Temporomandibular Joint (TMJ) Disorder Overview

temporomandibular joint

The most complex joints in the body are the two temporomandibular joints (TMJ). These joints are located in front of the ears and connect the lower jaw (mandible) to the temporal bone of the skull. Temporomandibular joints are complex, both rotating and sliding, and involve numerous components: muscles, nerves, tendons, ligaments, bones, connective tissue, and teeth.

TMJ Symptoms are Varied and Mimic Other Health Issues

TMJ is difficult to diagnose because many of the symptoms of TMJ are also symptoms that can be attributed to other heath problems. Some symptoms are periodic; some improve over time while others can worsen. Symptoms of TMJ are described as:
  • pain in the shoulders or neck
  • migraines or chronic headaches
  • stiffness of the jaw muscle
  • limited movement of the jaw or locking of the jaw
  • painful clicking jaw
  • popping, or grinding of the jaw when opening or closing the mouth
  • ear pain such as pressure or ringing in the ears
  • decreased hearing
  • dizziness or vision problems
Other health issues have to be ruled out before a TMJ diagnosis is considered. TMJ patients may see a multitude of providers that include primary doctors, specialists such as ear, nose and throat doctors, chiropractors and dentists before a diagnosis of TMJ is made.

Causes and Treatments for TMJ

Not all causes of TMJ are known but genetic, hormonal, and biological factors can influence the development of TMJ disorder. Factors that can contribute to developing TMJ are teeth clenching or grinding of teeth, nail biting habits, an injury to the area, infections, previous dental treatments, or auto immune disease. Most TMJ patients report a hypersensitivity to pain.

TMJ is not recognized as a specialty in either the American Dental Association (ADA) or the American Medical Association (AMA) due to the lack of basic or clinical science; and most insurance companies will not cover treatment for TMJ because there is no standardized method of treatment. There is also no empirical evidence that TMJ can be prevented by any treatment. However, there are some treatments that seem to help diminish TMJ pain.

The National Institute of Health (NIH) suggests the following treatments:
  • self-care practices (eating soft food, avoiding extreme movements of the jaw such as yawning, avoiding repetitive movement such as chewing gum, or applying moist heat or cold to the area)
  • avoidance of treatments that cause permanent change to the bite or jaw such as crowns, bridges, grinding down of teeth
  • avoidance of surgery on the teeth or jaw area
  • replacement of the temporomandibular joint as a last resort
Many TMJ patients are fitted with a mandibular repositioning (MORA) device. Though this is a widely used treatment option; the scientific validity of the device is unproven. Over time, some symptoms go away without any treatment. Others seem to improve temporarily with some self-care practices. Other treatments include using a stabilization splint which is a nightguard that is fitted to the patient’s teeth. Over-the-counter bite guards are not recommended as they may actually increase pain if they shift the teeth.

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The Dog Days of Summer

dog days of summer
No matter your age, if you don’t take certain precautions, the hot weather can be a miserable experience. A lot of what we know about protecting ourselves is common sense but some people live more dangerously than others.

The hottest and muggiest days of summer have been known to fall between early July and early September. During this time period, the reward comes from an opportunity to move a bit slower, dress in clothes that reveal some skin and go to the beach or have a holiday cookout. This and more can be the result of experiencing the sultry days of summer as long as you follow these simple rules first.

Beating The Heat

  • Always dress children in light-colored cotton clothing. Babies should wear cotton t-shirts instead of going to an outing shirtless. Cotton can absorb heat and keep babies cooler. Also try shirts made from 100 percent Bamboo to reap the benefits of staying cool without perspiration.
  • If babies get sunburn, never put medicated lotions on their bodies unless instructed by a physician first. Instead, be sure to buy baby lotions with the necessary sunscreen protection already in them.
  • Choose sunscreens that have a broad spectrum of protection. Dry skin is not the only cause of wrinkles. Intense sunshine exposure is one of the leading causing of skin damage and wrinkles. Your options for sun protection are SPF moisturizers, basic sunscreens or tinted moisturizers.
  • Drink plenty of liquids and stay away from sugar filled carbonated drinks. Carbonated drinks have an alarming amount of sugar, overwhelming calories, harmful additives and can ruin your appetite for healthy foods that your body needs.
  • Senior citizens should try to stay in cool places during warm weather. Now that the dog days of summer are upon us, the risk of heatstroke among older people is much higher. If you do not have air conditioning, go somewhere that does. A movie theater, the mall, a friend or relatives or a community center for seniors are a few good places.
  • Try to do all chores in the morning or afternoon when it's cooler, instead of the peak hours between noon and 5 p.m. Never try to overexert yourself in warm weather. It slows you down and increases your chances of passing out. Arm yourself with water bottles and damp towels to keep cool even if you're just outdoors at a cookout.
  • If you have been out in the sun for an extended period of time and feel tired, weak and nauseated, drink plenty of liquids, soak in cool water and seek medical attention if symptoms are severe.

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The United States Nursing Shortage Crisis

nursing

In The Desperate United States Nursing Shortage, we examined the statistics that define the nursing shortage in the U.S., particularly in California. Here, we will go deeper into the issues and offer possible suggestions.

There are so few spots available in academic nursing programs because there are just not enough educators. To be a nurse educator, you must possess a bachelor's degree, at the very minimum. A master's prepared educator is ideal. Additionally, all nurse administrators in hospital settings must be bachelor's prepared or higher as well. Hospital administration pays more than education, so the candidates that are qualified for both, often pursue administration. As hospitals become more expansive and service-oriented - which they must do to survive in this precarious industry - they will have to increase salaries to draw highly qualified administrators. This, in turn, increases the salary gap between hospital administrators and nurse educators even more.

According to Diana Christiansen, president of The Atticus Group, a health care consultancy, "In California alone, enrollment must expand by 90 percent to meet the expected need for nurses. However, nursing schools are struggling to hire the faculty to meet the current 16 percent expansion in place. And 2010 this is predicted to be the biggest year for nursing faculty retirement in history."

Consider the pipeline behind those retiring nurses. There aren't enough BSNs to replace the retirees, much less support a large expansion, which will be necessary to replace the Baby Boomers. "We know the nursing doctoral programs are expanding," says Christiansen. "But 50 percent of the people in the programs do not plan to teach. So, this whole expansion effort on the part of the schools is a house of cards."

Ideas for Nursing Recruitment and Retention

In order to recruit new nurses, hospitals need to develop an expansion or recruitment partnership with their supporting schools. Riverside Community Hospital (www.rchc.org) in Riverside, California and Long Beach Memorial Hospital (www.memorialcare.com/long_beach/) in Long Beach, California created proprietary partnerships with their local colleges and universities with nursing programs, which allowed the institutions to double their enrollments.

The other storm brewing and gaining strength is the aging of nurse leaders. Have those nearing retirement had replacements identified and are they receiving the education and support they need to be ready? It is already extremely difficult for nursing schools to maintain enrollments, and this will occur at the time hospitals and colleges are losing staff to retirements. Meanwhile, part of hospital expansion efforts include adding more and more beds, which again expands the nurse-to-patient ratio into a greater, desperate deficit. And the cycle continues.

Another issue is that graduates of two-year RN programs have their choice of jobs unpon graduation. After spending at least two years of completing prerequisite classes and general education, and perhaps idling at least a year on a waiting list, they are eager to get out and get to work. They know that for future advancement they will need their Bachelor's of Science in Nursing (BSN), but they feel they need to work first and they can eventually go back. Many never do.

Once they begin working, the nurse to patient ratios are extremely high. Why? The nursing shortage. When nurses come in they are often extremely excited to begin the careers that they trained so hard and sacrificed so much for. However, because of hospital politics, the high nurse-to-patient ratio and the stereotypical dynamic that rookie nurses are often treated badly by their senior counterpoints and patronized by doctors frequently leads to disillusionment and then burnout.

Develop Academic Partnerships

So what can be done? For starters, adises Christiansen, hospitals need to be aggressively proactive. A head-in-the-sand approach simply will not do. In essence, this has what has brought us to this potentially catastrophic brink as it is. "Hospitals need to partner with their academic institutions and develop innovative programs that will increase enrollment and nurture their nurses once they have entered the workforce." Christiansen adds that the first year of a nurse's career is the most tenuous. Many dropout and never come back to the profession.

Next, employee mentoring programs must reverse the traditional hospital culture. Like the residency programs that are essentially a baptism-by-fire, it's a catchphrase in the industry that nurses "eat their young." In other words, the veterans had to endure strict treatment when breaking in, why shouldn't this generation of rookies do the same? Well, because in the situation the industry is in, they simply cannot afford to lose a single, qualified nursing professional to such treatment. Their jobs are difficult enough as it is, as they struggle to accomodate the needs of their patients, the demands of the doctors and the rigorous policies of the hospitals - talk about your perfect storms ...

Educating and nurturing baccalaureate-trained nurses should be the utmost priority for any hospital that expects to weather this storm that is already causing a deluge of debt and devastation in hospitals in many regions of the country. California is particularly vulnerable because of its enormous population. Offering nurse educators comparable salaries is another step. Or, perhaps balance the two by allowing hospital nurses to teach one or two days a week, alleviating their burnout, while maintaining their salaries and allowing them to educate the next generation of nursing professionals.

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The Symptoms of Piles and How To Deal With Them Effectively

symptoms of piles
Piles (also called hemorrhoids) can make life quite uncomfortable for those who need to deal with them. Even simple things like sitting, lying, or standing can become a hardship; people dealing with the symptoms of piles may find it almost impossible to find a comfortable position. This condition is caused by enlarged veins in the anal area. It can be triggered by a number of different events such as straining too hard when trying to pass a stool, spending too much time sitting or standing, or as a result of pregnancy.

The Symptoms of Piles

Sometimes the symptoms of piles can pass quickly with minor inconvenience and only mild discomfort. Other people may have a much harder time of it, and these hemorrhoids can really interfere with life. The usual pile symptoms include;
  • Itching in the anal/rectal area
  • Fresh blood on toilet paper (if the blood is a darker color then this could indicate a problem higher up in the bowel). People might also notice stained underwear or even blood dripping when they try to pass a bowel motion.
  • There may be a lump in the anal area if the hemorrhoid has prolapsed. Sometimes a prolapsed hemorrhoid can be eased back under the skin, but other times it becomes stuck and this will increase the symptoms.
  • Individuals may find it hard to get comfortable in any condition because of pain and discomfort
The symptoms of piles can be unpleasant but hemorrhoids rarely cause serious problems. It is important though that anyone noticing blood in their stool gets this checked out by their doctor. This is due to the possibility that it might be caused by something more sinister than piles.

How to Deal with Piles

There are a number of options for people who have to deal with the symptoms of piles. It is recommended that people speak to their doctors about the problem but there are some home treatments that might help.
  • Many people how have needed to deal with piles have found that sitting in a warm bath can provide some relief which lasts for an hour or two afterwards.
  • Most chemists will have a selection of creams that can be used to help ease the symptoms of hemorrhoids.
  • It is important to not spend too much time sitting or standing; this can exacerbate symptoms.
  • Eating more fiber and drinking plenty of fluids can make help people cope better with the discomfort caused when passing a stool.
If the symptoms of piles persist or get worse then people need to return to see their doctor for other options to deal with the problem.

The symptoms of piles can be hard to deal with. Most people will be able to deal with the problem without too much hardship, but all rectal bleeding should be investigated by a doctor to rule out more serious complaints.

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Pupil Anomalies

pupil anomalies
Taking a set of vitals is standard procedure for all medically trained caregivers and while patients rarely give it a second thought, health professionals love vital signs. The importance of these signs is self-evident to the medical world; they are the clues to a condition, an attribute of life and once in decline, a harbinger of death.

Vitals are not just numbers; they reflect a patient's well-being and show changes in circumstances, often particularly important ones. The eyes may be the windows to the soul, but just the pupils can reveal plenty of information for diagnosis purposes.

The Pupil

The pupil of the eye resembles a black hole that can constrict (close), or dilate (open), in response to various factors. Essentially the role of the pupil is to adapt and change size to allow the maximum amount of light into the retina without causing damage. The retina converts the light into nerve impulses which travel to the optic nerve and then directly to the brain, allowing a person to see.

Pupils have an involuntary reflex but they can and do react to emotional states. Pupil sizes can portray the following emotions:
  • fear
  • hostility
  • sympathy
  • love

Pupil Changes Caused By Medical Conditions

Medical caregivers examine pupil size because they can be directly correlated to health conditions. In this case, it isn’t only the size of the pupils that are noted but their reactivity and equality too. In normal circumstances, pupils should be neither large nor small, but average. If extra light is supplied, both pupils should constrict and if surroundings become darker, both pupils should dilate, equally. What happens in one eye should also happen in the other, giving a bilateral reaction.

Drugs are by no means the single factor of pupil change, but depending on the type of drug involved they can cause pupils to constrict, dilate, or show a lack of reactivity. Drugs are often the first suspect in any pupil changes where there has been no trauma and no history of an existing illness.

Pupil Appearance

Significant or possible causes of constricted pupils include:
  • drugs such as Heroin, Fentanyl, Codeine, Tramadol and other narcotics
  • migraine
  • corneal ulcer
  • Horner Syndrome (damage to the sympathetic nervous system serving the eyes)
  • pancoast tumor (carcinoma of the lung apex)
  • uveitis (inflammation of the inner eye)
  • prescription eye drops
Significant or possible causes of dilated pupils include:
  • adrenaline
  • drugs such as antipsychotic agents, atropine, cocaine
  • blood loss
  • OTC and prescription eye drops
  • Seratonin Syndrome (a toxic reaction to serotonin)
Significant or possible causes of unequal pupils include:
  • stroke
  • head injury
  • artificial eye
  • eye Injury
  • Adie’s Syndrome (light response slower in one eye possibly due to a mechanism malfunction)
  • third cranial nerve palsy
  • tumor
  • meningitis
  • encephalitis
Significant or possible causes for lack of reactivity in pupils include:
  • drugs
  • lack of oxygen to the brain
  • brainstem coma
  • death
Pupil Facts and considerations:
  • Most of the light entering the eye does not escape, which is why the pupil appears black.
  • It takes longer for a pupil to dilate than constrict.
  • Pupils can miss the mark immediately; they will shrink down and then reopen slightly.
  • If both pupils are dilated, it is usually due to drugs, not disease.
  • Red eyes are the result of the camera flash bouncing off the retina, back out of the eye and into the camera lens.
  • Emergency medical responders carry pupil gauges to measure pupil size.
  • Pupils that are fixed and dilated typically indicate impending death.

Baseline Pupil Sizes

As with any vital sign, a baseline should always be taken for comparison purposes. When checking the pupils, note the size before shining a light into them. Do one eye at a time covering the opposite eye with your hand. When the light hits the pupil it should constrict and when the light is removed, it should dilate back to its normal position.

While the pupil size, reactivity and equality will not specifically diagnose a condition, it can offer tremendous clues for health professionals in the pursuit of a diagnosis.

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The Role of Flossing in Teeth Cleaning

floss

Teeth cleaning is a daily chore, with some people cleaning their teeth up to two or three times per day. Not only is it required for fresh breath, but cleaning teeth is necessary if one wants to avoid plaque stains and tooth decay.

Another desired benefit of teeth cleaning that most people wish to attain is whiter teeth. It may appear to sound obvious that whitening one’s teeth comes with brushing, but there’s a lot more to it than that.

Dentists recommend the use of floss to reach in places that the normal toothbrush cannot.

Dental Floss and Flossing Teeth

When people clean their teeth, they often don’t realise that there are places that standard and electric toothbrushes miss. It might not matter how many times per day individuals clean their teeth, but failure to reach certain areas around the teeth may facilitate the build up of plaque and subsequent tooth decay.

That is why the use of floss to supplement the teeth cleaning process is necessary.
Dental floss itself is a collection of plastic fibres or thin nylon filaments. Flossing is done when individuals place the dental floss in between their teeth, hold it down and rub it back and forth.

Flossing and Whiter Teeth

Teeth cleaning by standard or electric toothbrush should be supplemented with flossing, if one hopes to achieve the regular status of whiter teeth. This is because flossing reaches in places that traditional brushing cannot. People may not realise it but the build up of plaque – and subsequent tooth decay – occur when toothbrushes do not scrub away the accumulated gunk from inaccessible places.

In fact, the most common areas where dentists instruct people to brush more often are in the small gaps between teeth. This isn’t surprising.
For the best results, it is recommended that one engages in flossing prior to traditional teeth cleaning by toothbrush. People tend to notice whiter teeth when they have flossed twice a day for several weeks. Thus it is a good habit to adopt.

Indeed, research carried out by Milan University Medical School in Italy reveals that the risk of heart disease is surprisingly lowered by regular flossing. This is because gum disease is prevented, and there is a link between gum disease and heart conditions, hence the reduced risk.

Floss for Whiter Teeth

Many perceive flossing as an added burden to an already mundane chore of teeth cleaning. But if individuals desire whiter teeth, they should overcome the reluctance and commence flossing today, citing the reduction in heart disease as a worthwhile incentive.

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