There’s Help for TMJ Pain, aka TMD

By Guest Contributor April 14, 2015 19:18

Non-Invasive Management Using Intra-Oral Orthotic Devices

By Dr. Abhijit Gune, DDS

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Your temporomandibular joint (TMJ) is a hinge that connects your jaw to the temporal bones of your skull, which are in front of each ear. It lets you move your jaw up and down and side to side, so you can talk, chew, and yawn.

Problems with your jaw and the muscles in your face that control it are known as temporomandibular disorders (TMD). But you may hear it wrongly called TMJ Pain, after the joint.

Temporomandibular disorders (TMD) are a heterogeneous group of musculoskeletal and neuromuscular conditions involving the temporomandibular joint complex, and surrounding musculature and osseous components. TMD affects up to 15 percent of adults, with a peak incidence at 20 to 40 years of age.

Estimated 10 million Americans suffer from TMD

We don’t know what exactly causes TMD. Dentists believe symptoms arise from problems with the muscles of your jaw or with the parts of the joint itself. Injury to your jaw, the joint, or the muscles of your head and neck –  like from a heavy blow or whiplash – can lead to TMD.

Other causes include:

  1. Grinding or clenching your teeth, which puts a lot of pressure on the joint.
  2. Movement of the soft cushion or disc between the ball and socket of the joint.
  3. Arthritis in the joint.
  4. Stress, which can cause you to tighten facial and jaw muscles or clench the teeth.

What are the symptoms of TMD?   gune-fig-5-

TMD often causes severe pain and discomfort. It can be temporary or last many years. It might affect one or both sides of your face. More women than men have it, and it’s most common among people between the ages of 20 and 40.

Common symptoms include:

  1. Pain or tenderness in your face, jaw joint area, neck and shoulders, and in or around the ear when you chew, speak, or open your mouth wide
  2. Problems when you try to open your mouth wide
  3. Jaws that get “stuck” or “lock” in the open- or closed-mouth position
  4. Clicking, popping, or grating sounds in the jaw joint when you open or close your mouth or chew. This may or may not be painful.
  5. A tired feeling in your face
  6. Trouble chewing or a sudden uncomfortable bite – as if the upper and lower teeth are not fitting together properly
  7. Swelling on the side of your face.

Do you suffer from TMD? 

Symptoms include dizziness, headache, tinnitus, neckache, upper shoulder pain, toothache and pain behind your eyes.  gune-fig-2

Proper diagnosis of TMD       

gune-fig-3Many other conditions cause similar symptoms – like tooth decay, sinus problems, arthritis or gum disease. To figure out what’s causing yours, the dentist will ask about your health history and conduct a physical exam.

We check your jaw joints for pain or tenderness and listen for clicks, pops, or grating sounds when you move them. We’ll also make sure your jaw works like it should and doesn’t lock when you open or close your mouth. Plus we’ll test your bite and check for problems with your facial muscles.

We may take facial X-rays for your TMJ so we can view your jaws, temporomandibular joints, and teeth to rule out other problems.

In our practice we use a 3D X-ray machine called CBCT, for Cone Beam Comuted Tomography. With today’s technology CBCT offers highest reliability with lowest radiation in TMJ pathology diagnosis. We may need to do other tests, like Magnetic Resonance Imaging (MRI). The MRI can show if the TMJ disc is in the proper position as your jaw moves.

There could be environmental, social, emotional, and cognitive triggers. You may get referred to a chiropractor, physical therapist or even a psychologist for further care and treatment. We (orthodontists) may also conduct a thorough exam to ensure your teeth, muscles, and joints work like they should. If you have a malocclusion we would recommend the necessary treatment after resolving your TMD symptoms.

gune-fig-4 Treatment for TMD pain using Orthotics 

After a thorough clinical exam and review of your medical history a tentative diagnosis is made about the primary source of pain. If a referral to your dentist (toothaches) or ENT (ear infections) would mimic TMD symptoms then we would usually refer you back to them.

If your TMD symptoms are diagnosed to be due to a discrepancy arising from the jaw muscles and clenching or grinding of your teeth then generally you would need to be fitted for an Intra-oral Orthotic. Orthotics come in many different types and many different materials. Beware of the boil and bite type available on the Internet or the stores. It is best to consult with your dentist or visit us.

gune-fig-6-vfThe two main types of orthotics we fabricate for our patients are called “stabilization splint” and “anterior repositioning splint.”

Depending on the type of TMD symptoms you are experiencing you may need one of these 2 types. If you have a CLICK or POP in your jaw joint then you would most likely need an anterior repositioning splint to begin with for the first four to six months. You would then follow up with the stabilization splint for night-time wear.

An ideal intra-oral orthotic should be made of a hard or semi-hard material (not soft) and should cover all your teeth in one arch with the opposing teeth contacting the splint material. You would need to wear the splint full time for the first three to six weeks followed by night-time only for the remaining period until the TMD symptoms have disappeared.


 

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 About the Author

Dr. Gune finished his Masters in Orthodontics in India in 2001. He obtained his DDS in California in 2004.  He is the owner and one of the practitioners at Sierra Orthodontics, sierraorthosmiles.com. They have offices in Sonora and Angels Camp. Dr. Gune has completed a mini residency in TMD and Oro-facial pain at the University of Kentucky, Lexington, KY. Contact him at (209) 532-2288 or email abhijeetpg@hotmail.com.

By Guest Contributor April 14, 2015 19:18
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