Diagnosis and Treatment of Orofacial Pain
& Temporomandibular Disorders

WHAT IS TMJ ?
    The letters, TMJ, are a commonly used abbreviation of the words temporo-mandibular joint. This is the joint that is found in front of the ear and connects the jawbone to the skull. Proper function of the TMJ is dependent on the maintenance of healthy teeth with a properly balanced bite. A TMJ that is not working properly may cause problems in one's general health. Though the term "TMJ" specifically relates to the jaw joint, it is often used as a generic term to describe dysfunction of the jaw muscles and associated problems as described below.

HOW DO YOU KNOW YOU HAVE A TMJ PROBLEM ?
    When the TM Joint is not working properly, you may experience noise and/or discomfort as you open and close your mouth. You may experience discomfort in your jaw muscles as you chew and even when at rest. You might also experience ear symptoms ( pain, stuffiness or itching, loss of hearing, dizziness, tinnitus) or eye symptoms (pain in or behind the eyes, blurring of vision).
    You could experience pain in a tooth or sensitivity of the teeth to cold not related to decay. There could be pain any where in the face, head, or neck. It is not uncommon to see people whose only complaint is that they tend to get a stiff neck. Sometimes the major complaint may be low back pain. Grinding or clenching of the teeth are also a sure sign of a TMJ problem.

WHAT CAUSES TMJ PROBLEMS ?
    An individual may develop problems with the TMJ for various reasons. Crooked teeth or a deep overbite may cause a stress in the TMJ and strain the muscles of the jaw. The loss of teeth can also create stress on the joint and muscles. Various types of trauma to the head, whiplash injuries, and even poor posture can trigger problems. More than a few problems have been caused by the strain of dental surgery, poorly executed orthodontics, or poorly fitted crowns and dentures. Sometimes TMJ symptoms may arise as a result of other physical problems such as a back or neck injury, as well as from excessive stress.

HOW CAN A TMJ PROBLEM CAUSE PROBLEMS ELSEWHERE IN THE BODY ?
    The TMJ has been called the most important joint in the body because of its profound influence on other aspects of the body. Your lower jaw is attached to the head and neck by numerous muscles. Therefore, any disturbance of the bite or function of the TMJ will affect the balance of the head, neck, and shoulders. In turn the posture and function of the rest of your body will be affected.
    TMJ disorders lead to stress in the skull, spine, and connective tissues which house, protect, and nourish the nervous system. Though your skull may seem as one bone, it is pliable and made of many bones that move in relation to one another. Problems with the TMJ and the bite may cause distortion in the shape and movement of these bones. This affects what is known as the cranial -sacral system (this is an integrated system connecting movements of the skull with those within the tailbone and pelvis). These effects on the muscles and supporting structures of the body create physical stress. Though the body has the ability to compensate for stress, eventually this ability deteriorates and symptoms develop.

HOW ARE TMJ PROBLEMS CORRECTED ?
    The treatment of each person suffering from TMJ dysfunction 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 examination. During the examination a comprehensive physical examination is made to evaluate sites of pain, as well as evaluating the functional integration of related body systems.
    The following diagnostic procedures may be performed by myself and my staff; X-rays of the teeth and TM Joint, plaster models of the mouth, and a computer-assisted analysis of the TM Joints and muscular movements of the jaw. After a comprehensive analysis of the information obtained a specific treatment plan is developed. Treatment is oriented to providing relief of pain and restoration of normal function of the involved structures. In many cases this would require the use of a biteplate to compensate for deficiencies in the bite.
    If there is distortion within the skull, it is corrected by the use of gentle techniques of cranial osteopathic manipulation. Chronic tension in the muscles of the head, neck, and jaw may be relieved by various techniques, such as myo-fascial release, applied kinesiology, acupuncture, or electronic relaxation therapy. The goal is to bring the TM joint and the muscles of the jaw into a comfortable and healthful balance. It is important for patient's to receive appropriate care from either an osteopath, a chiropractor, or a physical therapist during this time.
    Some patients may have metabolic imbalances associated with the structural imbalances affecting the jaw. In such cases the patient's body chemistry is improved through nutritionally oriented therapies, often involving homeopathy and use of medicinal herbs.
    Many times emotional support is necessary to facilitate healing. It is important that all areas of an individual's physical and psychological well-being be addressed in order for the best possible outcome to be achieved.
   

    While many patients improve immediately the process of healing does take time. Maximal improvement of a TM disorder is usually achieved within 4-6 months. For some patient's this may take longer.
    Once this state of balance and comfort is achieved a re-evaluation is then preformed to determine the stability of our results. In order to maintain the proper jaw balance some may require orthodontics (braces) and/or reconstruction (replacement of deficient fillings and crowns, implants, dentures and/ or bridgework ) . For others it may be appropriate to wean from full time use of a biteplate, and just use it when necessary for relief of jaw tension.