Temporomandibular (TMJ) Treatment
Many people know that their head hurts. They reach for Aspirin, Advil, Tylenol or any one or more of a plethora of pain medications in the market. They may go from doctor to doctor seeking relief. We term this pattern the “medical merry-go-round.” They are usually told there is nothing wrong with them after extensive and exhaustive conventional medical tests. Often they are told they will have to live with their pain. Often, these folks are at the end of their ropes emotionally.
What follows is an attempt to explain a fantastic physiologic process. The “neuromuscular technique” works for approximately 80% of head pain sufferers. Dr. Meyer has used this technology for 30+ years and is one of the most experienced in the country. Please be sure to read our TMJ Case Studies. There are links at the top of this page.
The jaw joints are a unique set of joints. They are designed to function in a smooth and harmonious manner. Every person has a range of adaptability or tolerance for all areas of their body. The jaw joints and associated structures, when subjected to forces outside the range of adaptability are said to be in dysfunction.
This dysfunction causes an exquisite irritation of the Trigeminal Nerve. This nerve and associated structures to often become painful as a signal that something is amiss. Sometimes the dysfunction is seen as a non-painful deviation of the jaw during opening or closing or at other times it can manifest as severe debilitating headaches or more. Then, the unsuspecting sufferer climbs aboard the medical merry-go-round. They search for answers by going from doctor to doctor, often specialists. Usually they get several rounds of various brain scans, physical exams, blood tests and medication to manage the pain. My favorite is “It’s all in your head”. Of course it is, but not for the reasons they all think.
When those treatment modalities don’t work out after a suitable trial period, they are recommended to a psychologist or a pain management specialist. Alas there is little relief. There are two very damaging, non-pain manifestations. Both are quite insidious. (See Bites or Occlusion)
Our approach to the problem begins with a diagnosis based on history, physical examination and objective biomedical tests. We employ 3D radiographs of the teeth, jaws airway and jaw joints. The advanced biomedical tests mentioned above are Electromyography (EMG); to ascertain the status of the muscles of the jaws while at rest and also in function. Transcutaneous Electric Nerve Stimulation (TNS) is used to relax the muscles, Electrosonography (ESG) and Computerized Mandibular Scans (CMS) used to track the movement of the jaws through time and space. Add to this; diagnostic models and photographs and you have rounded out the basic diagnostic tools necessary to make the initial treatment decisions.
Once the data is gathered it is analyzed by Dr. Meyer and a plan is designed. This may be a decision to gather additional information, move onto a precision oral orthosis, specific care to the teeth, a nighttime bite guard, physical medicine modalities, craniosacral therapy, Prolotherapy, Prolozone, PRP (known as Regenerative Orthopedic Therapies) or even surgery. There are also times when combinations of the above might be used to solve one’s problems.
Most often (approximately 90%) a precision orthosis is fabricated. It is made out of a clear vinyl that is low in toxicity. The top of the appliance is carved to look like teeth, function like teeth and be your new teeth. The orthosis is worn for twenty-four hours a day except to brush your teeth and clean the appliance.
Once you begin the treatment process, the following steps occur:
1) Two weeks (approx) from the diagnostic appointment, you return for the fitting of the appliance. (There are times that additional adjusting may be necessary to give you comfort. Our goal at the first appointment is to fit the appliance, make it as comfortable as possible, and instruct you on its care.) An appointment will be scheduled for 1 week from your fitting. You are sent home with the orthosis.
2) During your one-week follow up, we will assess any positive benefits or negative side effects. The introduction of the orthosis to your system can be quite a shift and we want to ensure that we monitor its effects closely in the beginning. After your appointment, we will schedule another for one month out.
3) At your one-month appointment, the appliance is checked for form, fit and comfort. We will also be monitoring what your body is doing / how are you reacting. You will grade yourself on a scorecard. This same process is followed at the next few appointments. During these visits, we may recommend some type of bodywork. This can be massage therapy, chiropractic, cranio sacral therapy or osteopathic care. Remember, your system was dysfunctional. That is suffering and ailing. As you return to a more normal state, different issues will arise and we want to be ready for you when they do.
4) At the end of 3-6 months of visits you are then put back on the K7 diagnostic system for a “check-out” session. Here you are given a battery of tests similar to the initial set on the first visit. The difference now however is that you should be healthier.
We will usually find one of two things happening at this visit. They are:
- You are stable with your orthosis (this is our hoped for outcome) or
- You have made strides in positive change and now need to have the orthosis altered so the muscles can function at an even better position. This will result in either a new orthosis or a “re-topping” of the existing orthosis. That decision is made at the time the testing is completed. Seldom will you have to return for the “topping” but you may, this is time dependent.
Once we have met the criteria for a successful outcome or have had to accept the limitations of your particular case, the next question is what to do next. The options we have available to us are:
Equilibration or Coronoplasty – this is the reshaping of the biting surface of the tooth be in better harmony with your special requirement.
Semi-permanent removable overlay orthosis – this is similar to the appliance you may have had but is made from a more durable material that will not wear down as readily as the vinyl or acrylic one has.
Fixed Rehabilitation – this is the permanent altering of your teeth by resurfacing them. This will be either with crowns, laminates, or bridges.
Orthodontics – the moving of your teeth to a more ideal position to fit your specific needs. This works well when your teeth have not been previously treated by a dentist (or only minimally; i.e. large fillings or crowns).
Oral Surgery– in a very small fraction (<1%) of the cases this is needed.
Combination Therapy – any of the above to achieve the desired results.
There is a book we highly recommend called “Solving the Pain Puzzle,” by Mary Lynn Pulley. This booklet is very informative. Please call the office and we can arrange for one to be sent to you.