Craniomandibular Dysfuction is a dental term which describes a collection of symptoms which result when the chewing muscles and jaw joints do not work together correctly.

"TMJ" is a popular term commonly used to describe the same group of symptoms.  TMJ stands for Temporomandibular Joints.  These are the two joints that connect your jaw to your skull.  When these joints are out of place, they can cause many problems, such as:

• Clicking or popping of the jaw joints

• Pain in or around the jaw joints

• Locking or limited opening of your mouth

Muscle spasm goes hand-in-hand with displaced jaw joints.  Because the nerves and muscles are so complex in this area, when these muscles are in spasm the problems can be far-reaching.  People suffer from symptoms they would never think to associate with their bite, such as:  headaches, pain behind the eyes, dizziness, earaches or ringing of the ears, clenching or grinding of the teeth, neck, shoulder, or back pain, numbness or tingling of the fingers.

The primary problem can be in the joints themselves, the muscles of the face and jaw, or a combination of these.  The term Craniomandibular Dysfunction (cranio = head; mandibular = jaw) is a more descriptive term because it refers to problems involving both the jaw joints themselves and the muscles of the face and head.  Because the symptoms masquerade as so many other conditions, many people travel from doctor to doctor in search of a cure.  It is estimated that as many as 44 million Americans suffer from one or more of these symptoms.  Many never think to seek a dentist for help.

What Causes Craniomandibular Dysfunction?
The structures that make it possible to open and close your mouth include the bones, joints, and muscles.  These are very specialized and must work together whenver you chew, speak, or swallow.

Your teeth are inserted in your jaw bone.  At the other end of your jaw bone are the temporomandibular joints.  These joints attach your jaw to your skull.   Muscles attach both the bones and joints and allow them to move.  Any problem which prevents the complex system of muscles, bones, and joints from working together in harmony may result in Craniomandibular Dysfunction.

A "Bad Bite"     
There are various ways this system can be disrupted, such as accidents involving a blow to the face or whiplash.  Yet the most common cause of Craniomandibular Dysfunction relates to your teeth and your bite.  If your bite isn't right, it can affect both the muscles and the joints.  What do we mean by a "bad bite"?  We mean that your upper and lower teeth do not come together in a way that provides the proper bracing support for your jaw against your skull.  This might result from a missing tooth, misaligned teeth, or back teeth which are too "short".   

Muscle Spasm         
Your upper and  lower teeth must come together firmly each time you swallow.  This happens over 2000 times each day and night!  When your bite is unstable your muscles must work extra hard.  This extra work makes them shortened and stiff.  Eventually this strain makes them feel painful.  A vicious cycle begins of increased tissue damage, muscle tenderness, and pain. The pain makes you feel tense and uptight.  This worsens the muscle spasm, which in turn increases the pain.

Jaw Joint Displacement
The position of your teeth can also affect the position of your jaw joints.  Each jaw joint is a ball and socket joint.  When functioning properly, the ball and socket do not actually touch because a thin disc of cartilage rides between them.  The disc acts as a cushion and allows the joint to move smoothly.  Each disc is held in place and guided by muscle.  If your bite is not right, the joint is pulled out of alignment.  Typically the disc is pulled forward.  Since it no longer serves as a cushion, the joint itself now rubs against the boney socket and presses on pain fibers.  Mild displacements cause a clicking or popping sound in the jaw joint; more severe displacements can be very painful and eventually can cause permanent damage to the joint.

An unstable bite can cause both jaw joint displacement and muscle strain and pain.  Many seemingly unrelated symptoms result which are collectively known as Craniomandibular Dysfuncion.  When this conditon is prolonged, the body begins to compensate and adapt by involving muscles in the neck, back, and even sometimes those of the arms, fingers, pelvis, legs, and feet.

Treatment
Since the teeth, jaw joints, and muscles can all be involved, treatment for this condition varies.  Typically, treatment will involve several phases.  The first goal is to relieve the muscle spasm and pain.  Then your dentist must correct the way the teeth fit together.  Often a temporary device (known as an orthotic or "splint") is worn over the teeth until the bite is stabilized.  Permanent correction may invovled selective re-shaping of the teeth, building crowns on the teeth, orthodontics, or a permanent appliance to lay over the teeth.  If the jaw joint itself is damaged, it must be specifically treated.  Though infrequent, surgery is sometimes required to correct a damaged joint.  Ultimately, your dentist will stabilize your bite so that the teeth, muscles, and joints all work together without strain.

The important aim of correcting your bite is to insure optimal long-term health.  If you have any of the signs or symptoms mentioned, discuss them with us.  Your health is your most priceless possession

TMJ / TMD Diagnosis

Dr. Williams uses state-of-the-art technology to determine if your symptoms are caused by malocclusion and if so, what your optimal jaw position is. He uses computerized jaw tracking instruments to record jaw movement, resting position, and path of closure. Electromyography is used to measure your jaw’s muscle function in both its stressed and relaxed positions, and will also measure the jaw-to-skull relationship to see if there is a structural imbalance. Sonography is used to record jaw joint sounds to detect any abnormalities. Additionally, x-rays or CT scans of the jaw may be taken to help evaluate the condition and positioning of the joint. These advanced diagnostic procedures can be done right in our office.

TMJ / TMD Treatment

Once Dr. Williams has diagnosed you with TMJ, he can determine the best course of treatment for your specific needs. Typically treatment will follow three steps:

1. Relieve muscle spasm and pain.
   The immediate concern for Dr Williams is to provide relief of your symptoms. The best way to do this is by using a technology called ULF-TENS. ULF-TENS stands for Ultra Low Frequency Transcutaneous Electrical Neural Stimulation, but don’t let this term intimidate you. Basically, ULF-TENS is a way to relax muscles with a gentle massage of the muscles. The rhythmic pulsing relaxes the muscles by increasing blood flow and pumping out waste products. ULF-TENS also helps with pain relief by stimulating the body’s production of endorphins, the body’s natural anesthetic.

2. Stabilize the bite.
   Often for this step a temporary device, known as an orthotic is worn over the teeth. The orthotic allows  Dr. Williams to make easy adjustments to the plastic without adjusting the teeth until the bite is stabilized. Once symptoms are relieved and the bite has been stabilized, Dr. Williams will move on to the next step and permanently adjust your bite to the correct position.

3. Long-term management.
   There are a variety of ways to correct your bite in a more permanent way. Four of the most common of these approaches are outlined below:

• Coronoplasty/Equilibration
  Coronoplasty is smoothing and reshaping the enamel of the teeth to correct your bite. It is a simple procedure that does not require anesthesia and can be used when the bite is only slightly misaligned.

• Removable Overlay Partials
  These are permanent orthotics that usually fit over the back teeth and are designed to maintain an aligned bite.

• Reconstruction
  This approach involves making the teeth higher by using crowns. This permanently realigns the bite and provides structural support for the jaw.

• Orthodontics (Braces)
  When the teeth are healthy they may be moved to the optimal position using braces.

 

Common Neuromuscular TMJ / TMD Symptoms

If you suffer from any of the following symptoms, a neuromuscular dentist may be able to help you. Click on any of the symptoms for more information about the symptom and how a neuromuscular dentist can help relieve your pain.

• Headaches / Migraines

• Facial pain

• Jaw Pain

• Neck and shoulder pain

• Tinnitus (Ringing in the ears)

• Sensitive and sore teeth

• Limited jaw movement or locking jaw

• Clicking or popping in the jaw joints

   

  Headaches / Migraines

  

Headaches are one of the most common symptoms of a TMJ (temporomandibular joint) problem. Tension headaches are the most common type of headache, and the TMJ headache is a tension type of headache. It is often described as a feeling of wearing a hat two sizes too small, with pain in a ring around the head, or as a migraine headache.

There are a few TMJ-related causes for tension headaches. Constant contraction of muscle fibers within a muscle, create tension, pressure or a tight feeling in the face and head, but constant tight muscle fibers prevent or reduce blood flow to that area. The body sends more blood to the areas and this can result an increase in general blood pressure to the muscles and head, sometimes referred to as vascular headaches. Clenching and grinding the teeth, which are TMJ symptoms produce pain from the muscles in the head, which is a headache.

Unfortunately, these headaches can be so frequent or severe that they are frequently misdiagnosed and treated as migraine headaches.

The pain from muscle headaches can be blocked with medications, or nerves cut with brain surgery or muscles somewhat relaxed with muscle and psychological therapy, but the cause of the disease and damage from the bad bite, malocclusion, will persist. Side effects with medications, complications from brain surgery, and limited results with muscle or psychological therapy do not correct the source of the problem. Neuromuscular dentistry ensures the muscles are happy because they do not have to work hard positioning the teeth to a strained bite.

By putting the temporomandibular joint back into alignment and placing the jaw into its optimal position, neuromuscular dentistry can alleviate most headache problems related to TMJ, muscle, nerve and joint disorders.

Facial Pain

When a patient’s bite is not properly aligned, TMJ (temporomandibular joint) dysfunctions and a number of related symptoms can arise. One of these symptoms is facial pain.

The jaw area of the face is a complex network of bones, joints, muscles, and nerves. When the jaw becomes unaligned, the surrounding bones, muscles, and nerves are also affected. This includes the muscles of the face, which experience strain or spasm because the muscles are working extra hard to compensate for the unstable bite.

A neuromuscular dentist can help facial pain problems by working with the source of the problem, the bite. Your neuromuscular dentist will stabilize and realign your bite so that the teeth, muscles, and joints all work together without strain.

 

Jaw Pain

Because TMJ is a dysfunction of the jaw joint, jaw pain is a very common symptom. A “bad bite ” in which your upper and lower teeth do not come together in proper alignment also disrupts the placement of the jaw and the surrounding muscles. This imbalance in the bite-jaw-muscle relationship is what causes the pain in the jaw. Pressure and forces on the teeth can cause bone to dissolve or extra boney projections to be built up.

A neuromuscular dentist can help alleviate jaw pain related to TMJ by realigning the bite. Once the jaw is back into its most relaxed position the surrounding muscles can also resume their natural function. 

Neck and Shoulder Pain

Having a “bad bite” (malocclusion) causes an imbalance in the jaw-to-skull relationship, which in turn twists the jaw into a strained position that refers pain to the muscles in the neck, shoulders, and back.

Muscles work as a team. Seldom does a single muscle work without other muscles in the team joining in. The bones in the neck, especially the atlas and axis, are intimately involved with the muscles of chewing, biting, talking, breathing, and head posture. Sore, tight, contracted muscles of the jaw will tilt the head and shoulders causing compensation from neck, shoulder and back muscles. Although the neuromuscular dentist does not claim to treat neck, back, shoulder, or arm pain, patients are pleased how frequently these problems can be relieved.

Neuromuscular dentists understand that the bones, joints, muscles, and nerves in the face and neck have a complex relationship. They work to correct the bite, relieving strain on the jaw and the surrounding muscles. Once the bite has been aligned, resulting pain in many areas of the body disappears.

Tinnitus (Ringing in the Ears)

Ringing in the ears, or tinnitus, is another symptom of TMJ that is commonly misdiagnosed and often goes untreated or is treated ineffectively. In many cases ringing in the ears is one of the results of having a strained bite in which the jaw is not aligned. The jaw area of the face is a complex network of muscles and nerves, and when the bite is misaligned muscles and nerves throughout the head, including the ears, can be affected.

If your neuromuscular dentist diagnoses the cause of your tinnitus to be an unstable or misaligned bite, he or she can work with the source of the problem by stabilizing and realigning the bite so that the entire jaw area works together without pain. Your bite will be back to its normal position, relieving the ringing in your ears that was caused by the misaligned bite.

Sensitive and Sore Teeth

Sensitive or sore teeth are common symptoms of TMJ (temporomandibular joint disorder). If the teeth are the cause of TMJ then any or all of the teeth may be sore. The teeth may also become sensitive because of clenching or grinding the teeth, a common action in many people, when the disc of the TMJ is displaced. Click here for more information on the displaced TMJ disc.

Unfortunately, when seeking relief from this tooth pain many patients are misdiagnosed and may even go as far as having the nerve from the tooth removed with root canals or even having the tooth extracted. The worst part is that these measures may not relieve the pain, and can actually make it worse!

Neuromuscular dentists relieve sensitive and sore teeth related to TMJ by going to the source of the problem—the “ bad bite ” and misaligned jaw. In most cases, correction of the bite can be accomplished without the use of surgery, and patients report long-lasting pain relief.

Limited Jaw Movement or Locked Jaw

Limited jaw movement or locking jaw may feel like the lower jaw is catching when the jaw is opened. In some cases a person with a locked jaw must move the jaw to one side or the other in order to open the mouth wide. A person might also have to open the mouth until a popping sound is heard and felt, at which point the jaw unlocks.

Limited jaw movement or locking jaw is often a result of a “bad bite.” When the bite is not aligned correctly it causes problems in the jaw joint, the TMJ (temporomandibular joint). The unaligned bite can result in locking jaw, clicking or popping in the jaw, and headaches.

Neuromuscular dentistry realigns the bite by measuring the jaw in its most relaxed position and then putting the jaw back into its natural position. In most cases this repositioning can be accomplished without braces or surgery.

Clicking or Popping in Jaw Joints

Clicking, popping, or snapping in the jaw joint is the most common symptom of TMJ. There may or may not be pain in the jaw when the clicking or popping sound is heard. The clicking sound may even be so loud that others can hear it when you chew or speak.

Usually the cause of the popping jaw is a displaced disc in the jaw. The jaw joints are ball and socket joints, just like the shoulder joint. When ball and socket joints are functioning properly, the ball and socket do not touch because of a thin disc of cartilage located between the ball and socket. This disc of cartilage is held in place and guided by a muscle.

If your bite is not right or trauma tears the tissues the jaw joint is pulled out of alignment, and the disc is typically pulled forward or torn. Now that the cartilage disc is not serving as a cushion between the ball and socket these bones are rubbing against each other and pressing on nerves, causing pain in the jaw and clicking or popping sounds in the jaw joint. The muscles holding the disc in place are now strained as well, causing additional pain in the jaw and face as well as in the head, neck, back and shoulders.

Neuromuscular Dentistry works to realign the bite, which also realigns the displaced disc. Once the jaw is realigned and the disc is back in place the clicking and popping sounds in the jaw stop and the muscles holing the disc in place can relax, alleviating the jaw, face, head, neck, back, and shoulder pain that resulted.