We understand that Temporo-mandibular joint disorder (TMD or TMJ as it’s commonly called) is complicated for the general public. Patients could have read different materials, visited different practitioners and received very different opinions. We hope to explain TMD in layman’s terms, the way we understand it from learning and treating patients for decades, and hopefully this page can be helpful to you.
With years of experience seeing TMD patients, the most common routes where patients come to visit us are:
- Headaches or facial pain referral by MD/ENT where they ruled out sinus or other facial or neurological issues
- Self-referral or professional referral when patients experience painful jaw joint clicks or TMJ clicks
When presenting with the same symptoms to a surgeon, a chiropractor, or a physical/massage therapist, patients could receive recommendations of surgical intervention, manipulation, or massage therapy, respectively. They all have their merits. We, in fact, work with different local experts to achieve the best outcome on an individual basis.
As dentists with very extensive and specific training in evaluating bite harmony with muscles and the TM joint, we have treated and have seen fascinating responses with expansion, bite corrections, either with nightguards, splint therapy (orthotic), or partial/complete bite adjustment. We always try to resolve the symptoms non-surgically. Granted there are times when surgery is indicated, but it is of our opinion that the majority of the patients can achieve great improvement with this effective and conservative treatment.
Please feel free to contact us to learn more about how we can help your TMJ symptoms or request an appointment online. We will love to help you figure out the best course of treatment. Please read below for a quick summary of our most current understanding of TMD.
The TMJ system is an interaction between muscles (1 – lateral pterygoid muscle), articular disc (2), joint (3 – condyle), posterior disc space (4), and airway (not in the above picture). The disc (labeled “articular disc”) is a piece of cartilage cushioning between the ball and the socket. Notice the disc (2) has muscle (1) attached to it, but it does not have a counter muscle behind it. What’s behind the disc is retrodiscal tissue, which is vascular and highly innervated. When the lateral pterygoid muscles (1) tense up, the only direction the disc (2) pull is forward and towards the center – as shown on the above picture. This will lead to tears and microtears creating separation of condyle and the disc, and the ball joint will compress posterior disc space.
Additionally, when a patient has insufficient upper jaw development, the lower jaw (which grows slower than the upper jaw) gets “trapped” and constantly pushed back, repeated micro tear of the disc to the joint will lead to partial or complete separation of the disc to the condylar joint. The posterior disc space (4) has nerves, blood vessels (and no opposing muscle), so when the posterior disc space is compressed, sometimes it will lead to “joint” pain, tinnitus or localized headaches. As focal pain turns acute, our body’s response is to protect ourselves. So all of the muscles that govern movement of the jaw will work in sync to balance the jaw to prevent joint pain. Unfortunately, over worked muscles will get fatigued so often times “TMJ” will lead to myofacial pain.
Painful R joint: Noticed the increased space in front of the joint indicating joint pushing back. Disc (not visible in CT scan) is forward and has partial separation from the ball joint.
Asymptomatic L joint: also retruded, but the space distribution appears to be more normal
With advanced trainings in reading CT scans and MRI, the doctors can diagnose any structural deformation, joint clicks, deviations on opening, and joint pain/inflammation. With the proximity of the TMJ to the ear canal, earaches or ringing in the ear could also be a common symptom.
Muscles govern the movement of the jaw. People who clenches, grinds, or have habits with excessive use of lower jaw can experience symptoms similar to overworked, tired muscles. Symptom includes headaches, facial pain, pain behind eyes, incoordination of muscles, tenderness to touch are common with TMD.
Often times, a poor bite or a bite that does not function in harmony with the joint, can cause joint and muscle symptoms (as illustrated above). Common signs and symptoms that we usually see with teeth are: cold sensitivity, excessive wear, mobility of teeth, fractures, and pain on chewing. Also, hyperactivity of the muscle will cause accelerated tooth wear (as above).
Reasons for treating TMJ
TMJ sufferers report that their symptoms generally worsen during periods of prolonged or unexpected stress, and that intense outbreaks of the condition can lead to all sorts of joint, muscle or teeth symptoms described above.
The most common cause of TMJ is under-development of the upper jaw and lead to the misalignment of the teeth, often called “bad bite.” It is possible for the dentist to expand, realign, or adjust the teeth without the need for painful or expensive surgeries. Often times, the goal of treatment is to prevent or delay major work that could be needed in the future. The realignment/adjustment will often times stop the pounding headaches, myofacial pain, and the jaw joint pain.
The grinding teeth symptom is particularly common and usually occurs at night. More and more research has defined night time bruxism (nocturnal bruxism) as a movement disorder. The movement disorder is a response to air flow or airway obstruction. The grinding will eventually erode the structure of the teeth and lead to much more severe dental problems in the future. Concurrently with periodontal disease, untreated TMJ is one of the prime underlying factors in eroded jawbones and loose teeth.
It is important for anyone experiencing the symptoms of TMJ to visit the dentist for an exact diagnosis.
What does treating TMJ involve?
Everything starts with a correct diagnosis. Conservative in nature, Drs. Goodman and Ko will proceed with the least invasive option first. Often times it will be appliance therapy (ie. Expansion or a Nightguard – below) to alleviate any muscle or joint symptoms. Dental appliances can also act as a useful diagnostic tool. Once the symptoms are controlled with appliances and/or at times with pharmaceuticals, further treatment could involve orthodontics, bite adjustments, prosthetics (restorations,crowns,veneers), and in very rare instances, surgery.
If you are experiencing any symptoms of TMJ, we encourage you to contact our office today at (508) 850-0686 to schedule an appointment.