If you are reading this, you likely are looking for answers to your TMJ (Temporomandibular joint) problem. TMJ is a popular term used to describe a disorder of the jaw joints, chewing muscles and bite. Symptoms can masquerade as a multitude of other problems such as sinus headaches, migraines, neck and shoulder stiffness, earaches and tooth problems. These symptoms can be caused by an instability of your chewing system (stomatognathic systems) and can be successfully treated by a dentist who has specialized training in managing these disorders, such as Dr. Mike Gallagher.
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. These are the 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 and Facial Pain
- Earaches or ringing of the ears
- Clenching or grinding of the teeth
- Worn, broken loose and chipped teeth
- Neck, shoulder, or back pain
- Teeth that are sensitive to hot/cold and or biting
- Abfractions or wedge-shaped notches in the teeth at the gum line
- Gum recession
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 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. A healthy bite has the proper amount of overlap of the upper front teeth over the lower front teeth. This guides side to side chewing motion (think of guardrails on a roadway). The front teeth protect the back teeth by limiting excess stress during chewing. When the front teeth are not aligned properly or are worn down, they are unable to provide this protective function, damaging the front and back teeth, bone, gums, TMJ’s and jaw muscles.
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.
Diagnosis and Treatment
Diagnosis of TMD involves a thorough history; an examination of the jaw joint and chewing muscles; evaluating joint noises; and checking the teeth and bite for wear and proper alignment. In some case, additional records may include study models for detailed bite analysis and imaging such as CBCT or MRI.
Since the teeth, jaw joints, and muscles can all be involved, treatment for this condition can vary and will usually involve several phases. The first phase is to relieve the muscle spasm and pain and stabilize the jaw joint in the jaw socket. Often a temporary device known as a “bite splint” or Condylar Centering Orthotic (C2O) is worn over the teeth until the muscles relax and the pain is relieved. Once your jaw joint is stabilized, the second phase is to evaluate your bite for corrective options so you are not dependent on the “bite splint” for comfort and stability. Permanent correction involves the selective reshaping of the teeth; adding to the teeth with conservative bonding materials; building crowns on the teeth and/or orthodontics. Rarely, if the jaw joint itself is damaged, it may need surgical care. Ultimately, Dr. Gallagher can stabilize and Rejuvenate your bite so that the teeth, muscles, and joints all work together naturally for optimal long-term health and comfort.