TMJ is the most complex joint in the body called the temporomandibular joint.

TMD is dysfunction of that joint called temporomandibular disorder.  It is a cluster of symptoms which occur in the face, head, neck and shoulders.  They can consist of any of the following:

• severe headaches (including migraines)
• jaw pain
• locking jaws
• popping or clicking in the jaw movement
• neck and shoulder pain
• tingling and numbness in the arms and fingertips
• teeth grinding 

JOINT

• The TMJ is in front of the ear hole where the lower jaw meets the upper jaw.  It is an unusual joint because it can move in three directions:

• up and down
• forward and back
• sideways

In between the lower jaw and the upper jaw (inside the TMJ) is a disc or pad which acts as a shock absorber.  In normal jaw movement, the bones glide over the disc so that no pain or tension is felt.

The jaw joint is also unusual in that it's very close to the brain.  If there's any compression of the joint, it can affect about a third of the impulses traveling from the brain to the rest of the body.  This can lead to symptoms in addition to the ones above such as:

• ringing in the ears
• sleeping difficulty
• hearing problems
• sinus problems
• general irritability
• neck and back problems
• posture problems

CAUSES OF TMD

An injury to the jaw joint area and some diseases can cause TMD.  Heredity can play a role in some cases.  The important dental consideration is how well your teeth come together when you bite.

There is no fixed definition of TMD.  It can be temporary and treated by physical therapy and medication for the pain or swelling.  It can also become chronic.

Neuromuscular dentists have developed effective methods of treating chronic TMD when it is caused by a dental problem.

The symptoms can appear without any obvious cause.  Years of mild facial trauma, like clenching of the teeth or gum chewing can lead to TMD symptoms.  It can be the other way around, too, where clenching and grinding of the teeth are symptoms of TMD.

   MIALIGNED BITE

When you bring your teeth together, they normally fit comfortably against each other.  Sometimes, for various reasons, they don't quite fit and there's some awkwardness and tension.  This is called malocclusion (a misaligned bite) and can be treated by a neuromuscular dentist.

The jaw muscles try to improve the fit which can cause teeth grinding during sleep, and as much as they try, they get no good results.  When this continues for long enough, the jaw muscles get strained which in turn puts strain on their ligaments, tendons and bones to which they are attached.

This ongoing stress and discomfort eventually creates an inflammation or swelling in the area which puts pressure on the large nerves.  There are 3 large nerves running through the temple area and extending across the face and head, and down the neck extending into the shoulders.

Inflammation of these nerves causes severe pain so typical of TMJ disorder.

   PROGRESSION OF TMD

Speech, chewing, swallowing and facial expressions can all be affected.  Eventually, if the TMD goes long enough, the pressure on teeth and bones can damage them, wearing them down or creating sharp points which increase pain levels even further.

  UNDIAGNOSED TMD

Some people in the U.S. and Canada have been found to have TMD after they have consulted many doctors for many years to no effect.  When the cause is dental, the remedy has to be dental too, so temporary relief from medical prescriptions is a relief for a while but doesn't affect the dental cause of the pain.  An experienced neuromuscular dentist will be able to analyze the problem, relieve the pain and improve your misaligned bite.

   TMD TESTING

TMD treatment happens in several steps with the goal of achieving as much comfort in as natural a jaw function as possible.  For some people, a total cure can be obtained and for others where a total cure cannot be obtained-management becomes the treatment goal.  To re-align your bite, your current bite must first be analyzed.

The first thing to do is relax the muscles.  They're overworked and are fatigued or in spasm.

     Transcutaneous Electrical Neural Stimulation (TENS)

A TENS unit is small and consists of a 9 volt battery, a signal generator and a set of electrodes.  The treatment sends a small current of electricity to the facial muscles which relaxes them and relieves pain.

• The treatment session lasts about an hour
• It feels like tapping on your face
• You can read or sleep during this treatment
• There are no side effects as only the small facial muscles needing the treatment are targeted and no medication is needed

When the face and jaw are fully relaxed, Dr. Heit uses a computer to record the relaxed jaw position.

     Analyzing Jaw Movement

An electromyograph (EMG) records the muscle movement.  From all this information, Dr. Heit can analyze your misaligned bite and determine a new bite position.  To achieve the new bite, work can be done on:

• Muscles
• Jaw joints
• Nerves
• Teeth

Many times Dr. Heit uses a multidisciplinary approach and will consult other professionals to speed the progress of your treatment-especially in complex cases.  Dr. Heit has a team to take care of you.

TMD TREATMENT

     An orthosis

Based on the jaw movement information she has gathered, Dr. Heit will make an orthosis (a jaw repositioning device) to fit over your lower back teeth and behind your front teeth.  You cannot remove this device and it is used for 1 month to make the diagnosis and prove that it is actually your bite that is causing your symptoms.

From there, Dr. Heit will retest your jaw position to assess your progress then discuss further options for permanent relief in your individual case.

    What are the options?

Depending how far away your neuromuscular jaw position is from your original jaw position, it will dictate the options for your individual case.

If it is far away, then the permanent solution is to move your teeth into the position which support the neuromuscular bite which has been established and proven by the orthosis.  This could include orthodontics (braces), some crowns or even crowns on every tooth in your mouth (full mouth reconstruction). Many  people take advantage of neuromuscular dentistry to prevent the development of TMD using this technique to do the work they need anyway (ie orthodontics, full mouth reconstruction).

If it is very close to your original jaw position, then you may need a bite adjustment on your own teeth (tooth reshaping) or some minor dental restorations to achieve your proven bite (jaw) position.

Alternatively, a removable orthosis can be worn in any case on a part-time basis, or discontinued and resumed later if symptoms reoccur.  Some people wear the removable orthosis full time until they are ready for their permanent solution down the road.

 

If you've been suffering the pain and distress of any TMD symptoms, schedule a free consultation with Dr. Heit at Scotia Square Dentistry as soon as you can.  Together you can discuss the situation and come up with a plan to rid you of that pain.  Dr. Heit's dental office is a friendly and comfortable place and she uses the best modern technology for diagnosis and treatment.