Temporomandibular Joint (TMJ)/ Temporal Mandibular Dysfunction (TMD) and Neuromuscular Dentistry

Teeth Clenching and Teeth Grinding

Jaw-joint pain is a cycle of soreness and muscle spasms that can occur if the bite is not aligned properly and/or if the patient clenches or grinds the teeth. Teeth grinding or teeth clenching (bruxism), in turn, can also occur when there are mechanical problems with the bite or it can be a physical reaction to psychological stressors. People under stress often clench and /or grind their teeth, either consciously or unconsciously. Bruxism can increase the wear on the TMJ and intensify jaw pain.

Common Symptoms of TMJ Disorders

  • Frequent Headaches or Migraine Headaches
  • Worn Down Teeth from Grinding Teeth
  • Popping or Clicking in the Jaw Joint are signs of a malfunctioning meniscus
  • Pain Behind the Eyes can be referred pain
  • Sensitive Teeth from the stress of clenching or grinding
  • Earaches or ringing in the ears (tinnitus)
  • Difficulty Opening and Closing the Mouth
  • Painful muscles/ Stiffness in the jaws, neck and shoulders

Headaches/Migraines and TMJ symptoms

Headaches or migraines related to TMJ are caused by the constant contraction in the jaw muscles. The tension reduces blood flow to the surrounding area, creating head, neck and facial pain. The constant contraction from the muscle fibers and decreased blood flow are related to the bite that causes more clenching and grinding of the teeth and leads to headaches. A bite is referred to the fit of the teeth in relation to the jaw joint. Both the bite and the jaw joint or TMJ must function together. When the bite is "off" or "bad", the patient clenches and grinds more often, resulting in a variety of symptoms.

Worn Lower Teeth
Severe wear of the lower teeth from grinding. Over 50% of the teeth are ground
away from bruxism. This patient has a deep bite, facial collapse and TMJ pain

Teeth Clenching and Grinding (Bruxism)

Bruxism leads to short, worn down teeth that continue to damage the TMJ. Teeth can wear down much shorter than normal if the patient clenches and grinds their teeth too much. The damage to the teeth can be significant and the patient’s bite can wear down flat. The more the teeth wear down the more the patient grinds their teeth, causing the cycle to continue. However, younger patient may not have much tooth wear but still have TMJ symptoms. They don’t necessarily need a complex reconstruction, but may need dental treatment to restore comfort.

Severe Teeth Wear
When the bite is worn down and the wear on the teeth is severe, TMJ symptoms
can get worse. Face-Lift Dentistry ® is necessary to correct the bite and establish
facial height and support

Jaw Joint Clicking or Jaw Popping

Jaws that click or pop are usually signs of TMD. The jaw clicks or pops because the pad that lies between the skull and the lower jaw pops out during jaw movements. Some people experience pain and others do not. Many patients believe that these sounds are normal because they have had jaw joint clicking and popping their entire lives. It is best when the clicking or popping is treated early in life to increase the chance of relieving these symptoms. (View more TMJ Case Studies here.)

Diagnosing and Treating TMJ Disorders

There is different technology available to help diagnose TMJ disorders, including: Tomography, CT Scan, Sonography and Electromyography. Combined with an experienced doctor, the right equipment is essential to analyze the bite. Millions of people suffer from TMD but treatment and life style changes can restore health and harmony to the joint. Everyone is unique with a different physiological make-up, drug history and physical history. The treatment options need to be specific to the individual needs of each patient.

Neuromuscular Dentistry

Neuromuscular dentistry has the same goals as any other doctor treating TMJ, but the methodology may be different. Many neuromuscular dentists develop faith in certain equipment or methodology that are not very consistent or accurate. Neuromuscular Dentistry relies on the use of Sonography, Joint Vibration Analysis and Elctromyography. These technologies measure the degree of muscle contraction at any given moment and at a particular location on that muscle. We have found, however, that these technologies can be very unpredictable and misleading. The readings vary significantly based on the location of the sensors. Not all neuromuscular dentists use the equipment improperly and some do achieve excellent results with pain relief and management.

Toothe Wear and Deep Overbite - Before and After
Severe tooth wear and a deep overbite shorten the patient’s face.
Face Lift Dentistry ® can completely rebuild the bite, lengthen the face
and support the lips while improving the TMJ position

Complex Motion Tomography –Jaw Joint Images

In order to get the right diagnosis, it is important to see the condition of the jaw joint in a variety of positions. Is the joint significantly worn down? Is the disc popping in front of the lower jaw? Complex Motion Tomography provides a variety of images but delivers less than 700 times the radiation than a CAT Scan. Los Angeles cosmetic dentist Sam Muslin is one of the few dentists in the State of California to have a Complex Motion Tomography Unit right in his office. The images are the state of the art in terms of understanding the condition of the jaw joint and the relationship of the upper and lower jaws to the TMJ.

TMJ Treatment Options

The diagnosis is the key to treatment options. Some patients can do very well with the simplest level of care (i.e., a bite splint, orthotic device or night guard). These appliances can reposition the jaw in a more comfortable position and relieve pain and stress on the jaw joint. Other patients may require braces or orthodontics in order to get the jaw and the bite in harmony. In more advanced cases, patients require Face-lift Dentistry ® to reposition the jaw (see the patient above.)

TMJ Case Study
This patient had severe TMJ pain and was being treated by three dentists - unsuccessfully.
The TMJ pain was finally tested and treated by repositioning the bite with temporary fillings
that lengthened her teeth. It worked so well, she decided to have her smile widened and
teeth lengthened while getting porcelain restorations to replace the test fillings.
She went from severe pain to total comfort and an entirely new look
with one Master Dentist