TMJ Disorder and Further Treatment Options

What Doctors Treat TMJ Disorder?
Given that TMJ disorder sufferers have so many diverse symptoms, management can include numerous different physicians of varying specialties. Headaches may be treated by a neurologist, ear pain can be evaluated by an ear, nose and throat (ENT) specialist, and pain can be treated by a pain management specialist. A dentist may utilize splints to correct bite issues, while an Oral and Maxillofacial Surgeon (OMS) can assist with both surgical and non-surgical interventions. Other healthcare professionals that may form part of a patient's care team can include Physiotherapists, Acupuncturists, Chiropractors, Osteopaths, Orthodontists, Nutritionists, Psychologists, Psychiatrists, Massage Therapists, and of course the family doctor (PCP or GP).

It is well worth noting, however, that a well-qualified dentist, using the correct procedures, can often alleviate many of the other symptoms involved in your TMJ disorder, lessening the need for any other professional care.

Alternative medicine
Because stress has been shown to contribute to TMJ disorders, stress-relieving relaxation techniques may reduce jaw clenching or teeth grinding and help alleviate TMJ disorder symptoms. Possible beneficial techniques include:

• Deep breathing. To practice deep breathing, sit comfortably on a chair with your feet flat on the floor. Breathe in deeply through your nose, and allow your abdomen to expand as you breathe in. Hold for just a second, and then exhale through your mouth, gently pushing in your abdomen with your hand.

• Progressive muscle relaxation. This involves relaxing a series of muscles one at a time. Begin increasing the tension level in a group of muscles, such as a leg or an arm, by tightening the muscles and then relaxing them. Then move on to the next muscle group. It may also prove beneficial to apply warm, moist heat.

• Guided imagery. Also known as visualization, this method of relaxation involves lying quietly and imagining yourself in a wonderful, lovely place. Your ideal vacation or getaway. Allow yourself to completely experience the setting with all of your senses, as if you were essentially there. For example, imagine lying on the deck of your sailboat as it coasts along the Mediterranean Sea. Picture the perfect azure sky, smell the salt water, hear the sounds of the soft waves, and feel the warmth of the golden sun on your skin. The messages your brain receives as you experience these senses help you to relax.
  

There are some TMJ sufferers who are actually unaware of the cause of their condition. Many people, who technically have TMJ disorder, manage with their symptoms, since they do not interfere severely with their lives. Patients with TMJ disorder quite often grind their teeth to find a comfortable bite. This causes flat areas on the tops of the teeth called occlusal wear facets. Wear facets often fit together revealing the bite that the body has been trying to create. Constant grinding also flexes and dissolves tooth roots. A notch at the bottom front of the tooth called an abfraction. Many hygienists confuse this for overzealous tooth brushing, but there are many patients who never brush who still have them.

When a patient's jaw joints or jaw muscles are irritated, there can be deviation of the lower jaw to one side on opening. This is called mandibular opening deviation. For a variety of reasons, the human face does not always grow symmetrically. Facial asymmetry can cause TMJ problems. Repeated jaw muscle spasm can cause muscle shortening with limited opening. Looking at the side of a person's face, you can often make out the lower jaw. The bottom of the lower jaw is typically parallel to the floor. Conversely, many TMD patients have a sharp downward angle. This TMJ symptom is called a sharp mandibular plane angle.

TMD sufferers often have speech irregularities that add to their muscular and functional problems. A dished out profile can be an indicator of a TMJ problem. It is often seen in patients who have a shortened facial height, which forces the TMJ towards the ear. As a defensive reflex, the body uses the chewing muscles to pull the jaw joint forward. This can often bring on muscle spasm and pain. Like a dished out profile, a short lower facial third can be a reflection of this same problem.

Another TMJ disorder symptom is when the corners of the mouth get red, swollen and painful. It's called angular chelitis and is also seen when denture patients are wearing worn out dentures. An imbalance in the chewing and facial muscles occasionally causes an uncharacteristic lip posture, which can cause the face to look unusual. The horizontal facial fold under the lip and above the chin can be excessive. This is called a deep mentalis crease. It is not uncommon for a TMJ patient to have a forward head posture. This abnormal posture causes the head to be positioned forward. It stretches the anterior neck muscles and pulls the lower jaw backward into the patient's ears.

It is not unusual to see swelling of a TMJ sufferer’s face. This TMJ symptom is called facial edema. Some sufferers have unusual movements of their necks (cervical torticollis) and lower jaws. (mandibular torticollis). Headaches truly plague TMJ sufferers. The most common TMJ related headache is a located on the side of the head over the area of the temple. This is called a temporal headache and is often misdiagnosed as a migraine.

The disparity of a TMJ patient's facial, chewing and neck muscles can cause problems swallowing. This is called dysphagia. Because of the instability of the jaw, head and neck, cervical problems are frequent. This can lead to occipital headaches located at the back of the head. Postural problems are a characteristic TMJ disorder symptom. This abnormal posture may be due to the modification of the body to mouth breathing and the need to hold the head forward to breathe better. In severe cases, forward posture can cause thoracic outlet syndrome and paresthesia of the fingertips. (Paresthesia is an abnormal or unexplained tingling, pricking, or burning sensation on the skin)

Deprogrammers
The idea of deprogramming is based on the reflexive relaxation of the lower jaw when the back teeth are not allowed to engage. The various muscles that open and close the jaw learn and remember the level of contraction required to execute their movements in a coordinated, relaxed way. They learn which positions of these muscles cause pain, and which don't, and store all the information in your brain in the form of "engrams" which are similar to automatic, unconscious computer programs that your body uses each time you open or close your mouth. In persons with TMJ disorder, these movements can be quite complex.

The Treatment of TMD

The Bruxing Guard

The solution to treating these patients is to decrease the patient's inclination to clench and grind her teeth. Even if, when the teeth are closed together, and the joints do not line up correctly, all the symptoms tend to fade away if the patient does not tend to keep the teeth together with the forces distinctive of bruxing. The most conventional and least expensive treatment for TMD is the construction of a hard acrylic bruxing guard (flexible plastics are now being used as well). These are horseshoe-shaped plastic appliances, which usually fit over the top teeth and have a smooth surface on the underside so the lower teeth can slide over the plastic without resistance. This prevents the teeth from locking together, and relieves a lot of the force placed on the teeth and joints. If an appliance like this is worn long enough, the bruxing habit may ultimately disappear altogether, which would be the ideal treatment goal if it always happened. Unfortunately, bruxing guards still allow the patient to clench against the guard. Since clenching is linked with overuse of the temporalis muscle, patients may still encounter tension headaches even though they wear their guard religiously.

The Bite Adjusted Bruxing Guard

Bruxing guards perform even better if they are structured so that when the lower teeth come in contact with the appliance, the joints are forced to sit in their most natural, relaxed positions in the most upper part of the socket. This position can be determined quite simply by a process known as deprogramming during which a piece of plastic is inserted over the top front teeth that does not allow the posterior teeth to make any contact. Usually, within an hour or so of wearing one, the jaw has relaxed into a more natural position with the joints in a more desirable position. A bite registration is then taken with the deprogramming device in place so the new bruxing guard can be designed to the new bite-adjusted jaw position, which corresponds to a more physiologically acceptable joint position. Deprogramming has an additional advantage in that if it works, it will relieve the symptoms very quickly and can be worn until the more permanent bruxing guard can be built.

The main disadvantage with this treatment modality is that your teeth do not look any better after you have cured the pain associated with TMJ disorder, and if the bruxing habits do not disappear on their own, the patient must continue wearing a bruxing guard whenever he is likely to be bruxing. In addition, patients still can clench against any bruxing guard. Therefore, even a correctly balanced bruxing guard will not consistently relieve all tension or migraine headaches, even though it usually will lessen their occurrence. The major advantage to this treatment modality is that it is economical and can often alleviate long-standing pain that has been a major impediment to a normal lifestyle for many years.

The Orthodontic Option

Another treatment option is orthodontics. In this case, the natural teeth are moved into a more correct position that allows the joints to sit correctly in their sockets. The correct position is established through a science called cephalometrics, which is a subcategory of diagnostic x-rays. A tremendous side effect of considering orthodontics to treat TMJ disorder, is that not only will you be left with a lovely smile when all is said and done, but the process is much more likely to break the bruxing habit than nearly any other treatment, as well.

We recommend considering checking out this website for referrals to highly qualified dentists who specialize in TMJ disorders:

http://www.top3dentists.com/pages/tmj

How To Choose The Right Dentist

When it comes to getting the right dental care, there’s nothing as important as choosing the right dentist. The whole process is not as simple as you might think either. Most of the experts in the field suggest that getting the right dentist is a very personal undertaking that demands you first ask yourself what you will expect from this oral health professional.

So we started to ask many of the highly trained dentists, how would they choose a dentist for themselves? The following are the criteria that these dentists considered.

1. Continuing Education: Unlike what we thought, none of these dentists looked at the dental school training. They only looked at the training the dentist have received after graduating from dental school. Most dentists take about 25 hours of continuing education, and the highly qualified and trained dentists usually take upward of 100-200 hours of continuing education.

2. The type of continuing education course: So now comes the question of are all continuing educations the same? The answer was no. Many dentists take courses that do not mean much. The courses and institutions that were highly respected by our panel of dentists were courses at LVI or The Las Vegas Institute, The Pankey Institute, Dawson Center, The Hornbrook Group, The Rosenthal Institute, Nash Institute, Kois Center, OBI or Orognathic Bioesthetic International, Misch Implant Institute, Medical College of Georgia, UCLA Aesthetic Contiuum, MAP Institue, Center for Advanced Dental Education, Brock Rondeau Seminars to name a few.

3. The accolades: These are Fellowships, Diplomate, Mastership awards or board certifications that these dentists have received from different organizations. For many of these the dentists would have to go through vigorous written, oral and practical examinations in order to receive such awards. Depending on which organization they have received these, this would give an indication to the other dentists as to the training and the level of expertise these dentists would have in different fields of dentistry.

4. Years in practice: But most importantly the years they have had these special training for. For example, someone might be practicing dentistry for 20 years, but was doing the same wrong thing. Another one might be practicing for 20 years but have only started to learn these advanced principles for one year, and another dentists has been practicing for 10 years, but have been going through these vigorous and advanced training for 5 years. They all picked the latter of the three choices.

5. Before and After photos: This gives an indication of the work they can perform, make sure these are the dentist’s own work. Some dentists believe it or not, they buy before and after photos and they actually show case these as their own work on their website and in their office. Make sure they have performed cases that are similar to yours and look at the results.

6. Patient testimonials: Ask for 3-5 references. Patients who have had similar procedures done. Talk to them to see what their experience was.

7. After that you can start selecting the names of the dentists that you think you’d like to see.

A great source for finding the highly trained dentists is www.top3dentists.com. The dentists on this site have been invited to join. So unlike any other dental referral source that any one dentist can join, the dentists listed at www.top3dentists.com have been carefully evaluated to make sure they have the highest level of training the each special area of expertise. So now your job is much easier, all you need to do is to choose the one that you think you can get along with the best. Remember, you want to have a long term relationship with your dentist, so you must become a part of their family. Do they like you and do you like them so much that you would be happy to go to visit your dentist?

To find a right dentist, visit www.top3dentists.com.

TMJ

WHAT ARE TMJ and TMD’s?

Temporomandibular disorders are often called “TMJ” by doctors, sufferers and even insurance agencies; even though the term TMJ is actually an acronym referring only to the jaw joints themselves.

For the purpose of this article, we will go over the basics of TMJ, and then in future discussions, I will bring you more in depth information into each of the areas we touch on today.

Temporomandibular Joints
TMJs are located on both sides of the face approximately one centimeter in front of the ears, connecting the jaw (mandible) to the skull (temporal bone). They are the most intricate joints in the entire human body, providing revolution (pivoting) movement like all joints, as well as descending movement, called translation. That is what allows us to open our mouths wide and move our jaws from left to right. Between the top end of the jaw (condyle) and the socket in the skull is a disc of cartilage, which — like the discs in the neck and back — serve as shock absorbers, protecting the bones from hitting each other. This is the ball and socket joint, the only joint in the head, and if something goes wrong with either one of them, you may begin to experience serious discomfort or even life altering pain.

As mentioned, the TMJ is characteristic of the type of joint called a “ball and socket”. The ball is the rounded part technically known as the “condyle” of the joint. The condyle rotates in a cuplike depression (the socket) technically known as the “fossa.” Although the joint looks like it is attached immediately to the sinuses, it is actually separated from them by soft tissue ligaments, which completely enclose the joint, but are not visible even on an x-ray. Also not visible on an x-ray is the meniscus which is a disk of cartilage, which surrounds the space between the condyle and the fossa and is able to move forward and backward as the jaw opens and closes. The condyle and the fossa are each covered with a thin layer of inflexible cartilage of their own. All three layers of cartilage help to provide smooth, frictionless surfaces for easy joint function.

The Joints Work With the Neuromuscular System
The movement of the jaw is orchestrated by a multifaceted set of muscles, which are, in turn, controlled by the body’s local and central nervous system. Together, they are called the neuromuscular system. The whole jaw-joint system is held together by ligaments, which place perimeters on their range of motion in all directions — just as they do in all the joints of the body.

A Distinctive System of Many Parts
The TMJ joint system is unique in many ways. The left and right joints must coordinate, working at the same time for the jaw to move. While the opening, lateral and forward movements of the jaw are controlled by the shape of the bones and are a function of muscles and ligaments, the closing end-point of the jaw movement is controlled by the coming together of the teeth — the bite or occlusion. No other joint in the body has such a rigid end-point limit.

When a dentist thinks of TMJ, he or she usually considers the issue at large more than just the anatomy of the joint itself. The joint is really a part of the total complex system that makes the jaws operate correctly. To a dentist, the appropriate, vigorous function of the TMJ system requires normal structure and utility of all the component parts, including muscles, nervous system, ligaments, joints, bones, discs, connecting tissues and the dental occlusion. In fact, it is usually pain in these structures that compels most people toward TMJ treatment.

Through modern dentistry, there are several different terms used to describe the problems associated with TMD (defined as a group of symptoms which have a common source). Each term commonly corresponds to a particular “era” in the history of the study of the disorder, but all are still in general use and mean basically the same thing with weight on slightly different characteristics of the syndrome. They include MPD (MyoFascial Pain dysfunction), MFPDS (MyoFascial Pain dysfunction Syndrome), the more general TMD (TemperoMandibular Dysfunction) and the latest in a long line, Craniomandibular Disorders (CMD).

For the purposes of this article, I will use the term TMD to differentiate the painful symptoms of the disease from “TMJ”, the name for the actual joint itself.

Some Symptoms of TMD (an overview)
The symptoms of TMD can include the following:

• Severe headaches
• Neck aches, especially stiff necks
• Ear aches, (which are actually pain in front of the ear or ears)
• Jaw aching on one or both sides
• Extreme difficulty keeping mouth open at dentist’s office
• Joint pain when opening the mouth
• Difficulty opening the jaws wide, especially for any length of time
• An inability to open the mouth at all at times
• Pain when chewing
• Discomfort or pain to any of these areas
• Pain in cheek muscles
• Uncontrollable tongue movements
• Tongue Pain
• Non-specific jaw and jaw joint problems
• Difficulty opening the jaw smoothly or evenly
• Jaw deviates to one side when opening
• Inability to find the correct bite with teeth
• Uncontrollable jaw movements
• Extremely sensitive teeth
• Phantom tooth pain
• Dislocating of jaw, easy and often
• Clenching teeth
• Grinding the teeth, known as bruxism
• Involuntary clicking or popping noises upon opening or closing the mouth
• An extraordinary amount of complications from routine dental procedures
• Dizziness
• Fullness of the ear
• Ringing in the ear
• Ear pain without infection
• Bloodshot eyes
• Blurring of vision
• Eye pain above, below and behind the eyes
• Pressure behind the eyes
• Sensitivity to light
• Watering of the eyes
• Hair and/or scalp painful or very sensitive to the touch
• Sleep apnea

All of these TMD symptoms can vary in seriousness from mild to debilitating. On the mild end, the sufferer may attempt to ignore the discomfort, perhaps not even seeking any relief at all. Escalating on the pain scale a bit, the person may still not fully realize they even need to see a qualified professional, and attempt to get by with over the counter pain relief. At some point, however, sleep disruption, or a variety of other painful, or quality of life issues will begin to crop into the sufferer’s life to the degree where they must pursue professional advice and assistance.

In future articles I will delve into how each of these different symptoms, many of them so seemingly unrelated, can all be so blessedly relieved by a qualified dentist, if indeed it is determined that your troubles are caused by your TMJs.

Pre-Disposing Factors
In this article, we will look a just a few of the many pre-disposing factors which can make you a candidate for TMD.

Differences Between the Sexes
TMD affects women significantly more than it does men. This is somewhat due to the disparity in bone and muscle densities between the two sexes, and partly to differences in psychological outlook and sensitivities to worldviews, et.. Studies show that women are more responsive to emotional imagery and have a stronger cardiovascular reaction to stress than men have.

Age as a Factor
The good news is, that almost universally speaking, TMD follows what can be looked at as a “Bell Curve.” The greatest preponderance of sufferers will experience their worst symptoms between the ages of 25 to 45. This implies that it is related to psychological and physiological variables, which alter throughout life. As the patient ages past the significant age of 45, these variables begin to diminish in such a way that the problem lessens and sooner or later vanishes, sometimes without any treatment at all. TMD does occur in some younger or older patients, of course, but with decreasing frequency as age decreases or increases from the medium age of 35.

Posture
In an ordinary relaxed state, the lower jaw, affected by gravity, tends to drop into eccentric positions away from the regular position in which the upper and lower teeth would normally come together. This is especially true in persons who tend to hold their heads so that their jaw line is not parallel to the floor (perpendicular to the force of gravity). Normally, this would not cause any problems, however persons who grind or clench their teeth may grind in these abnormal positions. This places unequal and eccentric pressures on their face, head and neck muscles as well as the TM Joints. Consider the front desk receptionist who keeps her computer monitor to her left, her keyboard in the pullout drawer under the desk in front of her, and who talks on the phone keeping the receiver tucked between her right shoulder and her right ear. Imagine the strain she is placing on her TMJs, not to mention neck muscles, et.

Occlusion
Occlusion describes the way your upper and lower teeth come together.
In most people, the upper and lower teeth naturally line up so that when they come together, the TM Joints are sitting normally in their sockets. Whenever something disturbs the way they come together, say a new filling or a lost tooth, this can effect the relative positions of the two TM Joints. Grinding or clenching in these eccentric positions can cause muscle splinting (cramping) and joint problems. There is a complex, dynamic balance between the way that the teeth come together, the muscles that work the jaws, the TM Joints, and their relationship to the posture of the head and neck. A change in any part of the system affects all others and changes the balance.

In Conclusion
As you have learned from this introductory article, TMJs, and the troublesome TMDs, describes a group of diseases that can involve the jaw joints, the muscles that control jaw movement and the dental occlusion. TMJ / TMDs are physical disorders arising from an imbalance in the precise working relationship of the jaw and skull with the muscles that move the jaw, as well as the nervous system associated with these systems. This disproportion results in muscle exhaustion, spasm and/or joint dysfunction, and even changes in the teeth, which in turn cause a diversity of symptoms, exclusive to each person. In following articles, we will look further into each area we broached today, and into others, as well.

When to See a Dentist for TMJs Or Temporomandibular Joint Disorders

Basic Symptoms of TMJ Disorder

The characteristic symptoms of TMJ are pain and tenderness of the jaw muscles, clicking and grinding noises during movement of the jaw, and limited or irregular jaw movement.
Some other symptoms may include: spasm and sensitivity of various facial and neck muscles, preauricular (in front of the auricle of the ear) tenderness, facial asymmetry, malocclusion and persistent postural head tilting.

The classic problem, provoked by oral conditions, is very often an emotional one. The development of symptoms seems to be caused by a combination of factors: a physiologic predisposition, psychological and physical stress, and the sufferer’s inability to manage the stress. Stress management, used in unison with supportive treatment with heat and muscle relaxants, can often have a profound effect.

TMJ disorders cause tenderness and pain in the TMJ, the joint on each side of your head in front of your ears, where your lower jawbone meets your skull. This joint allows you to talk, chew and yawn.

It is estimated that approximately 10 percent of people in the United States experience pain associated with TMJ disorders, according to the National Institute of Dental and Craniofacial Research, part of the National Institute of Health. Women are more likely than men to develop TMJ disorders.

In most cases, pain and discomfort associated with TMJ disorders can be alleviated with self-managed care or non-surgical treatments, but more severe cases often require treatment with dental and/or surgical interventions.

It is vital to keep in mind that everyone is unique. Please see a qualified dentist to receive a thorough examination and diagnosis before jumping to any conclusions about your health.

When to See a Dentist

If you have unrelenting pain or tenderness in your TMJ, if you have facial pain and experience clicking or grating when you chew or move your jaw, or if you can’t open or close your jaw completely, seek medical attention. Your dentist can discuss possible causes and treatments of TMJ disorders with you.

See your health care provider immediately if you are having trouble eating or opening your mouth. Keep in mind that a wide variety of possible conditions can cause TMJ symptoms, from arthritis to whiplash injuries. Experts who are specially trained in facial pain can help diagnose and treat TMJ. Dentists who specialize in evaluating and treating TMJ disorders will typically perform x-ray exams and may use a kinesiograph or EMG (electromyography). They may give you a mouth guard.

A Thorough Exam is Critical

All too often patients are determined to be “chronic pain patients” and their complaints written off as stress or psychological disorders. These patients may be relegated to treatment focusing only on medication and counseling, with no treatment of the actual physical cause of their illness. A thorough analysis of each patient is essential to establish the source of their pain. Early and suitable treatment of a TMJ / TMD may avoid the progression to a chronic pain state.

Preparing for Your Appointment

You will in all probability visit your regular dentist first regarding your TMJ symptoms, before seeking a referral to a more qualified specialist.

What You Can Do

Make good use of your time with your dentist. Have a list of questions prepared ahead of time, ordering them from most important to least important in case your time runs out. For TMJ disorders, some basic questions to ask your dentist include:

• What is the most likely cause of my symptoms?

• Are there any other possible causes?

• What types of tests will I need, if any?

• What treatments are available?

• What approach do you normally recommend?

• Should I see a specialist? Whom do you recommend?

Questions To Ask the Specialist about Temperomandibular Joint (TMJ) Disorder

• What tests need to be done to diagnose TMJ?

• What is the cause of the problem?

• What type of treatment will you be recommending?

• Will you be prescribing any medications?

• What, if any, are the side effects?

• How long does it typically take the treatment to start relieving symptoms?

• Will surgical correction be required?

• How effective is the surgery normally, in a case like mine?

What to Expect From Your Dentist

During your appointment, your dentist will probably:

• Request you fill out a full medical history, including questions about how long you have been experiencing pain, including whether you have ever had an injury to your jaw, and whether you have had any recent dental procedures

• Listen to and feel your jaw, especially when you open and close your mouth

• Scrutinize the range of motion in your jaw

• Examine your bite to check for abnormalities in the alignment of the jaws

• Check for conditions — such as a high filling, a tipped tooth, teeth displaced due to earlier loss of other teeth or certain inherited characteristics — that can cause misalignment of your jaw

• Examine your teeth for unusual wear patterns that would signify chronic grinding

• Press on areas around your jaw to identify sites of pain, tenderness or discomfort

• Ask questions about your level of stress or anxiety and how you’re coping during the visit

What You Can Do in the Meantime

Prior to your appointment, you may be able to reduce some of your discomfort in the following ways:

• Avoid clenching or grinding your teeth.

• Use warm, moist heat or ice on the painful area.

• Take over-the-counter anti-inflammatories, such as ibuprofen.

• Try to reduce your stress and anxiety.

• Avoid eating hard foods

• Do not chew gum.

• Drink plenty of water every day and get adequate sleep.

• Maintain good posture, especially if you spend long hours at a computer. Pause often to change position, rest your hands and arms, and alleviate stressed muscles.

• Use safety measures to decrease the possibility of fractures and dislocations.

Diagnosis of TMJ Disorder

TMJ disorder has so many varied symptoms, some of which can imitate other disorders. It has been called “The Great Imposter” by many physicians, and because of this, a proper diagnosis can be difficult.

The most frequent method of diagnosing TMJ Disorder (TMJD or TMD) is by visiting a physician and having a physical exam and history performed. The physician or dentist will examine the patient’s face and jaw for pain and tenderness, listen to the joint for noises, check the patient’s bite, and measure how far the jaw can open. The physician will usually take x-rays of the joints, which will permit him to see the bones and surrounding teeth and make sure that no other problems affecting these structures are causing the symptoms. Sometimes, other tests are ordered, such as CT scans, which are used to inspect the bony detail of the joint, or MRIs to observe the soft tissues of the joint, including the disc.

The types of imaging used in TMJ Disorder diagnosis are:

• Computed Tomography (CT or CAT Scan) - This provides detail of the bones in the joint and surrounding areas, but does not provide great detail of soft tissues such as muscles or the discs. CT Scanners are situated in imaging centers or in hospitals.

• Magnetic Resonance Imaging (MRI) - This provides detail of the soft tissues of the joint, including the discs and muscles. These are located in imaging centers or in hospitals.

• Tomography – This is a type of x-ray that shows cross-sections of the jaw area. Many dentists have one of these machines in their office.

• Other Dental X-Rays: Routine dental x-rays done in the dentist’s office can provide views of the joint and adjacent bones and teeth.

If the doctor diagnoses TMJ disorder, he or she might make referrals to specialists.

Check out this website for referrals of highly qualified dentists who specialize in TMJ disorders: http://www.top3dentists.com/pages/tmj

Association of TMJ Disorders with Other Problems

The diagnosis of TMJ Disorders is usually based on the occurrence of the distinguishing clinical signs and symptoms that the patient presents upon examination. In other words, for the most part, the patient expresses that he or she is suffering from a group of subjective symptoms, such as recurring headaches, neck aches, ultra-sensitive teeth etc. Using what the patient tells the dentist, he will then begin to look for more objective signs of the TMJ disorder such as clicking of the joints, divergence upon opening and closing the mouth, and periodontal involvement.

There is, however, one objective sign that is visible upon dental x-rays which may lead the dentist to believe that the patient is obsessed with parafuntional habits such as bruxing, ice and/or excessive gum chewing and severe clenching the teeth.

The dentist will be able to discern a widening of the periodontal ligament toward the crown of the teeth. Rather than a normal, relatively thin line between the bone and the tooth, it will begin to widen as it progresses up the root toward the crown. This widening is called “funneling” of the periodontal ligament, and is a prime indication that the patient tends to place immense pressure on the teeth. The presence of funneling on dental x-rays nearly always means that the patient is bruxing, but it does not always indicate that the patient actually requires treatment for TMD. When a dentist notices this objective sign on an x-ray, he will ask the patient if he or she is suffering from any of the fundamental symptoms of TMJ disorder. If the patient answers in the negative, then no treatment is indicated, however, if the answer is in the positive, then the patient is told the treatment options. If the patient determines their symptoms are severe enough to require treatment, then the dentist will proceed from there.

Top 3 Dentists is a resource for anyone looking for the optimum in dental practice. Being at the top doesn’t mean being the most expensive, but it does mean being the most qualified.

Search for the Top 3 Dentists in your area who practice in that specialty. Please note that some of our Periodontists (or other specialists) may require a direct referral from a General Dentist. In such cases, you would simply choose one of the general Top 3 Dentists to perform a comprehensive examination on you — and then ask for a referral to the specialist of your choice.