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How Neuromuscular Dentists Diagnose and Treat TMJ/TMD Symptoms
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TMJ / TMD Diagnosis
Neuromuscular dentists use state-of-the-art technology to determine if your symptoms are caused by malocclusion and if so, what your optimal jaw position is. The dentist uses computerized jaw tracking instruments to record jaw movement, resting position, and path of closure. Electromyography is used to measure your jaw’s muscle function in both its stressed and relaxed positions, and will also measure the jaw-to-skull relationship to see if there is a structural imbalance. Sonography is used to record jaw joint sounds to detect any abnormalities. Additionally, x-rays of the jaw may be taken to help evaluate the condition and positioning of the joint.
 When a patient’s bite is not properly aligned, the TMJ may dysfunction and a number of related symptoms can arise. One of these symptoms is facial pain.
The jaw area of the face is a complex network of bones, joints, muscles, and nerves. When the jaw becomes unaligned, the surrounding bones, muscles, and nerves are also affected. This includes the muscles of the face, which experience strain or spasm because the muscles are working extra hard to compensate for the unstable bite.
A neuromuscular dentist can help facial pain problems by working with the source of the problem, the bite. Your neuromuscular dentist will stabilize and realign your bite so that the teeth , muscles, and joints all work together without strain.
Having a “ bad bite” ( malocclusion) causes an imbalance in the jaw-to-skull relationship, which in turn twists the jaw into a strained position that refers pain to the muscles in the neck, shoulders, and back.
Muscles work as a team. Seldom does a single muscle work without other muscles in the team joining in. The bones in the neck, especially the atlas and axis, are intimately involved with the muscles of chewing, biting, talking, breathing, and head posture. Sore, tight, contracted muscles of the jaw will tilt the head and shoulders causing compensation from neck, shoulder and back muscles. Although the neuromuscular dentist does not claim to treat neck, back, shoulder, or arm pain, patients are pleased how frequently these problems can be relieved.
Neuromuscular dentists understand that the bones, joints, muscles, and nerves in the face and neck have a complex relationship. They work to correct the bite, relieving strain on the jaw and the surrounding muscles. Once the bite has been aligned, resulting pain in many areas of the body disappears.
Ringing in the ears , or tinnitus, is another symptom of TMJ that is commonly misdiagnosed and often goes untreated or is treated ineffectively. In many cases ringing in the ears is one of the results of having a strained bite in which the jaw is not aligned. The jaw area of the face is a complex network of muscles and nerves, and when the bite is misaligned muscles and nerves throughout the head, including the ears, can be affected.
If your neuromuscular dentist diagnoses the cause of your tinnitus to be an unstable or misaligned bite, he or she can work with the source of the problem by stabilizing and realigning the bite so that the entire jaw area works together without pain. Your bite will be back to its normal position, relieving the ringing in your ears that was caused by the misaligned bite.
 Sensitive or sore teeth are common symptoms of TMJ ( temporomandibular joint disorder). If the teeth are the cause of TMJ then any or all of the teeth may be sore. The teeth may also become sensitive because of clenching or grinding the teeth, a common action in many people, when the disc of the TMJ is displaced.
Unfortunately, when seeking relief from this tooth pain many patients are misdiagnosed and may even go as far as having the nerve from the tooth removed with root canals or even having the tooth extracted. The worst part is that these measures may not relieve the pain, and can actually make it worse!
Neuromuscular dentists relieve sensitive and sore teeth related to TMJ by going to the source of the problem—the “ bad bite” and misaligned jaw. In most cases, correction of the bite can be accomplished without the use of surgery, and patients report long-lasting pain relief.
| Clicking or Popping in Jaw Joints |
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Clicking, popping, or snapping in the jaw joint is the most common symptom of TMJ. There may or may not be pain in the jaw when the clicking or popping sound is heard. The clicking sound may even be so loud that others can hear it when you chew or speak.
Usually the cause of the popping jaw is a displaced disc in the jaw. The jaw joints are ball and socket joints, just like the shoulder joint. When ball and socket joints are functioning properly, the ball and socket do not touch because of a thin disc of cartilage located between the ball and socket. This disc of cartilage is held in place and guided by a muscle.
If your bite is not right or trauma tears the tissues the jaw joint is pulled out of alignment, and the disc is typically pulled forward or torn. Now that the cartilage disc is not serving as a cushion between the ball and socket these bones are rubbing against each other and pressing on nerves, causing pain in the jaw and clicking or popping sounds in the jaw joint. The muscles holding the disc in place are now strained as well, causing additional pain in the jaw and face as well as in the head, neck, back and shoulders.
Neuromuscular Dentistry works to realign the bite, which gives the disc a chance to realign. Once the jaw is realigned and the disc is back in place the clicking and popping sounds in the jaw may stop and the muscles holing the disc in place can relax, alleviating the jaw, face, head, neck, back, and shoulder pain that resulted
Limited jaw movement or locking jaw may feel like the lower jaw is catching when the jaw is opened. In some cases a person with a locked jaw must move the jaw to one side or the other in order to open the mouth wide. A person might also have to open the mouth until a popping sound is heard and felt, at which point the jaw unlocks.
Limited jaw movement or locking jaw is often a result of a “bad bite.” When the bite is not aligned correctly it causes problems in the jaw joint, the TMJ (temporomandibular joint). The unaligned bite can result in locking jaw, clicking or popping in the jaw, and headaches.
Neuromuscular dentistry realigns the bite by measuring the jaw in its most relaxed position and then putting the jaw back into its natural position. In most cases this repositioning can be accomplished without braces or surgery.
| Numbness or Tingling in Hands / Arms |
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 The nerves and muscles in the jaw area of the face are very complex, so when your bite is off, these nerves and muscles are also affected. A misaligned bite can cause the muscles throughout the jaw, face, neck and shoulders to go into spasm. When these muscles (scalenes) are in spasm they can pinch the nerves (brachial plexis) leading down the arms and into the hands, which in turn results in feelings of numbness or tingling.
Neuromuscular dentists can help you with numbness or tingling in your hands or arms by working with the source of the problem—your bite. Once your bite is aligned, the muscles affected by the jaw joint will be able to go back to their normal function, relieving the spasm and the numbness and tingling that are felt as a result.
 While not a physical symptom, the majority of people suffering from TMJ also suffer from depression, usually as a result of their condition being so commonly misdiagnosed or dismissed as having no physical cause. There is also scientific evidence that shows that patients with ch ron ic pain , a condition that nearly all TMJ patients can claim, have chemical changes in the brain as a result of the pain. These chemicals can cause depression.
Because TMJ is a multifaceted disorder, many patients need to work with more that one specialist to return to optimal health. Some patients work with a neuromuscular dentist as well as a psychological counselor and sometimes a chiropractor or physician. However, other patients experience complete pain relief from the treatment their neuromuscular dentist provides and the peace of mind that comes from having their condition diagnosed and treated. Speak with your neuromuscular dentist about your personal needs.
Once your neuromuscular dentist has diagnosed your TMJ problem, he or she can determine the best course of treatment for your specific needs. Typically treatment will follow three steps:
- Relieve muscle spasm and pain
The immediate concern for neuromuscular dentists is to provide relief of your symptoms. The best way to do this is by using a technology called ULF-TENS. ULF-TENS stands for Ultra Low Frequency Transcutaneous Electrical Neural Stimulation, but don’t let this term intimidate you. Basically, ULF-TENS is a way to relax muscles with a gentle massage. The rhythmic pulsing relaxes the muscles by increasing blood flow and pumping out waste products. ULF-TENS also helps with pain relief by stimulating the body’s production of endorphins, the body’s natural anesthetic.
- Stabilize the bite
Often for this step a temporary device, known as an orthotic is worn over the teeth. The orthotic allows your neuromuscular dentist to make easy adjustments to the plastic without adjusting the teeth until the bite is stabilized. Once symptoms are relieved and the bite has been stabilized, your dentist will move on to the next step and permanently adjust your bite to the correct position.
- Long-term management
There are a variety of ways to correct your bite in a more permanent way. Four of the most common of these approaches are outlined below:
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Coronoplasty/Equilibration
Co ron oplasty is smoothing and reshaping the enamel of the teeth to correct your bite. It is a simple procedure that does not require anesthesia and can be used when the bite is only slightly misaligned. |
Reconstruction
This approach involves increasing the vertical dimension of the teeth using porcelain restorations. This permanently realigns the bite and provides structural support for the jaw. |
Orthodontics (Braces)
When the teeth are healthy (not worn down or over-restored) they may be moved to the optimal position using braces. |
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Information courtesy of LVI Global
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