WHAT IS TMJ PAIN?

The temporomandibular joint disorder is often referred to as TMJD, TMJ or TMD. The jaw joint is possibly the one joint in the human body we take most for granted.

We constantly use the jaw joint on a minute to minute basis without even realizing it. When the jaw joint is damaged, other parts of the system such as the muscles and teeth become irritated. The jaw joint itself is usually not painful; therefore, the pain is referred to other areas and structures. Consequently, TMJ disorder has earned the name and is known as “The Great Impostor”. The most common TMJ symptoms are headaches, ear symptoms, and restricted jaw motion. The jaw is usually not the root cause of any of these conditions.

The temporomandibular joint is the joint in front of the ear which connects the upper jaw to the lower jaw on either side of your head. The TM joint affects how we talk, eat, yawn, swallow, lick our lips, and whistle… Basically, anything you do with your mouth.

Between the upper and lower jawbones is a disc of cartilage, which actually acts as a ‘third bone’ and will move in coordination with the lower jaw. Because the TM joint is one of the most complex joints in the human body, it is a common place for issues to arise. These issues can cause pain and discomfort and often go unidentified for long periods of time. The nerve to the TMJ is a branch of the trigeminal nerve. An injury to the TMJ can be confused with neuralgia of the trigeminal nerve. The two bones of the TMJ are held together by a series of ligaments, which can be damaged, just like any other joint in the body.

A damaged TMJ ligament usually results in a change in both the position of the disc, and the lower jaw. The bones are connected by two main muscles: the temporalis and the masseter. Any or all of these muscles may be painful and refer pain to your head, face, ears, and neck. They may also cause cause abnormal movement of the lower jaw.

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SYMPTOMS

Common Symptoms of a TMJ Disorder
Trauma is a common cause of TMJ injury; however, what we consider trauma is not always limited to severe accidents, such as a traffic crash. Injuries including a headbutt from a child or a sports injury can cause TMJ symptoms as well.
Listed below are many common symptoms:
  • Headache or migraine headache
  • Pain in and around the ear, cheek or temple
  • Ringing in the ear, ear pressure, or dizziness
  • Tightness or difficulty in moving the jaw
  • Clicking or popping joint sounds
  • Grating feeling or sounds in the jaw joint

CAUSES OF TMJ

Whiplash
Whiplash is a common cause of TMD and is usually associated with a motor vehicle accident or something similar. Whiplash occurs when the head is suddenly thrust forward then backward in a violent motion.
Common complaints when suffering with whiplash include:
  • Neck pain or stiffness
  • Headaches (especially temporal and occipital-where neck attaches to head)
  • TMJ related symptoms
  • Dizziness or light-headedness
  • Changes in vision (light sensitivity, blurred vision etc.)
  • Difficulties in swallowing, or tongue thrusts
  • Change in the fit of the teeth or the bite
Direct Trauma
Direct Trauma to the lower jaw in auto accidents and indirect trauma (whiplash injuries), are both known to produce TMJ injuries. Recently, the advent of air bags, which no doubt have saved numerous lives, has also been known to cause TMJ injuries.
Patients injured by trauma often suffer the following symptoms:
  • Burned or abraded skin on the face, chest and shoulder
  • TMJ pain and swelling
  • Limited mouth movement
  • Lateral and cervical neck pain
  • Change in the fit or bite of the teeth
Opening Too Wide
All joints have limitations to movement and the TMJ is no exception. If you open wide for a long time, or if your mouth is very quickly forced wide open, ligaments may be stretched or torn. Jaw dislocation rarely happens without a prior history of trauma; however, it does happen.
Patients with TMJ injuries often suffer the following symptoms:
  • Bruising
  • TMJ pain and swelling
  • Limited mouth movement
  • Jaw pain
  • Headache
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EXAMINATION

Physical Examination
You will receive exams of your face, head, neck, and jaw muscles initially, and routinely over the course of your treatment for a TMJ disorder. Exams may include pressing (palpating) the muscles, the jaw joints and evaluating and measuring how you move your jaw and the jaw functions. Dr. Romriell will examine the jaw joint and jaw muscles for pain, tension, and tenderness. In most cases, range of mandibular motion measurements and CAT scan imaging will be a vital part of your initial exam and regular follow-up checks.
Range of Motion of the Jaw
Temporomandibular disorder (TMD) usually limits jaw movement. With treatment and compliance the jaw’s range of motion should increase. Normal jaw opening is 50 mm and should move 15 mm left and 15 mm right without pain. Your range of jaw motion in opening and moving to the left and right side will be measured at every appointment throughout your TMJ treatment.
Imaging Tests, X-Rays, EMG and CT Scans
The TMJ Sleep Center is the only office in the region that has the ability to perform all of these imaging tests right in our office. We have advanced, highly accurate equipment and techniques. Dr. Romriell can see inside your jaw joint and pinpoint any concerns including bone on bone contact, fractures, dislocations, and bone degeneration within the jaw joint.
Magnetic Resonance Imaging (MRI)
MRI creates images of soft tissue, muscles, disc, and ligaments of the jaw and head. We send the patient out to have an MRI taken when there appears to be a need for surgical treatment of the jaw joint. In an MRI image, we are looking at the position and condition of the disc in the jaw joint, jaw joint position, jaw and disc dislocations, joint degeneration, and fractures.
Tooth Impressions
We take an imprint of your teeth and record your bite to give us an exact replica of your teeth and your bite position. With the jaw records our doctors have a very accurate model to evaluate your bite and construct the necessary TMJ treatment appliances designed to improve jaw movement and patient comfort.
BBBS
The ball bearing bite recorder is a two-piece appliance we construct in the laboratory on the models of your teeth. The BBB’s fit over the top and bottom teeth and allows the doctor to very accurately record the patients bite. The TMJ Sleep Center is the only center in the area we are aware of that regularly uses this technology for the recording of the bite and the construction of dental appliances.
EMG – Electromyography
The primary symptoms of a TMJ disorder usually come from the muscles. EMG is a method of evaluation of the ability of muscles to contract (work). It will measure muscle activity while at rest, and record muscle contraction while doing those activities of normal life. The recording will determine if the appropriate muscles are working together at the right time.
JVA – Joint Vibration Analysis
Many of our patients are concerned that they may need jaw joint surgery. Joint vibration analysis is a valuable tool in identifying the presence of bone upon bone contact within the jaw joint during jaw motions. It will assist Dr. Romriell in identifying cases of potential need of jaw surgery. The possibility of the wearing of bone upon bone is obviously not a good thing, and we would like to know if that condition exists prior to initiating any conservative TMJ treatment.
EGN Electrognathography
EGN is a computerized method of recording and preserving the movements of the jaw as an individual opens, closes, chews, and swallows. TMJ patients usually have jaw joint problems, and tight sore chewing muscles both of which have an effect upon the way the jaw moves. The jaw will deflect toward the tightest jaw muscles and toward the side of the joint that is the most restricted in its ability to move.
T-Scan
The T-Scan provides a computerized dynamic recording of the tooth contact as an individual bites down and chews. We record the pre-treatment bite condition of our patients showing which tooth touches 1st, 2nd, 3rd, 4th, and so on. The T-Scan records the amount of force on each tooth and the balance of force front to back, and left to right. This recording is made at least twice during treatment including the beginning bite position, and the recording of the bite or tooth contact at maximum TMJ improvement. Most of the patients need to have their bite improved following TMJ treatment. The T-Scan is utilized with most patients for shaping and contouring the teeth to achieve a balanced bite.
Neuromuscular Examination
The jaw joint is one of the most complex and delicate joints in the human body. We assess to determine if there are any imbalances using a range of motion and T-scan recording. This is non invasive procedure that studies have shown to be the most accurate device of its kind. The whole body approach combines state of the art ultrasound, cold laser, microcurrent, and trigger point manipulation techniques. See additional information at TruDenta.

TREATMENTS

GET THE RIGHT TREATMENT PLAN
Proper Diagnosis + Proper Treatment = Positive Results
Each patient and each case is different. It is the proper diagnosis by Dr. Romriell with the input from the patient that determines how the condition will be treated. When proper diagnosis and proper treatment are combined positive results are achieved. Please contact The TMJ Sleep Center today for a complimentary consultation. We will answer your questions and determine which treatment option will be most successful.
Non-Invasive Treatments
  • Explanation – presenting symptoms and correct diagnosis creates understanding
  • Self education and home treatments (such as massage techniques and heat patches)
  • Relaxation and exercise techniques
  • Splints/mouth guards
  • Behavioral techniques
  • Prolo Therapy
  • Jaw joint lavage (Arthrocentesis)
Drug Treatments
  • Anti-inflammatory drugs/pain medications /muscle relaxants
  • Sleep aids, antidepressants and other similar medications
Invasive Treatments
  • Injections, including steroid injections
  • Surgery (jaw joint replacement surgery)
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