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Your Temporomandibular Joint and Its Treatment

The temporomandibular joint is right in front of the ears. You can feel it with your fingertips. It allows your lower jaw to open and close, and move forward and side-to-side. Like any joint, it can undergo wear and tear changes. The bony part of the joint can degenerate. The cartilage disc can become misshapen or lose its normal position. The blood vessels and nerves behind the joint can become inflamed and irritated. All of this can occur with or without pain and alteration of joint function.

During your examination, we will perform orthopedic types of tests on the TMJ such as palpation (pressing various areas), auscultation (listening while the jaw moves), range of motion tests, and loading or joint compression tests. These allow us to assess the current status of joint form and function. If you have joint pain, we will determine exactly which structure(s) are involved in order to make a diagnosis. We will also palpate the muscles of the head and neck area to determine if they may be a source of pain. The causative factor(s) of the TMJ or muscle pain must be determined. The causes can be multiple, such as trauma, habits such a bruxism (grinding the teeth), sleep disorders, psychological factors and medical conditions.

The bite of the teeth (occlusion) has a direct effect on TMJ structure and muscle function. If the bite is incorrect, it can cause undue stress and force on the TMJ structure and cause the muscle to overwork. Both undue stress and force can be a source of pain and/or dysfunction. If it is determined that there is a cause/effect relationship between the incorrect bite of the teeth and TMJ/muscle symptoms, a bite splint could be recommended. A bite splint (which can fit on your upper or lower teeth) creates an artificial physiologic biting surface that alleviates undue stress and force, providing for better joint and muscle function and comfort. We carefully and precisely fit and adjust this bite splint because as you wear the splint, your bite on it will change, requiring additional adjustments to the splint. The goal is to alleviate the signs and symptoms of TMJ disorders, as well as stabilize your bite on the splint.


Once the goal of splint therapy is met, we will reevaluate your TMJs and reassess your bite using models of your teeth attached to an articulator (jaw simulator). Then carefully study your bite to determine what corrections can be made to optimize your oral comfort, function, health and esthetics.



When your temporomandibular joint (TMJ) is seated fully into the socket (fossa), in a comfortable, relaxed position and when the muscles are relaxed – all of your teeth should touch simultaneously. When you squeeze firmly from this relaxed position, there should be no "shifting" of either the jaw or individual teeth. When you move your jaw from side to side, the front teeth should glide, and the back teeth should immediately come apart. This type of bite is what we refer to as a "minimal stress, minimal adaptation, least destructive" type of bite.

If there is an incorrect bite, undue stress can be introduced to the TM joints, the teeth and the supporting structures. The muscles work extra hard for the jaw to find an "accommodating" position and can become tense and painful.

If we determine that you have a bad bite, the first step is to complete the rest of the examination and make a diagnosis. The cause-effect relationship between a bad bite and other signs and symptoms of breakdown should be determined. If the cause-effect relationship can be determined, then the bite should be corrected. If joints or muscles are symptomatic, bite splint therapy or other adjunctive therapy is usually a first step before bite correction.



Correction of the bite involves the reshaping and recontouring the teeth so that they all touch simultaneously and with equal intensity when the TMJ is in the correct position and the muscles relax. This procedure is first performed on plaster models of your mouth to verify the desired outcome. It is a very precise, exacting procedure that requires careful follow up. Since reshaping is only done on the enamel of the tooth, no discomfort is felt.

When equilibration is completed, you will experience the comfortable feeling of all your teeth touching equally. This is quite a gratifying result with the long-term benefits of optimal comfort, function, and minimized wear and tear.



The Specifics: TMJ Anatomy

The way our muscles, teeth and joint work together is extremely complicated. In fact the TMJ is the most complicated joint in your body. No other joint you have moves in the intricate ways that they do. Think about one simple aspect.................what other bone in your body has the right and left side joints connected and moving at the same time?



MANDIBLE - the lower jaw.
CONDYLE - the "ball" end of the mandible.
DISC - a dense connective tissue pad that acts as a cushion between the condyle and the socket that it fits into. (Somewhat like the cartilage in your knees)


MUSCLES - there are numerous muscles that "power" the TMJ.
The two illustrated here are the two most frequently involved in soreness / pain.



Types of TMJ Problems:

When people exhibit a problem with their TMJs, it is most often exhibited as:



Problems associated with the jaw joint itself.

Clicking and Popping of the Joint: Quite often, the disc is displaced to a position in front of the condyle. This results in first a "clicking" or "popping" sound. The disc at this stage is still able to slip or pop back onto the top position on the condyle during the open / close cycle.



Closed Lock Position: Some people may then experience "locking" of the jaw joint. This occurs because the disc is no longer able to slip or pop back on top of the condyle during the opening or closing cycle. (It is perpetually trapped forward). Because this occurs, the mandible opens only in the first part of its motion and is not able to complete a full cycle - the person often exhibits a limited opening of their mouth.



Pain emanating from the jaw joint itself.

  • Usually either an inflammatory response within the joint and /or
  • Highly innervated tissue being compressed.

Problems associated with the muscles.

  • Sore muscles (usually in the temple or cheek areas). Headaches that can be actually muscle soreness.
  • Limited opening.

Problems with the teeth.

  • Loose teeth.
  • Broken teeth.
  • Broken crowns or other prosthetics.
  • Sore teeth.
  • Excessively worn teeth.
  • Loss of bone support.

Ear problems.

  • Hissing or ringing.
  • Ear pain, ear ache (in the absence of infection).
  • Vertigo, dizziness.

There can be numerous causes for TMJ to occur, but the most common is the simple fact that when the teeth come together, the TMJs are not in socket. This can be a hard concept to understand, some basic thoughts may help explain this.

Move your lower jaw forward.....now left.....now right......as you can see, the jaw joint can move in and out of socket freely. This is an unusual movement for a joint (what if your knees could come out of socket?). Now that you can see there is movement allowed in the joint it is important to understand that there is actually one position when closed that is a correct and stable socket position. In this position the powerful muscles that move the joint are at 'rest' and there exists no damaging forces being applied to the joint, teeth or muscles. Now throw in the teeth, what if in the position of maximum tooth contact the jaw joint had to come out of the 'rest' position to accommodate? The result is that the jaw joint is not in its 'rest' position when the teeth come together and the muscles 'know' this. The muscles will try to get the joints to the 'rest' position but in this scenario they can't. Most commonly this results in muscle hyperactivity usually exhibited as bruxing (nightgrinding) and day clenching.

People do not notice that they have this discrepancy present. The reason for this is that the muscles that control the joint position shift the jaw down (out of socket) just before the teeth make contact. This is known as an "avoidance pattern" - the muscles move the joint so that the teeth won't crash into each other.

Therefore the determining factors for which symptoms or problems a person may acquire is usually a combination of several factors....

  • How far their teeth are misdirecting their TMJs.
  • How much they brux (grinding of the teeth at night while sleeping).
  • How much stress they're under - stress increases bruxing DRAMATICALLY.
  • How much clenching they do during the day.
  • How genetically susceptible they are. Many people have a bite that is "off", yet they do not show any TMJ symptoms.

So what is the solution? What will make TMJ problems go away? If you have followed the discussion above then the answer is most often to provide an occlusion (bite) so that when the teeth come into full contact, the joints are not forced out of their 'rest' position.

In summary, jaw joint dysfunction treatment is complex and individual. A successful treatment is designed for each individual patient. The design takes the form of careful analysis and production of a splint using every possible piece of information available and required follow-up treatment. Other treatments that may be indicated include restoration of teeth, crown replacement and orthodontic treatment. Again, suggested dental treatment is individual and fits into a long-term dental plan for optimal dental health.

DePasquale Dental
3218 East Market St.
York, PA 17402
Phone: 717-755-3061
Fax: 717-757-4401