The TMJ’s are the jaw joints located just in front of the ears. The design of these joints is unique as they have the capacity to allow the jaw to rotate open as well as slide and rotate at the same time. Hence they are sometimes called “sliding hinge joints”. Another unique feature of the TMJ’ is that one joint can be simply rotating while the other is sliding and rotating. All of this is made possible through the complex interplay of muscles, ligaments, bones, blood supply, and disc structures. Simply put, this is a very complex joint system commonly taken for granted until it causes problems. And because of the complexity of the design of the TM Joint system, the problems related to them can be complex as well.For instance, it is common to have muscle, nerve, bone, ligament, and disc problems occurring all at the same time in one or both jaw joints. This can lead to various levels of pain and disability.
It is also a common misconception that the TMJ’s represent a “rigid system”, where the joints hinge much like that of a cabinet door. This level of thinking is grossly inaccurate and unhelpful when problem-solving. The TMJ joint system is in actuality a very flexible system with bones bending, muscles moving, and ligaments stretching. Additionally, the TM joints are influenced by what happens with the mouth. More specifically, the jaw joints are influenced by the teeth and bite of the individual as well as by habits like teeth clenching or teeth grinding.
Dr. Henny brings to the team 27 years of experience and specific training in the area of TMJ problems through the Bethesda Naval Hospital, The Pankey Institute, The Dawson Institute, and though Mark Piper, MD, DMD – widely regarded as the world leader in the development of successful TMJ treatment strategies.
Temporomandibular Joint Disorder (TMD) is a collective term referring to a number of clinical problems involving the Temporomandibular Joints (TMJ's) and associated muscles and structures of the area.
TMD is thought to be fairly common as several researchers have found clicking and popping noises in the jaw joints to be present in 40-60% of the general population. Considering that normal healthy TMJ's are completely silent at all times, the 40-60% figure is a rather staggering one to consider. The good news is that TMD symptoms are quite variable in nature, with most being a mild annoyance. However, a small percentage of patients with TMD have symptoms which degenerate into crippling chronic pain and limited jaw mobility. A recent National Institute of Health study indicates that over nine million Americans suffer from TMJ pain on a regular basis.
Common symptoms of TMD are:
• Pain about the face, head and neck regions
• Clicking, popping, and or grating noises in the jaw joints
• A limited ability to open the mouth wide or move it side-to-side
• Frequent headaches, often around the temple area
• Earaches, buzzing, or ringing noises in the ears
• Deep pain the jaw joint itself
• Soreness or pain in the cheek area
• "Sticking", "catching" or "locking up" of the jaw
• A sudden inability to find a comfortable bite position
Common causes of TMD symptoms are one or more of the following:
• Long-term strain on the TMJ's caused by a sleep pattern of chronic grinding and/or clenching of the teeth (bruxism). This may lead to permanent damage to the teeth and TMJ�s themselves.
• Certain types of malocclusion (bad bites) can chronically overstress the TMJs and related structures every time the individual chews. This in turn can lead to TM joint damage.
• Accidents involving direct or indirect trauma to the head, face, and / or neck may lead to partial or total TMJ disc dislocation, stretched or torn TMJ ligaments, and impaired joint function.
• Extensive dental procedures which have overstressed the muscles, joints, ligaments, nerves, may also lead to TMJ ligament inflammation or damage. This in turn could lead to muscle spasms and / or TMJ disc dislocation.
• General anesthesia intubations which strain weak TM joints or damage healthy TM joints by overextending the joint while the patient is asleep.
• Arthritis of the TMJ's particularly in patients which TM disc dislocations
• Systemic diseases such as gout, lupus, scleroderma, and fibromyalgia may also contribute to TMJ - like symptoms or problems.
• Growth and / or developmental disturbances of the structures of the face and TM joints may cause malformation of the TM joint structures than thus dysfunction.
• Some other reasons for TMD are less identifiable and may result from a combination of small events such as lying against a partially strained or damaged (but previously asymptomatic) TMJ while sleeping.
• Facial muscle irritability due to an inadequate diet. Research shows that substances such as caffeine, nicotine, and sugar can significantly increase muscle tension and impair their performance.
• Emotional stress. Studies have also shown a link between stress and the frequency of teeth grinding at night. This chronic and prolonged nightly activity ultimately damages the TM joints or impair the body's ability to heal a damaged joint.
How are TMJ Disorders Treated?
Initial treatment for TMJ disorder can range from resting the joints, switching to a soft diet and prescribed medication to stabilization of the joints through the use of a specially designed and custom adjusted hard acrylic orthotic appliance that fits on the top of the teeth. This appliance, when properly designed, redistributes the stresses on the TMJ's, and muscle system while specifically guarding and guiding certain joint movements. Injections into the joints are also used on occasion to diminish inflammation and encourage ligament repair.
Does it work?
The vast majority of cases we treat are successfully managed through the use of orthotic appliances and / or a combination of orthotic appliance and physical therapy to reduce symptoms and accelerate healing.
Are all dentists similar in training and experience with treating TMJ?
No. It is advisable to research the training level and experience of your treating dentist to determine their success rate and skill level in the area of TMJ treatment. Dr. Henny has advanced training in the area of TMJ treatment through the Bethesda Naval Hospital, The Pankey Institute for Advanced Dental Study, and The Dawson Center for Advanced Dental Study in addition to over 12 years of successfully treating TMJ disorders.
Can I just buy a mouth guard at the store and treat this problem myself?
This is generally not advisable. Self care with these non-adjustable devices can put additional strain on already damaged jaw joints. They may also cause an individual to grind their teeth even more at night and thus worsen the symptoms.
What happens to the 5% of patients who are not successfully treated via professionally designed and managed orthotic appliances?
The vast majority of TMJ patients – perhaps in the 95% range – respond positively to non-surgical, “conservative” therapies. In a small number of cases, conservative therapies render no significant level of improvement. In this group of patients, the amount of breakdown of the internal joint structures is so severe that they cannot achieve comfort or normal functioning without some level of surgical intervention. It is important to understand that TMJ surgery has a long history of mixed outcomes and many failures. This fact alone creates a bias in the minds of many people today toward selecting surgery as a definitive option. You may therefore hear from one or more people something like “TMJ surgery never works”. It is also important to understand that the reason why so many TMJ surgeries have been unsuccessful is that the techniques and approaches used were underdeveloped, mis-applied, or to some degree experimental. TMJ surgery moved past the point of experimentation when Mark Piper, MD, DDS started to study the problems and create real solutions over 25 years ago. Mark has been successfully providing TMJ surgery solutions for over 25 years now and has over 20,000 documented cases to support his surgical approaches as well as how they work out over long periods of time. We have had a number of patients over the years that have required surgical treatment. Virtually all of the patients who were treated by surgeons other than Dr. Piper experienced a mixed or negative outcome. Conversely, ALL of the patients we have referred to Dr. Piper for treatment have achieved a normal level of functioning with minimal to no problems going forward. A number of these cases are now over ten years post-op.To learn more about Mark Piper, MD, DMD, and his work visit : www.piperclinic.com