Temporomandibular Joint and Muscle Disorder and Cosmetic Dental Concerns Following Treatment
Every cause has an effect. The effect reveals how the patient adapted to the problem at hand. If a patient’s teeth do not fit together properly then they may have muscle or jaw pain, headaches, worn, loose, or chipped teeth. There is sometimes evidence of one or more of those symptoms but most likely they happened at different times in the patient’s life. For example: you may have a click in your knee. For me to assume that you have an active problem is completely inaccurate. What I do know is that something caused the click to happen (an injury, etc) and the way your body adapted was with tissue changes that now produce a click. You now have no pain at all and are able to perform all normal physical activities. If I were to ask you, however, if you ever had pain or discomfort in that knee in the past you are more than likely to tell me “yes”. This is very similar to the dental patient.
I may see a patient with some evidence of wear to their teeth. I know that the wear is an effect, an adaptation to something. The question is whether or not it is active and, if it is active then what is causing it? How about a patient with severe muscle and joint pain? The pain is the effect of something but what? Occlusion, which is the alignment of the teeth of the upper and lower jaws when brought together, is one of the most poorly understood and misdiagnosed concepts by dentists. Most dentists are trained to think that wear to the teeth means a patient must be grinding their teeth. What if a patient has a tooth that is out of alignment and receives more friction to it than other teeth do with normal eating and chewing? That one tooth may have severe wear but the rest of the teeth are unworn. Is this patient grinding their teeth? NO! And what if the wear was the adaptation and the tooth is so worn now that it is no longer in the way. Do we need to treat it anymore? Confused? You should be. Occlusion is complex and being able to identify chipped, broken teeth and sore muscles is easy. It is understanding the history of what lead to this that becomes difficult. In depth studies of occlusion along with listening and asking the right questions makes all the difference.
This patient presented for a routine new patient exam. On clinical examination I found she had some clicking on one side of her jaw. She said the click was painless and that she’s had it for as long as she could remember. I asked some questions that may seem simple and random but actually tell me a lot more about the patient’s possible diagnosis. I asked her if she was able to chew gum (not if sheliked chewing gum). This is an important distinction because I have some patients tell me they don’t like chewing gum and when I really probe a little deeper they tell me something like, “Well my jaw starts to ache so I just don’t chew gum anymore.” This is different from not enjoying the taste or act of chewing gum. This is because they CAN’T chew gum. This answer tells me that they get muscle fatigue from something as simple and short in duration as chewing their food. From there it leads me to other questions based on what I suspect to be the problem at hand. “Does your mouth get tired when you speak for long periods of time?” This would tell me that in order to speak they have to position their jaw unnaturally, which causes more muscle tension and strain. This patient answered “yes” to both these questions and asked me how I knew (like I was a magician or something). I also expected that she would have very little wear to her teeth since her body’s way of compensating for her teeth misalignment was by avoidance and thus resulted in increased muscle activity and tension.
With further evaluation it was determined that the patient did not have enough freedom between her upper and lower teeth to allow for normal speaking and chewing. She had to subconsciously hold her jaw back to avoid hitting her teeth with one another when she ate or spoke. The treatment was simple…orthodontics to make some spaces which would give her lower jaw room to move. However that would create a new problem….spaces between her upper teeth. In a single appointment, I added direct bonding to close the spaces. For the first time in over 20 years this patient had no pain and the only treatment she needed was some orthodontics and conservative bonding. She is ecstatic and never knew that something could be done to get rid of her pain. This is just one type of occlusal diagnosis… there are many others. Do you suffer from TMD?
Temporomandibular joint and muscle disorders (TMJ disorders) are problems or symptoms of the chewing muscles and joints that connect your lower jaw to your skull. It is a very common and sometimes debilitating problem for many patients.
Many TMJ-related symptoms are caused by the effects of physical stress on the structures around the joint. These structures include:
- Cartilage disk at the joint
- Muscles of the jaw, face, and neck
- Nearby ligaments, blood vessels, and nerves
There are many factors that can cause TMD and these can include:
- Bad bite
- Tooth grinding
- Poor posture
The symptoms associated with TMD are a wide range and can include some or many of the following:
- Biting or chewing difficulty or discomfort
- Clicking, popping, or grating sound when opening or closing the mouth
- Dull, aching pain in the face
- Jaw pain or tenderness of the jaw
- Locking of the jaw
- Difficulty opening or closing the mouth