Lais Dentistry

TMJ

A healthy TMJ requires finding the right solution:

In a comprehensive approach to dental care, making sure that you have a healthy TMJ has to be the starting point. You cannot restore a bite, restore a smile, or have anything that is going to function well long term for the patient, if the joints aren’t healthy. Fortunately, the majority of jaw pain is muscle pain that is often related to the bite. And if the bite is corrected and in harmony with where the muscles need to function, and the muscles can be calmed down and comforted. And a very small percentage of patients with jaw pain can actually be a problem within the jaw joint itself and many of these can be treated through splint and bite therapy but some of them have to be surgically corrected to get the comfort that’s needed. And all of that needs to be done prior to doing any major restorative work such as crowning teeth, changing bite, and other restorative work. So the foundation has to start with the joints that are healthy and comfortable and in good position. Then the bite can be constructed to be in harmony with that.

How we address TMJ disorder:

The first thing we do is a true assessment with each of our patients to find out if the joints can be loaded without pain, which they should be, similar to the knee or any other joint in the body. We do measurements of range of motion, such as how far can they open and move their jaw from side to side, is it even, do they open without their jaw deviating from one side to another Deviation would indicate a problem within the joint in most cases. We also listen to the joints with a Doppler ultra sound to give us an indication of the health of the joint itself, It all starts with a good assessment. Once we’ve got the assessment it’s going to give us a good idea in most cases whether the problem is a muscle problem (which it is most of the time) or if it is in the joint. Each is handled/addressed a little differently. In a lot of cases it is wise to utilize a full arch splint where we can recreate an ideal bite that fulfills all the criteria for a good bite in harmony with the joints without doing anything to the teeth until we verify that we can get them comfortable and get the joints in a good place and everything is healthy…And then and only then, should you start on any restorative treatment.

The splints we use are often diagnostic as well as therapeutic. Many of the problems have occurred over long periods of time. While many of them resolve instantaneously, many others take an extended amount of treatment to get them healthy. A joint with abnormal pressure over an extended amount of time may have inflammation or a change within the joint itself that have to change back as you get a proper bite. This is one reason splint therapy sometimes takes some time: the joints themselves will heal and remodel and you want to wait until that remodeling has completed before you start restoring the bite. If you restore the bite where the joint is when it’s not completely healthy that bite is going to change as the joint heals.

What are some symptoms of a TMJ disorder?

Headaches:

There are many, many causes for headaches, but the majority of headaches are muscle related. We hear a lot of patients talking about their headaches caused by stress. In many cases, people get headaches because of stress because they are clenching and their bite is not in harmony with their joints. Certainly not in all of them, but that is a big part of it. And when their bite is in harmony with the jaw joints and the muscles are relaxed, they are less prone to get headaches.

Earaches:

Many people complain of earaches when it may be TMJ pain. The physician may tell them that there is nothing wrong with the ear. Often times it’s an inflammation in or around the jaw joint that is making it feel like an ear ache. A lot of jaw pain is transient. It is brought on by stress and once the stress is gone then a lot of the symptoms will subside. That doesn’t necessarily mean their bite is really great but it does mean they can adapt to it…except during times of stress…and if they get their bite and jaw in harmony then it takes a lot more stress to bring on those symptoms.

Temporary pain relief:

Something someone can do in the event that they have an acute muscle problem is to use ice packs: 20 minutes on one side and then 20 minutes on the other side…for the first day or two of the acute episode. And then change that over into using moister heat after that and gently exercising their muscles…stretching, making sure they relax and don’t clench their teeth, get on a soft diet, and take mild anti inflammatory such as Advil.

TMD (TMJ dysfunction) is the dental term describing a collection of symptoms, which result when the chewing muscles, bite and jaw joints do not work together correctly.  TMJ stands for the temporomandibular joints. These are the two joints that connect your jaw to your skull. When these joints are not functioning as designed, they can cause many problems, such as:

  • Clicking or popping noises
  • Pain to opening or closing the jaw
  • Locking or limited opening of your mouth

Muscle spasm goes hand-in-hand with displaced jaw joints. Because the nerves and muscles are so complex in this area, when these muscles are in spasm the problems can be far-reaching. People suffer from symptoms they would never think to associate with their bite, such as:

  • Headaches
  • Pain behind the eyes
  • Dizziness
  • Earaches or ringing of the ears
  • Clenching or grinding of the teeth
  • Worn, broken loose and chipped teeth
  • Neck, shoulder, or back pain
  • Numbness, or tingling of the fingers

The primary problem can be in the joints themselves; the muscles of the face and jaw; the bite (how the teeth fit and work for chewing) or a combination of these. Because the symptoms masquerade as so many other conditions, many people travel from doctor to doctor in search of relief. It is estimated that as many as 10-15% of Americans suffer from one or more of these symptoms. Many never think to seek a dentist trained in TMD for help.

What Causes Temporomandibular Joint Dysfunction?

The structures that make it possible to open and close your mouth include the jawbones, jaw joints, and chewing muscles. These are very specialized and must work together whenever you chew, speak, or swallow. Your teeth are also inserted in your jaw bone. At the other end of your jaw bone are the temporomandibular joints. These joints attach your jaw to your skull. Muscles attach both the bones and joints and allow them to move. Any problem which prevents the complex system of teeth, muscles, bones, and joints from working together in harmony may result in TMD.

A “Bad Bite”

There are various ways this system can be disrupted, such as accidents involving a blow to the face or a whiplash. Yet the most common cause of TMD relates to your teeth and your bite. If your bite isn’t right, it can affect both the muscles and the joints. What do we mean by a “bad bite”? We mean that your upper and lower teeth do not come together in a way that provides the proper bracing support for your jaw against your skull. This might result from a missing tooth, misaligned teeth, or bite that has drifted due to tooth wear or teeth grinding.

Muscle Spasm

Your upper and lower teeth must come together firmly each time you swallow. This happens over 1000 times each day and night! When your bite is unstable your muscles must work extra hard. This extra work makes them shortened and stiff. Eventually this strain makes them feel painful. A vicious cycle begins of increased tissue damage, muscle tenderness, and pain. The pain makes you feel tense and uptight. This worsens the muscle spasm, which in turn increases the pain.

Jaw Joint Displacement

The position of your teeth can also affect the position of your jaw joints. Each jaw joint is a ball and socket joint. When functioning properly, the ball and socket do not actually touch because a thin disc of cartilage rides between them. The disc acts as a cushion and allows the joint to move smoothly. Each disc is held in place and guided by muscle. If your bite is not right, the disc is pulled forward by hyperactivity of the muscle. Since the disc no longer serves as a cushion, the joint itself now rubs against the boney socket and presses on pain fibers. Mild displacements cause a clicking or popping sound in the jaw joint; more severe displacements can be very painful and eventually can cause permanent damage to the joint.  An unstable bite can cause both jaw joint displacement and muscle strain and pain.  When this condition is prolonged, the body begins to compensate and adapt by involving muscles in the neck, back, and shoulders.

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