TMJ, Muscle & Occlusion - Root Cause Dentistry

What is TMJ?

The temporomandibular joint (TMJ) complex is often associated with negative connotations such as clenching and grinding of teeth, sore muscles of the jaws, headaches and migraines, tinnitus, clicking and popping noises made in the joint, and pain. However, what most people don’t realize is that the TMJ complex is beautifully designed and is a crucial element in the way our teeth fit and work together with the muscles that assist in the movement of the joint. All three components, joint-muscles-teeth, must work harmoniously to function as one system.

The TMJ complex consists of the condyle (bone at the top of the lower jaw), the disk (a cushion that separates the lower jaw from the base of the skull), and ligaments (that help to tether the disk to the condyle). A stable bite (occlusion) depends on a stable temporomandibular joint, and a stable TMJ is dependent on proper growth and development of the maxillofacial complex along with the nasal-respiratory complex.

Temporomandibular joint disorder (TMJ) is a condition that affects the joints and muscles that control jaw movement. Symptoms may include:

pain or tenderness in the jaw

difficulty opening or closing the mouth

clicking or popping sounds in the jaw

headaches or earaches

The muscles of the head, neck, and face play an important role in TMJ disorder. Dysfunction in these muscles can lead to jaw pain and discomfort, and can even contribute to headaches and migraines.

A full evaluation of the TMJ involves assessing discomfort/pain, joint noises (clicking, popping, crepitus), range of motion, nerve pain, muscle palpation, bruxism (clenching/grinding), poor bite, worn-down teeth, and airway screenings.

Clenching, Airway Problems and Night Guards.

When the airway is compromised, it can cause patients to clench or grind their teeth at night, leading to TMJ pain and dysfunction. This is because when the airway is obstructed, the brain signals the body to tighten the muscles in an effort to open the airway. This can put excessive pressure on the TMJ, leading to pain, discomfort, and a misaligned bite.

We now know that night guards, which are beneficial for clenching and/or grinding, can contribute to making sleep-disordered breathing (SDB) worse 50% of the time, and improve it 50% of the time. We aim to understand a patient’s risk factors and perform sleep screenings for SDB in the TMJ evaluation process.

TMJ Classifications

There is a classification system to describe the different types of TMJ conditions.

STAGE 1 (NORMAL):

Healthy discs, ligaments, and cartilage.

STAGE 2 (Normal disc position with occasional clicking/popping):

Partial damage to ligament or cartilage.

Stage 3 (Consistent popping/clicking and/or locking):

Partial disc subluxation.

Stage 4:

Complete disc dislocation.

Stage 5 (Degenerative joint disease):

No disc and bone on bone.

While most people can function normally with clicking and popping for most of their lives, it doesn’t mean that the teeth will withstand the same abuse. Often we see the teeth take the beating over the years through stress lines (cracks), fractures of the tooth and root, and when a patient’s bite changes over time.

Prevention & Treatment

At Root Cause, the goal is to recognize the signs before the patient has TMJ symptoms. We can help stabilize the bite, muscles, and joint by fabricating a customized splint (orthotic) or by performing an analysis of how to perfect the bite to get it back to a healthier state. If the damage to the joint has progressed, there are surgical interventions possible to repair the disc or reconstruct the joint by our TMJ specialist/surgeons, that Dr. Miller and Dr. Gross collaborate with out of state.

Depending on a patient’s severity, our recommendations may include obtaining additional imaging of the joint (CBCT) and/or the disc (MRI) while working with an integrated physical therapist, myofascial release therapy, craniosacral and/or acupuncturist.