CRB CLINIC DIGITAL DENTISTRY
TMJ dysfunction
Diagnosis and treatment (Pain, crunching in the jaw joint, asymmetry of mouth opening)
License of the Ministry of Health of Ukraine AD No. 063321 dated 06.09.12.
CRB CLINIC
DIGITAL DENTISTRY
DIGITAL DENTISTRY
Fast and effective treatment for TMJ dysfunction
Successful treatment is achieved by combining treatment of jaw joints/bite with restoration of muscles, ligaments and the human nervous system.
Consultations by phone:
044 580 40 04
044 580 40 04
CRB clinic
What is TMJ dysfunction?
TMJ dysfunction is a collective term used to describe various problems in the temporomandibular joint (TMJ), surrounding muscles, and ligaments, as well as the consequences of these disorders, such as jaw joint crunching and pain, tinnitus, abnormal mouth opening, tooth wear, osteoarthritis, and so on.
The unique and complex nature of the diagnosis lies in the large number of components involved in the jaw joints: muscles, ligaments, nerves, teeth, and so on. All of these components interact with each other. Understanding the causes of the disorder and ensuring successful treatment requires a comprehensive approach to the entire system.
The unique and complex nature of the diagnosis lies in the large number of components involved in the jaw joints: muscles, ligaments, nerves, teeth, and so on. All of these components interact with each other. Understanding the causes of the disorder and ensuring successful treatment requires a comprehensive approach to the entire system.
Symptoms of TMJ dysfunction
The symptoms of the disease are varied and can vary greatly among different patients.
Pain is a symptom of one or more conditions:
- Destruction/deformation of the joint head or articular disc (arthrosis). Typically, pain occurs due to excessive pressure in the joint;
- Overstretching and micro-tears of ligaments (shown in yellow in the photo);
- Overstraining of the masticatory muscles (muscle pain). Pain is usually felt when pressing on the muscles in the jaw area. This symptom is accompanied by external enlargement (swelling) of the muscles and swelling of the lower third of the face;
- Pressure on the nerve bundle running directly near the joint can cause pain in the ear, facial muscles, jaw, and head;
- Impaired cerebral circulation causes headaches, tinnitus, and dizziness. This occurs due to the connection of the TMJ with the cervical vertebrae. Overstraining the facial and neck muscles changes the position of the cervical vertebrae, which contain large blood vessels. As a result, the brain, along with the blood, does not receive enough oxygen and nutrition.
- Destruction/deformation of the joint head or articular disc (arthrosis). Typically, pain occurs due to excessive pressure in the joint;
- Overstretching and micro-tears of ligaments (shown in yellow in the photo);
- Overstraining of the masticatory muscles (muscle pain). Pain is usually felt when pressing on the muscles in the jaw area. This symptom is accompanied by external enlargement (swelling) of the muscles and swelling of the lower third of the face;
- Pressure on the nerve bundle running directly near the joint can cause pain in the ear, facial muscles, jaw, and head;
- Impaired cerebral circulation causes headaches, tinnitus, and dizziness. This occurs due to the connection of the TMJ with the cervical vertebrae. Overstraining the facial and neck muscles changes the position of the cervical vertebrae, which contain large blood vessels. As a result, the brain, along with the blood, does not receive enough oxygen and nutrition.
Extraneous sounds occur when opening the mouth, chewing, yawning, and sometimes when talking. They are associated with abnormal movement of the joint head and the intra-articular cartilaginous disc. Normally, these two elements should move synchronously, with the joint head always resting on the disc, which ensures smooth movement within the joint and protects the head itself from wear. Clicking and crunching sounds occur when the joint head slips off the disc. This is an initial symptom of the disease.
Creaking sounds, however, indicate almost complete destruction or impingement of the disc and occur when the joint head rubs against the glenoid fossa. This leads to arthrosis, which wears away and deforms the bone, an irreversible process.
Creaking sounds, however, indicate almost complete destruction or impingement of the disc and occur when the joint head rubs against the glenoid fossa. This leads to arthrosis, which wears away and deforms the bone, an irreversible process.
Tooth wear is a symptom that is practically unnoticeable to the patient. The wear occurs slowly, so the patient doesn't notice the change in tooth height.
Tooth wear is a consequence of spasm of the masticatory muscles (or bruxism), which often accompanies TMJ dysfunction. The masseter muscles, or chewing muscles, are the strongest muscles in the body. When they spasm, the jaw clenches so hard that the tooth enamel can't withstand it and wears away.
An additional symptom is grinding the teeth during sleep—this is caused by the teeth rubbing against each other under intense pressure.
You can first notice tooth wear on your front incisors and canines—they should normally have sharp cutting edges. However, when they are worn down, the edge is clearly not sharp, but has a flat surface.
Tooth wear is a consequence of spasm of the masticatory muscles (or bruxism), which often accompanies TMJ dysfunction. The masseter muscles, or chewing muscles, are the strongest muscles in the body. When they spasm, the jaw clenches so hard that the tooth enamel can't withstand it and wears away.
An additional symptom is grinding the teeth during sleep—this is caused by the teeth rubbing against each other under intense pressure.
You can first notice tooth wear on your front incisors and canines—they should normally have sharp cutting edges. However, when they are worn down, the edge is clearly not sharp, but has a flat surface.
Asymmetry in the jaw joints can cause the mouth to open laterally, in an arc, or in a zigzag pattern.
In cases of intra-articular disc dysfunction, stepwise mouth opening, incomplete or limited mouth opening, can occur. Rarely, joint subluxation and excessively wide mouth opening can occur.
In cases of intra-articular disc dysfunction, stepwise mouth opening, incomplete or limited mouth opening, can occur. Rarely, joint subluxation and excessively wide mouth opening can occur.
According to statistics, tinnitus is associated with TMJ dysfunction in more than half of cases. This can be caused by pressure on the nerve bundle located behind the temporal bone. Tinnitus can also be caused by facial muscle strain, which leads to changes in the tissues of the auditory system, vibration of the eardrum, or dilation of the Eustachian tubes. In these cases, treating the dysfunction completely eliminates tinnitus.
With TMJ dysfunction, the load on the teeth changes. Teeth wear down, jaws shift, and proper contact between the upper and lower jaws disappears. All this leads to uneven distribution of load on the teeth and the development of so-called "supercontacts"—areas of extremely high load.
Overload on individual teeth leads to their deformation, chipping, wedge-shaped defects, and microcracks.
Naturally, in such an unfavorable environment, a person is more likely to develop cavities, even with normal hygiene.
Unfavorable load also affects the condition of the bone tissue in which the teeth are located. The bone begins to recede, and the gums recede, exposing the root. However, periodontal problems may not be present. The danger of this condition is that with excessive bone loss, the tooth becomes loose and may fall out. Replacing it with an implant without bone height is impossible.
Teeth wear associated with TMJ dysfunction is a factor that leads to another symptom: increased tooth sensitivity. As teeth wear, enamel becomes thinner, dentin becomes exposed, and teeth become sensitive to food, heat, cold, and other factors.
Overload on individual teeth leads to their deformation, chipping, wedge-shaped defects, and microcracks.
Naturally, in such an unfavorable environment, a person is more likely to develop cavities, even with normal hygiene.
Unfavorable load also affects the condition of the bone tissue in which the teeth are located. The bone begins to recede, and the gums recede, exposing the root. However, periodontal problems may not be present. The danger of this condition is that with excessive bone loss, the tooth becomes loose and may fall out. Replacing it with an implant without bone height is impossible.
Teeth wear associated with TMJ dysfunction is a factor that leads to another symptom: increased tooth sensitivity. As teeth wear, enamel becomes thinner, dentin becomes exposed, and teeth become sensitive to food, heat, cold, and other factors.
TMJ dysfunction almost always affects appearance. This can include facial asymmetry, changes in facial shape (a square face), changes in the shape of the chin, and the appearance of jowls.
Asymmetry develops because the position of the right and left jaw joints becomes different (asymmetrical), the jaw position also changes (tilted to one side), and the facial muscles on the right and left sides have asymmetrical tone (overstrained, overly relaxed).
Visually, a person may have drooping eyes, corners of the mouth, eyebrows at different heights, ears at different heights, cheekbones of different strength on the left and right, nasolabial folds, and wrinkles.
Facial oval changes develop due to overstrain of the masticatory muscles (masseters). The muscles spasm and increase in volume. Because of this, the lower third of the face becomes more massive and square.
The appearance of a pointed, "senile" chin and jowls is associated with tooth wear and loss of vertical alignment. Once the vertical alignment of the teeth is restored, the facial shape is restored.
Asymmetry develops because the position of the right and left jaw joints becomes different (asymmetrical), the jaw position also changes (tilted to one side), and the facial muscles on the right and left sides have asymmetrical tone (overstrained, overly relaxed).
Visually, a person may have drooping eyes, corners of the mouth, eyebrows at different heights, ears at different heights, cheekbones of different strength on the left and right, nasolabial folds, and wrinkles.
Facial oval changes develop due to overstrain of the masticatory muscles (masseters). The muscles spasm and increase in volume. Because of this, the lower third of the face becomes more massive and square.
The appearance of a pointed, "senile" chin and jowls is associated with tooth wear and loss of vertical alignment. Once the vertical alignment of the teeth is restored, the facial shape is restored.
Large bundles of nerve fibers are located beneath the temporal bone and in the neck area. If pressure is placed on these nerves when the jaw is displaced on one side, innervation to one side of the body may be disrupted. Most often, this occurs when nerve impulses are weakened to the muscles. The muscles on one side of the body become weaker. You may notice a drooping shoulder, scapula, nipple, a twisted knee, ankle, or bunion—all of which will be more pronounced on one side of the body. Treating such problems without addressing the underlying dysfunction is ineffective or temporary.
The problem may also manifest itself with sudden exertion (starting a gym class, hiking, etc.). Due to the weakness of the weak muscles, other muscles will take on the load, performing both their own function and that of the inactive muscle. Increased stress leads to muscle spasms, pain, and the development of myofascial syndrome.
The problem may also manifest itself with sudden exertion (starting a gym class, hiking, etc.). Due to the weakness of the weak muscles, other muscles will take on the load, performing both their own function and that of the inactive muscle. Increased stress leads to muscle spasms, pain, and the development of myofascial syndrome.
Cause of TMJ dysfunction
Each case is individual, and the causes may vary. But the most common cause is a malocclusion or change in the bite.
This can be a change in tooth height due to wear, fillings, or crowns. Orthodontic problems (malaligned teeth) can also cause the upper and lower jaws to close incorrectly (a misaligned dental arch).
This creates areas of increased, abnormal stress. In these areas, teeth can wear down or chip, resulting in a reduction in tooth size. This causes the jaw joints to function incorrectly (out of sync) when the teeth close, which triggers dysfunction.
When malocclusion occurs, every meal and chewing negatively impacts the jaw joints.
This can be a change in tooth height due to wear, fillings, or crowns. Orthodontic problems (malaligned teeth) can also cause the upper and lower jaws to close incorrectly (a misaligned dental arch).
This creates areas of increased, abnormal stress. In these areas, teeth can wear down or chip, resulting in a reduction in tooth size. This causes the jaw joints to function incorrectly (out of sync) when the teeth close, which triggers dysfunction.
When malocclusion occurs, every meal and chewing negatively impacts the jaw joints.
Effect on the nervous system
TMJ dysfunction can cause pain and muscle dysfunction in the face and head. This is due to excessive pressure on the temporal bone, which in turn puts pressure on the nearby nerve endings. The figure shows that the temporomandibular canals contain the large trigeminal ganglion, as well as the vestibulocochlear and facial nerves, and branches of the vagus and glossopharyngeal nerves. Blockage of the nerve endings at this level also automatically weakens the innervation of the muscle chain on either the left or right side of the body. As a result, problems can arise below, such as spinal curvature, improper gait, knee or ankle misalignment, etc.
What are the dangers of TMJ dysfunction?
With TMJ dysfunction, abnormal loads occur, which lead to destruction in the tissues of the dental system, as well as the spine.
- Teeth abrasionTMJ dysfunction causes severe tension in the masticatory muscles. This leads to excessive stress on the teeth and increased enamel wear, exposing dentin. Teeth lose not only their protection but also their height. Worn teeth cannot be restored by the body. Correct height can be restored by installing onlays, crowns, etc.
- Arthrosis, destruction of the jaw jointWith TMJ dysfunction, the jaw doesn't function properly, causing the joint head to move along an abnormal trajectory. This causes the joint to become deformed and wear out. The cartilaginous articular disc also deteriorates: it loses volume, cracks, and wears away. These degenerative processes are called arthrosis. The body cannot repair damaged tissue; it can only halt further destruction.
- Changes in the cervical vertebraeWith TMJ dysfunction, the jaw joints function abnormally and asymmetrically. To stabilize them, the neck muscles are additionally activated, spasming in an attempt to maintain the skeletal system in the correct position. Since these muscles are also connected to one or two cervical vertebrae, they simultaneously compress the neck area. As a result, both the intervertebral discs and the cervical vertebrae themselves suffer.
- Jaw bone lossWith TMJ dysfunction, the load on the teeth is distributed unevenly. In areas of excess pressure, recession, gum recession, and bone loss occur. Bone not only decreases in volume but also changes its structure, becoming loose, less strong, and less able to support teeth. As a result, teeth become unstable and fall out. Implant integration into such bone areas is impossible or problematic.
Consultations by phone:
044 580 40 04
044 580 40 04
CRB CLINIC
DIGITAL DENTISTRY
DIGITAL DENTISTRY
TMJ Dysfunction Treatment Protocol
Combining digital dentistry and traditional orthopedics.
Exclusively at CRB Clinic
Exclusively at CRB Clinic
1. Correction of joint position
Correcting the joint position is the most complex and important part of treatment. The position and function of the jaw, muscles, and the entire dental system largely depend on the joint's position.
CRB Clinic specialists use computer modeling: all data is entered into the program, and the anatomically correct joint position is calculated, which is then used to model the functioning of the dental system. The result is carefully verified to take into account the individual characteristics of the patient.
To accurately position the joint according to the model, we manufacture a custom-made positioning mouthguard. The mouthguard controls the height and position of the jaw, promoting the development of correct jaw movement habits.
The outcome of wearing the mouthguard is assessed by two markers:
1) Innervation testing using functional tests. With the joint positioned correctly, pressure on the nerve bundle is eliminated, and the innervation of the muscle chains should improve.
2) Control CT scans. One week after wearing the mouthguard, we perform follow-up CT scans to assess the joint position before and after wearing the mouthguard.
CRB Clinic specialists use computer modeling: all data is entered into the program, and the anatomically correct joint position is calculated, which is then used to model the functioning of the dental system. The result is carefully verified to take into account the individual characteristics of the patient.
To accurately position the joint according to the model, we manufacture a custom-made positioning mouthguard. The mouthguard controls the height and position of the jaw, promoting the development of correct jaw movement habits.
The outcome of wearing the mouthguard is assessed by two markers:
1) Innervation testing using functional tests. With the joint positioned correctly, pressure on the nerve bundle is eliminated, and the innervation of the muscle chains should improve.
2) Control CT scans. One week after wearing the mouthguard, we perform follow-up CT scans to assess the joint position before and after wearing the mouthguard.
Computer modeling of joint function
This video shows how each TMJ joint is modeled.
Modeling of a dissociative cap
This video shows how a mouth guard is modeled after the TMJ joints are separated.
2. Restoration of muscles and ligaments
It's important to understand that when wearing a mouth guard, the muscles and ligaments resist any changes in the jaw/joint position. Therefore, it's important to combine wearing a mouth guard with simultaneous muscle and ligament rehabilitation.
Using physiotherapy, we eliminate old muscle memory and muscle spasms and achieve uniform muscle tone. This facilitates the correction process, making it faster and less painful.
The main tools for restoring the muscles and ligaments of the jaw joint are shock wave therapy with the Swiss Storz Medical device and individual manual therapy for each ligament.
Hyaluronic acid and medication can also be used to restore joint elasticity.
Using kinesitherapy, we engage all the muscles necessary for jaw function.
Using physiotherapy, we eliminate old muscle memory and muscle spasms and achieve uniform muscle tone. This facilitates the correction process, making it faster and less painful.
The main tools for restoring the muscles and ligaments of the jaw joint are shock wave therapy with the Swiss Storz Medical device and individual manual therapy for each ligament.
Hyaluronic acid and medication can also be used to restore joint elasticity.
Using kinesitherapy, we engage all the muscles necessary for jaw function.
3. Working with the bite
After restoring the musculoskeletal system and eliminating the main symptoms of TMJ dysfunction, the results should be consolidated. This can only be achieved by correcting the bite and creating a proper occlusal key. A proper bite realigns the jaw joints, halts joint degeneration, and ensures proper musculoskeletal function.
Depending on the indication, treatment with braces/aligners or restoration of the desired tooth height with veneers or crowns may be prescribed to correct the bite.
Please note
Below you can see how a person's face changes after restoring the proper position of the joint and occlusal key.
Elena came to us with pain and crunching in her jaw joint, along with intermittent tinnitus. It should be noted that all symptoms have been eliminated following treatment.
Depending on the indication, treatment with braces/aligners or restoration of the desired tooth height with veneers or crowns may be prescribed to correct the bite.
Please note
Below you can see how a person's face changes after restoring the proper position of the joint and occlusal key.
Elena came to us with pain and crunching in her jaw joint, along with intermittent tinnitus. It should be noted that all symptoms have been eliminated following treatment.
Digital diagnostics for TMJ dysfunction
The purpose of diagnosis is to identify what exactly led to TMJ dysfunction, as well as what consequences of the dysfunction exist today.
During diagnostics, we evaluate the condition and function of the jaw joints, cervical vertebrae, the muscular-ligamentous system, the correct bite, the condition of the periodontium and the condition of the bone structures of the joint.
The diagnostic consists of 7 stages
and takes 2 hours.
Price - 8500 UAH.
Based on the information received, a consultation is held, a treatment plan is drawn up, and an extended consultation is conducted.
During diagnostics, we evaluate the condition and function of the jaw joints, cervical vertebrae, the muscular-ligamentous system, the correct bite, the condition of the periodontium and the condition of the bone structures of the joint.
The diagnostic consists of 7 stages
and takes 2 hours.
Price - 8500 UAH.
Based on the information received, a consultation is held, a treatment plan is drawn up, and an extended consultation is conducted.
1) CT scan of both jaws, jaw joints, and cervical vertebrae - allows for an understanding of the condition of the teeth, root canals, bone, joint position, and cervical vertebrae;
2) Dental scanning - allows for an assessment of the correct bite (correct occlusion of the teeth);
3) Periodontal screening - necessary for assessing the condition of the gums and the volume of the root bone;
4) Photographic protocol - allows for an assessment of the condition of the teeth (presence of chips, cracks, wear), as well as the presence of facial asymmetry caused by uneven muscle tone or bone deformity;
5) Assessment of the amplitude and trajectory of jaw movement - provides an understanding of the presence of joint restrictions and movement asymmetries;
6) Myography - allows for an understanding of the condition of the muscles and the detection of desynchronization of the musculoskeletal system in the jaw system. 7) Innervation testing - allows us to understand whether the nerve bundle is being pinched by the current position of the joint, which can cause additional symptoms throughout the body.
2) Dental scanning - allows for an assessment of the correct bite (correct occlusion of the teeth);
3) Periodontal screening - necessary for assessing the condition of the gums and the volume of the root bone;
4) Photographic protocol - allows for an assessment of the condition of the teeth (presence of chips, cracks, wear), as well as the presence of facial asymmetry caused by uneven muscle tone or bone deformity;
5) Assessment of the amplitude and trajectory of jaw movement - provides an understanding of the presence of joint restrictions and movement asymmetries;
6) Myography - allows for an understanding of the condition of the muscles and the detection of desynchronization of the musculoskeletal system in the jaw system. 7) Innervation testing - allows us to understand whether the nerve bundle is being pinched by the current position of the joint, which can cause additional symptoms throughout the body.