Every year, millions of people suffer from headaches, migraines, face pain and unresolved ear complaints. All too often they travel from doctor to doctor in search of relief, only to discover that no one can or has helped them.

TemporoMandibular  Disorders (TMD) are an all too common finding for many of these people who sometimes have suffered for many years without finding relief or knowledgeable help. More commonly called "TMJ" (for TemporoMandibular Joint) these afflictions are often caused by mis-alignments of the lower jaw as it relates to the base of the skull. Other causes include injury, neck and back problems, airway issues, growth and development problems of the jaws, and jaw joint problems.

TMD is often called "the Grand Imposter" because of its ability to mimic so many other medical problems which on the surface don’t seem related. This is why a very careful analysis is necessary to rule in or out the presence of TMD and its accompanying neuromuscular complications, as well as to rule out other medical problems such as tumors, sinus and ear pathology, and so forth.

A list of common signs and symptoms associated with TMD includes:

• Migraines and tension headaches
• Neck aches and shoulder/back pain
• Numbness in fingers or arms
• Facial or jaw pain, muscle pain
• Clicking or grating sound in the jaw joints
• Limited jaw movements or locking of the jaw
• Congestion or stuffiness of the ears
• Ringing in the ears
• Worn, chipped or cracked teeth
• Broken dental restorations
• Pain or soreness around the jaw joints or ears
• Sensitive teeth
• Grooves on sides of teeth at the gum line
• Extra bone growth on side of jaws or roof of mouth
• Crooked teeth and dental mal-occlusions (bad bites).
• Snoring and sleep apnea

Amazingly, these varied problems and conditions can all occur because of an unbalanced jaw or bite relationship which stresses the muscles and nerves in the jaws. When this happens, the muscles and the nerves which control these areas can become over-active, producing muscle tension, ear-related problems, and migraine headaches, to name a few.
When you look carefully at some of the symptoms, it’s easy to understand why TMD patients might wind up in a variety of other health professionals offices seeking relief for complaints that would drive them in these varied directions.

Unfortunately, many dentists and physicians are unaware of the common thread that runs through these problems, and that problems with the jaws and the dental bite could be the source of so much discomfort and involve such a varied array of problems.

If you find yourself suffering from any of these problems, it could easily be your bite. One of the more modern and most predictable treatments for TMJ available today is found in the new discipline called Neuromuscular Dentistry.

The essence of this new occlusion treatment model is based on the idea that the muscles and posture relationships of the jaws-head-neck-back complex must all be properly balanced in their relationships with each other - or else the nerves which control these structures won’t be "happy".

In ‘real life’ the lower jaw or mandible literally hangs in a sling of muscles and ligaments beneath the base of the skull. The teeth actually dictate or determine the actual anatomic position of the lower jaw when it closes and the teeth come together. The teeth act like gears which mesh together and allow the lower jaw to brace against the upper teeth and jaws.

Your jaws and teeth come together to serve many purposes. This is obvious as far as chewing is concerned. By closing together they also enable swallowing, and help to brace head and neck posture, and to help support the airway. As long as the bite position is one of comfort for the jaw and neck muscles, all can work okay. But when muscles must work a little extra hard to hold an unbalanced bite, or if the bite loses its balanced support, then problems can begin.

Things can go wrong when the muscles and nerves exhaust themselves trying to accommodate a distorted or torque in the jaw position which is "off" due to a bad bite or an otherwise unbalanced jaw posture relationship. With heightened jaw muscle activity, teeth can be worn down from grinding and clenching. Additionally, muscles can become damaged due to poor oxygen use in a constantly tense muscle, jaw bone structure can be damaged, joint ligaments can be stretched or torn, and nerve pathways can become "activated" causing migraines and sensitized pain pathways in the brain.

These unbalanced positions can arise early in life from inadequate growth & development, improper orthodontic or dental treatment, injury and related tissue damage, and other mal-adaptive compensations arising from problems with the general body posture.

Said simply, if your nerves and muscles "don’t like" the jaw positions where your teeth come together, then they can cause muscle tension and nerve hyper-activity which leads to migraine headaches and face pain.  Other related problems (such as ear, sinus, teeth, and neck pain) occur due to their proximity to the jaws and the co-activation of muscles and nerves involved in these processes.

Neuromuscular dentistry addresses the relationship of the jaws and how they relate to general neck and body posture. Thirty years of research and clinical experience have shown the neuromuscular technique to be effective in treating people with various levels of head and neck pain. This is because for the first time ever we now can determine the correct position of the jaws as per the needs and wants of the nerves and muscles themselves.

Heretofore, the only options available were to accept the dental bite position where it was and to offer limited palliative care, which totally missed the true cause of these problems. This explains why historically TMJ has been such a difficult condition to treat and why so many physicians and dentists (and patients) have been perplexed with it.

Through the use of sophisticated computer analysis dentists can help manage or alleviate TMJ problems by objectively determining a natural, comfortably balanced jaw position, and correcting a misaligned bite. The use of TENS (Transcutaneous Electrical Neural Stimulation) is an important part of the treatment. This is because it relaxes the jaw and neck muscles. TENS helps relieve pain from muscle tension and improves oxygen levels and blood flow in the muscles. This helps remove painful lactic acid build ups, and releases endorphins, the bodies own natural pain killers.

SEMG [surface electromyography] is then utilized to evaluate the electrical activity in the muscles in various jaw positions (similar to how an EKG measures the heart muscle electrical activity). With the combined use of TENS and computerized jaw-tracking, dentists are thus able to find a balanced and natural rest position for the jaw, where the muscles and nerves are calm and relaxed.

If there are problems specific to the joints themselves, such as popping, clicking or "derangements" within the joint, joint sounds are evaluated using joint sonography, which along with special x-rays of the joint called "tomograms" can reveal valuable information about the health of the jaw joint and its ligaments and protective disc.

These sophisticated electronic instruments have been used in medical specialties for many years and have now found application in dentistry. This objective collection of data is analyzed and combined with specialized joint x-rays as required, to diagnose the problem - after which a precise and individualized treatment plan is developed.

Prior to the development of this new technology and the current understanding of these neuromuscular principles, dentists and physicians were left to guess at what these symptoms meant and how best to treat them. Too often their treatments were and are ineffective, ill-advised, and/or rely heavily on medications to relax muscles and obtund pain. Amazingly, many schools of thought ignorantly and innocently dismiss the complaints and the condition explaining them away as psychological in origin and in need of psychological therapy. While it may be true that chronic unrelenting pain and other TMD symptoms can drive this, it is refreshing to now understand the physiology and science behind migraines and facial pain and to know that we can now do something about it beside ignoring or redirecting the diagnosis.

As a chronic degenerative condition, TMD usually requires years to develop and finally produce problems. Some sufferers find themselves looking back and realizing that they have been suffering for many years without ever understanding why. If it is allowed to continue unchecked and untreated, painful bone deformation and remodeling (osteodegenerative disease and arthritis) can occur in the jaw joint, which then often requires surgery to correct in its more extreme situations.

Fortunately, an increasing number of physicians are learning that people with jaw related problems often show up in their offices first with ear complaints, headaches, neck and back pain, etc. As more physicians discover these connections they are beginning to refer patients to a neuromuscular trained dentist for a proper evaluation. Those who aren’t aware or who don’t make these screening referrals, consign their patients to a lifetime of pain medication, psychological counseling, and of course, often unrelenting pain.

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