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.
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.Want to learn more about TMJ disorder? Download our FREE Guide for more information.
Common Symptoms of a TMJ DisorderTrauma 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
WhiplashWhiplash 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 TraumaDirect 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 WideAll 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:
- TMJ pain and swelling
- Limited mouth movement
- Jaw pain
Physical ExaminationYou 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 JawTemporomandibular 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 ScansThe 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 ImpressionsWe 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.
BBBSThe 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 – ElectromyographyThe 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 AnalysisMany 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 ElectrognathographyEGN 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-ScanThe 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 ExaminationThe 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.
- 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)
- Anti-inflammatory drugs/pain medications /muscle relaxants
- Sleep aids, antidepressants and other similar medications
- Injections, including steroid injections
- Surgery (jaw joint replacement surgery)
Barbara Hamilton - Greatly Improved
Thank you Dr. Romriell and staff. Your care has been administered in a professional and caring manner. When I first visited the TMJ Center I had very limited range of motion in my jaw. Eating was painful and difficult. After a few months of therapy and wearing the appliances day and night, my jaw is less sore and range of motion has greatly improved. The staff has been good to accommodate me with last minute appointments when I needed an extra visit, or just needed to rearrange my schedule. Barbara
Stephanie Bolster - Changed My World
My treatment has been more than I expected, with faster results than I expected. I wasn’t in pain for very long before I decided to seek treatment, and I am glad that I didn’t wait. Not only did I learn about many things that were probably being done “wrong” from the beginning on my part, I learned techniques to correct them as well as ways to avoid making mistakes in the first place. My appliances have changed my world- I am much more aware of what my teeth, tongue, jaw and face muscles are doing now. I am nervous now to be without my appliances during the day, I know/hope that day is inevitable. I feel so much better in general!!! Of course I would recommend the TMJ Sleep Center to anyone who is having trouble. Thank You, Stephanie Bolster
Katherine-TMJ Sleep Center was priceless!
The TMJ Sleep Center and Dr. Romriell provided superior medical treatment. Not only did they accomplish everything that was assured to me in the initial consultation and testing visit, but they exceeded my expectations. Within a short time of beginning treatment with The TMJ Sleep Center my pain was reduced, my ability to eat was restored, and they took careful attention to tailor the treatment to my specific needs. The staff was kind, helpful, and very accommodating with appointment times. After 25 years of complaining to numerous dentists that I was in pain, only to be told that, “I was just sensitive”, Dr. Romriell quickly identified, diagnosed, and successfully treated my condition. As with any commitment to a year worth of medical treatment, that included a six hour round trip drive for each visit, it at first appeared to be a daunting task. In hindsight, it was painless, the time passed quickly, and has now improved my day to day quality of life to such an extent that I can only say, my time and treatment at The TMJ Sleep Center was priceless! Katherine
Misha-forever grateful to Dr. Romriell
I had sustained a head injury 4 years prior to coming to Dr. Romriell and had been struggling with many areas of my life; many of which I didn’t quite understand or know who to seek for help. I was having headaches everyday; I had poor concentration; my eyes were sensitive to light; I had low self-esteem and confidence; I was depressed; I had high anxiety; I had not been able to run and compete as I once did. I knew I was only a fraction of who I once was and needed help. I began working with Dr. Romriell and he started to give me a glimmer of hope that I could get better and that I had something to offer to the world. Treatment with him has been long and tough for me to make changes in my life for the better. I can now say my life is beginning to get better. I am starting to have less headaches and more joy in my life. These areas are changing my life. It helps with my depression and my confidence. I always felt better when I left Dr. Romriell’s office and he made me feel like I mattered. My eyes felt better and my muscles felt relaxed. This is helping other areas of my life that I have struggled with since the accident. I still have a long way to go, but I feel like I am beginning to find myself again. I am forever grateful to Dr. Romriell and those who work with him for helping a “lost sheep” when no one else could or wanted to take notice. Misha
Dennis Anderson - Changed My Life
THANK YOU! THANK YOU! THANK YOU! Dr. Romriell I want to take this time to tell you that the treatment you have provided me for my sleep apnea is PHENOMENAL… You have changed my life, I didn’t know what sleep was until I got my appliance and discovered real sleep and the beauty of it. I would recommend this to EVERYONE with a sleep problem. My WIFE says THANK YOU too! Dennis Anderson
Melissa-The TMJ Sleep Center to get your life back
Thank goodness for Dr. Romriell! Twenty one years ago, when I was twenty five years old, I experienced a wide range of disturbing symptoms. I was a very healthy person and I couldn’t figure out why I was experiencing earaches and pain in my temples, causing disabling headaches. The worst thing was the dizziness. My neck muscles were in knots. I remember I had difficulty sleeping because the bed would spin like I was intoxicated! I also had sinusitis that would not clear up, my tongue burned, and my throat hurt on one side. Dr. Romriell knew what to do. Surely, at that time, there were very few dentists that knew much about TMJ disorders. After 2 weeks of my using the treatment appliance Dr. Romriell designed for me I was back to complete health. My symptoms totally disappeared. I have been free from the TMJ symptoms for 21 years. Thank goodness for Dr. Romriell! Thank you Dr. Romriell and staff for giving me my life back so many years ago. Good health is everything! Good health is something we take for granted in our lives, until it is ripped away for one reason or another. I would absolutely recommend Dr. Dwight Romriell and The TMJ Sleep Center to get your life back and recover from a TMJ disorder. Melissa
Darth West - Thank You
Thanks for helping me. You guys are great. This is the greatest invention since the invention of the wheel. I know I’ll do lots better thanks to you. Darth West
Stacey Christensen - I Got My Life Back
My name is Stacey Christensen. I was involved in a car accident on Jan. 22, 2009. My daughter who was in the car with me had a tooth knocked out as a result of the accident. As recommended by her doctor, I brought her to see Dr Romriell. I had been suffering with what I thought was emotional issues as a result of the accident. At our appointment, Michelle, who was seeing my daughter told me how important is was for me to have my jaw looked at, and that a lot of my symptoms went along with TMJ. I was really thinking to myself “YA RIGHT”. I did make the appointment and on that very day Dr. Romriell told me that my jaw was out and that he was going to put it back in and I would feel back to normal shortly there after. I would have never believed that my jaw being knocked out could have caused me to feel emotionally unbalanced. Dr. Romriell put my jaw in and almost instantly the haze cleared from my eyes, and I could think again. The feeling of hopelessness and helplessness were gone. I didn’t have the urge to cry over feeling overwhelmed. I really felt like I got my life back. I am so thankful for the caring and educated staff here at The TMJ Center. I trust them wholeheartedly with everything they do. I would no doubt still be suffering needlessly if Michelle had not convinced me to make an appointment with Dr. Romriell. Stacey Christensen
Charlene Wojtak - Thank You, Thank You All!
One early morning while getting ready for work I noticed that I could not open my mouth. I did not know why. The left side of my jaw into my ear was very painful. I could not eat, sleep or talk. Several days later I still was not any better so I called my dentist. That appointment was quick since I was in such pain and he did not make me open my mouth just in case I might not be able to then close it. I have never experienced anything like this pain before. My dentist then referred me to Dr Romriell for TMJ. Dr. Romriell asked if I had been in an accident recently or had any head trauma. I replied not since the early 80’s when I was in a motorcycle accident suffering a fractured skull. Preliminaries with Dr. Romriell led to his diagnosis of severe TMJ/TMD. My left jaw joint was locked, the disc on top was not in proper position and the muscle was tense giving me the severe pain not only in my head but in the other areas of the upper half of my body. Treatment might take 1-2 years to be back to normal. For 3 months every week I visited the doctor in tears from the pain. Treatment progressed finally at 6 months visiting every 3 weeks without pain and a big grin back on my face. All the care and information I received as well as stretches and exercises have helped to comfort me and returning back to normal is wonderful. I highly recommend the awesome Dr. Romriell and great team at The TMJ Sleep Center. Thank you, Thank you all! Charlene Wojtak
Carol Burk - How Do I Ever Thank You
Your staff and in particular –you- have treated me with such kindness and tenderness for 5 years and I do not know that I can ever thank you sufficiently. Everyone here has lifted my spirits when I am discouraged. Thank you so much. Carol Burk
As was disclosed in an earlier request, I was involved in an automobile accident that resulted in a whiplash injury. Initially, I thought I was fine but shortly after the accident symptoms began to surface. It was also a short time after the accident that I had my semiannual dental appointment for a cleaning and a check up. I complained of a progressively worsening of a painful popping jaw with other accompanying discomforts. My dentist provided some literature on TMJ disorders and possible causes. Because I was busy with other therapy and hoped that all would resolve in time, I set the documents aside. After all, I had sustained no obvious facial impacts. Since the accident, I have headaches that do not go away, ringing in the ears, and painful muscles in the neck, shoulders, and back. These were just the more painful elements; I can no longer drive at night, read well, speak well in groups larger than 10 or 15 people, or understand conversations in groups of more than 4 or 5. Lights and noise are constant irritations that make the other symptoms even worse. Two years after that dental appointment, my dentist performed a TMJ evaluation based on a few measurements, range of motion, and jaw noise. He suggested I wear an appliance that he had made for me and continue observation on a more frequent basis. I followed instructions for one full year, and on the one year anniversary date, the evaluation showed that range of motion was less than half in all directions and the noise levels had not changed. With this observation, my dentist recommended that I have the condition evaluated at the TMJ Sleep Center by Dr. Dwight Romriell. It is now about 14 months since treatments began and have begun Phase 2 treatment. At this point, I have noted the following:
- Changes Since the Beginning of Treatment
- I have a considerable increase in the range of motion; both opening and side to side.
- There is no noisy, painful jaw clicking/snapping.
- So far I have not experienced a locking up or difficulty in closing my jaw.
- Muscle discomfort below the temples is significantly reduced.
- After the initial consultation, I had hopes that the headaches would cease, but they continue. They have never really changed since the accident regardless of therapy or medications. Disappointed, perhaps a little, but I suspect that there may simply be multiple reasons that the headaches continue, and I need to be patient until all causes are identified, and a correction for each is enabled.
- Like the headaches, a continual state of dizziness accompanies me throughout the day and night. There are times that I think the headaches and dizziness are connected. For this reason, I believe the dizziness will go away when the headaches go away or visa versa.
- I have had a continual string of episodes where tender points in my neck, shoulders, and upper back/torso seem to intensify the headaches. These in turn seem to intensify the dizziness. I have learned that these points may be referred to as trigger points. I expect that as long as they remain active in my neck, shoulders, and upper back none of the other irritations will go away.
- I feel that my Phase 1 treatment went well and that progress made was also very good. The cold weather seems to have had an impact on the rate of progress. This may be tied to my ability to keep sensitive muscles from becoming chilled.
- I have absolutely no complaints about methods of treatment and the personnel are some of the most courteous and personable I have met.
- I am beginning to find that improvements are gratifying and greatly appreciated.
- The care I am receiving has exceeded all my expectations from the beginning.
- Something I need to learn is how to unconsciously relax muscles in my neck, back, shoulders, and jaw.
I would recommend friends and acquaintances with a TMJ problem to go to the TMJ Sleep Center. Respectfully, Dennis Bingham
- Life Changes
- I have had numerous changes to my life since 4 ½ years ago.
- I have had to relearn several skills.
- I am discovering that some skills appear to be permanently gone.
- My ability to enjoy my family is significantly impacted.
- The list of life changes is quite extensive, but I am learning to adapt.
Bobbie Thornock - I truly appreciate the care and concern
In July 2010 I came to the realization, in my abject condition, which I desperately needed help with a temporal mandibular joint problem. There was clicking and popping sounds, together with PAIN in my left jaw. I had limited opening as well as sometimes a “locking” due to the pain. Sometimes my back teeth would be tender. I had some extensive work done by Dr. Kris Monk in Idaho Falls; therefore I called his office and gave them my symptoms. I was immediately referred to Pocatello to see Dr. Dwight Romriell DMD DAAPM. He is known to be the best in this area. When I called his office, I was greeted pleasantly and courteously and set with an appointment to see Dr. Romriell. Living in Shelley; I thought it might be hard to find the office; however, it was easy following the directions given to me by Shonda. As I walked in the office for my first appointment, Shonda warmly greeted me and offered me juice or water. There was no waiting, as Connie immediately came to escort me back for the CT scan and prep work before meeting Dr. Romriell. Procedures were followed and I was fitted with a Mandibular Oral Re-positioning Appliance (MORA) and told to wear it constantly, day and night even sleeping and eating. This I have done consistently, due to Dr. Romriell’s candor and ability to instill in me the desire to follow his procedures. I have had no trouble being amenable in his requests for my treatment. It took a little getting use to at first, but I have done quite well with my treatment thus far. I can definitely tell a difference, especially when I yawn, open my mouth to chew, and brush my teeth without pain. According to my records, I have made positive progress and I truly appreciate the care and concern each time I visited during my appointments I HIGHLY RECOMMEND Dr. Romriell to anyone who has my problem or other problems for which he is very qualified to solve. I really appreciate the care and concern of all the office staff . Sincere Thanks. Bobbie Thornock
Aimee King - No More Pain!
I never even knew about TMJ. When I found out I thought that treatments wouldn’t work. Ever since treatment started my pain has gone away. I have noticed that I am happier now that it is being treated. The doctor and nursing staff are really nice and helpful. I would like to thank them immensely. I couldn’t believe that I wasn’t the only one with this condition. Thanks to all of you guys at the TMJ Sleep Center. Aimee King