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TMJ Disorder and Further Treatment Options

Posted Nov 04 2009 10:04pm

What Doctors Treat TMJ Disorder?
Given that TMJ disorder sufferers have so many diverse symptoms, management can include numerous different physicians of varying specialties. Headaches may be treated by a neurologist, ear pain can be evaluated by an ear, nose and throat (ENT) specialist, and pain can be treated by a pain management specialist. A dentist may utilize splints to correct bite issues, while an Oral and Maxillofacial Surgeon (OMS) can assist with both surgical and non-surgical interventions. Other healthcare professionals that may form part of a patient’s care team can include Physiotherapists, Acupuncturists, Chiropractors, Osteopaths, Orthodontists, Nutritionists, Psychologists, Psychiatrists, Massage Therapists, and of course the family doctor (PCP or GP).

It is well worth noting, however, that a well-qualified dentist, using the correct procedures, can often alleviate many of the other symptoms involved in your TMJ disorder, lessening the need for any other professional care.

Alternative medicine
Because stress has been shown to contribute to TMJ disorders, stress-relieving relaxation techniques may reduce jaw clenching or teeth grinding and help alleviate TMJ disorder symptoms. Possible beneficial techniques include:

  • Deep breathing. To practice deep breathing, sit comfortably on a chair with your feet flat on the floor. Breathe in deeply through your nose, and allow your abdomen to expand as you breathe in. Hold for just a second, and then exhale through your mouth, gently pushing in your abdomen with your hand.
  • Progressive muscle relaxation. This involves relaxing a series of muscles one at a time. Begin increasing the tension level in a group of muscles, such as a leg or an arm, by tightening the muscles and then relaxing them. Then move on to the next muscle group. It may also prove beneficial to apply warm, moist heat.
  • Guided imagery. Also known as visualization, this method of relaxation involves lying quietly and imagining yourself in a wonderful, lovely place. Your ideal vacation or getaway. Allow yourself to completely experience the setting with all of your senses, as if you were essentially there. For example, imagine lying on the deck of your sailboat as it coasts along the Mediterranean Sea. Picture the perfect azure sky, smell the salt water, hear the sounds of the soft waves, and feel the warmth of the golden sun on your skin. The messages your brain receives as you experience these senses help you to relax.

There are some TMJ sufferers who are actually unaware of the cause of their condition. Many people, who technically have TMJ disorder, manage with their symptoms, since they do not interfere severely with their lives. Patients with TMJ disorder quite often grind their teeth to find a comfortable bite. This causes flat areas on the tops of the teeth called occlusal wear facets. Wear facets often fit together revealing the bite that the body has been trying to create. Constant grinding also flexes and dissolves tooth roots. A notch at the bottom front of the tooth called an abfraction. Many hygienists confuse this for overzealous tooth brushing, but there are many patients who never brush who still have them.

When a patient’s jaw joints or jaw muscles are irritated, there can be deviation of the lower jaw to one side on opening. This is called mandibular opening deviation. For a variety of reasons, the human face does not always grow symmetrically. Facial asymmetry can cause TMJ problems. Repeated jaw muscle spasm can cause muscle shortening with limited opening. Looking at the side of a person’s face, you can often make out the lower jaw. The bottom of the lower jaw is typically parallel to the floor. Conversely, many TMD patients have a sharp downward angle. This TMJ symptom is called a sharp mandibular plane angle.

TMD sufferers often have speech irregularities that add to their muscular and functional problems. A dished out profile can be an indicator of a TMJ problem. It is often seen in patients who have a shortened facial height, which forces the TMJ towards the ear. As a defensive reflex, the body uses the chewing muscles to pull the jaw joint forward. This can often bring on muscle spasm and pain. Like a dished out profile, a short lower facial third can be a reflection of this same problem.

Another TMJ disorder symptom is when the corners of the mouth get red, swollen and painful. It’s called angular chelitis and is also seen when denture patients are wearing worn out dentures. An imbalance in the chewing and facial muscles occasionally causes an uncharacteristic lip posture, which can cause the face to look unusual. The horizontal facial fold under the lip and above the chin can be excessive. This is called a deep mentalis crease. It is not uncommon for a TMJ patient to have a forward head posture. This abnormal posture causes the head to be positioned forward. It stretches the anterior neck muscles and pulls the lower jaw backward into the patient’s ears.

It is not unusual to see swelling of a TMJ sufferer’s face. This TMJ symptom is called facial edema. Some sufferers have unusual movements of their necks (cervical torticollis) and lower jaws. (mandibular torticollis). Headaches truly plague TMJ sufferers. The most common TMJ related headache is a located on the side of the head over the area of the temple. This is called a temporal headache and is often misdiagnosed as a migraine.

The disparity of a TMJ patient’s facial, chewing and neck muscles can cause problems swallowing. This is called dysphagia. Because of the instability of the jaw, head and neck, cervical problems are frequent. This can lead to occipital headaches located at the back of the head. Postural problems are a characteristic TMJ disorder symptom. This abnormal posture may be due to the modification of the body to mouth breathing and the need to hold the head forward to breathe better. In severe cases, forward posture can cause thoracic outlet syndrome and paresthesia of the fingertips. (Paresthesia is an abnormal or unexplained tingling, pricking, or burning sensation on the skin)

Deprogrammers
The idea of deprogramming is based on the reflexive relaxation of the lower jaw when the back teeth are not allowed to engage. The various muscles that open and close the jaw learn and remember the level of contraction required to execute their movements in a coordinated, relaxed way. They learn which positions of these muscles cause pain, and which don’t, and store all the information in your brain in the form of “engrams” which are similar to automatic, unconscious computer programs that your body uses each time you open or close your mouth. In persons with TMJ disorder, these movements can be quite complex.

The Treatment of TMD

The Bruxing Guard
The solution to treating these patients is to decrease the patient’s inclination to clench and grind her teeth. Even if, when the teeth are closed together, and the joints do not line up correctly, all the symptoms tend to fade away if the patient does not tend to keep the teeth together with the forces distinctive of bruxing. The most conventional and least expensive treatment for TMD is the construction of a hard acrylic bruxing guard (flexible plastics are now being used as well). These are horseshoe-shaped plastic appliances, which usually fit over the top teeth and have a smooth surface on the underside so the lower teeth can slide over the plastic without resistance. This prevents the teeth from locking together, and relieves a lot of the force placed on the teeth and joints. If an appliance like this is worn long enough, the bruxing habit may ultimately disappear altogether, which would be the ideal treatment goal if it always happened.

Unfortunately, bruxing guards still allow the patient to clench against the guard. Since clenching is linked with overuse of the temporalis muscle, patients may still encounter tension headaches even though they wear their guard religiously.

The Bite Adjusted Bruxing Guard
Bruxing guards perform even better if they are structured so that when the lower teeth come in contact with the appliance, the joints are forced to sit in their most natural, relaxed positions in the most upper part of the socket. This position can be determined quite simply by a process known as deprogramming during which a piece of plastic is inserted over the top front teeth that does not allow the posterior teeth to make any contact. Usually, within an hour or so of wearing one, the jaw has relaxed into a more natural position with the joints in a more desirable position. A bite registration is then taken with the deprogramming device in place so the new bruxing guard can be designed to the new bite-adjusted jaw position, which corresponds to a more physiologically acceptable joint position. Deprogramming has an additional advantage in that if it works, it will relieve the symptoms very quickly and can be worn until the more permanent bruxing guard can be built.

The main disadvantage with this treatment modality is that your teeth do not look any better after you have cured the pain associated with TMJ disorder, and if the bruxing habits do not disappear on their own, the patient must continue wearing a bruxing guard whenever he is likely to be bruxing. In addition, patients still can clench against any bruxing guard. Therefore, even a correctly balanced bruxing guard will not consistently relieve all tension or migraine headaches, even though it usually will lessen their occurrence. The major advantage to this treatment modality is that it is economical and can often alleviate long-standing pain that has been a major impediment to a normal lifestyle for many years.

The Orthodontic Option
Another treatment option is orthodontics. In this case, the natural teeth are moved into a more correct position that allows the joints to sit correctly in their sockets. The correct position is established through a science called cephalometrics, which is a subcategory of diagnostic x-rays. A tremendous side effect of considering orthodontics to treat TMJ disorder, is that not only will you be left with a lovely smile when all is said and done, but the process is much more likely to break the bruxing habit than nearly any other treatment, as well.

We recommend considering checking out this website for referrals to highly qualified dentists who specialize in TMJ disorders:

     www.sajithmr.com

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