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Car Accident = Symptoms = TMJD

Jeehyun Hoke, 36, had a memorable introduction some months ago to Dr. Charles Ferzli, one of the area’s pre-eminent experts in the diagnosis and treatment of TMJD—temporomandibular joint dysfunction.

Dr. Ferzli works with a colleague to prepare TMJ tests for a new patient.

“I really needed help,” she recalls. “I had experienced a very painful auto accident—my car was hit from the rear—and as a consequence, my head snapped back sharply as a result of the impact. There was a lot of unresolved pain that got increasingly intense. And within two weeks, I was unable to open my jaw beyond a couple of centimeters. I had to chop up my food into fine particles to eat.

Jeehyun Hoke

“I took this problem to my family dentist, who after a brief exam told me I needed specialized care to resolve the problem and to ease the persistent pain. He strongly recommended that I see Dr. Ferzli. That was great advice. After a very thorough exam, and extensive testing, Dr. Ferzli prepared two mouth guards for me, one for use while sleeping, the other for use in the day time. I am now at the point where I no longer need the day-time mouth guard, and I am pain-free. My jaw is working fine, and I can eat naturally.”

Locating Pain

Notes Dr. Ferzli, “When we have a patient suffering from head and neck pain, we focus to discern the origin of that pain. Where is it coming from? We do a series of neurologic tests to zero in on the location of the pain. And thus we know ahead of time whether we will be able to help the patient before we initiate treatment.

Common TMJ Symptoms

  • Limited jaw opening
  • Clicking or popping jaw joints
  • Severe, one-sided headaches (such as cluster headaches)
  • Headaches that feel like sinus infections
  • Clenching during the day or at night
  • Swelling on the side of the face
  • Recent changes to the bite
  • Grinding teeth at night (bruxism)
  • Uncontrollable tongue movement
  • An earache in the absence of an infection
  • Stiffness or “lock” feeling in the jaw when talking, yawning or eating (swallowing)
  • Difficulty opening and closing the mouth and/or chewing
  • Upper and lower teeth that do not align properly (malocclusion)
  • Dizziness
  • Eye pain and eye problems
  • Neck and shoulder problems
  • Ear pain such as hissing, buzzing, ringing or roaring sounds
  • Frequent waking up with headaches or experiencing frequent tension headaches

“The temporomandibular joint syndrome,” he explains, “is a disorder of the nerves and jaw muscles caused by injury to the temporomandibular joint—as this patient experienced. The joint is the connection between the jawbone and the skull.

“The injured TMJ can lead to pain with chewing, crackling, popping and clicking of the jaw, tooth grinding called bruxism, swelling on the sides of the face, nerve inflammation, and morning headaches including migraines.”

Many Symptoms of a Complex Problem

Common symptoms of TMJ disorder, notes Dr. Ferzli, span a wide range, and may not seem to be connected to the jaw (see box,
). It is often difficult for practitioners to hone in on the TMJ condition “because symptoms suggest so many other issues,” notes Dr. Ferzli. “It could be neck pain, or lower back pain, or foot pain. It could be the beginning of carpal tunnel pain. These are all issues related to the trigeminal nerve—the fifth cranial nerve.

“Doing a trigger point injection in the area of pain doesn’t always treat the problem, because the source of pain is actually somewhere else. So most of the treatment we offer involves decompressing the TMJ area with oral appliances—as we did for Ms. Hoke—and by doing so, we are reducing the inflammation, improving range of movement, and decreasing pain in related muscles.

To Serve His Patients

In his exacting work, Dr. Ferzli uses an array of state-of-the-art tools to guide patients along the path of healing and relief, including::

  • CBCT X-rays: to determine alignment of the head and spine;
  • Photography: to see if ears, eyes, and posture are properly aligned;
  • Joint vibrational analysis: to help determine health of the TMJ joint when the patient opens & closes their mouth;
  • Jaw tracker: an instrument that measures and records the movement of a patient’s jaw, used to determine how fast the jaw opens and closes—and how straight the mouth is when opening and closing.

“We also recommend a diet to decrease inflammation. We often notice that after the first week of treatment, the patient’s symptoms are lessened dramatically.”

Noting that craniofacial pain and sleep disorders are complex problems, often associated with other health issues, Dr. Ferzli says “I work with several colleagues in the medical profession to help my patients. As appropriate, I refer my patients to several ENT physicians for nasal evaluation, to a chiropractor or physical therapist for spinal problems, as well as to a podiatrist.”

Dr. Charles Ferzli:
An Ardent Student

Charles Ferzli graduated from the University of North Carolina at Chapel Hill with a Doctor of Dental Surgery (DDS) degree in 1997. He worked in a Medicaid office for a year followed by two other associateships before starting his own practice. For the next 13 years, he devoted himself to being the best dentist he could be by taking courses from every branch dentistry has to offer, and was one of the early dentists to invest in revolutionary technology to provide better quality dentistry for his patients, such as CEREC in 2000 and Periolase in 2006. During this period, he gained experience in performing complex cosmetic procedures, orthodontics, dental implantology, and conscious sedation.

It was when he took a mini-residency course from the American Academy of Craniofacial Pain and earned a fellowship that Dr. Ferzli found his passion for treating head and neck pain—or craniofacial pain. He decided then that he wanted to devote the rest of his career helping people who suffer from pain and sleep disorders.

He became a center owner of TMJ and Sleep Therapy Centre Inter-national in 2012. He has acquired the highest level of education in several organizations focusing on helping patients with head and neck pain, and sleep-related breathing disorder problems and is a Fellow of the American Academy of Craniofacial Pain, a Diplomate of the American Board of Craniofacial Pain, a Diplomate of the American Board of Craniofacial Dental Sleep Medicine, and a Diplomate of the American Board of Dental Sleep Medicine.

Dr. Ferzli is affiliated with the Academy of General Dentistry, the American Academy of Pain Management, the American Academy of Orofacial Pain, and the American Academy of Craniofacial Pain.