Temporomandibular (Jaw) Joint Disorders
TMD's are the most frequently misdiagnosed of the medical/dental conditions because few doctors (physicians, dentists, chiropractor, osteopaths etc.) have proper training in the diagnosis and treatment of TMD. The most common symptoms of TMD are head pain (headache) and clicking or popping of the jaw joints, but the eyes, ears, neck and shoulders, the mouth, teeth and throat may be affected. Unfortunately because these disorders have many overlapping symptoms they mimic many other conditions.

Symptoms of TMJ The most common symptoms are clicking/popping or grating sounds from the joints. The grating sound is often the sound of bone rubbing against bone when the disc is dislocated. The jaw may also lock open or closed.

A second common symptom is headache or head pain. TMJ head pain is most often felt in the temples, around the eyes, in the back of the head and the neck, or in the shoulders. TMJ headaches are often described like "wearing a hat two sizes too small", for the pain rings the head.

Clenching or grinding of the teeth (bruxism) is also a common symptom of TMJ. The abnormal forces and strain produced by tired, spastic muscles can refer pain into the neck, face or head. These muscle tension headaches can be so severe that they are confused with migraine headaches. Unfortunately, the patients are often not examined for TMJ and the "migraine" treatment works poorly. Further, the teeth themselves may become sensitive or painful due to TMJ and/or bruxism. The teeth may be cold sensitive or painful upon chewing. The pain will most commonly be diffuse, but may feel to be in a single tooth. Too often, this tooth pain resulted in unnecessary root canals or extraction of teeth.

Ear problems are also symptoms of TMJ. The most common ear problems are ringing/buzzing, fullness or a stuffy feeling and there may even appear to be a hearing loss in an otherwise normal appearing ear. Patients may feel dizzy or disoriented when suffering from TMJ.

Depression and sleep disturbances are common with TMJ.

As you can see there are many possible symptoms associated with TMJ. Because the head and neck are the most complicated parts of the body other health problems can present some of the same symptoms as TMJ. TMJ is called the Great Imposter because of the overlapping symptoms. Therefore, it is especially important to have a proper diagnosis made before beginning treatment.

Self-assessment Test for TMJ Do your TM Joints click, pop or make a grating sound?

  • Do your jaws ever lock?
  • Do you have frequent headaches?
  • Do your headaches involve the temples, around the eyes and/or the back of the head?
  • Do you clench or grind your teeth?
  • Are your teeth sensitive to temperature changes or chewing.
  • Have you had unexplained toothaches?
  • Is it painful to open widely or to move your jaw from side to side?
  • Do your neck and shoulder muscles ache or are tender to pressure?
  • Do you have a ringing or buzzing in your ears?
  • Do you frequently feel dizzy?
  • Do you have trouble sleeping through the night?
  • Do you have trouble falling asleep?
  • Is it had to get back to sleep once you awaken?
  • Do you wake up tired and/or with sore jaw muscles?

If your answers are "yes" to the questions above there could be a chance that you have TMJ.

Diagnosis of TMJ:
For a proper diagnosis of TMJ we will need a Detailed Medical and Dental History. Medical history should include all past medical dental problems and treatments, any history of trauma, especially to the head and neck region, specific questions about your symptoms and the nature and duration of any pain and jaw problems.

Treatment of TMJ:
Treatments consists of three phases.

The Phase I goal is to reduce and eliminate joint and muscle pain. The most common form of treatment is with a splint. A splint is a custom designed and fitted plastic mouthpiece that come in a variety of shapes and designs.

All splints fall into three main categories.

The first type is a Nightguard. A nightguard is an upper appliance designed only to prevent damage to teeth from grinding while your asleep. It can also be worn during the day if the patient is experiencing severe stress. Nightguards are not very helpful in treating TMJ.

The second type of appliance is a Superior Repositioning Appliance. The Superior Repositioning Appliance is of no benefit of treating TMJ and can cause unwanted tooth movement. This appliance is know as NCTI.

The third type of appliance is the Anterior Repositioning Appliance. This appliance brings the lower jaw forward; recapturing the articular disc and preventing repeated dislocations. The appliance is worn 24 hours daily to prevent more damage and to allow maximum healing of the damaged joint tissues.

Phase II can begin once the patient has reached the point of maximum improvement and is stable and pain-free. The goal of Phase II therapy is to maintain the support of the TM Joints by the teeth in a pain-free position. Several different types of therapy are available for Phase II treatment.

Long-term Splint Use:
Some patients may be able to be weaned from full-time use of the splint. The patient will stop wearing the appliance for increasing periods daily and if the symptoms do not return, then the patient will wear the splint at night or during periods of severe stress.

If t long-term splint wear is an option then a semi-permanent splint can be made with a metal framework. this splint can last many years with minimum maintenance.

Orthodontics:
Orthodontics is the treatment of choice for many TMJ patients. This treatment usually brings the mandible forward to relieve pressure and bring the teeth together in a position that supports the pain-free jaw position.
Dental Reconstruction:
Crowns, bridges and other dental restorations can also provide support for the jaw in the pain-free position. These restorations require a very high skill level from the dentist to restore a mouth to this new jaw position. Be certain that the dentist has a strong background in reconstructive dentistry and understands the special needs of a TMJ patient.

TM Joint Surgery:
TM Joint surgery should be the last resort for treatment because a very high percentage of TM Joint surgeries are failures. Before TM Joint surgery is tried make sure that ALL conservative treatment was a failure. Make sure any physical problems can be seen with an MRI, x-rays, or with dye injections into the joint (arthograms). Make certain that this is not an exploratory surgery or that the surgeon "thinks" this surgery will help. Make sure that the patient is suffering so much that they must take strong pain medication, and their life-style is greatly altered. The patient must be desperate before surgery is attempted.