Occlusal and TMJ Problems and Headaches
What is a TMJ?? The TMJ, or ‘temporo-mandibular joint’, is the joint that connects your lower jaw to your skull. The movement within this joint allows you to open and close your mouth and chew from side to side. If you have a problem or have damage to your TMJ it may affect your occlusion, which is another word for the way your teeth meet when your jaws bite together.
What kind of problems could I have?? If your teeth do not fit together correctly or you have had an accident to your head then there are several ‘occlusal problems’ you could suffer from which can include; problems with the teeth, gums, the TMJ or even within the muscles that move your jaw.
- Teeth There are many signs that can show on your teeth that you may be suffering from occlusal problems. If your teeth are out of line, are constantly breaking or chipping, heavily worn, have fillings that repeatedly keep breaking or even have crowns that keep coming loose then you may be suffering. Sensitivity, aching and tender to bite on teeth are also signs.
- Gums If you are hitting onto one tooth particularly, the stress could cause the gum and bone to recede around that one tooth
- TMJ You may suffer from clicking, grinding, locking or pain in your jaw joints. Some people may also find they can hear a ringing or buzzing in their ears. Quite often patients find it difficult to open their mouths wide or even to close. This could be a result of your teeth not fitting together properly or could also be due to a trauma to the TMJ.
- Muscles If the TMJ has had a trauma to it or it is in the wrong position due to your occlusion then the muscles that move the jaw have to work a lot harder and will become tired. This may lead to muscle spasm, continual headaches or migraines in particular first thing on a morning upon waking, pain behind the eyes, sinus pain, or even pains in the neck, shoulders and even back.
How do I tell if I am suffering an occlusal problem?? Although the majority of us have imperfect occlusion or even missing teeth we adjust accordingly therefore we never notice any symptoms. However, occasionally if we become stressed for example, we may notice symptoms, some that will come and go and others that may stay longer. If you notice that you are suffering from any of the following then you may be suffering from an occlusal problem or TMJ dysfunction.
- Headaches or migraines
- Neck, shoulder or back ache
- Tenderness around the jaw on biting, chewing or opening
- Clenching or grinding of teeth
- Toothache or sensitivity for no apparent reason
- Worn of flattened teeth
- Broken or chipped teeth or fillings
- Loose teeth or crowns
- Sore or inflamed gums
- Ear ache or pains behind eyes or sinus pain
- Tenderness to pressure
- An accident or trauma to the jaw or face
If you notice one or more of these symptoms you should discuss it with us. There may be a simple explanation for it or it may be that you have an occlusal or TMJ problem. Either way we will go through it with you and help come up with a diagnosis.
If it is an occlusal or TMJ problem how is it diagnosed?? Depending on what symptoms you are having will depend on the severity of your problem and the treatment we recommend. Before treating the problem we will need to diagnose it correctly to make sure there is no underlying problem, so it is common for us to take mounted study models to see how your teeth fit together when your TMJ is situated correctly. It may also be necessary to listen to your TMJ to see if there is any damage to it, this can be done with the use of JVA (Joint Vibration Analysis) machine, where we can record the sounds your joint makes.
If we feel there may have been trauma to your TMJ then we may recommend sending you to have a MRI scan so we can see if the TMJ is in the correct position and if it has been damaged e.g. during a car crash a whiplash injury is very common in causing damage to the TMJ.
We may also diagnose with the use of a splint to see whether the problem is in or around the joint.
How can occlusal or TMJ problems be treated?? There are several ways to treat occlusal or TMJ problems depending on the severity of the problem and the symptoms.
- Splint therapy Splint therapy depends on your situation. No two people are the same, so your splint will be as individual as you are. How it needs to be worn and for how long depends on your own circumstances and will be explained to you.The appliance will be fitted accurately to your teeth and the aim is to help the joint heal better. Splints are often worn at night but in some cases this may need to be increased to full time. There is no ' one size fits all solution' here, getting the right splint to work for the right patient and achieve the desired result can take time. Some types of splint can increase grinding or clenching and so we monitor their use carefully to try to make sure we make things better, not worse . If your symptoms improve then your bite may need to be equilibrated.
- Equilibration or tooth adjustment is a technique we use to make all your teeth fit together correctly when biting or closing together so there are no stresses put on your teeth, muscles or TMJ. A few gentle adjustments are made mainly to fillings or restorations but sometimes teeth so that when closing together all your teeth touch at the same time. There are various ways of doing this and in some cases we use computerised occlusal modelling to see how even the bite is . In some cases the even bite helps stabilise the TMJ and reduce the stresses within the joint .A tooth which hits before others can often show problems such as pain or fracture.
- Replacement of missing teeth In some circumstances if you have several teeth missing it may be necessary to replace missing teeth with either dentures, bridges or implants so that the TMJ has equal support on both sides of the jaw.
- Restorations Sometimes teeth cannot be equilibrated as they are worn down too much, in these cases it may be necessary to rebuild the teeth with restorations such as crowns, inlays or fillings so that all teeth touch at the same time and the TMJ is sat comfortably.
- Orthodontics We have many options of braces including Invisalign, which is an invisible brace, fixed or removable braces or ALFs. Each patient is different so we would go through your options with you personally and we will always complete orthodontics from a TMJ perspective.
- Diet and Exercise By putting less stress on the joint you may find you can control the pain or symptoms you get. For example, by eating a soft diet and doing specific exercise to your TMJ you may find with time your symptoms improve and your pain lessens or disappears completely.
- Medication In severe cases medication may be needed to reduce the pain but this is usually temporary.
- Relaxation If stress is the cause of you grinding or clenching then trying different relaxation techniques may be of benefit to you.
If you feel you are suffering from occlusal or TMJ problems then talk to us straight away. Many patients never associated these symptoms with dental problems. These symptoms are caused by many things but if it is your occlusion or TMJ then we will hopefully be able to help you.