Information You Should Know About Your Condition
It is important that you understand that there is no cure for your condition. If your joints click and pop, orthodontic treatment will not make that go away. Excessive opening of the jaw, a noisy joint, limited opening and/or locking of the jaw usually indicates a problem within the jaw joint. This is called an internal derangement. Straightening the teeth will not improve this situation. This is the result of a damaged ligament. Ligaments are structures that stabilize the joints in our bodies. We have ligaments in the knees, fingers, shoulders, and all joints of the body including the temporal mandibular joints. When ligaments become stretched or damaged, they no longer stabilize the joints. Once a ligament becomes stretched or damaged, the ligament does not return to its original length, and the joint becomes unstable. In the jaw joint (or TMJ) it is the ligaments that hold the disc in its proper position.
The disc is a piece of cartilage that separates the jaw bone (condyle) from the skull bone. This disc acts as a cushion or shock absorber that separates the two bones. The disc is held in place by the ligaments. When the jaw joint starts making noise, like clicking, popping or crunchy noises, the ligament has become damaged and is no longer holding the disc (shock absorber) in its proper place. The stretched or damaged ligament is also responsible for knee problems, shoulder problems, ankle problems and many other joints in our body where joint problems may occur. When ligaments of other joints (except for the TMJ) become problematic, you would go to a medical doctor. Joint problems are medical problems, but for some unknown reason, a problem with the jaw joint is treated by dentists. Most medical doctors know very little about the jaw joint and have no idea how to treat it. There may be several reasons for this:
1. It could be because in most cases nothing really bad happens if the ligaments of the jaw joint are damaged.
2. It could be because 30-70% of the population have jaw joints that make noise.
3. It could be because teeth are on the bone connected to the jaw joint. However, a foot is connected to the same bone of the knee, yet you would not see a foot doctor for a knee problem.
We have an upper jaw and a lower jaw, but it is the lower jaw that connects to the skull by the TMJ. The lower jaw hangs off the skull by muscles of the face and the ligaments. We can think of the lower jaw as a hanging bone that is not bearing any weight, unlike the knee or hip joints that bear the weight of the body. For every 1 pound of body weight, the knee feels 4 pounds. So a 200 pound man is putting 800 pounds of pressure on the knee. Because the knee has all that weight on it, if the disc in the knee is not positioned properly between the upper and lower bone of the leg, the bones eventually wear away and the knee joint needs to be replaced by a metal joint. In the United States, 600,000-800,000 knee joints and hip joints are replaced every year. Since the jaw joint does not have all that weight put on it, very few jaw joints need to be replaced.
For simplicity, we can divide problems or pain in the area of the jaw located in front of the ear and the face muscles, head and neck muscles into two groups:
1. Problems of the joint itself, called internal derangement, which is in reality a medical problem.
2. Problems in the form of muscle pain of the face, head or neck, which is called orofacial pain.
It is possible to have both problems at the same time. You could have joint pain and muscle pain. It is my job to examine you to determine what your discomfort is coming from. There are many medical problems which can cause pain or discomfort in the neck and shoulders. After reviewing the questionnaire you filled out, I will examine you for signs and symptoms of joint or muscle problems. If I determine that you are a candidate for TMJ treatment, I may begin your treatment with an appliance that fits over your upper teeth, called a splint. The splint is a flat piece of plastic that covers the surface of your teeth and is for diagnosis only. It does not move teeth and it is not a magic cure. The splint is used for the following reasons:
1. To determine if the pain you are having is bite related
2. To tell me where your teeth should fit together while keeping your muscles comfortable.
Let me explain each of these a little further. It is very important that you wear the splint 100% of the time. I want you to eat with it and sleep with it in your mouth. The only time you should have it out is when you brush your teeth or clean the appliance. When you have it out of your mouth, do not touch your teeth together.
If you have a malocclusion (crooked teeth or an uneven bite) that is causing your jaw to be moved in an unnatural way, the splint will balance your bite to improve your occlusion. For this reason any pain that is due to a crooked bite will go away.
The second reason for placing you in a splint is to determine where your bite should be (where it is comfortable for your jaw joint). Wearing the splint stops your teeth from touching together. Your jaw will start closing where your muscles want it to close, not where your teeth want it to close. Many times there is a difference where your teeth want it to close. If your teeth cause the jaw to move in an unnatural way for long periods of time, the muscles become sore, they go into spasm and hurt. Wearing the splint full time deprograms the muscles, they forget where they use to close, and start closing where they are comfortable. If you do not wear the splint full time, the muscles never become deprogrammed and the splint will not give me the information I need to make a diagnosis.
After you have worn the splint full time for approximately one month, I will examine you again. At that time, I will remove the splint to see where your teeth are hitting when you close your teeth together. I will be able to determine at that time if your muscle position and tooth position are the same. We will also discuss your pain to determine if it has improved. If it has, I will have you continue wearing the splint to keep you comfortable for another month or two. Your next step will be to make a decision about what you want to do next. You may not want to pursue orthodontic treatment. If not, you may wear the splint as needed for as long as you like, possibly the rest of your life. You may elect to have orthodontic treatment to try to move the teeth into a better position. This may help you reduce splint wear to only occasionally. The purpose of orthodontic treatment is to position the teeth so they fit together without the splint as they do with the splint. To accomplish this, crowns, bridges or jaw surgery are sometimes necessary. You will not necessarily get rid of the clicking and popping or the locking, because if you remember, these are internal derangements that just straightening the teeth will not help. The orthodontic treatment will position the teeth in as good a position as possible so the bite is not aggravating the jaw joint day after day as you use your joint. If the joint makes noise, but does not cause pain, the treatment has helped. If the locking or joint pain becomes a problem and interferes with your life, then you may be a candidate for temporomandibular joint surgery. Surgery is only recommended as a last resort. Surgery is not a cure all. A joint that has had surgery is still an unhealthy joint. It may help in some cases. It is sometimes better to live with a little joint noise and occasional locking than to have surgery. We do not want to do surgery unless absolutely necessary.
Let’s talk about what could cause this problem. Most people have no idea why or when their joints became a problem. Joint problems may be due to stress, genetics, habits, or trauma. Any or all of these things can affect your joint health. The joints can be hurt while yawning, opening too large when eating, sleeping on your face or any type of facial trauma. Any force that pushes the lower jaw backwards can hurt it. The position of the teeth may play only a small part of the total problem. Diet can also be a factor; caffeine for example should be avoided, as should chewing gum.
The treatment will be taken one step at a time. If at any time it becomes apparent that the joints are not responding, I may refer you to a family dentist, physical therapist, physician or oral surgeon for treatment. It is important to remember that the care and treatment is a multi-disciplinary problem. Oftentimes it will take more than one person to help you get better.