Q: Do adults who have serious TMJ pain-dysfunction-headache problems always need orthodontic treatment?
A: Not always. Adult TMJ patients will need their bites realigned with “splints” and removable European-style Functional Appliance techniques to get their lower jaws (mandibles) to bite and work farther forward just that little bit to get all that pressure off the nerves and arteries in the back part of their jaw sockets. This is what eliminates the headaches (sometimes in as little as 1-2 weeks) and other jaw muscle and facial pains, and helps heal the damaged jaw joint components back to normal. Once the jaw joints are fully healed and all the headaches, jaw pains and other symptoms have been eliminated, the bite can then, and only then, be perfected by means of capping some of the back teeth, or by restoring the bite with other bite restorative techniques. Braces are not always needed.
Q: What is the success rate for treating TMJ pain-dysfunction problems with Functional Appliances?
A: The success rates with Functional Appliances, or techniques very similar to them, is the highest of any of the many other techniques I have ever used or even seen. It is hard for even professionals to believe, but success rates in the 95% are common place for the body of clinicians that can truly employ these techniques to the fullest. (Successful treatment is considered as a 90% overall reduction in headaches and facial pain – or better.)
Q: Does TMJ surgery help?
A: Seldom. People who are skilled in the Functional Jaw Orthopedics philosophy of treatment are usually against TMJ surgery except in the most extreme cases. In over 3 decades of treating TMJ patients, I have never had to refer a patient for TMJ surgery. But I have treated many patients successfully who have had the misfortune to undergo TMJ surgery that has failed! Such patients still respond very well to Functional Jaw Orthopedic type treatment, albeit their recovery time is sometimes drawn out over a longer period of time. Yet they still experience significant improvement with proper treatment.
Q: Does correction of TMJ pain-dysfunction problems by Functional Jaw Orthopedic techniques last?
A: Yes. Often, after completion of treatment (bite correction), little removable retainers are worn by the patients during their sleep at night to preserve and protect the newly corrected bite. This is done sometimes for certain types of patients for years after the completion of treatment. We nickname these little devices “Pajamas for the teeth.” Patients have no problem doing this. Many wear these devices on their teeth at night long after they need to because it is sort of a “TMJ security blanket” for them during their sleep.
Q: Why is there so much controversy over how to treat TMJ pain-dysfunction problems?
A: Often, under the umbrella of old knowledge, clinicians tried to treat individual symptoms expressed by TMJ patients. Because there were many types of pains and symptoms possible in the overall TMJ pain-dysfunction problem, there are many types of treatments. It all boils down to this. If a dentist wants to treat TMJ Pain- dysfunction syndrome he/she must understand orthodontics (and Functional Jaw Orthopedics as a part of it). And if a dentist wants to do orthodontics, he/she simply must understand not only TMJ problems but also the Functional Appliances that are used to correct them. Put even more simply, if you want to do “joints” you’d better understand “ortho.” And if you want to do, “ortho” you’d better understand “joints.” They are almost the same in the super discipline of Functional Jaw Orthopedics and are intimately related, one irrevocably intertwined with the other. Don’t let anyone try to convince you otherwise.
Q: Can wearing a bite guard of some sort during sleep at night help a person with “TMJ”?
A: Sometimes, just wearing a bite guard at night can help. But chances aren’t likely such methods will prove successful if the patient’s particular TMJ problems are of an advanced nature, i.e. severe. A few people are lucky enough to have a milder form of “TMJ” such that by wearing a properly constructed bite guard (or splint) during sleep it allows the TMJs (jaw joints) enough rest during the night so that they can withstand the abuse they get from a bad bite or malocclusion all the next day provided they once again get the protection and recovery time afforded by the bite guard or splint the very next night again. The danger here is that if a splint is not designed correctly by the dentist for that particular patient, such methods could make the pains and headaches worse, or possibly worsen the bite.
Q: Can a bad set of TMJs cause pains to travel from the side of the head down the neck to the shoulders, back and even to the hips and legs?
A: Definitely yes. Neck, shoulder, and upper back pains are common in TMJ patients. TMJ pain–dysfunction syndrome can worsen pre-existing neck and spinal problems mightily. Only rarely does the referred pain pattern travel all the way down to the legs. But it is possible.
Q: How many types of TMJ syndromes are there?
A: Basically, there is actually only one type TMJ pain-dysfunction syndrome of the type we are discussing here. It is not all chemical arthritis, like gout. It is not an autoimmune arthritis like rheumatoid. It is an osteoarthiritis, i.e. a breakdown of the internal joint parts by means of accumulated trauma i.e. wear and tear.
Q: What is MPD?
A: Myofacial Pain Disorder is an older name use to describe the sore jaw muscles that accompany TMJ pain–dysfunction syndrome. Some people think, mistakenly, that “MPD” is an entity unto itself. Not so. It is merely a part of the overall TMJ syndrome. The jaw muscles are sore and may even develop “trigger points” because they are chronically tense and over-worked almost all the time in people with TMJ syndrome. The pain nerves of the muscles of the jaw go through the same areas of the brain as do the pain nerves that are being damaged in the back of the jaw joint. Because of the chronic pain state of the jaw joints and the neurological effects that causes in pain processing centers in the brain, the pain signals of the tense, sore jaw muscles get amplified. This feeds their propensity to be tense which adds to more muscle soreness. Sometimes this process causes pain referral to other parts of the head or even headaches themselves.
Q: What role do stress and/or menses have on TMJ?
A: These factors make TMJ pain–dysfunction temporarily
worse for the patient by causing chemical changes in the brain and body
that amplify pain and cause an increase in severity of the headaches!
Q: Can diet affect TMJ?
A: Yes. Certain foods that normally don’t bother other
people can be “triggers” for precipitating migraines or other
types of headache in certain patients with advanced levels of TMJ because
they represent a form of a chemical stressor that activates neurologically
primed headache pain mechanisms in the brain. Such brain reflex mechanisms
have been “set up” by advanced forms of jaw joint-damage-initiated
TMJ pain-dysfunction problems and the particularly serious problem of
chronic compression nerve damage that “TMJ” often causes in
the back of the jaw sockets.
Q: What does jaw joint clicking during chewing mean?
A: It means that the internal parts of the jaw joint are becoming
torn apart (disarticulated) by a lower jaw that closes the teeth together
in a bite that pushes the whole lower jaw too far back. This then causes
a little shock absorbing disc in the jaw socket to become torn loose and
slip back and forth between the rounded end of the lower jaw (condyle),
and the surrounding confines of the socket. It is similar to the way a
person can get a “slipped disc” in their spine. In the spinal
example, bone then pinches the nerves coming out of the spine. Just as
in TMJ syndrome, pain in the spinal example eventually ensues, usually
in the back, and is often referred down the leg. In TMJ the pinched nerves
of the jaw sockets often refer pain up to anywhere in the head, (i.e.
the headache), and sometimes down to anywhere in the neck and shoulders.
Q: Can a person have jaw clicking and no pain?
A: Yes, but they are “on the bubble” TMJ-wise. Pain,
headaches, and other TMJ related symptoms could start to appear anytime
for these people. Maybe they’ll get lucky and the headaches and
facial pains will stay away. Maybe not.
Q: Do silent joints mean anything?
A: Two things: either it means 1) the joints are perfectly healthy
and as a result the patient can’t possibly have TMJ pain –
dysfunction syndrome or it means 2) that the joints are degenerated and
destroyed. Everything in there is ground up to the point where there’s
not enough stuff left inside the joint to even make noise anymore as the
parts move across one another during talking and chewing. Sometimes even
a low grade gritting sound can be detected, sort of like rubbing two pieces
of sandpaper together. This “sandpaper against sandpaper”
sound (or feeling) is called “crepitus” or “crepitation.”
It is a sign of very advanced joint degeneration. Not to worry. Joints
this bad can still be cured NONSURGICALLY with proper treatment!