TMJ Disorders, Facial Pain and Headaches

TMJ stands for temporomandibular joint. Temporal, represents the temple area of the skull; mandibular represents the mandible, or lower jaw; the joint is where the head and jaw meet. This joint may be aggravated by a misalignment of the teeth, neck problems, trauma, excessive muscle tension or a combination of all of the above. Between the jaw bone and the base of the skull, a disc acts as a buffer, and five muscles on each side, balancing the jaw like a hammock, are involved in the movement of the lower jaw.

Problems in this area can cause:
• Headaches
• Earaches and tinnitus 
• Trouble/soreness in opening and closing the mouth
• Clicking or popping of the jaw
• Pain in the jaw muscles
• Soreness in the area, sometimes extending to the face

Treatment of temporomandibular joint disorders, or TMD, is done in phases in this practice - FOUR of them, to be exact. Phase I (one) is critical.  It is the DIAGNOSIS phase.  Treatment of facial and and TMJ disorders are difficult, if not impossible to treat without a proper diagnosis.  The information obtained during this phase allows us to provide the proper treatment for your individual disorder.

Phase II used to establish where the mandible wants to be in space so that the joint and the muscles are comfortable. This can include an appliance called an orthotic, which is used to stabilize the bite in a position that decreases the stress on the joint. This appliance is typically worn during the day, including when eating.  When Maximum Medical Improvement is reached, verification records are taken again to verify objectively the success of the treatment position. 

Phase III is designed to hold you in the position found during Phase II. Phase III dental treatments for the TMD condition can include replacing missing teeth, moving teeth, adjusting the bite, filling gaps between teeth, etc. The goal of Phase III to restore the mouth to the position that eliminates the need to wear the orthotic during the day to keep the joint stable. This position is evaluated in plastic first, using the orthotic or temporary crowns (if indicated), then duplicated either through tooth movement orthodontically, or restoratively using fillings, crowns or bonding to the teeth. Sometimes it is as simple as weaning off of the orthotic. It weaning is not possible without the symptoms coming back, the need for definative therapy is verified.

There is no one solution that is right for all cases. If untreated and the condition progresses to extremes, surgery may be required to repair a badly damaged joint, but this is reserved as a last resort, not primary treatment.

Stability of the joint is usually maintained with the use of an appliance at night that does not allow clenching or grinding. The appliance most often used is a Long Term Anterior Deprogrammer with a Lingual Ramp.  The lingual ramp maintains the front to back position of your bite, which also may help wiht your airway, and the deprogrammer component activates the "jaw open" reflex that keeps the massters and temporalis muscles from going into their maximum contraction while sleeping.

When there is not an anterior-posterior issue an NTI-tss, the appliance shown above, is used to keep the back teeth from touching. This treatment appliance is designed to minimize the damage to the teeth and joint that occurs during the night from the forces generated during nighttime clenching and grinding, also known as bruxism. It is a small appliance, about the size of your thumb’s first digit, that fits over your front teeth. Your opposing front teeth will have a clear retainer over them, very similar to an Invisalign aligner, so that you are touching plastic to plastic.  The opposing teeth will contact a flat area on the appliance that allows the lower jaw to rest in a neutral position. It will allow you to move from side to side when you are sleeping, but it will not allow anything from the eye teeth back to touch.

If, during Phase I, it is found that you also have an issue with keeping your airway open while sleeping, the night appliance used will be designed to address both issues, joint position and airway patency.  If it is found that you have structural issues adding to your total picture, co-therapy with an ENT, chiropractor or osteopathic physician may also be recommended.

Nutritional support during the treatment process, and after, is highly recommended, and your case success can be adversely effected by not addressing that component of the healing process.  This practice is recommending the whole food supplement products of Standard Process for their supportive therapy.  These supplements are made from whole foods, not chemically formulated, so that your body gets ALL the components it needs to process the vitamins and minerals most effectively.  Additional therapuetic treatment modilities such as ultrasound, moist heat, spray and stretch and electrogalvanic stimulation can be used when indicated. 

Phase IV, or the maintenance phase, is just as important as the treatment phases.  This is critical to minimize the probablility of your system relapsing into the state of symptoms that brought your to the crisis state in the first place.  You can maintain your relationship with your primary dental provider, if it is not Dr. Wiggins, but annual followups, at minimum, are recommended, as well as maintenance of the supplement program recommended for your systemic health maintenance.