How do you know if you have a TMJ or TMD?
If you answer yes to a number of the following you are a candidate for TMJ or TMD.
- Do you have frequent headaches?
- Does your neck, back of your head or shoulders hurt frequently?
- Do you hear popping, clicking or cracking sounds when you chew?
- Do you hear a grating sound in your jaw joint?
- Do you have stuffiness, pressure or pain in your ears?
- Do you have crooked, missing, bucked or crowded teeth?
- Do you have an overbite?
- Do you hear a ringing or buzzing sound in either or both of your ears?
- Do you experience dizziness (vertigo) frequently?
- Do your jaws feel tight or difficult to open?
- Do your jaws ache after eating?
- Do you wake up in the morning with sore facial muscles?
- Are you aware of clinching or grinding teeth while you are asleep, frustrated or under stress?
- Do you suffer from depression or decreased energy level as a result of any of the above symptoms?
- Are your teeth sensitive, loose broken or worn?
- Have you been hit in the jaw or had a whiplash injury?
- Is it hard to use your front teeth to bite or tear food?
- Have you been told that you might have TMD?
Most headache sufferers go from doctor to doctor looking for some kind of answer. Each new physician or therapist knows our problem and proceeds to treat us accordingly.
During our quest for pain relief, many of us have been told we have TMJ, a disorder of the jaw joint. So we visit a dentist who specializes in Temporomandibular joint dysfunction (TMJ). Temporo refers to the temple bone of the skull, mandibular refers to the lower jaw (i.e., the mandible), and the joint is where the two meet, just in front of the ear canal. The TMJ practitioner attempts to treat all the parts that control chewing: the teeth, the jaw joint, and the muscles.
In TMJ treatment, two particular theories attempt to explain why we have headaches. The first concerns the manner in which the upper and lower teeth meet, or bite, called the occlusion. Some TMJ practitioners feel that an improper bite is the cause of the headache pain. They believe that patients with a bad bite are constantly straining the jaw muscles (including the temporalis) to hold the lower jaw in such a position to create a proper bite. This strenuous activity results in myofascial (i.e. muscular) dysfunction, displayed as headaches. The TMJ practitioners solution is to alter the teeth or bite through orthotic treatment first and then if needed by either orthodontics, crowns, or some combination) to obtain the proper bite. The second theory assumes that the jaw joint itself is somehow damaged, which ultimately causes headache pain. The headache occurs when the muscles that surround the damaged joint assume a tightened (contracted) posture, in order to protect and support the damaged joint. Both theories utilize identical initial treatment. A special mouthpiece, called a orthotic, is fitted to the upper or lower teeth and covers the back molars.
What causes TMJ pain?
The TMJ or Temperomandibular Joint is the hinge that functions when the jaw opens and closes. There are many theories and practices to treating TMJ pain. Every TMJ dentist will have his or her own theory on TMJ treatment. People will often report neck and upper back pain, headaches, sore muscles and even migraines. Neuromuscular dentistry practices under the premise that when the teeth are shortened (either by wear, grinding, old age, clenching or even the cumulative effects of large amounts of dentistry) then the jaw over-closes causing stress and pressure in the TMJ. By restoring the vertical dimension to the teeth or by positioning a carefully fitted orthotic optimal health and function is restored to the TMJ. Many people suffering from TMJ pain have found relief using the techniques and theories of neuromuscular dentistry.
Compact Orthotic (Labial Bow & Lingual Wire)
The Compact Orthotic is a Mandibular repositioning orthotic that has about 50% less bulk than the traditional Day Appliance. Compact Orthotic also has no acrylic on lingual of anterior teeth, which allows more tongue space. It is available with Labial Bow (left) or Lingual Wire (right) depending on the patients preference.
Stage I: Diagnosis
Treatment should be based upon an accurate diagnosis following a complete history and comprehensive examination of each patient. This stage is called Stage I. It is our firm belief that treatment must always follow diagnosis. Insertion of a dental appliance without accurate diagnosis does not provide an environment where we can predict results, let alone know what we are trying to treat. Therefore, along with the complete history and examination, we need radiographs of the jaw joint and possibly of the head and neck.
We may also incorporate computer-aided diagnostics. This can include computerized recording of jaw joint sounds to assist in determining the level of deterioration present in the jaw joints, computerized recording of jaw movement, and computerized recording of muscle activity. All of this information will be used to formulate a specific treatment plan for each patients individual needs.
Stage II: Therapy
Once a treatment plan has been decided, Stage II, or therapy begins. The goal of therapy is again to unstress the jaw joint, provide therapy to reduce muscle spasm, and assist with improvement of body posture while repositioning the jaw so that it is related to the head in a more physiologically correct position. The improvement in the positional relationship of the jaw to the head is done in tandem with therapy to eliminate spasm and trigger areas in muscles as well as identify and correct perpetuating factors that may cause a return of symptoms.
A dentist trained in these areas is, however, the key clinician by whom a chronic head and neck pain patient must be treated. Only a dentist is trained to work with the dental bite and the relationship of the jaw to the head. Further, teeth that are missing, worn down, or do not provide for a correct dental bite can make a malrelationship of the jaw to the head difficult to treat successfully without dental intervention.
If it is determined that a malalignment of the jaw exists, an intra-oral appliance called an orthotic (sometimes called a splint) is commonly prescribed. Normally, the orthotic is worn 24 hours a day. This device will help to unstress the jaw joint and relieve muscle spasms in both the head and neck.
If referral for treatment with other health care providers is deemed necessary, it will be done at this time so that they can take advantage of the unstressed jaw position allowed by the orthotic. We have found well-timed combination therapies by dental and other health care providers to be most effective.
Single modalities such as an orthotic are used as the first method to stop the cycle of pain. Patients may also experience significant results from the therapeutic use of ultrasound, vapocoolant spray and stretch, trigger point injection with local anesthetic, hot packs, exercise therapy, and posture training. Each level of therapy is added to the treatment regimen as needed.
Additional orthotics may be needed during Stage II therapy depending on the individual. Some patients may complete therapy by gradually reducing wear of the initial appliance. Eventually, they may need to wear the orthotic only during the night time. Other individuals may need further appliance therapy to have successful management of their pain. The goal of additional appliance therapy is to predict the most physiologically correct position for the jaw with the most orthopedically correct body posture attainable.
Stage III: Stabilization
Once pain therapy is completed, the patient is ready for Stage III, or stabilization, during which we try to stabilize the physiologic jaw position realized in Stage II single handedly through orthotic treatment, sometimes one of the following is needed to complete therapy, coronoplasty (slight reshaping of the enamel of the teeth to remove interferences), orthodontics, fixed prosthetics (crowns and/or bridges), removable dental prosthetics, or a combination of the above.
Stage IV: Maintenance
A final stage, maintenance, is often necessary because, as stated earlier, there is no cure but rather management of TMJ disorders. This stage is relatively simple and generally involves fabrication of an appliance to wear during sleep or when symptoms temporarily increase. Frequency of use of the appliance is dictated by the patient and their symptoms.
In summary, typical treatment for TMJ dysfunction usually follows this pattern:
- Initial screening and consultation;
- Complete history and evaluation including radiographs and computerized diagnostics if needed;
- Appliance therapy to reposition the jaw in a more comfortable and correct position in tandem with physical medicine if needed;
- Weekly, biweekly, and then monthly adjustments for three to six months;
- When both the doctor and patient are satisfied with the progress of treatment, a more permanent positioning of the jaw is considered. In each case, that positioning should follow appliance therapy and will vary according to the patients need for bite space and current oral conditions.
We desire all of our patients to be aware of the nature, scope, and prognosis of their treatment. Please note that there are two distinct stages of TMJ treatment: symptom relief and stabilization of the correction. The improvement rate of each patient will vary. Some may improve 80% or more, others less. Therefore, we cannot guarantee specific improvements of any one individual. Much of the success lies in the hands of the patient. Proper diet, muscle exercises and wearing of the appliances plays as significant a role in treatment as does the work of your doctor.
The care of the craniomandibular pain patient is changing. The emphasis on examination and diagnosis has expanded. Therapeutics have broadened to overlap all fields of health care. The multidisciplinary approach is encouraged to achieve more thorough lasting results. The understanding of the interrelationship between medicine and dentistry grows stronger each year. Consequently, there is renewed hope for those who suffer from the chronic pain of TMJ dysfunction.
Some of the symptoms or signs of TMJ may be surprising, but patients with a TMJ disorder may suffer from the following:
- Pain in neck, shoulder, and back
- Clicking or popping of jaw joints
- Reduced ability to open or close mouth
- Loose teeth
- Facial pain
- Pain and sensitivity in teeth
- Crowded teeth
- Biting or chewing difficulty
- Difficulty swallowing
- Worn, chipped, or cracked teeth or fillings
- Numbness in arms and fingers
- Clenching or grinding of teeth/jaw
- Earache: ringing in the ears or ear pressure