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TMD & NM Dentistry

Do you experience TMJ, chronic head, neck & facial pain disorders?

Your bite (the way your teeth contact when your mouth is closed) affects your face, jaw, head, neck and play a significant role in your overall health. So if this isn’t properly aligned, you can end can up dealing with chronic pain.

Patients with unbalanced bites can suffer from headaches, migraines, jaw and neck pain, jaw clicking or popping, problems with swallowing, snoring or sleep apnea, vertigo, tinnitus (ringing in the ears), sensitive teeth, and posture problems.

TMD & TMJ, What do these terms mean?

Tempromandibular Disorders= are disorders of the jaw muscles, joints, and the nerves associated with facial pain.

Tempromandibular Joint= is an anatomical feature. The structure that connects between the temporal bone and the lower jaw, allowing for your jaw to open and close your mouth.

What is TMJ/TMD pain?

When this system is out of balance, it creates dysfunction, pain, crooked teeth, head, neck and facial pain disorders,’TMJ’ disorders, impaired athletic performance and sleep disorders.

At a very basic level, the cause for much of this is the same. Imbalance in the system. It was once explained to me, by an osteopathic physician, "I believe, that the head is a highly specialized vertebrae. All vertebrae in our spine have three points of contact, like a three legged chair."

The exception is the head. It sits on two rockers (superior facets) with the vertebrae below (atlas). What is the third point of contact? The teeth!!! Any impairment in how the teeth contact will torque and distort the connections and, more importantly, the paired muscles all the way down the spine.

This was nicely demonstrated in rats by D’Attilio et. al. in the Journal of Craniomandibular Practice, April 2005. A plastic filling placed on the molar of a rat created a distortion in the bite called a scoliosis. It was corrected by the removal of the filling. (see photos below)

It was also demonstrated in humans by Dr. Al Fonder in his classic text ‘The Dental Physician’
(published in 1984), in this case using mercury fillings to ’balance;’ the bite. (see photos below)

Why does jaw torque cause problems? What is torque?

The best analogy I can think of is the position of a plane in the air. The positioning is described as having Pitch, Roll and Yaw.

The same analogy can be used to describe the position of the lower jaw in space. As the lower jaw comes up to meet the upper teeth, in an ideal position, the paired muscles work evenly and when the teeth contact they are identical in the amount of force they put on the teeth. Sadly, most dysfunction, and pain and most of the other disorders are caused by uneven muscles, which sets up pain patterns in the unbalanced muscles.

You see most people have two positions for their jaws...

1. One where the teeth meet and all connect

2. And another where the muscles are balanced and the teeth do not connect

The discrepancy between these two positions and the ability of the patient to adapt determines the pathology we see and feel. Pathology can mean many things but for us we see mainly tooth wear and breakdown and muscle fatigue and pain. Most therapy is geared toward alleviating symptoms rather than addressing the cause.

The goal of any therapies working with ALL of these disorders should be to get the jaw in a position now referred as physiologic rest position (PRP). This position takes the torque out of the system and allows the muscles to heal.

The problem with traditional therapeutic treatments:

The first, using ‘splints’ or ‘nightguards’ or anything else put in the mouth, even dentures and sleep appliances are not made to the PRP, so although they have been reasonably successful, they still leave torque in the system and indeed can make things worse (like sleep apnea). The key being for the ‘successful’ cases is that the therapies have not exceeded the adaptive capacity of the patient. For most that cannot tolerate anything put in their mouths, often the reason is that the appliance or device has exceeded their adaptive capacity (there are many reasons). Most therapies are best practices taught over the years that seem to come close but at best are best guesses to the PRP. The ideal way to get to PRP is to be able to measure it objectively and there are instruments we use to do that.

The primary instrument used to objectively determine where to establish proper jaw position is the K7 computer evaluation system.

(See video above)

Once we have established the correct position, we verify it with a device called the TekScan , often referred to as the GPS system for the bite. This determines if the teeth are contacting correctly.

As Dr. Bob Jankelson used to say “If you can measure it, it is a fact, if you cannot, it is an opinion”.

This whole area is fascinating and constantly evolving. For more in depth information, I urge you to explore the information in the links below.

For specifics on ‘TMJ’ and head neck and facial pain therapies these two sites are the most comprehensive: |

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