TMJ Disorders

 TMJ Disorders - Causes, Diagnosis and Treatment

For sufferers of Temporomandibular joint disorders, headaches and chronic pain are common occurrences. Fortunately, for TMJ disorder patients seeking help, there is hope! Dr. Gordon can provide a safe, non-surgical solution that will allow you to live without the inconvenience and frustration of daily pain.

What is TMJ and what are its symptoms?
What are the causes of TMJ?
How is TMJ diagnosed?
How is TMJ treated?

What is TMJ and what are its symptoms? Many patients in our society suffer from TMJ disorders without even knowing it. Temporomandibular Joint (TMJ) dysfunction refers to the pain that develops around the jaw and its associated muscles. The TMJ disorder can make speaking, chewing, swallowing, and facial expressions strained and uncomfortable. In fact, chronic pain, which among other things can be caused by TMJ, is the third largest health problem in the United States. Approximately 40 percent of all chronic pain syndromes are concentrated in the head and neck areas. Jaw pain, muscle tension, and the clicking, popping, or grating of the jaw are all signs of TMJ.

The Temporomandibular joint, located directly in front of the ear, consists of two bones--the skull bone and the jawbone. Positioned between these two bones is a shock absorber-like disc known as the intra-articular disc. This disc provides smooth, quiet, harmonious movement during the opening and closing of the mouth, and it also acts as a cushion against heavy forces generated by strong jaw muscles. As the mouth opens and closes, the disc moves and glides along, forward and backward in synchrony, always holding its position between each bony structure. Problems arise, though, when the relationship among the teeth, muscles, and joints changes. Such conditions lead to TMJ dysfunction.

Fifteen percent of TMJ disorders are genetic and 85 percent are acquired, according to recent statistics. Some estimates suggest that 20 percent of Americans possess one or more symptoms of a TMJ disorder.

Common symptoms of TMJ include:

• Dull, aching pain around the ear, face, temples, neck, back of head, back of eyes, and shoulders
• Migraine-like headaches
• Ringing in the ears, hearing loss, ear stuffiness/congestion, or ear pain
• Jaw clicking or popping
• Grating noises when opening or closing the mouth
• Difficulty opening and closing the mouth
• Difficult or painful chewing
• Locking of the jaw, whether open or closed
• Dizziness or nausea
• Numbing of or tingling in the fingers
• Insomnia
• Depression

What are the causes of TMJ? Any disturbance of the harmony between the teeth, muscles, and joints can trigger neurological impulses, which in turn cause painful TMJ dysfunction.

Such disturbances include:

• Malocclusion (improper bite)
• Misalignment
• Trauma/blow to the jaw or head
• Excessive yawning or prolonged periods with the mouth open too wide
• Clenching or grinding the teeth
• Loss of teeth, especially the back molars
• Cervical traction involving the head, jaws, and neck
• Compromised tongue position
• Upper airway constriction, resulting in chronic mouth breathing, snoring, and malocclusion
• Poor posture (hip tilt, asymmetrical body mechanics, scoliosis)
• Arthritis

Some dental signs of TMJ include:

• Crowded teeth
• Narrow arches
• Crossbites
• Wear facets
• Unlevel bite plane
• Gumline tooth erosion
• Generalized tooth sensitivity
• Enamel cusp fractures
• Porcelain crown fractures
• Deep overbite

How is TMJ diagnosed?

At the TMJ Institute of Newport Beach, we use several methods to diagnose Temporomandibular Joint (TMJ) disorders, including:

Clinical Examination

A proper diagnosis always begins with a thorough examination by Dr. Gordon. The clinical exam involves a detailed medical-dental history with specific questions about the symptoms, nature, and duration of jaw problems. It also consists of the following:

• Postural Examination--This type of exam searches for imbalances in the body's mechanics. One's posture affects the positional relationship of the lower jaw to the cranium and can result in or contribute to TMJ problems. If body symmetry is not within normal limits, chiropractic care, physical therapy, or massage therapy may be recommended.
• Craniocervical Examination--During this part of the exam, we evaluate the planes of the skull and the cervical ranges of motion.
• Limited Neurological Examination-- As part of this examination, we screen for nerve or brain damage that may cause or mimic TMJ symptoms.
• TMJ Examination--This type of exam tracks the range of jaw movement, including velocity, smoothness, muscle incoordination, and crossover patterns.
• Muscle Palpation--During this exam, the doctor evaluates the head, neck, and shoulders for the presence of inflammation, degrees of tenderness, and trigger point referral patterns.

Radiographic Imaging

By using digital X-rays, cat scans and tomographs to examine the joints, the doctor is able to see the hidden areas in question. Changes in position can also easily be detected using this method. 

Cephalometric Analysis Measurements of the planes and angles of the facial bones enables Dr. Gordon to map out a "skeletal blueprint" of the face and jaw. He then uses a sophisticated, cephalometric analysis of this blueprint to unlock and discover the hidden factors involved in the root cause of TMJ Dysfunction.

Neuromuscular Analysis We use computerized electro-diagnostic instrumentation for a more sophisticated approach to identifying and treating Temporomandibular joint (TMJ) dysfunction. Now neuromuscular dentists such as Dr. Gordon can record, measure, and track clinical data using three-dimensional jaw movements and electrical muscle activity. The father of neuromuscular dentistry, Dr. Bernard Jankelson, said, "If it has  been measured, it is a fact. If it has not been measured, it is an opinion." In this age of evidence-based diagnosis and treatment, it is imperative that the treating clinician uses objectivity when addressing TMJ disorders. Patients of Dr. Gordon can be rest assured that he uses only the latest technology to diagnose and treat TMJ disorders.

Computerized Mandibular Scanning (CMS) Computerized mandibular scanning (CMS) allows for a thorough assessment of jaw function. CMS measures the rotational movement of the jaw in three dimensions of space and time to within 0.1 mm of accuracy. With the use of a magnetic tracking device and sensor array, it projects the data on a calibrated computer monitor.

How is TMJ treated?

By utilizing a comprehensive approach and analysis, Dr. Gordon can eliminate Temporomandibular joint (TMJ) pain and dysfunction by balancing the relationship among the teeth, muscles, and joints. For optimal results, we offer a two-phase treatment plan at our Newport Beach location:

Phase One of TMJ Disorder Treatment

When treating the TMJ disorder, Dr. Gordon first fits a specialized type of splint made of clear, hard acrylic over the lower teeth. Called a neuromuscular orthosis, this device is worn full-time and creates ultimate balance among the teeth, muscles, and joints. Usually, it is worn for three to nine months (longer if there is a sharper degree of musculoskeletal involvement) and may be used in conjunction with chiropractic care, physical therapy, or massage therapy.

Phase Two of TMJ Disorder Treatment

Phase Two begins only after the patient has successfully completed Phase One of treatment. We strive to permanently stabilize the temporomandibular joints in one of several ways:

• Semi-permanent splint--Similar to the design of the neuromuscular orthosis but made of metal, this device may be worn for years, and has minimal maintenance.
• Comprehensive Orthodontics--This involves braces being worn from anywhere between nine months to three years in an effort to pull teeth into the appropriate positions, thereby eliminating TMJ dysfunction.

• Reconstruction--Comprehensive rehabilitation and restoration provide the finest and most predictable results possible. Because teeth are restored with an occlusal bite pattern of such high precision neuromuscular balance is achieved and maintained long term. Today's advancements in porcelain-ceramic technology allow not only functional but also aesthetic concerns and demands to be addressed, resolved, and successfully fulfilled. More aesthetic options are available today with this approach for enhancements in color, contours, and facial appearances that produce the most natural-looking results.

Dr. Gordon will base the TMJ treatment you receive on a personal and thorough evaluation.

Reconstruction/Neuromuscular Dentistry

For patients with more complex dental problems, Dr. Gordon turns to reconstruction and neuromuscular dentistry. Neuromuscular dentistry recognizes that the teeth, gums, muscles, and bones are part of a system that must work as a unit in order to function properly. He can replace missing teeth, repair damaged teeth, and correct jaw abnormalities in a way that recreates optimum facial balance and natural beauty.

One method Dr. Gordon uses to achieve such balance is computerized electrodiagnostic instrumentation, which allows for three-dimensional imaging of jaw movement, measurements of muscle activity, and detection of sound in the jaw joint.

Our goal is to provide patients with the finest care possible and to preserve their health and appearance. Here, we combine advanced science with an aesthetic touch to make our patients feel as beautiful, confident, and secure as they deserve.