TMD/TMJ

What is Temporomandibular Joint Disorder (TMD)?

  • What is TMJ? Temporomandibular Joint
  • What is TMJD? Temporomandibular Joint Dysfunction Syndrome
  • What is MPD? Myofascial Pain and Dysfunction
  • Why are TMJ disorders called? "The Great Imposter"

The difficulty in dealing with a chronic pain disorder is that it is not always well defined, is frequently misdiagnosed, and is very stressful to patients. I believe it is best summed up by Ashleigh Brilliant.

"My struggle to remain healthy is gradually killing me."  

Patients struggle with their lives, their jobs, their families and feel as if they are failing everyone.  Unlike diseases like cancer or debilitating injuries, they look normal and are often told to relax, toughen up, or grow up.  The pain they suffer is internal and they often feel as if they are seen by the world as lazy or complainers.  When they have tests like CT scans and MRIs, they are hoping to find something definite that is wrong with them.

Many of these patients would be happy to have tests show a brain tumor because they feel that would justify their pain and prove to the world it was real.  They struggle against an unseen foe and they feel alone in the battle.

The beauty of neuromuscular diagnosis and treatment is that it measures the functional aspects of the disorder and explains why these patients have been suffering.  Bill Dickerson is the founder of LVI, the Las Vegas Institute of Advanced Dental Studies, that teaches Neuromuscular Dentistry as part of comprehensive dental care, and he is famous for saying “you don’t know what you don’t know.”

That explains why medicine has not embraced Neuromuscular Dentistry as an answer to numerous problems. Dentists are living in a world where knowledge is doubling every 3 years, and by the time they graduate medical school half of what they learned about treatment is already obsolete. They do not have the time or capacity to study an entirely new field.  It is only a tiny percentage of dentists who know and understand the complexities of neuromuscular dentistry.  ICCMO, the International College of Cranio Mandibular Orthopedics was started by Dr. Barney Jankelson, the Father of Neuromuscular Dentistry and has been dedicated to advancing knowledge in the field.  Incredible research comes from both the European and Asian communities, specifically Japanese and Italian researchers.  LVI under the leadership of Norman Thomas as head of clinical research is making amazing progress in the study of Neuromuscular Dentistry.

There are actually three different schools of thought concerning TM joint disorders.  There is one group who believes that most of the problems are psychological and are best treated by medications and drugs following the typical medical model.  The Academy of Orofacial Pain is the organization promoting this philosophy.  The AOP has an excellent journal with articles about this approach to medical management of TM Joint and related disorders.  Many of the members take a more universal view of diagnosis and treatment.

The second school of thought can be termed the Centric Relation School.  This school believes that occlusion and how the jaw functions is important. The CR school believes that the TM joints are the most important determinate of function and therefore determine the correct jaw position by the CR-trained doctor manipulating the jaw to its terminal hinge position or loaded medial pole position.  The definition of centric relation has changed numerous times over the last 50 years with over 25 definitions in recent years. The most popular method of determining centric relation today is bimanual manipulation and load testing of the TM joints. These doctors believe that the best muscles to determine jaw position are the muscles in the clinician’s hands.

Neuromuscular dentistry is dramatically different in how jaw function and position is determined.  The simplest explanation is that neuromuscular dentistry creates a healthy relaxed musculature that returns to that condition after function (tooth contact).  The position of the jaw is primarily determined by the muscles when utilizing Neuromuscular Dentistry.  The occlusion is not based on a TM Joint position (centric relation) but rather in myocentric. This is a position that allows muscles to return to their most relaxed position after function, 

Myocentric occlusion is designed to limit the amount of muscle accommodation to a minimum during function.  The swallow is a reflex that occurs approximately two thousand times a day.  It is a resetting mechanism for the neuromuscular system of the jaws, hyoid bone as well as head and neck posture.

When the occlusion does not match the muscle physiology two thousand times a day the muscles must accommodate to protect the whole.  This is because the occlusion is primary and will dominate, and the muscles must accommodate even at the expense of muscle health.  This creates a repetitive strain injury similar to tennis elbow or carpal tunnel problems.  Muscle movements that are perfectly normal and not harmful when done just a few times become pathologic when they are repeated thousands of times.

When a patient swallows, a normal swallow has all the teeth come together and the patient swallows very easily.  Patients with neuromuscular dysfunction often find it difficult to close their teeth together and swallow and they often make a facial grimace during such a swallow.

Many of these patients exhibit aberrant or reversed deviate swallow where they use their tongue, lips, or cheeks to cushion their swallow.  If they use their tongues they develop scalloped tongues where there are literally impressions of the teeth on the sides of the tongue.  Using the tongue in this matter raises the hyoid bone and causes forward head posture.

Scalloped tongues are 60-70 % predictive of sleep apnea and forward head posture is implicated in sleep apnea, chronic neck and back pain and problems at the atlas/axis cranial joints.

A major difference between neuromuscular dentistry and centric relation dentistry is concern over the head posture and body posture.  Centric relation dentists manipulate the patient’s jaw and do not have to concern themselves with the rest of the body articulations.  Neuromuscular dentists are forced by nature’s physiology to be more holistic (whole body oriented) in their treatment.

The temporomandibular joint (TMJ) is one of the most versatile joints in your body. It is the hinge joint of your jaw that sits just below your ear. It allows your mouth to open, rotate from side to side, and even slide backwards and forwards. It is also attached to the most powerful muscles of your body: your jaw muscles. All this action and energy can lead to problems that cause discomfort known as temporomandibular joint disorder or TMD.

The ear and the TM joint arise from the same embryonic tissues, and the muscles and nerves often cause TM disorders to masquerade as ear problems.  TMJ disorders were originally called Costen’s Syndrome.  Dr. Costen was an otolaryngologist in St. Louis who saw a great many patients with severe ear problems that he recognized as actually being problems associated with the TM joint and surrounding muscles.  TMJ disorders have been dubbed “The Great Imposter” because they are often missed in diagnosis and patients are diagnosed with ear infections, sinus infections, migraines, or chronic daily headaches.

Contact our TMD/TMJ doctors for a neuromuscular dentistry consultation. Get the proper diagnosis and treatment for your TMD headaches and TMJ headaches today!

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