Q1) What is TMJ?

The temporomandibular joints (TMJ) are the joints that allow us to talk, chew, swallow and yawn. These flexible joints connect the mandibular (lower jaw bone), to the temporal bone on the side of the skull, in front of and at the level of the ear.

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Q2) What is a TMD?

TMD can mean either Temporomandibular Joint Dysfunction or Disorder. They are interchangeable terms given to a group of symptoms that occur when the jaw joints and the associated muscles are in disharmony. It can also be known as TMJ syndrome, TMJ Dysfunction, or TMJ Disorder and when it affects your neck, lower back, posture in general it is also called CCMD ( Cranio Cervical Mandibular Dysfunction) or as we would like to call it MPDS (Myofacial Postural /Pain dysfunction Syndrome).

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Q3) Why Does My Jaw Make Noise, should I get it checked?

One of the first signs of TMJ problems is a clicking noise when opening or closing the mouth. The noise can happen all the time or sporadically. In some people the noise is very quiet and hard to hear, in others, it is loud enough to hear across the dinner table. The reason the jaw is making noise is that the cartilaginous disc (one between the jaw bone and skull joint) has lost its ligamental integrity and it keeps popping between the two bones when the lower jaw opens/closes. This is not normal or healthy. When left untreated can lead to the jaw getting stuck or locked. 

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Q4) How Do You Diagnose TMJ Problems?

TMJ disorders are diagnosed by patient history and interview, physical examination, and by using our various diagnostic instruments; the range of motion (Jaw tracker), joint sounds/vibrations (ESG), joint hard tissue images (CBCT), and in some cases, sleep study tests and hospital-based soft tissue diagnostics. Prior to any treatment suggestions, a diagnosis of your condition will be made from there your journey to wellbeing begins.

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Q5) My Dentist Took X-Rays Can We Use Them?

Routine dental x-rays such as a panoramic (OPG) x-ray can give some information about what might be going on in the joint space but this alone does not help to diagnose the condition of the bones associated with the jaw joint. It will frequently be necessary to obtain a 3D image of the joint through the use of a technology not typically found in a dental office. This image is called a CBCT scan or Cone Beam. You may be referred to a diagnostic imaging center to have this completed.

 

Q6)  Will Drugs Help?

Drugs play a limited role in the treatment of your TMJ issues. It may be necessary to prescribe analgesics, corticosteroids, muscle relaxants, anti-anxiety drugs, antidepressants, or local anesthetics, for a limited short period initially to getting the pain cycle broken. We do not believe in long-term medication and work towards treating you to be independent of the same.

 

Q7) Why And When Are Sleep Studies Recommended In TMJ Situations?

We all are aware that oxygen is the elixir of life. Obstructive Sleep Apnoea (OSA) is considered the number one silent killer which affects our body in every system. Our systems are highly dependent on the oxygen levels in the body. It has been reported that more than 60% of patients with TMJ issues suffer from OSA. OSA can affect the mouth, the tongue, the teeth, and the jaw joint. Because such a high correlation exists between the two disorders, it may be suggested during the course of TMJ therapy that a sleep study be obtained.

 

Q8) Could My Headache Be A Result Of My TMJ Issue?

It depends on the type of headache. Headaches are complicated and deserve to be evaluated carefully by a medical doctor. Headaches may result from issues within the skull, outside of the skull, the spine, blood pressure, medication, and many other causes. We can never guarantee that TMJ appliances will solve headache issues, but we have found that frequent headache occurrence improves with TMJ therapy.

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Q9)  What Might Happen If I Do Nothing?

Unfortunately, the future is worse than the present. TMJ issues are progressive; they continue to get worse over time. The progression usually follows this pathway:

Mild;

Short term sharp pains, jaw inflammation resulting in muscle tenderness, jaw joint noises, limited range of motion and locking of the jaw,

Moderate;

Changes in the bony makeup of the jaw joint, wear and destruction of teeth, loss of a portion of the jaw joint resulting in a permanent change in the bite and ability to chew.

Severe:

Cascading pain that reaches down till your toes, nerve entrapments which express as a burning sensation, numbness or at times direct sharp persistent neural pains.

 

Q10). What is neuromuscular dentistry?

A. Neuromuscular dentistry is a type of dental treatment that specializes in fixing jaw misalignments. Jaw misalignment is when the upper and lower teeth do not line up properly with each other. This problem can cause facial pain, swelling, headaches, and significant stress and wear on jaw muscles. Temporomandibular joint disorder (TMJ) is one common jaw problem that is due to jaw misalignment.

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Q11) WHY Is Neuromuscular Dentistry Important and Is There a Scientific Support for its Efficacy?

Occlusion is the foundation of dentistry. It is of key importance in the success of every major dental procedure. Occlusion is affected by a quartet of factors – Airways, the teeth, the muscles, and the temporomandibular joints. Traditional dentistry has focused on the teeth - what might be called "one-dimensional" dentistry. Neuromuscular Dentistry (NMD) is a term that has been applied to the additional consideration of the "second, third and fourth dimensions" – Airway, Muscles and TM joints. There is a significant body of literature published over the past 35 years that support's the efficacy of neuromuscular dental principles. Reference.

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Jankelson, R.R. Neuromuscular Dental Diagnosis &Treatment. Ishayaku Euro-America. 2005.

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Jankelson, R.R., Adib. F. Literature Review of Scientific Studies Supporting the Efficacy of Surface

Electromyography, Low-Frequency TENS, and Mandibular Tracking for Diagnosis and Treatment of TMD. Myotronics. 1995.

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Cooper, B. Recognition of craniomandibular disorders. Otol. Clinics of N. America. Vol. 25. No.4. 1992.

 

Dickerson, W, Chan, C, Mazzocco, M. The Scientific Approach to Neuromuscular Occlusion. Signature. Vol. 7. No.2. pp. 14~17. 2000.

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Lynn, J., Mazzocco, M.W., Miloser, S.J. & Zullo, T. Diagnosis & treatment of craniocervical pain and headache based on neuromuscular parameters. Amer. J. Pain Management. Vol. 2, No.3. pp. 143~151. 1992.

 

Q12) WHAT Is a TENS machine? (Transcutaneous Electrical Neural Stimulation).

 TENS is a widely used term, but as used in Neuromuscular Dentistry it is more properly called ultra-low frequency (ULF) electrical muscle stimulation. This safe, battery-operated device delivers a mild electrical stimulus to the muscles via neural pathways. The stimulus induces involuntary contraction of the muscles controlled by the facial (7th) and masticatory (5th) cranial nerves and further when needed for the neck, Spinal accessory (11th) cranial nerve.

 

Q13) WHAT Is a Jaw Tracking device?

"Jaw tracking" is one of the modalities used by Neuromuscular Dentists. It is used to precisely identify the relationship of the mandible (lower jaw) to the skull and to study mandibular movement dynamically. It utilizes a tiny magnet affixed to the lower anterior teeth. Sensors track the path of the mandible in three dimensions by sensing magnetic field changes. Firstly, it provides every tiny detail from the functioning of the lower jaw in relation to the skull. Secondly, it provides a digitally reproducible image which aids in taking a neuromuscular bite and finally verifying the trajectory and response in a measured way. Quantifiability and repeatability in this science are supreme.

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Q14) Why do I have these problems?

The lower jaw is one of the most functioning joint and bone in our body. It is seen to start functioning right when in the womb. The TM joint also functions to generate very high forces (Chewing, biting…etc), so eventually if your bite is not well-balanced and when changes have been made to the teeth without a proper balance, then isn't it natural to develop issues as aging occurs?

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Q15) I see a lot of specialists claiming to treat TMJ dysfunctions? How are you different?

We are not different from our colleagues, it's just that every specialist has his choice of expertise he/she gathers over years of hard work, perseverance, and persistence. At some point in time, when it comes to management we would have diversified, some would prefer just medication, some would use dental mechanical principles gathered over years, some would want all data quantified, and some surgery. We are the group that believes in quantifying data, as it helps in reproducible results. Although few, we too have our share of patients for whom just supplementing a few trace minerals and vitamins had sufficed. As long as amputating surgical options are way down on your priority list, whatever mode of treatment you chose, you are not harming your body.

 

Q16) Would I need to follow any particular diet during the treatment?

Yes, you would depending on what stage of the TMD you are in. In mild cases where only a few visits to us will suffice, we generally do not recommend any diet. However, when a protracted treatment course is indicated we could recommend the initial few days of liquid diets and progressively get you through to having all forms of food.

 

Q17) Would I be able to do heavy exercises?

We do not recommend heavy weightlifting exercises, which would delay and hamper the process of healing, however, our objective remains to get you to a fully functional human being.

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Q18) At what age can a TMD occur?

If the airway is compromised from a very young age, then young kids can be affected. Recent scientific data suggests 45% of ADHD (attention deficit hyperactivity Disorder) is from a restricted airway. The youngest patient under our care is just 4 years old.

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