Giovanni Iuculano, DDS, and Victor D. Woodlief, DMD
Many dentists list TMJ disorders among the issues they treat—but did you know that at the present time, TMJ therapy is not yet a formally recognized area of dental specialty? The study of these disorders is currently an emerging focus in dentistry, and among dentists, treatment experience and methods can vary widely. Fortunately, there are many well-trained dentists who have successfully treated patients and helped them to find relief. What should patients look for when seeking a dentist to treat these issues? In this article, we explore the details of TMJ disorders, and identify the most important questions to ask.
We’ll start with the basics of TMJ disorders.
What is a TMJ disorder, and what are its symptoms?
A TMJ disorder (or dysfunction), also known as a TMD, refers generally to a condition in which an individual experiences pain and/or difficulty with the muscles around one or both of the jaw joints; or with the structures of one or both jaw joints themselves. Sufferers may experience clicking, grating, or popping sounds in the jaw joints; tired, stiff, or locked jaws; or painful symptoms such as headaches, jaw joint pain, neck/back pain, earaches, ringing in the ears, facial muscle pain, dizziness, or even numbness or tingling of the fingers.
What should I look for in selecting a dentist to treat my TMJ disorder?
Because TMJ therapy is a developing area of dentistry, dentists with the most training and experience in this area will have attended hundreds—and in some cases, thousands—of hours’ worth of continuing education on this topic. If you’re not sure, ask about your dentist’s participation in such courses. How many hours’ worth has s/he attended, and how recently?
We also recommend selecting a provider who has:
1. A clear understanding of the need to customize a treatment plan according to an individual patient’s needs.
Does the dentist offer treatment with specialized therapy techniques based on individual case details? The specifics of patient cases are as varied as patients themselves. For example, one patient may suffer painful headaches along with clicking and popping around the area of the jaw joint, while another has no headaches, but severe jaw stiffness and inability to open her jaw past a certain point. Some patients may require only specialized dental appliances while others may need injection therapy. The details of a case will determine the most effective treatment protocol.
2. In-office pain management technology.
What kind of pain management technology is available in the dentist’s office? Because many TMJ disorders can cause pain in various parts of the body, and/or stiff or locked jaws, sufferers should seek a dentist who offers in-office pain management technology such as cold laser therapy (also known as low-level light laser therapy). While symptoms and their severity can vary, cases involving severe pain levels or very stiff jaw joints frequently require pain reduction, and relaxation of joints and muscles, before any treatment—or even evaluation, in extreme cases—can begin. Cold laser therapy is safe, painless, and effective, with many patients experiencing noticeable relief within a few hours.
3. Use of specialized assessment techniques.
How does the dentist evaluate and assess patients for TMJ disorders? As already mentioned, these issues may involve any number of symptoms at varying degrees of severity. The symptoms may affect parts of the body that at first may not appear to be affected by issues originating within the jaw area, but in fact, they may be. For that reason, it is important that a dentist evaluate a sufferer’s head and neck as well as his or her jaws and mouth before any treatment begins. “No one should be placing an appliance in a patient’s mouth without knowing the patient’s specific TM joint anatomy and the proper healing position for the joint when fabricating an appliance for TMJ therapy,” says Dr. Woodlief.
To perform a thorough evaluation, experienced dentists typically look at five points to properly assess and diagnose the patient’s primary condition and problem.
a. The evaluation begins with a detailed look at the patient’s health history and the pain pattern, location, and intensity. This should all be documented by the patient. Dentists can prescribe treatment most effectively when they understand clearly what the patient is feeling and experiencing.
b. A comprehensive clinical examination comes next. The dentist will perform a detailed evaluation of the patient’s range of motion (ROM) of both the neck and jaw joints, look for trigger points in the muscles around the head and neck by completing a palpation exam, evaluate the maxilla and mandible (upper and lower jaws) for proper width and size discrepancies, look at any lip or tongue ties, and evaluate the tongue for proper function.
c. Because TMJ and sleep disorders commonly occur together, the dentist will have the patient do a take-home sleep test to evaluate for any possible sleep breathing disorders. Any existing sleep disorder conditions play a big part in the pain component of the problem.
d. The dentist will take photographs of the patient’s mouth to evaluate the way the patient’s bite might be affecting the condition. Experienced dentists also look at the patient’s posture to see how the problems are affecting the rest of the body.
e. Finally, the dentist will obtain a 3D dental cone beam computer tomography (CBCT) scan to evaluate the hard structures of the face, evaluate the jaw joint condition, look at the nose and sinuses, the vertebrae in the neck, and look at the airway.
If you have questions about any part of the evaluation process, be sure to ask your dentist. “We believe it’s very important to educate the patients along the way during this evaluation,” says Dr. Iuculano.
4. In-office assessment technology.
What kind of technology is available in the dentist’s office? Specialized technology such as a dental cone beam computer tomography (CBCT) unit can provide crucial details about a patient’s issue. The CBCT is a specialized x-ray unit that provides 3D images of teeth, soft tissues, nerve paths, sinus cavities, and bone within the craniofacial region—any or all of which may be affected by a TMD. CBCT scans are painless, quick (the scan process usually takes less than two minutes), and safe. The radiation level of a CBCT unit is approximately 1000 times lower than that of a conventional medical CAT scanner.
Which treatment options exist for TMJ disorders?
Various treatment options exist, including:
- Laser therapy
- Oral appliance therapy
- Injection therapy (prolotherapy)
- ALF therapy (specialized orthodontic treatment, sometimes prescribed in connection with osteopathy)
- Prescription medication
- Surgery (for extreme cases)
As previously stated, your dentist should thoroughly evaluate your mouth, head, and neck in order to determine which of these treatments (or combination of treatments, in many cases) is appropriate for your case.
A TMJ disorder, although inconvenient or painful, can be treated successfully! Selecting a dentist with the right combination of knowledge, technology, and experience is the key to relief.