The temporomandibular joint is the most complex bilateral joint system in the human body. The body of the mandible is supported by two temporomandibular joints, one on each end. The mandible is designed to perform rotations and translations in the housing assembly of the disc and in the temporomandibular joints.
The final area of rest for the mandible is determined not by what moves the bone (muscles), but by the position and angulations of the teeth. Therefore, the full function of the temporomandibular joints is determined by three elements – muscles, bones, and teeth.
The point of closure of the mandible will result in either a healthy position or Temporomandibular Dysfunction (TMD). Teeth make the final choice of closure and position of the mandible. Maximum intercuspation is the point where the head of the condyle either will sit in the TMJ Disc or wrongly compress the bilaminar zone (a vital blood supply to the head and brain).
Tooth-to-tooth contact is a literal force to be reckoned with 300 to 400 pounds per square inch. These same forces also are translated from the head of the condyle to the fibrocartilagenous disc assembly. Can you imagine what would go wrong if the forces of mastication were applied to a nerve or blood vessel without protection from the disc assembly? Without the proper protection and function of the disc, we have the beginning of TMD.
When the head of the condyle is not seated correctly in the articulating disc assembly (most often a posterior superior position), a TMJ dysfunction occurs. This unfortunate person can experience many different symptoms. Most commonly reported symptoms of TMD are severe and frequent headaches and or migraines.
Other commonly reported symptoms are upper neck and head pain, sore and tender muscles, eye pain, ringing in the ears, dizziness, generalized anxiety, pain upon eating, sore and tired jaw muscles, clicking and popping jaw joints, and limited jaw movements. Women are more likely than men (by a 4:1 ratio) to be affected with TMD. The reasons are not entirely clear. Women generally suffer more from inflammatory disorders and there is some suggestion that female hormones may be a cause.
Many people who suffer from TMD have other issues that are closely related. The complexity of the TMD condition has led some health care professionals to treat the symptoms rather than the root causes. TMD is truly a condition rather than a disease or a syndrome. This condition results from the growth of bones of the head, the positions of the teeth, and the operation of the mastication musculature. This triad of muscles, teeth, and bones should be the focus of the TMD condition. If any of these areas are compromised, it can lead to the symptoms of TMD. Fortunately, a person suffering from TMD will experience a dramatic improvement with appropriate treatment.
Factors that play a large role in typical TMD are deep bites, cross bites, anterior tooth crowding, and the ever-destructive class 2 (div
2) malocclusions. Some patients display all the factors, but are completely free of the hideous symptoms. Others have only a single factor, but suffer all the symptoms.
Many dentists and physicians are not sufficiently well versed in the treatment of TMD dysfunction. Segments of the health care community attempt to treat TMJ dysfunction with medications, heat / cold packs, spinal adjustments, or acupuncture treatments. The dental community itself is still split about how a healthy joint system should work. Many dentists treat with TMJ surgeries, occlusal splints, or orthopedic and orthodontic procedures. While each method encounters a degree of success, none has proven completely satisfactory. New ideas and training on how to look at a healthy joint system are now coming to light. This type of training is mostly offered as post-doctrinal education.
The ideal treatment for TMD would conclude without follow-up care from a dentist or physician. Ideally, this would be called, “TMD Graduation.” No more symptoms, no more head and neck pains. The majority of TMD patients (95%) who undergo TMD treatment in my practice may completely get rid of their frequent headaches and migraines and the other listed symptoms. However, even those who retain some symptoms now have a beautiful smile as a by-product of TMD treatment. Occasionally, some of the 95 percent still report having one or two headaches over the course of a year, but the type of headache is dramatically less intense.
1. Is it possible that my migraines are caused by a different source other than TMD?
Yes, migraines can be caused by factors not related to TMD. However, an estimated 62 percent of all females with migraines are related to TMD.
2. With the varying degree of the TMD condition, is it possible that my condition may appear to be TMD, but is not?
In order to know if your condition is TMD, you should have your symptoms carefully and thoroughly reviewed. Pictures of your head, neck, and teeth are viewed and measured to determine if your condition is TMD. Remember that some people have all the classic clinical factors related to the TMD condition, but have none of the symptoms of the condition.
3. Is it possible to be diagnosed with TMD and related conditions and there be no treatment available?
There are different types of TMD diagnoses. The most commonly seen is the “Typical” TMD. This is best described as the lower jaw appearing to be set backward. The orthodontic malocclusion is called retrognathic
mandibular position or the class 2 malocclusion. There are two subcategories of the class 2 malocclusion. Most commonly related to the condition of TMD is the class 2 division 2. Patients diagnosed with this condition of the lower jaw almost always have deep bites
and very crowded upper and lower teeth. The likelihood that treatment of this type of TMD condition will resolve is excellent. Besides resolving head and neck pain, this treatment will result in an improved facial soft tissue support and of course a beautiful smile. Another commonly seen TMD condition is the diagnoses of the “non-typical” TMD. This is seen where the patient has a near-perfect class 1 occlusion. Some of these patients already have had orthodontics to straighten their teeth and their smile is very nice. These particular patients have only one problem – small discrepancies in the upper and lower jaw positions. In order to resolve this condition, the upper jaw is “stretched” forward and the lower jaw follows suit.
4. My jaw is popping more and more, will
I have TMD symptoms later on in life?
There are several factors that come into
play. If you are not experiencing any of the other symptoms of TMD, it is much less likely. If you are having two or more headaches per week and several migraines per month, it is definitely something that should be diagnosed and possibly treated.
5. Can the extraction of baby teeth without space maintainers result or cause a predisposition for TMD?
Sadly, YES. The extraction of baby teeth needs to be carefully monitored. Using the technique of “Modified Controlled Serial Extraction” is very important. This process saves the remaining spaces for the soon-to-erupt adult teeth.
6. What is the treatment time, generally speaking, for TMD?
“Non-Typical” TMD is slightly shorter than “Typical” TMD. The first phase of treatment takes from 1 to 12 months and the actual braces are on 12-16 months. Age of the patient is the biggest variable, as well as how much movement the teeth will need to be corrected.
7. Why would someone with “perfect occlusion” and straight teeth have TMD?
This does seem very odd. Some TMD experts may find this very difficult to explain. The TMD condition is your first clue that the occlusion is not perfect. The hard truth is that mandible is not in the correct position and neither is the maxilla, despite the apparently perfect occlusion.
8. Referring back to question 7, how would you determine the correct position of the maxilla and the mandible?
The correct position of the mandible can be teased out of hiding by removing the event of the teeth from touching each other. This is done with an acrylic occlusal covering appliance. There are several different types; one is the “M.A.R.A.,” and another is the “Maxillary Sagittal Appliance.” Both appliances produce the same effects. Once the appliance has been worn for a few days, it starts to have the appropriate effect on the desired mandibular position. The muscles of mastication make the correct closures and stopping points and the teeth are taken out of the equation. From this new, desired mandibular position, the patient should have a full release of the TMD symptoms.
9. Once the patient has full release of the TMD symptoms, using the acrylic appliance, can the treatment stop with just the appliance?
YES, some dentists do stop with this appliance. There are several problems that can occur later on from wearing this appliance too long i.e. for years. It will cause a deepening in the curve of spee in the occlusion, which is another factor to TMD. In addition to a deepening curve of spee, the anterior teeth will further erupt. As time progresses, the acrylic appliance get thinner and weaker and will eventually break. Very likely, the conditions of TMD will quickly return. In short, if the patient still has an appliance in his or her mouth, then the patient has not graduated from treatment. The purpose of full TMD treatment is to finish with the appliances.
10. Can an appliance be used to determine if the conditions of TMD can be resolved?
Yes. One of the appliances can be used to determine if your condition is TMD or not. The results come directly to the patient in 1 to 6 days after starting the use of the appliance. Some patients report being very sore on the third and fourth days of wearing the appliance. It’s like going to the gym and working out for the first time. These muscles can get sore. If there is no change in the reported symptoms such as migraines or headaches, neck pain etc., the appliance can be discontinued. The great part of this treatment is that there is absolutely no harm trying one of these appliances for such a short time to test the TMD conditions. This trial week is very easily reversible, just remove the appliance. No harm done testing the TMD condition.
11. How is the appliance to be worn?
The appliance must be kept in the mouth at all times, never allowing the teeth to touch. Many patients try experimenting with the appliance to see what happens if they take it out. Within a few hours, headaches or ringing ears return. The appliance must be worn while eating. The appliance only comes out for adjustments and for basic home hygiene, including brushing and flossing.
12. Why must I wear the braces for only 12 months? This seems faster than my friend’s orthodontic treatment.
Major corrections are occurring while wearing the appliance(s) and this will cut down the time needed to wear braces. Multiple changes are occurring to your teeth and bite that help in the process of braces, but it is happening while wearing this appliance. All these advantages are utilized to the fullest to cut down the time in braces.
13. Will my medical insurance cover TMD treatment?
Yes and No. This will depend on your medical insurance, but some medical insurance companies do have coverage. As a courtesy, we will send in a pre-approval claim to your insurance company.
In conclusion: TMD is a condition and is mostly correctible. This condition controls nearly 30 million Americans or more. Millions of work days are lost every month due to the symptoms of TMD. It cannot be treated successfully with a pill because it is not a disease or an illness. Seek help if you suffer from the conditions of TMD. It is preventable … there is hope. My staff and I are changing lives daily. If you suffer from migraines / severe headaches, neck pain, shoulder pain, ringing in the ears, jaw joint sounds, eye pain, sinus troubles, limited jaw movements, and anxiety, you may have TMD.
14. What the TMJ consult consists of which is?
We take 3 digital X-rays and a panoramic and 2 TMJ / TMD X-rays of the condyles. We will have you fill out a TMJ / TMD packet and take a JVA / JT (Joint vibration analysis / Jaw tracker) which will inform us of deviations and sounds of the jaw. From that information, we will give you a comprehensive exam with diagnosis and together come up with a treatment plan that will fit your needs.