TMJ Speciality– One of the difficulties for a dentist is finding the reason for dental and facial pain.
Pain that flits around the mouth, sometimes left, sometimes right, maybe in the upper or lower jaw, is often difficult to identify. Teeth that are sensitive but have no reason to be, dull aches that radiate into the ear and sinus with no sign of infection. Teeth that hurt in the morning often accompanied by a headache and neck pain.
Numbness in the face, tightness of the throat, earache, tinnitus, dizziness and deafness, often confound the practitioner who can find no visible cause for the symptom. These problems require good detective work and an ability to help you the patient, understand that not all toothaches are due to the teeth!
Many people have clicking jaws, some know that they grind their teeth at night, others observe the wear on their lower front teeth and chipping or translucency of the uppers. Equating this to daily headaches, neck and back pain is a bit of a stretch for some, while others understand that an unbalanced bite can have a profound affect not only on the jaw joints but also on the mechanics of the body, witnessed by forward head posture, neck pain, shoulder height discrepancies and even frozen shoulder!
Multidisciplinary approach
Putting this all in context, dentists, chiropractors, osteopaths and physiotherapists have combined their skills to treat the myriad of symptoms attributable to Disorders of the Jaw Joint complex, perhaps better known of as TMJ. My introduction to TMJ in 1984 – was through both the Pankey Institute in Florida and Dr Harold Gelb in New York. Their teachings were very different, however the common thread was the link between the bite and the jaw joints.
Dr’s Gelb, Farrar, Fonder, Pertes and others, went on from this point to show the relationship between the teeth, the jaw joints the skull and the neck. Guzay, a physicist, demonstrated the working relationship between the jaw joint and the upper cervical spine. Further research and clinical experience has shown us that the teeth/jaw complex, doesn’t work in isolation but is involved in the workings of the rest of the body.
This important understanding has lead us to the realisation that the mouth should no longer be considered as separate from the rest of the body, as so much that goes on in the mouth impacts the body as a whole.
In describing Dental Distress Syndrome, (TMJ) the late Dr Aelred Fonder DDS, from Rock Falls, Illinois put it this way:
“Distress produced by maloccluded teeth (unbalanced bite – missing teeth etc) and the resultant spasms and malfunctioning of the musculature of the jaws, head neck and shoulders, causes physio-pathological alterations throughout the systems of the soma and psyche. Widespread normalisation is observed in all systems of soma and psyche when a corrective dental splint restores occlusal balance, allowing the powerful muscles of astication to function at their physiological contracting and resting lengths.”
The imbalance in the bite, may lead to head, neck and back pain of dental origin, ringing in the ears, deafness, sinus congestion, snoring, swallowing difficulties, facial pain, clicking or locking of the jaw joints and a general feeling of malaise, some patients may even suffer chronic fatigue or fibromyalgia. As part of the overall patient assessment, understanding this aspect of care is essential, as we move towards the goal of patient wellness. It is important to identify which practitioners need to be involved in treatment and who should start the process.
Dental assessment
A thorough history is taken, muscles are palpated, jaw joints checked, opening of the mouth measured and body posture observed. Then the teeth and soft tissues are assessed, jaw movements checked and x-rays and study models taken when required.
Treatment
With this information a variety of dental splints are individually made. Upper, lower or both. These splints are adjusted to balance the bite relative to the jaw joints, head and spine.
Adjustments are made over time and often in a coordinated effort with other professionals to ensure that all aspects of this neuromuscular condition are treated.
The great thing about splints is that they are both diagnostic and treatment based. They can be adjusted and may form a template for future permanent treatment, ensuring that symptoms are relieved prior to extensive work being carried out. They are patient operated. You have control, however they don’t work in a handbag or your trouser pocket!
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