The temporomandibular joint (TMJ) connects the mandible (lower jaw bone) to the cranium (skull). This is the most complicated joint of the entire body. It is one that allows forward and backward movements as well as rotational and side to side movements. The term TMD stands for Temporo-Mandibular Disorder.
TMD is often characterized as complications or problems with this joint. Some of the most common symptoms of TMD are:
- Pain in areas outside of the jaw (headaches and/or neckaches)
- Jaw pain with or without jaw movement
- Clicking or popping sounds with jaw movement
- Muscle spasm that may limit jaw movement
- Locking of the jaw joint preventing jaw movement
Some causes of this disorder relate to genetics, hormones, low-level infections, auto-immune diseases and trauma. Clenching and/or grinding of the teeth are also a factor.
Diagnosis of such conditions and evaluation of the causes are best performed by dentists experienced in this discipline. Since the vast majority of causes relate to occlusion (bite), some common treatments are Night Guards, Bite Guards and Bite Adjustments. The doctors at Northwest Dental Medicine will be able to guide you toward the most appropriate treatment model.
Dr. Rick Light is both medically and dentally board certified in the fields of Temporomandibular Joint Dysfunction (TMD), Craniofacial Pain (Head, Neck & Facial Pains) and Pain Management as well as Sleep Breathing Disorders (Snoring & Obstructive Sleep Apneas). Dr. Light has co-authored publications dealing with radiographic interpretations of dentally related conditions for radiologists (MD’s), and dentistry’s contribution to medicine in obstructive sleep apnea patients. He is a Master of Excellence and Distinguished Fellow of the American Academy of Craniofacial Pain (AACP) as well as a Fellow of the International College of Cranio-Mandibular Orthopedics (ICCMO).
Muscle relaxers, preventative medications, anti-inflammatory medications and others can be effectively utilized in alleviating symptoms and discomfort.
In conjunction with the treatment of TMD, it is often necessary to work with other qualified health care professionals in the medical and alternative medical fields such as chiropractors, physical therapies, and radiologists.
In order to maximize treatment results, it may be necessary to use a series of modalities to release muscle tension and optimize movement of the jaw.
- Spray and Stretch is a technique that uses cold therapy on the skin to allow for increased mobility while stretching the muscles.
- Hot and cold therapies may be used to relax muscles and decrease inflammation
- Manual pressure on trigger points allows for the myofascial release of spasms and tightness.
- TENS is Transcutaneous Electrical Nerve Stimulation is used to relax the muscles, which thereby decreases pain
- Manual Manipulation of the jaw joint to gently guide the disk back into proper position
- Dynamic decompression and stabilization is where the jaw is guided into movements to deprogram muscle memory and then stabilized using an intraoral device such as an orthotic
- Therapeutic injections may include administering a local anesthetic into the joint capsule in order to create volume in the superior joint space above the disc, thereby promoting an opportunity for disc recapture.
We use Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) to detect hard and soft tissue anomalies and destruction. These diagnostic images allow for evaluation of joint position, posterior-superior joint spacing, cervical displacement and alterations.
We use the Model K7 Evaluation System and J5 Myomonitor. This is a computer-based system for three-dimensional jaw tracking, surface electromyography and recording of joint sounds while the muscles are in their most physiologically relaxed state.
An orthopedic repositioning appliance is fabricated based on an evaluation and the above imaging and computer analysis.
This device functions to:
- Realign the mandible and maintain proper posture of the condyle within the mandibular fossa which is determined by the muscles, the way the teeth come together, and the TM joint itself.
- Re-establish joint space by decompression of retro-discal tissue, that often causes pain and inflammation.
- Establish and maintain proper condyle-disc relationship that eliminates the anterior disc displacement causing the movement of the condyle into the posterior-superior position. Without establishing this proper relationship, there can be limitations in opening and closing, and sometimes even “lock-jaw.”
- Stabilize the bite to decrease the adverse effects on the teeth and supporting structures caused by joint pathology, clenching and grinding. Continued trauma to the teeth due to TMJ dysfunction/clenching/grinding can lead to tooth pain, tooth fracture, abfraction lesions and even bone loss.
How is this different from a nightguard:
A nightguard is a universal piece of plastic about 2-3mm thick that allows teeth to rub against the plastic rather than themselves. An orthotic is a device that holds your jaw in a specific position based on the three dimensions (yaw, pitch, roll or up/down, right/left, side to side). An orthotic is not designed to alter your bite, however, one’s teeth may fit together differently after the temporomandibular joint and surrounding structures have healed and remodeled. The goal of an orthotic is to eliminate pain, clicking, popping and condylar impingement.