Information for Patients

Information and Forms

square_bullet What Is TMJ?
square_bullet Who Treats Pain of Head & Jaw?
square_bullet The Jaw System – How it works
square_bullet Basic Home Care
square_bullet Bite Affecting Pain
square_bullet Things You Should Know as We Begin Your Treatment
square_bullet Two-Phase Treatment
square_bullet Function of Appliance
square_bullet Insurance Benefits for TMD
square_bullet Snoring and Obstructive Sleep
Apnea Treatment
square_bullet Special Needs Dentistry

square_bullet What is TMJ?

square_bullet A Healthy Jaw System

square_bullet Problems in the Jaw System

square_bullet The Temporomandibular Joints

square_bullet The Teeth

square_bullet The Muscles of Mastication



What Is “TMJ”?
The term, “TMJ”, has been commonly used in magazine articles and in television reports and elsewhere as if it designates a distinct, well-defined disorder. This is a misrepresentation that, although innocent, has led to a certain amount of confusion among the general public. The letters stand for Temporo Mandibular Joint. This term, “TMJ”, actually refers to a broad class of conditions involving the jaw system that may or may not include problems with the temporomandibular (jaw) joints.

The American Dental Association has made “TMD” the accepted terminology, standing for Temporomandibular Disorders. This is a better term for general use. But the term “TMJ” will probably continue to be used and may continue to contribute to some confusion in the future.

As a broad group of disorders, “TMJ” or “TMD” represent conditions that have certain common symptoms, primarily pain and dysfunction, which occur principally in the muscles and joints of the jaw system. These symptoms do not originate in the teeth, even though it is sometimes difficult for the patient to tell the difference.

The symptoms that are most commonly associated with temporomandibular disorders include:
• Stiffness, tiredness, and/or pain in the jaw
• Chronic, recurring headaches
• Clicking, popping or grating sounds in the jaw joints
• “Earaches”, which may actually be pain in the jaw joints
• Pain in the jaw when chewing or opening wide
• Restricted jaw opening, catching or locking
• Difficulty or pain when closing the teeth together comfortably in a “normal” bite
• A bite that feels “off”

Patients with “TMJ” may experience several of these symptoms but when the condition is first developing, any single symptoms may be significant.

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A Healthy Jaw System
As long as our bodies are functioning fairly well, most of us tend to take our relative good health pretty much for granted. With respect to the jaw system, most people think of their teeth and gums as the primary structures that need to be maintained in a state of health. People who receive regular dental care and who practice good oral hygiene reasonably assume that their chewing mechanism is being maintained in a relatively healthy state. This may be true; however, there can be changes going on in the chewing mechanism which are not so obvious and that may not be recognized in routine dental examinations.

The jaw system, as a functional mechanism, involves not just the teeth and gums, but also the temporomandibular joints and the muscles that control all aspects of jaw function, movement, and positioning. In the entire human body, there is no other joint system that involves such a complex interplay of functional components as occurs in the jaw mechanism.

In a healthy jaw system, the temporomandibular joints, which are the functional foundation of the jaw mechanism, are structurally intact and function without pain. For the jaw system to function in a healthy manner, the teeth must come together in a manner that provides adequate support for the joints and muscles. This means that the fit of the bite must be harmonious with the optimum structural and functional position of the jaw joints and must also allow easy, efficient movement during normal jaw function. When these conditions exist, the muscles of the jaw system are more able to function in a relaxed manner without excessive muscular activity. The jaw system functions optimally when the joints are healthy, when the bite supports and protects the joints, and when the muscles are able to function in a relaxed manner.

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Problems in the Jaw System
To appreciate some of the problems that can progressively develop in this system, it is important to understand the role of each of the individual components of the system and how they functionally interact.

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The Temporomandibular Joints
These highly complex joints are structurally and functionally unique in the human body. They are the functional foundation of the jaw system and when they are not functioning optimally, the entire jaw mechanism is compromised.

It is well established that 30-40% of the general population has clicking, popping or other sounds in the jaw joints during jaw movement. Joint sounds of this kind indicate a structural change. In spite of this change, most people in whom this occurs do not experience any significant difficulty. However, this structural change does predispose the person to developing pain and other possible difficulties. As long as this continues to be nor more than uncomplicated clicking or popping, without pain or catching in the joints, there may be no reason to be concerned. However, at the first sign of any of the symptoms mentioned above, particularly if catching or locking begin to occur, a careful evaluation, without delay, by an dentist who is knowledgeable regarding these conditions is strongly recommended. If evaluation is delayed, the problem may progress and may become more difficult to treat.

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The Teeth
Today, with proper oral hygiene and regular dental maintenance, most people can expect to keep their natural teeth for a lifetime. The loss of even a few teth can represent a major compromise to the function of a healthy jaw system through loss of some of the support that the teeth provide to the jaw. The support of a solid bite on natural teeth is critical to the healthy function of the other jaw components, the joints and muscles.

There is no other joint system in the entire human body that has a component comparable to the teeth that can so profoundly affect the other components of the system, the temporomandibular joints and the muscles of mastication. When you close your mouth, you will always close where the teeth fit together best, whether or not it is a good position for the jaw joints or for the muscles that control the jaw. Many people think of a “bad bite” as primarily an esthetic problem. However, even though the teeth may look great and may superficially appear to fit well, a bad bit can still exist and can contribute significantly to problems with the temporomandibular joints and/or the muscles that control the function of the jaw.

Very few people have a truly ideal bite and, fortunately, when the criteria for an ideal bite are not completely met, the body is often able to adapt and accommodate to some degree. However, even though the body may have adapted to these discrepancies for many years, if sufficient stresses develop within the jaw system, for any of several reasons, the body’s ability to adapt may be exceeded and pain and other problems of abnormal function may be the eventual result.

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The Muscles of Mastication
When problems within the jaw system begin to surface, they are most commonly seen first in stiff, tight muscles and perhaps in difficulty opening or difficulty being able to hold the mouth open, such at dental appointments. This condition may gradually lead to painful jaw muscles that can appear as headaches or as aching or a tired feeling in the jaw. Most muscle pain is a result of over use of the muscle for any of several reasons.

Earlier it was mentioned that the body is able to adapt and accommodate, to some degree, to a bad bite. When this occurs, it is the muscles that do most of the accommodating. Most people are unaware of a high spot in their bite or other discrepancy. The reason for this is that the muscles will adjust the jaw, if they can, to avoid the high spot. This is a little like taking a hike with a rock in your shoe. With each step, certain muscles, which are not normally used in walking, are now repeatedly used to “compensate”, to avoid stepping on the rock over and over. After awhile, the result can be sore muscles in the leg or hip. A very similar thing occurs when the jaw muscles need to “compensate” for a bad bite. With time, and perhaps with the addition of other sources of strain to the muscles, jaw muscle pain will develop from the muscles that are having to function in a “compensated” manner.

If pain should develop in the jaw joints, as described earlier, the jaw muscles also tighten to protect the painful joints. This chronic, prolonged tightening, referred to as “splinting”, with time can also contribute to pain in the muscles. Clenching and grinding the teeth also contributes to excessive use of the muscles.

Any of these factors, as well as certain systemic conditions, can adversely affect jaw muscles, leading to muscle fatigue, muscle incoordination, and pain. Very often it is a combination of several of these factors, occurring at once, that cause muscle pain or headaches to appear.

The first objective of treatment of a jaw problem is, of course, to eliminate the pain. But it is equally important to provide an environment in which all of the affected components of the system can achieve homeostasis, a return of normal function, or as near to that as is possible. Restoring this level of homeostasis is the best means of minimizing the potential for these problems to recur chronically in the future

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