2. TMD, Headaches and Trauma Evidence Based Continuing Education Recommendations #1 When treating patients with whiplash injuries to the neck, it is essential to screen them for TMJ pain and dysfunction at their initial evaluation and at follow up evaluation for up to one year. Source: Journal of the American Dental Association JADA 2007; 138 (8): 1084-91 See attached copy of article, pg 1090. Evidence Strength: A, consistent good quality patient oriented evidence. This is a consistent, high quality cohort study.

3. TMD, Headaches and Trauma Evidence Based Continuing Education Recommendations (continued…) #2 Because temporomandibular disorders (TMD) remain a frequent cause of visits to primary care physicians, internists and pediatricians, learning to screen for TMD is helpful in providing effective treatment strategies. Source: New England Journal of Medicine N Engl J Med 2008; 359: 2693-705 See attached copy of article pgs 2697, 2702 Evidence Strength: C, consensus, usual practice, expert opinion. This review focuses on the most common forms of TMD seen by the primary care physician: myofascial pain disorder, intra-articular disk derangement disorders, osteoarthritis, and rheumatoid arthritis.

6. The following video is a real-life traumatic TMD captured on film. (video also available at www.tmjdoctorofmaryland.com) Briefly, Chris Hoiles, the Oriole catcher was struck in the side of his helmet by the back swing of a batter. Mr. Hoiles commented he didn’t really know what happened to him (he was stunned). Then he explained he was hit in the side of the head and he complains of headaches and jaw pain. (The Temporalis Muscle when injured contracts, elevating the lower jaw, hence his headache and jaw pain). His wife then commented that the doctor said there was nothing wrong and he was being taken to the emergency room of a hospital for a C.A.T. Scan.

7. A Real Life TMD Injury

13. Headaches are a chief symptom of TMD. The vast majority of all headaches are muscular in nature (muscle tension type headaches). Muscle induced headaches come from either the neck, face and head muscles or all three. This is why headache patients referred for CAT Scans and neurological tests report negative (normal) results the majority of the time. These tests look for blood vessel or neurological damage inside the skull, but not damage to the muscles controlling the opening and closing of the mouth on the outside of the skull.

15. Patients with headaches, a negative CAT scan, and a normal neurological evaluation may well have a temporomandibular disorder Figure 1

16. Use the TMD Questionnaire (see attachment in packet). Several ‘yes’ responses indicate the need for further evaluation by a dentist with extensive training in TMD evaluation and treatment. Screening Questions for TMJ Injuries

17. If you have headaches , a negative C.A.T. Scan and a normal neurological evaluation, you may well have a temporomandibular disorder. Do you experience headaches ? (Especially in the morning when you wake up or in the evening when you go to bed?) YES  NO  Do you have pain around the eyes, in the forehead, or at your temples? YES  NO  Do you have pain in the face, neck, or shoulders? YES  NO  Do you have pain, ringing, or buzzing in your ears? YES  NO  Screening Questions for TMJ Injuries

18. Do you experience clogging, fullness, or pressure in your ears that comes and goes? YES  NO  Do you experience dizziness? YES  NO  Do you experience a clicking, popping, or snapping in your jaw joints when you open wide, close your mouth, or bite down? YES  NO  Do you have pain when you open wide, close your mouth, or bite down? YES  NO  Do you have difficulty with chewing, talking, or yawning? YES  NO  **A COMBINATION OF ANY “YES” ANSWERS TO THESE QUESTIONS IS INDICATIVE FOR A TMJ EVALUATION BY A DENTIST.** Screening Questions for TMJ Injuries