’’TMJ’’, although it has become almost a household word, is a non-specific, catch-all term for a variety of pain/dysfunction conditions of the head and neck. It was originally derived from ’’Temporomandi-bular Joint’’, your jaw joints – once thought to be the source of most of these ailments.
Today we know that there are many causes of head and neck problems that may or may not be related to the temporomandibular joint. For this reason, although not as widely familiar, most dentists use ’’TMD’’ (for temporomandibular disorders) to more accurately describe the condition.
You may normally think of a number of the symptoms of TMD as being medical conditions, not related to dentistry.
This article will explain what they are, why they may involve your dentist, and how your dentist would diagnose and treat them.
SIGNS & SYMPTOMS OF TMD
Pain or dysfunction of the head and neck is a very common condition and one that might be resolved very simply or might be very complex and frustrating to treat, depending upon the circumstance.
The bite can be a factor in many types of pain or functional problems because of the inter-relationship of the overall musculoskeletal system. Since there is a relationship between the teeth, jaw joints, head and neck muscles, and head posture, a problem in any one of these areas may affect others. These can include painful clicking or popping of the jaw joint, various types of head and neck pain, swallowing problems, postural problems, and excessive snoring or sleep apnea, to mention a few. If it is suspected that you suffer from this type of problem, the neuromuscular dentist may ask you if you have any of the symptoms shown below.
In addition, he will be looking for a number of signs in your posture, appearance and condition of your teeth, and existing bite that might aid in diagnosis. An imperfect bite often plays a significant role in these conditions and the dentist experienced in treating them may resolve the problem. However, diagnosing these problems can be very difficult at times and may require the collective efforts of your dentist and other health care professionals.
MUSCULOSKELETAL SIGNS AND SYMPTOMS
Do you suffer from any of these?
* Headaches * Jaw joint pain * Jaw joint noise or clicking * Limited mouth opening * Ear congestion * Dizziness * Ringing in the ears (tinnitus) * Difficulty swallowing * Loose teeth * Pain behind the eyes * Clenching or grinding * Facial pain * Sensitive teeth * Chewing difficulties * Neck pain * Postural problems * Tingling of the fingertips * Hot & cold sensitivity of teeth * Nervousness or insomnia * Sore jaw muscles or ’tired’ muscles upon awakening * Head and scalp painful to touch
THE DENTIST’S DIAGNOSIS
The neuromuscular dentist will consider all of the information gathered by taking your history and doing a physical examination of your teeth, head and neck.
When indicated, he may conduct a series of tests using non-invasive electronic instruments. Data from these tests will indicate to your dentist whether your bite is a major contributing factor to your problem and will help rule in or rule out your bite as the cause of, or major component of, your condition.
If these tests show that your habitual bite is a probable cause of your condition or pain, the neuromuscular dentist then identifies a jaw position while the jaw muscles are in a relaxed state. This jaw position and the corresponding new bite is called neuromuscular occlusion, an occlusion based on ’’happy muscles’’- those that are physiologically at rest.
The muscles of the head and neck often accommodate to allow an otherwise imperfect occlusion to function. The brain quickly becomes « programmed » (through proprioception) to maintain this accommodation. Using a propriocepted position of the mandible for treatment planning may have less than ideal results as it simply maintains what may have been the accommodated position of a poor occlusion.
Poor occlusion (bite) might result too from an injury to the head and neck or chin, or from a whiplash car accident, or from an intubation for a general anesthesia, or from any dental treatment like orthodontic, fillings, crowns and bridges. Arthritis of the joint or any remodeling of it will cause a poor bite and a poor bite will cause a remodeling of your joints which might become painful.
Proprioception can be overcome and a relaxed state of the musculature can be achieved in a reasonable period of time through ultra-low frequency TENS stimulation. From this relaxed state a new occlusion (neuromuscular occlusion) is established and can be used in various dental treatments and procedures.
TREATMENT
An orthotic is a custom made appliance fabricated of plastic that can be worn over or fixed to the teeth to maintain the neuromuscularly derived bite position. At this point, nothing is done to permanently alter your teeth or your bite. You typically wear this plastic appliance for a prescribed period of time to verify that this new jaw position solves or reduces the problem. If it does, it has proven that the imperfect bite was the cause of the problem and you may elect to go on and have your natural teeth treated to permanently maintain that new bite position.
If symptoms are not substantially alleviated, the bite position is most likely not the cause of the problem. Your natural bite has not been altered and other causes may then be further explored. (Although this latter circumstance is possible, it is not likely since the dentist will only proceed with an orthotic if there are strong indications that the bite is a major factor in your problem.)
Neuromuscular dentistry (NMD) is a term applied to techniques that expand upon the traditional approach to dentistry and considers the entire system that controls the positioning and function of the jaw. The neuromuscular dentist seeks to establish a jaw position based on a harmonious relationship of the three main factors affecting occlusion – the teeth, muscles and jaw joints. The resulting jaw position is called the neuromuscular bite.
Dr. Yves Delessert, DDS, is a postgraduate of U.C.L.A. (University of California Los Angeles) with a postdoctoral degree in Prosthodontics and he also earned a Master of Science in Education from U.S.C. (University of Southern California). He then completed a third postdoctoral degree F.A.C.E. (Foundation for Continued Education) in full mouth rehabilitation in Burlingame/California. He was a visiting lecturer at U.C.L.A. and clinical assistant Professor at U.S.C. He later opened his dental office in San Juan Capistrano. After fourteen years in the States he moved to Kuwait where he was the Consultant and Head of Department for the Armed Forces Hospital and Allies. After eleven years in Kuwait he moved back to Carouge/Geneva, his home town where he has a General Dentistry, Prosthetics and Pain/Dysfunction practice.
He is a fellow of the International College of Cranio Mandibular Orthopedics, member of American Academy of Craniofacial Pain, American College of Prosthodontists, American Academy of Dental Sleep Medicine and Society Dental Science.
Av.du Cardinal Mermillod 1 1227 Carouge, Gen?ve Switzerland. Tel. +41 (0) 22 300 67 60
