Michael C. Goldman, DDS

TMJ  Problems

Many people suffer mild to severely debilitating discomfort in their face and jaw and even neck, shoulders and back related to dysfunction of the working  together of the upper and lower jaws.

Such unfortunate people often run into a hard time getting a  diagnosis, and an even harder time getting treatment and relief.  There's a lot of confusion about "TMJ".

The "Semantic" Confusion...

There are many professionals in dentistry and in medicine that might suggest that there's no such pathology as "TMJ"....Well, I'll try to explain to you that it's partly a semantic problem,  a matter of language.

If you talk about "TMJ" as in, "Doctor, do I have TMJ ?", the answer really is "TMJ is not a disorder or pathology or problem..."  That's simply because TMJ is the abbreviation for the name of the bone joint connecting your lower jaw to your skull.  So you could have an arthritic TMJ, a compressed TMJ, an inflamed TMJ, a dysfunctional TMJ...

It's like if you wondered if you had pneumonia and you asked  your doctor  if you had "lung"....It's pretty stuffy and silly, but it is part of the communication difficulties around the "TMJ problem".

The "Diagnosis" Confusion...

The symptoms you can  have from  problems   related to the TMJ mechanism are so wide and varied that they  serve no purpose to even try to list because they are things we all get sometimes, like headache, pains here and there in the face, neck, shoulders, back, even lower back and pelvis.   Or ear problems, dizziness, vertigo, ringing or whistling in  the ears, or pain, recurrent earaches, ear infection, clicking or grinding sounds or feelings inside the ear.  Or pain on opening or closing the mouth... and many more.

Obviously many if not all these symptoms could arise due to medical or dental problems not related to the jaw joints, like just "normal" ear infection, or toothache, or sinus pains.

But when the problem doesn't go away and all the "normal" things have been ruled out as much as possible many people start to wonder if the problem is related to the TMJ.

OK, So What is a TMJ Problem...

The TMJ jaw joints  are the  joints that let your lower jaw open and close relative to your  upper teeth.  Without going into a lot of useless detail let me just say it's a much more complicated joint than your elbow or knee (and you know how much trouble those joints can be !)  There are lots of nerves and muscles connected to them to get them to work with speaking and chewing...and biting as in self-defense.

When things are working right and you gently bring your teeth together in a relaxed way, all your teeth should hit  at the same time as opposed to say a molar hits first on the upper left and then your jaw shifts a little to the side and forward to  get the others to touch.  Your bite should be even and solid feeling and the jaw muscles should be evenly stressed on both sides of your face.   There are a number of reasons that your jaw position could be "off center" and not in that ideal balanced bite position.

It could be because you're under a lot of emotional, psychological, stress you to be  clenching or grinding your teeth in your sleep...or at work...and the muscles are overworked and in spasm ( like a "Charlie horse" leg spasm).  It could be that  your spine is  chiropractically "out" and needs to be adjusted, or there's a cranio-sacral   osteopathic problem that affects the position of the parts of the skull.  Your muscles  could be weak due  to a nutritional problem or due to an energetic [acupuncture] imbalance. There are medical problems why your muscles, joints, nerves, connective tissues may not be  doing the right things.

It could also be due to a dental problem.......Very commonly, it is related to  a tooth that you had extracted and  your bite gradually shifted, thus changing the way your teeth come together.  Or teeth have   worn unevenly, or dental work has been done and the bite was never adjusted perfectly, or the dental restorations  wore down faster or slower than the surrounding natural tooth structure depending on what the dental restorations were made of in the first place........

All these things can make the TMJ jaw joints, the related muscles and the teeth be in conflict with each other rather than working together as a harmonious team.  When they fight each other, eventually something gives out.  It could be that the muscles  start to go into spasm, or that the joint gets stretched  or compressed and gets inflamed and painful.  

It could be that you  grind more and make teeth hurt or even break or get loose. The sore part  could hurt by itself or you could get referred pain so it feels like the pain is somewhere else!  It's very strange stuff.

The "Treatment" Confusion...

Even more confusing is the  treatment... Because these problems can sometimes be related to too much stress in your life, sometimes they are successfully treated by psychotherapy.  Aha! you say, it's psychosomatic! Well, yes, sometimes it is.

Sometimes it's related to your spine being "out". The chiropractor makes it better.  Aha! you say, it's chiropractic!   Well, yes, sometimes it is.

Sometimes acupuncture can help dramatically. What does that  mean? Well, I'm not sure and neither is anybody else! But it is not uncommon for acupuncture to help it.

And so on through many other specialties and sub-specialties. Sometimes there's a functional problem inside the  joint where it's actually permanently damaged so that  oral surgery is needed.  Fortunately , I believe, that's rarely the case.   Un-fortunately,   many others (especially oral surgeons) feel it is often the case....

You would think dentists would be able to tell you quickly and easily if you have a TMJ problem...Well, most often that's not so.   Partly because lots of dentists don't get much into  TMJ treatment at all, and also because there's no quick and easy way to diagnose it.   Sometimes it's pretty obvious but most often it's such a mixed up bag of symptoms and no clear evidence to  see clinically so that the dentist is  guessing... at least for a while.

So, What does Dr. Goldman do...

The first thing I do when  a TMJ problem is suspected is to  try to get a sense of what's going on with the  whole person.   I would  ask about  home, job, relationships etc.  Not in the way a psychiatrist  might  ask, but just basic conversation  to get an idea about  what might be going on in your life that could be a contributing factor. I'd also want to know if  you've  been to an ear-nose-throat doctor to rule out symptoms that might be more medical in nature, or if  head pain has been medically ruled out.  After all, sometimes there can be an infection, or a tumor, or other medical problem which I  can't diagnose - and if there's a more serious medical problem we  wouldn't want to miss it - so we need to be careful and try to respect what the body is trying to tell us!

If it seems like maybe the main problem is in the   mouth area where I  do my work, I might suggest  some simple mouth exercises.  Or I might suggest medication to relax  the muscles if I think   things could recover with just a little help.

I often suggest an appliance that I make.  It's usually like a retainer that works in a very special way.  I lets the muscles relax and disconnects the fighting between the  muscles and joints and teeth.  If my educated guess is correct, relief is usually started to be felt almost immediately.   If it doesn't help, then the problem  is probably elsewhere and I may  or may not be able to  do more. 

But if it does help, as it most often does, then many good things begin to happen.  Aside from getting at least some relief, you begin to be able to feel things about your bite that  you weren't able to feel before (it's like as if there had been numbness in places other than  where it hurts, and now the numbness is beginning to go away), and with this new ability to feel your bite you can  give me feedback that helps me to know what to do next.  It's very much a cooperative effort.

From that point it's a matter of coming to an understanding of what is going on in your specific situation  and then looking at what options are available to change things in a way that you will be able to function better and more comfortably.  Sometimes it's just a matter of continuing to use the appliance during sleep; sometimes structural changes must be made to your bite... and doing that can range from very simple to  a very big deal.  Most of the time it's somewhere in-between.

Let's talk about it....!


More info about the following is available  if you select  "topics".

Cosmetic dentistry is about doing   quality , esthetic dentistry in a way that looks natural to begin with, and furthermore,   can even  improve  one's  attractiveness through techniques such as bonding, bleaching, veneers, caps, implants and more.  It can   be like "instant orthodontics" in correcting  crooked, twisted or misplaced teeth in many instances.  Dark or misshapen teeth can be restored.   Smiles that lack youthful vigor or beauty can be revitalized! See Topics / Info..

Bleaching, veneers, bonding, caps, bridges, and implants  are cosmetic dentistry treatments that are also  discussed in  Cosmetic Dentistry, and more...

Holism in dentistry is an approach to dental treatment, primarily  caring for  patients' health and safety from both a conventional as well as  "alternative healthcare" point of view.   It is sometimes called "biological" dentistry or "biocompatible" dentistry.  In it's fullest sense, I believe it   acknowledges and deals with  the mind, body and spirit of the patient, not just his or her "teeth".  See Topics / Info.....