Temporomandibular Dysfunction (TMD)

Temporomandibular Dysfunction (TMD) is a jaw joint disorder whereby the upper and lower teeth are misaligned and do not properly close together, therefore lacking the proper support the muscles in the face need for chewing and swallowing. As a result these muscles are forced into a strained position, which causes headaches, facial pain, jaw pain, chipped or worn teeth, clicking or popping in the jaw, limited jaw movement, snoring, grinding of teeth, frequent ear infections, restricted airway, numbness in the arms and pain in the neck or shoulders. Depending on the severity and number of these symptoms present, our dentists will recommend the best treatment plan for you.


How it’s done

There are many methods that can be used to treat this disorder starting with more conservative options such as wearing a night guard while sleeping. These appliances are plastic mouthpieces that act as a barrier between the upper and lower teeth therefore stopping them from grinding together.

Another conservative approach is corrective dental treatments. In this method the dentist measures the optimum position of your upper and lower jaw in order to have a relaxed bite, and then realigns the teeth accordingly with the use of braces. Sometimes botox is also used to help relax the masseteric nerve, which in turn helps remedy teeth grinding. Semi-conservative treatments for TMD include several pain relieving methods, leaving surgical methods as a more controversial last resort.

The pain relieving methods include:

  1. Transcutaneous electrical nerve stimulation (TENS): low-level electrical currents are used to relieve pain by relaxing the jaw joint and facial muscles.
  2. Ultrasound: heat is applied to the area to relieve soreness.
  3. Trigger-point injections: facial muscles called “trigger points” are injected with pain medication or anesthesia.
  4. Radio wave therapy: with the use of radio waves, a low level of electrical stimulation at the joint increases blood flow, therefore relieving joint pain.

Once all conservative approaches have been exhausted, the patient may need to turn to more invasive, irreversible surgical options. However, surgical treatments of TMD should only be considered in severe cases as a last resort when all else has failed. All surgical methods are performed under general anesthesia and they include:

  • Arthrocentesis: considered a minor procedure, arthrocentesis is performed for patients that cannot comfortably open their jaw but have not had previous TMD problems. Our dentists will insert needles in the affected joint area next to the patient’s ear to wash it out with sterile solution, hence removing any scarred tissue and improving jaw mobility.
  • Arthroscopy: Under arthroscopic surgery a small incision is made in front of the ear in order to insert a slender instrument that contains a lens and light. This instrument allows the surgeon to examine the TMJ and surrounding area further through a connected video screen. After reviewing the patient’s case, the surgeon may choose to remove inflamed tissue or realign the disc or condyle. Arthroscopy is preferred to open-joint surgery because it is less invasive therefore resulting in less scarring, complications and recovery time. However, certain cases may require open-joint surgery.
  • Open-joint surgery: as opposed to arthroscopy, open-joint surgery requires opening up the whole area around the TMJ in order to get a ‘full picture’. The surgeon then repositions or removes parts of the joint area to improve the person’s bite. Open-joint surgery is the most invasive TMD corrective procedure and is necessary if:
  • The bone structures in the jaw joint are deteriorating
  • There are tumors present in or around the TMJ
  • The joint has severe scarring or chips of bone

Even your children are susceptible to TMD challenges, so make sure that you have their teeth checked regularly in order to spare them any avoidable discomfort.

To find out more about our pediatric services go to the Pediatric Dentistry section.