What Is TMJ / TMD?
The temporomandibular joint (often abbreviated TMJ, which is why some people use TMD to refer to temporomandibular joint disorders) is the joint in the jaw where the mandible, or lower jaw, meets the temporal bone in the skull. The alignment of the joint is largely determined by the way the teeth in the upper jaw align with the teeth in the lower jaw. This is commonly referred to as the “bite,” and a misaligned bite, or malocclusion, is a major cause of TMJ.
Jaw dysfunction can cause jaw-related symptoms. Jaw pain, jaw sounds, and problems with jaw movement are all common in this condition. Because the jaw joint is at an important intersection of the body, symptoms can also be far-reaching.
TMJ is one of a number of what we now call chronic overlapping pain conditions (COPC), in which people experience multiple, painful conditions. About three-quarters of all people with TMJ have at least one other COPC.
Symptoms of TMD
Several important facial nerves pass through the jaw, so misalignment can compress these nerves, leading to a variety of symptoms. Some typical symptoms of TMD include:
- Pain, popping or clicking in the jaw
- Earache or ringing of the ears
- Tension in the shoulders, upper back, face, and neck pain
- Uneven bite
- Difficulty chewing
- Limited range of motion in jaw
Some of these symptoms can be related to much more serious conditions, so it is important to have a doctor evaluate your case to ensure there are no other medical conditions present. If the symptoms remain unexplained, TMD may be the culprit.
What Percentage of TMJ Patients Experience Associated Pain Conditions?
- Migraine: 100%
- Chronic lower back pain: 25%
- Irritable bowel syndrome: 5%
- Fibromyalgia: 40%
- Vulvodynia: 0%
- Interstitial cystitis: 0%
- Endometriosis: 15%
- Chronic Fatigue Syndrome: 80%
- Cardiac Arrhythmia’s: 80%
- Dizziness: 60%
- Ear pain & Tinnitus: 50%
- Fibromyalgia: 50%
Some research even suggests that TMJ plays a causative role in these conditions through the release of calcitonin gene-related peptide (CGRP). This has been so solidly established for migraines, that new migraine drugs target CGRP. We also know that TMJ treatment can help with migraines. Research has not yet established the impact of TMJ treatment on these other conditions.
It is common for people with TMJ to get diagnosed with a related condition, such as Meniere’s disease or trigeminal neuralgia. We have helped patients with these conditions to get relief from their bothersome, potentially debilitating, symptoms.
Diagnosing TMJ can be a challenge. We utilize a scientific, high-tech approach called neuromuscular dentistry that produces verifiable, objective data that can guide treatment. The K-7 system allows us to gather comprehensive data about the function of your jaw. Amplified sound analysis, muscle tension measurements, and precise jaw tracking help determine the nature of your TMJ.
We may also use imaging such as an MRI or CT scan to view your jaw tissues in detail. Kinetisense motion tracking allows us to see the impact of TMJ beyond your jaw. By taking detailed pictures of your body in motion and remaining still, this technology allows us to see how TMJ imbalance impacts the entire body. Because we collect this comprehensive suite of data, we can distinguish TMJ from other conditions with overlapping symptoms.
We like to have comprehensive data on our patients so we are very thorough in obtaining diagnostics. We take our time to gather all the details in our patient’s baseline position. We have X-rays, scans, questionnaires for patients to complete, and digital imaging.
Usually, the initial diagnostics are completed over one day 2-3 hours, and the next day we have patients come in for a shorter visit to verify their bite and to go over their treatment plan once we know more about their occlusal disorder.
How Long Does It Take to Diagnose TMJ?
TMJ is diagnosed on the day of the appointment and the first phase is all about stabilization. Once patients have started the first phase of treatment, we see them periodically to verify that they are on the right path to complete stability. We can measure stability with certainty by utilizing equipment that documents the patient’s progress.
For more information, see TMJ Treatment Options.
Why We Don’t Recommend BOTOX® Treatment for TMJ
BOTOX uses botulinum toxin type A to create temporary muscle paralysis. Although it is famous as a cosmetic treatment (and we use it often for that purpose), it is also a prescription medication approved for numerous conditions–but not for TMJ.
Some doctors and dentists use BOTOX “off-label” to treat TMJ. They inject the compound into the jaw muscles and other head and neck muscles. This causes flaccid muscle paralysis–the muscles relax and won’t fully tense up. This can relieve symptoms caused by overactive jaw muscles–a common circumstance in TMJ.
However, we don’t utilize BOTOX in this way because it:
- Has unexplored side effects
- Interferes with diagnosis and treatment
- Isn’t a long-term solution
- Seems unnecessary
For these reasons, we recommend against BOTOX treatment for TMJ.
Potential Side Effects of BOTOX for TMJ
Part of the approval process for a medication involves exploring the potential side effects to determine if a drug is safe and effective for its intended use. We haven’t seen that in the case of BOTOX for TMJ. Some studies suggest potential side effects such as:
- Muscle atrophy
- Bone loss
- Problems speaking, breathing, or swallowing
- The spread of toxin effects
We don’t know how severe these and other side effects are and can’t balance them against treatment benefits.
BOTOX Interferes with Diagnosis
Successful TMJ diagnosis depends on understanding the dysfunction in your jaw muscles. We can’t do this when our muscles have been paralyzed. Although BOTOX will wear off, until we can be sure it’s worn off, we can’t be sure we’re observing your jaw’s natural function (or dysfunction).
BOTOX Is Not a Long-Term Solution
As with cosmetic applications, therapeutic applications of BOTOX provide only temporary relief. While this relief can last a few months, it eventually wears off, and your symptoms will return. We prefer to find solutions that can give you years of comfort–many of our patients never see their TMJ symptoms return.
BOTOX Is Unnecessary
We haven’t seen a need for BOTOX in TMJ treatment. While we don’t have a 100% success rate, we haven’t seen many cases we couldn’t treat that would benefit from BOTOX. Why utilize an unapproved, potentially risky, and temporary solution when we get long-term relief safely for our patients?
There are many potential treatments for TMJ in Columbus, OH. Sometimes minor muscle massage using TENS (transcutaneous electric nerve stimulation) gives relief. Other times, this is simply a necessary step that helps us diagnose what’s really wrong with your bite.
In many cases, correcting the bite can alleviate TMD. We may begin with temporary bite treatments, such as an orthotic or splint (similar to a sports mouthguard) that you wear at night. If you like the results but want to get rid of the splint, we might adjust the bite permanently using dental restorations or orthodontics.
TMJ Treatment Process
TMJ treatment involves two phases. The first phase seeks to alleviate the pain and symptoms you are experiencing. Dr. Firouzian can accomplish this using TENS therapy, which applies low-level electrical nerve stimulation to relax your jaw and return it to its ideal resting position. Other treatments commonly used to alleviate TMJ symptoms include:
- Altering your diet to include softer foods
- Jaw exercises
- Hot and cold packs
- Over-the-counter anti-inflammatory (NSAID) drugs such as ibuprofen
The second phase of your TMJ treatment will provide you with a long-term solution to your jaw alignment issues. The second phase will never begin unless the first phase is identified to be stabilizing the condition. Once stabilization is underway, permanent stabilization if the goal with phase II. This may include:
How Soon Do Patients Notice the Benefits of TMJ Treatment?
TMJ treatment starts providing patients with relief almost immediately. They see their pain lessen as they are wearing an orthotic that prevents the TMJ joints from the type of compression that leads to all the symptoms that are a consequence of their unhealthy bite. However, the relief of symptoms alone is not what we use to verify results. We verify the results by repeating the diagnostic tests that initially identified the problem and then we search for confirmation that the body’s muscles are adapting and responding positively to the impact we have created with the patient’s new bite.
Additionally, since the orthotic is not removed and is worn 24/7, it is far easier for patients to use it as they are doing all the routine functions of speaking, chewing, and swallowing. So the orthotic becomes easier to adapt to. Once the certainty of bite stabilization offers patients the maximum medical improvement, we typically see almost all symptoms resolve and can be assured that we have been able to identify the best long-term bite.
Get TMJ Treatment in Columbus, OH
An experienced physiologic dentist is the ideal person to treat any symptoms related to TMJ disorder. Physiologic dentistry is a specialty that focuses on how the muscles, nerves, and joints of your jaw work together in your bite. A physiologic dentist will work to achieve a harmonious relationship between the muscles, joints, and nerves so that your bite returns to its ideal resting position, enabling it to function properly.
Contact Firouzian Dentistry at (614) 848-5001 today to schedule your initial consultation. Dr. Michael Firouzian serves patients in Columbus, Dublin, and New Albany, Ohio.