An Overview

 

Please take the time to read this section, it will change your perspective as a dental patient forever. I know it changed my life as a dentist. It is a little long, but well worth reading in its entirety. At the end of each page you will be prompted to click to go to the next page until this section is done.

 

An important and honest discussion on Facial Pain and TMJ disorders 

    If you suffer from frequent headaches, if your jaws are sore and achy, if your teeth are very sensitive to cold and sweets, or your joints pop, click or hurt when you chew, then you may have been told that you "have TMJ." If you have tried to go online and do some research, or if you have asked anyone about this issue, then you are probably more confused than ever.

    Unfortunately the dental profession has not made this job any easier. I would venture to say that there is not a more contentious subject with dentists than the diagnosis and treatment of a TMJ disorder.  In fact, if you put a dozen dentists in a room and begin a "TMJ" discussion, you may find a dozen different opinions.

    So who would be right?

    In the world of "evidence-based medicine,"  only those treatments, materials, and methods that yield proven, consistent, and positive results are considered successful. The same must go for the treatment of TMJ.

    Our office has specialized in successfully diagnosing and treating this common and often debilitating condition for many years.  The protocols that I practice have been in place for decades, beginning with Dr. Peter Dawson and the early pioneers who perfected these treatments that continue even today.It is evidenced-based and, in my opinion, the only protocol that yields consistent successful results.

    As you will soon find out, understanding this subject is central to understanding the harmony and balance which is required to provide a lifetime of dental health and comfort.

What is "TMJ" and why all the confusion...

    Lets get right to the point. The term "TMJ" is not the name of a clinical condition or a disease. It is the name of an anatomical structure. In this case the joint on either side of the jaw which connects two bones - the Temporalis bone of the skull and the Mandible, or lower jaw bone.

    Hence this joint is correctly called the Temporomandibular Joint or "TMJ."

    A patient will often tell me "I have TMJ."  Respectfully resisting the urge to reply "so do I, one on each side," I proceed to teach them what the term really means.

     With that out of the way, the conversation then begins to yield an entire list of problems that they may have been suffering from. Some problems may be within the joint itself and others may have nothing to do with the joint at all.

    Often I hear of severe, frequent headaches, pain in their joints or their teeth when they chew, tooth sensitivity, or just an ache in their teeth, gum recession, and much more.

    For now, lets concentrate on problems that yield pain or dysfunction in the actual TMJ itself a condition that is properly called "TMJ Dysfunction Syndrome."   

Conditions affecting the TMJ itself...

    Clinical issues that are isolated to just the TMJ can be placed into two categories - those that are isolated within the joint itself or those that result from problems that originate outside of the joint.

    If you look at the image to the right, you will see that the joint is encased in a capsule of connective tissue. Therefore problems that present as an actual physical deformity of the tissues within the capsule of the joint are appropriately called "intracapsular defects."

    As an aside, make a note of the muscle that also implants itself into the capsule. This muscle attaches not only to the lower jaw bone, but to the disk that separates the lower jaw bone from the socket in the skull. Much more on that in a moment.

    The good news is that intracapsular defects are very easily to identify. They do not require expensive testing machinery or multiple office visits to determine if they exist.

    We can identify an intracapsular defect by merely placing our fingers under the jaw and, with gentle force, loading the joint upward into the socket to see if this causes any pain. If the patient winces upon loading the joint, then there is always an anatomical problem somewhere in the joint complex itself, 100% of the time.

    Once this is determined, it can also be confirmed with ultrasound. Our office employs the same ultrasound device that is used to listen to fetal heartbeats during pregnancy. It is an inexpensive test and confirms the existence of many types of problems in the TMJ.

    Intracapsular defects may include include severe, advanced arthritis of the joint; a complete or partially displaced disk in the joint; or damage from actual trauma to the bones (getting hit in the jaw, e.g.) Regardless of the cause, the treatment always involves a surgical repair, so the patient is immediately referred to a skilled oral surgeon.

 

TMJ Issues that originate from outside the joint itself...

    The second category of TMJ issues may present as symptoms within the joint itself, but the origin of the problem is not outside of the joint. After decades of research, it has become clear that all of these "extracapsular" TMJ issues are consistently secondary to a more complex story that includes muscles, nerves and teeth.

    What if I told you that the pain in your joint, your facial pain, tooth sensitivity, or tooth pain is actually caused by your chewing muscles going into uncoordinated spasms called clenching? And what if I told you that the cause of these muscular spasms is always an imbalance in how your teeth strike each other?

    You will be very surprised to find out that emotional stress is not the cause of clenching. In fact it isn't even a co-factor. I can very confidently state that clenching is not due to stress, but that it can cause you a lot of stress. I can equally state that anyone who exhibits this habit will always display tooth to tooth contacts that interfere with how the jaw wants and needs to function. This imbalance creates muscular confusion and clenching results.

    There is a position that the TMJ prefers to be in when the jaw is at rest and just before the teeth come into contact. It is called "centric relation."   It is a skeletal position that provides stability so that this joint can absorb some pretty severe forces when the teeth do come into contact. If the TMJ was not skeletally braced in this almost hinge-like position, it could really harm itself.

    But in order to function properly, the teeth need to allow the jaw to assume this centric relation position. If the teeth interfere with proper TMJ positioning bad things can happen in the joint, bad things can happen to the muscles, and bad things can happen to the teeth themselves.

    Before we go any further, lets talk a little more about the relationship between Centric Balance, Occlusal Trauma, and the TMJ.

 

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