TMJ – Temporomandibular Joint Disorder – TMD


Could your bite be causing problems?

TMJ/TMD Symptoms: Headaches

       Headaches are one of the most common symptoms of a TMJ (temporomandibular joint) problem. 90% of all headaches are Tension headaches  and the TMJ headache is a tension type of headache. It is often described as a migraine headache.

       There are a few TMJ-related causes for tension headaches. Constant contraction of muscle fibers within a muscle, create tension, pressure or a tight feeling in the face and head, and constant tight muscle fibers prevent or reduce blood flow to that area. The body sends more blood to the areas and this can result an increase in general blood pressure to the muscles and head, sometimes referred to as vascular headaches. Clenching and grinding the teeth, which are TMJ symptoms, produce pain from the muscles in the head, which is a headache. Furthermore, there are 2 muscles in the neck that are attached directly to the covering of the brain, which can cause a direct headache.

        Unfortunately, these headaches can be so frequent or severe that they are frequently misdiagnosed and treated as migraine headaches.

       The pain from muscle headaches can be blocked with medications, or nerves cut with brain surgery or muscles somewhat relaxed with muscle and psychological therapy, but the cause of the disease and damage from the bad bite, malocclusion, will persist. Side effects with medications, complications from brain surgery, and limited results with muscle or psychological therapy do not correct the source of the problem. Neuromuscular dentistry ensures the muscles are happy because they do not have to work hard positioning the teeth to a strained bite.

       By putting the temporomandibular joint back into alignment and placing the jaw into its optimal position, neuromuscular dentistry can alleviate most headache problems related to TMJ, muscle, nerve and joint disorders.

TMJ/TMD Symptoms: Facial Pain

       When a patient’s bite is not properly aligned, TMJ (temporomandibular joint) dysfunctions and a number of related symptoms can arise. One of these symptoms is facial pain.

       The jaw area of the face is a complex network of bones, joints, muscles, and nerves. When the jaw becomes unaligned, the surrounding bones, muscles, and nerves are also affected. This includes the muscles of the face, which experience strain or spasm because the
muscles are working extra hard to compensate for the unstable bite.

       A neuromuscular dentist can helpfacial pain problems by working with the source of the problem, the bite. He will stabilize and realign your bite so that the teeth, muscles, and joints all work together without strain.

TMJ Symptoms: Neck and Shoulder Pain

       Having a ‘bad bite‘ (malocclusion) causes an imbalance in the jaw-to-skullrelationship, which in turn twists the jaw into a strained position that refers pain to the muscles in the neck, shoulders, and back.

       Muscles work as a team. Seldom does a single muscle work without other muscles in the team joining in. The bones in the neck, especially the atlas and axis, are intimately involved with the muscles of chewing, biting, talking, breathing, and head posture. Sore, tight, contracted muscles of the jaw will tilt the head and shoulders causing compensation from neck, shoulder and back muscles. Although the neuromuscular dentist does not claim to treat neck, back, shoulder, or arm pain, patients are pleased how frequently these problems can be relieved.

       A neuromuscular dentist understands that the bones, joints, muscles, and nerves in the face and neck have a complex relationship. He works to correct the bite, relieving strain on the jaw and the surrounding muscles. Once the bite has been aligned, resulting pain in many areas of the body disappears.

Symptoms: Tinnitus (Ringing in the Ears)

       Ringing in the ears, or tinnitus, is another symptom of TMJ that is commonly misdiagnosed and often goes untreated or is treated ineffectively. In many cases ringing in the ears is one of the results of having a strained bite in which the jaw is not aligned. The jaw area of the face is a complex network of muscles and nerves, and when the bite is misaligned muscles and nerves throughout the head, including the ears, can be affected.

       If A neuromuscular dentist diagnoses the cause of your tinnitus to be an unstable or misaligned bite, he can work with the source of the problem by stabilizing and realigning the bite so that the entire jaw area works together without pain. Your bite will be back to its normal position, relieving the ringing in your ears that was caused by the misaligned bite.

TMJ Symptoms: Clicking or Popping in Jaw Joints

       Clicking, popping, or snapping in the jaw joint is the most common symptom of TMJ. There may or may not be pain in the jaw when the clicking or popping sound is heard. The clicking sound may even be so loud that others can hear it when you chew or speak.

      

Usually the cause of the popping jaw is a displaced disc in the jaw. The jaw joints are ball and socket joints, just like the shoulder joint. When ball and socket joints are functioning properly, the ball and socket do not touch because of a thin disc of cartilage located between the ball and socket. This disc of cartilage is held in place and guided by a muscle.

      

If your bite is not right or trauma tears the tissues the jaw joint is pulled out of alignment, and the disc is typically pulled forward or torn. Now that the cartilage disc is not serving as a cushion between the ball and socket these bones are rubbing against each other and pressing on nerves, causing pain in the jaw and clicking or popping sounds in the jaw joint. The muscles holding the disc in place are now strained as well, causing additional pain in the jaw and face as well as in the head, neck, back and shoulders.

       Neuromuscular Dentistry works to realign the bite, which also realigns the displaced disc. Once the jaw is realigned and the disc is back in place the clicking and popping sounds in the jaw stop and the muscles holing the disc in place can relax, alleviating the jaw, face, head, neck, back, and shoulder pain that resulted.

TMJ Symptoms: Jaw Pain

      

Because TMJ is a dysfunction of the jaw joint, jaw pain is a very common symptom. A “bad bite” in which your upper and lower teeth do not come together in proper alignment also disrupts the placement of the jaw and the surrounding muscles. This imbalance in the bite-jaw-muscle relationship is what causes the pain in the jaw. Pressure and forces on the teeth can cause bone to dissolve or extra boney projections to be built up. 

       A neuromuscular dentist can help alleviate jaw pain related to TMJ by realigning the bite. Once the jaw is back into its most relaxed position the surrounding muscles can also resume their natural function.

How Neuromuscular Dentists Diagnose and Treat TMJ/TMD Symptoms

TMJ / TMD Diagnosis

 

       A neuromuscular dentist uses state-of-the-art technology to determine if your symptoms are caused by malocclusion and if so, what your optimal jaw position is. A neuromuscular dentist uses computerized jaw tracking instruments to record jaw movement, resting position, and path of closure. Electromyography is used to measure your jaw’s muscle function in both its stressed and relaxed positions, and will also measure the jaw-to-skull relationship to see if there is a structural imbalance.

Sonography is used to record jaw joint sounds to detect any abnormalities. Additionally, x-rays of the jaw may be taken to help evaluate the condition and positioning of the joint.

 

TMJ / TMD Treatment

 

       Once A neuromuscular
dentist has diagnosed you with TMJ, he or she can determine the best course of treatment for your specific needs. Typically treatment will follow three steps:

  1. Relieve muscle spasm and pain.

    The immediate concern for neuromuscular dentists is to provide relief of your symptoms. The best way to do this is by using a technology called ULF-TENS. ULF-TENS stands for Ultra Low Frequency Transcutaneous Electrical Neural Stimulation, but don’t let this term intimidate you. Basically, ULF-TENS is a way to relax muscles with a gentle massage of the muscles. The rhythmic pulsing relaxes the muscles by increasing blood flow and pumping out waste products. ULF-TENS also helps with pain relief by stimulating the body’s production of endorphins, the body’s natural anesthetic.

  2. Stabilize the bite .
    Often for this step a temporary device, known as an orthotic is worn over the teeth. The orthotic allows your neuromuscular dentist to make easy adjustments to the plastic without adjusting the teeth until the bite is stabilized. Once symptoms are relieved and the bite has been stabilized, your dentist will move on to the next step and permanently adjust your bite to the correct position.
  3. Long-term management.
    There are a variety of ways to correct your bite in a more permanent way. Four of the most common of these approaches are outlined below:
  • Coronoplasty/Equilibration
    Coronoplasty is smoothing and reshaping the enamel of the teeth to correct your bite. It is a simple procedure that does not require anesthesia and can be used when the bite is only slightly misaligned.
  • Removable Overlay Partials
    These are permanent orthotics that usually fit over the back teeth and are designed to maintain an aligned bite.
  • Reconstruction
    This approach involves making the teeth higher by using crowns. This permanently realigns the bite and provides structural support for the jaw.
  • Orthodontics

    (Braces)
    When the teeth are healthy they may be moved to the optimal position using braces.

   

Some of the equipment used are featured below.

  J-5 Myomonitor

       J-5 Myomonitor is a muscle stimulating device to help relax muscles of the jaw and neck simultaneously using transcutaneous electrical muscle stimulation. It is a battery powered device that the guest controls and it is used to treat the following:

 

  • Temporomandibular joint (TMJ) dysfunction and associated pain
  • To relieve symptoms associated with muscle spasm

  • To relax muscles and establish a physiologic biting position

  • To take bite registrations and impressions for dentures

  • To increase blood circulation

  • To maintain or increase mandibular range of motion

             This helps neuromuscular dentists find a reproducible physiologic rest position or the position in which measurements of muscle activity is calmest. The ultimate goal is relaxed muscles and relaxed muscles are free from tension and pain and will function properly when chewing and speaking and smiling. Tense muscles can cause head,neck and back pain and this new technology may help relieve some of these symptoms. An orthotic or splint is constructed to fit over the teeth to help the muscles relax at the position as determined by the J5.

     
     
    K-7

    Computerized

    Jaw Tracking and Surface Electromyography
      
     
      

           Neuromuscular dentists can invest in technology that will precisely and quantitatively measure the activity in your jaw and neck muscles.  They have found that calm muscles are “happy” muscles and are free from pain.  They can determine by watching the muscle activity the most comfortable position for your jaw. They can track your jaw to that position and capture that physiologic rest position.  This will allow them to make an orthotic in that position to allow your muscles to relax and heal. Which allows you to be comfortable with your new jaw position. After a series of adjustments on the orthotic as the joint heals, symptoms start to resolve.