TMJ Disorders

What is the TMJ?

The temporomandibular joint (TMJ), is a small but important joint located just in front of the ear canals. It marks the junction between the upper and lower jaws and functions as a complex hinge that allows the lower jaw (mandible) to move during function.

What symptoms do TMJ patients complain of?

TMJ patients complain of a sometimes confusing variety of symptoms because the pain in many head neck disorders is referred rather than regional. This means that the pain can be originating in the jaw joint, but the brain perceives the pain as originating elsewhere.

Who should I see for an evaluation?

When TMJ symptoms become an issue, a prosthodontist, Dr. Ron, should be consulted. You will complete a thorough medical and dental history including information about medications you are taking, lifestyle considerations, and stress levels you encounter every day. Dr. Ron will personally examine the head neck areas, including the TMJs and record the clinical findings. Some joint testing is usually necessary such as tomograms and magnetic resonance imaging. Most of the tests are done right in Dr. Ron’s office.

Your teeth will be examined and impressions will be obtained so that models of your teeth can be examined to determine if your bite is contributing to your TMJ disorder. When discussing your problem with Dr. Ron, be prepared to give details about the following areas of concern:

• Origin of the problem
  • Duration and character of the pain you are experiencing
  • Joint noises such as clicking, popping or grinding noises
  • Range of motion of the lower jaw
  • Any head neck trauma (could be years ago)
  • Level of stress experienced at work or at home
  • Previous or current treatment and their results

What is a prosthodontist?

Prosthodontics is a recognized specialty of the dental profession encompassing the non surgical treatment of diseases , injuries and deformities involving both the functional and cosmetic aspects of the mouth, teeth, gum tissues, jaws and jaw joints. A prosthodontist is a graduate of an accredited dental school who has completed additional post doctorate training in an accredited two year residency program.

The American College of Prosthodontists functions to provide continuing education for members of the dental profession, support research and scientific investigation, maintain professional standards of practice and benefit patients served by the membership.

Prosthodontists specialize in YOU! Dr. Ron graduated from the University of Pittsburgh, School of Dental Medicine in 1975. He has created smiles of distinction for folks in all walks of life and has lectured extensively on three continents on Non Surgical Management of TMJ Disorders.

What are TMJ disorders?

TMJ disorders can be very tricky to diagnose. Symptoms can range from relatively minor headaches to serious “migraine” like headaches with neck, ear aches, limited ability to open the mouth, shoulder and back pain, and other symptoms that can be extremely painful and potentially debilitating.

Misalignment of the jaws when a person bites down can cause a TMJ problem. Sometimes the misalignment is a result of jaw growth discrepancies from birth. Sometimes the problem is a worn denture or even natural teeth that have wear on the chewing surfaces.

Arthritis of the jaw joints can mimic many other TMJ disorders. Arthritis is generally linked to other forms of arthritis in the body. Some studies seem to link trauma to degenerative jaw changes that are very similar to arthritis.

Jaw injuries such as jaw whiplash or a blow to the jaw or chin can displace the condyle and/or the joint disc. Dislocation of the joint disc structures can result in pressure of the bones on sensitive nerve endings in and around the joint. This kind of TMJ disorder is called an internal derangement because the problem is inside the joint and involves displacement or dislocation of the joint disc tissues.

In some cases of TMJ internal derangement, the disc is displaced or dislocated, which removes the cushioning effect between the ball and socket of the joint. This can result in tenderness and/or pain in the joint itself.

Disc dislocation or displacement occurs in progressive stages and may produce clicking joint noises or popping sounds along with restricted jaw opening and closing. In some cases, the lower jaw can get locked open or shut when the disc is so far forward in the joint that it blocks the normal joint movement. This forward condyle positioning can lead to degenerative joint changes which are regarded as a form of arthritis of the joint boney tissues.

Rheumatoid arthritis can cause a fusing of the moving parts of the joint. Fusing can also occur after certain kinds of surgery or in cases of significant trauma. Jaw fusion can prevent jaw movement completely and is usually a surgical treatment plan.

What about stress?

Folks with TMJ problems seem to be less able to deal with normal stress levels and in fact some cases can be caused by excessive stress. Clenching and tooth grinding (bruxism) can also be a sign of a TMJ disorder or in turn they too can cause a TMJ problem. Additional symptoms include clicking or grating sounds in the joint, pain in the face or joint with jaw opening or during chewing, facial stiffness and others.

As you can see, TMJ problems can be very complex and the key to treatment is an accurate diagnosis which guides objective treatment. When TMJ symptoms become obvious, a prosthodontist should be consulted. A specialist in the areas of the mouth, teeth and jaws, Dr. Ron has specific training and experience to diagnose and treat a TMJ problem non surgically.

What kind of imaging studies are usually required?

Special imaging studies of the joints may be required to get the objective diagnosis that would guide treatment. The first level of imaging is a film of the jaws called a panoramic study. This allows Dr. Ron to evaluate the teeth, the jaws individually, the sinuses and the areas around the TMJs with fair to good accuracy. This is a common dental study and many patients already have this kind of film available. This study allows Dr. Ron to evaluate the teeth, jaw bones and related structures for abscesses, fractures, cysts, tumors, etc. The chief value of this study is that it helps to eliminate many of the more common pathologies that can cause pain that mimics TMJ disorders. In other words, this film shows the whole mouth area and allows Dr. Ron to rule out problems other than TMJ disorders as a cause of the discomfort. This study is usually covered under conventional dental insurance plans.

The second level of imaging is specific tomograms of the TMJs. This study is highly technical and uses sophisticated expensive equipment that dedicated specifically to get perfect temporomandibular joint images. TMJ tomography requires scientific instruments that is not commonly available in imaging centers or especially dental offices. Dr. Ron has this technology right in his office. This assures that the specific studies necessary are obtained with the information necessary to determine the position of the bones in the temporomandibular joints. Common findings in patients with TMJ disorders are misalignment of the ball and socket bones of the joint and joint space compression or narrowing. This study is often covered under dental and medical insurance plans.

The third level of imaging is magnetic resonance imaging (MRI). MRI is the gold standard for determining the status of the joint soft tissues, the disc, the nerves and blood vessels and the muscles. If the discs are out of position, then pressure on nerves and blood vessels is the likely causation of TMJ related signs and symptoms such as ear and headaches, joint noises and bite problems. Dr. Ron has a good network of medical radiologists that can get the quality of MR imaging necessary and more importantly, a high level of expertise in reading this kind of study.

What do I need to know about treatment?

Once Dr. Ron objectively determines the specific TMJ problem, the treatment can begin. There is no recipe to treat TMJ patients but there are general approaches to specific problems. For instance, if the TMJ disc is displaced, a highly refined jaw positioning device, a Stabilization Prosthesis Appliance may be indicated. This appliance helps the patient find the comfortable jaw position to get the pressure off of the jaw joints. In appropriate cases, the remission of headache and jaw related symptoms can be very dramatic.

In other cases, medications along with acupuncture and physical therapy measures can be the treatment or an adjunct to Stabilization Prosthesis treatment. In general, it is good advice to avoid hard or chewy foods, wide jaw opening maneuvers and prolonged speaking to give the joints a break for healing. Moist heat applied to the face in joint areas can help relax sore muscles. Jaw exercises with biofeedback and ultrasound/electrical stimulation can also help speed healing and resolution of symptoms.

What other treatment may be necessary?

In cases of internal derangement, after the first phase of treatment, the second phase can include orthodontic treatment or restorations such as crowns on the posterior teeth to correct a defective bite. This is necessary to restore proper harmony between the teeth, muscles and the jaw joints. In general, Dr. Ron does not recommend jaw surgery to treat TMJ problems except in very extreme cases. A non surgical approach is the goal.

If you have other questions or require additional information, you may call Dr. Ron and speak to his staff. The number is 702-310-5970. You will receive health history and insurance forms to fill out before your office visit to save time. You should be prepared to undergo a complete dental facial examination of your bite, your jaw muscles and your jaw joints. It is better if you don’t take any pain medications for at least a few days prior to your first visit so that Dr. Ron can evaluate the location and quality and duration of the pain you are experiencing.