TMJ

The temporomandibular joints (TMJ Joints) are the hinges located on either side of the face that connect the lower jaw to the skull. Each temporomandibular joint has two sections that permit the hinge and gliding actions needed to open the mouth widely. The joints work together with the facial bones and five pairs of muscles to allow opening and closing of the mouth and forward, backward, and side-to-side movements of the lower jaw. Any disturbance of this facial symphony can trigger TMJ dysfunctions: muscles and joints not working together correctly, causing muscle spasm, resulting in pain, muscle tenderness, and tissue damage. With these disturbances, arthritic changes can accelerate, muscles can tighten and the bite can feel off.  Simply having a dentist adjust the teeth usually makes TMJ symptoms worse and can throw the jaw further off line and create even more pain; this is why it is imperative to see a TMJ specialist.

Interesting fact: 80% of TMJ patients are women so estrogen plays a big role in setting the stage for the effects of micro and macro trauma. There are estrogen receptors in the TMJ so women of child bearing age are sensitized to feel increased pain in the TMJ. Clenching , Grinding and Bruxism producemicro trauma and repetitive strain injury which can cause degenerative changes and inflammation in the joint. 4 Bicuspid extractions in orthodontic therapy with over retraction of the maxilla are a very common contributing factor in our practice. Any headgear which retracts the maxilla can also contribute to TMJ disorders. Systemic joint laxity or hypermobility syndromein women make the TMJ more susceptible to injury, clicking, popping and locking.

TMJ has many causative factors the more common of which are malocclusion or problems in the way the teeth fit together, a blow to the jaw or head, clenching or grinding of the teeth, arthritis of the jaw, poorly fitting dentures, yawning for prolonged periods with the mouth open too wide, recent dental work, accidents that damage facial bones or the jaw, extraction of teeth or missing back teeth, birth trauma due to delivery complications, and traction involving the head, jaws, and neck.

The most common TMJ dysfunction originates in the jaw muscles and is called myofascial pain dysfunction (MPD). MPD strikes four times as many women as men – usually those between 13 and 60 years old – and results from a tendency to deal with tension and stress by clenching or grinding the teeth. These habits can tire the muscles and trigger spasms, producing pain, more spasms and, eventually, a TMJ dysfunction. MPD sufferers may or may not have problems with their bite.

Because this dysfunction mimics so many other conditions, diagnosis may be complicated. Many people may spend a great deal of time and money searching for the source of their symptoms. If your physician cannot find any underlying conditions, he could consider the possibility of TMJ dysfunction and recommend that you consult a dentist with a special interest in the diagnosis and treatment of TMJ dysfunctions.

TMJ stands for Temporomandibular Joint, the joint which connects the mandible to the temporal bone. The mandible is the moving component.

TMD refers to Temporomandibular Disorders which are joint, muscle, tendon and ligament disorders of the jaws. Pain and inflammation as well as limited opening, clicking and locking are included in this broad category. TMD is in the same medical class as TMJ.

Daytime symptoms typically call for daytime appliance therapy for at least 6-8 weeks along with cognitive behavioral attention. Nighttime treatment depends on the diagnosis. A locking, clicking, misaligned jaw may require a Farrar anti retrusion appliance. Breathing related sleep disorders may call for an appliance which maintains an open airway. There are a variety of appliances for sleep bruxism and clenching and grinding. Long term, certain appliances are used for sports, working out and lifting heavy objects as well as travel. Many of our patients use their lower appliances while playing musical instruments, working on computers or painting.

Hard acrylic appliances are best cleaned with efferdent or polident denture cleaners . Our staff will use a special solution in the ultrasonic during your visits.

Dr. Michael Gelb will often recommend physical therapy during appliance therapy. It is important to do appliance therapy and physical therapy concomitantly. Physical therapy is recommended for both myofascial pain as well as to increase range of motion. The joint is mobilized during manual therapy in order to establish normal translation and lateral movements with at least 36-54 mm opening.

Many of our TMJ patients are referred for applied kinesiology which recognizes the importance of the jaws and feet in neck, back and face pain. Cranial treatment has been added to the AK protocol. Some patients will do better with chiropractic than physical therapy. Lately atlas orthogonist therapy has been getting good reviews. SOT combined with cranialsacral is also very effective.

For patients who have had trauma and who hasn’t, this can be a most effective treatment. Dr. Michael Gelb works with the top cranial practitioners in the area. CT is a gentle non force technique that goes deep to solve layers of problems.

We only recommend emergency dental treatment prior to TMJ therapy and Oral appliance therapy for snoring and sleep apnea. One of the goals of TMD treatment is to find a jaw position where all chief complaints have been alleviated. We work with the top cosmetic and restorative dentists to find the ideal correct bite prior to starting dental treatment. Oral appliance therapy for sleep apnea can change the bite. We want to alleviate all airway complaints and achieve a bite which is harmonious with an open airway.

I think the best orthodontists in the world treat to an open airway, that is they move the upper and lower jaws to a position that allows the tongue and palate to move forward. This produces the best looking smiles in the world. These orthodontist like Bill Hang and John Mew achieve greater horizontal growth and intervene earlier than others.

Only 5-10% of our patients need orthodontics after TMJ treatment. Most children under age 13 will need orthodontics after their TMJ treatment. Some children come to me in braces, mid orthodontic treatment due to clicking or locking. We work with the child to alleviate symptoms and allow the orthodontics to be completed.

My father taught me Lips Together Teeth Apart with the tongue up to the palate. I teach a mixture of Alexander and Pilates.. Chest up, belly button in with a string pulling you up from the back of the skull .Chin down in a military tuck. But remember to keep the teeth apart. Your teeth only touch when you swallow and you swallow 2-3,000 times a day.