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21.05.2014
Temporomandibular joint dysfunction, more commonly known as TMD, affects more than 15 percent of American adults.
There are many causes of  TMD disorders including traumatic injury to the chin, jaw or joint itself, missing back teeth, poor alignment of the jaws, poor alignment of the teeth, arthritis, stressful situations, normal tooth wear over time, or poor dental treatment that adversely affected the bite to a more open or closed position than normal. For questions about headaches, bruxism, or TMD, please Contact Oliverie Dental for more information. The temporomandibular joint (TMJ) is the area right in front of the ear on either side of the head where the upper jaw (maxilla) and lower jaw (mandible) meet.
The temporomandibular joints are very complex and are made up of muscles, tendons, a disc and bones.You have a temperomandibular joint on each side of your jaw (right and left side). Micro trauma is considered internal, such as grinding the teeth (bruxism) and clenching (jaw tightening). TMJ pain can usually occur because of unbalanced activity, spasm, or overuse of the jaw muscles. Most patients are quite successful with conventional conservative therapy (such as resting the jaw or night guard). We are a full service dental practice that specializes in relaxation and cosmetic dentistry services, dental implants, TMJ disorder treatment, periodontal disease treatment, teeth whitening, porcelain crowns and porcelain veneers, and other restorative dental care. Temporomandibular joint disorder (TMJD or TMD), or TMJ syndrome, is an umbrella term covering acute or chronic inflammation of the temporomandibular joint, which connects the mandible to the skull. The temporomandibular joint is susceptible to many of the conditions that affect other joints in the body, including ankylosis, arthritis, trauma, dislocations, developmental anomalies, neoplasia and reactive lesions. Signs and symptoms of temporomandibular joint disorder vary in their presentation and can be very complex, but are often simple. Unlike a typical finger or vertebral junctions, each TMJ actually has two joints, which allows it to rotate and to translate (slide). The surfaces in contact with one another (bone and cartilage) do not have any receptors to transmit the feeling of pain. Due to the proximity of the ear to the temporomandibular joint, TMJ pain can often be confused with ear pain.
The dysfunction involved is most often in regards to the relationship between the condyle of the mandible and the disc. Malalignment of the occlusal surfaces of the teeth due to defective crowns or other restorative procedures. Patients with TMD often experience pain such as migraines or headaches, and consider this pain TMJ-related.
Jaw joint dysfunction can often be treated successfully and doesn’t lead to other problems.
Massage your affected muscles and apply a heat pad, such as a hot water bottle (filled with warm but not boiling water) wrapped in a cloth or towel. You may find over-the-counter painkillers, such as paracetamol or ibuprofen, can help to ease your pain. There are some other medicines your dentist might suggest if you’re in a lot of pain. Surgery for jaw joint dysfunction is very rare and may be offered if other non-surgical treatments have been tried but haven’t worked. Disc displacement happens when the articular disc (a thin disc within the joint) is in the wrong position, you have dislocated your jaw, or your jaw joint has been injured.
Injuries can also trigger jaw joint dysfunction, such as a knock to your jaw, or overstretching when yawning, or during dental treatment.
Joint noises, such as clicking, cracking or popping can happen if the articular disc has moved out of its normal position. Painkillers that you can buy over-the-counter, such as paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may help to relieve your pain.
If you're in a lot of pain, your dentist may prescribe a muscle-relaxing medicine to help reduce the tightness and pain in your jaw. If your symptoms are severe, your dentist may prescribe a drug called diazepam, which relaxes your muscles and can also reduce anxiety.
There’s some evidence that suggests physiotherapy may help to improve the symptoms of jaw joint dysfunction for some people. In particular, transcutaneous electric nerve stimulation (TENS) may be used to treat jaw joint dysfunction.
Acupuncture may also be useful in relieving jaw joint pain, though the research is limited. Some forms of jaw joint dysfunction may lead to you getting arthritis in your jaw joints (temporomandibular joints). If you have myofascial pain for a long period of time, it may cause secondary degenerative arthritis but this is uncommon.
Massaging your affected muscles and applying a heat pad, such as a hot water bottle (filled with warm but not boiling water) wrapped in a cloth or towel. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice. Jaw clicking is usually related to the disc being displaced from its normal position and it goes into place when the mouth is opened, aka Disc Displacement with Reduction. If the disc stops reducing (going back into place), the clicking noise can stop, aka Disc Displacement without Reduction.
There are numerous problems, including neck pain, that can be attributed to issues involving the muscles in the jaw. Trigger points in the jaw muscles can create a sensation of pressure in the eyes, eyebrows, and the sinuses, which patients may discover as the root of the problem only after sinus medications have no effect on their symptoms. Assessing the condition of the joint may involve the use of X-rays, MRI, and CT scans in order to discern any inflammation, osteophyte growth, disc degeneration, or alternate pathology causing the problems. Patients may find that switching to soft foods, and avoiding chewing gum or other such habits can reduce their symptoms. General dentistry, which we are all familiar with, treats teeth and gums, filling cavities, doing crowns, dentures, root canals etc.
It may seem mysterious that a jaw joint problem could cause symptoms in the shoulders or hands or ears. Common symptoms include an uncomfortable bite, pain in or around the ear, headaches, bruxism (grinding of the teeth), tenderness of the jaw, clicking or popping noises when opening and closing the mouth, and even neck aches. These disorders often lead to clenching of the teeth during the day and grinding of the teeth while sleeping (bruxism), which in turn causes a great deal of damage to the teeth and the jaw joint itself. Muscles attached to and surrounding the jaw joint control the position and movement of the jaw. Patients may complain that it is difficult to find a  comfortable bite or that the way their teeth fit together has changed.  Chewing on only one side of the jaw can lead to or be a result of TMJ  problems. This continuous pounding on the temporomandibular joint can change the alignment of the teeth. This trauma can fracture the jawbone, cause dislocation of the TMJ, or cause damage to the cartilage disc of the joint. It is very common for people under stress to release this nervous energy by either consciously or unconsciously grinding  and clenching their teeth.


About 80% of patients with a TMJ disorder complain of headache and about 40% report facial pain, and ear pain. About one half of patients with a TMJ disorder notice ear pain and do not have any signs of ear infection.
Grinding, crunching, clicking, or popping sounds (medical term = crepitus) are common for patients with a TMJ disorder. If your symptoms persist, your doctor may recommend medications or a night guard to help keep you from grinding your teeth at night. Dentist or doctor will recommend over the counter medications (like Aleve or Motrin), or prescription medications such as Dolobid are a first option to relieve pain. Antidepressants prescribed to be taken at bedtime have been successful in relieving TMJ pain in some patients. These types of drugs are sometimes used for a few days or weeks to help relieve pain caused by TMJ disorders. Injecting botulinum toxin (example Botox) into the jaw muscles may give relief to pain associated with TMJ disorders.
For patients who grind their teeth patients may gain from wearing a  firm custom made appliance.
For patients whose main symptom is from stress or anxiety they may benefit from a visit to a psychotherapist.
The success of treatment depends on how severe the symptoms are and how well you comply with treatment. Marielaina Perrone's advanced training and years of experience translate into greater confidence and convenience for your entire family. On average the symptoms will involve more than one of the numerous TMJ components: muscles, nerves, tendons, ligaments, bones, connective tissue, and the teeth. The pain therefore originates from one of the surrounding soft tissues, or from the trigeminal nerve itself, which runs through the joint area. The pain may be referred in around half of all patients and experienced as otalgia (earache). Impaired tooth mobility and tooth loss can be caused by destruction of the supporting bone and by heavy forces being placed on teeth. Over-opening the jaw beyond its range for the individual or unusually aggressive or repetitive sliding of the jaw sideways (laterally) or forward (protrusive). There is some evidence that some people who use a biofeedback headband to reduce nighttime clenching experience a reduction in TMD. They can stop your jaw joint and the muscles that control the movement of your jaw from working correctly.
Sometimes you may also hear the condition referred to as temporomandibular dysfunction or temporomandibular joint dysfunction. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.
This is a cover made from plastic that fits over your upper or lower teeth and stops them coming into contact with each other. Surgery may involve opening your jaw joint and operating on the bones, cartilages and ligaments. It involves pain or discomfort in your muscles or the tissue (myofascia) that surrounds the muscles in your jaw joint.
Rarely, it can affect your jaw joint, but is more common in the knees, hips and small joints of your hand. The disc sometimes slips forward and as it returns to its normal position between the bones of your jaw joint, a noise is made.
Always read the patient information leaflet that comes with your medicine, and if you have any questions, ask your pharmacist for advice. Medicines to help treat depression, known as antidepressants, may also be tried to help relieve pain.
Your dentist will usually only prescribe this if you're in a lot of pain and you can only take it for a short amount of time.
A review of research found limited evidence that active exercises, manual therapies (such as massage and manipulation), some types of electrotherapy, postural correction and relaxation techniques may be beneficial. This is a type of electrotherapy which involves using a device that stimulates the nerves with mild electrical pulses to relieve pain. This is where your dentist or physiotherapist sprays a cooling substance over your cheeks and temples, which allows him or her to stretch your jaw muscles. Experts say that more research needs to be done before clear recommendations about acupuncture can be made for jaw joint pain. Talk to your dentist about whether physiotherapy treatments might be a suitable option for you.
Treatment is generally the same as jaw joint dysfunction treatment and may include one or more of the following. A systematic review of the effectiveness of exercise, manual therapy, electrotherapy, relaxation training and biofeedback in the management of temporomandibular disorder.
Sometimes, you will hear people or doctors refer to TMJ, which is the acronym for the temporomandibular joint, itself.
In recent years, with computers and lasers, dentistry has taken giant strides forward and expanded its conception of how to treat teeth. It can be caused by trauma to the head that knocks the joint out of alignment, moving the cartilage pad or mandible from their correct positions.
We open and close the jaw so many times each day, and this continual strain builds up in the muscles and related tissues, creating inflammation and swelling. They are often thought of as migraines, and the sufferer may visit several doctors in search of relief.
There are several large nerves in the facial areas, with many branches running through the entire head, face, neck, shoulder, and arm areas. Failure to treat TMD early on can lead to serious damage of the joint and possible need for surgical intervention. Migraines, tension headaches, and sometimes even sinus headaches are diagnosed based on subjective symptoms reported by the patient, sometimes leading to incorrect diagnosis and treatment.  Medical specialists may not be aware of the link between the bite and headaches. For most patients, the ideal result can be achieved, while for others, considering the nature and stage of the illness, effective management may be the maximum goal. When the muscles are relaxed and in balance and both jaw joints open and close comfortably, we are able to talk, chew, or yawn without discomfort or pain. A problem with either one can lead to stiffness, headaches, ear pain, bite problems ( also called a malocclusion), clicking sounds, or locked jaws. Teeth grinding as a habit can result in muscle spasm and inflammatory reactions, thus causing the initial pain. Pain in the TMJ can also occur following dental treatment whereby the joint is stretched open for extended periods of time. 50% of those patients will have resolution of their tinnitus after successful treatment of their TMJ disorder. Your dentist will conduct a careful patient history, dental examination, and take necessary x-rays to determine the cause of your symptoms.


This night guard prevents your teeth from coming together in contact, and repositions teeth to decompress the jaw joint. This would allow the patient to become self aware of stress triggers as well learning relaxation techniques to relieve stress.
As always, it is best to maintain regular appointments to see your dentist and let them know if there any TMJ issues developing. You’ll find complete dental expertise, utilizing the latest advancements in dentistry, all here under one roof. Because the disorder transcends the boundaries between several health-care disciplines—in particular, dentistry and neurology—there are a variety of treatment approaches.
Ear pain associated with the swelling of proximal tissue is a symptom of temporomandibular joint disorder. When receptors from one of these areas are triggered, the pain can cause a reflex to limit the mandible’s movement. The movement of the teeth affects how they contact one another when the mouth closes, and the overall relationship between the teeth, muscles, and joints can be altered. These movements may also be due to parafunctional habits or a malalignment of the jaw or dentition.
The joint allows your jaw bone (mandible) to move from side to side, backwards and forwards, and allows you to open and close your mouth. But if they get worse or don’t improve within a few days, see your dentist for advice.
Because your jaw joint is complicated and there are many possible causes of jaw problems, it can be difficult to work out what is causing your symptoms.
However, if your symptoms last for longer than four to six weeks, your dentist may refer you to a specialist. Your doctor will prescribe you a lower dose than what is usually given to treat depression. If you have arthritis in your jaw joint, you may have pain on one side of your jaw and have difficulty opening your mouth. This can be tested by placing your fingers over the TMJ area (located front of the ears) and listening of noises when opening and closing the mouth. The jaw joint, in front of the ear, is a ball and socket joint where the lower jaw (mandible) connects with the temporal bone of the skull. One of the new dentistry areas is neuromuscular dentistry, which looks at the jaw joint and its related structures – muscles, nerves, blood vessels, ligaments, and other soft tissue – as well as teeth and gums. Sometimes it’s slowly caused by chronic tooth grinding, and sometimes by misaligned teeth. Most people with the condition were not aware of what a correct bite felt like because they always had a conflict between their teeth and jaw. For some, simple treatment designed to relax the muscles and reduce inflammation may be all that is needed. The temporomandibular joint functions to move the jaw, especially in biting and chewing, talking, and yawning. We can also feel the joint motion if we put a little finger against the inside front part of the ear canal.
Changes in the normal stimuli or height of the teeth, misalignment of the teeth, and changes in the chewing muscles may cause temporomandibular joint changes. Teeth grinding and clenching are habits that may be diagnosed in people who complain of pain in the temporomandibular joint or have facial pain that includes the muscles involved in chewing. Massage and heat application following your dental appointment can help relive the discomfort. These symptoms are usually caused by Eustachian-tube dysfunction (structure responsible for the regulation of pressure in the middle ear). Conventional treatment consists of a diet of soft foods along with warm compresses to settle down the tension of the muscles. Furthermore, inflammation of the joints or damage to the trigeminal nerve can cause constant pain, even without movement of the jaw. Treatment of TMD may then significantly reduce symptoms of otalgia and tinnitus, as well as atypical facial pain.
Pulpitis, inflammation of the dental pulp, is another symptom that may result from excessive surface erosion. Both osteoarthritis and rheumatoid arthritis can affect your jaw joint, as well as infectious and traumatic arthritis. A neuromuscular dentist considers the whole face, head, neck and shoulder area when examining or treating dental problems. Genetic factors can play a part, and some systemic diseases and developmental abnormalities. These nerves with their many branches, register sensation in all the areas where they extend.
We are trained to determine whether there is a link between headaches and the bite for individuals we see with headaches. If a patient is experiencing TMJ difficulty the simple act of opening and closing your mouth can cause considerable pain. Opening your mouth allows the rounded ends of the lower jaw (condyles) to glide along the joint socket of the temporal bone.
These can include arthritis, trauma to the jaw, or muscle fatigue from clenching or grinding your teeth. Ear specialists are routinely called on to make the definitive diagnosis of a TMJ disorder.
It is believed that patients with TMJ syndromes have hyperactivity (muscle spasms) of the muscles responsible for regulating the opening and closing of the Eustachian tube.
Despite some of these findings, some researchers question whether TMD therapy can reduce symptoms in the ear, and there is currently an ongoing debate to settle the controversy.
Perhaps the most important factor is the way the teeth meet together: the equilibration of forces of mastication and therefore the displacements of the condyle. Your dentist may also examine your head, neck, face and jaw to see if there is any tenderness. It is thought that a majority of Americans suffer from TMJ to some degree or other, without knowing it. When one part of a nerve branch is compressed, the resulting pain can be felt by other parts of that nerve.
We can treat these problems without medicine, by helping the bite fit better with various modalities including bite analysis, equilibration, night guards, and occlusal splint therapy. TMJ disorders most commonly occur in women between the ages of 30 and 50, but can occur in teens after braces, and in both men and women at any age. You may be asked to move your jaw in all directions to make sure you can move it freely and find out if it’s painful or makes clicking noises when you move it.



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