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Neuromuscular Dentistry - TMJ FAQ

TMJ Jaw Joint Pain Ask The Dentist John Purpura Question:
TMJ Confusion: The treatment I've been recieving has made it worse. I've been getting treated for TMJ for four years. I was treated with an appliance that reposistioned my lower jaw pushing it forward and when I was finished with that I was given an appliance to wear at night.

The problem is I feel more discomfort now then I did in the begining. In order to bite down, my lower jaw has to slide back. When I am in a biting position my jaw locks on the left side and I am unable to open my mouth. My muscles as well as my teeth are very sore.

The dentist I have been going to has filed down my teeth quite a few times to try to create an even bite, even at times when I said my bite feels fine. I also don't feel comfortable with my teeth constantly being filed down. Every time they're filed my bite becomes more uneven and my teeth become sore and sensitive.

I am puzzled on what to do next. I honestly feel as though the dentist I have been going to doesn't know what else to do but I'm not sure where else I can go to be treated. I am really trying to find somewhere else that knows more about TMJ. What is happening with my TMJ and what other kind of treatment options are there? ....Visitor from Connecticut

Your description is one that reminds me of a diagnosis of an anterior displacement with occasional non-reduction of the left t-m joint. What this means in plain English is that the cushioning disc that keeps the bones of the temporal-mandibular joint from rubbing against each other has moved forwards and is not allowing the bones to move freely.

You should be hearing a loud click in the ear and than the jaw is able to move easier.

Lets describe the anatomy of this particular joint. As with any joint we have two bones which are moving against each other. The bones are moved by muscles and are cushioned by cartilage. The cartilage gets it's nutrients from the synovial fluid and this particular (TM) joint, it also has a further cushioning device, a fibrous disc, which sits between the bones.

The first appliance that you where wearing move the head of the mandible (called the condyle) forwards and down allowing the condyle to move into the position which would recapture the disc. This would allow the jaw to move freely and not to get caught up on the disc. This type of device is called an anterior repositioning splint. They cannot be worn all the time for they will cause a change in the bony jaw structure after many years due to the fact that form follows function. After that, the night guard is used which should allow the jaw to move freely in all directions.

The grinding of teeth is called an occlusal adjustment and is something that will have some benefits, but only after the muscles are at total rest. If the muscle of one side are stressed more than the other then the jaw will not be closing completely in unison, and will be deviating to one side.

Also if the condlye is not in the fully seated position with the disc, than the jaw will also have a deviation. Any adjustment in this position will mechically move the jaw into the deviated position upon the teeth meeting during closing.

The next step is to have an MRI which will determine if the disk is out of place and if the jaw compensates for it being out of place. The results of that test will have a factor on what the next step to correct the problem is.

The pain in the teeth and muscle are from the abnormal use that they are performing, similar to going to the gym and not working out with the equipment properly.

FOUR years is some time to be suffering from this disorder and some time will be needed to correct the problem. Conservative management is appropriate, until all of the proper testing is performed. A consult with a TMD doctor is advised.

John Purpura, DDS

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