Photo courtesy of TMJ Implants, Inc.

                                                                                                                                                     www.tmj.com

TMJ-What is this?      

Everyone has TMJ.  TMJ is the Temporo-Mandibular Joint.  This is the jaw joint.  It is similar to the joint of the elbow or the knee.  So you “have knee” and you have "elbow" and therefore, you have "TMJ". Two in fact, a right one and a left one. 

Anatomy of the TMJ:

The lower jaw is called the mandible.  The condyle is a part of the mandible, for simplicity purposes of this discussion it is like a ball.  The skull has a socket-like area where the ball of the lower jaw fits.  Since it would be damaging to have one hard structure like these surfaces of bone rub another, there is a softer disk that sits in between the two bones.  So when the jaw opens, the ball rotates in the socket the disk acts to cushion the bones to protect them from what would otherwise be harsh rubbing. This protects against wear and damage. A main point to understand is that the lower teeth are anchored in their sockets in the bone of the lower jaw.  Everything you move your mandible your lower teeth move accordingly. 

Muscles, tendons and ligaments are also needed to make the system move. The ball and socket is located just in front of the outside opening of your ear on each side.  There is a left and a right TMJ.

What can go wrong with the TMJ:

If any of the associated structures is out of balance and harmony the system will not function optimally.  Comfortable function will soon stop.  The disk can be out of position. The development of the balls (condyles) can be altered if trauma occurs while the child is developing.  But the main issue can also be the bite.  If the teeth are poorly aligned it can adversely impact the structures of the TMJ.  The bite can disturb function of chewing.  

The Bite and how it all relates to the system:

The bite is one of the primary components that affect the TMJ and associated structures.  It is also true that the TMJ relationship can affect the bite. Many times the bite can feel comfortable yet be off just a little and cause a tremendous amount of problems and dysfunction in the jaw joint. Do you hear a click or pop?  If so that is your disk that is making that sound.  It means there is a lack of harmony in the system.  The disk is not staying between the two bones and the bones are popping off and on the disk.

How do you know what is happening in the joint?

This can be a complicated discussion.  There are many different examinations that can be performed.  Please refer to the page called  “complete exam” for more details of the exam process and why it is so important to have a comprehensive exam performed.

Can there be a problem in the joint and yet feel comfortable anyway?

Unfortunately in dentistry, if you have discomfort it usually means the dis-ease is advanced.  We strive to be preventive.  It is easier to stay healthy than to be come healthy. Let’s look at a few examples of this.  Remember the five worst words are “maybe it will go away”.  Decay in a tooth starts and there is no pain at all usually. It can take some time to progress towards the nerve of the tooth.  By the time the tooth hurts it is full of decay and most of the tooth can be destroyed in the process.  If the decay is repaired before it gets too deep a simple filling could be a solution.  In the latter case more extensive procedures are needed such as root canal therapy, posts and then a crown.  A far cry from only having a simple filling placed.  It bears repeating..."It is much easier to stay healthy than it is to get healthy!"  Let’s look at gum disease which involves bone loss.  The bone is what supports the teeth.  If you lose the bone you lose the teeth.  This rarely causes discomfort during the bone loss process. But towards the end of the process infections occur in the gums, pus and blood become visible and it hurts.  Too late.  It is too far gone to help these infected teeth.  Now you are looking at needing implants to replace the infected teeth or dentures, sometimes called: “plates”, “clackers”. 

The same is true for the TMJ.  If the bite is not balanced deterioration of the joint structures will occur.  Yes, it may be slow…but as you can see by the above examples you can stay healthy and treat this proactively and in a preventive manner.  Or, you can wait and need major reconstruction. 

What is Occlusal-muscle disorder?

This occurs when the bite is not well aligned.  The muscles then have to hold the jaw in a position that is less than ideal.  The jaw is no longer in the anatomically correct position.  The muscles have to work overtime to maintain this position and lactic acid build up occurs.  This chemical is the same as if you went to the gym and worked out too hard.  Your muscles would be sore.  This problem is evident by “tension” headaches, migraines, tired face, clicking jaw, popping jaw and poor function. Neck pain can also be related to the bite.  Those muscles get sore to compensate for the misalignment of the bite.

Sounds like witchcraft to you?  How about putting a pebble in your shoe and having to walk five miles.  You can bet by the end of that most uncomfortable walk your legs will be limping, your foot will be sore. Your back muscles will be out of sorts and painful,  as well as your muscles and structure of your neck and head. Go figure, all this from a tiny little pebble.  Yes indeed, the system was stressed and so the whole system is adversely affected.

A famous chemist said  “if you palace a stress on a system, the system will react to relieve the stress”.  His name was LeChatlier.  It is called LeChatlier’s Principal. A principal is not philosophy. It is a constant.

Good News:

It is possible to help prevent this and it is certainly possible to rid yourself of this as well.  This is nothing new.  The studies and techniques regarding all this have been tried and true for the past 50 years.  It is just that we have been a society of pills and potions.  But now many people want a drug free solution.  This is a true solution as it is an anatomical solution. New studies now indicate other anatomical markers are diagnostic in managing problems with muscles and the joint.  Based on these well identifiable landmarks corrections can be made that are definitive.  This makes for mor accurate diagnosis and more effective treatment methods which lead to a predictable outcome. It is really exciting and gratifying to be so effective as a clinician.

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Steven H. Feit, D.M.D., P.A.
7000 West Camino Real
Suite 130
Boca Raton, FL 33433

Phone: (561) 338-7535
Fax:      (561) 368-2981
feit@stevenfeit.com