Your tempomandibular joints (TMJs), more commonly known as your jaw joints, are the articulation point of your lower jaw and your skull. The articulation point within each joint should be on a disc (meniscus type tissue). When the articulation point is too far back, the articulation point is on bilaminar tissue (blood and nerve supply) leading to soft tissue impingement which can result in varying degrees of pain and dysfunction. The pain and dysfunction are known as Temporomandibular Disorder (TMD). The disorder is highly undiagnosed, complex and multifactorial since the pain can affect multiple areas often causing the patient to be passed down from one healthcare provider to the next. The healthcare providers end up treating the symptoms rather than the root cause.
A few common symptoms of TMD include:
- Earaches, congestion or ringing in the ears
- Clicking, popping, locking of the jaw
- Tired jaw when chewing or limited jaw opening
- Headaches & migraines, neck pain or back pain
- Eye pain
- Severely worn and broken teeth
The final articulating position on the TMJs (bilaminar zone/soft tissue impingement or a nonpathologic position) are determined by the angulation and position of the teeth (maximum intercuspation of your teeth). Oral muscles can also cause your jaw to go back (tongue thrust). Your jaw will close until your teeth touch (maximum intercuspation) even if the final resting position of the joint is impinging soft tissue. Something as simple as an acrylic splint or retainer can change the final resting position of the TMJs to take the pressure off the nerve and blood supply of the bilaminar zone. This will result in a decrease of symptoms of varying degrees. There are also many ways to develop your jaws and move your teeth to hold you jaw in a position that does not impinge on the delicate soft tissue (bilaminar zone or retrodiscal tissue).
Muscles, bones, and teeth are the focus of our TMD treatment. The length of treatment is based on the treatment method that the patient chooses and their diagnosis arther it be an acrylic splint, or developing the jaws and moving the teeth. More comprehensive treatment takes longer and splints only change the TMJ position while they are worn. Sleep Disordered Breathing (SDB) is a structural problem that is closely related to TMD. Some risk factors are
- Small upper jaw
- Lower jaw that is too far back
- Dental cross bites
- Crooked teeth
- Deep bites
- Hypertrophic closing/biting muscles
Dentists are normally the first to notice TMD because of the close association of the jaws and teeth, but many are not trained on how to correct the disorder. It is essential when treating TMD that you find a reputable doctor in treating a complicated subject.
When treating TMJD we look to dental orthopedics instead of orthodontics. Orthopedics simply put is changing the size, shape, and relationship of the bones of the face and jaws to create symmetry and balance. The simple concept of Orthopedics suggests that dental overcrowding is not due to there being too many teeth, but to the fact that facial growth has not reached its full genetic and growth potential. It takes into consideration airway issues, upper and lower jaw relationship and proper tongue position. Orthodontics simply put is the movement and correct alignment of the teeth. Both disciplines deal with malocclusion or “bad bite”
Dr. Brandi Lindsey prefers to holistically treat TMD with orthopedics, orthodontics and myofunctional therapy. Treatment begins with orthopedic appliances to regrow and reshape the jaw bone and change the jaw relationships to one another and the skull. “Phase 2” is initiated with braces, clear aligners, myobrace or healthy Start System to move your teeth keep your jaw in the new correct position (change the maximum intercuspation) and train how to breathe and position your oral muscles to prevent relapse.