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home : the jaw jointCommon sense:The rare quality to detect what is right. The knack of seeing things as they are and doing things as they ought to be done. He who attains knowledge and possesses common sense does not require rules - JB A BIT OF A DISCUSSION ON THE JAW JOINT: The temporo mandibular joint [the TMJ - the jaw joint in front of the ear] has an importance way beyond its small size. It is arguably the most important joint in the body – where would we be if we couldn’t move our mouths? When working properly, the TMJ is a beautifully efficient example of natural dynamics. It enables us to speak, eat, and display a range of human emotions –smiling in particular – and, when looked after, it should last the required four score years and ten! But when things go wrong for the TMJ, all hell can break loose! Here’s a few problems than can be traced back to a jaw joint dysfunction: • Clicking and / or locking jaws • Headaches – including migraines • Limited jaws opening • Bruxism – tooth grinding, usually when asleep • Tinnitus [ringing ears] • Eye pain and light sensitivity • Swallowing problems • Pain around the head and face • Balance problems • Neck and shoulder problems If you think this is confusing, consider that there is even confusion in the terminology of this group of disorders. We have mentioned temporo mandibular joint dysfunction. It is also known as cranio mandibular cervical pain. And associated with all this is myofacial pain dysfunction where the primary problem is not in the joint itself but rather in the associated head and neck muscles Most people who come to us with TMJ problems are concerned about their clicking jaws and perhaps headaches or migraines. Then they realise a lot of other unexplained problems [especially those listed above] may have the same or a related cause. And a lot of these patients will have walked the streets for years, seeking help from a variety of health professionals – doctors, physiotherapists, osteopaths, massage therapists, and acupuncturists – just to name a few!  But if the jaw joints are out of harmony with the dental bite, then whatever drugs or manipulation techniques are tried, once the teeth bite together, then that therapy is undone. So the best health professional to treat TMJ problems is a general dentist who is trained in the diagnosis and treatment of TMJ problems. Unfortunately there is practically no instruction on the TMJ and its function and pathology at University dental schools. It is up to the individual dentist to further his education in this field by joining organisations of dentists who have a special interest in TMJ problems and by attending courses and conferences on cranio mandibular disorders. Dr Burford from our office has been a member of the American Academy of Craniofacial Pain for over ten years and now holds “fellowship eligible status” in that organisation. He attends conferences in the United States every year and he has completed over 800 hours of continuing education in this field. Dr Burford has lectured on the TMJ and its associated problems in New Zealand, Australia, the United States, Canada, and Africa. So that’s a general explanation of TMJ and craniomandibular pain problems. For more information, read on! Or you can find a wealth of information on the TMJ web sites we have listed. We know a lot of stuff on the internet is junk, but the sites we have detailed below are from the offices of some very clever dentists who have had years of experience treating these sorts of problems. Read them! You could start with Gerry Murphy and then look at Brendan Stack. And don't miss Wes Shankland who has an extremely informative web site! Before you finish, Bob Talley also has lots of very good information WHERE DID MY TMJ PROBLEMS COME FROM? Not an easy question to answer! There are a bunch of things that may be involved in causing TMJ / facial pains. First of all, you can’t catch it and it may not be hereditary But you should expect that one or more of the following factors may have contributed to your problem: Trauma – including whiplash or any blow to the jaws or to the head and neck region. Or even perhaps just sitting too heavily in a chair – this started crippling pain for one of our patients! And the pain [as is typical for soft tissue injuries] may take weeks or months following the accident before it is noticed. We always look for a tell tale scar on the chin – it is surprising how many people forget the various crashes they have had! Stress – many commentators say that stress is ALWAYS one of the factors in TMJ dysfunction. The first muscles to contract in people with stress are the chewing muscles. And if you clench and / or grind your teeth under stress [which may be as simple as just driving a car] then you are adding another factor to your craniomandibular pain. So muscle hyperactivity – which is a part of myofacial pain dysfunction – is closely related to TMJ pains and disorders Habits – especially thumb sucking which drives the lower jaw backwards into the sensitive soft tissue at the back of the jaw joint. But also nail biting, clenching and grinding the teeth, and even lying on the carpet, chin in hands, watching tv can affect the jaw joint. A tongue thrust swallow is a common but rarely recognised cause of jaw and orthodontic problems Dentistry – we all know how bad a filling feels when it may be only a fraction of a millimetre too high – well, anything done in the mouth can be a factor in pain in the jaws - especially long appointments where the mouth is stretched open with a bite block or a rubber dam preventing the mouth from moving over a long period. Yes I know that these long appointments are frequently unavoidable and I am certainly not criticising my colleagues for using these procedures. But please tell your dentist first if you have a dodgy jaw joint and ask him to give you regular breaks where you can rinse and relax your jaw for a few moments - and ask him not to use one of those mouth prop things. Orthodontics and Oral Surgery - are likely to cause more trouble than general dentistry. Oral surgery – especially where an automatic mallet or hammer or other serious force is used – and orthodontics – especially where teeth are extracted and the mouth is constricted so that the lower jaw is locked into an imbalanced position - are not good news for your jaw joint. These two treatments together – oral surgery plus orthodontics – where the jaw may be cut and realigned [‘orthognathic surgery’], should be agreed to only as a last resort. There are alternatives to surgery with orthodontics that are cheaper and safer and more sensible in most cases [see our section on ‘functional appliances’] Other orthodontic things we don’t like besides this orthognathic surgery include headgear – what kids call cats whiskers – that constricts the natural growth of the jaws. To us, these straps that are worn around the neck or over the back of the head are a modern day version of the Chinese custom of binding the feet of the princesses to make their feet appear small. And if you wonder about us getting cranky about this – then try asking osteopaths or chiropractors what they think of this procedure – and then stand back because they are likely to get violent! Loss or wear of teeth – when you loose a tooth or even part of a tooth, then the bite may become imbalanced. Wear on teeth occurs with grinding [bruxism] and just general wear and tear – especially if you are from South East Asia and chew beetle nut or if you are an Inuit and eat raw meat and chew skins! Tooth removal will generally result in the chin and nose eventually coming closer together, giving stress and uneven wear to the jaw joints. Even extractions for orthodontic purposes commonly lead to a loss of lower face height [that’s why we try not to extract teeth in our office!] Medical treatments – here are a couple of things for you to ponder: intubation for a general anaesthetic is likely to pull seriously on the lower jaw and the jaw joint and can kick off TMJ pain. And we have been able to trace jaw disorders way back to a forceps birth where really strong forces are applied to the sides of the baby’s head. We always tell expectant mothers to make an appointment to see a cranio osteopath within days of the baby’s birth to get the head back into shape – forceps birth or not. Remember, being born is like getting out of a car through the exhaust pipe Incisal interference – some dentists feel this is the MAJOR reason for TMJ disorders. Where the lower jaw is pushed backwards during jaw closing by the shape of the incisor teeth – say by a crown that is too thick or by upper incisors that are sloped towards the roof of the mouth [known as a class 2/2 bite] – then the lower jaw can push into the delicate soft tissue at the back of the joint capsule. Bingo – pain and headaches or migraines! Jaw overuse – if you run marathons, you will end up with hip / leg problems in later life. If you overuse your jaw – as with regular chewing of gum – then similarly in later life you can expect jaw joint problems. The same goes for some occupations – using a jack hammer at work or other activities where the head and neck are repeatedly jarred – can lead to TMJ degeneration. If you are an All Black then you probably will have suffered some sort of TMJ damage Loose joints - some people – especially teenage girls – show a greater than normal joint flexibility or looseness. Physiotherapists call this condition 'systemic hypermobility'. It generally means the person is likely to dislocate joints like ankles and has to avoid vigorous sports. In the US, this loose jointedness in teenage girls is so widely recognised that it has its own name: 'cheerleaders syndrome'. It is thought to be related to oestrogen levels in the body. Girls who have systemic hypermobility are likely to have clicking or locking jaws, frequently with pain and headaches as well Arthritic degeneration - makes sense. If you suffer from arthritis, then your jaw may be a part of this pattern. Try using glucosamine / chondroitin sulphate [in your local health food shop and probably called ‘joint lubricant’] SO NOW I HAVE A TMJ PROBLEM, HOW DO WE GET RID OF IT? First of all, we frequently can’t cure a TMJ / craniomandibular pain problem – unless this is a short term problem of under 6 months and it had a simple cause like a fall or blow to the jaw or head. Usually we 'manage’ the problem, rather than ‘cure’ it. And we will tell you that, although you might feel great, with no jaw sounds or headaches and normal function of your mouth, if you slip over or are in whiplash incident or whack your head, then expect that you will have to come back to us for further treatment for another bout of pain or joint related problems. As a rule of thumb, the longer you have had craniomandibular pain, and the older you are, then the harder it is to get rid of the problems. But that’s not a reason to quit! So, first up, we do a detailed analysis with several xrays and make study models and do a whole lot of measurements so that we know as much as possible about what is going wrong. Sometimes we do a computer based analysis of the jaws and muscles using EMG and jaw tracking equipment Then we most commonly make one of the several types of splints [also known as orthotics or plates] that we use to support and align the jaws. Sort of like crutches for your leg - the splint is crutches for your jaw. We get lots of imformation from the responses to this correction of the jaw relationships. The most common orthotic we use is the Gelb splint which supports the jaw and moves the lower jaw into a balanced position with the skull and the jaw joint And then we could use physiotherapy type treatments - such as massage or ultrasound - to get the muscles or jaws functioning normally. We sometimes inject anaesthetics or prolo solutions [to strengthen the ligaments] into the joints or muscles. We use electromodality equipment such as microcurrent or TENS units or infrared. We could go to orthodontic treatments to align or erupt the teeth. Or we could have crowns or bridges to correct the bite. Or we could send you to a cranio osteopath, chiropractor, or physiotherapist, for more xpecialised support treatment. So you see that there are all sorts of things we do to correct a TMJ dysfunction and/or head pains. We arent people with only one magic treatment - and if that doesnt work then what do we do next problem! And we get good results. Most of our patients get rid of most or all of their symptoms - and we like that! We didn't say that we refer patients to oral surgeons - although we do refer from time to time. That is because only the extreme 2% to 3% of patients should have surgery. It simply must be the last resort. Surgery is totally invasive and totally irreversible - of course. So we try to correct TMJ problems by conservative and non invasive techniques. Only if the conservative techniques do not achieve the results we expect - and we would allow 12 months to determine this - would we consider a surgical option |
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