Ask The Doctor

At MedCenter TMJ, it is Dr. Auvenshine’s goal to educate his patients so that patients can make informed decisions and better understand their unique problems and treatment solutions. At any time, please feel free to ask Dr. Auvenshine or our staff questions regarding your care. In addition, you may submit questions to Dr. Auvenshine via e-mail at and he will gladly address your question on this website.


By Dr. Ronald Auvenshine

The terms of definition of the field of TMD and orofacial pain have gone through several changes over the years. I have actively been involved in the treatment of TMD since 1971. At that time it was simply referred to as TMJ. Later, as we began to further define the various causes of TMJ problems, there was a need to further sub-classify each of the conditions into it’s own category. The field of dentistry has struggled with the naming of the umbrella term for TMJ problems and still is in the process of refining and standardizing the nomenclature of the field. I personally prefer the umbrella term Craniomandibular Disorders. However, I am in the minority.

It is not uncommon for a patient to come to their dentist or physician and say, “I think I have TMJ.” Sometimes they are told, “Like the knee you actually have two TMJ’s.” When we refer to temporomandibular disorders, the reference is anything that involves the function, integrity, and the stabilization of the temporomandibular joints.

Any degenerative or traumatic event that can destroy other joints can also affect the temporomandibular joints. Therefore, all of the various forms of arthritis are found within the temporomandibular joints. Osteoarthritis is most often due to the aging process. Secondary Arthritis is most often the result of trauma. Rheumatoid Arthritis, which is thought to be an autoimmune disease, can attack the temporomandibular joints as it does other weight bearing joints in the body. All of these degenerative diseases have less effect on the TMJ if detected early in their development.

Temporomandibular Disorders can be subdivided into extracapsular and intracapsular disorders. Extracapsular means that there may be muscle tension or pressure on the joint, but the joint itself is healthy and all the anatomical parts are in place. This is referred to as a Myofascial Pain. If, however, there is an internal problem of the TMJ, this is referred to as an intracapsular problem. Intracapsular problems can be anything from displacement of the intercartilaginous disc, or any degenerative change, which may have affected the joint.

In addition to the classification of intracapsular, and extracapsular, there is a third category of facial pain for which a patient will seek treatment. This category is referred to as Orofacial Pain of non-TMD origin. Such things as trigeminal neuralgia, migraine headache, neuritis, continuous pain disorder, and reflex sympathetic dystrophy are categories of this classification.

Acute vs. Chronic Pain

By Dr. Ronald Auvenshine

In pain medicine, one of the classification systems is based on the length of time the pain has been present. If a person experiences pain within the first six-month period, it is referred to as acute pain. If the pain persists beyond six months, the patient is now classified as having chronic pain.

Chronic Pain Disorder can vary in severity from mild to moderate to severe pain. If the pain persists for a long time, more than likely the pain will not go away without some form of treatment. Outcomes are better for acute pain than for chronic pain. However, our special interest is helping the chronic pain patient feel relief and improve their quality of life. Not all head pain is of TMJ origin; however, current research substantiates the fact that Tension- type Headaches are the most prevalent of all headache types. Even though the migraine headache is the most severe and debilitating type of headache and the one for which a person will most often seek medical treatment, the Tension- type Headache or chronic daily headache is the most prevalent. Current medical research indicates that TMD is a major part of the Tension- type Headache.

Since there is nothing built into the system of jaw function to favor muscle relaxation, the patient who suffers from painful TMD must seek the treatment of a dentist who is knowledgeable in treatment techniques and appliance design to help the ailing system recover so that the pain can be controlled.

If left untreated, the pain progresses from mild, to moderate, to severe. It has been my experience over the years that the pain can become so debilitating that suicidal thoughts begin to be experienced by the chronic pain sufferer. This is why early detection and treatment is so important.

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