Temporomandibular Dysfunction (TMD) is frequently a condition causing pain. That is the reason most patients seek treatment. The pain of TMD can be associated with (or confused with) the pain of other conditions such as Tooth Abscess or Trauma from biting; Sinusitis, Migraines, Cervicogenic Headaches (of neck origin); Neurologic (such as Trigeminal Neuralgia); Arthritis, Salivary Gland pathology and other conditions.

Correct Diagnosis is important to differentiate TMD pain coming from the TM Joint or the related muscles of Mastication (chewing muscles) and the other conditions above. Often patients present with multiple conditions which need to be addressed as their pains may summate or interact to perpetuate the individual's pain. It is important to differentiate the various sources of pain to properly identify what is truly TMD which I treat and what should be referred to another specialist for management (dentist, oral surgeon, neurologist, pain specialist, ENT, chiropractor etc).

I have devoted 30 years of my life between full-time academics and private practice to improving my knowledge of the interdisciplinary ramifications of diagnosis of TMD, and developing a network of others knowledgeable in the disciplines that my patients may require to achieve relief of their symptoms. I have conducted research at the university in issues relating to TMD and have taught courses to graduate students about the biology and management of TMD and have given lectures in Asia, Europe and the Americas.

Treatments I render to my patients are generally with the use of some type of orthotic (bite plate). I do not limit myself to a SINGLE type of appliance. I have developed methods of using several types of appliances that are based on principles of anatomy and physiology (rather than using one standard appliance for all conditions, as is common in most practices). I most commonly use a physiologically designed night-guard which has been very successful in relieving symptoms even in patients who were not relieved by the standard night-guards in general use. Most of the patients I see have some sort of standard night-guard which is not keeping their symptoms from worsening.

My referral network of other specialists has been developed over years to include the most knowledgeable and experienced individuals for whom I have the greatest respect. We collaborate on treatment of the more involved and complex pain cases to achieve a satisfactory improvement in all areas of pain.

Please review my biography and several letters I have sent to referring colleagues outlining my thoughts on Temporomandibular Dysfunction diagnosis and treatment.


HEADACHE: Frequent, frontal, temporal, retro-ocular and dull/tight headaches of muscular origin.

FACIAL PAIN: Masticatory muscle pain; Masseters, Temporalis and Digastrics are a most common areas of complaint but all masticatory (chewing) muscles may be painful. Preauricular pain (anterior to the ears). Chewing may be painful.

NECK AND UPPER BACK PAIN: Trapezius, Stemocleidomastoid, Rhomboid among others.

TEMPOROMANDIBULAR JOINTS: Clicking, locking and crepitus (grating sounds). May be painful on mandibular movements and chewing. Bony degeneration or disc displacements may be seen on radiographs or MRI images.

EARS: Stuffiness, fullness. Sharp pain stimulated by chewing or unstimulated.

CERVICOGENIC HEADACHES: Often starting in the occipital (upper neck) area and projecting to frontal, parietal and orbital areas. May be aggravated by posterior cervical muscle hyperactivity associated with Temporomandibular Dysfunction.

MASSETER HYPERTROPHY: From bruxing and/or clenching.

TINNITIS: Low level in one or both ears.

FORWARD HEAD POSTURE: Related to the posterior cervical muscle hyperactivity of TMD.

NUMBNESS OR TINGLING: In fingers, hands or arms.

TOOTH WEAR: From bruxing. Cuspal pits (from enamel rod fracture) and periodontal recession on the buccal from clenching are also seen.

TOOTH PAIN: Sensitivity to cold or pain on chewing.

SLEEP: Is disturbed by pain which increases bruxing/clenching and results in more pain and fatigue. Patients frequently report better sleep patterns after treatment for TMD.