Oral appliances (OA) are a front-line treatment available in comprehensive family dentistry for patients with varying needs. They are frequently recommended as the initial treatment for mild to moderate sleep apnea but are also used in conjunction with CPAP therapy to enhance breathing. Indications for Oral Appliance Sleep Apnea therapy Mild to moderate Obstructive Sleep…
TMJ Diagnosis and Treatment
What is TMJ?
TMJ stands for “temporomandibular joint.” The name is quite misleading, as the most common causes of pain are not a result of true joint problems, but are most frequently a result of pain from the muscles around the joint and sides of the face and head. For that reason we prefer to call the problem TMD, or temporomandibular dysfunction
Signs and Symptoms
- Biting or chewing difficulty or discomfort
- Clicking, popping, or grating sound when opening or closing the mouth
- Dull, aching pain in the face
- Jaw pain or tenderness of the jaw
- Locking of the jaw
- Difficulty opening or closing the mouth
There are two matching temporomandibular joints — one on each side of your head, located just in front of your ears. The abbreviation “TMJ” literally refers to the joint but is often used to mean any disorders or symptoms of this region.
Many TMD-related symptoms are caused by the effects of physical stress on the structures around the joint.
- Most commonly the pain is a result of tooth clenching and grinding, causing persistent mild trauma to the muscles of the jaw, face and frequently the neck and shoulders.
- The second most common cause is significant trauma to the head and neck, such as a car accident or a fall that directly traumatized the neck or jaw.
- Changing bite as a result of multiple missing back teeth, causing a shift in the position of the joint.
- Poor sleep is being recognized as a significant causative factor in TMD.
Your dentist will examine your head, neck and jaw joint in the following ways:
- Palpation of the temporomandibular joints for pain or tenderness
- Listening for clicking, popping, or grating sounds during jaw movement
- Looking for limited motion or locking of the jaw while opening or closing the mouth
- observing bite and facial muscle function.
- Panoramic X-rays will usually be taken. These full face X-rays allow us to view the entire jaw, temporomandibular joints, and teeth to make sure other problems aren’t causing the TMD symptoms.
- Occasionally, other imaging tests, such as magnetic resonance imaging (MRI) or a computer tomography (CT), are needed. The MRI views the soft tissue such as the TMJ disc to see if it is in the proper position as the jaw moves. A CT scan helps view the bony detail of the joint.
Treatments available to comprehensive family dentistry for TMD range from simple self-care practices and conservative treatments to dental reconstructions, injections and surgery.
It is our belief that the most conservative effective therapy is the best in relieving or reducing the initial symptoms. Most often additional treatment to stabilize or rebuild the proper bite will be needed to prevent the recurrence of the problem. Common conservative treatment includes the following:
- Moist heat, soft foods, OTC pain relievers such as ibuprofin, anti-anxiety medications, short-term muscle relaxants.
Early and mild symptoms can frequently be reduced or eliminated with these simple palliative treatments.
- Bite splints/Bite guards: to prevent clenching, relax jaw muscles, temporarily restore a poor bite to relax muscles
Designs and usage varies, some for daytime use and some for night-time use.
- Bite adjustments: non-orthodontic stabilization of the bite by adjusting the way your teeth meet when you close and move the jaw.
- Corrective dental treatment: orthodontics, bite reconstruction, replacement of missing teeth.