TMJ & Orofacial Myofunctional Therapy
Pain Relief with The Most Modern & Holistic Treatments
Millions of Americans suffer from chronic facial and neck pain as well as recurring headaches, jaw movement disorders, neuropathic pain disorders, and sleep disorders. In some cases, this pain is due to disturbances in the masticatory system causing temporomandibular joint (TMJ) symptoms. This system is the core physiological structure of the jaw necessary for chewing and swallowing. If you have been suffering from chronic facial, jaw, head, and/or neck pain for years, chances are you’ve undergone different types of treatments without finding their root cause.
Treating Pain & Symptoms
It might be hard to believe that a problem in your jaw could be the main cause of pain in another part of your body, mainly your head and neck area. However, it has been known that numerous research has shown that a variety of symptoms such as severe headaches as well as jaw, neck, back, and shoulder pain have been associated with Temporomandibular Joint (jaw joint) dysfunction.
Having completed extensive continuing studies regarding TMJ, Dr. Maryam Horiyat can help you find relief from these bothersome symptoms
A Life without TMJ Disorder!
What Is Gnathology?
Gnathology contains the Greek root “gnathos”, which literally translates to the study of the jaw. Gnathological dentistry focuses on studying the masticatory system (the system responsible for chewing the food so that it can be swallowed).
The masticatory system is defined by the core physiological structure of the jaw. As no physiological structure is perfect, there are some functional disturbances:
Gnathological dentistry aims to treat these disturbances and treat patient with TMJ symptoms. The treatment process involves the re-alignment of the jaw through a special and customized orthotic device.
What Is TMJ / TMD?
TEMPOROMANDIBULAR JOINTS CONNECT THE LOWER JAWBONE (Mandible) TO THE SKULL (Temporal Bone). The TMJ jaw joint like other joints is composed of cartilage, muscles, ligaments, and bone; TMJ is responsible for the movement of the lower jaw during chewing, talking, and yawning. Temporomandibular disorders (TMD) are referred to as a group of conditions characterized by pain in the jaw and surrounding area as well as restraint in the movement of the mandible due to any traumatic, psychological, metabolic, or mechanical stimulant. TMD can be caused by the problem of the joint itself arthritis, constricted blood supply, inflammation, internal derangements (disc displacements), or the muscles surrounding the joint (myofascial pain syndrome).
TMJ pain and TMD are closely related disorders that affect approximately 35% of patients over the age of 30. When TMJ pain and dysfunction are left undiagnosed or untreated, substantial, permanent, and unhealthy changes may occur to the teeth, supporting bone, and the highly complex temporomandibular joint. Both myofascial pain (muscle pain, tension, spasms, and headache) and TMJ Dysfunction (popping, clicking, or locking of the jaw) are closely related to how teeth fit. When teeth or bites are misaligned whether, from injury or bite issues, certain abnormal habits may develop, leading to hyperactive muscles of mastication and ultimately clenching.
Signs & Symptoms of TMJ / TMD
Unfortunately, the majority of TMJ Dysfunction cases are treated by medical doctors using drugs to treat only the symptoms of the disease (headaches, neck aches, depression, etc.). As a qualified holistic and biological dentists, we not only could treat the symptoms of the TMJ but also fix the causes of the disease so that the symptoms are permanently resolved. We do this in several ways depending on the specific cause. Properly diagnosing the cause of TMJ Dysfunction is key to properly treating the disease. In our office, we have utilized 3-Dimensional images of the TMJ using a Cone Beam CT-Scan (CBCT). This allows us to precisely evaluate the joints, it ultimately allows us to see that our treatment has resolved the diseased condition.
Qualitatively it is usually a dull ache but can be more acute. Also, commonly described as feelings of tension, tightness, or fatigue on the sides of the head, either unilaterally (on one side) or bilateral (on both sides). The frequency can be episodic or constant with varying intensity throughout the day. The pain typically worsens with jaw movement or functions, i.e. eating, talking, yawning, and opening wide.
Types of Pain:
- HEADACHE: They are the most common symptoms of TMD; They are usually tension-type, but TMD can be an initiator for vascular or migraine headaches. Headaches that are worse during sleep or upon awakening are usually TMD-related.
- FACIAL PAIN: Usually in the jaw joints (located in front of ears) and in the masticatory muscles (sides of the face); pain in the cheeks and lower jaw are also common.
- EAR PAIN: This is usually referred to as pain from the TMJs and is secondary to the close anatomical relationship between the jaw joints and ear canals. Other common ear symptoms include ringing or tinnitus and a stuffy or clogged sensation. Hearing loss and vertigo are sometimes reported though are uncommon. Patients commonly mistake these ear symptoms as indications of sinus problems, but for most adults, the symptoms are manifestations of TMD.
- NECK / SHOULDER PAIN: This commonly represents a separate neck problem, i.e. cervical degenerative disease, but can be related to either the TMJ problem contributing to the neck pain or vice versa.
- TOOTHACHE: When associated with TMD, tooth pain/soreness is usually generalized, variable, and can change locations in the mouth.
- JOINT SOUNDS: Clicking or popping sounds usually indicate the presence of a reducing displaced disk, though can indicate a change in the shape of intra-articular tissues. Crepitus or grinding/grating/sandpaper sounds are highly correlated with the presence of TMJ arthritis.
- JAW LOCKING: It refers to jaws getting stuck in either the open or closed position.
- OPEN LOCKING: It usually results from a combination of TMJ hypermobility in conjunction with contraction of the jaw-closing muscles.
- CLOSED LOCKING: It usually results from a TMJ disk displacement that the condyle can no longer recapture. Closed locking is usually preceded by jaw popping, i.e. a reducing disk displacement.
- TRISMUS: This condition is when the limited jaw opens and is usually indicative of an intra-articular problem, as opposed to a muscular disorder, and can be caused by non-reducing disk displacements or arthritis.
- BITE CHANGES: Most alterations in a patient’s occlusion are perceived, but not clinically detectable.
- SLEEP DISRUPTION (insomnia): It can be an important risk factor for TMD because of the relationship between sleep quality and bruxism.
Possible Causes of TMJ
TMJ pain or jaw pain is usually caused by muscle spasms in the muscles of the head and neck, shoulders, and back. Although muscle spasms leading to jaw pain can originate from many resources, the most common reason is teeth misalignment, and musculoskeletal. The muscle spasms causing TMJ pain are most triggered by:
Today, there are two philosophies for TMJ treatment by which clinical dentist are treating their patients.
- Gnathology – The first and oldest philosophy is that of Gnathology which is based on a belief that the temporomandibular joints hinge on an axis of rotation in the glenoid fossa of the skull. All occlusion is guided and brought together to a fined tuned order, determined by the axis of jaw joint rotation. The emphasis is on occlusion and joint position which is fundamentally called “centric relation”.
- Neuromuscular – The second newer philosophy is Neuromuscular, based on the understanding that the temporomandibular joints are in a physiologic resting position based on the guidance of muscles and stabilized by the occlusion of both the upper and lower teeth. Emphasis is on a physiologic position of the jaw/ mandible position to the skull (neuromuscular rest position), the physiology of rested muscles to support a physiologic occlusion for the stability of all three entities: the TM joints, the muscle, and the teeth.
TMJ Treatment Options
Biostimulation, also known as low-level laser therapy, is a type of laser therapy that can stimulate anti-inflammatory properties in the TMJ structures by preventing the release of histamines and prostaglandins. This stimulation promotes reducing the pain from inflammation by increasing the blood flow to the treated area which ultimately stimulates healing.
Our laser is the ONLY laser that is FDA cleared for pain therapy. The exclusive beam-dispersing handpiece has several therapeutic applications, including providing temporary relief of minor muscle and joint pain and stiffness.
The cause of TMJ dysfunction is often crooked teeth. If a deep bite is the cause of TMJ dysfunction, we simply need to straighten the teeth with braces to resolve the disease.
If underdeveloped dental arches are the cause of TMJ, we could use comfortable and removable arch development appliances to properly develop the dental arches.
If retruded lower jaw (retraction of the chin) is the cause of TMJ, surgery and functional jaw orthopedics could be the solutions to resolve the disease.
Missing or badly worn posterior teeth are a common cause of TMJ dysfunction. This can be resolved by replacing missing teeth with metal-free zirconia implants or building up the worn teeth with porcelain crowns.
The relationship between Temporomandibular Disorders (TMD) and malocclusion (bite disorder) is an extremely critical issue in dentistry. Sudden changes in occlusion can be the secondary cause of jaw joints and muscle disorders due to the connection between these structures and dental occlusion. For instance, if an improper size of restorations like a dental crown is placed without adjusting the bite, the malocclusion could trigger TMJ.
At Aria Dental, we have implemented a digital bite analysis system (T-scan) to digitally identify high forces and premature contacts after placement of any restorations, oral reconstruction, and dental implants.
Appliances that reposition the jaw to decrease clicking and decompress nerves related to TMJ pain. Stabilization appliances are also used for myofascial pain and cognitive behavioral habit control.
Botox is injected into facial muscles afflicted with soreness and discomfort to temporarily lessen muscle spasms causing TMJ and jaw tension for 3-8 months.
Trigger point injection therapy involves the injection of a local anesthetic into tender points to eliminate pain.
Physical therapy and cold laser can be used in myofascial release, mobilization of the TMJs, and deep muscle therapy to lessen pain and symptoms associated with TMJ disorders.
Homeopathic remedies are natural substances from vegetable or mineral sources and have no drugs or chemicals such as Arum Triphyllum, Chamomilla, Granatum, or Rhus Toxicodendron.
Arum Triphyllum – For pain in joint on swallowing.
Calcarea Flourica – For hypermobile joints
Calcarea Phosphorica – When mouth cannot be opened without pain.
Carbo Vegetabilis – For vertigo with nausea and tinnitus.
Chamomilla – For low pain threshold and when unbearable spasms of pain radiating into the ears.
Cuprum Metallicum – For trismus of muscles.
Granatum – For painful cracking of the joint.
Magnesium Phosphorica – For muscle spasms.
Phytolacca Decanda – For earaches with pain extending into teeth, jaw, and throat.
Rhus Toxicodendron – Use for joint stiffness that improves with movement and for popping” of TMJ.
Adjunctive with other non-surgical treatments, medication such as muscle relaxants, Medrol, Neuropathic medications, and/or sedatives may help relieve the pain associated with TMJ disorders. However, you need to consult with your dentists, or physician before starting any medication.
DDS . AIAOMT . CIABDM
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