What is TMJ?
The letters, TMJ, are a commonly used abbreviation for the temporomandibular joint. This is the joint found in front of the ear, connecting the jawbone to the skull. But, often, the term “TMJ” is used to describe a broader condition that may involve strain and lack of balance within the muscles of the jaw and neck as well as the bones of the skull and face. This is more accurately described as TMD or Temporomandibular Disorder.
The effects of TMD are not limited to the head, neck, or jaw; they have the potential to affect the function of the whole body. This diffusion of symptoms is one of the reasons TMJ disorders are so often overlooked and misdiagnosed. We have seen many cases in which the correction of the underlying jaw problem has led to relief of chronic back problems, breathing problems, difficulty walking, foot problems, digestive issues, fatigue, and generalized stress.
We recently had a patient who came in with a toothache. Another dentist told her she needed root canal treatment but she wanted a second opinion. It turns out the pain was caused by her bite putting too much pressure on her tooth! We made her a simple bite support to keep pressure off the sore tooth. The next week she came back to see us, grateful for the relief of her toothache, and even better, she said that wearing the bite support had given her relief of severe and debilitating back pain! She had been at her wit’s end with the back pain. Had been told by doctors that only surgery offered hope of relief.
How Do You Know You Have a TMJ / TMD Disorder?
There are many different symptoms of TMJ. When the TM joint is not working properly, you may experience:
- noise and/or pain as you open and close your mouth
- pain in your jaw muscles as you chew and even when at rest
- ear symptoms (ear pain, stuffiness or itching, loss of hearing, dizziness, tinnitus)
- eye symptoms (pain in or behind the eyes, blurring of vision).
- pain in a tooth or sensitivity of the teeth
- chronic headache or migraine
- pain anywhere in the face, head, or neck
- stiff neck
- low back pain
- grinding or clenching of the teeth are also a sure sign of a TMJ disorder
How Are TMJ / TMD Problems Corrected?
The treatment of each person suffering from TMJ disorder must be tailored to the particular needs of the individual. A careful study must be done to clearly define the nature of the your problem. This involves a thorough consultation and a thorough examination.
During the examination, an evaluation is made of the sites of your pain, as well as of the functional integration of related body systems. We often make plaster models of your teeth to help us understand how your bite may contribute to your condition. In some cases we use special x‑rays of the TMJ, computerized neuromuscular analysis of jaw function, and even sonography to listen to jaw sounds.
We often begin TMJ / TMD treatment with gentle pain relieving techniques drawn from Acupuncture, Applied Kinesiology, and Cranial‑Sacral Therapy.
When appropriate, we provide TMJ treatments with moist heat packs or cold laser therapy.
We may use different bite appliances, used in sequence, to provide corrective support to the bite, that will relax and balance your jaw muscles, and by extension, the muscles through your body.
The goal is to bring the TM joint and the muscles of the jaw into a comfortable and healthful balance. It is often important for patients to receive appropriate care from either an osteopath, a chiropractor, or a physical therapist during this time to ensure that the neck and spine are also brought into proper alignment. Once comfort and balance have been achieved, it may be appropriate to discuss the correction of your bite with either Orthodontics and / or Restorative Dentistry.
We often make use of the concepts of Neuromuscular Dentistry utilizing technology developed originally through the combined effort of a dentist Dr. Bernard Jankelson, and an engineer John Radke. Their approach was based on the belief that if they first relaxed the jaw muscles it would be easier to find the correct position of the bite. They based their work on principles originally developed by Dr. Janet Travel a pioneer in the treatment of chronic pain.
Their goal was to resolve the pain and tension in the muscles of the jaw by first relaxing the muscles using an electronic device called a TENS (trans cutaneous electric nerve stimulator).
They developed instruments and methods that allow for measurements to be made and recorded by a computer providing insight into the muscular imbalances being caused by the bite. Then using an appliance worn on the teeth to correct the form of the bite the jaw would “reposition” to the most relaxed and comfortable position.
There are 3 different components to the systems that have evolved that are now manufactured by two different companies, Myotronics (a company developed by Jankelson) and Bioresearch (a company developed by Radke). We are using the most advanced equipment from Bioresearch.
The first of these is EMG or electromyography. This uses small pads applied to the skin over key jaw muscles connected to a computer by wires. The greater the tension that is present in the muscle the higher will be the output of electrical impulses picked up by the computer. This gives much insight into the influence of the the bite as a cause of muscular imbalance and pain. EMG allows us to observe for lack of symmetry and balance in the jaw muscles. Measurements are made with the muscles at rest and in function.
The second key element is the JawTracker, also known as a Kinesiograph , which measures the movements of the jaw. One very important movement measured is how the jaw moves from a position where the muscles are relaxed to the position where all the teeth are biting together.
With a healthy bite and muscular relationship a reference point on the front teeth will move a short distance of about 1.5-2mm on a straight line up and slightly forward as the jaw closes from rest. When there is a neuromuscular imbalance created by the bite the jaw will have to shift from its relaxed position often moving backwards and to the side as the muscles contract unevenly to get the bite to fit together.
As the jaw shifts on closure as a result of an ill fitting bite the TM joint is affected. As the jaw shifts, the ball (condyle) will be forced from its normal relationship to the cartilage in the joint and noise or clicking may occur.
This noise is measured by a 3rd device called Joint Sonography, which allows us to analyze the vibrations created in the joint. This gives us insight into the health of the joint; when arthritis has affected the TM Joint the vibrations created develop a higher pitch as the tissues in the joint dry out. This device also allows us to measure improvements in the joint as the sound vibration decreases with the establishment of a more relaxed and stable jaw position.
Using technology like this allows for more clarity in diagnosis and determining the correct alignment for the jaw. This clarity leads to more predictable results.