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TMJ Therapy

“TMD is not one disorder, but a group of conditions, often painful, that occur when chewing muscles and jaw joints do not work together correctly.”

Do you experience headaches, ear clicking, popping, ringing or pressure, dizziness, jaw pain, jaw locking, limited opening or movement of the jaw, clenching, grinding, broken or worn teeth? You may be one of the 60 million North Americans affected by TemproMandibular Joint Dysfunction (TMD). A recent study revealed that 53% of people with TMD suffered some level of depression, while 22% had symptoms of fatigue and/or insomnia due to disrupted sleep patterns.

 

What and where are the TMJ’s?

The tempromandibular joints (TMJ’s) are located on each side of the face near the ears where the lower jawbone (mandible) joins the temporal bone of your skull.

These are the only joints in the body that are required to operate simultaneously. Like every joint, they are a ball and socket joint. The “ball” is part of the lower jaw and the “socket” is part of the skull. The lower jaw is connected to your skull by muscles, and the blood supply and nerves are located at the back of each socket. For this system of joints and nerves to be healthy and painless, the ball needs to be located in the center of the socket.

 

What is TMD (Tempromandibular Dysfunction) and what causes it?

TMD is not one disorder, but a group of conditions, often painful, that occur when chewing muscles and jaw joints do not work together correctly. The most common cause of jaw related problems is a bad (misaligned) bite.

That being said, TMD may also be caused by pain somewhere else in your body. For example, you may have pain in your hip causing you to subconsciously clench your teeth and disrupt the alignment of your teeth. This clenching results in jaw pain (TMD). Your jaw pain (TMD) is now secondary pain. If your jaw pain is treated with some level of relief but the primary cause (the hip) is not addressed, the jaw pain can, and probably will, return.

Your teeth must meet over 2000 times a day/night. If your bit is unbalanced due to misaligned teeth, we also know that the jaw joints (TMJs Tempromandibular Joints) are out of alignment usually due to the lower jaw being pushed back (retrognathic position). As a result, the muscles are stretched and must work harder as they attempt to compensate for these misalignments. The blood supply and nerves are now feeling the pressure at the back of the socket, and this muscle tension becomes pain spreading around your ears to your head, neck, shoulders, and back. This pain causes your head to posture forward, away from the pain, putting more tension on all of these muscles.

The pressure on the nerves at the back of the socket triggers a reaction in the entire nervous system activating the body’s “Flight or Fight” (sympathetic) response. This is the body’s response to stress that prepares the body for action and is not meant to operate for long periods of time. However, for those people whose jaw is pushed into this back (retrognathic) position, they are in a constant state of “Flight or Fight”. Being in “high alert” for any extended period of time can be very tiring, and remaining in this state for long periods will cause other body systems to break down. Think of the body as a system of gears, when one gear breaks, it affects the entire system. This is how the misalignment of your teeth and TMJs can affect your entire body.

 

What is the solution?

Restoring harmony to your TMJ’s and bite requires having clear knowledge of how your jaw functions, and diagnosing the primary cause of the pain. Since serious medical problems, such as vascular disease, cervical disc disorder or brain tumors, may produce symptoms similar to those related to TMD, the initial step would be a diagnostic process that determines whether your symptoms are the result of TMD or some other cause. The doctor will make such a diagnosis after completing a comprehensive exam of the TMJs, head, and neck. The exam is typically followed by a two-phase treatment plan.

Phase I is all about stabilizing the joints, reducing inflammation, and addressing the primary source of the pain. Once the diagnostic analysis is complete, Phase I involves, but is not limited to, the use of orthotic appliances, physical therapy, natural supplements and medications, nutritional counseling, and various physical therapy modalities. As discussed earlier, this misalignment often affects posture, or neck and shoulder pain. In some cases it is necessary to be referred to other professionals, such as chiropractors, physical therapists, nutritionists, oral surgeons, medical doctors, neurologists, or ear, nose, and throat specialists in order to treat certain aspects of your TMD.

This phase, called “Positioning Orthotic Therapy,” will be deemed complete when you have reached “maximum medical improvement” (MMI) for your TMD condition. At that time there would be discussion of how to gradually discontinue or “wean” your use of the orthotic appliance. If you had been seeing other professionals, it may be necessary to continue seeing them for any persistent symptoms. If you were not seeing another professional but are experiencing some persistent symptoms, there may be a need to being add-on treatment.

At the completion of Phase I: Positioning Therapy, the patient then goes through a weaning process. If symptoms reoccur during weaning process, an additional, “finishing stage” of treatment called Phase II, may be required. Treatment may involve bite adjustment, orthodontics, or a “long term” appliance. The application of these proper and appropriate treatment modalities will correctly align the bite, keeping the joints and teeth healthy and stable.

Although most TMD conditions respond well to treatment, factors such as your general health, compliance with treatment directives, stress, posture, age, work habits, bite relationship, and the degree of existing tissue injury may affect the outcome, and reduce the opportunity for total resolution of your symptoms.