TMJ and TMJD, aka Craniomandibular Dysfunction (Jaw pain and dysfunction)
Dr. Jason Scoppa, TMJ specialist Seattle
Anatomy of the TMJ
The jaw consists of the maxillae and the mandible. The maxillae consists of two bones, a left upper and a right upper jaw. The mandible, which is the lower jaw bone, is suspended from the two Temporo Mandibular Joints (TMJ), located in the two temporal bones (cranial bones on the sides of your head). The TMJ’s are directly related to the two Sacro-Iliac Joints (SI Joints) which make up your pelvis. The right TMJ is related to the left SI Joint, and vice versa.
The TMJ consists of the mandibular fossa (the socket) in which the condyle of the mandible fits and articulates. Behind the condyle, and lining the fossa, is a nerve bed called the retro fiscal tissue. This is a nerve bed which is part of our vestibular mechanism, responsible for hearing and balance.
The mandible swings from the two temporo mandibular joints, and is suspended from these joints by the large Temporalis muscles, one on either side of the skull. The pterygoid muscles are responsible for opening the mouth, the temporalis and masseter muscles are responsible for closing, clenching, and chewing.
Potential Symptoms of TMJ and TMJD
headaches, neck pain, jaw pain, ringing in the ears, pain when you eat, clenching and/or grinding of the teeth, pain when you chew, sleep apnea, forward head posture, pain behind the eyes, clicking or popping in the jaw, limited or painful opening of the jaw
Causes of TMJ Pain and TMJD
Pain in the TMJ, and pain the surrounding structures (neck, headaches, etc.) which is often called TMJD, is usually multifaceted and can be caused by a number of different things. Some of these include:
*Malocclusion: This is where the teeth come together in such a way that the vestibular system is negatively effected. This can be caused by a decrease in the vertical dimension of the bite, overcrowding of teeth, or a situation where the upper incisors overlap the lower incisors and the upper arch is peaked, just to name a couple of examples.
*An underdeveloped maxillae: This, or a problem with an asymmetrical maxillae, can cause malocclusion issues.
*Retrusive/posterior and superior position of the TMJ: This is a situation where with the condyle of the mandible is compressing the retro discal tissue. Typically this an issue of decreased vertical dimension of the posterior teeth.
*Cranial and dural stress: Caused by tension within the dural sheet that covers the spinal cord and brain. This sheet has attachments into the sutures (joints) of the cranium, as well as strong attachments at the sacrum. So a torqued sacrum can cause dural stress, which can lead to TMJ issues.
*Upper cervical joint restrictions: This is typically a by-product of cranial and dural stress, since there is an attachment between the upper cervical spine (the joints of the spine, close to your head in your upper neck) and the dura.
*Sacro Iliac Joint (SI Joint) instability: Since the SI joints are the foundation on which your body rests, any instability in these joints will have the same effect on your body as a cracked foundation would have on a house. Instead of a crooked roof, cracks in the side of your house, and crooked pictures, you’d have asymmetrical muscle tension throughout your body, and increased tension on certain joints while others are not being utilized enough.
Dr. Scoppa has a number of different treatment options available, depending on what is causing your specific TMJ or TMJD condition. In general, problems are multifaceted and it takes a combination of treatment methods. Some of these include SOT chiropractic, Craniopathy, Myofascial work, and Proprioceptive training for the TMJ. This tends to be enough for 80% or more of the patients that come to us with TMJ and TMJD. For the other 20%, TMJ splints or night guards might be utilized. We work with a select few local dentists that understand the relationships we described above. In some instances, ortho work or maxillary expansion needs to be done by the dentist.
In deciding on a person or method to help you with your TMJ and TMJD symptoms, we strongly encourage people to utilize non-invasive methods of treatment first, before doing anything permanent or drastic. For example, we have had quite a few patients come in after going to a few local dentists and getting invasive treatments such as teeth shaving (where the dentists shaves the teeth down so that they look like they articulate properly, without addressing the actual asymmetry), expensive orthodontic work that is done improperly, etc. These people have a difficult time finding relief after those things are done, and often end up needing a lot of expensive ortho work in an attempt to correct the mistakes. So whether or not you choose our office, please choose someone that understands occlusion and will start with non-invasive methods of treatment FIRST.
Dr. Jason Scoppa, TMJ Specialist Seattle.