Many people suffer from dizziness, earaches, face, head, neck, shoulder and back pain, without knowing the cause. Previously, many patients seeking a way of dealing with these types of problems have only been offered pain relief rather than a cure, as it has not been possible for medical practitioners to reach a firm diagnosis as to the cause of the pain.
However, recent developments in diagnostic technologies have revealed that in many cases these previously uncured and painful ailments are actually symptoms of a problem with the patient’s bite (occlusion) and with the function of their jaw joint, otherwise known as their Temporomandibular joint (TMJ). With new knowledge and technology we are able to diagnose and treat TMJ problems that were previously overlooked. Dr Helen Harrison is an acknowledged expert in the field and has successfully treated many patients who had previously thought they would have to endure a life-time of discomfort.
Your jaw joint (TMJ), which holds your lower jaw in place, is suspended beneath your skull by an intricate system of muscles and tendons. The jaw joint is one of the most complex in the body. The jaw joint, surrounding muscles and the fit of your teeth are closely interrelated, each affecting the other as you make everyday jaw movements such as speaking and chewing. When your teeth are not in proper relation to each other and your jaw joints, the jaw automatically shifts to a new position in order to compensate for the misalignment of your teeth – a condition known as malocclusion.
When malocclusion exists, even what looks like a good bite could be at the expense of putting pressure on other jaw joint areas as the jaw shifts to accommodate the teeth. Signs of misaligned teeth may be clenching, grinding, premature tooth wear, stress on the muscles and tendons, some of which may occur during sleep.
Results of these signs may be symptoms of headaches and muscle ache, pains in the face, neck shoulders and back, dizziness, earache or ringing in the ears or otherwise unexplained pain or breakages of teeth.
It is possible to prove or disprove the involvement of teeth in causing the symptoms without making any permanent changes so a TMJ diagnosis is a very desirable procedure for anyone suffering the problems described. Appropriate treatment or further investigation can then be planned.
A detailed description of the symptoms is required and many questions regarding the occurrence and severity of the pain will be asked. It is necessary at this stage to eliminate other causes of TMJ pain; these include disease (eg. Paget’s disease of the bones), nutritional deficiencies (eg. Gout), tumours, trauma and infections.
X-rays are often taken in order to identify any abnormality of the joint anatomy but interpretation of these is very unreliable. Joint vibrational analysis, now available, provides a fast, non-invasive and repeatable record of the joint activity and is able to detect changes in the joints before symptoms arise.
Jaw re-positioners or splints may be used. These appliances are worn for a period of time fitted over the teeth. They are generally made of acrylic and may be refined and adjusted until it eliminates the disharmony and pain. In this way no permanent changes are made to the teeth until the problem is accurately diagnosed.
In order to study the relationship between a patient’s teeth and joints it is necessary to see how the joints guide the jaw without interference from the reflexes and muscles that are always accommodating to the fit of the teeth. To do this a record is taken measuring the relationship of the teeth to the jaw. This record is then reproduced on an instrument called an articulator. This simulation of your individual jaw movements and bite relationship without the interferences from the muscles or reflexes allows us to identify disharmonies and other interferences. Necessary restorative procedures – crowns, bridges, dentures, implants can be designed and built outside your mouth, analysed on the articulator and later positioned accurately in the mouth allowing proper fit and function.
A TekScan records in digital form the force and position of contacts during the biting sequence. This allows for immediate identification of any discrepancies or interferences in the bite. Minor adjustments can be made and checked without the need for other complex records. Using instrumentation such as this saves time and discomfort and helps provide an accurate, comfortable and durable result of treatment.
Almost everyone makes some muscular adjustment to accommodate the fit of their teeth to their jaw joint. This is a physiological and normal process that generally causes no problem or discomfort. A painful situation can arise either following some change to the teeth, dental treatment or trauma (acute onset) or as a result of long term wear to the teeth, breakdown of fillings or emotional stress (chronic onset). Emotional stress has a marked influence on muscle activity and reduces our ability to accommodate and existing malocclusion.
Prolonged muscular adaptation can cause changes and damage in the joint, limiting the range of movement possible (stiffness) or causing clicking.
After diagnosing the problem, a variety of treatments may be recommended. Initial phases of treatment are aimed to eliminate the pain. In the second stage treatment to correct the problem is implemented this may involve some minor adjustment of one or more teeth, orthodontics or restorative treatment such as crowns.
In addition to their role for diagnosis these appliances may be used as a longer term treatment to protect teeth from harmful night time grinding and eliminate problems that occur during a specific activity. Some problems of acute onset may be rectified simply by a period of wearing such an appliance, no further treatment being necessary. Tolerance of these appliances is very variable from one individual to another.
In occlusal equilibration, the tops of the teeth are re-shaped. This is done to alleviate pressure on individual teeth. It can be likened to having a pebble in your shoe. When there is an irritant present (the pebble) your foot automatically adapts and you may walk with a limp. Similarly the jaw is able to adapt to a tooth interference in malocclusion and if the irritant tooth is re-shaped a better fit is achieved and the adaptive behaviour ceases.
Occlusal restoration involves the replacement or reconstruction of teeth where simple reshaping procedures are insufficient to alleviate the problems. This is achieved with crowns, bridges, dentures or implants and generally involves multiple teeth.
Orthodontics or tooth movement may be used where teeth are sound but their position is causing the TMJ problems. Orthodontic treatments can be restricted to just one or two teeth, can be carried out at any age and may be possible to achieve with braces that are hardly visible.
Initial relief of symptoms and diagnosis with a splint or repositioning appliance is inexpensive. Definitive treatment however can seem very costly. However, the long term cost of maintaining teeth where there are many interferences and a malocclusion will be much more costly as the strain on both the teeth and any fillings or crowns will result in repetitive breakages and frequent visits for costly repairs. Crowns and fillings in a good stable occlusion will last for very many years without further attention.
The importance of early assessment and treatment cannot be overstated. TMJ problems can advance in stages and grow progressively worse. Thus a minor problem now could become a major source of pain in the future. Additionally, treatment success rates are substantially higher the earlier treatment is accomplished.
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