TMJ Help Program

It is possible to strengthen just about every single part of our bodies in some way or another. This is even true for our jaws. Yes, it is possible to do TMJ exercises and strengthen your temporomandibular joint. The TMJ is the joint that is in charge of how your jaw moves. It controls the opening and closing of your mouth and the movement of your lower jaw from side to side. It’s a cartilage covered ball and socket joint. The joint also has a disk in it whose job is mainly to prevent wear and tear from taking their toll on your jaw. While your jaw gets plenty of exercise when you eat, there might be other times when you want to do other kinds of exercises that will improve the health of your jaw.

Most people can go their entire lives without experiencing severe problems with their temporomandibular joints. Of course between five and fifteen percent of the population do experience some kind of problem with their TMJs and experience some kind of pain. Making sure to exercise your TMJ can help you prevent as well as overcome many of the issues that accompany TMJ disorders. Just make sure to do them properly or you could injure your jaw further.

A similar comparison can be made to sore elbows and ankles. If your elbows and ankles are sore, do you need to exercise those parts of your body all the time to heal them if they are injured? Of course not. Typically you apply ice and heat to the affected area of your body and then, once it starts to feel better, you might exercise it to strengthen the muscles that surround it. This is the same thing that you need to do with your temporomandibular joints. While there are facial yoga exercises that you can do to strengthen your jaw, if you over do it then in the long run you could end up doing more harm than good.

If you have been experiencing signs and symptoms of a TMJ disorder you need to figure out what is causing the problem before you try any strengthening exercises or begin any treatments. Sometimes they are caused by the shifting of your teeth (this can’t be cured by facial exercises). Sometimes the disorders are caused by stress in your daily life. Before you try to treat the problems in your jaw joint, you need to figure out what is causing your jaw to move incorrectly or to lock. Seek out the help of your doctor and dentist to figure out what is causing your disorder. Exercising your TMJ could only exacerbate the problem if you try to do the exercise before figuring out the cause of the problem.

Of course, there are plenty of reasons that you should exercise your temporomandibular joints on a regular basis. Exercise will strengthen the joint and the stronger your jaw, the easier time it will have standing up to the wear and tear of TMJ disorders. Just make sure to proceed with caution if you start to experience pain.

Most of us can go through our entire lives without giving much thought to the smaller parts of our bodies that we use all the time. One of these parts is the temporomandibular joint (or TMJ) or the joint that helps your jaw move. Most of us don’t spend much time (if any time at all) thinking about this. In fact most of us don’t start thinking about our bodies until something starts to hurt. Of course, once something starts to hurt, then it is all that we tend to think about. The same is true for TMJ irritation. And when this occurs, you might need to see a doctor for TMJ diagnosis and treatment. A professional diagnosis is the best way to figure out what’s really the problem and treat it appropriately.

TMJ disorders and problems affect roughly ten percent of the population at least once in their lifetimes. Usually, however, it is a small problem that can easily be cured with some preventative treatments. Sometimes, unfortunately, the problems happen because of serious jaw disorders and once in a while these problems require corrective surgery. The good news is that this only happens to a very small percentage of the people who experience problems with their TMJ.

One of the best ways to ensure that you are able to properly treat a TMJ disorder is to recognize the symptoms associated with it and know when to see your physician and dentist. While the pain could be localized to your actual joint, it is possible for it to radiate to other places on your face and up to your ear. Some people hear clicking while they chew or talk but that isn’t a definite symptom of a TMJ disorder. Sometimes it may also cause headaches or an uneven bite (which can cause problems with chewing).

When you visit your doctor and dentist to have a TMJ disorder diagnosed, you will go through a series of tests. Your doctor will start by having you move your jaw in different directions while he or she listens for any noises and feeling for any odd movements that the joint might be making. Some doctors and dentists will analyze your bite by having you bite down on a piece of wax. This will help them see how your teeth come together when you bite. Lastly they might do a series of x-rays or other procedures that will help them see exactly how your jaw is set and identify any problems that could be contribute to TMJ disorder.

Typically, these disorders are easily treated with simple stress management. This is because most are caused by repetitive motions like chewing or teeth grinding. You might also need some dental or orthodontic treatment to solve the problems and treat the disorder. There are also some other good resources that are available to solve the problem yourself that have proven to be effective and less expensive. Whatever your treatment plans, remember that all of the treatment you do is to increase the health of your TMJ joint.

Headache and TMJ syndrome may go together if you have chronic recurring headaches. While wildly over diagnosed in the 1970’s recently newer imaging techniques, such as MRI’s, have allowed for a better look at this facial joint that causes so much pain.

TMJ or temporomandibular joint syndrome as the disorder is commonly called is poorly understood at the present time in terms of how it is caused. While many patients have bruxism or grinding of the teeth at night, others may have had trauma, osteoarthritis, or rheumatoid arthritis. Many times the cause is unknown. For those of you with migraine, the constant clenching of the jaw causes muscle spasms in the temples. This then leads to a migraine.

The symptoms of TMJ may be any or all of the following: pain or tenderness in jaw and/or around the ear, difficulty chewing, a clicking sound when jaw is opened, spasms causing the jaw to “lock” when open or closing, uncomfortable or uneven bite, and finally, headache!

Testing for TMJ

Diagnosing TMJ involves a good history of how you sleep, grinding habits during the day and general tension. An exam of the jaw should involve palpation of the joint both inside and outside of the mouth. Imaging of your jaw may be needed to find out how much damage is in the joint. X-rays, a CT of the jaw or even an MRI would assist the doctor. Once diagnosed you should be referred to a dentist who specializes in TMJ syndrome.

Treatment of TMJ

Treatment of TMJ may greatly reduce your headaches. But like anything else, a multi-factorial approach to the problem will yield the best results for you. These are the most common treatments for TMJ sufferers who also have migraine.

Overuse of jaw muscles. This is mostly a lifestyle change. You must be willing to recognize when you are grinding your teeth during the day and learn to relax the jaw. Also, try not to eat foods that are difficult to chew until you heal a bit more.

Appliances .Depending on your particular situation, the dentist may make a bite plate or splint to help align your teeth at night. A night guard appliance could also be used to help prevent grinding.

Medications. Various medications may ease your pain and thereby reduce your headaches. A short course of steroids will reduce inflammation, or if the condition is not severe an anti-inflammatory could be used. Spasming of jaw muscles could contribute to the problem, and the ideal medication for this is Elavil.

Dental Repairs. Your dentist may recommend dental work that may not make much sense to you at first. However, correcting bite, repairing teeth and filing down tooth edges that aren’t meeting correctly will all serve to decrease TMJ.

Surgery. This is a final option and is reserved for cases where the above options have failed. In this case the joint is so badly damaged that joint reconstruction or replacement may be recommended. And again..your headache and TMJ may be reduced!

If in doubt, see your dentist to begin with and ask about testing for TMJ. Discuss this with your headache specialist also as they are very familiar with the condition. If you do not see a headache specialist, your primary care physician should be able to help.

TMD X-Ray and Tomography

Temporomandibular joint tomographic x-rays play a valuable role in diagnosis and treatment. Recent studies have concluded that a fairly high rate of unexpected new osseous and positional findings support the need for tomograms in patients with a clinical diagnosis of derangement or joint pathology. Approximately forty to fifty percent of tomographic radiographic examinations produced a change in diagnosis.

Tomography is medically necessary to evaluate bony changes in the condyle and temporal bone such as flattening, erosion, and sclerosis. Condylar position and asymmetries of mandibular anatomy can be most clearly evaluated with the exacting multiple slice technology of tomography. Additionally, the ability to screen for additional abnormalities such as tumors or cysts is provided by tomographic radiography.

References:

Efficacy of TMJ radiographs in terms of expected versus actual findings, UCLA, Oral Surgery, Oral Medicine, Oral Pathology 1995;79:367-81

Care for Temporomandibular Disorder Cervical and Facial Myositis and Cephalgia

Treatment consisted of maxillary and mandibular orthopedic repositioning appliances to recapture the displaced discs. The maxillary appliance serves as a stabilizer for sleeping and reclining to offset gravitational forces. This appliance is very bulky in the anterior area and would greatly impede mastication and speaking. The mandibular appliance was fabricated and is intended for daytime use and can be used for mastication and usual daily activities.

TMD Trauma

A study in the Journal of Oral Rehabilitation in 1996 titled “Trauma in Patients with Temporomandibular Disorders: frequency and treatment outcome” was to assess the incidence of jaw injury in TMD patients and to compare the severity of the symptoms, the clinical characteristics and the treatment outcome in TMD patients with or without a history of trauma to the head and neck region directly linked to the onset of symptoms. The study sample included 400 consecutive TMD clinical patients. In 24.5% of patients the onset of the pain and dysfunction could be linked directly to the trauma, mainly whiplash accidents.

No significant differences could be found between the two groups in daily recurrent headache, dizziness, neck pain, joint crepitation and pain in the joints. Maximal mouth opening was less than 2-0 mm in 14.3% of patient with a history of trauma and in 4.1% of those without such a history. According to the Helkimo dysfunction index (DI), more trauma than non-trauma TMD patients belonged to the severe dysfunction groups (DI 4 and 5) at first examination.

The outcome of a conservative treatment procedure (counseling, occlusal splint, physiotherapy, occasionally occlusal therapy and non-steroidal antiinflammation drugs was not different between the two groups at the 1 year evaluation. The degree of maximal opening was similar: less than 20 mm in 3.7% and 2.2% in trauma and non-trauma patients respectively.

Forty percent and 41% respectively were symptom free or had DU = 1. The results suggest that external trauma to the joint or to the jaw in general is an important initiating factor in the etiology of TMD and also that the prognosis is favorable.

Treating for a Temporomandibular Disorder and Cephalgia

The necessity for range of motion movements is as follows:

Taking range of motion movements is an accepted test for diagnosis and treatment of temporomandibular disorders. The measurements are a tool to evaluate progress and assist in treatment decisions. Normal range of motion for mandibular opening is approximately 50 mm with 12 mm being the norm for right and left lateral excursions. A reduced opening with difficult excursion may indicate a severe trismus or a closed lock of the temporomandibular joint. An opening much above the norm may indicate hypermobility and stretched ligaments in the jaw joint.

A Clinical Outline of Temporomandibular Joint Diagnosis and Treatment, by Dr. William B. Farrar and Dr. William L. McCarty examines in detail the necessity for various range of motion measurements and is suggested reading.

Surgical procedures and/or an orthopedic repositioning appliance were provided to reposition the mandible, relieve muscle pain, edema, nerve impingement and recapture the displaced articular disc.

Restorative procedures are necessary to complete orthopedic stability of the mandible and maintain the current jaw position. A specific court ruling regarding insurance cases states:

Goss v. Medical Service of the District of Columbia, DC Court of Appeals, No. 81 1276, 13 June 1983.

The medical insurer’s position was that restorative bridge work is considered dentistry. The patient’s position was that the crowns were medically necessary to correct a malpositioned jaw.

Court results: “There was no need for the crown and bridge work independent of the jaw. In fact the crowns were directly related to and required by the medical condition affecting the jaw. The treatment did not treat the teeth or tooth relationship as the patient’s teeth were used only to support the devices required to stabilize the jaw position.”

A Medical Necessity

Clinical examination revealed: articular disk disorder, muscle spasm, and cephalgia.

An orthopedic jaw stabilization orthotic was placed to position the condyles in the fossa in a more true anatomical position, reduce stress to the jaw joint, increase joint space, allow remodeling of the condyle, heal retrodiscal tissue, capture the dislocated articular disc, provide proper alignment of the mandible to the skull, reduce myospasm and pain, and maintain the muscles of mastication in proper physiologic resting length.

This appliance is orthopedic and neuromuscular treatment and should be considered as a medical necessity by the insurer.

Post Surgical Orthotic / Medical Necessity

A post-surgical orthotic device is designed to allow healing of the retrodiscal tissue and stabilize the mechanism of the temporomandibular joint. The orthotic is important for rehabilitation. Without it, extreme pressure and intra-articular edema could result. Postsurgical orthotic therapy is used to position the jaw in a similar fashion as if a stabilization splint or cast were used post-operatively on a knee, hip or any other joint. The orthotic therapy is treatment to bone, cartilage, ligaments, and muscles and should be handled as a medical necessity by insurance carriers.

Orthodontics

Symptoms of headaches, facial pain, and dizziness. Objective findings included limited range of motion, muscle tenderness upon palpation (masseter, temporalis, bilateral), crepitus of the temporomandibular joint, and deviation of the jaw upon opening and closing. Maxillary and mandibular interdental fixation devices (CPT 21110) were placed to provide a stable jaw position. Treatment was not to the teeth but was orthopedic and neuromuscular in nature. Courts have ruled on similar insurance claims sent to medical insurance that “devices used to treat the patient’s condition were intended to relieve pain from the mandibular joint rather than to correct dental problems. Reasonable minds would not inevitably conclude that, as a matter of law, procedures performed were “dental services” excluded from coverage under health policy”. Because of the medical nature of the diagnosis, treatment should be considered as a medical necessity.

DO YOU wake up in the morning with an aching jaw, headache, and difficulty opening your mouth? You have probably been grinding your teeth.

Regular grinding, known as bruxism, can wear teeth away and almost rivals snoring on the annoyance scale.

- Stress is believed to be a major role in the condition and it is also linked to the non-alignment of the top and bottom teeth.

- The mind subconsciously tries to correct the position during sleep, triggering the grinding.

- Other causes include snoring and sleep apnoea, where the upper airway relaxes during sleep causing blockage of airflow.

- Drinking tea and coffee or alcohol before going to bed can also increase the chance of tooth grinding.

- Some may be unaware they are grinding away so it’s worth asking the dentist for a check-up.

- Damage to teeth can often be repaired and there are mouth-guards available to help protect from further damage.

You may have to wear this mouth-guard for life and it’s worth finding out if it needs to be renewed as your teeth change.

- If the grinding is due to misalignment you should talk to your dentist about a brace.

- Other possible remedies include hypnosis and behavioural therapy to allow you relax.

- Avoid chewing gum: the repetitive action of chewing is almost identical to the motion of the jaw during bruxism.

- Hold a warm, damp cloth to your face before bedtime to relax the jaw.

Do you clench and grind your teeth? Are you waking up with painful headaches that radiate from your temples, ears or jaw? Do you have limited mouth opening? Do you have sensitive teeth, loose teeth or toothaches in the absence of tooth decay? Do you have crowns or cosmetic veneers that constantly come off and need to be re-cemented periodically? Do you have clicking or popping of your jaw joint?

If you answered yes to any of these questions, then you may be suffering from a common problem known as TMJ Disorder, an often misunderstood or misdiagnosed condition. In our 18 years of experience Downtown, we have successfully treated thousands of patients for this problem. Our experience has led us to believe that TMJ Disorder is prevalent in the Downtown population.

The Downtown patient works on average more than 40 hours per week and shoulders most of the responsibilities in the household. This results in high levels of stress due to the high pressures of daily life. There is no doubt that stress is a major factor in increasing the symptoms of TMJ, but contrary to what most people believe, it’s not the primary cause. The primary causes are reflexes that are triggered by the teeth that cause spasms of the numerous muscles of the jaw, neck and face.

Most joints of the body are fixed in a hinge axis. This is the same movement a door makes when it’s opening and closing from its hinge. The jaw joint is the only joint in the body that is able to slide out of its socket. Because it can do this, it’s able to deviate from its hinge axis and do the complex motion of chewing, an ability we all take for granted.

If teeth occlude (come together) at the hinge axis position of the jaw, most people would be fine. However, if the teeth developed in a position where the bite occludes outside this hinge axis, where the jaw is slightly protruded from the socket, then there is a potential for TMJ symptoms. The average person cannot tell if their bite comes together forward of this hinge axis, only observing that their jaw is intermittently sore or they have a sudden, uncontrollable urge to clench and grind their teeth. Only a properly trained dental professional can diagnose if the teeth are occluding outside of this hinge axis position.

The initial treatment for TMJ Disorder is relatively simple and noninvasive. However, it does require thorough care by a dental professional. We simply make a custom TMJ splint, adjusting it meticulously at several appointments so that the patient’s teeth come together on the device in the ideal hinge axis position. After achieving proper adjustment the splint will eventually neutralize the harmful reflexes. A mouth guard from a drugstore or by mail order will not resolve TMJ Disorder because it will be arbitrarily set to a bite position. After wearing a proper TMJ splint for only 48 hours, the TMJ patient will notice a difference. They will find that their jaw feels more rested, headaches occur less frequently and teeth sensitivity is resolved.

For the most part, TMJ Disorder can be managed with splint therapy. But fixing the bite itself could be required if an individual cannot wear a splint indefinitely, by either re-contouring certain teeth, doing crowns and/or veneers, doing orthodontic treatment or a combination of any of these treatments. But contrary to what most people have heard, there is an effective treatment for this disorder. At the same time, if not treated and ignored, it will worsen, resulting in breaking teeth, worsening gum disease and/or severe jaw joint damage requiring painful surgeries.

A landmark study at the University at Buffalo on the causes of facial and jaw pain is in the final stages of recruiting participants.

The last time you visited your dentist, perhaps he did a test for TMD — a disorder involving the joints and muscles in the jaw. It can be extremely painful. But dental researchers don’t know much about what causes the disorder. In 2006, the School of Dental Medicine at UB received $3.3 million for the first large-scale study of risk factors.

Associate Professor Richard Ohrbach, who is heading up the study, says he and his colleagues have recruited 700 people for their study. They need another 140 by the end of October.

For now, Ohrbach says they’re primarily looking for people who do not have TMD symptoms. He says they’ll be tracked for the next three to five years to determine who and how many develop the disorder.

Once that information is in hand, Ohrbach says researchers will be better able to treat — and event prevent — the disorder. He says 60 to 70 percent of the population will display some sign of TMD in their lifetimes. But just one in ten have serious enough symptoms to require treatment.

People interested in participating in the UB study should call the Dental School hotline at 829-2984.

Out of Alaska comes Dr. Catherine Mormile, a new leader in health care with her bold, new book, which explains that temporomandibular joint disorders (TMD) are really one word for two diagnoses. One diagnosis, joint TMD presents with measurable structural damage to the cartilage, bones, and ligaments of the joint itself. The other, muscular TMD, presents as a painful condition of the muscles involved in chewing, and often involving the muscles of the scalp, base of neck, and shoulders. With a background of stubbornly surviving near-death on the Iditarod Trail, academic excellence, and scientific inquiry, Dr. Mormile now offers her one-of-a-kind way of thinking and approach to the nagging problem of TMD to all.

Anchorage, AK (PRWEB) August 14, 2008 — Out of Alaska has come a new leader in health care with her bold, new ways to explain and treat temporomandibular joint disorders (TMD). With background of stubbornly surviving near-death on the Iditarod Trail, academic excellence, and scientific inquiry, doctor of physical therapy, Catherine Mormile has written and illustrated a new ground breaking and evidence-based book, which explains a new paradigm concept: Temporomandibular joint disorders: One name for two diagnoses.

Using her signature thinking out of the box approach, Dr. Mormile shatters previously held notions to identify and explain a fresh new way of approaching temporomandibular joint disorders to clinicians and patients alike.

Disorders of the temporomandibular joint are sources of distress and dysfunction for an estimated 10 million Americans. Temporomandibular joint disorders can occur in men and women alike. However, four times more women report TMD dysfunction than men. Additional distress of TMD occurs when both the patient and medical practitioner attempt to accurately identify the problem because, like the two sides of one coin, TMD is one name for two diagnoses. One diagnosis, joint TMD presents with measurable structural damage to the cartilage, bones, and ligaments located within the joint itself. The other, muscular TMD, presents as a painful condition of the muscles involved in chewing, and often involving the muscles of the scalp, base of neck, and shoulders. Muscular TMD is often a sub-class of fibromyalgia and some regional pain disorders. Sometimes both muscle and joint conditions occur simultaneously.

Dr. Mormile has successfully treated more than a thousand TMD patients in her private practice in Anchorage, Alaska. This book was forged after her personal recovery of surviving a near-death experience and subsequent traumatic brain injury while competing in the Iditarod sled-dog race. Upon recovery, she wrote the 228-pg. text and illustrated the 140 black and while pencil drawings at her Knik, Alaskan homestead with her husband and more than thirty furry animal companions.

In 2006, in recognition for over coming adversity and ridicule while continuing to serve the State of Alaska and its people, she was awarded an Alaska State Legislature citation.

Dr. Mormile now offers her one-of-a-kind way of thinking and approach to the nagging problem of TMD to all.

Temporomandibular joint disorders: One name for two diagnoses is currently available for $49.95 plus $7.00 shipping and handling by contacting: Mormile Physical Therapy, 1600 A Street Suite 215, Anchorage, Alaska, 99501, phone (907) 561-1800, Fax (907) 562-4705 or e-mail donmormile @ alaska.net.