Treatment of TMJ

Dr Gary L White TMJ.jpg

treatment of tmj

In some cases, the symptoms of TMJ disorders may go away without treatment. If your symptoms persist, Dr. White may recommend a variety of treatment options, often more than one to be done at the same time.

The Temporal Mandibular Joint, TMJ, is a bilateral joint with both sides mirror images of the other. Each end of the lower jaw, mandible, has a rounded, football shaped, protrusion called the condyle. The condyle is suspended by muscle and ligaments into a cupped shaped area of the skull just in front of the ear called the fossa. Between the condyle and the fossa is a connective tissue disc which helps the two bony surfaces to smoothly glide over each other. This system allows for coordinated movement of the jaw placing the position of the teeth to consume food and aid in speech. This is accomplished by rotation of the condyle in the fossa and forward movement of condyle out of the fossa to maximum opening. The two sides of the mandible can at this point move independently of each other making for lateral movement of the jaw as in chewing food.

When we put all that together there are three things that must happen in harmony for effective, pain-free function. The three components are bone, muscle, and teeth working together in harmony. When correctly aligned the upper and lower teeth come together, called occlusion, to allow all the muscles to relax. This position or bite should be quiet and pain-free. If it is not then we have what is called TMJ but rather should be called TMD or temporal mandibular disfunction or disease.

A typical TMD patient will arrive at the office complaining of jaw pain, a popping or clicking noise when opening or closing, chipped or severely worn front teeth often with mobility, and back teeth with the cusp worn down. In most cases this is caused by a loss of the harmony between the teeth and muscles resulting in two bites - one where the teeth want to close and one where the muscles want to close causing a “rocking” of the jaw. This causes muscle fatigue and pain and can also result in displacement of the disc. When the disc are dislocated you hear the popping or clicking of the joint when opening and/or closing.

Treatment for this condition begins with a determination of a bite or occlusion where the muscles can relax meaning the condyle is seated correctly in the fossa. Once this is determined we make molds of your teeth to place on a mechanical jaw in the corrected position. At this position we fabricate an acrylic guard to the correct bite. After several days wearing the guard, usually while asleep, the muscles begin to relax allowing us to easily identify the parts of the teeth or tooth which have been interfering with the correct bite. We mark these points and carefully remove fractions of a millimeter of enamel. This can take several visits to achieve positive results. The patient should be pain-free and the popping or click may or may not be gone, but at least it will not get any worse.

This is only a small example of what can be the cause of TMD. A careful full examination should always be the first step. If your jaw pain is not caused by a tooth/muscle problem the treatment described above would be of little benefit.

If you think you may be a having some symptoms or if you would just like more information I would be glad to discuss this with you.