Temporomandibular Joint Disorder (TMD)
Jette and Steven Holbrook – our passion for treating TMD
We now have over 30 years of experience in treating patients with occlusal problems and feel so passionately about this subject because the causes of facial pain are so often misdiagnosed. Most patients come to see us after years of suffering and are so relieved to learn that they can be helped toward a pain-free life.
We have both dedicated many years of post-graduate training to this specific discipline. In the UK we have trained under Roy Higson who is the Dentist most responsible for bringing the importance of occlusion to the dental profession in the UK and is recognised as one of the leading experts in this field. We have also trained in America under Dr Henry Gremillon, Dr Jeff Okeson and Dr Niles Guichet who are recognised as world authorities on TMD.
Having trained with Roy we then went on to support him by delivering courses about TMD and dental occlusion both to dental students and at a post graduate level. Jette is also currently the Chair of The British Society of Occlusal Studies (BSOS), a post graduate study club for 300 like-minded Dentists.
Temporomandibular Joint Disorder (TMJD, TMD, TMJ, Myo-facial Pain, Cranio Mandibular Syndrome) or TMJ syndrome is a collective term covering acute or chronic pain and other related symptoms possibly linked to the way the jaw functions and the way the teeth move over each other. The flexibility in the joint allows you to chew from side to side as well as open and close your mouth. Neck, back and shoulder muscles also contribute as bracing muscles which allow our jaws to move smoothly and efficiently.
If your teeth don’t fit together properly, you can have problems in your teeth, gums, the temporomandibular joint (jaw joint) or the muscles that control movement of your jaw as they begin to suffer from fatigue. These problems are called ‘occlusal’ problems.
Occlusal problems can be indicated by teeth that are aching, worn, chipped or broken, fractured fillings and loose crowns. If the jaw is in the wrong position, the jaw muscles can become overworked and start to ache or contribute to other symptoms which are associated with TMJ disorders including:
- Biting or chewing difficulty or discomfort
- Clicking, popping, or grating sound when opening or closing the mouth
- Dull, aching pain in the face
- Earache (particularly in the morning)
- Headache (particularly in the morning)
- Hearing loss
- Jaw pain or tenderness of the jaw
- Reduced ability to open or close the mouth
- Ringing in the ears (Tinnitus)
- Neck and shoulder pain
It is important to note that many different factors can contribute to these symptoms. Conditions other than occlusal problems can cause similar symptoms such as fibromyalgia, arthritis, back problems and even poor posture, but if an examination by your GP has been unable to identify the cause of the symptoms and relieve the pain, we would strongly recommend a trip to the Dentist as another way of potentially addressing the problem.
We are Dentists though and therefore we will now focus on the bite side.
When visiting the Dentist for your routine check-up, it is important that you mention any neck, facial pain or headaches as part of your medical history update, especially if they occur in the morning.
Stress can also be a factor. When some people are not responding well to stress they can change the behaviour of their jaws consciously (e.g. during the day) or unconsciously (e.g. at night). For example they might tense up their chewing muscles, clench their teeth and even grind their teeth at night. This can cause short or long term problems to the teeth and joint.
In the same way that not all facial pain will be caused by occlusal problems, not all occlusal problems will lead to pain. Some people will go through life with the most awful of bites and yet experience no problems or pain whatsoever. Yet another individual with just the smallest of discrepancies could display many of the symptoms listed above and be living with constant pain. This very simplistic observation provides another example as to why this is such a complex subject and why we need to be adaptable and treat each case uniquely.
We are both happy to discuss any concerns over the phone initially, and through questioning start to assess whether we believe we may be able to help.
When it comes to treating occlusal problems, there is no text book solution. Every person and every case is different and we will treat them as such. As yet there are no impressive gadgets to replace the years of experience we have in this field that enable us to work out what is happening within the bite and how that may be contributing to the pain being experienced.
Initially we will undertake a thorough clinical assessment that will begin by looking at how the teeth bite together and move over each over. We will examine the muscles and look for soreness. We will assess the function of the temporomandibular joint i.e. its range of movement and listen for any joint noises. At this point, before starting more complex and therefore more costly treatments, we will often look to eliminate other potential causes by making a hard plastic appliance (an Anterior De-programmer) that fits over your front teeth. This device is made so that when you bite on it your back teeth are kept apart in order for the muscles to relax. This appliance will be worn at night for up to 2 weeks. If the pain alleviates or disappears completely, then it is logical to conclude that it is the bite, and occlusal issues causing the problems.
The next stage is often then to build an appliance that again will sit over the teeth, but this time will allow the teeth to come back together in the correct position i.e. to promote a perfect bite. The appliance will be adjusted over time in order to bring the teeth together in such a way that the pain, and symptoms, stays away. This solution could be the end of the treatment, but there are permanent options available that remove the need for continued use of the guard.
If the appliance works over the longer term, this will allow us to diagnose any jaw misalignment problems and make a decision regarding permanent correction of your bite while protecting the existing teeth and joint from further harm. We can do this by copying the function of the guard by changing the teeth to ensure they bite correctly and most importantly, keep the pain away.
Whether the solution is simple or complex will vary by individual. There is no correlation between the size of the bite problem and the level of pain. It could be that only slight changes to the size and shape of the teeth may be required, although sometimes a bite may be so poor that crowns will be required or orthodontic treatment and crowns. In the very worst cases surgery may be required to find a permanent solution.
Regrettably though, there will also be some patients that have TMD symptoms but neither the medical or dental professions can find the cause.
Can we help?
A referral form is available for completion by GPs and Dentists who believe we can help in the treatment of their patients.
Individuals are also welcome to contact us directly to arrange an initial consultation.
The British Society of Occlusal Studies ‘headache and facial pain’ web site contains very useful information and contact points across the UK for patients. The BSOS web site aims to educate patients so that they better understand their pain problem as well as explain how their problems can be treated.