It can be challenging for dentists to get at the root cause of a patient’s TMD symptoms, but that’s where our specialized neuromuscular training helps our patients. At Hiebert Smith Dental Group, we use neuromuscular dentistry to look beyond the care of individual teeth, focusing instead on how the teeth, jaw, head, and neck function in harmony. By widening the outlook beyond the jaw and teeth, we can customize treatments that correct overbites, unusual tooth wear, painful jaw symptoms, and other issues revolving around TMD.
What Is Neuromuscular Dentistry?
Neuromuscular dentistry is a branch of dentistry that considers the physiologic aspects of head and neck symptoms. This type of dentistry seeks to cure TMD by retraining the muscles, tissues, and nerves to properly align the jaw at rest. If left untreated, the jaw must work harder to perform basic functions, such as chewing or speaking and in turn may repeatedly injure the surrounding muscles.
What Is Temporomandibular Disorder (TMD)?
Any type of discomfort involving pain or tenderness in the muscles and/or joint that control jaw movement is referred to as Temporomandibular Disorder, or TMD & TMJ. These are the joints that make it possible for us to move our jaw sideways, forward and in circular motions. Normal day to day habits like chewing, talking, yawning will become very uncomfortable, meaning it should be taken care of as soon as you notice these symptoms. Some patients suffer from this condition for many years without seeking help. Have a consultation with Dr. David Hiebert or Dr. Keri Smith to learn what you can do to help your TMD pain.
What’s the Difference Between TMD, TMJ, And TMJD?
The variety of terms used when discussing temporomandibular joint disorder can create unnecessary confusion. Knowing that they are often used interchangeably can help patients understand that each may describe the painful condition that occurs in the jaw. TMJ is the actual joint in question, the temporomandibular joint. TMD and TMJD are the terms we use when discussing temporomandibular joint disorder.
What Causes TMD?
The causes can be a direct result of an improperly aligned bite, but they can also be the result of less obvious factors, such as nightly bruxism (teeth grinding), teeth clenching, or overall stress. There might even be a genetic predisposition to TMD. These are the typical causes of TMD:
- Misalignment of the teeth and/or the jaw
- Teeth clenching
- Long-term teeth grinding
- Trauma to the teeth and/or jaw
- Stress or anxiety
- Poor posture in the neck and upper back
What are the Symptoms of TMD?
According to the American Dental Association, 10.8 million Americans suffer from temporomandibular disorder syndrome (TMD). The condition is caused by an improperly aligned jaw. If you hear a clicking or cracking noise when you move your jaw, you may have TMD. This condition contributes to a myriad of problems including:
- Sore neck muscles
- Tinnitus (Ringing in the ears)
- Worn, chipped teeth
- Facial pain
- Sore jaw joints
- Numbness of the fingertips
Is TMJ Painful?
The temporomandibular joints move like a hinge when the mouth opens and closes. Each joint also slides forward and backward and from side to side. Joints are made up of bones and cartilage and are moved with the support of muscles, tendons, and nerves. With so many working parts, it is possible for stress to occur in any one of them. Pain may develop for one of a few reasons:
- The shock-absorbing disc of the joint moves out of alignment or erodes
- The cartilage in the TMJ degrades and becomes arthritic
- The joint is injured by an impact to the face
- In some cases, the diagnostic evaluation does not identify a direct reason for TMJ pain.
How Is TMD Diagnosed?
At Hiebert Smith Dental Group we use state of the art diagnostic instruments, including a specially tuned TENS unit and EMG. With sophisticated computer analysis, we are able to quantify your optimal jaw and bite position and thus find a balance between facial muscles and joints. Bite evaluation and analysis are comfortable and pain-free, resulting in precise diagnoses.
The first point of examination is muscle and joint palpation. As you open and close your mouth, and clench your teeth, we feel for function in the different facial muscles and the temporomandibular joints. Pain or tenderness is an indicator of misalignment or the overworking of muscles. Catches, locks, clicks, and pops when moving the jaw are also typical signs of alignment problems.
After examination and analysis of the pain patterns, we will usually recommend making a neuromuscular oral orthotic, fabricated to your “relaxed muscle position bite”. A majority of headache patients experience a decrease in headache frequency and intensity within several weeks of first wearing the orthotic. The entire process is 100% non-invasive and very relaxing.
Other more involved tests include:
- Full-face x-rays, MRIs, or CT scans — These may be used to view the position of the jaw and temporomandibular joints.
- Sonography – Sound waves are used to determine whether there are any problems with jaw alignment. We also listen for any abnormal sounds emanating from the jaw.
- Electromyography (EMG) – This method uses the electricity generated by jaw muscles to measure both muscle and nerve function. It can help us see when there is a reaction (such as pain) to movement.
- Computerized test equipment — This is used to measure the correct resting position of the jaw, identifying misalignment problems.
When treating TMD, Dr. Hiebert and Dr. Smith use a variety of methods. Sometimes one option may not be effective, so we’ll move on to another. Our treatments usually involve a combination of lifestyle changes, cosmetic and general dentistry, and possible nerve stimulation. These are some of the methods that we use to help our patients:
- Splints or night guards — Night grinding and clenching is the main factor in TMD. To combat this, it’s important to put the jaw in the correct position at night. To do this, we fabricate plastic mouthpieces that fit over the upper and lower teeth. Patients usually wear these at night.
- Exercises — Tightening the jaw muscles and clenching the teeth is a common cause of TMD problems. We have various jaw exercises that stimulate and relax the jaw muscles.
- Cosmetic dentistry — To correct alignment, we can replace missing teeth with dental implants or bridges, crown overly worn teeth, or move the teeth with orthodontics. This can involve widening constricted arches.
- Lifestyle changes — Stress and anxiety are often the root causes of TMD; stress reduction techniques are important.
- Transcutaneous electrical nerve stimulation (TENS) — Small electrical pulses are delivered to the jaw muscles through a small wand. These pulses stimulate the nerves, encouraging the muscles to relax and the jaw to fall into alignment.
Neuromuscular Dentistry FAQs
What Happens if TMJ is Left Untreated?
If the tires of a car are not in alignment, the tires do not wear well because they are not traveling straight down the road. This causes them to degrade more quickly. The same can be said of the teeth of someone with TMD. Not only does misalignment in the jaw put more stress on teeth, but it also causes surrounding muscles to be tense more often than not. Without treatment, the alignment issue may worsen as the joints continue to degrade. Ongoing TMD may affect sleep due to grinding and clenching, which could lead to sleep disorders, a decreased quality of life, and hormone disruption.
Do I get my teeth fixed before I see you for TMJ and Sleep Disorders?
The temporomandibular joint disorder may or may not be caused by your teeth. We use innovative neuromuscular techniques to identify the cause of TMJ pain and also to develop an appropriate treatment protocol based on each patient’s needs. Don’t wait to schedule your visit. The sooner your neuromuscular dentist evaluates your jaw, the sooner you can feel good again.
Are There Any Tests I Can Perform at Home to Sense If I Have TMJ?
Observing symptoms that occur when you open and close your mouth is one of the easiest ways to identify a potential problem with the temporomandibular joints. For example, you may look for signs like having difficult taking bites of food or hearing a popping sound when you chew.
If you want clearer proof that your jaw joint may be the source of uncomfortable symptoms, you can perform a straightforward test that takes only a few seconds. To test your TMJs, gently place a finger in front of your ear. Do not press hard against the joint. With fingers in place on each side, open your mouth slightly. You will feel the joints move. Then, open your mouth wide. As you do, pay attention to what you feel beneath your fingers. Do you feel a grating sensation? Does your jaw feel tender when it moves? Do you hear clicking or popping? Each of these is an indication that your TMJ may be out of alignment.
What are TMJ headaches and migraines?
TMJ disorder can cause a number of symptoms, including headaches. This is because the muscles that work alongside the temporomandibular joints span down from the jaw and also along the sides and top of the head. Anyone of these muscles, when contracted, could generate pain in a certain area. A TMJ headache or migraine is a type of pain that results due to chronic muscle tension in the face, head, and neck.
What causes TMJ headaches?
The brain expects the temporomandibular joints to be in alignment. It’s one of those physiological aspects of living that is on auto-pilot. When the TMJ is not aligned, all of the muscles in the face, head, and neck that are involved with these joints become stressed. This is because the brain instinctively attempts to correct this alignment issue. It does so all day, every day, even while you sleep. The muscles that work hard to realign the joint quickly develop chronic tension. Tension is a crucial factor in the development of TMJ headaches, but there’s more. Often, people who have TMD clench or grind their teeth. This exerts even more pressure on already-stressed joints. As a result, a key nerve center in the brain, the Trigeminal Nucleus Caudalis, becomes aggravated. It is this nerve center that is associated with TMJ migraines.
Can TMD Be Cured?
This condition should be treated as you would treat any muscular injury. You can find relief with lifestyle changes like applying heat, muscle relaxers and having a softer diet. In severe cases, the problem may only be solved by surgical treatments. While a certain degree of pain is manageable, intense pain can really impact a person’s day-to-day life and overall happiness.