TEMPOROMANDILBULAR JOINT (TMJ)

What is the TMJ?

Temporomandibular Joint (TMJ) is the joint in which the mandible (lower jaw) articulates with the base of the skull on the Temporal bone.

TMJ is responsible for the up, down, left, and right movement of the mandibule.

What is TMD?

TMJ disorder or TMD is a group of disorders that consist of myofascial pain, internal derangement of the joint, and/or inflammation of the joint in the form of arthritis. The aetiology of these disorders is not fully understood yet, however, habitual clenching and grinding of the teeth, trauma to the jaw, whiplash from automobile accidents, and sleep apnea can generally aggravate the problem.

The symptoms of TMD can range from muscle stiffness in the jaw and temple areas, discomfort when opening and closing the mouth, clicking, grating, or popping of the joint when in motion, radiating pain in the face and jaw areas, limited movement of the jaw or even a lock jaw, as well as migraines and headaches. There are various interventions that can be done in order to minimize these symptoms.

Reducing the symptoms of TMD?

Mild TMD discomfort can be controlled by following certain home care steps that range form eating soft foods, avoiding extreme movements of the jaw, applying cold therapy, and gentle exercising and stretching of the jaw. Also, pain management with non-steroidal anti-inflammatory drugs (NSAID), such as Ibuprofen, Motrin, or Advil, can be done for those transient painful episodes.

When TMD symptoms can’t be controlled and the discomfort seems to be worse, an oral appliance that would stabilize the jaw can be used, called a night guard. After a diagnostic consultation, an impression of the teeth and how they articulate together is taken, then the night guard is fabricated specifically for the lower or upper teeth. This approach is the most widely used treatment due to it conservative nature and clinical success.

Neuromuscular Dentistry

A neuromuscular (NMD) approach is another way of resolve symptoms associated with TMJ. NMD works best when the symptoms are relate to the jaw muscles and bite. After a consultation with the practitioner, we establish a relaxed jaw position by using a myomonitor or a tensing unit (BNM-40). This devise delivers a mild electric stimulation to the muscles of the jaw through adhesive patch electrodes, allowing the muscles to go into a relaxed state. Once the jaw muscles are in the relaxed stage, a putty-like material is placed in between the teeth – bite registration – to record the position of the teeth in relation to each other. Then an oral orthotics is fabricated to fit the teeth and mimic that relaxed position.

Acupuncture and Laser Acupuncture

Pain relief can be achieved by using alternative and complementary medical therapy, such as acupuncture and laser acupuncture. Research results suggest that acupuncture is an effective intervention in reducing symptoms associated with TMD. The treatment alters the EMG of masticatory muscular activities, that in turn reduces the muscular spasm and then reliefs the painful episode. In addition, this non-invasive and no side effects modality is effective for in relieving chronic myofascial pain associated with grinding/clinching of the teeth and bruxism. Before the treatment, a thorough investigation is done to establish a treatment plan and if acupuncture/laser acupuncture is the right modality for you.

Some of the latest research on Acupuncture and TMD:

  • Acupuncture in the Treatment of Pain in Temporomandibular Disorders: A Systematic Review and Meta-analysis of Randomized Controlled Trials. The Clinical Journal of Pain, 06/18/2010
  • Acupuncture for temporomandibular disorders: a systematic review. J Orofac Pain. 2010 Spring;24(2):152-62.
  • Effectiveness of Acupuncture in the Treatment of Temporomandibular Disorders of Muscular Origin: A Systematic Review of the Last Decade. The Journal of Alternative and Complementary Medicine. January 2010, 16(1): 107-112
  • Acupuncture and Temporomandibular Disorders: A 3-Month Follow-up EMG Study. The Journal of Alternative and Complementary Medicine. December 2009, 15(12): 1307-1310.
  • Effects of Trigger Point Acupuncture Treatment on Temporomandibular Disorders: A Preliminary Randomized Clinical Trial. Journal of Acupuncture and Meridian Studies. Volume 5, Issue 2 , Pages 57-62, April 2012