TMJ

The temporomandibular joint is your jaw joint. It can become a very problematic and painful joint when used incorrectly. Muscle spasm, dislocation and aching are common issues when this joint becomes uncoordinated.

Treatment of temporomandibular joint disorder

The Temporomandibular joint (TMJ) or jaw joint is suspended from the base of the skull by an intricate system of tendons and muscles. It is also the most complicated joint in the human body. There are two TMJs, one each side, the interplay between which causes three dimensional motion. This makes jaw movements incredibly complex and difficult to analyse.

The way your teeth fit together is called Occlusion. When your teeth are not in proper relation to each other and to your TMJs, the jaw moves to a new position in an attempt to compensate for the misalignment of the teeth, a condition known as Malocclusion. With a malocclusion, clenching or grinding your teeth (Bruxism) can cause abnormal tooth wear, cracked or broken teeth, muscle spasm, sore TMJs, headaches, neck and shoulder pain, sore teeth, earache and many other problems.

Before advising the proper treatment for your particular problem, a variety of diagnostic procedures may be necessary. In my practice, it is standard procedure to take impressions of the upper and lower teeth. Two sets of casts are made from these impressions and with the other records taken at this time, these casts are mounted on an instrument called an Articulator. The articulator is a mechanical and relational jaw motion simulator which permits analysis of the problem and treatment planning. The amount of time required to do this analysis is about one clinical hour (ie: when your presence is required) and about two to three laboratory hours (when your presence is not required).

The mounted casts are then studied and a treatment plan formulated. In very severe cases of malocclusion, orthodontic treatment (braces) may be suggested to bodily move the teeth to a more correct position. In less severe cases, an Occlusal Equilibration may be indicated. This is a minor reshaping of the biting surfaces of the teeth so they mesh together. Some teeth may need to be built up with bonded plastic fillings, metal fillings or crowns, etc. Missing teeth may need to be replaced with bridgework or dentures. After a careful adjustment of the casts of your teeth is completed, the amount of time required to correct the problem can be appointed. Then your own teeth are reshaped in the same manner using a fine drill, and bonding plastic, crowns, etc., as needed. Usually the amount of tooth structure removed is so small that you will be unable to detect visually any change in your teeth. Medication may be given to you to take before the equilibration appointment to decrease your saliva flow to facilitate the adjustment.

There is a settling in period after the equilibration. This is usually 7 – 10 days, during which time one or more teeth may feel a little high and your bite may feel strange. This is perfectly normal and will disappear with time. Future appointments are made as needed for the further refinement of your occlusion.

Tempromandibular joint pain/muscle dysfunction home care instructions

  • Avoid sleeping on your jaw. (This is the most important regimen). Back sleeping is the best sleeping position to enable your jaw to relax. (A small pillow or rolled up towel to support the neck curvature is optional and may be helpful). You will probably find it necessary to elevate your knees with a large pillow to reduce any back comfort.

  • Application of moist hat with a hot towel or hydrogulator to the affected side at lest twice a day for approximately 20 minutes, more often if possible.

  • Avoid chewy foods and avoid biting anything on your front teeth. (Soft diet is recommended).

  • Limit the intake of sugar and caffeine as both are stimulants to the nervous system.

  • If prescribed, take medication as directed.

  • Avoid clenching your teeth as much as possible.

  • If so instructed, use the “leaf gauge principle” as directed to treat acute episodes of painful muscle spasms and for the management of your clicking and popping joints.

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