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
What is a prosthodontist?
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
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
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
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
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
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
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
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
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
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.