Your Smile and TMD

By Jeffrey L. Brown, DDS

It is almost impossible to maintain a nice smile when you are hurting, and especially when that pain comes from TMD (Temporomandibular Disorder). When the discs in the jaw joints are out of place, they can and will pinch nerves and blood vessels in the jaw joints. This is a concept that few doctors understand as it was never taught in school. Such training often requires extensive post-graduate education, and oftentimes that can be very hard to find!

As a patient, you should be aware that there are many ways to treat the TMJ disorder. To figure out which one(s) are right for you, the first step is diagnosing. A proper diagnosis is where it all starts and that means a very good MRI (soft tissue) and CBCT x-ray of the joints. From there, your course of treatment might include orthotic (non-surgical dental oral appliance treatment), physical therapy, osteopathy, dry needling, acupuncture, massage, and even laser therapy.

At our office, we most frequently use appliance therapy to make space for the displaced discs to return into the socket. Along with your appliances, we oftentimes do massage or laser therapy. This is a specialty treatment. Our massage therapist incorporates the Fotona laser to achieve good energy deep into the tissues to maximize healing. It quite honestly feels ‘wonderful’ according to our patients.

When a patient wears an orthotic appliance on their lower teeth, this allows the displaced discs the chance to get back into proper position within the socket. This takes time. Most cases the displacements occurred over the course of years and it often takes a year for those discs to go back into place, if they will at all. In the event that they do not go back where they belong, a minor surgery can be done to put them back into the joints. This is called plication.

The other appliance that is used is the ALF. This little wire has the ability to open up the palate which makes it easier to breathe. It can also lower a high palatal vault which allows better nasal breathing. When a person breathes through their nose more, this allows for better production of nitric oxide which helps the body to heal better. It also helps level the cranial bones to some extent and thus reduce asymmetry of the skull. This little device really is amazing. Admittedly, it takes years of training to get a handle on it, but it is well worth it.

Ultimately, when a TMD case has healed or improved enough to not need surgery, it is time to finish up so you do not need to wear appliances any longer. This can be accomplished either by orthodontics or prosthodontics. The purpose is to support your jaw joints and the discs in the correct anatomical position. It is important that you understand the mechanism of how this works so choose your provider carefully and do your research! Your smile is worth it.