TMJ Disorders and Headaches

TMJ stands for temporomandibular joint. Temporal, represents the temple area of the skull; mandibular represents the mandible, or lower jaw; the joint is where the head and jaw meet. Problems in this joint may be caused by a misalignment of the teeth, trauma, excessive muscle tension or a combination of all of the above. Between these two bones, a disc acts as a buffer, and five muscles on each side are involved in the movement of the lower jaw.

Problems in this area can cause:
• Headaches
• Earaches
• Trouble/soreness in opening and closing the mouth
• Clicking or popping of the jaw
• Pain in the jaw muscles
• Soreness in the area, sometimes extending to the face

Treatment of temporomandibular joint disorders, or TMD, is done in phases in this practice. Phase one is used to establish where the mandible wants to be in space so that the joint and the muscles are comfortable. This usually includes an appliance called an orthotic, which is used to stabilize the bite in a position that decreases the stress on the joint. This appliance is typically worn during the day, including when eating.

Phase II is designed to hold you in the position found during Phase I. Phase II dental treatments for the TMD condition can include replacing missing teeth, moving teeth, adjusting the bite, filling gaps between teeth, etc. The goal of Phase two is to restore the mouth to the position that eliminates the need to wear the orthotic during the day to keep the joint stable. This position is evaluated in plastic first, using the orthotic, then duplicated either through tooth movement orthodontically, or restoratively using fillings, crowns or bonding to the teeth. Sometimes it is as simple as weaning off of the orhtotic. There is no one solution that is right for all cases. If untreated and the condition progresses to extremes, surgery may be required to repair a badly damaged joint, but this is reserved as a last resort, not primary treatment.

Stability of the joint is usually maintained with the use of an appliance at night that does not allow clenching or grinding. The appliance most often used is a NTI-tss. This treatment appliance is designed to minimize the damage to the teeth and joint that occurs during the night from the forces generated during nighttime clenching and grinding, also known as bruxism. It is a small appliance, about the size of your thumb’s first digit, that fits over your front teeth. Your opposing front teeth will contact a flat area on the appliance that allows the lower jaw to rest in a neutral position. It will allow you to move from side to side when you are sleeping, but it will not allow anything from the eye teeth back to touch. A similar appliance, the Relaxer , can also be used when more retention is required. It is lab fabricated and uses more teeth for anchorage.