What is TMJ?
Although it is commonly called TMJ, that term actually means Temporomandibular Joint – or your jaw joint. The more accurate term is TMD or Tempormandibular Disorder, and that refers to a broad array of symptoms that can arise from an issue in how the lower jaw functions and rests. The symptoms number in the hundreds and don’t all affect people equally and has made accurate and consistent diagnosis of the condition very difficult and in fact, poorly understood by the dental profession as well as physicians and other health care modalities. Some common symptoms include:
- ‘Migraine’ pain
- Facial pain
- Jaw joint pain
- Back, neck, cervical pain
- Postural problems (forward head posture)
- Pain in the face
- opening of the mouth (commonly known as “Locked Jaw”)
- Headaches (tension type)
- Pain in the muscles surrounding the temporomandibular joints
- Pain in the occipital (back), temporal (side), frontal (front), or sub-orbital (below the eyes)
- Pain behind the eyes – dagger and ice pick feelings
- Multiple bites that feels uncomfortable or, “off,” and continually changing
- Tender sensitive teeth to cold
- Deviation of the jaw to one side
- The jaw locking open or closed
- Ringing in the ears, ear pain, and ear congestion
- Sinus like symptoms
- Dizziness or vertigo
- Visual Disturbances
- Tingling in fingers and hands
- Insomnia -difficulty sleeping
Dr. Langston is a fellow at the Las Vegas Institute of Advanced Dental Studies
Hidden underneath these symptoms are generally a negative impact on the blood flow to the brain as well as diminished airway and often night-time sleep problems.
Why hasn’t anyone caught it before?
The fundamental principles that are taught in dental programs are focused on the mechanical function of the hard tissue. The very foundation of traditional education in the study of occlusion is focused on creating harmony between the bony jaw joint and the articulation between the teeth. While this seems at first to be quite logical, there are significant portions of the system completely ignored.
The complete system is comprised of three critical components and all three must be considered and managed in order to create predictable success and relief for people who suffer with issues related to the occlusion. While it is obviously critical to have the upper and lower teeth contact and mesh correctly that isn’t sufficient. Additionally, it is important that the jaw joint itself is in a functional relationship, however what that precise relationship is has been the subject of debate for decades. In fact, there are approximately 30 different definitions of that one true relationship that makes the system work. These two considerations are important; however they cannot be addressed in absence of the muscles and soft tissue that complete the system.
A pioneer in the science and physiology of muscles and soft tissue, Dr. Janet Travell, recognized that approximately 90% of the pain in the body comes from muscles. Since the muscles of the head and neck are all related to or affected by the bite or jaw relationship, it is critical to consider muscle comfort in the assessment, diagnosis and treatment of patients who suffer with bite issues. Traditional dental education still focuses on the relationship between the upper and lower teeth combined with the jaw joint position but completely misses scientific evaluation of the musculature.
When addressing any system, it is essential to evaluate all of the system. Considering the bite or occlusion, the components of the system are the teeth, joints, and muscles and various soft tissues. The Neuromuscular approach is the most complete perspective as it blends all three of these components starting with objective data to evaluate the function and comfort of the muscles.
But my Physician said it was from….??
Medicine is charged with finding answers, and more importantly, relief. The primary goal of the appointment is to drill down to the basic issue as fast as possible. The unfortunate reality of much of medicine today is that it is driven by finding a diagnosis to determine a treatment protocol. Whether that diagnosis is accurately describing the source of the issue is not always an issue. Many things we suffer with have an easily found source such as a broken bone or an infection. Manage the fracture or get the body ahead of the bacteria and the patient will heal. However, many other conditions are labeled based on the collection of symptoms and the treatment is guided by what may help to abate or relieve the symptoms.
Fibromyalgia and Migraine are both based on symptoms and the underlying cause is not a part of the equation so much as finding potential relief and managing triggers of the pain. There are medications and treatments that seem to improve the symptomology of the condition and these are suggested to the patient and that is where the search ends. As a patient, it is important to minimize the pain that is associated, but it would be much more beneficial to address the actual source and eliminate the condition completely.
With respect to the wide variety of symptoms that can be created by TMD issues and the multitude of conditions that can be mimicked, the search ends with looking for the proverbial straw. The focus is on the trigger or managing the symptoms. If the source is something that the physician is trained to see then a complete solution can be attained. If the source is something that the treating physician, or dentist, is not trained to recognize it simply goes unnoticed and unmanaged. This is precisely the reason that so many people suffer needlessly. The teaching of medicine leaves issues of the jaw and teeth to dentists. The teaching of dentists has a heavy emphasis on the management of the hard tissues and little or no time is devoted to the muscle and soft tissues. The muscles account for the pain but dentists do not even evaluate them. The muscles function based on how the jaw and teeth relate but physicians don’t evaluate that. The chronic suffering and pain is because the source falls between the cracks in health care.
A Neuromuscular dentist can objectively evaluate and manage both the hard tissues and the soft tissues and that perspective leads to predictability that previously simply didn’t exist. By addressing both sides of the dysfunction, the hard and soft tissues, the Neuromuscular dentist is able to create a functional dynamic where the teeth will support a proper jaw relationship as well as muscle comfort.
How do I know it will even work?
This is one of the most important questions to ask! The typical approach to redesigning how the mouth functions is to change it and then check to see if it is better. When correcting a smile and bite with braces, the dentist or orthodontist will make some educated guesses about how the mouth should be shaped based on averages. Then the braces are placed and the teeth are moved, and after the case is complete the system is subjectively evaluated with questions like “Do you like your smile?” and perhaps “Does it seem to be working well for you?”, however in reality the question is loaded. After two years of braces and finally getting that metal out of your mouth of course it is nice to be done! To top it off, it isn’t until the bite settles in and long term function and comfort can be evaluated that you really know the answer to that question.
Even more dramatic is orthognathic surgery. In those cases the patient goes through that same round of braces and then has jaw surgery to take them to a new place.The jaws are then wired together for six weeks or so while they heal and then finally after they are unwired they can start to find out if that can even be a comfortable position to live in.While there are some cases where jaw surgery is a good option, the vast majority of cases have a less severe option that should be considered.
With the LVI Neuromuscular trained dentist guiding the case, a reversible and easily removable appliance is used first to see if the new bite relationship is even comfortable. This is started not from the dentist pushing your jaw into some arbitrary position, but rather from a relaxed and neutral muscle-comfortable bite where we know that not only are the jaws comfortable, but so are the muscles that support them. It has been established that some 90% of the pain in the body comes from muscles and it stands to reason that the pain in the head and neck would also be related to the muscles. Of the nearly 200 muscles in the head and neck, nearly all of them are related to the bite either directly or indirectly.
The LVI NM trained dentist will try this new relationship first as a part of the diagnostic protocol and then after it is determined that this is a more comfortable and stable bite, the process of achieving that full time can be started.