Dentist - Glen Ellyn
Dr. John C. Workman
45 S. Park Blvd
Suite-190
Glen Ellyn, IL 60137
(630) 469-3558
Temporomandibular Joint Dysfunction (TMJ or TMD)
Temporomandibular Disorders
Many people who suffer from such seemingly disparate symptoms as headaches, earaches, tenderness of the jaw muscles, or dull, aching facial pain often share a common problem. These people-numbering close to 10 million Americans-all suffer from what has come to be known as temporomandibular (TM) disorders. TM disorders can have a variety of causes. Generally, TM disorders are believed to result when the chewing muscles and jaw joints do not work together correctly. In many cases, TM disorders can be successfully treated by a trained dentist.
How the Chewing Muscles and Jaw Muscles Work
The structures that make it possible to open and close the mouth are very specialized and work together when you chew, speak, and swallow. These structures include the muscles, ligaments, bones and joints of the jaw.
Five pairs of muscles allow you to open and close your mouth. They also control forward, backward, and side-to-side movements of the lower jaw. Also involved in these movements are the temporomandibular joints. Each of these important joints has two sections, connected by a disk, that make possible the hinge action and gliding action needed to open the mouth smoothly and widely. Any problem that prevents this complex system of muscles, bones, and joints from working together properly may result in a TM disorder.
Signs and Symptoms of TM Disorders
TM disorders have many signs and symptoms. Some of the most common ones include the following:
1. Pain in or around the ear. This pain often spreads to the face.
2. Tenderness of the jaw muscles.
3. Clicking or popping noise when one opens or closes the mouth.
4. Difficulty in opening one's mouth.
5. Jaws that “get stuck,” “lock,” “or go out.”
6. Pain brought on by yawning, chewing, or opening the mouth widely.
7. Certain types of headaches or neck aches.
We can help determine the cause of your symptoms by conducting a series of diagnostic tests. These may include a complete medical history, a clinical examination, X-rays, and casts (models) of your teeth. We may order an MRI or CT scan to determine the exact location or health of your disc. Proper diagnosis is an important step before treatment. It can save you time and money by ensuring that you receive the treatment appropriate for your particular problem.
Causes of TM Disorders
Remember that TM disorders often result when the chewing muscles and the temporomandibular (TMJ) joint do not work together correctly. When this occurs, the muscles will often go into spasm (cramp). This spasm can then become part of a cycle that results in tissue damage, pain, and muscle tenderness.
Although accidents such as injuries to the jaw, head, or neck or disease such as arthritis may result in some TM problems, factors relating to the teeth and bite are also common causes of TM disorders. Among these factors are the following:
1. Oral habits such as clenching the teeth (bruxism). These habits can tire the muscles and cause them to go into spasm. The spasm causes pain, which in turn causes more spasm. The end result of this spasm-pain-spasm cycle may eventually be a TM disorder.
2. Problems with the way the teeth fit together or bite. Improperly aligned teeth can sometimes place the chewing muscles under stress and cause them to go into spasm, thus setting off the harmful cycle described earlier. Frequently, oral habits and problems with the bite work together to cause TM disorders.
Example 1: Paula is under a great deal of pressure from work. She develops a habit of grinding her teeth while sleeping. This causes a muscle spasm and, eventually, pain and tenderness in her jaw muscles. Because of these problems, a slight change in the position of Paula's jaw occurs, and her teeth no longer fit together correctly. She develops a new chewing pattern, and this increases the muscle spasm.
Example 2: Ever since he was a boy, David has had teeth that do not fit together correctly when his mouth is closed. This never seemed to be much of a problem for him, but now his bad bite triggers tooth clenching and causes his chewing muscles to function incorrectly. A muscle spasm occurs, and pain limits the normal range of David's jaw movements. As a result, David's chewing pattern changes and this contributes to his TM symptoms.
Treatment of TM Disorders
Since the teeth, chewing muscles, and TMJ all can be involved in a TM disorder, treatments vary. Dr. Workman will determine what type of treatment is needed for your particular problem. Many times, treatment will involve a series of phases. This step-by-step approach is in your best interest because only minor corrective treatment may be needed. If pain and other symptoms persist, a more involved treatment, such as changing the way your teeth fit together or even surgery is recommended, may be needed. However, surgery is recommended infrequently and only when a precise cause of the disorder has been pinpointed and usually should not be undertaken until more conservative treatments of the disorder have been tried first.
Some common methods of treating TM disorders are listed below:
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Elimination of spasms and pain.
This can be done by applying moist heat to the face, using prescribed muscle relaxants or other medications, massaging the muscles, and eating soft, non-chewy foods. Bite plates or dental orthotic appliances adjusted carefully so that muscles can relax breaking the cycle of pain and allowing tissues involved to heal. These appliances can also protect the muscles, teeth, and joints from further damage.
2. Counseling or biofeedback/relaxation training.
Many times, counseling is used along with other forms of treatment. If emotional stress is a factor that contributes or causes clenching or grinding of the teeth, that stress should be reduced or eliminated. Biofeedback, a relaxation technique that teaches people to control tension throughout various parts of the body with the aid of an electronic monitoring device, can also be helpful in reducing muscle tension in the jaws.
3. Correcting the way the teeth fit together
If your bite is incorrect or uneven, it can be adjusted by selective grinding of the teeth. Orthodontic appliances (braces) and other dental procedures may also be used to reduce problems caused by incorrect tooth contact (improperly aligned teeth).
4. Surgery.
If muscle spasms have occurred for long periods, the TMJ itself may become injured, arthritic, and slip out of its normal position because of the long term trauma that has occurred over time. Tissues in the TMJ can become malformed and injured from the long term effects of muscle spasm. In addition, the bones and the soft tissues of the TMJ may slip out of position because of trauma, such as a blow to the head, or due to some other cause. Occasionally in severe cases such as these, surgery may be needed to correct the TMJ problem
Remember, in many cases the pain, headaches, and other symptoms associated with TM disorders can be successfully and readily treated.
Dr. Workman has successfully treated patients with TM disorders for over twenty-five years.
We welcome your questions and invite you for a thorough exam and consultation.
Dr. John C. Workman and Staff
Check this out for more information: www.pankeydentist.org
Click on "The Role Your Bite Plays in Your Oral Health and Dentistry"
Note: Most of this information was taken from the ADA pamphlet "TM Disorders"
The Hushed-up Mouth Disease that's more Destructive than Cavities and Gum Disease put Together!
Occlusal Disease and the Temporo-mandibular (jaw) Joint
Donald N. Reid, D.D.S.
The TMJ or "Jaw" Joint
Your Temporo-Mandibular (jaw) joint or "TMJ" has the honor of being the most complex joint in the human body. It is the joint that connects the lower jaw to the upper jaw and skull. It fits into sockets in your skull called fossa and is the hinge to close the jaws during chewing or talking. It contains a unique cushioning pad or disc made of collagen, dense, non-compressible material. All other human joints have pads made of a different substance.
The TMJ also has the honor of causing more:
- Loose teeth
- Cracked teeth, Tooth pain
- Headache pain, Muscle pain and soreness
- Worn teeth, Broken teeth, than cavities or gum disease combined.
The joint can be in an infinite number of positions but there is a very precise position the joint should be in when all teeth come together at once to bite. This position is called "centric relation". This describes a healthy bite. This position of the teeth being in harmony with the jaw is a safe place for the teeth to be healthy long term. Anything less than perfect and dentists refer to it as a misaligned or improper (unhealthy) bite. Think of the TMJ as the hinges of a door with the lower jaw as the door and the upper jaw as the door frame. When the hinges are out of centric relation, the door sticks or has trouble shutting smoothly. Eventually the door, the frame or both will wear down, loosen or maybe splinter as the door is forced shut over and over.
30-Plus Years Ago...
Shortly after graduation from Temple University Dental School, I vividly recall my father calling and tearfully describing some tests my younger sister, Jeanne, was undergoing to rule out a problem within her brain, possibly a tumor. She was experiencing severe headaches, facial pain, jaw pain, and loud noises in her ears. She also had numbness in her neck and sometimes hands. Incidentally, she had recently completed adult orthodontics to correct a crowded looking smile.
Thankfully, I had a close dentist friend, Dr. Tom Risbrudt, who was late president Richard Nixon's personal dentist. He had recently confided in me his strong conviction that the jaw joint "TMJ" was related to maladies typically outside our realm of diagnosis and understanding as dentists, namely headaches, ear problems, facial pain and the like. What if Jeanne's problem were due to simply a misaligned bite?
Tom suggested she should go to an orthodontist who may be able to help due to his understanding of the jaw joint or TMJ. The hundred mile trip was well worth the outcome. He simply repositioned a few teeth to allow her bite to close in a better position, and subsequently the pain in the muscles, nerves, and joint subsided within several days and they have never returned!
While a student in dental school, one of the very first patients in the clinic had no teeth - zero - just like over twenty five million other Americans. He wanted me to make a full set of dentures for him. In order for dentures to have any chance of fitting smoothly and comfortably, the bite has to be so precise that all teeth strike simultaneously upon clenching. The problem was no one could convince me where the position was, or even how to find.
Recognized Disease But Little Treatment...
While at a national American Dental Association convention in Philadelphia attended by over 35,000 dentists, I randomly asked dentists and dental students about their true understanding of the bite forces we commonly called occlusion. I asked:
- Do you believe the forces of the bite are destructive to our patient's mouths? If so howgreat a problem is it?
- What was your understanding of the mechanics of this system in the dental schools you attended?
- What greater understanding of the jaw joint and its related components have you acquired since graduating from dental school?
- How do you treat the jaw position to reduce the effects of a misaligned bite?
Regardless of the dentist's age, sex, location, or years in practice, the responses were strikingly and overwhelmingly similar in nature. Almost 100 percent of the responses could be summarized as follows.
"The stress from the bite is a major detriment to our clinical dentistry. Things break, get
loose, and wear away."
"Dental school presentation of the TMJ was vague, confusing, and never understood as a
clinical position with any degree of precision."
"I don't treat these problems because I don't understand them. I'll refer them to a TMJ
specialist if they get bad enough."
Internationally recognized and highly respected dentist researcher and spokesperson, Dr. Gordon Christenson of Provo, Utah, commented in a national dental journal.
"There are three diseases dentists treat. Tooth disease, gum and bone disease, and occlusion disease. We treat tooth disease too much, gum and bone disease too little, and we don't even talk about occlusal disease, yet it is by far the most destructive of all three and is present in the majority of our patient's mouths."
World-renowned authority on the diagnosis of occlusion and its effects,
Dr. Peter Dawson of St. Petersburg, Florida, states.
"Occlusal disease is the #1 cause of tooth loses, patient discomfort, patient dissatisfaction, oro-facial pain, missed diagnosis and the #1 most un-diagnosed problem."
World-class teacher, practicing dentist, author and lecturer, Dr. Frank Spear of Seattle, Washington, says.
"The confusion over occlusion abounds but nonetheless, it still remains the single most important element contributing to the long term success of our clinical restorations."
Are You A Sufferer From Occlusal Disease?
- Headaches in the temple region, brow area, behind the eye, or lateral part of the skull.
- Generally tight and sore facial muscles and or pain.
- Pain around the ears or TMJ area.
- Noices, popping, or grating while chewing or opening.
- Sensitive teeth
- Teeth movement
- Teeth wearing or fracturing
- Bone around the teeth breaking down
- Loose teeth
- Receeding gums or a notching of the teeth at the root/gum junction
- Teeth grinding or bruxing
- Intermittent blurred vision
- Dizziness
- Ringing in the ears
Not all of these symptoms are necessarily caused by a mal-aligned bite, but they should be ruled out.
Based on numerous published scientific studies and 23 years of clinical observation, I see these effects daily and they are indeed the most destructive forces on the majority of my patient's mouths and the greatest detriment to the longevity of the dentistry I provide.
Dr. John C. Workman