TMJ/TMD

What is TMD (TMJ)?

Temporomandibular Joint Disorder or TMD (TMJ), refers to problems involving both the jaw joints and the muscles of the head, neck and face. Any problem which prevents the complex system of muscles, bones and joints from working together in harmony may result in TMD.

The temporomandibular joints may be the most sophisticated joints in the body because they move up and down, side to side and in a wide range of motion. These joints are located in front of the ears and, unlike other joints in the body, move in unison. Muscles attach to the bones and joints which allow such movements. We use them to eat, talk, yawn, sing, and swallow. When the jaw joint functions properly, the bones do not actually touch because of a thin layer of cartilage that cushions them.

To get an idea of how the joints function, place your fingers on the sides of your face in front of your ears. Open and close your mouth and you will feel the movement. It should feel smooth when opening, closing or moving your jaw from side to side. It should not click, pop or grind. The disc can “misfunction” for any one of several reasons – trauma, such as a blow to the face or a fall, arthritis, poor posture, a “bad bite” – missing or loose teeth, improperly fitting dentures or partials – any anomaly that prevents your teeth from coming together and provide proper bracing for the jaws.

Signs and Symptoms

TMD is often a chronic and frequently degenerative disease. Anyone suffering from the following symptoms should seek advice from a qualified dental professional:

• Headaches
• Pain behind the eyes
• Dizziness (vertigo)
• Clicking, popping or grinding sounds in jaw joints
• Locking jaw
• Earaches, stuffiness or ringing ears
• Difficulty swallowing, eating, chewing
• Worn or loose teeth
• Sensitive teeth (sharp or dull)
• Non-restful sleep (snoring, sleep apnea)

Stress is also a cause of TMD. It is a known fact that stress brings on many physical problems such as headaches, teeth clenching or grinding and tense neck and shoulder muscles. It is estimated that over 50% of the population are night grinders. Unconscious grinding is a response to stressful emotions such as anger, frustration or worry creating even more strain on the jaw joints.

You might already know this to be true since your last: quarterly review, mother-in-law visit or mid-term exam. Additional maladies also have a hand in TMD. Depression and anxiety are directly correlated to the dysfunction of your jaw. Keep in mind this is not a comprehensive list.

Test Your Joints

Do you need a consultation appointment?

The first self examination you can do is the simplest: Sleep. We want you to be aware of your sleep patterns and cognizant of your habits before you hit the hay and again upon waking. Take time to appreciate the following:

• What did you eat? Was it high in sugar, protein, caffeine?
• Were you relaxed during the afternoon hours? Check to see if your brows are furrowed, hands clenched, and/or teeth touching.
• Did you fall asleep easily? Did you awake at all during your slumber? Do you have soreness in you head or neck? Any additional morning tooth pain?

Touch: our second self exam includes applying moderate pressure to the muscles of your face. Start by applying pressure to your temples with about 5 lbs. Come down the sides of your face and apply the same pressure to the jaw muscles. Do you find that you have areas of intense pain and/or areas of pain relief?

Clicking/Popping: open and close your jaw. Do you hear clicking or popping? Now, place your fingers over your jaw joint and open and close your mouth again. Do you feel a click? Did one side click while the other was silent? Caveat: it is very important that you only open and close your mouth within your normal range. Do not force your jaw open or closed.

Notes: Take some time and note this information.

Please feel free to bring this information with Dr. Parekh.

Splints and Therapy

One common solution to TMD, is an orthotic device (bite splint) which will be custom made for your mouth by your dentist. Several types of splints are available. The most appropriate splint is selected for your specific condition. The bite splint is one part of the overall TMD therapy and as your jaw muscles begin to relax, the splint will need to be adjusted by your dentist.

Your regular dentist may not be able to help you since not all dentists have the appropriate training or expertise in jaw disorders. This is also true of medical professionals who often refer patients to us to make a TMD diagnosis. It is common for a TMD sufferer to visit several doctors in search of an answer. Because of its complexity, this disorder is often called the “great imposter”. Many times patients come to us only after they have seen a neurologist, otolaryngologist, orthodontist, oral surgeon or other specialist.

Every case of TMJ is unique. To accurately diagnose the disorder, the following steps are generally taken during your first appointment:

A Co-Discovery Exam, a comprehensive interview between you and the dentist

• A clinical exam of the jaw, head, neck, shoulders; the dentist will feel your muscles and jaw joints to determine pain or tenderness
• X-Rays are often taken and a CT scan will likely be ordered
• An Occlusal Analysis will measure and analyze the way you bite
• Impressions (models) of your teeth may also be done to study your bite pattern
• Joint Vibratory Analysis (JVA)
• TMJ Scale

In addition, there are several supplemental treatments and physical medicine modalities your dentist may use to access your disorder. These may include:

• Ultrasound
• TENS – Transcutaneous Electrical Neural Stimulation – a painless treatment that blocks pain sensations by causing slight repetitive contractions that flow through electrodes placed over the joints/muscles
• Hot/Cold Therapy
• Spray and Stretch Therapy
• Massage Therapy
• Nutrition Counseling
• Vitamin Regimen