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TMJ Disorders Explained

Blog0215_TMJ_PainDo your jaws pop and click when you chew? Here’s what you need to know.

Things aren’t always what they seem to be. Sometimes aches and pains crop up in one place, but the real problem originates elsewhere. If you have unexplained pain in your face or head, it’s possible that you have temporomandibular joint (TMJ) disorder. Your doctor will probably refer to it as TMD, but most people call it TMJ. And you’re not alone. According to McKinley Health Center at University of Illinois at Urbana-Champaign, about 10 million Americans have TMJ disorder.

What causes TMJ disorder?

Let’s start with those joints. You have one on each side of your head. They each have a cushioning disc between a ball and socket. When everything works as it should, the discs allow your jaws to open, rotate, and glide, permitting you to speak, swallow, and chew easily.

TMJ disorders occur when your jaw joints don’t function properly. It can stem from a variety of causes such as injury, teeth grinding, and arthritis. It can also occur because your teeth and jaws are out of alignment.

What are the symptoms of TMJ disorder?

You may notice that your bite is a bit off. One of the more obvious signs is a popping or clicking sound when you chew. That means your disc is out of alignment – it’s actually dislocating and relocating as you chew. You may also have joint or jaw pain, but not everyone does. Some people experience headaches, earaches, or neck pain due to TMD.

Seattle area dentist Jessica Saepoff of Natural Dental Health Associates says there are other clues, as well. “Snoring is not normal. Mouth breathing is not normal. Kids should be breathing through their nose, and their breathing should be quiet. Misaligned jaws can affect the airway and lead to sleep apnea. Any child who has trouble breathing through the nose is very likely to have deficient facial growth. Correcting breathing issues early promotes proper face growth and development.”

How is TMJ disorder diagnosed and treated?

Blog0215_TMJ_SmileYour dentist will want to see if everything is aligned correctly. They’ll check your range of motion by testing how far you can open your mouth without clicking or popping, getting stuck, or having pain. They’ll also check to see if your teeth are aligned. If TMD is suspected, your dentist may order some imaging tests to get a more detailed look.

Dr. Saepoff uses cone beam 3D dental imaging to see all the bony aspects of the joint from different directions. If necessary, she will use magnetic resonance imaging (MRI) to look at the soft tissues of the disc.

There’s no one-size-fits-all solution, but it’s not something that should be ignored. “It’s a dislocated joint. If it was any other joint, would you ignore it?” asks Saepoff, who explains the three main options that may permanently correct your bite:

1. The least expensive choice is to use a removable splint. It’s a simple, non-invasive device that snaps into place on your bottom teeth. It’s tooth colored and durable enough to chew on. Some patients need to wear it all day, but some find that wearing it only at night is enough to help. It works by stabilizing the teeth so your bite closes into the right position. “We do this with expansion orthotics and no extractions. We don’t use any nickel, which has a high allergy response,” says Saepoff.

“The mainstream treatment is to wean off the splint and go back to being dislocated, as long as the pain doesn’t come back. But once it’s corrected and function is improved, we can offer choices on permanent corrections.”

2. Orthodontic correction is another option, particularly for children or for adults who have few restorations. It takes somewhat longer than regular orthodontics, but the teeth can be moved so they work with the jaw. Once the bite is corrected, the teeth can be straightened for a more presentable smile.

3. The fastest, but most expensive treatment is to correct the biting surface by restoring teeth with inlays or crowns. This will help keep teeth aligned after the TMJ is fixed.

If none of these treatments is feasible, or if they don’t work, surgery may be necessary to put the disc back in place.

While all that is going on, you may want to give some thought to your diet. According to Saepoff, avoiding wheat and sugar can help reduce inflammation, which can eliminate many of our aches and pains.

Without treatment, TMD can become a chronic problem. In some cases, the disc will stop clicking, but that’s only because it’s permanently out of position. However, if your jaws still open wide enough to chew and you’re not in pain, it may be okay to leave it alone, but you’ll want your dentist to monitor it. “Technically, you have a dislocated joint, but once you do anything to disrupt the normal chewing pattern, it’s like kicking a bees’ nest and can result in destabilization,” says Saepoff.

Saepoff, who has been treating TMJ problems for 15 years, believes many of these problems are preventable in kids. “My practice is now focusing on correcting facial growth and development problems early to prevent future joint and airway problems – but you’ve got to fix the jaws before you fix the teeth. And it’s best to diagnose and treat it as early as possible.” Dr. Saepoff can be reached at appointments@orthoTMJsleep.com.

Photo: Man w/jaw pain: Eric Allix Rogers via Flickr | Smiling woman: greyerbaby via morgueFile

Ann Pietrangelo is a freelance writer and the author of "No More Secs!" and “Catch That Look.”

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