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			QUEEN MARY HOLISTIC CENTER, Medical Plaza, Ortigas Center, San Miguel Ave., Pasig City, Philippines 1605
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What is TMJ?

Temporo-Mandibular Joint disorder, or TMJ disorder, is a problem in the jaw and surrounding areas of the head and neck that causes pain, discomfort, and disability in millions of people each year. Many people suffer needlessly as they search in vain for relief from their pains. With the application of new technology and acquisition of proper training, dentists are able to diagnose and treat TMJ disorder. With all of this new information emerging, dentists will now be able to understand TMJ disorder and can become more productive in their treatment and prevention of it. Today, the medical profession is becoming more cognizant that dentistry plays a vital role in this process and more often seeks the expertise of dentists knowledgeable in this new field of treatment.

“Bad bite” (Malocclusion) and the Temporomandibular Joint

Your jaw joint, which holds your lower jaw in place, is suspended beneath your skull by an intricate system of muscles and tendons. The jaw joints, also known as the temporomandibular joints (TMJ), are some of the most complex in the body. The jaw joint, surrounding muscles, and the fit of your teeth are closely interrelated, each affecting the other as you make everyday jaw movements such as speaking and chewing.

The way your teeth fit together is called Occlusion. When your teeth are not in proper relation to each other and to your jaw joints, the jaw automatically shifts to a new position in an attempt to compensate for the misalignment of your teeth‑a condition known as malocclusion (teeth do not fit together properly).

When malocclusion exists, even what looks like a good bite could be at the expense of putting pressure on other jaw joint areas as the jaw shifts to accommodate the teeth. Symptoms of misaligned teeth may be clenching, grinding, premature tooth wear, stress on the muscles and tendons, some of which may occur during sleep. Results of these symptoms are headaches and muscular aches and pains in the face, neck, shoulders and back, dizziness, earaches, ringing in the ears and many other problems.

In addition to these common conditions which often (but not always) relate to malocclusion and cause pain in and around the temporomandibular joint, there are other conditions which can affect the function and comfort of this joint and the total body health. These conditions include disease, nutritional deficiencies (e.g. gout, tumors, trauma and infections).

Diagnosing the Problem

Before prescribing the proper treatment for your particular problem, a variety of diagnostic procedures may be necessary. A radiograph (x‑ray) may be taken of your jaw joint. This provides a clear picture of your own particular TMJ anatomy and position of the various structures within the jaw joint. The visual radiograph is also used as a means for detecting disease in the jaw joint.Jaw repositioners may be used. These appliances are worn for a given period of time. The appliance is refined and adjusted until it eliminates the bite disharmony and pain. In this way, the bite need not be permanently altered until the problem is accurately diagnosed via the splint and other procedures. Permanent treatment would then be prescribed to duplicate the effects of the appliance, e.g. equilibration or occlusal adjustment, orthodontics or restorative procedures such as crowns.

Treatment Modalities

After diagnosing the problem, a variety of treatments may be recommended. initial phases of treatment are aimed to eliminate the( TMJ pain‑the symptoms resulting from the actual problem. In the second stage, the actual treatment to correct the problem is implemented. Various TMJ treatments are explained briefly below.

Occlusal Equilibration

In occlusal equilibration, the tops of the teeth are reshaped. This is done to alleviate pressure on individual teeth. The reshaping procedure has been found to be the solution for many conditions which cause discomfort in the head, neck and shoulders and breakdown o the dental structures. Occlusal equilibration can be likened to a pebble in your shoe. When there is an irritant present (the pebble), your foot automatically adapts to the pebble‑e.g. you may walk with a limp. With malocclusion, an existing interference (as with a tooth too high for comfort), the jaw also adapts to the particular uncomfortable tooth fit. During equilibration, the irritant (too high of a tooth) is reshaped for a better fit.

Occlusal Restoration

Occlusal restoration involves the replacement or reconstruction of teeth in addition to the reshaping procedures (which eliminate high spots on the teeth), thus allowing the face and jaw muscles to relax.

Splint/Jaw Repositioner Appliances

Splint/jaw repositioning appliances are not only used in diagnosis, but they are also used as treatment to temporarily eliminate the bite disharmony and resulting pain. Then, during the second stage of treatment, orthodontics, crowns or equilibration may be recommended to build the bite to a permanent, healthy, relationship.

Signs & Symptoms

Self Evaluation Test:

Check yourself if you are suffering from anyone of these signs & symptoms:

▪ Dizziness
▪ Headaches
▪ Migraines
▪ Facial pain
▪ Pain down the arms radiating to the fingers
▪ Limited jaw opening/Pain upon jaw movement
▪ Ringing in the ears
▪ Grinding/clenching of the teeth
▪ Chronic neck, shoulder & backache (upper & lower)
▪ Muscle pain
▪ Insomnia
▪ Depression
▪ Throat problem
▪ Eye problems
▪ Forgetfulness
▪ Hypersensitivity (non carious teeth)

- could be felt even without caries due to trauma like premature contacts, grinding or clenching, faulty tooth brushing & even moving of teeth in orthodontic treatment.

Actual Cases

TMJ Orthodontics

TMJ THERAPY AND ORTHODONTIC FINISHING

Patient #3 – F , 37 YRS. OLD
Complaints: Deep bite, Jaw popping/clicking, Headaches, Pain in cheek muscles.
Management: TMJ therapy, Orthodontics – braces

TMJ Management

TMJ THERAPY, CROWNS and OVER DENTURE

Patient #2 – M, 47 YRS. OLD
Complaints: Vertigo, Ear problem, Missing teeth, Bad bite
Management: Porcelain jacket crowns on posterior, Overdenture, Bonding

TMJ THERAPY, FULL MOUTH RECONSTRUCTION & FACIAL ASYMMETRY CORRECTION

Patient #8 – F, 37 YRS. OLD
Complaints: Open bite (front teeth), deviated lower jaw (facial asymmetry).
Management: Full mouth reconstruction, Balancing facial asymmetry, Enhancing flat upper lift support by bone augmentation on the pre-maxilla, Porcelain jacket bridge crowns, Gum pad placement to balance facial asymmetry.

TMJ THERAPY, FULL MOUTH RECONSTRUCTION and FACIAL ASYMMETRY

Patient #5 – M, 46 YRS. OLD
Complaints: Cross-bite, Deviated jaw, Flat upper lip.
Management: TMJ therapy, Cross-bite correction, porcelain without metal, implant placement, bone augmentation on upper pre-maxilla to enhance upper lip support.

TMJ THERAPY and FACIAL ASYMMETRY CORRECTION

Patient #10 – F, 21 YRS. OLD
Complaints: Deviated lower jaw, Bad bite
Management: TMJ management, Placement of orthotic appliance.