One of the most common jaw disorders is related to a problem with the temporomandibular joint. This joint is actually the hinge that connects the jaw to the head. The relationship of the jaw to the head is dictated by three things: the jaw joint, the muscles that open and close the jaw and support the head, and the teeth themselves. All three have to work in harmony or TMJ dysfunction may exist.
Terms such as TMD (temporamandibular disorder) and CMCD (cranio-mandibular cervical disorder) are the appropriate terms for the problems patients may have. TMD and CMCD along with related cervical spine posture abnormalities can cause migraine type headaches, ear and eye problems, sinus pain, dizziness, swallowing difficulties, clicking jaw joints, clenching and grinding of your teeth, facial pain, toothaches, nausea and fatigue.
Occlusion, much like the fit of a shoe, is how your teeth fit together. When your teeth do not fit together right, your muscles go into spasm, producing too much lactic acid causing cramps and pain. Occlusion misalignment stimulates muscular hyperactivity that results in TMD and/or Craniofacial pain.
In our office, Dr. Stender uses the most advanced diagnostic tools available to narrow down the cause of your TMD or Craniofacial pain and determine the best treatment to eliminate the problem.
A detailed medical and dental history will be documented, including all past medical and/or dental problems and treatments, any history of trauma (especially to head or neck region), specific questions about your symptoms, and the nature and duration of pain and jaw problems. A Range of Motiontest will be done to check to movement of the jaw and whether there is a deviation or deflection of the jaw upon opening. Muscle palpation will also be done. This checks for possible muscle contractions and trigger points that could indicate a problem with the chewing muscles.
An evaluation of hard tissues is accomplished using our Galileos 3-D X-ray.
Evaluation of soft tissue is accomplished by the following:
BioEMG II® Muscle Testing
BioEMG II ® Muscle Testing measures and records how the muscles connected to your jaw function when your jaw moves and relaxes. Dr. Stender or his Assistant will affix 9 patches to your forehead, face, and neck. The wires from the EMG unit are then attached to the patches. Then, you will be asked to do things like rest your jaw, clench your teeth together and swallow. The EMG records the electrical activity of the muscles, quantifies the data and displays it on a computer screen. In other words, the EMG tells Dr. Stender whether or not your muscles are doing what they are supposed to be doing. It is fast, informative and pain free.
The BioJVA ®
The BioJVA ®, otherwise known as Joint Vibration Analysis, records audible and sub-audible pops and clicks from your jaw joints as you open and close your mouth. Normal joints produce little or no vibration, but a number of abnormal conditions produce distinct vibrations that can be identified by Dr. Stender with the use of the JVA. A headset is placed in front of your ears directly over each joint. Then, you will be asked to “open wide and close” numerous times. Any vibrations recorded will be analyzed and displayed on the computer screen. From this procedure, Dr. Stender will be able to see if your joints are functioning normally or not.
Evaluation of jaw movements are documented by:
JT-3D® Computerized Jaw Tracking
The JT-3D ® Computerized Jaw Tracking measures and records how your jaw moves during normal activities. Dr. Stender or an assistant will affix a small magnet on your lower teeth and place a headset over your head like a hat. Then you will be asked to do things like open and close your mouth several times quickly and several other jaw movements to measure exactly how your jaw moves and functions. The magnet and headgear work like a tracking system allowing Dr. Stender to see the movement pattern on the computer screen and then analyze it. The JT-3D ® can be used to objectively assess the quality of your chewing, speech and envelope of function.
Understanding the force, timing and balance of your bite is essential to evaluating the health of your teeth. Too much force on a single tooth or set of teeth can cause pain, tooth movement or fracture. When replacing damaged teeth with restorations, we want to make sure that we are alleviating any environmental stressors like improper force, timing or balance of occlusion (the way you bite). T-Scan III allows Dr. Stender to objectively asses your bite and aids in adjustments to it. You will be asked to bite on a thin plastic wafer that is placed between your teeth. The fast and pain free procedure will provide Dr. Stender with valuable information about your bite.
Dr. Stender treats TMD and/or Craniofacial pain with a number of different methods. One method is with the NTI-tss Dental Device. This device is a pre-fabricated matrix that that Dr. Stender retro-fits and customizes to your front teeth. The most distinguishing characteristic of the NTI device is that it creates exclusive contact between the incisors (front teeth) only. Preventing any molar or canine contact is a key element to preventing jaw clenching and teeth grinding that can cause intense pain. Dr. Stender dictates the design of the NTI device based on your unique bite presentation. Additionally, Dr. Stender ensures that the device design does not overly “open” your mouth which would result in another negative sensory input. The NTI device fits comfortably on either the upper or lower front teeth. For most patients, it is worn during sleep.
An additional method of treatment is with a Maxillary B-Splint. This is a very thin retainer with an anterior stop so the back teeth are excluded. It is worn at night only or for 24 hours a day depending on the severity of the case.
Full mouth occlusal equilibration with the T-Scan III is yet another method of treatment. With this, your bite is balanced so you bite down evenly throughout your mouth.
Orthodontics can be very beneficial in treating TMD for some patients as well. And, in the most severe cases, complete reconstruction is recommended.
Since each patient’s case is unique, Dr. Stender will recommend the treatment or combination of treatments most appropriate for you.