The overused term TMJ only describes the joint that attaches the lower jaw, mandible, to the temporal bone of your head. For years we have used the term to describe a myriad of dysfunctions which can result in intolerable pain and even the inability to open one’s mouth.
The proper term is TMD which stands for Temporomandibular Dysfunction. As I mentioned in a previous article on nutrition, there exists vast amounts of misinformation to be found in this subject regarding the cause, prevention and treatment.
In a normal person the major cause is simply keeping the teeth together too much. Ideally the teeth only meet when we swallow. Over fifty years ago a study using electrodes placed on the teeth found that symptomless subjects averaged 16 minutes a day of tooth contact while TMD subjects averaged 16 hours a day. That’s 60 times as much contact!
Opening the mouth too wide can also injure this joint. Too much chewing, such as gum, hard or tough foods also can do harm as well as clenching and grinding (bruxism).
Another cause is trauma, such as a blow to the jaw. Hollywood shows actors punching each other in the jaw and just walking away rubbing it. Don’t believe everything you see in the movies! The damage from a punch to the jaw can be extremely painful, lifelong and often requires surgery.
There are some diseases that can damage this joint such as osteoarthritis and rheumatoid arthritis. Obstructive Sleep Apnea (OSA) can greatly exacerbate TMD due to the greatly increased strength that the muscles of the jaw exhibit when asleep.
If you Google TMD you will find many forms of treatment including the traditional western methods of treating the symptom rather that the cause, from suggesting drugs, adjusting the bite, to surgery and more. There is little or no emphasis on the importance of a complete medical history and, even more important, a review of the medical history by the doctor with the patient. An exam including muscle palpation should always be performed, and appropriate x-rays should be taken. Drug use should be noted for possible interaction or abuse.
In our practice, with the exception of injury due to trauma, we find that most drugs can only interfere with the discovery of the cause of TMD and its correction. I have taken over patients that are already on several prescribed drugs for pain. I compare this to taking a narcotic to cover the pain of a thorn in your foot and expecting it to be better after walking on it rather that merely removing the thorn.
Proper treatment of a true TMD syndrome can include many practitioners, but should always have a coordinator that understands the cause and directs the treatment. Most severe TMD cases also suffer from myofacial pain and, many times, migraines. The skill to manage these patients requires extensive training and years of experience as well as a holistic approach. Understanding how elements of the body interrelate is crucial to optimal health care.
Important in my treatment of TMD is the use of a lower orthotic splint. When the joint is damaged the splints goal is to cause the joint to unload, rather than compress. This, many times, gives immediate relief as well as important information. I have found that the more popular upper splint assumes the practitioner knows where the jaw belongs (centric relation) and places the teeth in into the full coverage splint causing a fit (centric occlusion). This does not allow the joint to find its “happy place” where clenching the teeth does not compress the joint and it can assume a position where it is pain free. The upper splint interferes with speech and thus results on non compliance.
Just a few days ago I returned from El Salvador where I was asked to teach my methods of treatment. All the splints used there were upper splints with the occlusion of the teeth built into them. The patients I treated were in extreme pain and, within one or two days, were relatively free from pain after using a properly designed lower splint designed and supplied by me.
Once the patient is symptom free new records should be taken including mounted (articulated) models and x-rays. Only now can we determine if occlusal adjustment, orthodontia, dental reconstruction, Arthricenesis (joint irrigation) or surgical repositioning of the jaws will help.
Robert Brown, DDS has a TMJ, orthodontia, and sleep apnea practice in Danville and thoroughly enjoys discussing holistic medicine. You can contact him at 925-837-8048, at info@aodtc.com, or visit his web site at www.aodtc.com.
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