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Temporomandibular Joint Disorder (Known as TMJ or TMD)

TMJ, Neck Pain, & Migraines

At Riverbend Dental Center, Dr. Schmidt takes a comprehensive approach to treating Temporomandibular Joint Disorder, looking at patient's overall medical history and lifestyle, as well as what may have caused the patient's TMJ problems.

First of all, it's important to understand what people mean when they say "I have TMJ." Actually when sufferers say they have TMJ, which actually just stands for the Temporomandibular Joint, they really mean they have TMD, which stands for Temporomandibular Joint Disorder. Both terms are used though to describe the condition. TMJ Disorder can be a painful, debilitating condition that often gets worse over time when untreated. Some patients only experience minor discomfort for the condition, other can experience extreme, life-altering pain. TMJ Disorder is a complex condition because there can be so many factors involved. Muscles, nerves, tendons, bones, teeth, and connective tissue can all contribute to the problem, so unlike a broken leg or a cracked tooth, there is usually not just one issue that the doctor or dentist has to deal with when treating the problem. The TMJ connects the lower jaw (mandible) to the skull (temporal bone) in front of the ear. Muscles attached to the jaw and surrounding the jaw joint control the position and movement of the jaw, which allows you to move your jaw side to side or open and close it.

It's important to remember that when you are opening or moving your mouth, it is NOT normal to experience pain. When everything is working as it should, you should be able to chew, yawn and smile with no pain or discomfort. Any type of pain is one of the several warning signs that something is not right. TMJ Disorder can actually cross over among the specialties of orthopedics, neurology, and dental/orthodontics, leaving the patients sometimes unsure who he or she should visit first.

What causes TMJ Disorder?

Here are some of the common causes of TMD:

  • Grinding or clenching your teeth
  • Accident or injury
  • Osteoarthritis or rheumatoid arthritis in the TMJ
  • Stress (Stress is bad for our bodies for a number of reasons….in the case of TMJ Disorder, stress can cause a person to tighten their facial and jaw muscles)
  • Dislocation of the disc or soft cushion between the ball and socket

Do I have TMJ Disorder?

Some common warning signs

  • Pain or tenderness in the face, jaw joint area, neck and shoulders
  • Pain when chewing or talking
  • Frequent neck aches or headaches
  • Waking up with stiff or sore muscles around the jaw
  • Limited ability to open the mouth
  • Ringing in the ears
  • Hearing problems
  • Dizziness
  • A jaw that gets locked in the open or closed position
  • Clicking, popping, or grating sounds in the jaw joint when opening or closing the mouth (which may or may not be accompanied by pain)
  • A tired feeling in the face that can sometimes cause a feeling of numbness
  • Swelling of the face (sometimes just on one side)
  • Change in your bite

Diagnosing TMJ Disorder:

The good news is that in most cases, TMJ Disorder can be treated, and pain relieved, without going under the knife. Treatment may involve the use of a special dental splint, orthodontics, or a combination of both, but diagnosing the type of TMD and severity of the problem can be difficult if a professional does not have the experience and equipment for a proper diagnosis. At Riverbend Dental Center, we have the latest diagnostic equipment to quickly and painlessly determine the severity of your problem.

Because we recognize how serious and common TMJ Disorder is, and that it is often misdiagnosed when the right equipment is not used, at Riverbend Dental Center we have made a big investment in the acquiring the latest and greatest to properly diagnose TMJ Disorder. Because of this cutting edge equipment, we can also show patients on a computer screen, 3d X-rays, and printouts exactly where the problem is, how severe it is, and why it requires the treatment plan prescribed by Dr. Schmidt.

Diagnosing TMJ Disorder - Kodak 900 ExtraOral Imaging System

After the patient fills out a comprehensive medical questionnaire, Dr. Schmidt will typically take X-rays with the Kodak 9000 Extraoral imaging system, a state-of-the-art system that allows Dr. Schmidt to see inside the jaw, the joints, and the discs, and rule out any other issues that may be contributing to the patient's problem. 2D and 3D images are produced by this cutting edge system, and the entire scan takes less than 3 minutes.

Diagnosing TMJ Disorder - T-Scan® III

Computerized Occlusal Analysis

At Riverbend Dental Center, Dr. Schmidt uses the T-Scan as one of his tools to help him diagnose and treat a number of problems involving the bite. When a bite is off it can cause pain, broken restorations, gum disease, tooth loss, headaches and even TMJ disorder. The T-Scan is the only clinical diagnostic device available that senses and analyzes occlusal contact forces to quantify whether a patient's bite is actually balanced. And the best part, is patients can actually see on the flat screen TV in their treatment center exactly what is going on with their bite. Dr. Schmidt actually plays the patient a short "movie" of the bite analysis after it's done (the entire test takes just a few minutes), and a printout of the results can also be provided for the patients. "Bottom line, the T-Scan has become one of our valuable tools that gives us a precise, no guesswork analysis of the patient's bite. There's no gray area anymore when it comes to the patient's bite. This device is great for us, the dentist, in terms of developing the best treatment plan, whether orthodontics and/or TMJ disorder treatment is needed, and it's great for the patient, because it shows them on the video screen exactly what's going on inside their mouth with their bite," said Dr. Schmidt.

For years, dental occlusal analysis (which basically means in layman's terms measuring patient's bite) has been largely a matter of guesswork for dentists. Before, Dr. Schmidt says methods like wax, and pressure indicator paste were basically all dentists had to assess and balance the occlusal forces. Most of these methods are not sensitive enough to detect simultaneous contact, and none measure both biting time and force. Thanks to the T-Scan® system, Dr. Schmidt says these issues have all been addressed.

How does computerized occlusal analysis work?

The ultra-thin, reusable sensor (Dr. Schmidt likes to refer to it as a "wafer"), is shaped to fit the patient's dental arch. The "wafer" is inserted into the sensor handle, which connects into the USB port of Dr. Schmidt's computer. Evaluating occlusal forces is now as simple as having a patient bite down on the sensor while the computer analyzes and displays timing and force data in high resolution, vivid, full-color 3-D or 2-D graphics.

Diagnosing TMJ Disorder: JVA (Joint Vibration Analysis)

The JVA is now available at Riverbend Dental Center! Here's a look inside this cutting edge technology that helps Dr. Schmidt make a precise, accurate TMJ Disorder diagnosis.

JVA - A very simple principle
Bio-JVA Joint Vibration Analysis is based on simple principles of motion and friction: When smooth surfaces rub together, little friction is created… and little vibration. If these surfaces become rough, then friction and vibration are created when these surfaces articulate
BioJVA™ Fast and Accurate
JVA provides a fast, non-invasive, and repeatable measurement of TMJ function to aid in your diagnosis of TMJ function. Understanding TMJ function is vital anytime you are changing the vertical, lateral, or A/P position of the mandible. Common treatments that change mandibular such as TMD treatment, Orthodontics, Prosthodontics, Reconstruction and Sleep Dentistry can all from JVA testing.
How it works
Human joints have surfaces which rub together in function. Smooth, well lubricated surfaces in a proper biomechanical relationship produce little friction and little vibration. But surface changes, such as those caused by degeneration, tears, or displacements of the disk, generally produce friction and vibration. Different disorders can produce different vibration patterns or "signatures". PC-assisted vibration analysis helps identify these patterns and helps you distinguish among various TM disorders.

TMJ Disorder Treatment Options:

At Riverbend Dental Center, Dr. Schmidt takes a comprehensive approach to treating each patient's TMJ problems. There are a number of non-surgical treatment options Dr. Schmidt may present the patient with, including various appliances that can be worn. Although Dr. Schmidt will determine which device is best for each individual patient's specific case, the MORA device has been one of the devices he says has given many of his TMJ Disorder patients a lot of relief. In some cases, an appliance like the MORA may be worn first, followed by some type of orthodontic treatment, especially if a misaligned bite is one of the contributors to the patient's TMJ Disorder.

MORA Device

Although TMD treatment is based on each individual patient's specific needs, many patients find tremendous relief with the use of a removable appliance like the MORA. The MORA devices stands for Mandibular Orthopedic Repositioning Appliance. It is designed to reposition the mandible with its condyle to achieve optimal neuro-muscular balance. Dr. Schmidt says basically what the MORA is doing is helping the patient get a balance between the muscles they chew with, the jaw bone, and the skull. Dr. Schmidt likes to call the MORA Appliance a TMJ patient's crutches! Imagine walking around with a broken leg without a cast and crutches. Dr. Schmidt says for a patient suffering with untreated TMJ, not wearing the proper corrective appliance is basically like walking around without treating a broken or fractured limb. The appliance consists of clear acrylic bite pads covering the molars and bicuspids connected by a heavy, oval lingual bar. While it may take a little getting used to speaking with the appliance in, because it is clear and fits over the bottom teeth, the MORA is not very noticeable when worn. How long does it need to be worn? Dr. Schmidt says it can take anywhere from a few months to a year to get the jaw repositioned properly and eliminate pain or clicking depending on the patient's specific case.

Some Lifestyle changes to help ease the discomfort of TMJ Disorder:

  • Eat soft food: Eating soft foods is recommended for patents suffering from TMJ Disorder, especially those in the initial months of treatment. Also, try cutting your food (especially things like steak) into small pieces to decrease the amount of chewing required. Avoid hard and crunchy foods (Ice and whole almonds are 2 of TMD's biggest enemies!) and foods that require your mouth to open wide. (Overstuffed poboys may not be your best friend anymore!
  • Apply moist heat or cold packs: Sometimes Dr. Schmidt will recommend patients with severe TMD see a physical therapist. Often times the physical therapist will recommend that the patient do some easy, at-home exercises to relax and stretch the muscles around the face and jaw. Applying ice and heat as directed by Dr. Schmidt and/or your physical therapist can also bring a patient additional relief. When and how to apply the ice and heat may depend on your specific condition, so make sure to follow instructions given by your dentist or therapist.
  • Avoid extreme jaw movements: It may be easier said than done, but especially those with acute cases, try to avoid a lot of chewing, yelling (not good for the soul anyway :) and yawning. Remember, especially while your TMD is being initially treated, everything should be done to make sure there is as little trauma and movement to this area of your body on a daily basis.
  • Keep your teeth slightly apart: What a lot of TMD sufferers don't realize is that they are often clenching their teeth, even when they don't realize it during the day. One easy tip is to keep your mouth slightly open throughout the day. Try this easy tip… Place your tongue between your teeth. It can be an easy way to remind yourself not to clench or grind. For those in stressful work or personal situations, be especially mindful of doing this, because it's often one of the ways our bodies react to stress. This is also why you may notice that when you are going through a very stressful situation, your neck tenses up, and your shoulders and back may start to give you problems as well.
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© Copyright 2006 - Dental WebSmith, Inc. and Glenn V. Schmidt, DDS, MS. All rights reserved worldwide. Disclaimer: The information provided within is intended to help you better understand dental conditions and procedures. It is not meant to serve as delivery of medical or dental care. If you have specific questions or concerns, contact your health care provider.


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© Copyright 2006 - Dental WebSmith, Inc. and Glenn V. Schmidt, DDS, MS. All rights reserved worldwide. Disclaimer: The information provided within is intended to help you better understand dental conditions and procedures. It is not meant to serve as delivery of medical or dental care. If you have specific questions or concerns, contact your health care provider.