TMJ - Temopromandibular Joint Information

Temporomandibular joint and muscle disorders, commonly called “TMJ,” are a group of conditions that cause pain and dysfunction in the jaw joint and the muscles that control jaw movement. We don’t know for certain how many people have TMJ disorders, but some estimates suggest that over 10 million North Americans are affected. The condition appears to be more common in women than men. TMJ is referred to by different names such as TMD, TMJ disorder, and TMJ dysfunction.

For most people, pain in the area of the jaw joint or muscles does not signal a serious problem. Generally, discomfort from these conditions is occasional and temporary, often occurring in cycles. The pain eventually goes away with little or no treatment. Some people, however, develop significant, long-term symptoms.

What is the temporomandibular joint?

tmj

The temporomandibular joint connects the lower jaw, called the mandible, to the bone at the side of the head, which is the temporal bone. If you place your fingers just in front of your ears and open your mouth, you can feel the joints. Because these joints are flexible, the jaw can move smoothly up and down and side to side, enabling us to talk, chew, and yawn. Muscles and ligaments attached to and surrounding the jaw joint control its position and movement.

When we open our mouths, the rounded ends of the lower jaw, called condyles, glide along the joint socket of the temporal bone. The condyles slide back to their original position when we close our mouths. To keep this motion smooth, a soft disc lies between the condyle and the temporal bone. This disc absorbs shocks to the jaw joint from chewing and other movements.

The temporomandibular joint is different from the body’s other joints since the joint actually dislocates after opening past a certain point. The combination of hinge and sliding motions makes this joint among the most complicated in the body. Also, the tissues that make up the temporomandibular joint differ from other load-bearing joints, like the knee or hip. Because of its complex movement and unique makeup, the jaw joint and its controlling muscles can pose a tremendous challenge to both patients and health care providers when problems arise.

What are TMJ disorders?

Disorders of the jaw joint and chewing muscles – and how people respond to them – vary widely. Researchers generally agree that the conditions fall into three main categories:

Myofascial pain, the most common temporomandibular disorder, involves discomfort or pain in the muscles that control jaw function.

Internal derangement of the joint involves a displaced disc, dislocated jaw, or injury to the condyle.

Arthritis refers to a group of degenerative/inflammatory joint disorders that can affect the temporomandibular joint.

A person may have one or more of these conditions at the same time. Some people have other health problems that co-exist with TMJ disorders, such as chronic fatigue syndrome, sleep disturbances or fibromyalgia, a painful condition that affects muscles and other soft tissues throughout the body. It is not known whether these disorders share a common cause.

People who have a rheumatic disease, such as rheumatoid arthritis, may develop TMJ disease as a secondary condition. Rheumatic diseases refer to a large group of disorders that cause pain, inflammation, and stiffness in the joints, muscles, and bone. Both rheumatoid arthritis and some TMJ disorders involve inflammation of the tissues that line the joints. The exact relationship between these conditions is not known.

How jaw joint and muscle disorders progress is not clear. Symptoms worsen and ease over time, but what causes these changes is not known. Most people have relatively mild forms of the disorder. Their symptoms improve significantly, or disappear spontaneously, within weeks or months. For others, the condition causes long-term, persistent and debilitating pain.

What causes TMJ disorders?

Trauma to the jaw or temporomandibular joint plays a role in some TMJ disorders. But for most jaw joint and muscle problems, scientists don’t know the causes. For many people, symptoms seem to start without obvious reason. Research disputes the popular belief that a bad bite or orthodontic braces can trigger TMJ disorders. Because the condition is more common in women than in men, scientists are exploring a possible link between female hormones and TMJ disorders.

There is no scientific proof that clicking sounds in the jaw joint lead to serious problems. In fact, jaw clicking is common in the general population. Jaw noises alone, without pain or limited jaw movement, do not indicate a TMJ disorder and do not warrant treatment.

The roles of stress and tooth grinding as major causes of TMJ disorders are also unclear. Many people with these disorders do not grind their teeth, and many long-time tooth grinders do not have painful joint symptoms. Scientists note that people with sore, tender chewing muscles are less likely than others to grind their teeth because it causes pain. Researchers also found that stress seen in many persons with jaw joint and muscle disorders is more likely the result of dealing with chronic jaw pain or dysfunction than the cause of the condition.

What are the signs and symptoms?

A variety of symptoms may be linked to TMJ disorders. Pain, particularly in the chewing muscles and/or jaw joint, is the most common symptom. Other likely symptoms include:

Radiating pain in the face, jaw, or neck.

Jaw muscle stiffness.

Limited movement or locking of the jaw.

Painful clicking, popping or grating in the jaw joint when opening or closing the mouth.

A change in the way the upper and lower teeth fit together.

How are TMJ disorders diagnosed?

There is no widely accepted, standard test now available to correctly diagnose TMJ disorders. Because the exact causes and symptoms are not clear, identifying these disorders can be difficult and confusing. Currently, we note the patient’s description of symptoms, take a detailed medical and dental history, and examine problem areas, including the head, neck, face, and jaw. Imaging studies may also be recommended.

You may want to consult us to rule out known causes of pain. Facial pain can be a symptom of many other conditions, such as sinus or ear infections, various types of headaches, and facial neuralgias (nerve-related facial pain). Ruling out these problems first helps in identifying TMJ disorders.

How are TMJ disorders treated?

Because more studies are needed on the safety and effectiveness of most treatments for jaw joint and muscle disorders, experts strongly recommend using the most conservative, reversible treatments possible. Conservative treatments do not invade the tissues of the face, jaw, or joint, or involve surgery. Reversible treatments do not cause permanent changes in the structure or position of the jaw or teeth. Even when TMJ disorders have become persistent, most patients still do not need aggressive types of treatment.

Conservative Treatments

Because the most common jaw joint and muscle problems are temporary and do not get worse, simple treatment is all that is usually needed to relieve discomfort.

Self-Care Practices

There are steps you can take that may be helpful in easing symptoms, such as:

Eating soft foods.

Applying ice packs.

Avoiding extreme jaw movements (such as wide yawning, loud singing, and gum chewing).

Learning techniques for relaxing and reducing stress.

Practicing gentle jaw stretching and relaxing exercises that may help increase jaw movement.

We can recommend exercises if appropriate for your particular condition.

Pain Medications

For many people with TMJ disorders, short-term use of over-the-counter pain medicines or nonsteroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen, may provide temporary relief from jaw discomfort. When necessary, we can prescribe stronger pain or anti-inflammatory medications, muscle relaxants, or anti-depressants to help ease symptoms.

Stabilization Splints

We may recommend an oral appliance called a bruxism splint, stabilization splint, night guard, or bite guard, which is a plastic guard that fits over the upper or lower teeth. Stabilization splints are the most widely used treatments for TMJ disorders. Studies of their effectiveness in providing pain relief, however, have been inconclusive. If a stabilization splint is recommended, it should be used only for a short time and should not cause permanent changes in the bite. If a splint causes or increases pain, stop using it and let us know.

The conservative, reversible treatments described are useful for temporary relief of pain – they are not cures for TMJ disorders. If symptoms continue over time, come back often, or worsen, please let us know.

Surgery

Other types of treatments, such as surgical procedures, invade the tissues. Surgical treatments are controversial, often irreversible, and should be approach with caution where possible. There have been no long-term clinical trials to study the safety and effectiveness of surgical treatments for TMJ disorders. Nor are there standards to identify people who would most likely benefit from surgery. Failure to respond to conservative treatments, for example, does not automatically mean that surgery is necessary.

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Wisdom Teeth

Wisdom teeth get their name because they usually appear around age 18. They can erupt straight, crooked or not at all. Even if they come in straight, wisdom teeth might need to be extracted due to a lack of space and the ability to be cleaned and maintained. Please read and view the images below for the various types of erupting patterns and impactions.

Vertical Impactions

vertical-impactions

The lower tooth, in the image to the left, is partially vertically impacted. This means that part of the tooth is above the bone and visible in the mouth, and part of it is submerged in the bone. This tooth could still erupt properly as the tooth next to it is not in its way.

The upper tooth is fully vertically impacted. This means that the entire tooth is submerged in the bone.

If no tooth movement is shown after a few years, then we know that the teeth are impacted and should be considered for removal. This tooth could still erupt properly as the tooth next to it is not in its way.

 

 

Mesial Impactions

mesial-impactionsThe lower tooth, in the image to the left, is partially mesially erupted. This means that part of the tooth is above the bone and visible in the mouth and part of it is submerged in the bone and that is it tilted mesially, which means it is tipped toward the front of the mouth. This tooth will not likely erupt properly as the tooth next to it is in its way. These teeth typically need to be extracted because the bacteria that get under the gum tissue are almost impossible to clean, which causes an infection. The tooth next to the wisdom tooth can also decay due to the wisdom tooth.

The upper tooth is fully mesially impacted. This means that the entire tooth is submerged in the bone and is tipped toward the front of the mouth. These teeth can be observed for a few years but it is best if they get removed especially if other teeth need to be removed.

 

 

Distal Impactions

distal-impactionsThe lower tooth, in the image to the left, is partially distally erupted. This means that part of the tooth is above the bone and visible in the mouth, and part of it is submerged in the bone and that is it tilted distally, which means it is tipped toward the back of the mouth. This tooth will not likely erupt properly due to a lack of space toward the back of the jaw. These teeth typically need to be removed because the bacteria that gets under the gum tissue is almost impossible to clean, which then causes an infection.

The upper tooth is fully distally impacted. This means that the entire tooth is submerged in bone and is tipped toward the back of the mouth. These teeth can be observed for a few years but it is best if they get removed especially if other teeth need to be removed.

 

 

Horizontal Impactions

horizontal-impactionsBoth of the teeth, in the image to the left, are horizontally impacted. This means that the tooth is perpendicular where they should be. This tooth will not erupt properly since there is no place for them to go and there is almost no chance that they will be guided into proper position in the mouth.

These teeth typically need to be extracted but they can be observed for a few years but it is best if they get removed especially if other teeth need to be removed.

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Tooth Fractures

cracked-tooth-split-rootFractured Cusp

This is the most common type of fracture and it has the best long term prognosis. In this type of fracture, a part of the tooth can completely break off and, occasionally, no pain is felt after the tooth fractures.

Treatment for this type of fracture is to place a crown on the tooth. If the fracture extends into the middle part of the tooth, root canal therapy would be required in addition to a crown.

Vertical Furcation Fracture

cracked-tooth-vertical-furcationThis tooth has a vertical crack that extends vertically into or toward the furcation. The furcation, which is where the arrow is pointing, is the place where the tooth splits into two or more separate roots. The nerve is almost always involved in a vertical furcation crack. The tooth rarely separates into two pieces because the tooth is held in position by the surrounding bone.

The prognosis for this type of crack is fair but it depends on how deep the crack extends into the internal aspect of the tooth. The options are to treat the tooth with a root canal followed by a build up, post and crown or to extract the tooth.

Split Root Fracture

cracked-tooth-split-rootA split root fracture, known as a subgingival oblique fracture can be restorable but it depends on where the fracture ends. Subgingival means below the gumline. If the fracture is not to far below the gumline, the tooth can be restored with a procedure called crown lengthening followed by a crown. The tooth might also require root canal treatment. If the fracture is too far below the gumline, it is unrestorable and requires extraction.

These types of fractures occur for various reasons such as biting down on very hard foods or foreign objects, the presence of a previous filling in the tooth, and a tooth that had root canal therapy that was not treated with a crown.

Vertical Root Fracture

cracked-tooth-vertical-rootVertical root fractures are not a very common type of fracture and it usually occurs with teeth that have had root canal therapy. If the fracture is very short in length, the tooth can possibly be saved by performing an apicoectomy. This involves gaining access to the root tip within the bone and removing the part of the root that is fractured. The only other option is an extraction.

Oblique Root Fractures

Oblique Root Fractures are fractures that are limited to the roots of teeth and the crown portion is intact. The fractured root is generally entirely below the gumline and usually entirely in bone.

cracked-tooth-obliqueIf the fracture is close to the crown as shown by number 1 the tooth is usually unrestorable. The tooth might be able to be treated with endodontic therapy and root amputation if the remaining roots are strong and healthy but the overall prognosis is poor.

If the fracture is close to the tip of the root as shown by number 2, the tooth can try to be restored with root canal therapy. The root canal cannot be performed on the fractured root tip and the body tends to resorb the untreated piece. The prognosis for this procedure is fair to good, and regular exams are recommended to check how the body responds to the treatment.

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ClearCorrect Removable Orthodontics

Looking for an alternative to braces? ClearCorrect is the clear and simple choice. No wires. No brackets. Just clear, convenient comfort-every reason to smile.

With ClearCorrect, we can straighten your teeth using a series of clear, custom, removable aligners. Each aligner moves your teeth just a little bit at a time until you eventually get straight teeth.

We will evaluate your teeth and talk about any problems or goals you have for your smile. Once we establish ClearCorrect is the right treatment option for you, we will take impressions, photos, and x-rays of your teeth that ClearCorrect uses in manufacturing your custom aligners.

Your Custom Treatment Plan

teeth-moldWe will send your records such as your impressions, photos, and x-rays to ClearCorrect with a prescription for your custom aligners. ClearCorrect uses your records to create exact 3D models of your teeth. Then working with us every step of the way, and following the precise instructions provided on your prescription, ClearCorrect maps out a complete treatment plan of gradual adjustment that takes your teeth from where they are currently to where we want them to end up. Once completed, we will be able to preview the projected results of your treatment in your “treatment set-up,” a computer representation of your teeth before and after treatment.

Your Aligners are Computer-Crafted

clear-correct-alignerWhen everyone, including you, is satisfied with the projected results shown in your treatment set-up, the manufacturing process begins. Using the latest digital mapping and molding technology, ClearCorrect creates your custom aligners with computer precision. ClearCorrect then sends your aligners to us for delivery to you.

 

Progress Wearing Your Aligners

clear-correct-placementYou’ll wear your aligners all the time, except while eating and drinking or during daily tooth care, such as brushing and flossing. Your ClearCorrect aligners are so clear they are barely noticeable so they won’t have an impact on your day to day life. Aligner by aligner, you’ll be able to see the difference as your teeth slowly adjust and align to your target smile. You’ll visit us periodically for checkups to see how you’re progressing until you eventually have the straight smile you’ve always wanted.

 

The Choice Is Clear!

With the results and convenience ClearCorrect offers and the advantages it has over other treatment options, it’s an easy decision. With ClearCorrect you can get the obvious benefits and confidence you’ll enjoy with straight teeth so you too can show off your smile.
 

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Fillings

How Teeth Are Restored

After diagnosing the problem and devising a treatment plan, the next step to restore a tooth to health is to make you comfortable. We will give you a local anesthetic so that you do not feel any discomfort. After the decay is removed, the tooth is ready to receive either a direct restoration or an indirect restoration.

A direct restoration means that the tooth can likely be restored in one visit and that there is sufficient tooth structure for the filling to go inside of the tooth. Examples of direct restorations are amalgam, which is silver-colored; and composite, which is tooth-colored. There have been more amalgam fillings placed worldwide than any other kind of filling, but tooth-colored fillings are being placed more frequently in recent years because they match the remaining teeth and look like the natural tooth.

An indirect filling means that the restoration is made outside of your mouth, either by a lab or by a milling machine. An indirect filling also needs to be cemented into place. Examples of indirect restorations are crowns, inlays, and onlays. A crown covers the entire tooth, an inlay fits inside the tooth and can replace a wall of the tooth, and an onlay replaces at least one cusp of the tooth.

Most indirect restorations take two or more appointments to complete, with the exception of restorations that are milled by a machine in the office. Cast gold is the most durable indirect restoration material, but porcelain ceramics are gaining in popularity because of their superior esthetic qualities.

fillings_kussmanComposite Fillings

Composite fillings are also called plastic or tooth colored fillings. Getting this kind of filling depends on where the tooth is in your mouth. There is a lot of force applied to the back teeth when we bite, so size and location is important when deciding to use this type of restoration. To place this filling, we remove all decay and other filling material from your tooth. A bonding material is placed and then the composite resin is put into the prepared tooth in thin layers. Each layer gets hard with the help of a special light that we hold over the tooth to cure the material. When the last layer of the filling is hard, we shape the material so it looks and feels natural.

Advantages

  • Single visit
  • Conservative tooth preparation
  • Does not corrode

Porcelain Restorations

Porcelain is the most natural looking of the choices we have to restore teeth. It is used either by itself in veneers, inlays, onlays, and crowns, as well as combined with metal for crowns. Porcelain restorations require two visits or they can be milled in the office with a milling machine. After the porcelain is cemented to your tooth, it is very difficult to notice that the tooth had any treatment at all.

Advantages

  • Color
  • Resistance to surface wear
  • Long lasting
  • Wears well as it holds up to chewing force
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