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TMJ Disorders
Temporomandibular Disorders (also known as Craniomandibular Dysfunction and Craniofacial Pain), more commonly known as “TMJ” is a term to describe a jaw joint disorder and the muscles that control the joints. These are the two joints that connect the jaw to the skull located on each side of the head in front of the ears.

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 observe the action of the jaw joint 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 displaced, there can be mild discomfort to severe pain. When this condition is prolonged, the body begins to compensate by involving muscles or joints in other areas: the neck, throat, upper and lower back, arms and fingers, pelvis 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:

Structures that make it possible to open and close your mouth include the bones, joints and muscles, nerves and teeth. Your teeth are inserted into your jaw bone. At the other end of your jaw bone are the TM joints which connect the jaw to the skull. The joints are then “held” to the skull 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 trauma (whiplash) or a blow to the face, connective disorders (arthritis) or skeletal malformations and posture.

The most common cause of TMD would be the relationship between your teeth and your bite. Therefore a “bad bite” prevents your upper and lower teeth coming together in a level way that provides proper bracing support for the jaws. This can be due to missing or 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 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:

Every 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 symptoms and pain and may address stress and nutritional issues. Supplemental treatments and physical medicine modalities may include:
  • Ultrasound
  • Physical Therapy
  • Relaxation Therapy
  • Nutrition Counseling
  • Various Injections
  • TENS
  • Chiropractic
  • Hot/Cold Therapy
  • Spray & Stretch
  • Iontophoresis
  • Laser
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:
(1) Proper diagnosis offering appropriate treatment to combat head, neck and facial pain
(2) to help patients regain full function
(3) to stabilize the bite

A brief guideline would be a the use of a temporary, levelling, easy-to-wear splint (orthotic) of clear acrylic is made to fit over 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, building crowns (reconstructive), orthodontics or a permanent appliance.
After treatment is finished it is usually requiredto wear a splint at night.
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.

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!
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