About 12 million adults in the United States have temporomandibular joint pain, according to a recent study. And it is twice as common in women as in men, especially in women between the ages of 35 and 44.
“Young women are one of my largest patient groups,” said Dr. M. Johnson Hagood, DDS, at Vero Beach Art of Dentistry. “I think it’s because their ligaments aren’t 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 to clench and grind their teeth. Even some tooth extractions and orthodontics can contribute to jaw joint problems, as holding your mouth open enough to extract a tooth 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 putting 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 the muscles that control jaw movement.
“We often hear patients complain that they have TMJ, but really, that’s like saying I have knees,” Dr. Hagood said. “It’s more accurate to say they have TMD, which refers to pain in the jaw joint or masticatory muscles. I would say at least 15 percent of the population has TMD symptoms at some point in their lives.
“TMD is caused by either macrotrauma or microtrauma. Macrotrauma is caused by injuries we had as children, when we fell off a bicycle and hit our chin hard enough to go into one or both jaw joints. Microtrauma accounts for nearly 80 percent of all TMD disorders. It happens when people either clench or grind their teeth in their sleep or during the day when they don’t need to.”
For some people symptoms seem to start for no apparent reason. They may experience pain in the masticatory muscles or jaw joint, and this pain may spread to the face and neck. Jaw stiffness and limited jaw movement or locking 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 painless clicking or popping in the TMJs is considered normal and does not 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 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 as little invasive and conservative treatment as possible.
For some, simple treatments designed to relax the muscles and reduce inflammation, such as splint therapy, are used. For others, more comprehensive diagnoses and dental restorations are required.
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 can dig into his tool chest with specialized equipment to further diagnose the disorder.
“The first thing I want to see is a CT scan of their jaw joints,” he said. “We have an advanced Cone Beam CAT scan that gives me a 3D image of the jaw that I can move around and see in every dimension. This way I can see how the jaw lines up.
“We also use joint vibration analysis which detects the vibration in the joints, which is proportional to friction, which is proportional to damage. Different disturbances produce different vibration patterns and the recording identifies these patterns. Since we’re trying to increase range of motion and comfort, we measure vibration when we first see a patient and then see if the joint gets 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 each tooth gives off and will show us where certain teeth hit harder than other teeth. This helps us smooth out the bite.”
Treatment for TMD can range from resting the joints, switching to a soft diet, special jaw exercises, and prescription medications, to stabilizing the joints using a custom-designed and custom-fit hard acrylic orthotic appliance that fits over the upper teeth. Generally, bite splint therapy is the cornerstone of treatment modalities. When properly designed, the device redistributes pressure on the TMJ and musculature while protecting and guiding certain joint movements.
Once the inflammation is reduced and the jaw joints are properly seated, the chewing 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 restorations and opposing teeth.
“We now know that sleep-disordered breathing is one of the main drivers of people clenching and unclenching,” noted Dr. Hagood. “And a lot of people with TMD problems also have neck and back problems, so I’ll refer them to specialists. What I learned is that I need a team of professionals to solve TMD.”
In addition, there is a simple exercise that can help relieve or prevent TMD symptoms.
Just move your jaw left and right and blink three or four times a day. These movements help to circulate the synovial fluid in the joints. Also, taking 1000 mg of extended-release vitamin C before going to bed has been shown 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 training. He has been providing dental 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 his new Central Beach location at 866 Dalia Lane . , 772-231-6949.
