How do you know if you have a bite problem?
Do you suffer from . . .
- Clenching or grinding
- Sore or tender jaw joints
- Neck, shoulder, or back pain
- Facial pain
- Limited mouth opening
- Postural problems
- Unexplainable sensitive teeth
- Unexplainable loose teeth
- Locking jaw joint
- Clicking sounds from jaw
- Ringing in the ears
If you answered “yes” to any of the above, you may be suffering from temporomandibular disorder (TMD). You also may be interested in finding out what neuromuscular dentistry (NMD) has to offer you.
Temporomandibular Disorder (TMD)
TMD is a chronic condition that affects millions of people. Most don’t realize that a properly trained dentist can help reduce or eliminate these signs and symptoms. Dr. Boyd possesses the technology, training, and experience to target the true source and cause of your problem. Using a neuromuscular approach to this common dental complaint, he can establish a stable and comfortable bite position where jaw joints and muscles are balanced and relaxed.
Neuromuscular Dentistry can help.
Many people do not realize that muscles play an important role in dentistry. The science of Neuromuscular Dentistry (NMD) enhances traditional dentistry by evaluating and treating your overall oral health by considering how your muscles, teeth, and joints all work together.
Many people have a war going on in their mouths between the jaw muscles and the teeth. With some people, the muscles are winning that war, grinding the tops of the teeth in an attempt to position the jaws more favourably. These patients typically have little or no muscle pain but have extensively damaged teeth. In this case, treatment is required to protect the teeth.
On the other hand, if the teeth are winning the battle, then the muscles take the brunt of the damage. These patients may have numerous complaints including clicking and sore jaw joints, headaches, or chronic pain in the head, neck, and shoulders. These are patients that are often highly motivated to seek relief from pain and may have tried numerous unsuccessful remedies in the past.
Essentially, the neuromuscular approach to dentistry determines the optimal jaw position where posturing muscles are all relaxed to the greatest degree returning you to a state of musculoskeletal harmony and balance.
How Are the Muscles Relaxed?
The jaw muscles are subconsciously “programmed” by the brain. Consequently, most individuals have difficulty consciously reaching a truly relaxed state. To help your muscles reach that relaxed state, we use a “TENS” unit to deliver gentle stimulation to your muscles.
The TENS unit is a battery operated electrical muscle stimulator. Mild electrical stimulation is delivered through the skin to reach nerves that control specific facial and jaw muscles. The stimulus delivered will cause your facial and jaw muscles to twitch or pulse every one and a half seconds. After 40 - 60 minutes, this electrically induced “exercise” will allow your muscles to overcome their programming and reach a truly relaxed state.
How Do We Know When The Bite Is Right?
We confirm that your muscles are actually relaxed by measuring muscle activity with surface electrodes. We confirm and record the relaxed position of your jaw with highly sophisticated, computerized diagnostic equipment.
Then, we capture this jaw position by placing a fast-setting putty-like material between your teeth. Now we can easily reproduce your ideal bite position. By comparing your usual bite position with the ideal jaw position we can determine if treatment is indicated.
How Many Appointments Do We Need?
The first appointment usually consists of an interview, a thorough musculo-occlusal-skeletal exam, and impressions for study models. Once we have generated a diagnosis, we can then discuss your personalized treatment plan.
At the second appointment, after relaxing all of the relevant muscles (using TENS), and allowing the jaw to find its “ideal” position, we carry out computerized mandibular scanning (CMS) simultaneously with electromyography (EMG) to identify and record this position accurately in three dimensions.
During the third appointment, dependent on earlier findings, we will generally do one of two things:
- either adjust your bite as needed to enable your jaw to reach the ideal position without interferences, or
- deliver an orthotic to accomplish the same goal in a different way.
Usually, two or three more follow up appointments are scheduled for fine-tuning. You will probably find these appointments the easiest and most relaxing you’ve ever had in a dental office.
What is an Orthotic
You have likely heard of an orthotic designed to slip into someone’s shoes. These are often employed to compensate for a skeletal or muscular imbalance that throws the skeleton out of alignment. An orthotic for the mouth does the same job. By bringing your lower jaw back into proper alignment with your skull, we can eliminate the signs and symptoms that have plagued so many people for so long.
The orthotic itself is made of hard, clear acrylic. It is a precision-fit removable appliance that covers the lower teeth. It can be inserted or removed with ease whenever you like. As a minimum, most people will sleep each night with the orthotic in their mouth. Some patients benefit from wearing the orthotic during the day as well. Really, you can use the orthotic as much or as little as you feel you need.
Is the Orthotic Comfortable to Wear?
Because the orthotic allows the jaw to reach an ideal position where the muscles are relaxed, nocturnal teeth grinding ceases. The orthotic does not need to be as strong (and bulky) as conventional night guards – it represents a much more elegant solution to a common problem. You will find that it drops effortlessly into place and sits unobtrusively in your mouth for as long as you require.
Where Do We Go From Here
If simple bite adjustments were sufficient, then treatment is complete at this point. If an orthotic was delivered, and we have established a stable and comfortable jaw position, you may be content to simply carry on using this appliance as needed to maintain a symptom-free state.
Instead of an orthotic, you may choose to have your teeth covered with crowns in order to hold your bite permanently in the new, ideal (and comfortable) position. This typically involves restoring all of the teeth in either the upper jaw or sometimes both jaws (depending on the severity of the problem). Treatment like this has the added bonus of giving you a fabulous new smile at the same time!
The goal is the same in that the shape and positioning of the teeth are altered to optimize muscle relaxation.
“I have been plagued by migraine headaches since I was a child. After trying all manner of cures, the first treatment that actually eliminated them was a dental orthotic – cessation of my headaches was astonishing, and I realized that TMD was the primary problem.”
I came to Dr. Boyd because I could no longer handle the severe pain in my jaw joints, head, neck, and shoulder muscles. I required massage therapy weekly. He suggested an orthotic to reduce symptoms and I immediately agreed. The experience was amazing. I noticed a huge difference and relief instantly! I no longer have headaches and I don’t need massage therapy anymore. I can’t believe how I lived without it.
My teeth grinding has been a curiosity for my family since childhood. It became a problem when I was 20 when daily headaches were attributed to TMJ problems. Since then, I have crunched through 2 or 3 night guards, declined surgery, and taken countless medications. Finally, I broke a molar one night while wearing my night guard. It was then, 20 years after I began having problems, that Dr. Boyd convinced me to try a new appliance. It’s comfortable to wear and has made me more aware of my jaw position during the day, so it’s more relaxed. The headaches were gone completely within two weeks. Most importantly, I’ve completely stopped grinding my teeth. I’d highly recommend it.
Prior to receiving my orthotic, I was shattering my porcelain veneers. After a very short period of time, the orthotic I used at night changed the way my mouth was, at rest, and all problems have ceased. I would definitely recommend this procedure.
Patient last names have been removed to respect their privacy.
Temporomandibular joint and muscle disorders, commonly called TMJ, are a group of conditions that cause pain and dysfunction in the jaw joint and the muscles that control jaw movement. We don't know for certain how many people have TMJ disorders, but some estimates suggest that over 10 million North Americans are affected. The condition appears to be more common in women than men. TMJ is referred to by different names such as TMD, TMJ disorder, and TMJ dysfunction.
For most people, pain in the area of the jaw joint or muscles does not signal a serious problem. Generally, discomfort from these conditions is occasional and temporary, often occurring in cycles. The pain eventually goes away with little or no treatment. Some people, however, develop significant, long-term symptoms.
- What is the temporomandibular joint?
- What are TMJ disorders?
- What causes TMJ disorders?
- What are the signs and symptoms?
- How are TMJ disorders diagnosed?
- How are TMJ disorders treated?
- Conservative Treatments
The temporomandibular joint connects the lower jaw, called the mandible, to the bone at the side of the head, which is the temporal bone. If you place your fingers just in front of your ears and open your mouth, you can feel the joints. Because these joints are flexible, the jaw can move smoothly up and down and side to side, enabling us to talk, chew, and yawn. Muscles and ligaments attached to and surrounding the jaw joint control its position and movement.
When we open our mouths, the rounded ends of the lower jaw, called condyles, glide along the joint socket of the temporal bone. The condyles slide back to their original position when we close our mouths. To keep this motion smooth, a soft disc lies between the condyle and the temporal bone. This disc absorbs shocks to the jaw joint from chewing and other movements.
The temporomandibular joint is different from the body's other joints since the joint actually dislocates after opening past a certain point. The combination of hinge and sliding motions makes this joint among the most complicated in the body. Also, the tissues that make up the temporomandibular joint differ from other load-bearing joints, like the knee or hip. Because of its complex movement and unique makeup, the jaw joint and its controlling muscles can pose a tremendous challenge to both patients and health care providers when problems arise.
Disorders of the jaw joint and chewing muscles - and how people respond to them - vary widely. Researchers generally agree that the conditions fall into three main categories:
- Myofascial pain, the most common temporomandibular disorder, involves discomfort or pain in the muscles that control jaw function.
- Internal derangement of the joint involves a displaced disc, dislocated jaw, or injury to the condyle.
- Arthritis refers to a group of degenerative/inflammatory joint disorders that can affect the temporomandibular joint.
A person may have one or more of these conditions at the same time. Some people have other health problems that co-exist with TMJ disorders, such as chronic fatigue syndrome, sleep disturbances or fibromyalgia, a painful condition that affects muscles and other soft tissues throughout the body. It is not known whether these disorders share a common cause.
People who have a rheumatic disease, such as rheumatoid arthritis, may develop TMJ disease as a secondary condition. Rheumatic diseases refer to a large group of disorders that cause pain, inflammation, and stiffness in the joints, muscles, and bone. Both rheumatoid arthritis and some TMJ disorders involve inflammation of the tissues that line the joints. The exact relationship between these conditions is not known.
How jaw joint and muscle disorders progress is not clear. Symptoms worsen and ease over time, but what causes these changes is not known. Most people have relatively mild forms of the disorder. Their symptoms improve significantly, or disappear spontaneously, within weeks or months. For others, the condition causes long-term, persistent and debilitating pain.
Trauma to the jaw or temporomandibular joint plays a role in some TMJ disorders. But for most jaw joint and muscle problems, scientists don't know the causes. For many people, symptoms seem to start without obvious reason. Research disputes the popular belief that a bad bite or orthodontic braces can trigger TMJ disorders. Because the condition is more common in women than in men, scientists are exploring a possible link between female hormones and TMJ disorders.
There is no scientific proof that clicking sounds in the jaw joint lead to serious problems. In fact, jaw clicking is common in the general population. Jaw noises alone, without pain or limited jaw movement, do not indicate a TMJ disorder and do not warrant treatment.
The roles of stress and tooth grinding as major causes of TMJ disorders are also unclear. Many people with these disorders do not grind their teeth, and many long-time tooth grinders do not have painful joint symptoms. Scientists note that people with sore, tender chewing muscles are less likely than others to grind their teeth because it causes pain. Researchers also found that stress seen in many persons with jaw joint and muscle disorders is more likely the result of dealing with chronic jaw pain or dysfunction than the cause of the condition.
A variety of symptoms may be linked to TMJ disorders. Pain, particularly in the chewing muscles and/or jaw joint, is the most common symptom. Other likely symptoms include:
- Radiating pain in the face, jaw, or neck
- Jaw muscle stiffness
- Limited movement or locking of the jaw
- Painful clicking, popping or grating in the jaw joint when opening or closing the mouth
- A change in the way the upper and lower teeth fit together
There is no widely accepted, standard test available to correctly diagnose TMJ disorders. Because the exact causes and symptoms are not clear, identifying these disorders can be difficult and confusing. Currently, we note the patient's description of symptoms, take a detailed medical and dental history, and examine problem areas, including the head, neck, face, and jaw. Imaging studies may also be recommended.
You may want to consult your doctor to rule out other causes of pain. Facial pain can be a symptom of many other conditions, such as sinus or ear infections, various types of headaches, and facial neuralgias (nerve-related facial pain). Ruling out these problems first helps in identifying TMJ disorders.
Because more studies are needed on the safety and effectiveness of most treatments for jaw joint and muscle disorders, experts strongly recommend using the most conservative, reversible treatments possible. Conservative treatments do not invade the tissues of the face, jaw, or joint, or involve surgery. Reversible treatments do not cause permanent changes in the structure or position of the jaw or teeth. Even when TMJ disorders have become persistent, most patients still do not need aggressive types of treatment.
Because the most common jaw joint and muscle problems are temporary and do not get worse, simple treatment is all that is usually needed to relieve discomfort.
There are steps you can take that may be helpful in easing symptoms, such as:
- Eating soft foods
- Applying ice packs
- Avoiding extreme jaw movements (such as wide yawning, loud singing, and gum chewing)
- Learning techniques for relaxing and reducing stress
- Practicing gentle jaw stretching and relaxing exercises that may help increase jaw movement
- Exercises if appropriate for your particular condition
For many people with TMJ disorders, short-term use of over-the-counter pain medicines or nonsteroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen, may provide temporary relief from jaw discomfort. When necessary, we can prescribe stronger pain or anti-inflammatory medications, muscle relaxants, or anti-depressants to help ease symptoms.
We may recommend an oral appliance called a bruxism splint, stabilization splint, night guard, or bite guard, which is a plastic guard that fits over the upper or lower teeth. Stabilization splints are the most widely used treatments for TMJ disorders. Studies of their effectiveness in providing pain relief, however, have been inconclusive. If a stabilization splint is recommended, it should be used only for a short time and should not cause permanent changes in the bite. If a splint causes or increases pain, stop using it and let us know.
The conservative, reversible treatments described are useful for temporary relief of pain - they are not cures for TMJ disorders. If symptoms continue over time, come back often, or worsen, please let us know.
Other types of treatments, such as surgical procedures, invade the tissues. Surgical treatments are controversial, often irreversible, and should be approached with caution where possible. There have been no long-term clinical trials to study the safety and effectiveness of surgical treatments for TMJ disorders. Nor are there standards to identify people who would most likely benefit from surgery. Failure to respond to conservative treatments, for example, does not automatically mean that surgery is necessary.