TMD/TMJ – Shelby Township

What Is the Temporomandibular Joint (TMJ)?

The temporomandibular joint is the hinge joint that connects the lower jaw (mandible) to the temporal bone of the skull, which is immediately in front of the ear on each side of your head. The joints are flexible, allowing the jaw to move smoothly up and down and side to side and enabling you to talk, chew, and yawn. Muscles attached to and surrounding the jaw joint control the position and movement of the jaw.

DENTAL VIDEOS

Cone Beam CT Radiography (CBCT)

At The Gentle Dentist we have the ability at our office to examine the actual hard structures that comprise the TMJ. With our CBCT machine we are able to see small variations in the surface of the jaw joint  which helps us to gain a more accurate diagnosis of the workings of the jaw joint itself.  With the use of an oral radiology service we can help to not only diagnosis, but help to guide the patient to a higher level of care.

What Are the Symptoms of TMJ or TMD?

People with TMJ can experience severe pain and discomfort that can be temporary or last for many years. More women than men experience TMJ and TMD and is seen most commonly in people between the ages of 20 and 40. As one ages there is compensation and adaption of the joint that takes place.

Common symptoms of TMD include:

• Pain or tenderness in the face, jaw joint area, neck and shoulders, and in or around the ear when you chew, speak or open your mouth wide
• Limited ability to open the mouth very wide
• Jaws that get “stuck” or “lock” in the open- or closed-mouth position
• Clicking, popping, or grating sounds in the jaw joint when opening or closing the mouth (which may or may not be accompanied by pain)
• A tired feeling in the face
• Difficulty chewing or a sudden uncomfortable bite – as if the upper and lower teeth are not fitting together properly
• Swelling on the side of the face
• Tension, stress or muscular contraction headache.
• Migraine headaches.

Causes Of TMJ, TMD and Headaches:

• A Bad bite which causes the muscles of the face and jaw to become tense
• Stressful life style
• Clenching and/or Grinding of the teeth especially at night
• An accident that creates a whiplash effect on the head. The jaw joint withstands tremendous forces during these events.
• Arthritis history

HEADACHES

Daily Chronic Headache

Researchers have discovered many similarities between tension headache and migraine. Most now believe the two types may be on the same continuum, with tension headache just a mild form of migraine.

Depression and anxiety accompany daily chronic headache, and it occurs intermittently throughout life until it ultimately subsides. The migraine pain, like that of tension headache, is dull and moderate most of the time.

Migraine Diagnosis: if you have these symptoms you have a positive diagnosis for Migraine:

• Headache pain lasts 4 to 72 hours
• Is aggravated by normal routine physical activity
• Accompanying by at least one of the following: Nausea or vomiting (or both); Light and sound sensitivity
• No evidence of related organic systemic disease such as Allergies, tumors, low blood sugar, nerve pain, nerve pain, sleep apnea or connective tissue diseases. These need to be ruled out before a migraine diagnosis can be made.

Causes of Headache

There are many theories attempting to explain the etiology of headaches and TMJ. We do know that the Trigeminal Nerve has direct involvement with headaches.

The Trigeminal Nerve is the nerve that is filled with sensory input from behind and below the eyes, upper jaw, side of face, the temple, entire lower jaw and other areas of the head. The nerve also receives sensory input from the arteries that surrounds the brain. The yellow area on the diagram below shows the distribution of the Trigeminal nerve and where it serves. As you can see, many of the areas where headaches and TMJ manifest are directly innervated by this important nerve.. There is also a motor root division which sends nerve impulses to contract the jaw muscles. All of the branches converge into what is called as the sensory nucleus.

During TMJ, tension and migraine headaches it can be noted that any or all of the divisions of the nerve are involved with sensory overload from visual aura, temporal headaches, ringing in the ears, and even sinus aches.

The current understanding of the nature of the migraine, is that it results from a disorder of “sensory modulation”, meaning that information received by the Sensory Nucleus of the trigeminal nerve is misinterpreted, thereby resulting in either a disproportionate response, or an inappropriate response altogether. For example, during a migraine attack, the simple pressure changes of the fluid that surrounds the brain (resulting from the beating of the heart), is perceived as “pounding”.

When considering an abnormal Trigeminal system where the Sensory Nucleus is hypersensitive, it is not unusual for the Motor Division to be also hyperactive. A hyperactive Trigeminal Motor Root results in excessive jaw muscle contraction, during certain stages of sleep, resulting in intense jaw clenching and/or vigorous teeth grinding. These two activities produce a significant bombardment of noxious input (nociception) to the Sensory Nucleus, while also being the known cause of TMJ or TMD (temporomandibular disorders), thereby becoming a self-perpetuation of chronic headache and/or migraine. In order for jaw clenching and teeth grinding to cause damage the molars and/or canine teeth must be touching each other, or another object (like a traditional mouthpiece). When wearing an NTI the biting muscles relax and this breaks the cycle of clenching and headaches.

Treatment without drugs using the NTI device

The goal of treatment is to limit the amount of sensory input (that is, to limit your migraine “triggers”) to the Trigeminal Sensory Nucleus. Essentially, the goal is to limit as much negative input to the Trigeminal Sensory Nucleus as possible. We can do this with this remarkable effective device which is custom made to snap over your bottom or top front teeth. This will open the jaw with only the incisor teeth in contact. The effect of not having the canine and molars touching during sleep creates a significant reduction in contraction intensity, trigeminal stimulus and therefore reduction in headaches of all levels.

If you are tired of taking medications for your migraine consider these statistics for medically diagnosed migraine suffers:

Each subject had at least 2 migraines per month and had a physician’s prescription for Imitrex (sumatriptan, GlaxoSmithKline) as a rescue medication.

A research study for the use of the FDA approved NTI showed that after just eight weeks of using the NTI-tss:

• There were no side-effects and no new pain;
• 82% of NTI-tss users had a 77% average reduction in migraine events;
• Imitrex use was reduced by almost 50%
• Nausea episodes were reduced by 78%;
• Light-sensitive episodes were reduced by 66%;

Full Coverage Occusal Guards

The use of a full coverage guard is for those patients who:

• Have clicking in their jaw joint. This clicking is from the disc that lies between the lower jaw and the upper jaw.  This disc is the most complex joint in the human body and is active in movement when the jaw is opened widely.  If there is damage to the ligaments, surface of the disc or damage to the actual bone then this can lead to clicking, a grinding noise or even a situation where the jaw locks closed.
• Pain associated to a jaw joint that is breaking down and this active breakdown needs to have the pressure reduced in the joint space. This is accomplished by allowing all of the teeth to contact during the biting and grinding activity.
• Bruxism – which is the grinding of the teeth. The full coverage guard protects the teeth from further wear especially during the night when the patient is not aware of the actual pressure and damage they are causing.  The body naturally limits the amount of biting force to the teeth but during certain sleeping phases this “limit” is turned off and one is able to bite down 2-3 times as hard as they would do during the day time are reduced.