TMJ stands for the TemporoMandibular Joint. The temporal bone is a portion of the skull bone, the mandible is the lower jaw bone and the TMJ is the joint that connects the two. TMJ disorders consists of pain, dysfunction or derangement of this joint and it’s associated muscles. Because many of the symptoms of this problem are not in the joint itself the condition is more accurately referred to as TMD which stands for TemporoMandibular Disorder. Signs and symptoms of TMD include but are not limited to the following:

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Summary
The majority of TMD related pain is caused by muscles that are in hyper-contraction or spasm. This is usually caused by discrepancies in the way a person’s teeth come together in relation to where their jaw joint wants to be. In other words most TMD problems are caused by bite problems that result in muscle pain. This muscle pain can be severe and debilitating. It is often mistaken and misdiagnosed as common headache or migraine headache pain.

Some patients however, have pain or dysfunction that is caused by an internal derangement of the actual jaw joint. These are the patients that can have the clicking, popping or grinding noises in their joints. These patients usually also have muscle related pain and the bite discrepancies mentioned previously. Internal derangements of the joints can be caused by a bite problem, traumatic injury to the jaw or head or independent pathology. Traumatic injury such as whiplash or a physical blow to the mandible can cause damage to the delicate supporting ligaments of the joint. Some of the symptoms of a TMD that were caused by a traumatic event may not develop until months after the incident. There are many stages of joint derangement and it is important to establish the exact diagnosis for a patient before treatment is begun because the treatment and prognosis of different stages can vary greatly.

For an excellent overview of TMJ anatomy and classification of disorders visit the web site: www.Piperclinic.com. For another excellent overview of TMJ Disorder symptoms and treatment click here.

Dr. Holmes is trained and knowledgeable in the subject of contemporary diagnosis and treatment of TMD. By performing a very detailed clinical examination of the patient and interpreting radiographs, ultrasound and MRI scans he is able to determine an accurate diagnosis for the patient and a establish a definitive prognosis and course of treatment.

Treatment
Treatment of TMD consists of a wide range of possibilities. We treat our TMD patients in one or two phases depending on their initial diagnosis.

Phase 1 consists of the elimination or significant reduction in pain by relieving muscle spasm and inflammation. This can accomplished by alteration in dietary habits, medications, bite splints, anesthetics and physical therapy. This phase usually takes between one to eight weeks for resolution of symptoms depending on the initial severity of the problem. For patients with healthy joints that require only minor correction of their bite to relieve their symptoms, the permanent equilibration of their bite can be performed in phase 1, thus eliminating the need for a second phase of treatment.

Phase 2 is the correction of the underlying anatomical or physical cause of the patient’s TMD. For example, if a bite splint were used successfully in Phase 1 to alter a patient’s bite and relieve pain then Phase 2 would be the permanent alteration of the patient’s teeth or jaws to reproduce the bite created by the splint and thus eliminate the need for the splint. This can be accomplished a variety of ways and it depends and the severity of the individual’s problem. Methods we consider in Phase 2 are reshaping the teeth, restoring the teeth, orthodontic movement, jaw surgery and sometimes a combination of these options. Phase 2 could also include microscopic surgery of the joint space to correct an internal derangement or displaced disc with or without alteration of a patient’s dentition. There are very rare instances that microscopic surgery would be recommended as the initial (Phase 1) step in treatment. An example would be a young patient with a previously healthy joint and disc that was involved in a traumatic accident that resulted in the complete and severe displacement of the joint disc.

It is important to understand the most TMD symptoms are caused by bite problems and the solutions are fairly straightforward. Therefore, even if your symptoms are currently minor it is important to be proactive and follow through with any recommendations we have to equalize your bite so that major, debilitating complications are less likely to occur in the future.

There are many other disorders that either mimic TMD or are present in conjunction with TMD. Examples of some but not all of these other common problems are; fibromyalgia, cervical spine disorders, postural problems, dental pain, neuralgias, RSD, migranes, and ear/nose/throat disorders. We can help in determining if an additional source is wholly or partially responsible for your head and neck pain and if so refer you to the appropriate specialist for treatment.
The many possible sources, stages and treatment options of TMD make it imperative that an accurate diagnosis, prognosis and plan be established before any treatment is begun so that the patient has every opportunity for a direct, timely and successful solution.

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