Case Studies

Your Smile, Your Life ™
pauline

TMD Treatment Can Relieve Trigger Thumb Among Other Ailments

Pauline contacted our office complaining that her jaw was locking up on one side, making it difficult for her to eat. She described headaches, shoulder and neck aches, and explained that she was taking medication for the pain, but she did not know what was causing the pain.

At her first appointment, she told us she found our practice on the internet. She had been looking for a “TMJ specialist.” She reported that she had braces as a child and her first bicuspids were extracted for the orthodontic work. She started experiencing headaches after the braces were removed. She detailed a long history of medical issues including carpel tunnel release in 1995 as well as Reflex Sympathetic Distrophy (nerve condition) diagnosis he same year. A Transient Ischemic Attack (TIA) in 2003 caused a fall, resulting in a back injury and increased headaches. The same year she was diagnosed with Fibromyalgia, which resulted in her retirement with disability in 2005. In 2004 she experienced a cervical neck sprain in an automobile accident. In 2007 she sought treatment by a neurologist for repeated cluster headaches. The neurologist had prescribed the following medications to treat her various ailments:  adderall, metaxalone, imitrix, prednisone, and temazepam. In 2011 she had sought treatment by an accupuncturist.

We completed an occlusal analysis and took impressions for an orthotic to be manufactured specifically for Pauline to wear to adjust her bite over time. We delivered the orthotic approximately one month following her first visit to the office. She returned the next day for an adjustment, reporting that she was feeling much better and was experiencing less popping. A week later, she reported that her headaches were almost gone and that the neck pain and problems sleeping had improved. She said the popping and clicking had ceased.

In her visit approximately four months after orthotic placement, Pauline reported that her TMJ was better, she was better able to open her mouth, her clenching/grinding was better, and the pain in her neck and shoulder was better. Her headaches had not fully subsided, and she was experiencing some TMJ noise.

Meanwhile, while Pauline’s bite was being adjusted by the orthotic, we discussed her options for permanent resolution of her TMD. She decided to proceed with porcelain veneers designed to correct her bite. The veneers also offered a terrific cosmetic result for her. Approximately five months following delivery of the orthotic, we prepped Pauline’s teeth for porcelain veneers, designed to the bite established by the orthotic. A few weeks later, we cemented permanent restorations that established her new bite and her beautiful new smile.

A short time after we completed Pauline’s case, she told us that her trigger thumb symptoms had completely disappeared. Until that time, we were not aware of the trigger thumb issue; she had not disclosed the problem in her consults with us. When we talked about it, she said that she simply had not seen a connection between her TMD and her trigger thumb. We were so pleased she had this result, which we are now quite sure was related to resolution of her TMD. The neuromuscular treatments corrected her occlusion, which resulted in release of pressure on nerves in the neck. The release of pressure on those nerves can lead to increased nerve function in the hands. She told us that she had been planning surgery involving fenestration of the fascia of the thumb. She was thrilled to be able to cancel her surgery and reported that her surgeon was amazed at her recovery without surgery. We were also pleased with the bonus she received from our TMD treatment!

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