THE IMPORTANCE OF FINDING THE RIGHT DENTIST

A dentist who knows how to treat TMJ will first come up with a diagnosis so that s/he will know how to treat the condition properly. There are 2 common types of TMJ disorders – Primary and Secondary. Most dentists who do not really know anything about TMJ tend to see all TMJ cases as the Secondary type. In this type, the TMJ is basically normal but is made pathologic by some external factor such as clenching and grinding. To treat this, a splint (AKA mouth guard) is made for the patient to wear to try to relax the jaw muscles and return the TMJ back to its normal state. When the symptoms go away, there is no need to wear the appliance any longer.

However, most TMJ disorders are Primary and this involves anatomic problems such as a retruded—a term used when your front teeth are slated lingually (i.e., toward the back of your mouth)—chin, bad bites, deep overbites, upper front teeth that are slanted back, history of bicuspid extractions when orthodontics was done. To treat these cases, a properly designed splint needs to be worn to stabilize the TMJ so that the articular disk no longer dislocates (the cause of clicking and popping of the jaw joints) and physiotherapy is performed, if necessary, to eliminate trigger points and myospasm that cause the head and neck pain many patients have. These procedures are all reversible and are called Phase 1 Treatment. No permanent correction takes place during this phase and when the appliance is not worn, the patient will go back to his/her original condition. After 4–6 months of no more pain and clicking of the TMJ and the TMJ is stable, permanent changes can then be performed so that a splint will no longer need to be worn. This is called Phase 2 Treatment and may involve functional orthodontics (including braces) to change the bite, move the lower jaw forward, etc. to maintain the stability of the TMJ. There are other more expensive ways to do Phase 2 like full mouth reconstruction but that tends to be much more expensive than functional orthodontics.

TMJ always gets worse over time going from clicking and popping of the jaw to intermittent locking and then to permanent locking so that mouth opening is limited. Surgery should always be an option of last resort and is normally used when all else fails and the jaw joints are so broken down and causes so much pain that suicide is contemplated. How fast and how bad TMJ disorders will advance varies widely; many patients manage to survive (AKA put up with) TMJ pain and discomfort despite the severity of their condition.

Doctor Risto E. Hurme, D.D.S. from San Antonio Texas (coming to the WELLNESS VILLAGE in October) writes:

I attended a fascinating seminar in Hollister, California, led by Tasha Turzo, DO and Darick Nordstrom, DDS, on the benefits of integrating osteopathy, chiropractic, myofunctional therapy, and dentistry in the treatment of cranio-mandibular disorders. Dr. Nordstrom developed the ALF (Alternative Lightwire Functional) appliance, which I use in my practice. It is designed on the principle of preserving oral volume (POV). Oral volume is nature’s essential mechanism for protection of respiration and swallow/deglutition. People who have congenital abnormalities, birth trauma, or other factors affecting their oral volume can be helped to develop a correct dental arch with this appliance. The ALF is a very light wire appliance, doesn’t show or interfere with the natural physiological movements of the teeth in talking or eating, is constructed with an anterior omega loop in the upper arch, which attracts the tongue to its proper position and then augments the light force of the wire. Besides developing the dental arches and aligning teeth, the ALF helps bring the cranial bones into good functional motion. You can watch Dr. Nordstrom’s video at YouTube.com/watch?v=QxnR3BurUdM

Also at the seminar, Kathy Winslow, RDH (Registered Dental Hygienist) addressed tongue posture and its importance. Improper tongue position, pushing against the lower teeth, leads to many complications such as mouth breathing, posture problems and misaligned teeth. When necessary, I encourage my patients with improper tongue position to be treated with myofunctional therapy.

Sleep quality was also discussed. Poor sleep habits, such as sleeping on the face, can ruin jaw joints, compromise breathing, and lead to permanent distortions of the face, not to mention its effects on the rest of the body.

In Dr. Hurme’s September newsletter he offers a case history about his patient, PE, a lovely person and retired accountant, who had suffered for 17 years with debilitating chronic fatigue, headaches, teeth clenching and grinding, ear problems, and most seriously, dizziness (do these sound like any symptoms in Parkinson’s?). “She had an over-closed mouth, retrognathic jaw, and narrow arches. The dizziness was the first symptom to get better, and has stayed better. Now that her jaw is resting in its correct position, I am planning to utilize upper and lower ALF appliances in her Phase II treatment, for stabilization and to expand her arches.”

“My office has recently acquired an I-Cat 3D scanner, which is an important diagnostic tool in evaluating cranial distortions. It is fantastic for illustrating airway opening, wear on the condyles, etc.”