+How can I tell if I have TMJ/TMD?

Symptoms of TMJ can be many and varied but can usually be subdivided into those that occur A) around the jaw, B) around the head, C) around the whole body. Do you have any of the following?

Symptoms concerning the Jaws

  1. Clicking, grating, grinding noises or popping (loud or soft) of your jaw joints during chewing, talking, or yawning are all cardinal signs of “TMJ”, as are…
  2. Pain in the jaws, especially the jaw chewing muscles of the jaws, or pain right in front of the ear, especially when chewing.
  3. Excessive clenching or grinding of your teeth during sleep or even during waking hours.
  4. Limited or painful mouth opening, or “catching”.
  5. Difficulty closing your jaw all the way to your full normal bite.
  6. Jaws so stiff in the morning upon rising that you cannot get your mouth open for a while, or other types of jaw motion limitation.
  7. Pain in the teeth with no detectable dental cause.
  8. Severe jaw deviation upon opening.

Symptoms Concerning the Head

  1. Migraine headaches, of any type, intensity, duration, or location in the head.
  2. Chronic recurrent headaches of any frequency, intensity, pattern, location, or duration in the absence of any other known medical reason.
  3. Frequent ear pain or ear aches with no infection or other ear maladies present.
  4. Periodic ringing, hissing, or buzzing sounds in the ear, or periodic difficulty hearing.
  5. A plugged or stuffy sensation in the inner ears.
  6. Pressure or pain that throbs above or behind the eyes during a headache attack.
  7. Occasional dizziness or vertigo.
  8. Frequent pains at the base of the skull in the back of the neck.

Symptoms concerning the Entire Body

  1. Frequent neck-aches.
  2. Neck pains that spread down the shoulder and arm.
  3. Numbness or tingling in the fingers or “pins and needles” feeling that slowly spreads up the hand and forearm over 10 – 20 minutes, that then might “jump” to the side of the face or side of the head.
  4. Pains starting at the head and neck that spread down the back to the hips and legs.
  5. A generalized muscle weakness that comes and goes, usually limited to one side of the body or the other.
  6. A feeling at times that the head is too heavy for the neck muscles to hold upright.
  7. Frequent episodes of cold hands, cold feet. For females, extreme difficulties with PMS or variance in periodicity of their cycle.
  8. Difficulty sleeping. emotional fluctuations (irritability, anxiety, depression) not severe enough to require serious medical treatment but severe enough to be noticed by the patient and /or other family members and close friends.
  9. Nausea, vomiting, weakness, sensitivity to light, sound, or smells during the throws of a bad headache.
  10. Does chewing gum for more than 5 minutes cause headache, jaw pain, jaw muscle fatigue, or pain in the jaw joints?
    Do these and the above mentioned signs and symptoms sound like things you have frequently experienced along with your chronic recurrent headaches? If the answer is yes, you most likely have “TMJ”.

+Who needs Functional Jaw Orthopedics?

Surprisingly a huge number of people; children, teens and adults need Functional Jaw Orthopedics. Anyone, young or old, could need Functional Jaw Orthopedic treatments.. Here is why?

  • Children who have bad bites that trap and hold their lower jaws back too far, making their chins appear weak and making their upper teeth seem to stick too far out (buck teeth), often need some form of Functional Appliance treatment to make their faces appear normal and their smiles appear broader and more full.
  • Children with chronic recurrent headaches, in the absence of any other known medical cause, (such as diabetes, lupus, etc.) definitely need to be evaluated for treatment with Functional Appliances There is a 95% chance that their chronic recurrent headaches are related to some form of bad bite (chronic headaches in children are defined as 1 per month or more!). This holds true even if their bite appears “perfect” i.e. looks normal to the untrained eye. It must be remembered that looking right and actually FITTING right are two different things. This is true even if the child has already had braces! Changes in jaw growth direction after traditional metal braces are taken off can change everything.
  • Adults who have chronic recurrent headaches with or without jaw clicking during talking and chewing should definitely be evaluated (by someone who truly knows how to employ Functional Jaw Orthopedic techniques) for treatment with removable European-style Functional Appliances. Seldom will such techniques not provide the solution to chronic TMJ-based headache and facial pain problems, again even if braces have already been used once in the past.
  • Adolescents and adults who have had four side teeth (“bicuspids” or “premolars” as they’re called) extracted as part of their orthodontic treatment with metal braces and who have frequent headaches DEFINITELY should be evaluated for “TMJ” and the possible need for treatment with Functional Appliances!
    Here’s the big thing. People with chronic recurrent MIGRAINE HEADACHES absolutely must be evaluated for Functional Jaw Orthopedic treatments. Why? It is now firmly established that:
    • Migraine Headaches come from “TMJ”, or “TMD” as they now refer to it in more recent times.
    • Functional Jaw Orthopedics is the modern cure for dysfunctionally-induced TMJ/TMD problems.
    • Therefore, Functional Jaw Orthodpedic Treatments (Functional Orthodontics) is the permanent cure for migraines!

…this represents an enormous breakthrough for headache sufferers in these modern times.

+Is there a lot of controversy associated with TMJ treatment?

Again, boy is there! Here is why. “TMJ” or “TMD” can range from barely perceptible to very severe. It represents a whole family of odd symptoms. No two TMJ patients are exactly alike in frequency, duration, intensity, and variety of symptoms. Yet, in a way, from a broader more global view, people with the advanced form of TMJ are generally all alike. They follow a pattern. They can have their peculiarities in how they manifest their particular problems but generally the big thing the advanced TMJ patients all have in common are chronic recurrent headaches, and the migraine, with all its odd attributes and “focal neurological phenomenae” is the end stage of the long TMJ-based headache continuum. This is a big shock for both the medical and dental communities to have to choke down. But it’s true and nowdays, thanks to modern “high-tech” science, we can prove it! In over 30 years of treating patients, I have never seen a true migraine headache patient that didn’t have TMJ of the type we have been discussing here on this website! NEVER! The association of one with the other has proven out over these many years to be that incredibly consistent! That’s why knowledge (and the whole conglomerate of the Functional Jaw Orthopedics Philosophy) concerning the actual details of how Functional Appliances work is so important in these modern times. Dramatic and historic changes in the status quo of any major discipline are historically often met with equally major resistance. I can’t help that. In all fairness, many dental clinicians, specialists, and generalists alike are converting over to these new methods. Those that resist and criticize Functional Appliances have never really learned how to use them. Those that do learn never go back to the mistakes of former ways!

TMJ treatment for adults

+Do adults who have serious TMJ pain-dysfunction-headache problems always need orthodontic treatment?

Not always. Adult TMJ/TMD 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) long with the 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.

+What is the success rate for treating TMJ pain-dysfunction problems with Functional Appliances?

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.)

+Does TMJ surgery help?

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 who have already had TMJ surgery 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.

+Does correction of TMJ pain-dysfunction problems by Functional Jaw Orthopedic techniques last?

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 no longer need to because it is sort of a “TMJ security blanket” for them during their sleep.

+Why is there so much controversy over how to treat TMJ pain-dysfunction problems?

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.

+Can wearing a bite guard of some sort during sleep at night help a person with “TMJ”?

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.

+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?

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.

+How many types of TMJ syndromes are there?

Basically, there is actually only one type TMJ pain-dysfunction syndrome of the type we are discussing here. It is not a chemical form of arthritis, like gout. It is not an autoimmune form of 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.

+What is MPD?

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 in turn 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.

+What role do stress and/or menses have on TMJ?

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!

+Can diet affect TMJ?

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.

+What does jaw joint clicking during chewing mean?

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.

+Can a person have jaw clicking and no pain?

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.

+Do silent joints mean anything?

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 NON-SURGICALLY with proper treatment!

Orthodontics & Related TMD Problems in Children

+How old should children be before they start wearing braces?

Conventional metal braces can only be used on permanent or “adult” teeth. They cannot be put on deciduous (baby) teeth. So traditionally, children would normally be evaluated at about age 12 because that is the time just about all of the baby teeth have fallen out and are being replaced by the permanent teeth. But now in modern times we recommend children be examined by a dentist for orthodontic problems at about age 7. The reason is that now we have advanced techniques involving removable, retainer-like braces called “functional appliances” that do not need to be attached to permanent (adult) teeth. Such modern devices like this can now be used to prevent or correct many types of bad bites (malocclusions) before they get started or before they can cause further damage to the alignment of the permanent teeth and jaws.

+What are Functional Appliances?

Functional appliances are custom prescription-made removable retainer-like orthodontic devices. Functional Appliances are an extremely important part of the new and modern way of doing orthodontics in both children and adults. “Bad bites” or “crooked teeth” are called “malocclusions”. They may be thought of conceptually as biological triangles of varying degrees of 1) crooked teeth, siting in 2) crooked or misaligned jaw bones, which in turn are operated by a surrounding biological envelope of 3) “crooked” muscles, if you will. This forms sort of a 3-legged triangle of concerns. Traditional metal braces are great, and have been used for over 100 years to straighten crooked teeth. But that’s their big limitation, i.e. they generally only straighten teeth. They are very poor at straightening the “crooked bones” and “crooked muscle environment” that form the two other important components of most malocclusions (bad bites). Modern orthodontic clinicians now recognize this problem. That’s why Functional Appliances (Removable, plastic, Prescription-designed, retainer-like devices) are so important. They not only help the teeth but also the bones and muscles. There are many kinds of Functional Appliances. They were mostly developed over the last century in Europe and have now been in many ways perfected. They aren’t always as good at straightening individual teeth (like the metal braces are), but they’re TERRIFIC at straightening the crooked, misaligned bones (especially a misaligned lower jaw that’s back too far) and the misaligned muscles that work the jaws during chewing, talking and swallowing!

+Which is better, Metal braces or removable Functional Appliances?

Both are great. Each method has its own purpose. Being able to use as much of each method as needed on each case makes for far superior results compared to the old ways of being limited to using metal braces alone. This combined method of using metal braces and Functional Appliances is part of a whole new treatment approach collectively know as “Functional Jaw Orthopedics”. It represents the newest and most advanced “state of the art”, in both Orthodontics and TMJ treatments today.

+Why is Functional Jaw Orthopedics such a superior way of doing orthodontics?

This is an excellent question and could involve a very long and complicated answer. After all, it took yours truly over 11 years of writing a 3 volume series of major textbooks, each one over 500 pages long, to explain all this to dentists, orthodontists and pedodontists, who spend their whole careers studying this issue. But really, the answer, if you will grant me a little poetic license, can be quite short and easy to understand. Basically the reason the “Functional Jaw Orthopedics” method of doing braces for bad bites is so superior to former, more technically limited treatment methods that relied on metal braces only is that the Functional Jaw Orthopedic method can often produce much better looking faces for patients and definitely can produce much better temporomandibular joints (the jaw joints back by the ears) in many patients suffering from certain types of malocclusion.

+Why does Functional Jaw Orthopedic type orthodontic treatment produce better faces?

Functional Appliances are capable of bringing a small, undersized, retruded lower jaw that appears weak or sunken back too far, out forward to a more normal, pleasing position that lines up better with the upper jaw making the face appear fuller with a broader more attractive “Hollywood” smile. Metal braces generally cannot move a sunken back lower jaw forward in this fashion. Metal braces simply cannot change the actual bony size nor front-to-back alignment of the lower jaw. When it is back too far, making for a weak looking chin, all that the orthodontists could do “in the old days” with the more limited metal-braces-technique was to retract the upper front teeth back (sometimes only after taking side teeth out) so the upper front teeth on top could bite against the lower front teeth (which actually sit in a lower jaw that is back too far). This technique often caves in the lips and smile line and often makes for a less full, less attractive, older appearance to the face and smile. The extreme examples of this even have it ‘s own nickname; the “orthodontic look,” and it’s not very attractive compared to a fuller, broader smile. It’s a real problem. But not every case treated the old metal-braces-only way exhibits this phenomenon. But a sizable number do, and for the unfortunate individual that exhibits this “look” as a result of this older type of orthodontic treatment, percentages aren’t much comfort. However, there are a number of other more serious problems however with the short comings of the metal-braces-only traditional orthodontic techniques for many types of cases. Modern dentists are now beginning to finally understand them.

+What is the most serious short coming of the traditional Metal-braces-only technique?

Metal braces are called “fixed appliances”. The word “fixed” to a dentist means “glued in”, i.e. not removable from the mouth at will by the patient. Because metal braces only move teeth THROUGH the bone of the jaws, generally they cannot change the jaw bone size nor most importantly can they change the lower jaw to upper jaw, front to back, alignment at full bite (what dentists call full occlusion). A bite (occlusion) that forces the lower jaw too far back when the teeth close together puts tremendous pressure on the jaw joints back where the lower jaw is attached at the base of the skull back by the ears. This is called the “temporomandibular joint”. It is a sliding ball and socket affair. But the back of the jaw socket has a big nerve and artery complex in it and with enough time and pressure during biting and chewing, a lower jaw that is forced back just a bit too far during chewing damages this nerve and artery complex and causes tremendous pain, often pain that is neurologically referred to other areas in the face and head in the form of chronic recurrent headaches and sore, tired jaw muscles. Metal braces are poor at correcting this and can even push the bite further back sometimes making this condition worse. However, Functional Appliances, of various sorts, are designed to realign the lower jaw forward more properly. They also “reset” the improperly operating musculature around the lower jaw. By virtue of their ability to realign the entire bite FORWARD, Functional Appliances not only relieve the headache-causing pressure created by the lower jaw in its own socket, but also serve to fill out the face, and correct a weak looking chin with its retruded lower facial profile. This also fills out the smile line frontally to a fuller, broader “Hollywood” type smile. So lower jaw position prior to treatment means a lot. Dentists argue ferociously about all this and some of the traditionalists who use only metal braces say none of the above is true. But it is, and now days it can be proven!

+Can adults wear braces?

Yes. You are never too old to wear either fixed metal braces or to be treated with removable Functional Appliances if you really need them. Often removable Functional Appliances, in conjunction with special kinds of removable appliances designed especially for chewing, called “splints”, are used to cure painful, headache -causing temporomandibular joint (TMJ) problems in both children and adults.

+How long does treatment for orthodontic or combined orthodontic/TMJ problems take?

Treatment time can vary, but in modern times, it is often much faster than with previously used techniques. Treatment can usually range from 12 to up to 30 months in cases of severely deformed bites. Again much of it can be done with European Style removable Functional Appliances.

+Do “invisible braces,” the clear plastic see-through type, work?

Yes, they work very well in both teenage children and adults and because they are totally invisible, painless and very comfortable to wear, they are becoming very popular. Trouble is, only certain types of malocclusions (crooked bites) qualify for their use. They are for teeth only. Like metal braces, they cannot change the bone or muscle part of the Teeth/Bone/ Muscle triangle of malocclusion. Hence they are worthless in treating temporomandibular joint pain-dysfunction-headache problems!

+How much does orthodontic treatment cost?

It can vary due to the complexity and severity of the malocclusion (crooked bite) and whether or not there are TMJ (jaw joint pain – headache) problems. Treatment for children who have a TMJ problem that is caused by, or worsened by, a crooked bite that drives the lower jaw back too far during chewing, might cost a little bit more than treatment just for a regular malocclusion, it has been discovered that over 40% of children that need braces have some form of TMD (jaw joint) damage, even before treatment!! But the slight extra expense is well worth it as it will usually prevent life- long problems of chronic recurrent headache and jaw pains. Fees can range from $5000-$8000 depending on complexity. There are extra fees for the initial orthodontic records, which by the way should include a specific x-ray of the jaw joints, either a “transcranial” or “tomogram”. Panoramic radiographs or cephalometric radiographs do not qualify as “specific x-rays” of the temporomandibular joints. Special jaw joint x-rays are most important prior to initiating any sort of major orthodontic treatment.

+Do some types of malocclusions (crooked bites) require surgery?

Lower jaws that are way too long can only be corrected (reduced) by means of surgery. But most undersized lower jaws that used to be enlarged or lengthened by surgical advancement procedures can now be corrected by properly employed Functional Appliances. Surgery is almost never used for these types of retruded lower jaw type problems anymore, or at least shouldn’t be!

+Is there a “big fight” going on behind the scenes amongst dentists as to the proper way to do orthodontics?

Boy, is there! The traditional American orthodontic specialists, who were taught to use metal braces to treat every type of malocclusion even ones with a lower jaw that was too far back never thought much of the European style removable Functional Appliances nor did they believe that they actually worked. They were prejudiced against them from the start because they were never properly trained by their respective Universities in their proper use. The fact that they were developed by European physician – dentists and promoted heavily by American general practitioners (who were often open minded enough to see the benefits of Functional Appliances) didn’t exactly help matters much either. Many (though not all) American orthodontic specialists still insist Functional Appliances don’t work, don’t cure TMJ problems, and aren’t really superior to metal braces with regard to improving the face. Well guess what? They Do work. They Do cure TMJ, and they ARE better for the face! That’s why so many dentists, both specialists and generalists alike are gradually changing over to this entire new system known as Functional Jaw Orthopedics.

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