TMJ is the acronym for temporomandibular joint, which connects your lower jaw (the mandible) to your skull at the temporal bone. This joint controls many jaw functions, like chewing. If the chewing muscles or the joint itself are causing you pain you may have temporamandibular disorder, or TMD. TMD can be caused by stress, continual clenching of the jaw muscles, or teeth grinding.
Some of the symptoms of TMD are:
Pain when opening or closing mouth
Limited or painful jaw opening
Jaw becoming stuck open or shut
Frequent or severe headaches
Ear pain or ear stuffiness
Clicking or popping sounds when opening your mouth
Many of these symptoms can often be associated with other health problems, so only a medical professional can tell you if it is due to TMD. Teeth grinding is an especially problematic symptom because it can lead to further problems. Prolonged teeth grinding, or bruxism, can cause enamel to wear off teeth and expose dentin. This material is softer than enamel and more susceptible to decay. Sensitivity to hot and cold food or drink may also develop from excessive teeth grinding.
Most TMJ symptoms in Dr. Newby's opinion are caused by the malpositioning of the condyles in the TM joint space. Just as an orthopedist would reposition any other dislocated joint in the body to restore proper function, a dentist uses a correctly fabricated splint that fits between the upper and lower teeth to guide the lower jaw and thus the condyles forward to restore proper condyle position.
The symptoms above are one way of diagnosing TMD; the most definitive way is to have the TM joint areas imaged. Dr. Newby takes x-rays with a positioning device that aligns the x-ray tube. These x-rays are called transcranials and are taken in the closed, slightly open, and fully open positions for each TM joint.
Dr. Newby's method of treatment is a non-surgical approach designed by Dr. Ron Levandoski, the Levandoski splint. The Levandoski splint is made out of a clear plastic material that slightly softens at body temperature and snaps in over the lower teeth. As the patient bites down the lower jaw is guided slightly forward as the splint engages the top teeth. In this position the condyles are positioned correctly in the TM joint space. The splint is worn full time until proper range of motion is restored and the accompanying symptoms are reduced or eliminated. Thereafter the splint is worn while sleeping.
A permanent phase II correction may be necessary post splint treatment to align the teeth to the newly corrected position. This might involved orthodontics, crowns, an overpartial, or a combination of these techniques. Some patients opt not to do a phase II correction and will continue to wear their splint while sleeping. Most of these patients function fine during the day.
Top, frontal, and side view of the Levandoski splint:
Levandoski splint positioned in a patient’s mouth:
Illustrations of the side view of a healthy TM joint space with the landmarks identified:
A model representing a side view of the TM joint space, temporal bone, disc, and upper and lower jaws with teeth:
Normal TM joint: the TM joint space is slightly forward of center with much posterior joint space behind the condyle and the condyle approximately 2mm from the temporal bone
Displaced or advanced displaced TM joint: The teeth come together such that the condyles are forced back in the TM joint space:
Corrected by the Levandoski splint: the splint fits over the lower teeth and guides the lower jaw down and forward such that the condyles are now positioned correctly in the TM joint space: