The Smile Professionals : Dr. Claire Stagg DDS MS FAACP

TMJ Disorder: TMD

Temporomandibular Joint Disorders (also known as Craniomandibular Dysfunction and Craniofacial Pain), more commonly known as “TMJ”, is a term to describe an umbrella of disorders that occur within or around the jaw joints, ligaments, tendons and muscles that control these joints. These joints, located on each side of the head in front of the ears, are the two joints that connect the lower jaw bone to the skull.

The Temporomandibular joints are probably the most sophisticated joints in the body because they move up and down, side to side and in a wide range of motion. Muscles attach the bones and joints that allow such movements.

You can feel / observe the action of the jaw joints by placing your fingers in front of your ears on the sides of your face. Open and close your mouth and you will be able to feel the movement. It should feel smooth without any clicking or popping when opening, closing or moving the jaw from side to side.

When these joints are not in their correct position, there can ensue mild discomfort to severe pain. If this condition is prolonged, the body begins to compensate by involving other muscles or joints in close proximity or even very far away such as from the neck, throat, upper and lower back, arms and fingers, pelvis and even as far as the feet.

The head, neck and facial pain associated with TMD problems often masquerade as a multitude of other conditions such as sinus headaches, migraines, neck, shoulder stiffness and earaches. Fortunately, it can be treated successfully by a dentist who has the specially required training that is needed to manage these disorders.

It is estimated that as many as one in every four Americans suffer from one or more of these symptoms:
Headaches Pain behind the eyes Facial or throat pain Dizziness Earaches, congestion or ringing ears( tinnitus)	Clenching or grinding teeth Neck pain or stiffness Numbness or tingling of the fingers Click, pop / grating sound in jaw joints Tired jaws
The primary problem can be in the joints themselves, the muscles of the face and jaw or a combination of these. Because symptoms masquerade as so many other conditions, people travel from doctor to doctor is search of answers for pain relief. Many never think to seek out a dentist who is trained specifically in TMD.

CAUSES:

Your teeth are inserted into your jaw bones. Structures that make it possible to open and close your mouth include the bones, joints, muscles and nerves. At the other end of your lower jaw bone are the TM joints which connect the jaw to a fossa in the skull. The joints are then “held in place” by ligaments, muscle tendons and capsules allowing movements so as to talk, chew, sing, shout and swallow. Therefore any anomaly with any of the structural components will cause discomfort resulting eventually in pain and a TMD.

There are various ways this system can be disrupted such as macro trauma: whiplash or a blow to the face, connective disorders (arthritis) or skeletal malformations and posture.

However, the most common origin of TMD would be continuous micro trauma caused by a poor relationship between your teeth and your bite. A “bad bite” prevents your upper and lower teeth from coming together in a level way that provides proper bracing support for the jaws. This can be due to missing, misaligned teeth or back teeth that are too “short”.

Another factor that impacts on TMD is STRESS. Stress overloads the adaptive capabilities of the jaw. Due to stress some people unconsciously grind and/or clench their teeth creating even more strain on the jaw joints.

CONSEQUENCES:

Muscle Spasm:
It is important to know that the ONLY time that teeth actually touch is when you SWALLOW and you swallow automatically 2500 times throughout the day and night. The upper and lower teeth must come together firmly each time. When the bite is unstable and not level, the muscles must work harder than normal causing stress, strain and possibly stiffness. Eventually muscles feel tired and painful. A vicious cycle begins of increased tension, muscle spasm and pain.

Jaw Joint Disc Displacement:
When the jaw joints function properly, the bones do not actually touch because of a thin “disc” of cartilage that rides between them. The disc acts as a cushion and allows the joint to move smoothly. Each disc is held in place by ligaments and guided by muscle. If your bite is not meeting properly, the joint is pulled out of alignment – and the disc is usually pulled forward . Since the disc no longer serves as a cushion, the joint itself now rubs against the bony socket and presses on nerves (pain fibers) and blood vessels.

TREATMENT: Each case is unique! A thorough health questionnaire, examination and testing is performed to assess your condition, determine the cause and formulate a treatment plan. Dr. Stagg will discuss the onset, duration and intensity of signs, symptoms and pain and may address stress and nutritional issues. Supplemental treatments and physical medicine modalities performed either in our office or that you may be referred to a specialist for may include:
Ultrasound Iontophoresis Infrared Therapy Relaxation Therapy Nutrition Counseling Various Injections: Prolotherapy, Trigger Point Therapy TENS	Hot/Cold Therapy Spray & Stretch Iontophoresis Laser Physical Therapy Chiropractic / Osteopathic Myofunctional therapy
Because problems associated with the jaw joints can be progressive, accurate and immediate diagnosis and treatment is crucial. Early treatment will help avoid more damage such as degenerative arthritis. Dependent on your particular TMD problem, treatment may involve several phases that follow each other chronologically : (1) A proper diagnosis (2) Customized appropriate treatment to combat head, neck and facial pain to help patients regain full function (3) Stabilization of the bite (4) Final restorative procedures maintaining the properly positioned jaw hinge and bite. A brief guideline would be a the use of a temporary, leveling, easy-to-wear splints (orthotic) of clear acrylic that are made to fit over either or both the top or bottom teeth until the bite stabilizes and the muscles are relaxed and out of spasm. Permanent correction may involve selective reshaping of the teeth (Equilibration) , building crowns (reconstructive), orthodontics or a permanent appliance. After treatment is finished it is usually required to wear a stabilizing splint at night to avoid relapse. It is noteworthy to comment here that TMD and Sleep Breathing Disorders are commonly present together . Which came first, the chicken or the egg? It's important to be checked for an airway issue that could be compounding the pain symptoms. Though infrequent, surgery to correct a damaged joint is only needed in about 3% of all TMD cases. Ultimately, the goal of the conservative, non-surgical treatment Dr. Stagg offers is to help the teeth, muscles and joints all work together in harmony. If you have any of the signs or symptoms mentioned, talk to Dr. Stagg, your TMD dentist. Remember, your health is your most priceless possession. It is worth the investment!

Comments on a mouth leveling appliance from one of our patients:

"First of all, I had a severe motorcycle accident 45 years ago leaving me paralyzed from the chin down due to a broken neck. The more severe part of the paralysis lasted about a month, and then I began to get more and more ability back. Other related issues were balance problems, muscle weakness, (mostly right side) somewhat routine tripping and falling for no discernible reasons, that I took mostly in stride. I was too happy to be able to move about in general to let such difficulties bother me… I met Dr. Stagg in 2009, and began a thorough rebuild of my mouth with her. During my routine dental care with her, she talked about a mouth device (orthotic) and what could be accomplished with it. I was skeptical about this device and the cost but decided to give it a try…. Now I am here to tell you what a blessing it has become for me. I have never fallen down completely while wearing this appliance; my walking is much more sure and easier. I walk with greater ease and strength and balance. The outcome of where I intend to walk is far more assured and safe. I always have it in place in my mouth when I walk anywhere.

On a rare occasion, perhaps after having eaten something from a drive thru restaurant, I get out of my car with my appliance in my shirt pocket and start heading for my apartment building and begin to think ‘I am never going to make it there, what is the matter with me?’ And then realize “Oh, I forgot to put in my appliance”. So I stop, and put it in, and feel an immediate build up of strength power and coordination to finish my walk. I always have it with me and use it while walking or working on anything 99.99% of the time. I go nowhere without it. The difference between having it in place and not is like night and day."
Sincerely,
Randall B, Florida

2120 Highway A1A Indian Harbour Beach, FL 32937
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