TMJ Disorder and Pain Relief
Carey O’Rielly, DDS
The bones of the human head are directly
associated with two of the body's most complicated joint systems,
the cranial sutures of the skull and the TMJ (temporal
mandibular joint). The human head sits atop the cervical structure
with the center of gravity in front of the spine, linked by the musculature
and joints. The function of the head posture when moving or at rest
is dependent on the proper alignment of these muscles and joints.
Depending on the degree, misalignment of any of these muscles or
joints can translate into further stresses elsewhere in the structure.
Often the most troublesome chiropractic
cases are very simple dental orthopedic cases and even the most persistent
and skilful chiropractic adjustments will simply not hold when the
surfaces of the bite do not line up correctly. The adult human has
32 teeth including four wisdom teeth and each one of these teeth
has from 5 to 7 surfaces. When any one of these surfaces is compromised
in any way, the effects- though subtle at first- may be felt throughout
the structure, particularly the musculature. One reason for this
is the force involved with chewing, since the bite sustains up to
200 lbs of pressure several times a day.
Teeth can become loose, broken or
worn down. This can be caused by the body's attempts to compensate
for a misaligned bite or the aggravation of clenching (bruxing) and
grinding. These latter are stress responses to nervous tension that
are most often found among women. Of the 20% of the United States
population, mostly in their thirties and forties, who are suffering
from TMJ Disorder, four times as many women as men are affected.
The TMJ is the most active joint in
the body, in motion up to 2,000 times every day. We use this joint
in breathing, chewing, swallowing and speaking. In addition it directs
the postural relationships of the head, neck, tongue, chin and hyoid,
a small bone in the neck that supports the tongue. It is the only
joint in the body that acts as a two-sided hinge. This means that
any stress or misalignment on one side will reflect a disturbance
on the other side.
The painful aspects of TMJ dysfunction
or TMD, occur because of its association with the tri-geminal nerve.
There are three branches of the nerve that are involved with the
chewing function of the upper and lower jaw, and with the eyes and
ears. There are two groups of pain receptors, one which transmits
pain quickly and the other type which is more susceptible to chronic,
dull, pain and pressure. Both types of pain fibers have input to
Other areas connected to the trigeminal
nerve are the sinuses, ear canal, oral cavity and teeth. This helps
to explain why headaches, eye pain, sinus pressure, dental pain and
even neck and shoulder pain can be caused by TMJ dysfunction. The
trigeminal nerve is also involved with the reticular activating system,
part of the brain stem. It affects many functions of the cerebral
cortex of the brain that maintain our states of consciousness, including
our emotional states. This can help to explain the highly emotional
component of facial pain.
Among the ten symptoms of TMJ Disorder
- Clicking & popping of the TMJ joint
caused by lack of cartilage at the rear hinge point.
- Grinding sounds caused by irregular bone surface
at rear hinge point.
- Headaches and migraine headache caused by pressure
of ball (condyle) of joint pushing on weak bone structure at
rear of joint.
- Dizziness caused by lack of blood flow to brain
when blood vessels are obstructed.
- Ringing in the ears caused by pressure on the
- Excessive wear on teeth caused by stress of bruxing
- Severe pain all over head caused pinching of nerves
due to extreme misalignment of TMJ.
- Pain in neck generally caused by stress on muscles
due to misaligned bite.
- Earache caused by pressure on the ear canal.
- Sensitivity to light due to tri-geminal nerve
connection with the eyes.
It is possible to have TMJ dysfunction
for a long time without realizing it
since often the symptoms, such as some of those above, seem unrelated
to your jaw joint. At our practice we use an inter-disciplinary
healthcare model that focuses on the connection between the physiological
and structural integrity of the bite with that of the structure as
a whole. It is especially useful in the treatment of
conditions like TMJ dysfunction, arthritic conditions of the neck
This multi-faceted approach includes
dental corrections such as splint therapy, as well as minute, subtle
bite adjustments and muscular release. The dental appointment is
coordinated with chiropractic adjustments at a local facility on
the same day. The patient then returns to our office so that the
mouth and the rest of the system can be re-balanced with reference
to one another. This system creates a remarkable depth of structural
integrity that can be further enhanced when necessary by the use
of a splint to maintain the posture of the
At times the pain relief brought about
by this comprehensive alignment can be almost immediate. This can
be wonderful news for patients who have been treated for years for
migraine headache pain and have typically spent tens of thousands
of dollars on MRI studies, drugs and other therapy with little or
no improvement. The patient returns for follow up visits for three
to six months or up to one year depending on
the complexity of the case. Nutritional supplements and stress management
techniques are utilized in certain instances as well.
It is also important for the
patient to maintain a mindset of rest and rehabilitation for the
jaw so that it has time to adapt and heal. Avoiding chewing gum
and foods that require excessive chewing pressure as well as paying
attention when yawning become part of the patient's "homework" while
recovering from this sometimes baffling ailment. At the very least,
symptoms can be managed for pain relief when the patient's bite is
stabilized so that a degree of comfort is achieved. This can mean
a lot to those who have been long time sufferers from the discomfort
and pain of TMJ disorders.
Integrative Dental Practice
San Diego Cosmetic Dentist and Holistic Dental Care
4403 Manchester Avenue Suite 206-B
Encinitas, CA 92024