Simple and Effective Solutions for
TMJ and TMD Problems

If you have TMJ disorder, pain is commonly felt in and around the jaw areas. This pain may also extend to the throat, neck, shoulders, ears, and jaw muscles. The discomfort may be localized to a single area or spread across multiple regions.

Due to the proximity of the TMJ and the ear (located just an inch apart), about 80% of TMJ disorder cases include ear symptoms. These can manifest as ear pain, ear congestion, and ringing or fluttering in the ears. If these symptoms persist despite ear treatments, it could indicate a TMJ disorder, and consulting a TMJ specialist is advisable.

Yes, TMJ and the ear are closely situated, less than an inch apart. Because of this proximity, any inflammation or infection of the TMJ can quickly spread to the ear, leading to pain and tenderness in the ear.

With TMD, you may experience a dull, aching pain or discomfort in the jaw areas. This pain is not continuous and may come and go. The pain associated with TMD can be either acute (severe but temporary) or chronic (dull and persistent over a longer duration).

Researchers have found that 85% of patients with TMJ Disorders experience debilitating symptoms in other areas of the body. These comorbidities include:

1. Allergies
2. Cardiac arrhythmias
3. Chronic fatigue syndrome
4. Chronic headaches – migraine & tension headaches
5. Dizziness
6. Ear pain & tinnitus (ear ringing)
7. Endometriosis
8. Fibromyalgia
9. Generalized pain conditions
10. Interstitial cystitis
11. Irritable bowel syndrome
12. Sleep disorders or disturbances
13. Vulvodynia

Half of the patients with TMJ complain of ear pain. This ear pain is linked to jaw misalignment caused by factors such as clenching teeth due to stress, dental surgery, or trauma from an accident.

TMJ syndrome can cause symptoms in the head, neck, and face, making it hard to distinguish from other disorders. Conditions with similar symptoms include:

1. Atypical (vascular) neuralgia
2. Hypo- and hyperkinesia (abnormal jaw movements)
3. Giant cell arteritis
4. Lyme disease
5. Myositis (muscle inflammation)
6. Myositis ossificans (muscle calcification)
7. Otitis (earache)
8. Parotitis (salivary gland inflammation)
9. Scleroderma (chronic skin hardening)
10. Sinusitis
11. Temporal arteritis (inflammation of the temporal artery)
12. Toothache
13. Trigeminal neuralgia
14. Trotter’s syndrome (nasopharyngeal carcinoma)

Headaches are one of the most common symptoms of TMJ Disorders. A TMJ headache is a type of tension headache. It is typically felt as pain around the eyes or as a migraine headache. TMJ-related issues like clenching and grinding the teeth often lead to discomfort in the head muscles, resulting in headaches. Addressing your TMD can help alleviate your headaches.

There are several chronic health conditions commonly associated with TMJ dysfunction. These include:

• Obstructive sleep apnea
• Rheumatoid arthritis
• Systemic joint laxity
• Chronic back pain
• Irritable bowel syndrome (IBS)
• Headaches
• Chronic neck pain
• Interstitial cystitis
• Regular scuba diving

TMJ disorder is increasingly recognized as a condition that can affect multiple areas of the body. If you have symptoms of TMJ disorder, such as jaw grinding, difficulty opening your mouth, jaw lock, headaches, ear pain, or jaw tenderness, and you also experience arm, shoulder, or back pain, they may all be related. The body’s interconnected systems mean that an imbalance in one area can impact other parts of the body.

Rheumatoid arthritis (RA) is a chronic autoimmune condition that primarily affects the joints, causing warm, swollen, and painful joints. The TMJ is often one of the last joints to be affected. RA is associated with various clinical signs and symptoms, with discomfort being a major concern. This eventually leads to inflammation, reduced mobility, joint stiffness, and muscle spasms in the TMJ.

Recent research has shown a strong causal association between TMD and Obstructive Sleep Apnea (OSA). Severe TMD can limit the opening of the oral airway, resulting in a backward positioning (retrognathic posture) of the mandible, which can lead to oropharynx blockage as the tongue relaxes during sleep. This process is aggravated by alcohol intake and other chemicals.

Irritable bowel syndrome (IBS) is a disorder that causes abdominal pain and discomfort, including symptoms like vomiting and constipation. A recent study found that IBS causes structural changes in the brain, leading to alterations in emotion regulation, pain control, attention, and information processing. Due to these alterations in the brain’s pain regulation center, IBS is associated with chronic pain conditions such as chronic back pain, TMJ dysfunction, chronic neck pain, and other disorders throughout the body.

Scuba divers frequently experience changes in pressure when diving into deep seas. These pressure changes can lead to a condition known as barotrauma, which causes acute or chronic inflammation. Barotrauma can result in toothaches, headaches, swelling of the middle ear, tinnitus, headaches, joint pains, jaw joint inflammation, and TMJ pain.

TMJ disorders can be divided into four categories:

• Jaw muscles disorder
• Temporomandibular disorder – This can further be sub-divided into Disc displacements or dislocations and Incompatibility of TMJ structures
• Inflammatory disorders like arthritis
• Long-time restricted movement of the lower jaw
• Growth disorders – under or overgrowth of the jaw or jaw muscles

The term ‘degenerative joint disease’ applies to arthritis (both osteoarthritis and rheumatoid arthritis). In general, arthrosis can be a non-specific term for a joint disease, or specifically a degenerative disease. The TMJs are among the most commonly used joints in the body. Over time, either with normal or para-functional use of the joint, wear and degeneration, called osteoarthritis, may occur. Rheumatoid arthritis, an inflammatory joint condition, can also affect TMJs. Degenerative joint diseases can cause defects in the shape of the joint tissues, functional limits, and joint pain.

Usually, the temporomandibular joint has a disc that absorbs shock and facilitates the movement of the joint structure. However, in cases of excessive mouth opening, the disc can get displaced from its original location, restricting the movement of the lower jaw. This disc is present above the head of the lower jaw (condylar head of mandible) and is called an internal disc. Disc displacement can be of three types – disc displacement with reduction, disc displacement without reduction, and chronic disc displacement with reduction.

The typical symptom of TMJ disc displacement with reduction is the loud clicking or popping sound heard when you open or close your jaw. There might not be pain when opening or closing the jaw, but there could be discomfort while chewing hard food.

In disc displacement without reduction, there will be locking of the lower jaw and a reduction in jaw opening. The standard jaw opening is 45-60mm, but in disc displacement without reduction, the jaw opening could be reduced to less than 30mm. If the patient tries to close or move the jaw with pressure, pain will occur. Professional help is required to set the jaw in the correct position, as jaw locking can occur suddenly.

The term ‘degenerative joint disease’ applies to arthritis (both osteoarthritis and rheumatoid arthritis). In general, arthrosis can be a non-specific term for a joint disease, or specifically a degenerative disease. The TMJs are among the most commonly used joints in the body. Over time, either with normal or para-functional use of the joint, wear and degeneration, called osteoarthritis, may occur. Rheumatoid arthritis, an inflammatory joint condition, can also affect TMJs. Degenerative joint diseases can cause defects in the shape of the joint tissues, functional limits, and joint pain.

In TMJ disc displacement with reduction, the disc is partially or entirely displaced from its location but returns to its original position without any treatment.

In TMJ disc displacement without reduction, there is a loss of elasticity in the TMJ ligaments. This causes the disc to be in an anterior position with the mandibular condyle. As a result, there will be locking of the lower jaw in the closing position, and a reduction of jaw opening is seen. Dr. Adatrow can treat all kinds of TMJ disorders with his extensive expertise in TMJ.

If you begin to feel pain, tension, or clicking in your temporomandibular joint (TMJ), you may seek treatment to correct this condition, also known as temporomandibular joint disorder (TMD) or TMJ disorder. But first, you’ll need a diagnosis from Dr. Adatrow, who specializes in the condition. There is no single standard test for diagnosing TMJ disorder, so Dr. Adatrow may use a TMJ questionnaire, health history evaluation, physical examination, and diagnostic imaging to assess your condition.

Before or during your first appointment, our dental office will likely ask you to answer specific questions about your TMJ pain and discomfort.

• Do you experience any clicking, popping, or grinding sounds when you open and close your jaw?
• Do you have any pain, ringing, pressure, or fluid buildup in one or both ears?
• Do you clench your jaw or grind your teeth during sleep or while awake?
• Do you find it difficult to open your mouth fully?

You may also be asked when the symptoms began, how severely they impact your daily life, and if there is any activity or time of day during which the pain is worse.

Studies have found that psychological factors like stress, anxiety, and depression are often elevated in TMD patients. Our dental team conducts a psychological evaluation to provide you with the best treatment. Dr. Adatrow will ask about your pain level on a scale of 1-10 and may also have you fill out a questionnaire regarding your anxiety and depression levels.

Depending on the severity of your disorder, Dr. Adatrow may order diagnostic imaging to assess the joint’s integrity, monitor the condition’s progress, and determine an individualized treatment plan for you. Common imaging techniques used to diagnose TMJ include routine and panoramic x-rays, CT scans, MRI scans, and scintigraphy (bone scans).

Dr. Adatrow may prescribe a radiographic (x-ray) evaluation of your temporomandibular joint (TMJ) if deemed necessary to provide the most appropriate treatment.

Panoramic radiography provides images of your mandibular condyles, maxillary sinus, upper and lower teeth, and any alteration in the shape of your lower jaw. These structures are not visible clinically. OPG shows all the bony (hard) structures of the TMJ region in a two-dimensional (2D) view.

Magnetic resonance imaging (MRI) uses magnetic field pulses and radiofrequency signals rather than ionizing radiation to produce multiple digital image slices. Dr. Adatrow might recommend this when he needs to evaluate the soft tissue structures of your TMJ, such as jaw muscles, disc displacements, or any other swollen structure of the joint.

Clenching or grinding of teeth, also known as bruxism, can happen intentionally or unintentionally, during the day or at night. When you grind your teeth, it places excessive stress on the muscles and structures around the jaw joint and the TMJ itself, leading to the onset or worsening of TMD symptoms. Teeth grinding also wears down your teeth, causing a loss of balance in the relationship between the upper and lower teeth (occlusion).

Our dental team will perform a thorough clinical examination to diagnose TMJ disorder. The clinical evaluation of TMJ involves the following steps:

• Our dental team will obtain your detailed medical and dental history, including any previous trauma.
• Dr. Adatrow will evaluate your jaw opening by measuring the distance between the upper and lower front teeth.
• The doctor will examine the muscles around your jaw joint through palpation (touching) to check for pain or soreness.
• He will palpate your TMJ by asking you to open your mouth by 1-1.5 inches and assess for pain or tenderness.
• He will feel for any TMJ sounds by placing a finger over your TMJ while you open and close your mouth.

Many health conditions can mimic TMJ disorder. Therefore, Dr. Adatrow will ask questions about your current and previous health status, stress levels, hormonal imbalances, and medications. Some conditions that can mimic TMJ disorder include sinus or ear infections, dental cavities, or nerve disorders like trigeminal neuralgia.

History and clinical evaluation play a critical role in assessing the health of your TMJ. Providing detailed information is essential for us to offer the best treatment plan.

Yes, to give our dental team a complete picture of your overall health, bring a list of your medications, including supplements, to your appointment.

Computed tomography (CT) is a more advanced technique in which the patient is exposed to a fan-shaped x-ray beam that is guided to various detectors. These detectors move around the patient to capture 360-degree images. The images are received as data on a computer monitor and can be reconstructed to form two-dimensional (2D) or three-dimensional (3D) images. This method is ideal for viewing all the bony structures of the skull and jaw regions.

If an MRI is not suitable, ultrasound (US) can be used to detect internal TMJ dysfunctions. Ultrasound can identify soft tissue disorders or complications related to the temporomandibular joint and visualize all soft tissue structures in and around the TMJ, such as salivary glands, internal discs, and muscles.

Scintigraphy, also known as a bone scan, requires an initial dye injection into the affected area. Once your bones have absorbed the dye, a scan is performed to assess the health of your bones.

Conservative therapy refers to non-invasive treatments that avoid making irreversible changes to the teeth, jaw, joint, or tissue of the patient. If you’re dealing with TMJ disorder (also known as temporomandibular joint disorder or TMD), Dr. Adatrow offers several conservative treatment options to alleviate your symptoms.

Dr. Adatrow emphasizes a holistic and non-invasive approach to health problems. At Advanced Dental Implant and TMJ Center, patients are often provided with stabilization splints. A custom splint is made by taking an impression of your teeth or using a digital scan. You may be instructed to wear the splint 24/7 at the beginning of your treatment or only while sleeping. The success of splint therapy depends on how well you comply with Dr. Adatrow’s instructions. To ensure your dental splint fits correctly and provides maximum relief, our dental team may need to adjust it several times as your jaw adjusts.

Scintigraphy, also known as a bone scan, requires an initial dye injection into the affected area. Once your bones have absorbed the dye, a scan is performed to assess the health of your bones.

For temporary relief of TMJ pain, over-the-counter painkillers like ibuprofen, naproxen, and piroxicam can be used. If the pain is more severe, Dr. Adatrow might prescribe stronger medications, such as opioids (e.g., morphine, codeine), benzodiazepines (e.g., Valium, Xanax), muscle relaxants, and anticonvulsants. Anti-depression medications may also be prescribed to reduce stress and anxiety, which can exacerbate TMJ symptoms.

Low-level laser therapy (LLLT) is an infrared light treatment applied directly to the TMJ area. LLLT offers biostimulation and analgesic effects by direct radiation without causing thermal reactions. This therapy improves blood flow by increasing oxygen, glucose, and nutrients to the affected muscles, stimulates the body’s healing process, speeds up recovery time, and enhances the health of the TMJ.

Trigger points are muscle knots or highly tensed muscle areas. Trigger point injections involve injecting anesthetics like lidocaine or mepivacaine into these trigger points, numbing the area for several hours and relieving pain for days or even months.

In some cases, ultrasound may be employed, which provides deep heat to the muscles and joints. This therapy helps to relax muscles, improve circulation for recovery, and reduce pain, often aiding in quicker healing of the affected TMJ area.

According to the National Institute of Dental and Craniofacial Research, conservative and reversible treatment is recommended for TMJ because these methods do not harm oral tissues, and reversible treatments do not cause permanent changes. Dr. Adatrow will suggest the most appropriate conservative treatment for your specific condition.

Reducing stress and anxiety is crucial for calming your mind and releasing muscle tension, which can alleviate TMJ pain. Addressing stress and anxiety may also help reduce bruxism (teeth grinding and jaw clenching), which can contribute to TMJ disorder. Additionally, it may help you curb harmful oral habits like biting nails, cheeks, lips, or chewing on pens, which can exacerbate TMJ symptoms.

Trigger point injections provide pain relief by disrupting muscle knots and modifying pain transmission. These injections cause minimal discomfort and can be administered in our dental office.

A TMJ splint is a removable dental appliance that covers the surfaces of some or all of the upper and lower teeth. Often called occlusal splints, these devices help correct the biting relationship between the teeth. Splints are typically made from acrylic resin, and hard splints are commonly preferred due to their durability and ease of maintenance.

Dr. Adatrow believes in addressing the root cause of TMJ disorder rather than just the symptoms. As part of a holistic approach, he may prescribe physiotherapy and other TMJ Conservative therapies to support your overall treatment plan.

Yes, Dr. Adatrow can discuss supplement options to boost your TMJ health. He might recommend supplements such as glucosamine sulfate, calcium, magnesium, chondroitin sulfate, vitamin D3, vitamin B complex, turmeric, and vitamin C.

When experiencing severe TMJ dysfunction, chewing may be painful. Here are some dietary tips:

• Avoid prolonged chewing of gum.
• Avoid hard or chewy foods like apples, raw carrots, or celery. Instead, slice or cut them into bite-sized pieces before eating.
• Prefer softer foods such as scrambled eggs, oatmeal, yogurt, quiche, tofu, soup, smoothies, pasta, fish, mashed potatoes, milkshakes, bananas, applesauce, gelatin, or ice cream.
• Choose ground or finely diced meat to reduce the need for extensive chewing.

Occlusal adjustments involve modifying the enamel of the teeth to allow a more harmonious relationship between the upper and lower teeth. These adjustments can be made through orthodontic devices, restorations, crowns, or surgery. However, Dr. Adatrow typically avoids these irreversible methods for TMJ treatment, preferring to focus on TMJ Conservative therapy unless the severity of the condition warrants more drastic measures.

When muscle knots or tension in the jaw muscles or neck muscles are present, the movement of the temporomandibular joint (TMJ) can become restricted and painful. Massage therapy is recommended to relieve TMJ pain by relaxing these muscles and addressing muscle knots or spasms. If Dr. Adatrow detects tightness or muscle knots in your jaw, he may suggest seeing a massage therapist to help relieve the muscle tension.

Acupuncture may be recommended for TMJ dysfunction. It involves inserting sterile, thin needles into specific points on the body to help relieve muscular pain associated with TMJ. Although scientific evidence on its effectiveness is limited, some patients find pain relief through acupuncture.

Chiropractic adjustments might be suggested to alleviate tension in the neck or head, which can be related to jaw joint pressure. However, there is insufficient evidence supporting the effectiveness of chiropractic care in treating TMJ dysfunction.

During massage therapy for TMJ dysfunction, the therapist will start with gentle touch to relax the muscle. They will then apply firm pressure using their thumb or fingers to target trigger points or muscle knots. This helps in relieving muscle tension and improving the movement of the TMJ.

Ignoring TMJ dysfunction can lead to significant issues. Conditions such as teeth grinding, jaw clenching, osteoarthritis, or trauma can worsen the disorder. Untreated TMJ dysfunction may cause:

• Chronic pain, affecting overall quality of life
• Increased anxiety and depression due to persistent pain
• Headaches, neck tightness, and teeth grinding
• Sleep disruption and potential dental problems
• Premature wear and tear on teeth and gums
• Possible inner ear problems like tinnitus, dizziness, or balance issues

Addressing TMJ dysfunction early can prevent these significant side effects and improve overall health and well-being.

TENS (Transcutaneous Electrical Nerve Stimulation) is a non-surgical treatment for TMJ dysfunction pain. Dr. Adatrow uses adhesive electrode patches placed on the jaw and other pain areas, like the neck, connected to a TENS device. The device sends low-voltage electrical currents that block pain signals from reaching the brain, replacing pain with a pleasant, tingling sensation. This also encourages the release of endorphins, which reduce pain and enhance a sense of well-being. TENS treatment can help relax jaw muscles and minimize TMJ pain.

When conservative treatments and other non-invasive methods for treating TMJ disorder fail, Dr. Adatrow may recommend TMJ surgery. Here are the types of TMJ surgical procedures:

• Arthrocentesis: This procedure involves inserting a needle into the TMJ to remove inflammatory fluid and debris from the joint.
• TMJ Arthroscopy: A thin tube is placed in the joint space, and an arthroscope is used to view and correct defects within the TMJ.
• Modified Condyloma: This indirect surgical approach targets the mandible (lower jaw) rather than the joint itself to address TMJ issues.
• Disc Repositioning: In this procedure, Dr. Adatrow repositions the disc within the joint and secures it with stitches to restore normal function.
• Open-Joint Surgery: For severe cases, Dr. Adatrow might suggest open-joint surgery to either repair or replace the TMJ.

Candidates for TMJ surgery often experience one or more of the following symptoms:

• Intense, persistent jaw pain
• Difficulty opening and closing the mouth due to pain
• Inability to chew food because of jaw pain
• Progressive worsening of jaw pain or immobility
• Misalignment of the jaw due to injury or recent dental surgery

Surgery for TMJ disorder is considered if symptoms severely impact your quality of life and are not relieved by conservative treatments. Dr. Adatrow typically prefers conservative approaches but may recommend surgery if jaw joint degeneration is beyond repair or unresponsive to other treatments.

Most patients undergoing TMJ surgery in Memphis, TN can expect to stay in the hospital for one to two days. During orthodontic treatment, braces or orthodontic equipment are used to correct tooth alignment and are removed at the end of the procedure to prevent further movement. For those with bite irregularities or jaw deformities, jaw repositioning operations may be performed simultaneously with orthodontic treatment.

Post-surgery, a non-chew diet is typically recommended for 2 to 4 weeks. Jaw strengthening exercises with a hand-held jaw exerciser and regular therapy sessions are also crucial for recovery.