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The temporomandibular joint (TMJ) is the jaw
joint. It is just in front of the ear. In fact
the ear and the jaw joint are joined to each
other. You can feel the jaw joint move by
placing a finger in front of the ear and moving
your jaw from side to side or opening it. You
can also feel this movement by placing a
fingertip in the opening of the ear canal.
Before birth the small ear bones, which conduct
sound, grow off from the jaw bone and migrate
into the ear canal. There are ligaments and
nerves which connect the ear and jaw.
Therefore, jaw problems can cause ear problems
and ear problems can cause jaw problems.
Sometimes it is necessary for the patient to
have both an ear examination and a jaw
examination.
The jaw joints, the lower jaw bones and the
facial bones gradually change shape and size
throughout a person’s lifetime. The degree and
rate of change varies with each person. These
changes occur more rapidly if there are growth
abnormalities, injuries, or diseases. Any
change can cause the fit of the teeth to shift
slightly. If a person feels that his teeth do
not fit together properly it is usually not due
to tooth movement but rather to changes, which
have occurred in the TMJ, jaw bones and face
bones. Some of these changes are transient and
some are permanent. Usually these changes in
the jaws and bite occur so gradually they aren’t
noticed on a day by day basis. However, they
cause facial changes and make some people look
older than others. You, too, can see the
effects of these changes by observing your
parents or older family members or friends.
Orthopedic surgeons, medical doctors, and others
such as osteopathic physicians and chiropractors
work with other joints of the body. However,
the skills of a dentist are necessary to manage
TMJ problems – because if the teeth do not fit
together properly, the jaw joints cannot
possibly function normally. The lower jaw is
like a door which has hinges and a door jam. If
the door jam is not properly positioned, or is
inadequate to stop the door correctly, the
hinges will be damaged. The hinges will be
twisted or pulled slightly out of place every
time the door is shut.
Likewise, if a person has missing teeth, worn
out crowns, bridges or dentures, or if the teeth
are out of alignment or crooked, the chance of
TMJ problems is greatly increased. In fact
there are some types of malocclusion, such as
severe overbites, which almost always seem to
result in damage to the jaw joints. Likewise,
there are certain combinations of missing jaw
teeth, which also seem to result in damage to
the jaw joints.
If a person has a diseased or displaced jaw
joint and has surgery to correct the defect the
surgery will likely fail if the teeth are not
stable and properly aligned.
STRESS:
Stress of any type affects jaw function. This
is a well known fact. Even in ancient
literature we read, “there shall be wailing and
gnashing of the teeth.” More recently,
writings, include “He set his jaw and went
forward to do what he had to do” – or even more
recently “He bit the bullet.”
The stress may be several types. Physical
stress is not uncommon. It occurs when a
person is involved in too many activities. The
work load is simply too great. Daily activities
in the home, on the job, at church, in the P.T.A.,
service club, etc. can become overwhelming.
They are easier to get into than they are to get
out of. Consequently, sometimes jaw problems
seem to get worse because of the physical stress
of simply doing too much.
Emotional stress of several types. Anxiety
occurs when one becomes acutely frustrated
because problems cannot be solved – for example,
a child is sick and the doctor can’t be reached
or the washing machine is broken, the car has a
flat tire, the oven door is broken and company
is coming in two hours. Of course, there are
other problems of this type which last for
months, even years.
Unresolved conflicts occur when one
cannot or will not make an important decision
…to quit smoking – to buy some new clothes … to
break off a relationship …to trade cars, etc.
Sometimes, a person may not even be aware that
the decision-making process is going on deep
inside his or her mind, even at a subconscious
level. This is why it is sometimes helpful to
discuss problems and bring them out in the open
so they can be dealt with more directly. In any
event, unresolved conflicts are one of the
reasons some people’s jaw joints and muscles
hurt more than they used to.
There are other types of stress. But it is
important to know that physical or emotional
stress make jaw joint problems worse.
Therefore, management and control of stress is
often an important part of successful treatment.
NERVES:
About one-half of all the nerves of the brain go
to the mouth, jaws and lower face. There are
three types. Sensory nerves conduct
sensations – touch, heat, cold, pressure, pain,
etc. Motor nerves cause the muscles to
contract for movements of the lips, tongue, jaw,
palate, larynx, etc. Autonomic nerves
are part of the subconscious control system.
They turn on and select secretion of saliva,
tears, nasal secretions, etc. They also connect
to the rest of the body; the digestive system,
the heart, reproductive organs, etc. to get the
rest of the body ready for what’s going to
happen next.
These nerve systems are complex. Medical
science cannot explain all we would like to know
about how the nerves function in health and
disease. Fortunately, (in the last ten years)
much has been learned about pain, muscle
control, nerve reflexes, etc. Consequently,
more patients are being helped. More
importantly, it has been learned that patients
with chronic pains have real physical problems
and aren’t suffering because of emotional
instability.
Abnormalities of the jaw joints and nerves are
major causes of disease and illness in our
society – probably causing five to ten percent
of the population to suffer headaches, pain
and/or abnormal body function. Typically, the
pain begins in the region of the ear. Then
later it becomes a headache radiating through
the temple, behind the eye, and down the back of
the neck These have erroneously been
classified as vascular migraine headaches, when
in reality many so-called vascular problems and
neuromuscular contraction problems are secondary
to the derangements of the TMJ.
TMJ problems also cause neck, back, shoulder and
arm pains – and vice-versa. It is not uncommon
for TMJ patients to have arm pain, numbness or
weakness. If the neck vertebrae get out of
line, pain may radiate through the back of the
head into the region of the TMJ and temple.
Therefore, it is sometimes important to have an
examination and treatment for neck problems for
these can contribute to painful symptoms.
THE TMJ HEADACHE:
The TMJ symptoms are highly variable. Some
doctors call the TMJ “The Great Imposter”
because symptoms seem like migraines, sinus,
ear, eye and neck problems.
Usually pain begins in and around the ear
sometimes with stuffiness, buzzing, ringing,
fullness and even a sensation of water dripping
in the ear.
The pain migrates into the temple across the
side of the head and down the back of the neck.
In severe cases, the pain radiates behind the
eye, causing a deep pressure pain in the
retro-orbital region. These TMJ headaches are
like a deep ache. They last for hours or even
several days. Sometimes they are associated
with fuzzy vision (unable to focus the eyes
well) and nausea.
The TMJ headache is common and probably a grater
cause of suffering than most people suspect.
In the past most patients with these problems
have been classified as being neurotic or
“nervous” because no one knew much about jaw
joint problems. But actually these patients
have real physical problems; to label them as
being neurotic or “nervous” is unfair and
unjust. It simply makes the problem worse
because the patient instinctively knows that
something is physically wrong and to be called
neurotic frustrates him actually may cause
nervous symptoms. There is an old saying “if
you assume that a person is neurotic you can use
his symptoms to support your diagnosis”.
Nervous symptoms are common among jaw joint
patients but they are usually due to the chronic
pain, disturbances to the autonomic nervous
system, frustration of not receiving an accurate
diagnosis and the residual effects of
medications.
Whereas most people with jaw joint problems
don’t seem to suffer much and are able to cope
with TMJ problems there are others whose lives
are devastated by these problems. There are
literally millions suffering headache and other
physical and emotional disturbances because of
jaw joint problems.
In the past fifteen years tremendous scientific
advances have been made in recognizing and
classifying disorders of the jaw joints. A
considerable amount of this new information has
resulted from clinical studies conducted and
reported by our group here in Montgomery. Now
it is possible to diagnose and categorize many
different development problems, diseases and
other abnormal functions of the jaw joints.
Therefore, since we are able to diagnose the
different problems more accurately we can treat
them more effectively. This leads to improved
treatments.
THE DISC:
The disc, a small cushion in the jaw joint,
frequently gets out of place, causing clicking
and/or locking at first. This may not always
cause pain. Then later on the jaw seems to get
better for a few years, only to get worse again
as the joint begins to wear out because the disc
is displaced. When the joint begins to wear out
it makes a crunchy, grinding noise. This is
called Degenerative Joint Disease (DJD) or
Degenerative Arthritis. It is usually limited
to the jaw joints and may or may not be painful.
When the disc gets out of place it usually will
go back in place by itself. This requires jaw
repositioning with appliances called bite planes
or splints. There are many different types.
Some are designed to abruptly move the jaw into
the proper place. Some do it gradually and some
are simply designed to help the jaw relax.
Sometimes surgery is required to put the disc
back in place. However, following surgery there
is usually some limitation of movement and
residual pain may persist simply as a result of
the surgery. Therefore, the recommendation for
surgery is only made when the pain in the jaw
joints, nerves, and muscles cannot be controlled
by other means. In other words, remedial or
preventive jaw joint surgery is not recommended
except in cases of continuous or severe pain.
In chronic cases surgery may be required to
remove the disc and insert a plastic
replacement. This becomes necessary if the disc
is distorted or deformed from being displaced
for several years…or in the case of severe
injury the disc may be too badly damaged to be
left in the joint.
TREATMENT:
Treatment of jaw joints is divided into several
phases depending on the nature of the problem
and the age of the patient. In young
patients, if the disc is out of place, jaw
re-positioning therapy is recommended to put it
back in place even if it is not painful. This
recommendation is obligatory because there is no
way to predict how severe the problem may become
in the future.
However, if an adult has a disc, which
has been displaced for several years, the
chances of repositioning it are slim. If it
doesn’t hurt or cause headache, it is best
simply to do no treatment – leave it alone.
However, if it hurts or causes pain, relief can
be achieved in 80-85% of the cases by bite
splints (bite planes, muscle relaxation jaw
appliances, etc.) supported by muscle relaxation
therapy; mild muscle relaxant medication,
anti-inflammatory medication, and physical
therapy, biofeedback, etc. Of all the different
treatment programs, the bite splint (jaw
repositioner) has proven most effective.
Sometimes the treatment can be completed in a
few days or weeks. Usually the first phase of
treatment lasts 8 to 10 weeks, however, it may
last a year or more. The second phase depends
on what needs to be done to get the teeth to fit
together after the jaw joints have calmed down.
Sometimes the patient may simply wear the bite
splint at night or whenever the jaw becomes
uncomfortable. Sometimes a minor adjustment of
the bite will solve the problem. In other cases
orthodontics or restorative dentistry such as
crowns and bridges may be required.
There are times in the treatment program when
complete patient cooperation is absolutely
essential. This creates hardship for some
patients, because they may have difficulty
wearing the bite planes during certain
activities. For this reason, the appliances are
sometimes cemented or wired to the teeth for
several days or weeks. These problems can best
be solved by complete communication and
cooperation between the patient and the staff
members. If the patient has any unanswered
questions, he or she should ask the staff
member. Likewise, the staff members should
listen to the patients questions, provide the
answers if they can, and be sensitive to the
patients questions and needs.
The case of TMJ problems is complex. The
tendency to have TMJ problems may be inherited.
Childhood injuries are often a factor.
Sometimes TMJ problems lie dormant, then
suddenly begin to cause pain for little or no
reason. Usually it is impossible to treat the
cause – it is best simply to treat what is
actually wrong and try to make it better.
CONCLUSION:
Jaw joint problems are broadly classified as
developmental abnormalities, diseases and
dysfunctions. Also there are other problems
such as dental infections, split teeth, sinus
and ear problems, etc., which cause similar
symptoms. Nerve inflammations called neuralgia
also cause craniofacial pain. A thorough
examination including a review of the patients
history, clinical examination, x-rays and
laboratory tests provide the basis for the
diagnosis. The treatments are highly variable
and are based on the nature of the problem, how
long it has existed, the patients age, etc.
There is no way to use a cookbook philosophy of
treatment. Each patient is different from the
others and the treatment must be based on
individual needs.
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Office Hours |
Anderson Office:
Telephone: (765) 649-3388
Monday
8:00 a.m. to 5:00 p.m.
Tuesday
9:00 a.m. to 5:00 p.m.
Wednesday
8:00 a.m. to 6:00 p.m.
Thursday
9:00 a.m. to 5:00 p.m.
Friday
8:00 a.m. to 5:00 p.m.
Fishers Office:
Telephone:
(317) 578-1933
Monday - Thursday
8:00 a.m. to 5:00 p.m.
Friday
8:00 a.m. to 1:00 p.m. |
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News and Information
We now offer ViziLite Plus which is an early
detection oral cancer screening. It's simple and
quick and can be done in our office.
One American dies every hour from oral cancer.
Twenty five percent of oral cancers occur in
people who don't smoke and have no lifestyle
risk factors.
Oral Cancer is one of the most curable diseases
when it's caught early. A ViziLite Plus exam
can be performed immediately following a
regular visual examination and is quick and
painless.
If you are a smoker ,wear dentures or partials,
or have HPV (Human papilloma virus) it is highly
suggested that you have this test. Call the
office for more details or to schedule an exam.
NEW:
What is TMJ?
Click here to learn more.
We are pleased to announce we now offer
Zoom2, a new whitening system that only
takes one visit and one hour in the office. Teeth
may be lightened as many as nine shades in the one
visit depending on the individual patient's teeth.
Call us for details and screening to see if you
would be able to have this quick, easy treatment.
Please click
here to read
this important information about the dangers that
prescription and over-the-counter drugs can pose to
your health.
As a service to our patients, we now offer a
prescription drug disposal service, free of charge.
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