Head, Neck & Face Pain – TM Disorders: TMJ & TMD In Suwanee
Most of us can chew, yawn, open, and close our mouths effortlessly; our jaws and surrounding facial muscles work together in harmony. Any disruption in this intricate, harmonious relationship between muscles and bones, however, can trigger the chronic facial discomfort of a temporomandibular (TM) disorder. These disorders are often characterized by a vicious cycle of muscle spasm, pain, tenderness, tissue damage, more muscle spasm, and further injury. They are known as “TMJ” or “TMD” Problems, “TMJ” or “TMD”.
What is the TMJ and what is “TMD”?
The temporomandibular joint (TMJ) is the joint that connects the jaw to the skull. For a long time, dentists thought all TM disorders were caused solely by malocclusions or problems with the way the teeth fit together, causing pain and dysfunction in the TMJ (joint) and surrounding muscles. We now know that TM disorders are really a group of several different disorders, each with unique causes and each requiring unique treatments, but all related to how the jaws, joints, muscles, and teeth work together. “TMJ” or “TMD” are terms used as shorthand for this group of painful disorders which are by no means rare. An estimated 20+ million Americans suffer from them and each patient with “TMJ” needs to know that his or her pain has a specific diagnosis. “TMJ” is not a diagnosis. If you saw an orthopedist for a painful leg joint, you would be disappointed to be told you have “knee”, or with a painful upper limb, to be told you have “arm.” Similarly, a diagnosis of “TMJ” is a non-specific description of pain in this area. To begin solving and treating your pain and dysfunction problem requires evaluation and diagnosis of specific ailment(s) of the joints, muscles, nerves, ligaments, tendons, teeth, habits and function, prior to targeted treatment and therapy.
Our doctors are recognized in the treatment of TMJ disorders. They are trained to diagnose and treat jaw joint disorders. In addition to training in general and cosmetic dentistry, they have completed hundreds of hours of advanced dental training in the field of neuromuscular dentistry. Dr. Finkel studied with Dr. Barnie Jankelson and Dr. Janet Travell, two of the doctors/researchers whose work formed the basis of neuromuscular dentistry, Myofascial Pain Therapy and treatment for TMD.
With their advanced training and experience, our doctors can determine what type of headache or jaw pain therapy is right for you.
To make an appointment, call 770‑497‑9111 or click here to request an appointment online.
Signs and Symptoms of TMJ Disorder (TMD)
Because of the broad spectrum of symptoms associated with TMJ Disorder, it is often referred to as the “great imposter.” While there are many symptoms of TMJ Disorder, many patients do not associate their discomfort and pain with TMJ Disorder and are often left undiagnosed. Referred pain from the temporomandibular joint and muscles can mimic ear or sinus infections, and cause pain in the head, neck, shoulders, back, or eyes. Some of the most common symptoms are the following:
- Pain in or around the ear, often spreading to the face
- Tenderness of the jaw muscles
- Clicking or popping noise when one opens or closes the mouth
- Difficulty in opening one’s mouth
- Jaws that “get stuck,” “lock,” or “go out”
- Pain brought on by yawning, chewing, or opening the mouth widely
- Headaches or neck aches; especially disabling pain in the neck and base of the skull
- Ringing or stuffiness in the ears, or inner ear problems
- Dizziness, vertigo, or balance problems
- Increased nervousness
- Gross fatigue, aggravated by pain-induced sleep disorders
- Dementia; which appears to be aggravated by a bad bite and resultant improper brain function
Causes of TMJ Disorders
Causes of TMJ problems include history of facial trauma and/or motor vehicle accidents, sleep disorders with clenching and grinding, obstructive sleep apnea, medication side-effects, medical disorders, and neural (nerve) disorders. Heart disease, sinus infection, spinal problems, improper nutrition, inadequate hydration (fluids), and stress are also contributing factors. Harmful habits are a major cause of TMJ pain and include bruxing, pipe-smoking, pencil-biting, and gum-chewing. Gum chewing in females, especially young women, has been shown to cause TM joint popping, clicking, and pain. The repeated chewing trauma causes internal derangement of the joint; the inner parts of the joint do not work together in harmony. In many women, continued gum chewing results in permanent joint damage, improper function, and future TMJ problems. Gum-chewing is harmful to the joints and should be avoided.
Oral habits such as clenching the teeth or grinding the teeth (bruxism) can cause TMJ pain. These habits can tire the muscles and cause them to go into spasm. The spasm causes pain which, in turn, causes more spasm. The end result of this spasm-pain-spasm cycle may eventually be a TMJ Disorder. Problems in the way the teeth fit together, or bite, can initiate TMJ Disorders. Improperly aligned teeth can sometimes place the chewing muscles under stress and cause them to go into spasm, thus setting off the harmful cycle described earlier.
Paula is under a great deal of pressure from work. She develops a habit of grinding her teeth while sleeping. This causes muscle spasm and, eventually, pain and tenderness in her jaw muscles. Because of these problems, a slight change in the position of Paula’s jaw occurs, and her teeth no longer fit together correctly. She develops a new chewing pattern, and this increases the muscle spasm.
Ever since he was a boy, David, has had teeth that do not fit together correctly when his mouth is closed. This never seemed to be much of a problem for him, but now his bad bite triggers tooth clenching and causes his chewing muscles to function incorrectly. Muscle spasm occurs, and pain limits the normal range of David’s jaw movements. As a result, David’s chewing pattern changes, and this contributes to his TMJ symptoms.
Treatment Options for TMJ Disorders
Dentists use a wide range of treatments to manage TMJ Disorders, from drug therapy with muscle relaxants to surgery. Other components of treatment programs for TMJ Disorders include soft-food diets, massage, moist heat applications, bite adjustments, bite appliances, physical therapy, and relaxation exercises. Some common methods of treating TMJ Disorders are:
Elimination of spasm and pain
This can be done by applying moist heat to the face with exercises, using prescribed muscle relaxants or other medications, massaging the muscles, and eating soft, non-chewy foods. Bite plates or occlusal (bite) splints may be required to relax the muscles, to decompress the jaw joints, and to protect the teeth. This appliance, known as a “M.O.R.A.”, is a Mandibular Orthopedic Repositioning Appliance and may be used full-time daily, nightly, or in some combination to help the muscles relax.
Counseling or biofeedback/relaxation training
Many times, counseling is used along with other forms of treatment. If emotional stress is the factor that causes clenching or grinding of the teeth, that stress should be reduced or eliminated. Biofeedback can also be helpful in reducing muscle tension in the neck, jaws, and face. Physical therapy, nutritional supplementation, life-style guidance, and coping skills may help.
Changes in lifestyle and harmful habits
TMJ therapy may include improvements in nutrition, fluid intake, sleep hygiene, and daily exercise; special jaw and neck exercises may also be prescribed for your condition. It is important to avoid stressful neck positions at work and home. Posture training and breathing training may be needed, as may avoiding harmful habits such as overly-aggressive chewing, hard foods, and gum chewing. Gum chewing should always be avoided to minimize trauma to the TM joints and stress on the muscles.
Correcting the way the teeth fit together
If your bite is incorrect or uneven, it can be adjusted by selective bite adjustment of the teeth. Orthodontic appliance (braces) and other dental procedures may also be used to reduce problems caused by incorrect tooth contact (improperly aligned teeth). Correction of the problem can involve treating the bite of one or of several teeth. Correction can also involve braces or surgery to move all the teeth into a bite position that properly supports the joints and muscles of the face.
A MORA, or bite splint, may be used to help diagnose a bite problem, aid in healing of the joints and muscles, and provide long-term support of the joints and muscles in the correct position. The MORA may be initially worn full-time, out only to eat and clean, for diagnosis and to aid in initial healing. After initial (Phase I) therapy, it may be worn nightly and full-time during periods of stress. All or some of the above treatments will likely be employed in combination for both short-term healing and long-term maintenance of health. Both short-term and long-term treatment will also likely involve support of other health professionals and “adjunctive” lifestyle changes.
To make an appointment, call 770‑497‑9111 or click here to request an appointment online.