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TMJ Analysis and Diagnosis
T.M.J. stands for Temporo Mandibular Joint (the jaw joint in front of the ear) which is arguably the most important joint in the body.
We need it working properly for eating, talking, and laughing!
When it’s not functioning properly several symptoms present such as:
Clicking or locking jaws
Grinding and clenching the teeth
Headaches – including Migraines
Limited jaw opening
Tinnitus (ringing in the ear)
Eye pain and light sensitivity
Pain around the head and face
Neck and shoulder problems, and many more
These symptoms are often referred to as:
- T.M.J. Syndrome
- Cervical pain
- T.M.D. Dysfunction.
It is my experience that a lot of people suffer with one of more of the above symptoms, and frequently, for many years. They may, in desperation have sought out a cure from a variety of Health professionals – Doctors, Physiotherapists, Osteopaths, Chiropractors, Acupuncturists, and Massage Therapists to name a few!
Despite the well intended treatment by such professionals, it must be understood that if the jaw joints are out of harmony with the dental bite, no matter what drugs or manipulation techniques are tried, the moment the teeth begin to bite together the therapy becomes undone, thus perpetuating the problem and the need to see the practitioner!
So, the best Health professional to treat T.M.J. problems is a general Dentist trained in the diagnosis and treatment of T.M.J. problems.
You can avoid being misdiagnosed by learning more about T.M.J. below, and your own symptoms. (see previous list)
Jaw Joint Anatomy
Lets take a closer look at our anatomy to understand what is happening.
Only the lower jaw (Mandible) is able to move. The upper jaw (Maxilla) is part of the skull.
The teeth determine the position of the Mandible, and without them, the Mandible would be free floating, only having contact to the skull through the jaw joints themselves.
The teeth close only where they fit together the best. This may not be where the muscles and ligaments suspending and moving the jaw actually want to be.
The muscles will therefore assume whatever position is dictated to them by the teeth, or lack of them!
Muscles are composed of bundles of muscle fibres and these fibres have a certain length at which they operate the best – their 'physiological rest position'.
In this position the muscles are at their most relaxed and strongest. If the muscles are elongated, or foreshortened instead of in their relaxed resting length they will become tense.
This tense contraction impedes blood circulation, resulting in spasm and cramping of the muscle tissue.
We have all experienced muscle cramp. It is very painful, but goes away when the muscle relaxes again.
A Normal T.M.J.
An Abnormal T.M.J.
Where did my T.M.J. problem come from?
So now I have a T.M.J. problem – how do I get rid of it?
First of all the shorter the time frame you have this problem the easier it is to fix it!
As a rule of thumb, the longer you have a T.M.J. problem and the older you are the harder it is to treat.
Before treating a T.M.J. problem, a detailed analysis with X-rays, study models, photographs, and measurements of the jaw opening and closing positions are noted.
Some patients with severe dislocations of one or both joints may require specialist treatment in which case they may be referred out of the Practice.
However, many patients can be helped once the correct diagnosis is made. The challenge is to find where the muscles would like the jaw to be, instead of where the teeth would like the jaw to be.
Treatment is quite like the new approach to early orthodontics for the growing child where bad oral muscle habits are corrected, thus enhancing facial growth and avoiding the development of crooked teeth or malocclusion.
Once the relaxed muscular position (relaxed neuro-muscular position) has been determined, a splint can be fabricated to this comfortable position.
The splint is an acrylic ‘wafer’ that fits over the lower teeth in order to alter the way the upper and lower jaw fit together.
It is usually worn 24 hours a day except when eating.
After the splint relocates the jaw to the ‘physiological rest position’, the patient can respond better to other treatment modalities.
The T.M.J. cannot be treated in isolation as the body is a continuous interconnected system. Hence, a dysfunction which occurs in this joint can have other whole body effects. For this reason, other Health care practitioners may also play a role in cranial and spinal alignment.
For the best results patients may require multi-disciplinary therapies including Myofunctional therapy, Craniopathy, and Spinal adjustments.
Acupuncture, and other muscle relaxation treatments in the upper body would also help the muscles eliminate their trigger points and adapt to the new positioning.
Once the patient is symptom free, their bite may need to be re-constructed to this new biological position.
This phase of treatment may involve:
Occlusial equlibration (balancing the bite)
Build-ups on the back teeth
After re-constructing the bite relationship, the jaws will fit together in such a way that corresponds to the new physiological rest position of the muscles.
In this state, the muscles can relax when the jaws are closed, thus eliminating fatigue, cramping and other associated symptoms.
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Both Bridget and Tony are continuing to pursue their Post Graduate Education and upgrade their skills in the exciting areas of Orthodontics, Myofunctional Therapy, TMD, and OSA.
Bridget travelled to Chicago in March to attend the AAPMD meeting where several International speakers delivered new material on Sleep Apnoea. Afterwards she travelled on to Los Angeles for internship with two of the World leading experts in Myofunctional Therapy, Joy Moeller, and Barbara Greene.
She also attended White Memorial Hospital LA for training in Temporal-Mandibular Jaw dysfunction under the guidance of TMD Director Dr. Joseph Schames. A pilot scheme into which Bridget has been invited, is currently being designed at White Memorial in partnership with UCLA. Its aim is to deliver a fully accredited course to Myofunctional Therapists in areas such as TMD, OSA, while simultaneously involving them in pioneering research work.
She also attended lectures with Dr. Douglas Galen, a leading Maxillo-Facial Surgeon in LA who is recognising and currently addressing the serious negative effects of tongue tie.
She will to LA and attend further advanced training in June with Joy Moeller and Licia Paskay, and will continue to actively seek to improve her knowledge in the above listed fields.
Tony attended a 4 day TMJ course in London in March 2013 with Dr Liz Menzel, a TMD specialist working in Germany.
In September he will commence one year mini residency course in LA with Dr. Bill Hang, Orthodontist, in Functional Jaw Orthopaedics.
Bridget and Tony attended Dr. John Flutter's "Breathing and Posture" course in Germany in March. They are now both qualified to help patients establish positive Nasal Breathing patterns, and eliminate the all too common destructive "mouth breathing" patterns, which are now proven to profoundly and negatively affect ones health.
They travelled to London in June for Dr. John Mew's 4 day Symposium, on a myriad of topics including "Anthropology and the Evolution Man's Skull", "Baby Led Weaning", "Orthotropics, Orthopaedics, and Orthodontics", and of course Myofunctional Therapy.
In November they attended Dr. Derek Mahony's mini residency course in London which not only included further training in Orthopaedics, and Orthodontics, but also incorporated very valuable training in OSA.