Temporomandibular Joint Dysfunction (TMJ or TMD) and Occlusal Therapy
During your comprehensive exam, you and Dr. Workman may discover that you have problems with your bite or with your jaw joints, or both. Occlusal therapy may be suggested as part of the initial work you do together.
The jaw joint consists of a condyle (the ball) that fits snugly into its fossa (socket). Unlike other joints, the TMJ can move in three dimensions: side-to-side, front to back, and up and down. It is this flexibility that allows us to move our lower jaw so freely. There are muscles and ligaments that attach to the jaw and also to the skull that help hold it in place and move to the right place at the right time.
There are many causes of joint dysfunction: trauma, tumors, bony growths, arthritis and frequently poor bite relationships. The two most common are trauma and malocclusion or improper bite. When the joint is damaged, there can be noises that occur with function. Often characterized as clicks, pops, or grating, these noises are signs of damage inside of the joint or of muscles that aren't working together because of a poor bite.
Muscles that don't work in harmony can become sore and even tender to touch. Sometimes there is a sense of tension in the face or difficulty moving the jaw in all directions. If the ligaments or cartilage are damaged, there may be pain in the joint itself.
When there is a poor bite relationship, parafunctional bite habits may accompany this malocclusion. Such habits are clenching, grinding, tapping, or squeezing the teeth together. Parafunctional habits can result in sore jaw muscles and abnormally fast wear or breakdown of teeth. Sometimes the teeth fit together reasonably well, but the habits are present and cause premature wear and breakdown of the teeth.
As a Pankey-trained dentist, Dr. Workman has had extensive training in identifying unhealthy bite relationships and in their treatment.During the exam, Dr. Workman spends time marking your teeth with bite ribbon to identify the way the teeth meet and rub together. Part of your comprehensive exam also includes a muscle examination; you might experience feeling some soreness or tenderness when those muscles are provoked.
If any of these signs and symptoms is discovered, Dr. Workman may suggest occlusal therapy.The process starts with an
occlusal appliance. This hard acrylic appliance is fabricated to fit
snugly over either your upper or lower teeth. It is then meticulously adjusted to fit as perfectly
as possible against the opposing teeth. The appliance will be checked periodically and adjusted
until your bite stabilizes against it. Wearing the appliance is a time of discovery for both you and
your dentist. You will experience what a solid, stable bite feels like, and your dentist will learn
much about how your lower jaw functions against your upper teeth. It is very likely that many
of the signs and symptoms you both discovered will diminish or even disappear.
This is all valuable information for your dentist and gives insight into what your final treatment might look like. When the bite stabilizes on the appliance and the joints and muscles are comfortable, you will have experienced how your teeth might feel when your mouth is restored. How long this takes depends on your situation and the signs and symptoms with which you start.
Occlusal therapy frequently precedes the restorative work you and your dentist have agreed to complete. The appliance acts as a proving ground for the dentist to work out the mechanics of how your teeth fit together. As part of this occlusal therapy your dentist may ask permission to reshape teeth so they move smoothly against each other and fit together in the same solid position that you felt with the occlusal appliance.
In extreme cases where the joint has been badly damaged, appliance therapy will not work. In this instance your dentist may refer you to an oral surgeon who is specially trained in surgical treatment modalities. Surgical intervention is only necessary when there is no other choice and happens in less than 1% of cases.
Often occlusal appliances are fabricated when treatment is completed. This type of appliance is suggested when there
is concern about ongoing habits that cause premature breakdown
of teeth and restorative work that is present. Think about this type of appliance as a protector of
your investment.
Regardless of the reason for occlusal therapy, the best dentists will be sure to spend time with you so that you have a clear understanding of why it is prescribed, what to expect, and an idea of what the anticipated outcome will be. You can also ask whatever questions you need to have answered before you proceed.
Check this out for more information: pankeydentist.org
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:
- Lost teeth Loose wiggly teeth
- Cracked teeth Tooth pain
- Headache pain Muscle 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. 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:
1. Do you believe the forces of the bite are destructive to our patient’s mouths? If so how
great a problem is it?2. What was your understanding of the mechanics of this system in the dental schools you
attended?3. What greater understanding of the jaw joint and its related components have you
acquired since graduating from dental school?4. 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?
1. Headaches in the temple region, brow area, behind the eye, or lateral part of the skull.
2. Generally tight and sore facial muscles and or pain.
3. Pain around the ears or TMJ area.
4. Noices, popping, or grating while chewing or opening.
5. Sensitive teeth
6. Teeth movement
7. Teeth wearing or fracturing
8. Bone around the teeth breaking down
9. Loose teeth
10. Receeding gums or a notching of the teeth at the root/gum junction
11. Teeth grinding or bruxing
12. Intermittent blurred vision
13. Dizziness
14. 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