The Temporomandibular Joint, or TMJ for short, is the joint that allows your lower jaw to open and close and is circled in the picture below. The TMJ is unique in the way it functions and is sensitive to problems. TMJ problems can arise from the joint itself or from teeth and muscles. Many things can set off jaw pain: trauma like a car crash or the way in which our teeth develop. Click here to learn more about TMJ from the Mayo Clinic.
The temporomandibular joint consists of bone, ligament, muscle, and disc. Below is a cutaway view of the jaw joint, the disc is show in yellow/
The two main muscle groups that allow the jaw to move are shown below. These two muscle groups are largely responsible for much of the pain we feel with jaw dysfunction.
The animation below demonstrates a healthy joint where the disc, in yellow, allows the jaw to move smoothly.
The videos below demonstrate how the bones, muscle, and joint work together to allow our jaw to move. The first video shows how a normal joint works with the disc. The second video shows what happens in an unhelathy joint that is “popping” or “clicking.”
Our practice has extensive experience in treating disorders of the jaws and TMJ. While it may not be possible to completely eliminate every nuisance from jaw pain, in most cases we treat we eliminate or greatly reduce the symptoms shown in the image above.
Because problems with TMJ are progressive, there are some cases that, if left untreated long enough, will not respond to dental therapy. For this reason we recommend addressing potential bite and jaw problems early — ideally, before or at puberty.
We treat TMJ by first doing a complete analysis of your medical health, dental health, postural health, sleep quality, bite, chewing pattern, and the health of the joint itself. We then determine if we are able to help by addressing your bite, or the way your top and bottom teeth come together. If there is a large discrepancy, it is likely that addressing your bite will improve your quality of life. In severe cases, we sometimes have to work with a Physician, Oral Surgeon, Physical Therapist, and/or Chiropractor.
An orthotic is a device designed to reposition your jaw in a functional way. This means you can wear the appliance during the day, while you eat, and while you sleep. The orthotic is built using the computerized workup from your first appointment and is subsequently adjusted to your comfort. This means any adjustments are reversible since the modification of your bite is done using a piece of plastic. There are two ways to make orthotics:
A fixed orthotic looks and feels like teeth. Our patients cannot remove the appliance so it is worn 24/7. The advantage of using the fixed option is its comfort and precision. Usually the treatment time is faster with a fixed orthotic. The only downside to a fixed orthotic is it can only be used for a couple of months at a time before it needs to be removed and replaced or removed and transition into a more definitive treatment option.
A removable orthotic, as the name implies, means our patients can take the appliance in and out. The removable benefit is two fold: (1) a removable orthotic an be worn for life and (2) maintains the ability to clean your teeth. But the disadvantage is a removable orthotic is comparatively bulkier to wear.
Using the orthotic is completely reversible and requires no adjustment to your teeth. We will sometimes remake the orthoic or use a different type of orthotic. But for most, persistent pain indicates the need for an orthotic adjustment.
For most people, we can get their bite comfortable in 4-8 weeks with several adjustments. Some require less and some require more. But if our patient has started in a removable orthotic, they can continue to wear it indefinitely as long as we can check periodically that it is not wearing inappropriately or causing teeth to move.
For some patients, they wish to have a more permanent solution. For these patients, we generally recommend using either porcelain, braces, or both to achieve the smile and functional bite they are after.
The two videos below do an excellent job not only describing where TMJ disorders come from, but connecting TMJ and airway clearly and concisely. The animation and narration from the videos help illustrate the connection between your jaw and your sleep.
For most, this process starts with some difficulty breathing — mouth breathing or snoring at night, for example. The size of our airway is determined by many things but our bite is one of them. Either inadequate development or excessive wear on back teeth will compress the jaw joint, as illustrated below. And as the jaw joint becomes more compressed, it becomes more and more difficult to breathe. Because our bodies need oxygen to survive, we will do just about anything to maintain our ability to breathe. During the day, we may start to posture our heads forward and look more upwards so we can breathe easier, creating issues with our head and neck muscles, again illustrated below:
Difficulty breathing can cause problems at night as well. We can sometimes reflexively and unconsciously grind or clench our teeth. This can cause sore teeth or setting off headaches and muscle pain. If we continue to wear on our back teeth, attrition, or loss of tooth structure, can cause a compressed jaw joint making it even harder to breathe. And when we lay back to sleep, our tongue will naturally relax and fall backwards, making matters even worse.
If our tongue falls too far backwards, it hits the back of our throat and causes an interruption in breathing. Sleep apnea is a common disorder in which we have one or more pauses in breathing or shallow breaths while we sleep. Breathing pauses can last from a few seconds to minutes. They may occur 30 times or more an hour. Typically, normal breathing then starts again, sometimes with a loud snort or choking sound. Sleep apnea usually is a chronic (ongoing) condition that disrupts our sleep. When our breathing pauses or becomes shallow, we’ll often move out of deep sleep and into light sleep. As a result, the quality of our sleep is poor, which makes us tired during the day. If left untreated for long enough, sleep apnea causes a chronic hypoxia, meaning lack of oxygen. Our bodies will try to compensate for this lack of oxygen through a variety of mechanisms. OSA symptoms sometimes show up as other diseases like:
Our office does not diagnose sleep apnea because only a physician can do so. We do however screen for breathing problems by sending our patients home with a device that measures your breathing, amount of oxygen in your blood, and the quality of your sleep. After wearing the device at home for one night’s sleep, you bring the device back to our office where we can download the monitor data and send it to a medical doctor. The pulmonologist will then tell you if you have sleep apnea and make a recommendation for treatment based on the severity of your diagnosis.
The most advanced oral sleep appliance currently available is the Micr02. This device is FDA-approved and most patients rave about how comfortable it is to wear. This appliance is much less bulky compared to alternatives and is adjustable to our patient’s comfort. Here is what one looks like:
We routinely treat both TMJ and OSA together.