Problems with the TMJ or jaw joint has become a more common problem these days. One possible explanation of this might be that we are living longer. However, another factor could be that we are also keeping our teeth longer. If the teeth are not aligned properly, like the gears in a transmission, the jaw joint or TMJ has to move in a way the muscles do not normally want to make it move. This can cause a grinding of the teeth, a wearing of the TMJ, and a fatiguing of the muscles associated with chewing.
One of the many symptoms of TMJ problems is a headache. There could also be grinding with a wearing down of the teeth, neck pain, ear pain, dizziness, ringing in the ears or tinitus, eye pain, shoulder pain, and even numbness down to the hands. There are even some reports of TMJ problems associated with sleep apnea or OSA, as well as some auto-immune diseases.
Headaches from TMJ problems can be caused by the muscles becoming fatigued, or tired, due to their being overworked. This causes the muscles themselves to run out of proper chemicals to work - and they complain about it! The muscles used in chewing and working the TMJ can also cause headaches by being so tight around blood vessels or nerves. The TMJ muscles cut off the blood supply to other areas of the head and this lack of blood supply can cause the cry of pain to the brain. The constriction around the nerves going through the TMJ muscles can cause the pain to feel like the pain is coming from where the nerve is going to, like the eyes, yet the actual constriction is inside a TMJ muscle!
TMJ headaches can be alleviated if the TMJ muscles are relaxed and allow the blood supply and nerve conduction to flow properly. How this relaxation is accomplished will be discussed below.
Grinding or Bruxing can cause wear on the teeth which shows up as flat spots or even a yellow center on the edges of the front teeth. The yellow center is the soft dentin underneath the harder enamel. (The dentin is nine times softer than enamel. Even the food being chewed will cause the dentin to wear down inside the enamel.) This grinding is caused by the muscles of the TMJ wanting to move the jaw in a way that their fibers move best. If the teeth are not in allignment with where the teeth are needing to be to mesh for eating, they carry on a battle between them - but the TMJ is caught in the middle and the TMJ suffers too. This grinding can be controlled if the bite of the teeth are made to match up with the muscles in their relaxed position. This also allows the TMJ to be in a non-painful position.
The techniques for relaxing the TMJ muscles and matching up the bite to the muscles is discussed below.
Neck pain is usually an indirect pain from TMJ problems. When we have pain, if we find that we can avoid pain by changing our posture or body position in some way such as cocking our head to the side, we will keep our head in that position where we do not feel pain! However, in doing this we again make our muscles go where they are not comfortable and then the muscles complain. If the source of the original pain is from the TMJ muscles, massaging or re-aligning the neck will not remove the cause of the pain. Below, you can read of TMJ treatments that will help remove the neck pain from TMJ disharmony.
Ear pain can be caused either by a constriction of the muscles on a nerve going to the ear or from the inflammation surrounding the TMJ. If the muscles are relaxed and happy, the constriction and TMJ inflammation will diminish. The treatment for TMJ inflammation and TMJ muscle constriction is discussed below.
Dizziness or tinitus can also be caused by the TMJ muscles constricting down on the nerves going to the balance organs near our ears. This can be quite disrupting for the person who has this. Once the TMJ muscles that are constricting on the nerves to the balance organ are relaxed it makes recovery a lot easier. Sometimes it does take a while for the nerves to recover, so the sooner it is treated the better the results. This treatment is discussed below.
Eye pain can also be caused by the constricting of the nerves going to the eye muscles. This makes it feel like the eye itself is hurting. Once the TMJ muscles are relaxed the nerve can repair itself and the pain can go away. This TMJ muscle relaxation technique is discussed below.
Shoulder pain and hand numbness can be caused like the neck pain problem from fatigued TMJ muscles and posture changes. With the posture change to make the TMJ pain go away it causes constriction of other muscles in our necks that affect our shoulders and also the nerves going down our arms to our hands. When this happens we can have shoulder pain and the numbness or even pain in our hands.
Some of the TMJ pain treatment techniques have been to take muscle relaxing drugs. But, once the drugs stop, the pain comes back! Bite guards are sometimes made to protect the wear on the teeth and are usually only worn at night. But, not everybody gets relief from only wearing these at night. These bite guards have a flat surface on them and are thought to allow the muscles to just go where they want while they are worn. But, once the bite guard is taken out, the muscles are again made to go where the teeth want to go under orders from the brain. (After all, survival through eating is a higher priority - even if the muscles are complaining about it!)
Some TMJ pain treatments involve a dentist attempting to move the jaw with their hands to where they feel it should be. Then an appliance is made to hold the bite in that position. Over a period of time, adjustments to the appliance are made to where the muscles are calm, as determined by the patient's report and the dentist's perception. Sometimes the muscle relaxing drugs are used during this period also. Once it is determined the jaw is in the joint as the dentist wants it, the teeth are rebuilt with crowns to align the bite to this position. The guiding determination for this type of treatment is where the jaw fits into the jaw joint - not where the muscles are relaxed. This means the patient might still have jaw pain even after treatment. But, the x-rays of the joint can look real nice!
Neuromuscular TMJ treatments are intended to allow the TMJ muscles to work in the manner they want to function. Neuromuscular TMJ treatment allows the measurement of how relaxed the muscles are in a particular position of the jaw bite. The muscles are relaxed with a TENS unit that provides muscle relaxing impulses to the nerves going to the muscle fibers. Once the muscles are relaxed, a bite record is taken with some dental putty to record exactly where the muscles want to bite at. Then a TMJ orthotic is made from plastic that has cusps and grooves in it for the opposing teeth to bite into in a precise manner at the relaxed position found earlier. This TMJ orthotic is sometimes removable and is sometimes bonded to the teeth. The orthotic usually is worn for several months to assure the muscles are relaxed. This is determined by a neuromuscular dentist from the readings seen from an EMG or Electromyography computer. The EMG readings and bite will be checked and possibly adjusted during this period of TMJ orthotic wear.
Before the neuromuscular TMJ treatment is started a thorough examination is done. This includes palpating the TMJ muscles, checking for oral cancer, evaluation for gum disease and tooth decay, evaluation of the soundness of the teeth and restorations, review of medical history, sonogram or sound graph of the noise in the TMJ, dental 3-D Cat Scan of the skull which includes the TMJ, study models, and registration of the tension of the TMJ muscles by the EMG computer system. The EMG's are then taken again after the TMJ muscles are relaxed by the TENS. This is to determine what the condition of the TMJ and its muscle system is, as well as how sound the bite system is. This can let us know if the pain is indeed from the TMJ system, and if the neuromuscular TMJ treatment might be able to work, or if it might be from something else. In extreme cases the TMJ pains might be initially caused from other neck or back pains. The EMG's help us with determining that. In these extreme cases treatment might require treatment by other health care professionals at the same time. Remember the goal is to not just make the TMJ pain go away but to relax the muscles for the long run so the TMJ pain does not come back!
With the relaxation of the TMJ muscles the TMJ pain symptoms usually diminish. How long that takes will differ with each person. I have had patients whose pain that had lasted for up to 15 years go away in a matter of a few days of wearing the TMJ orthotic. The types of pain I have seen go away include all of the symptoms I have listed above. This is why I am very excited about Neuromuscular treatment for TMJ pain! Neuromuscular TMJ treatment may seem like it is something very new to dentistry, but it has been used over 40 years!
Once the TMJ pain and symptoms have been alleviated then something for the long term can be provided. This may involve continuing in a plastic orthotic - but the plastic will wear down and then the TMJ pain will come back as the bite collapses again. Having a Neuromuscular orthodontist move the teeth to the relaxed TMJ muscles position is great as long as the teeth are not too worn down. If the teeth are too worn, they will not hold or stay in one position. Then the teeth just slide around when eating - thus again causing the muscles to chew where they do not want to. Thus, if the teeth are too worn it would be necessary to rebuild with crowns or onlays the bite to hold the bite in the position that allows the muscles to be the most relaxed while chewing. Sometimes this might only involve the back teeth. Sometimes it might involve rebuilding all the teeth. This is why it is important to have the bite checked early to avoid more expensive reconstruction work!
If you would like more information on Neuromuscular TMJ pain treatment you can check out the TMJ Neuromuscular videos by clicking on the "Dental Health Guide" at the top left box at the top of this page. You can also go to the web site: www.leadingdentists.com
If you are suffering from TMJ pain with the symptoms I mentioned above I invite you to call the office and make an appointment with Nicole so this can be treated. Why would you want to suffer with TMJ pain any longer than you have?
Dr. Jenkins, Lisa, and Cindy at LVI advanced training on neuromuscular TMJ EMG and TENS equipment.
CONTACT INFORMATION:
12854 Tenth St.
Chino, CA 91710
(909) 628-5540