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)
Popping or clicking in the jaw movement
Neck and shoulder pain
Tingling and numbness in the arms and fingertips
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
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
Neck and back 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.
TMD can be temporary and treated by physical therapy and medication for the pain or swelling. It can also become chronic as the body accommodates to something not quite right in it's environment, ie; the bite.
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.
When you bring your teeth together, they normally fit comfortably against each other. Sometimes, for various reasons, they don't quite fit and this is called malocclusion (a misaligned bite) that can be treated.
The jaw muscles try to improve the fit, which may cause teeth grinding during sleep. 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. Teeth grinding can also cause excessive wear on the chewing (occlusal) surfaces of your teeth.
This ongoing stress and discomfort eventually creates inflammation or swelling in the area which puts pressure on the large nerves. There are 3 large nerves running through the temple area further, extending across the face and head, and down the neck running down to the shoulders.
Inflammation of these nerves may cause pain which is 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.
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.
One choice is an experienced dentist who is able to analyze the problem, take time to try to relieve the pain and improve your misaligned bite. Many times a multi-disciplinary and collaborative approach with other doctors and specialists is required to solve a complex case. Dr. Heit has a multi-disciplinary team that may be able to help you.
Sleep apnea can also mimic TMD. Dr. Heit will screen you for sleep apnea. Sometimes people have more than one diagnosis. Dr. Heit can organize a team of specialists to help you if you have a more complex presentation.
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 can first be analyzed clinically and using tools such as 3D imaging and biomedical instrumentation which measures your structure and function.
The next thing to do is relax the muscles if they are overworked, 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 relax 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, a computer is used to record the relaxed jaw position.
Analyzing Jaw Movement
An electromyograph (EMG) records the muscle movement. From all this information, your misaligned bite is analyzed and a new bite position is determined. To achieve the new bite, work/relief can be done on:
Based on the jaw movement information gathered, a diagnostic orthosis (a jaw repositioning device) is made 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.
This proof would be seen in the reduction of your symptoms as well as objectively verifiable in the muscle and jaw function measurements taken before and after the orthotic was in place.
What are the options?
Dr. Heit's role is to help fully inform you of all your options to do your dental work along with the pros and cons of those options. You also have the option of doing nothing or referral to any specialist. Dr. Heit will support whatever decision you make and encourages second opinions. There is disagreement among professionals on how to treat TMD and costs/successes of treatment varies. It is your choice.
Depending how far away your new jaw position is from your original jaw position, it can dictate the options for your individual case. Then you can decide what you want to do.
If it is far away, then the permanent solution can be 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 finding their neuromuscular bite to prevent the development of TMD using this technique to do the work they need/want 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 consultation with Dr. Heit at Scotia Square Dentistry as soon as you can. Together you can discuss the situation and come up with options to try to rid you of that pain.
Come visit us to see if we are a fit for you.
Dr. Heit is a general dentist.