Do you have frequent headaches, or neck and shoulder aches? If your bite isn’t right your muscles can tighten, causing pain in these areas.
Many times, people can treat these aches by taking an aspirin. However, for some the pain is so severe that it is hard to make it through the day. Many assume the headaches are due to a demanding job or stressful situation, and take medication to treat the symptom – not the cause. Neuromuscular Dentistry is the non-invasive way of finding the cause, and treats the causes as well as symptoms without the use of medications or surgery.
What is TMJ/TMD?
The temporomandibular joint, more commonly referred to as the “jaw joint,” connects the head and jaw together and assists in the basic opening and closing movements of the jaw. Unfortunately, this joint is a common area for recurring pain. Problems that may arise in this area are known as Temporomandibular Disorders (TMD).
Neuromuscular Dentistry is a non-invasive and non-medicated way that dentists use to treat TMD. Neuromuscular Dentistry deals with the nerves and muscles that are responsible for moving your lower jaw and the joints by studying the teeth, mandible, temporomandibular joint, head and neck and to see how they all work together.
Many times when your bite is incorrect, the surrounding muscles must overcompensate every time you swallow, chew or yawn, which can result in muscle spasms and other painful symptoms such as headaches and ringing in the ears. NMD evaluates how your teeth, muscles and joints interact and ensure that they work in harmony.
Because your dental health is linked to your overall well being, it is important to see your general physician regarding your concerns. We hope in giving you more information about TMD, that you will have a better understanding of the interaction of your teeth, jaw, joints and muscles, and the importance of treating the cause – not just the symptoms. If you have TMD, we encourage you to consider the non-invasive and non-medicating method of Neuromuscular Dentistry.
Symptoms of TMD
There are many different types of symptoms that indicate Temporomandibular Disorder “TMD“. Many symptoms masquerade in other forms, which can be recognized and treated by an experienced Neuromuscular Dentist in a non-invasive, non-medicating manner. If you experience any of the following symptoms, call our office to set up a complimentary consultation.
Head/Neck/Shoulders/Back
- Headaches
- Pain or stiffness in neck, shoulder and/or back
- Facial pain
- Painful head or scalp
- Numbness or tingling in arms and fingers
Teeth
- Clenching or grinding teeth
- Worn, chipped, or cracked teeth
- Pain and sensitivity in teeth
- Loose teeth
- Crowded teeth
- Some teeth not touching when you bite down
Jaw/Joints
- Clicking, popping or grating sound in jaw joints
- Sore or tired facial muscles after waking
- Jaw shifts to one side when opening/closing
- Limited or tight mouth opening
Ears/Eyes/Throat
- Ringing, hissing or buzzing in the ears
- Congestion in ears
- Dizziness
- Pain behind the eyes
- Difficulty swallowing
Frequent Causes of TMD
Temporomandibular Disorder doesn't appear overnight. It often takes years to develop. Many people think that emotional stress causes symptoms of TMD such as grinding or clenching your teeth. While emotional stress does play a part, TMD most often stems from a structural deficiency. Basically, when your teeth, jaw, joints and muscles are not working together in harmony, TMD can develop. Frequent causes may include:
- An injury to the head or neck area (e.g. whiplash or car accident)
- Missing teeth
- Extensive dental work with crowns or bridges
- Bad or irregular bite when your teeth meet (e.g. overbite; underbite)
- Misalignment of the upper and lower jaw
- Poor posture (i.e. Slouching; or carrying a heavy handbag or backpack)
- Forward head posture (i.e. when you jut your head forward when working on a computer for hours; or cradling the phone between your shoulder and ear; or reading a book)
- Sleeping posture (e.g. sleeping with one arm under your pillow)
Diagnosis and Treatment
Visit #1-Consultation
During your first visit, Dr. Saleh will meet with you to discuss your individual case including your symptoms and potential causes for your discomfort. He will also discuss the main ideas behind Neuromuscular Dentistry and how it can help. This visit takes one hour. Prior to your first visit, we will need you to fill-out some information about your medical history and symptoms. Make sure to have any previous information relating to your symptoms forwarded from your primary care physician.
Visit #2-Comprehensive Evaluation
During your comprehensive evaluation, Dr. Saleh will conduct a physical examination that includes manual testing of the head and neck muscles. You will also have an opportunity to discuss further questions with Dr. Saleh, as well as treatment goals. We take impressions of your mouth in order to make study models for your case. These procedures will enable us to measure the progress of your case as it develops. This visit takes approximately one hour. (If necessary, this appointment may be combined with visit #1 or #3).
Visit #3-Computerized Testing
When it comes to diagnosing Temporomandibular Disorder and determining treatment, the most adequate and stable position of you TMJ must be determined. Therefore, we conduct several computerized tests (using the same technology as EKG's and sonograms) to track, measure and analyze the activity of your muscles, and the movement of your jaw. These tests are imperative in order to accurately and objectivity diagnose the primary cause for your discomfort, and will take approximately two hours. One of the many ways we find the most stable position is by TENS- stimulating the muscles in order to relax. Depending on the severity and duration of your symptoms, this test may need to be conducted more than once and may sometimes incur additional costs.
After obtaining readings of your muscle activity in its everyday state, we then relax your muscles through stimulation in order to record the respective muscle activity afterwards. TENS, or transcutaneous electrical neural stimulation, relieves pain caused by spasms or muscle tension. By allowing us to relax the muscles of your face, neck and jaw, we can then determine where your current jaw position is, versus where the ideal position would be when relaxed.
Since your brain "subconsciously" programs the position of your jaw at rest, it is difficult to truly relax these muscles without electrical stimulation. Ultra-low frequency gently stimulates the muscles that may be overworked trying to maintain an incorrect, "programmed" position.
The TENS machine "exercises" your facial and jaw muscles causing them to twitch, or pulse, once every second. TENSing pumps out the toxins that have accumulated due to prolonged spasm. Associated with endorphin release, this in itself helps relieve pain. This stimulus is virtually painless and, finding relief from built-up pain, many patients often fall asleep.
After 45 minutes, your muscles will go into a relaxed state and the muscle activity is ready to be measured and recorded once again. We now have data in which to compare the activity of your muscles before and after relaxation.
Visit #4-Orthotic Appliance
After collecting and analyzing all of the diagnostic information compiled from the computerized tests, we are able to determine the first stage of treatment. In the majority of cases, the first step is to stabilize the patient's bite by creating a custom orthotic appliance (sometimes referred to as a biteplate.) Unlike some generic appliances on the market, this one is not one-size-fits-all. And it is much more than an orthotic. Each orthotic is created exclusively for the individual patient and is based on the statistical tests performed (see section Diagnosis for more information.)
Somewhat similar to a retainer, the orthotic is placed on the lower teeth. By adding height to the lower teeth, the appliance enables the teeth to come together properly. It performs the same function as an orthotic for a foot where one leg may be shorter than the other. The orthotic works to enable the teeth to hit in the same spot, every time you close your mouth, chew or swallow. (Your lower teeth hit your upper teeth every single time you swallow-which is over 1,000 times a day!) If the teeth don't hit in the proper place each time, the muscles overcompensate, and that is what causes muscle spasms, tension and grinding. However, when the teeth are aligned correctly, the surrounding muscles, jaw and joints can operate in harmony, relieving them of stress, strain and pain. Most patients report feeling relief within the first week.
By determining objectively where the lower jaw would like to be when the muscles are relaxed, the orthotic is then constructed to exact specifications for each patient in order to provide the optimal jaw position. Not only does this appliance help relieve the symptoms, but it also corrects the malocclusion via "training" or "reprogramming" the muscles go naturally into their ideal position.
Most people need to wear their orthotic for a minimum of three months to stabilize their bite and insure that their symptoms are gone. It is imperative to the success of the treatment that the orthotic be worn at all times (except when brushing/flossing.) While it may be necessary to wear it for longer than three months, Dr. Saleh will help you determine how long you should wear yours. Sometimes repeating some of the above mentioned tests may be required to help define the optimum bite for you. (There may be additional charges for additional testing or orthotics.) After approximately three months, or when your bite is stabilized, Dr. Saleh will help you decide the next and final steps for treatment.
Depending on the severity of your painful symptoms and the duration which you have been experiencing them, we may recommend that you visit other types of practitioners over the course of treatment. Specialists, chiropractors or massage therapists can aid in the relaxation of related muscle groups. Typically patients with severe pain take longer to treat because the muscles have been in spasm longer and therefore take longer to relax. By coordinating your treatment with the properly trained specialist, your pain may be reduced sooner and the optimal bite can be determined quicker.