By Josette Keelor -- Daily Staff Writer

For most people, corrective braces are the answer to a problem; for Shannon Bowen, of Strasburg, it was the beginning of hers. What began in her teen years progressed through her 20s and into her 30s, until she decided enough was enough.

Bowen, 38, had heard about temporomandibular joint dysfunction, but did not know that was the cause of her pain.

"[I] had headaches a lot, and a lot of popping and cracking in my jaw," she says.

She had not associated the headaches with the jaw problem, though, nor the neck or shoulder pain. It was even difficult to open her mouth very wide to eat and she had given up trying to chew gum or eat foods like hamburgers or bagels. "I just had this myriad of symptoms," she says.

Meeting with Dr. Craig Zunka changed all that.

The problem of TMD, commonly referred to by the name of the joint, TMJ, can have many causes, making it difficult to diagnose and treat, says Zunka, a dentist in Front Royal who treats chronic pain and TMJ problems.

"There's a lot of different facets to treating people with [TMD]," says Zunka. "There's so many different things that go on with the jaw joint," he says. TMD is the broad term for problems with the joint, but the specific problem is more complex, he says.

Bowen's TMD started after she was fitted for corrective braces as a teenager. It was gradual, Bowen says, and for 12 years she did not pursue a diagnosis or treatment for the pain, other than taking painkillers for her headaches.

A trip to Hawaii in 2001 was a turning point that pushed her to pursue a diagnosis from Zunka. When scuba-diving with her husband, Bowen had trouble Inserting and removing the mouth piece of her scuba gear without a lot of pain in her jaw.

"This is really affecting my quality of life," she says she thought at the time.

The temporomandibular joint is named for the place where the two bones — the temporal bone and the mandible — come together just under the ear.

"This is the most unique joint in the body," Zunka says, because it moves in three dimensions. It is the only joint in the body that does this, he says.

"The teeth really determine how the joint fits," he says, and if the teeth are misshapen or misaligned, they will also affect the joint.

TMD affects more than 10 million Americans according to certain estimates, says the Web site for the National Institute of Dental and Craniofacial Research, www.nidcr.nih.gov.

"It can strike with any ages," Zunka but "I don't see many cases until they're 15, 16."

Classic cases appear in people around the age of 35, he says, and are more common in women.

TMD was first noticed 53 years ago, Zunka says, when the American Equilibration Society became the first organization to work with the problem. The dysfunction would prove to be much more complex than dentists realized.

"Since then a lot of research has been done, and we know that TMD problems are way more complicated than just adjusting the bite," he says, noting cases in which patients realized relief from back pain after being treated for TMD. Straightening out the jaw would actually straighten the spine, he says.

Because the jaw constantly attempts to align itself after an injury, the entire body can be affected.

"Headaches are a prime symptom of TMJ [dysfunction]," Zunka says. "People who constantly grind their teeth could have TMJ problems."

TMD can also be caused by the disc of cartilage being out of place between the top end of the jaw and the socket in the skull.

An X-ray will show if the bones around the joint are misaligned, but Zunka says a Magnetic Resonance Imaging test is the only way to tell if the disc is out of place.

"Sometimes it's muscle-related and/or it could be arthritis related," he says. "Trauma can cause this," he says. A tooth extraction can also cause TMD, by altering the bite.

"That's probably one I see a lot," he says.

Another symptom of TMD is limited mobility of the jaw, when the jaw is locked open or closed for hours or even days. Though some people experience pain with TMD, others do not.

The first mode of treatment for TMD is getting the disc back in place to know where to put braces, Zunka says. Though Bowen says her case of TMD was caused by braces, orthodontists and other doctors have since become more informed with how to prevent altering the alignment of the jawbone when applying braces.

Zunka often uses braces as a treatment for TMD, so that the bite will allow the joint to close normally.

"Once you know where the disc is and where the bones are, one of the treatments is making a bite appliance," he says.

Bowen says the bite appliance she used, a mandibular orthopedic repositionary appliance, slowly took the pressure off her TMJ, easing pain.

"He worked with me, I want to say, for about a year and a half," she says, explaining that the treatment ended with surgery to move the disc back to where it belongs.

"It's really like a magic cure. It literally instantly feels better," Bowen. "The headaches, when they fix it, they just go away. It's pretty amazing how fast they just go away.

"I would have done it a lot sooner if I had known how not scary it was," she says.

She still wears a retainer to keep her teeth from shifting.

For Bowen, the combination of the bite appliance, physical therapy and surgery did the trick, but Zunka says that many treatments are available.

"Less than 10 percent of the people I see need joint surgery," he says.

Nutritional supplements are an option he says, as well as other alternative methods like acupuncture, magnetic therapy, homeopathy and the use of cold lasers and infrared technology, which he says decrease swelling and promote healing.

"You're not doing anything that's not reversible," Zunka says of all treatments he uses, barring surgery, which is always his last choice. "Conservative treatment, 90 percent of the time, treats the patient."

Contact Josette Keelor at jkeelor@nvdaily.com