Diagnosing and Treating TMJ Problems
Diagnosis of TMD involves a thorough history; an examination of the jaw joint and chewing muscles; evaluating joint noises; and checking the teeth and bite for wear and proper alignment. Additional records may include study models for detailed bite analysis and imaging such as Cone Beam Computed Tomography (CBCT).
Since the teeth, jaw joints, and muscles can all be involved, treatment for this condition can vary and will usually involve several phases. The first phase is to relieve the muscle spasm and pain and stabilize the jaw joint in the jaw socket. Often a temporary device known as a “bite splint” is worn over the teeth until the muscles relax and the pain is relieved. Once your jaw joint is stabilized, the second phase is to evaluate your bite for corrective options so you are not dependent on the “bite splint” for comfort and stability. Permanent correction involves refitting your bite and teeth with minimally invasive bonding materials – in some cases, building crowns on the teeth and/or orthodontics are needed. Rarely, if the jaw joint itself is damaged, it may need surgical care. Ultimately, Dr. Segulyev can stabilize your bite so that the teeth, muscles, and joints all work together naturally for optimal long-term health and comfort.
Proprioception. “Proprioception” describes the body’s ability to perceive an interference between teeth before it happens. The body quickly learns when teeth don’t fit together well when the jaw is fully seated in the jaw joint. The teeth will typically contact at a single point (called an interference) which will produce pain as all the force of closing is focused on that single point. You will naturally find a way of bringing the teeth together so that as many of them contact as possible, thus spreading the closing force across many teeth. Instead of closing on the interference and experiencing pain, you maneuver the jaw in a way that avoids the interference and closes in the more comfortable position of having many teeth together. This navigation is performed unconsciously, with the unconscious awareness of the interference being called “proprioception.”
What is a Stable and Unstable Chewing System?
The three reasons people lose their teeth are dental decay, gum disease and an unstable chewing system. Your chewing system consists of how your teeth fit together when your chewing muscles move your lower jaw up and down. An unstable chewing system, if not discovered and addressed, can cause excessive tooth wear; cracked or loose teeth; sensitive teeth; jaw joint disorders and early tooth loss.
Unstable: jaw joint not in socket where teeth fit
Stable: jaw joint in socket where teeth fit
Signs of an Unstable Chewing System:
You may have an unstable chewing system if you have one or more of the following signs and symptoms:
- Worn down, chipped, cracked or broken teeth
- Teeth that are sensitive to hot, cold and/or biting
- Multiple “root canals”
- Mobile or loosening teeth
- Clenching/grinding of your teeth
- Abfractions or wedge-shaped notches in the teeth at the gum line;
- Gum recession
- Severe localized bone loss around teeth
- Pain in the teeth and/or TMJ when you chew
- Headaches and facial muscle pain
- Teeth or dental work that fracture or break
On your back teeth, you will notice that there are points (cusps) and valleys (fossae). In a healthy bite, the cusps of your back teeth fit tightly into the fossae of your opposing teeth while the two jaw joints (TMJ’s) seat completely in their sockets. This is the least stressful and least destructive bite relationship for your teeth, bone, gums, TMJ’s, jaw muscles, and your existing dental work. The human bite is capable of generating forces measuring up to 900 pounds per square inch – so when your bite does not line up correctly, damage can and will occur.
In addition, a healthy bite has the proper amount of overlap of the upper front teeth over the lower front teeth to guide our side to side chewing motion (think of guardrails on a roadway). The front teeth protect the back teeth by limiting excess stress during chewing. When the front teeth are not aligned properly or are worn down, they are unable to provide this protective function, damaging the front and back teeth, bone, gums, TMJ’s and jaw muscles.
A simple way to demonstrate this “protective” function is by placing your hand on the side of your jaw and clenching fully on your back teeth. Can you feel how forcefully your muscles contract? Now, assuming that the upper and lower back teeth can separate from each other when your front teeth are edge-to-edge or canine-to-canine, try clenching with just your front teeth or canines. Can you feel how much less force is created by the muscles?
How is Occlusal Disease treated?
If your long-term goal is good dental health, you may choose to learn more about your unstable chewing system. We will recommend a detailed evaluation of your bite, which includes mounted study models, digital images and detailed records of your current condition. In many cases, bite splint therapy will be required to relax overworked chewing muscles and allow your jaw joint to properly seat in the jaw socket; years of an unstable bite can create chewing muscle imbalance and/or a TMJ disorder. Once your jaw joint is seated in the socket, a diagnosis of how your upper and lower teeth fit together is made to consider the most conservative option to stabilize your bite.