Approximately 12 million adults in the United States have pain in the temporomandibular joint, according to a recent study. And it’s twice as common in women than in men, especially in women between the ages of 35 and 44.
“Young females are one of my biggest groups of patients,” said Dr. M. Johnson Hagood, DDS, at Vero Beach Art of Dentistry. “I think it’s because their ligaments are not as strong as boys and their jaw joints were injured when they were younger. As they get older they tend to have more problems with their joints. Add to that the stresses of adulthood and they start clenching and grinding their teeth. Even some tooth extractions and orthodontics can contribute to problems with the jaw joints since just holding your mouth open wide enough to get a tooth out can stretch the ligaments.”
TMD (Temporomandibular Disorder) is a somewhat mysterious condition that affects the TMJ (temporomandibular Joint). Everyone has two TMJs, one on each side of the jaw. You can feel them by placing your fingers in front of your ears and opening your mouth. TMDs are a group of more than 30 conditions that cause pain and dysfunction in the jaw joint and muscles that control the jaw movement.
“We often hear patients complain that they have TMJ, but in reality, that’s like saying I have knees,” said Dr. Hagood. “It’s more accurate to say they have TMD, which refers to the pain in the jaw joint or masticatory muscles. I’d say that at least 15 percent of the population has symptoms of TMD at some time in their life.
“TMD is caused by either macro trauma or micro trauma. Macro trauma is caused by injuries we had as children, when we fell off a bicycle and hit our chins with enough force that it goes into one or both jaw joints. Micro trauma accounts for nearly 80 percent of all TMD disorders. It occurs when people either squeeze or grind their teeth in their sleep or during the day when they don’t need to.”
For some people symptoms seem to start without an obvious reason. They may experience pain in the chewing muscles or jaw joint and that pain can spread to the face and neck. Jaw stiffness and limited movement or locking of the jaw are other common signs of TMD.
Headaches, ringing in the ears, and painful clicking or popping of the jaw when opening or closing the mouth can also be symptoms of TMD. It is important to know that clicking or popping without pain in the TMJs are considered normal and don’t require any treatment.
Many symptoms of TMD go away on their own without any treatment; however, a small percentage of patients experience severe or even crippling pain and limited jaw mobility.
Dr. Hagood has done advanced study in the treatment of TMJ disorders, with extensive training with the Pankey Institute in Key Biscayne, considered to be one of the world’s leading institutes for research and treatment specializing in the study of occlusion (bite) and treatment of TMJ disorders. His goal is to achieve maximum improvement with comfort and normal function while using the least invasive and conservative treatment possible.
For some, simple treatments designed to relax the muscles and reduce inflammation such as splint therapy is used. For others, more comprehensive diagnostics and dental restorations are needed.
Dr. Hagood will examine the jaw joints, associated muscles and dental occlusion to determine what is causing the symptoms. Then depending on his clinical analysis, he may dig into his tool chest of specialized equipment to further diagnose the disorder.
“The first thing I want to see is a CAT scan of their jaw joints,” he said. “We have an advanced Cone Beam CAT scan that gives me a three-dimensional picture of the jaw that I can scroll through and see in every dimension. This way I can see how the jaw is lining up.
“We also utilize joint vibration analysis that picks up vibration in the joints, which is analogous to friction, which is analogous to damage. Different disorders produce different vibration patterns, and the recording identifies these patterns. Since we are trying to increase the range of motion and comfort, we measure the vibration when we first see a patient and then see if the joint is getting quieter over time.
“Another critical part of our diagnosis and treatment is the T-Scan,” he continued. “It’s a digital bite sensor that measures the force that every single tooth is giving, and it will show us where certain teeth are hitting harder than other teeth. This helps us even out the bite.”
Treatment for TMD can range from resting the joints, switching to a soft diet, special jaw exercises and prescribed medication, to stabilization of the joints using a specially designed and custom adjusted hard acrylic orthotic appliance that fits on the top teeth. Generally, bite splint therapy is the cornerstone of treatment modalities. When properly designed, the appliance redistributes the stresses on the TMJs and the muscle system while guarding and guiding certain joint movements.
Once inflammation is reduced and the jaw joints seat properly in place, the occlusal surfaces of the teeth can be modified to correct the bite. Teeth can be restored with crowns, veneers and implants to perfect the occlusion of the restorations and opposing teeth.
“We now know that sleep disorder breathing is one of the main drivers of people clenching and grinding,” Dr. Hagood noted. “And a lot of people with TMD problems also have neck and back problems so I will refer them to specialists. What I’ve learned is that I need a team of professionals to solve TMD.”
In addition, there is a simple exercise that can help alleviate or ward off TMD symptoms.
Simply shift your jaw left and right and open and close three or four times a day. Those motions help circulate synovial fluid in the joints. Also, taking 1000 mgs of sustained release vitamin C before going to bed has proven to be beneficial.
Dr. M. Johnson Hagood earned his Doctor of Dental Surgery (DDS) degree from the University of North Carolina School of Dentistry and has completed thousands of hours of advanced dental education. He’s provided dentistry services in Vero Beach for over 30 years and is accepting new patients at his mainland location, 2155 Ponce De Leon Circle, where the phone number is 772-567-2237, and at his new location in Central Beach at 866 Dalia Lane, 772-231-6949.
