TMJ/CMD

What is TMJ?

The temporomandibular joint, or the jaw joint (TMJ), is a small joint located in front of each ear. The TMJ is a very complex joint and is the most consistently used joint in the body.  It is the TMJ that allows us to talk, chew and swallow.  Due to the joints complexity and frequency of use it is subject injury just like any other joint in the body. Many people refer to the term “TMJ” to describe a symptom(s) related to their jaw joint dysfunction.

What is TMJ Disorder?

Temporomandibular Joint Disorder (TMD) or Cranio-Mandibular Dysfunction (CMD) is a condition that disrupts the daily normal function of the jaw and is usually accompanied by a variety of symptoms and will vary from person to person.

What Causes TMD or CMD?

There is not one specific reason why 10 million Americans suffer from TMJ disorders. Trauma to face or head, whiplash, bad bite (malocclusion), teeth clenching and grinding, ligament laxity, opening jaw too wide, and stress are all common associated risk factors that can contribute to TMD.

What are the Symptoms?

Headaches are one of the most common symptoms, with tension headaches being primary. It is often described as a feeling of wearing a hat two sizes too small, with pain in a ring around the head, or 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, but constant tight muscle fibers prevent or reduce blood flow to that area. The body sends more blood to the areas and this can result in 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. Unfortunately, these headaches can be so frequent or severe that they are frequently misdiagnosed and treated as migraine headaches.

Other common symptoms associated with TMD or CMD can be: jaw pain, face pain, jaw locking, jaw clicking, jaw popping, backaches, neck aches, ringing in ears, pain behind eyes, teeth grinding, worn teeth, clenching, dizziness, difficulty swallowing, tongue pain,  gum pain, and tooth pain.

How is TMD or CMD Diagnosed?

In our office a detailed medical and dental history form is completed by the patient and then reviewed with the doctor in an in office consultation appointment. Based on the patient’s health history questionnaire, their specific symptoms, and the nature of the pain, we will perform a physical examination to collect more information which will be used to properly diagnose the case.  The physical examination will include a variety of testing and evaluating methods.

Neuromuscular dentists use state-of-the-art technology to determine if your symptoms are caused by malocclusion and if so, what your optimal jaw position is. The 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. 

 

Physical examination will include:

 

  1. Structural/Postural exam and analysis including photos
  2. Airway examination and evaluation
  3. Cranial exam to evaluate the dental plane of occlusion, model analysis, and photos
  4. Dental examination includes an extensive oral evaluation, muscle palpation, Mandibular Scanning, and EMG muscle testing
  5. Neurologic examination include autonomic testing and evaluation
  6. TMJ examination includes Imaging and Joint Vibration Analysis

How is TMJ/CMD Treated?

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, however, ensures the muscles are happy because they do not have to work hard positioning the teeth to a strained bite. This is the method we use.

 

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. In this way, we can help with TMJ pain treatment and migraine headache relief.

 

Once you’ve been diagnosed you with TMJ/CMD, the best course of treatment for your specific needs is determined. Typically treatment will follow three steps:

 

  1. Relieve muscle spasm and pain. 
    This is the immediate concern 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:
    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.

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