah. So if we can, we want to try to avoid getting TMJ, but if we get it, there are options we like that. That sounds good in my ears. And speaking of sounds, wanted to ask you about , the clicking sounds that we've referenced here today is that, Bad. Is that dangerous? And maybe when it feels like our jaw has popped, , is that dangerous? It's like sometimes when your jaw clicks, it's kind of fun a little bit, but maybe that's not a good thing. Right doc?

Dr. Jack Annunziato: Not all sounds are scary or should be scary or a sign of worry. However, when we think about the jaw clicking, , I mentioned before that there is a disc that sits in the temporal mandibular joint. It is that sliding of the disc that moves forward and back as we open and close our mouth. And the way you can hear that click is almost, if you snap your fingers, it's your thumb sliding off of your middle or index finger. However, however you snap. So that click. Is a warning sign to us, but if it's not painful, I tend to say Don't worry about it. It's only when that clicking is a painful click that we really need to address your symptoms.

Scott Webb: Yeah, I see what you mean. Some clicking is bad. Some clicking is just fine. Don't worry about it. In all cases, obviously, if people are worried they should reach out to their primary or get a referral to see someone like yourself, however, that might work with their insurance. Wondering, as we get close to finishing up here, is there any chance that TMJ is indicative of another illness? Is it potentially a sign or symptom of something else?

Dr. Jack Annunziato: So again, TMJ is a kind of consolation of different symptoms and when we see a patient, we want to make sure that their neck is okay, that their mental health is okay, that there is no intraoral, gum disease, tooth decay. So oftentimes we're working with our other colleagues, like our dentists and oral surgeons to make sure that all the common causes of TMJ are being addressed.

Scott Webb: Yeah, I see what you mean. And I had, as my last question when I was putting things together today was sometimes, especially for things like this, that could be one thing, could be another thing might be not a big deal could be sign of a bigger problem. So you mentioned some of your other colleagues, like dentists. I wonder if folks might mention some of these signs and symptoms, to their dentist and maybe feel like they're being dismissed or trivialized, like, oh, you know, people's jaws click. What are you gonna do? wondering what your recommendation would be as someone you know, who deals with this , and really takes this whole body kind of approach to treating patients. What would be your advice if they feel like they're being dismissed by a dentist or anyone else, that this is just an insignificant thing?

Dr. Jack Annunziato: I get this question a lot, and it's not necessarily TMJ related, but in general, if you are having a question or a concern, start by asking. And if you don't feel like you're getting the right answer or a better explanation, you get another opinion. I welcome when a patient has come to me and they've said, I tried this, I tried this, and I tried this, and for whatever reason, it's not working. Help me understand what's going on. And so for a patient who maybe went to their dentist and they said, oh, think about it. , maybe it's nothing. Just flip it off. I'll see you in six months cause I'm only gonna see you in six months. You know, it's one of those things where maybe you don't wanna wait six months.

So I encourage everyone, make an appointment. Either with myself or your primary, ask these questions. A lot of times in medicine, our opinion is very siloed. You talk to your cardiologist about your heart stuff, you talk to your pulmonologist about your lung stuff. Physical medicine, rehab, or physiatrists are really those docs who kind of look at the whole picture, and we're not afraid to play in different sandboxes, if that makes any sense. We deal with neurologic conditions, we deal with musculoskeletal conditions. I treat all sorts of different areas of the body.

And so there is a lot of overlap, but because there's a lot of overlap, I usually can offer something to a patient, whether it's a medicine, manual therapy, physical therapy, or other different things. And sometimes I need the help with colleagues, but oftentimes I can at least give you a baseline to work off of.

Scott Webb: That's perfect. It's so great to have experts on, because in my mind I was thinking, all right, tmj, who's that? Maybe an ENT, somebody like that. Or maybe the dentist, So just to understand what a physiatrist does, how you can help folks, this sort of total mind and body approach, is really awesome and really educational. So thanks so much. You stay well.

Dr. Jack Annunziato: Thank you. Happy to help.

Scott Webb: Four more information about physical medicine and rehabilitation services at Valley. Please visit valley health.com/physical medicine

Or call 2 0 1 6 1 2 4 8 5 7.

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