TMJ

(Temporomandibular Joint Treatment)

Approximately 40 percent of all healthy individuals suffer from chronic headaches, and one out of eight people suffer from headaches so severe that they cannot function normally. Often, these problems are related to a common cause of chronic pain: TMJ Syndrome.

TMJ stands for temporomandibular joint. This is the joint in the jaw that allows the jaw to open, close, move backward and forward, and from side to side. The term "TMJ Syndrome" refers to a malpositioning of the respective jaw structures and associated muscles. This condition results in muscle contractions, which are a factor in approximately 80% of all tension-related headaches.

The first step is to recognize the possible problems caused by TMJ.

For instance, if you have any combination of the following complaints, you may be suffering from TMJ Syndrome:

• headache
• dizziness and/or lightheadedness
• ringing, buzzing, or clogged ears
• spasm and/or tightening in the back of the neck, shoulders, or face
• clicking or popping noises when opening or closing the jaw
• inability to open the mouth fully
• locking of the jaw joint
• pain behind the eyes
• earaches
• sinus pain.

Let's take a closer look at our physiology to understand what is actually happening. Only the lower jaw (mandible) is able to move; the upper jaw (maxilla) is part of the skull. The teeth determine the positioning of the mandible, and without teeth, the mandible would be free-floating, only having contact to the skull through the jaw joints themselves. However, the teeth close only in respect to where they fit together the best, which may or may not be where the muscles and ligaments that suspend and move the jaw, want to be. The muscles will therefore assume whatever position is dictated by the teeth.

Muscles are composed of bundles of muscle fibers, and these fibers have a certain resting length at which they operate the best - their "physiological rest position". At this position, the muscle is in its most relaxed and strongest position. If the muscle is elongated or foreshortened, instead of at its relaxed resting length, the muscle fibers will be tensed. This tense contraction impedes blood circulation, resulting in spasm and cramping of the muscle tissue.

There are basically two schools of thought regarding "correct" jaw placement. There are those dentists who use only the anatomical landmarks of the skull in its relationship to the lower jaw; then there are those, such as myself, who use the neuromuscular concept of occlusion (bite) that focuses on where the muscles want the jaw to be.

The challenge is to find out where the MUSCLES would like the jaw to be, instead of where the TEETH would like the jaw to be.

Computer-aided TMJ diagnostic techniques

At Lotus Dental we use the latest computer-aided diagnostic techniques to assess the TMJ, including

• joint vibrational analysis
• electromyography
• jaw movement tracking and
• occlussal analysis

together with X-Rays of the joints and skull and plaster casts of the teeth mounted on a specific diagnostic tool called the “aculiner articulator”.

We use a T.E.N.S. (transelectric nerve stimulation) therapy unit, by which the muscles can be pulsed to relaxation, the bite relationship can be determined, and a splint or the bite can be finished to this position. See www.biojva.com for further information on this exciting technology.

A splint is an acrylic wafer that fits over the top of the lower teeth in order to alter the way the upper and lower jaws fit together. After the splint relocates the jaw to the physiological rest position, the patient can respond better to the other modalities of treatment to assist his or her recovery from this syndrome.

Co-ordinated treatment

Besides positioning the mandible to where the muscles should be, there are other factors that come into play to restore balance to the body. The TMJ is the key focus in spinal alignment (such as with osteopathic or chiropractic treatment) and proper positioning of the bony cranial plates of the skull. Therefore, for best results the patients should receive spinal adjustments and/or cranial adjustments. Muscle relaxation treatments, especially in the upper body, also help the muscles eliminate their trigger points, and adapt to the new positioning.

Nutrition also plays an important role in treatment of & recovery from TMJ disorders and other musculo-skeletal problems.

This co-ordinated co-treatment with other health professionals is termed "chirodontics".

After the muscles begin to relax, the patient will begin to notice that when the splint is not in his or her mouth the teeth no longer fit together in the same way. This is a good sign that the jaw is adapting to its new, muscular positioning, instead of the tooth positioning. Therefore, the final phase of TMJ treatment is to alter the way in which the teeth fit together so that the patient's jaw is in the neuromuscular bite position even when the splint is not being worn.

Once the patient is symptom free, the dentist can begin to stabilize the patient's bite in the biologically compatible jaw position, which has already been established by the splint. Stabilisation can be accomplished by the following methods:

• occlusal equilibration (balancing the bite through reshaping the teeth)
• crowns (caps)
• orthodontics (moving the teeth)
• occlusal overlays (bonded porcelain/ceramic build-ups) or
• partial denture overlay (removable plate).

After reconstructing the bite relationship by one of the above methods, the patient's teeth will place the jaw together in a position that corresponds to the physiological rest position of the muscles. Now the muscles can relax when the jaws are closed, eliminating fatigue, cramping. and other associated symptoms.

TMJ Syndrome, although not a threat to longevity, can cause a lifetime of suffering. Through increased awareness of TMJ and appropriate treatment, the quality of life for people with this syndrome can be greatly enhanced.