John L. Ward D.D.S.
In Historic Downtown Ruston, LA
Comprehensive Dentistry from the Heart
TMJ Issues and Treatment
As humans we are given a special gift. Namely, a jawbone that "floats" under our skulls that is capable of movement in several directions (side to side, up and down, and front to back). Many animals cannot claim this versatility. Having this ability is to our advantage for the function of chewing (mastication), speaking, and gesturing. Try to imagine having only an up and down movement of our jaws (as dogs are only capable)! The enjoyment of food and the ability to speak would be severely hampered! However, the multi-movement capability comes with a price. Should the teeth be in improper alignment or if there is less than the optimum number of teeth, the system potentially breaks down.
The system referred to here is commonly called the Masticatory System. It has been studied by dentists, physicians and researchers for hundreds of years. In the era of modern medicine, a number of theories have been adopted as to what constitutes health and the deviation to disease or dysfunction. While the scope of this article is limited, it is the author's opinion that the more conservative approach to jaw joint health and function (promoted by Pankey, Mann, Schuyler & Dawson) is safest and best. (Peter Dawson D.D.S., Functional Occlusion: From TMJ to Smile Design (St. Louis:Mosby 2006)
When people ask, "do I have TMJ (or Temporomandibular Joints)?" The answer is yes! Technically, you and the majority (barring deformities) of humans have two! We possess both a left side and a right side joint. The real question is do I have TMD (Temporomandibular dysfunction or disease)?
Sore and painful jaw joints are often difficult for people to manage and endure. The challenge for the one treating them is to answer three broad questions: How did the present issue come about (history)? What is the scope of the current problem (diagnosis)? What are the best and appropriate options for treatment (proper care and treatment planning)?
There are two broad categories within TMD (temporomandibular dysfunction). The most common is occluso-muscular dysfunction. Most of the TMD issues relate to a muscle problem that has at its underlying core a mismatched bite (occlusion). Simply said, "The muscles are not happy because a bite problem is forcing them to act in an unnatural way". There is a zone of comfort that the muscles controlling jaw movements prefer to live in! When our muscles operate outside this zone of comfort, the system will soon show signs of breakdown. Therefore, we can say that all TMD is a stress on the system over time that results in breakdown.
Complicating matters is our adaptive capacity. As humans, our Designer endowed us with a "flexible" response to certain strains on the system. "We bend before we break". Most experts agree that there is a limit to this adaptive capacity. When our masticatory system runs out of options to adjust to the unnatural demand, breakdown occurs.
The second broad category of TMD is internal derangement. This refers to a joint that has been stressed over time (or sudden trauma) causing a tearing of the important structures inside the joint space. This is rarer than the muscle category and often requires specialized care. Therefore, the remaining portion of this article is devoted to the cause, diagnosis and treatment of Occluso-muscular issues associated with TMD.
The Bible refers to people reacting to extreme circumstances by "weeping and gnashing of teeth". Interestingly, the original Greek term for gnashing used is "brugmos" (pronounced broog-mos) meaning literally to "grate" the teeth against one another. Apparently, those who find themselves experiencing stress of Biblical proportions demonstrate the natural response of gritting their teeth.
According to the American Dental Association, other causes partly responsible for teeth grinding include "sleep disorders; an abnormal bite; misaligned teeth; and in children, irritation in the mouth and allergies." Implicated also are the use of tobacco and alcohol. (November 2016, Journal of the ADA).
Often ignored is the connection with temporal (temple area) headaches that can be traced to fatiguing of the muscles that close the lower jaw. Pressing the index fingers on the temples while squeezing the teeth together should elicit minimal discomfort. However, if there is an unusual sensation of discomfort, professional dental advice should be sought.
The obvious question arises, "what can be done about clenching and grinding?" Apologizing for vagueness, the answer is "It depends." While speedy relief of symptoms is the goal of every caring healthcare worker, it is important to arrive at an accurate diagnosis. Is stress the primary component? Is there an underlying but hidden bite alignment issue? Are prescription medications causing the side effect of increased nighttime grinding? Is there a Central Nervous System disorder?
Once a thorough examination and interview have been performed, the cause typically points to a short list of likely contributors to the problem. Narrowing the list to a small handful of possible reasons is crucial.
One of the most utilized therapies (besides prescription muscle relaxers) is use of a bite splint or night guard. The bite splint is a hard plastic appliance that is worn to simulate the optimum bite (in accordance with what the muscles dictate). Custom made by the dentist, it can provide almost immediate relief.
Physical therapy directed toward the muscles that control jaw movements is another treatment option that aids in the relief of discomfort. Once the symptoms have been treated, then it is time for the dentist or qualified healthcare worker to begin testing the muscles, the joints and the teeth for "hidden" causes.
Often times a bite mismatch will be at the threshold of the problem. This may mean a single upper tooth bumps against a lower tooth before the rest can come together. This can be corrected by selective smoothing and polishing of the prominent tooth surface. Dentists call this procedure an equilibration.
Other times the bite mismatch is too involved and requires several restorative options to merely allow alignment to occur. At the extreme end of the spectrum is orthodontics and/or orthognathic surgery.
In other circumstances, the loss of multiple teeth results in a strain on the remaining teeth and masticatory system. This may make chewing difficult or impossible. Years ago, Gerber, the baby food maker, observed a growing market for their products came from senior citizens. Perhaps due to failing teeth or digestive issues a larger percentage of baby food was being consumed by the elderly. Gerber attempted to capitalize on this trend by introducing a product line called "Senior Citizen". It was a failure that quickly was pulled from the market. Apparently, seniors did not wish the checkout clerk (or others watching) to stigmatize them as needing processed food. However, buying baby food could be assumed for a grandchild
In summary, it has been said that signs precede symptoms. It is prudent to watch for signs of teeth grinding that were highlighted above. Should you or someone you love need advice regarding this subject matter, please contact your dental health professional whose practice includes an emphasis on TMJ, Bruxism and bite related issues.
Finally, the gift of jaw movement that we have been afforded is a tremendous asset. Those who have endured the unfortunate treatment of having their jaws wired shut for a season would certainly affirm this notion! Therefore, when we or a loved one begins to experience symptoms related to the breakdown described above, it is time to seek help!
©2018 John L. Ward DDS - A Ruston Dentist
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