Many people suffer from stiffness or dysfunction of the jaw muscles, earaches, face, head, neck, shoulder and back pain, without knowing the cause of their pain. Over the last 5 years chiropractors, physiotherapists and medical GP’s have developed some awareness and treatment modalities.
It is known that a condition termed TMJ (temporomandibular joint) syndrome accounts for a large number of these previously uncured and painful ailments. The above types of pains are symptoms of the syndrome – not the problem itself. Correcting the problem rather than the symptom is at the heart of TMJ treatment.
Today, with new knowledge and technology, dentists are able to diagnose ant treat TMJ problems, which previously have been overlooked. Additionally, the medical profession is becoming more aware of dentistry’s involvement and physicians are referring patients to dentists knowledgeable in TMJ treatment.
Malocclusion and the Temporomandibular Joint
Your jaw joint, which holds your lower jaw in place, is suspended beneath your skull by an intricate system of muscles and tendons. The jaw joints, also known as the temporomandibular joints (TMJ), are some of the most complex in the body. The jaw joint, surrounding muscles, and the fit of your teeth are closely interrelated, each affecting the other as you make everyday jaw movement such as speaking and chewing.
The way your teeth fit together is called Occlusion. When your teeth are not in proper relation to each other and to your jaw joints, the jaw automatically shifts to a new position in an attempt to compensate for the misalignment of your teeth – a condition known as malocclusion (teeth do not fit together properly).
When malocclusion exists, even what looks like a good bite could be at the expense of putting pressure on other jaw joint areas as the jaw shifts to accommodate the teeth. The result of misarranged teeth may be clenching, grinding, premature tooth wear, stress on the muscles and tendons, some of which is often worst during sleep. Subsequently, this process may develop to headaches and muscular aches and pains in the face, neck, shoulders and back, dizziness, earaches, ringing in the ears and many other problems.
In addition to these common conditions which often (but not always) relate to malocclusion and cause pain in and around the temporomandibular joint, there are other conditions which can affect the function and comfort of this joint and the total body health. These conditions include disease, nutritional deficiencies (e.g. gout), tumours, trauma and infections.
Diagnosing the Problem
Before prescribing the proper treatment for your particular problem, a variety of diagnostic procedures may be necessary.
Jaw repositioners may be used. These appliances are worn for a given period of time. The appliance is simply refined and adjusted until it eliminates the bite disharmony and pain.
In order to study the relationship of the patient’s teeth and joints, the dentist will aim to see how the joints guide the jaw without interference from the reflexes and muscles, which are always working to adjust the way the teeth fit together. A record can be taken measuring the relationship of the teeth to the jaw. Once this record of the joint guidance is taken, it can be reproduced on an instrument called an articulator, which simulates your own particular jaw movements and bite relationship. Then without interference from reflexes and muscles, the bite can be studied for disharmonies and other interference. Necessary restorative procedures –crowns and bridges may be built outside of the mouth, analysed on the articulator and later positioned accurately in the mouth allowing proper fit and function.
Using instrumentation such as this saves you time and discomfort as it eliminates the need to sit in the dental chair while the fit and function is being adjusted.
After diagnosing the problem, a variety of treatments may be recommended. Initial phases of treatment are aimed to eliminate the TMJ pain. In the second stage, the actual treatment to correct the problem is implemented. Various TMJ treatments are explained below.
Initial Phase – Muscle Stimulation/Ultrasound
Muscle stimulation and ultrasound therapy may be prescribed to alleviate the pain before and during the actual treatment procedure. Anti-inflammatories, massage, exercises and heat applications are the primary tools of the emergency phase.
Splint/jaw Repositioner Appliances
Usually our first definitive treatment. Splint/jaw repositioning appliances are not only used in diagnosis, but they are also used as a treatment to temporarily eliminate the bite disharmony and resulting pain. The splint also helps us to estimate the effect a changed bite may have on an individual. They also help reduce the forces on the joints which reduce inflammation and then allows healing and repair. Then, during the second stage of treatment, orthodontics, crowns of equilibration may be recommended to build the bite to a permanent, healthy, relationship.
Only for cases where a lot of dental filling or dentures are required. Occlusal restoration involves the replacement or reconstruction of teeth in addition to the reshaping procedures (which eliminate high spots on the teeth), thus allowing the face and jaw muscles to relax.
Is usually not considered wise unless a test of different bite position is first trialled using an occlusal splint. In occlusal equilibration, the tops of the teeth are reshaped. This is done to alleviate pressure on individual teeth. The reshaping procedure has been found to be the solution for many conditions, which cause discomfort in the head, neck and shoulders and breakdown of the dental structures.
Occlusal equilibration can be likened to a pebble in your shoe. When there is an irritant present (the pebble), your foot automatically adapts to the pebble-e.g. you may walk with a limp. With malocclusion, an existing interference (as with a tooth too high for comfort), the jaw also adapts to the particularly uncomfortable tooth fit. During equilibration, the irritant (too high of a tooth) is reshaped for a better fit.
Early Treatment is Important
The importance of early treatment cannot be overstated. TMJ problems can advance in stages and grow progressively worse. Thus, a minor problem now could become a major source of pain in the future. Additionally, chances of successful treatment increase substantially the earlier treatment is accomplished.
Insurance Coverage of TMJ Treatment
Many people who have TMJ syndrome are reluctant to obtain treatment because they are afraid they will be unable to afford the expense. However, with the expansion of TMJ knowledge and treatment, the field of TMJ is being more widely recognised and it is thus easier to obtain insurance coverage.
Although dental insurance provides limited coverage, other types of coverage are now available. Since the TMJ treatment approach often involves standard medical procedures, insurance coverage for necessary TMJ treatment is becoming more commonly obtainable through health insurance.