jawbone | Sleep & TMJ Therapy

TMD Treatment: So Why Does This Treatment Take So Long?

bpadmin (lorna.goodman) — Wed, 18 Dec 2024 20:38:02 +0000

In so many of our cases, the person we treat must wear their dental oral appliance for at least a year or so to see if the articular discs will actually return to their proper place in their socket. In almost every case these past years, the condyle (top of the jawbone) goes so deeply into the glenoid fossa (the socket for the jawbone) that the articular disc (the cartilage material that covers the top of the jawbone) is displaced out of the socket. It is kind of like if your kneecap slipped off and is now off to the side- the pain can be quite extreme. Well, the condyle and disc are similar. If the articular disc is slipped off the condyle, it can and will rub into nerves and blood vessels and can lead to extreme discomfort.

In many of our cases the articular disc has been displaced for years, so to expect it to simply go back into proper position in just a month or two is not logical. Generally, we reassess your situation after working on the problem for a year or so. Most people will notice a change with the appliances in, but it takes about a year to figure out if they are doing better. If there is no improvement surgery may be recommended or just continue wearing the appliances a bit longer.

In almost all cases, the patient is doing better with their appliances even if the new MRI still shows some displacement. This is why TMD treatment can be so complicated. You really do NOT need to have a displaced disc go totally back into the socket. As long as you stop the condyle from pounding into the disc, the patient can feel better and live a good life even though

the discs may not be where they ideally should be.

In almost all cases, I can help our patients in managing the displaced discs for many years to come. Case in point; I am helping two of my immediate family members manage double displacements in both joints. The reason it works is that we took our time in the appliance therapy phase–a good year or more–and then ever so slowly erupted the back teeth so they would properly support the condyles and the discs in the sockets. Because of this, the surgery rate in my office is only one percent. That means of the 100 patients that I see in a week, only one person on average will be a surgical case. Not a bad percentage!

So, after a year or more of wearing dental oral appliances, we have to finish the case with orthodontics or crowns. Doing orthodontics is slow, boring and annoyingly time-consuming. You wear either braces or aligners for at least two to three years, and sometimes longer. The reason for this is that the back teeth need to erupt; i.e. grow upward along with the gum and bone around

them, and this process is very slow at all ages. That patient is also advised to consume a cup of bone broth daily to help stimulate the osteoblast cells (the cells that help bone grow).

So there you have it. Nothing I do is fast or exciting, but it works quite well for just about everybody. This is what I like to explain at the initial consult; allow me the time I need to help you and it is highly likely that you will feel better in the coming months!

If you currently struggle with TMJ issues and want to learn more about TMJ treatments in Falls Church, Virginia, please reach out to us. Dr. Jeffrey Brown and our team at Sleep & TMJ Therapy are excited to assist you! Just call 703-821-1103 today to learn more or schedule a consultation with Dr. Brown.

The post TMD Treatment: So Why Does This Treatment Take So Long? first appeared on Sleep & TMJ Therapy.

TMJ Disc Perforation Explained

bpadmin (lorna.goodman) — Wed, 27 Nov 2024 07:20:04 +0000

Experiencing jaw pain or discomfort can be alarming, especially if it interferes with your daily life. A common issue related to jaw pain is a perforated TMJ articular disc. The temporomandibular joint (TMJ) plays a crucial role in connecting your jaw to your skull, allowing for smooth movement. However, when the disc within this joint becomes perforated, it can lead to significant discomfort and potential complications. Understanding this condition is the first step toward effective management and relief.

Understanding the Temporomandibular Joint (TMJ)

The temporomandibular joint (TMJ) is a vital and intricate structure in the human body. Situated on either side of your head, just in front of your ears, the TMJ functions as a sliding hinge, enabling various jaw movements such as opening, closing and lateral motion. This joint is essential for daily activities like chewing, speaking and yawning. Within the TMJ, a small, cartilage-based articular disc serves a crucial role in cushioning the joint, absorbing shocks, and ensuring smooth interactions between the jawbone and the skull. The disc’s integrity is vital for the proper functioning of the TMJ, as any damage can disrupt its role and lead to significant discomfort. When an articular disc is slipped or displaced off the condyle (top of the jawbone), this can cause significant pain in the head and neck region. A displaced disc is also associated with headaches, migraines, dystonia and even tremors.

What is TMJ Disc Perforation?

TMJ disc perforation is a condition where the articular disc within the temporomandibular joint develops a tear or hole. This issue disrupts the disc’s normal function of cushioning and stabilizing the joint, leading to misalignment and improper movement of the jaw. The compromised disc can no longer provide the necessary support, resulting in pain, inflammation and restricted jaw movement. Disc perforation represents a more advanced stage of TMJ disorder, requiring medical attention. Factors like chronic teeth grinding (bruxism), trauma or underlying arthritic conditions can contribute to the wear and tear of the disc, making it more susceptible to perforation. Early identification and intervention are essential to manage this condition effectively. A properly done MRI of the TM joints is the best way to analyze the problem and identify the perforated disc. However, getting that excellent imaging is quite difficult for some reason. Again, lack of awareness amongst the medical professionals makes dealing with TMJ disorder understandably difficult.

Causes and Risk Factors of TMJ Disc Perforation

Several factors can contribute to the development of a perforated TMJ disc. Chronic clenching or grinding of teeth, also known as bruxism, is a major contributor, as it places excessive stress on the temporomandibular joint. Trauma to the jaw, such as from an accident or a physical impact, can also result in disc perforation. Additionally, certain arthritic conditions, such as osteoarthritis or rheumatoid arthritis, can weaken the disc and make it more prone to tearing. Structural abnormalities of the jaw, either congenital or acquired, can also increase the risk. It is important to recognize these risk factors early to implement preventive measures and seek timely medical advice for effective management.

Symptoms of TMJ Articular Disc

Symptoms of a perforated TMJ articular disc can vary widely among individuals, making it essential to recognize the signs early. Persistent jaw pain is one of the most common symptoms, often exacerbated by activities like chewing, speaking or yawning. You might also notice clicking, popping or grating sounds when you move your jaw. These noises occur due to the misalignment and instability caused by the damaged disc. Another symptom to be aware of is difficulty opening or closing your mouth fully, sometimes referred to as jaw locking. This can be particularly alarming and uncomfortable. Swelling and tenderness around the temporomandibular joint are also frequently reported, adding to the overall discomfort. In some cases, individuals may experience headaches, earaches, fullness in the ears and even tinnitus (ringing, buzzing and hissing) as the TMJ is located near the ear canal. These symptoms can significantly impact daily activities, emphasizing the need for timely medical consultation.

Treatment Options for TMJ Disc Perforation

Treatment options for a perforated TMJ articular disc range from conservative approaches to surgical interventions, depending on the severity of the condition. Non-surgical treatments often serve as the initial step, aimed at alleviating symptoms and improving joint function. In almost all cases an orthotic is commonly recommended to reduce stress on the TMJ. The orthotic device is always placed on the lower teeth and must be worn 24 hours per day to reduce the loading effect on the joints.

In cases where conservative treatments are insufficient, surgical options may be considered. This type of surgery allows for a more comprehensive view and treatment of the joint structure. The appliance worn is converted into a surgical splint and adjusted every month for about 6 months. This allows for healing from the surgery where the disc was replaced on top of the condyle (Disc plication surgery) or if severely damaged then the disc will be removed (meniscectomy).

Additionally, some patients may benefit from regenerative medicine techniques, such as platelet-rich plasma (PRP) injections, which aim to promote healing and reduce inflammation in the joint. These treatments are often considered experimental and should be discussed thoroughly with a healthcare provider.

Ultimately, the choice between conservative and surgical treatments should be made in consultation with a TMJ specialist, who can tailor the treatment plan to the individual’s specific condition and needs.

Preventing TMJ Disc Perforation

Preventing TMJ disc perforation involves proactive measures to minimize risk factors and maintain joint health. Stress management is essential, as reducing stress can help prevent teeth grinding and clenching, which place excessive pressure on the TMJ. For those who grind their teeth at night, wearing a mouthguard while sleeping can provide a protective barrier that reduces the impact on the joint. Keep in mind this is only while you wear it. It should be understood that a nightguard can only be worn if the patient is cleared for obstructive sleep apnea and underlying TMJ disorder. Be sure you see a real TMJ specialist who understands the implications of the guard. Regular dental check-ups are important for identifying and addressing issues like bruxism early on.

Maintaining good posture, especially while working at a desk or using electronic devices, can also reduce strain on the jaw and neck muscles. Being aware of your jaw movements and avoiding habits like chewing gum or biting nails can help reduce unnecessary stress on the TMJ. If you participate in contact sports or activities that risk facial injuries, wearing appropriate protective gear can help prevent trauma to the jaw.

Dietary choices can also play a role in prevention. Consuming softer foods and avoiding those that require extensive chewing can help minimize strain on the TMJ. Additionally, incorporating jaw exercises as recommended by a healthcare provider can strengthen the muscles around the joint, promoting better support and function.

By adopting these preventive measures, individuals can reduce the risk of developing a perforated TMJ disc and maintain overall joint health. Regular follow-ups with a TMJ provider ensure that the condition is monitored closely, and treatment plans can be adjusted as needed. Using pain management techniques can significantly improve daily comfort and quality of life.

By adopting these strategies and remaining vigilant about their condition, individuals can better manage their symptoms and lead a more comfortable, active life.

Do you struggle with TMJ issues and want to learn more about TMJ treatments in Falls Church, Virginia? Dr. Jeffrey Brown and our team at Sleep & TMJ Therapy can help! Please call our office at 703-821-1103 today to find out more or schedule a consultation with Dr. Brown.

The post TMJ Disc Perforation Explained first appeared on Sleep & TMJ Therapy.

So, What Is Cortical Erosion?

bpadmin (lorna.goodman) — Wed, 18 Oct 2023 06:07:26 +0000

In the world of TMD, cortical erosion most often refers to erosion and breakdown of the condyle (the top of the jawbone). It can also mean breakdown of the socket that holds the condyle. Basically, cortical erosion refers to a bony degeneration that occurs over time and this can lead to the condyles and joints being very prone to breakage eventually. This is why treating TMJ disorder should be done in a timely fashion- i.e. don’t wait!

In most cases, when the MRI is ordered of the TM joints, it is patently clear when there is cortical erosion of either the condyle or the fossa (socket for the condyle). The radiologist will most likely indicate that the articular disc (that protects the condyle) is displaced and thus the condyle is now exposed and is bone on bone in the fossa. This is not a good situation and can lead to all sorts of pain, asymmetry, and other problems in the head/neck region. Think of it like this: If the disc is slipped off the top of the condyle, it can no longer protect your condyle from banging into the socket bone-on-bone. Diagnosis: OUCH!

The cortical erosion of the condyles and fossas can also be diagnosed with the X-ray called CBCT (Cone-Beam Computed Tomography). The CBCT allows the dentist or the radiologist to look very precisely at the condyle and fossa and if erosion has begun it can be clearly seen in the images. Even though some people do not like taking the CBCT due to the radiation, it is really important to do these images every few years to follow up on the cortical erosions.

So, what does one do when cortical erosions are present? Well, in most cases it’s called ‘watchful waiting’ where the doctor checks the range of motion on a regular basis to make sure the erosions are not doing more obvious damage. You should wear your mouth appliance(s) accordingly to protect the joints. And every few years, just re-take the images and compare them to the previous images.

Unfortunately, if things worsen, surgery is sometimes all that is left to offer to a person with severely damaged joints. There are several types of surgery. The simplest surgery is called plication of the articular discs. This means just moving the slipped discs back into the proper position to reduce the risk of bone-on-bone damage to the condyle and fossa. The next level of surgery entails what is called menisectomy – removal of the damaged discs. If the discs are fully removed, this enhances the risk of bone-on-bone, condyle to fossa, banging or pounding. As long as the appliance (splint) is worn, this is not a problem. Unfortunately, if things get worse, then TJR (Total Joint Replacement) is indicated. This is a big surgery but very rarely indicated.

As with most health issues: Treat early and keep a careful watch on your health!

The post So, What Is Cortical Erosion? first appeared on Sleep & TMJ Therapy.

The Case of: “Why Does This Take So Long?”

bpadmin (lorna.goodman) — Wed, 06 Sep 2023 06:32:30 +0000

This is a question we hear at Sleep and TMJ Therapy almost every day. When a person hears that they need to wear an appliance or two for 12-18 months they almost inevitably want to know why it takes so long. Many people feel that the slipped discs can just be ‘pushed back into place’ and then the problem is fixed. It just does not work that way, although we all wish it would be that simple. The real problem with slipped discs is that you have to figure out how they got that way: Could it have been trauma? Maybe there was an accident that popped them out of place? Or what we see in so many cases are the back teeth are simply not tall enough to keep the condyle (top of the jawbone) from banging too hard in the socket.

Diagnosis of the problem is paramount. A really well-done MRI is critical in determining the path of treatment, and many times getting good imaging is quite difficult. So here is the first ‘delay’ in fixing the problem, getting an appointment for a well done and well-read MRI. It can take several weeks to get that appointment and quite honestly some people just do not want to wait. I can’t blame them either. Let’s get it done now!

The next delay is just getting an appointment at the office to discuss all the issues. This is where we look at the bone from the CBCT X-ray and the soft tissue from the MRI. In most cases, people want their insurance to pay at least something and that in turn creates the next delay. Next on our list is the fact that with TMJ appliances, they are custom-made. This takes time. They are not something sitting on the shelf, ready to put in the mouth. It takes weeks to make them since they are custom made for each person.

Now let’s get to the next big delay. You have to wear the devices for 12-18 months to give the discs a chance to move back into the proper position. That’s right folks, it takes that long, especially if the discs have been displaced for several years. The discs don’t just fall back into place instantly. It will take time and patience. Of course, some are not willing to devote such time (and patience) to their health, so they do not do anything. That is OK as not everyone is experiencing the same level of pain or discomfort. When it gets really bad, the patient will pursue treatment but generally now the problem is harder to fix, costs more, and takes more time. This is like most things in life.

Finally, the biggest time consumer of all – finishing after the discs are back in place. In most cases, orthodontic work is needed to grow the teeth taller to protect and support the TM joints (the jaw joints). Orthodontics can take 1 ½ -3 years, easily! So here you are, having spent all this time on appliances only to realize it’s going to take another couple of years. You are basically dedicating up to 4-5 years of your life toward fixing a TMJ problem. This is why we always tell our patients phase one is appliance therapy and phase two is finishing. Thus, the question has been answered. Now you know why TMJ treatment can take so long!

The post The Case of: “Why Does This Take So Long?” first appeared on Sleep & TMJ Therapy.

How Oral Health Affects the TM Joints

bpadmin (lorna.goodman) — Wed, 05 Apr 2023 06:29:57 +0000

It is really important to be aware of your oral health for so many reasons. Let’s start off with something that is considered to be really obvious; the loss of a tooth. When gum disease or a cavity gets to the point where a tooth is damaged beyond repair, it is likely that you will have to extract that tooth. This is a shame because once that tooth is gone, it becomes quite costly to replace it. Many years ago, it was so much easier to ‘just pull it out’ because this was simple and cheap. More recently, if your dentist was to extract a tooth, they would suggest a dental implant to replace that missing tooth. Unfortunately, this is expensive, and surgery would be needed. This is why so many people do not replace a missing tooth.

Another aspect of having a tooth pulled out is that upon removal of the tooth, the bite on that side will experience an almost immediate collapse in which the jawbone (condyle) will now go more deeply into the socket. This is where a TMJ problem begins. When that condyle jams further up into the jaw socket, it will impinge on the articular disc that covers the condyle. This can cause a gradual displacement of the disc and subsequent TMJ disorder. If multiple teeth are removed this can readily lead to the discs being pushed way out of proper placement and this can be quite painful for so many people.

With periodontal disease, the bone and gum support around the tooth becomes weaker over time. This can lead to the tooth getting loose in the socket and it can no longer be a good vertical support for the jaw joints. Just like the foundation of a house, if it starts to rot away, the whole house can tip sideways. The jaw is similar. If the teeth become looser due to periodontal disease, this can destabilize the jaw joints and the discs in those joints can become damaged more readily. By maintaining good periodontal support for your teeth, this will help the jaw joints stay healthier and stronger.

Unfortunately, oral cancer should be mentioned in this blog. Cancer in the mouth can lead to loss of teeth and bone which of course can lead to loss of TMJ support. This is why it is so important to keep up with your dentist and at least yearly have them do an oral cancer screening. This screening only takes a few minutes, yet it could save your life and your health. So many people are very afraid of cancer but if detected early enough it is fairly easy to treat.

As Dental Health awareness month is April, be smart and reach out to your dentist about your dental health. Ask questions. Ask if they are checking for periodontal disease. Ask about cavities. And most importantly, ask if they are checking for any signs of oral cancer or other diseases.

The post How Oral Health Affects the TM Joints first appeared on Sleep & TMJ Therapy.

Are Teeth Extractions Helpful?

bpadmin (lorna.goodman) — Sat, 30 Jul 2022 06:02:26 +0000

In the past, it was quite common for an orthodontist to order extractions of perfectly good teeth to make the process of moving teeth and creating space with the use of braces easier. So many children are now presenting with narrow arches and crowded teeth that it made sense (somewhat) to remove the crowded teeth, thus allowing the orthodontic work to go faster and easier. But somewhere along the way a few practitioners noticed that the removal of the bicuspid teeth would often cause the upper and lower jaws to collapse backward which would lead to a collapsing of the airway as well. They also rather astutely noticed that the palate would become smaller, which made breathing more difficult as well. There are still orthodontists today who practice the method of extracting the teeth to make room and the braces go easier. However, many more are learning that there just might be better techniques.

The extractions of impacted teeth are a completely different need but also can cause the same issue. In this situation, the teeth need to be removed because 1) the lack of space in the bone means the teeth cannot erupt or 2) the tooth is growing in the wrong direction or position. In this situation, the stress placed on the jaw joint can cause the disc to be displaced and in addition, put a strain on the muscles around the jaw joint.

Of course, another method of expansion is the good old-fashioned RPE (Rapid Palatal Expander), but even this has its issues. The RPE will often just open the palate rapidly and the midline suture might not form into solid bone — it might just be a cartilaginous suture that can move around over time. This would not be very effective. The reason is on a skeletal level this instability can cause changes and distortions in the cranium. Another approach to getting some expansion is to use the ALF appliance as much as possible with the understanding that a few months with the RPE might be OK.

Another problem that is frequently seen among dentists, pulling out bicuspids, which makes the upper and lower jaws move and therefore are no longer in the same position as previously. This change can affect how the condyles (top of the jawbone) fit into the sockets and in turn, can lead to a TMJ problem. When that condyle is re-positioned after extractions, it will no longer be in the same relationship to the disc that covers it. The disc can end up displaced over time. This is what can lead to head and neck pain. So many extraction patients end up with similar problems later in life.

There are some practitioners who will actually use a palatal expander to re-open the extraction spaces to put in dental implants to ‘restore’ what was taken away. This is actually a controversial topic. As we get a bit older, the bones in the skull do indeed become more solid and if you were to try expansion a lot — like the width of a bicuspid that had been removed — it might be too much for the body to handle. Does that make sense? It might be that the expansion is just too much of a ‘stretch’ and moving bones around might lead to more pain. This is another reason why the more conservative practitioners would use the ALF appliance to get as much gentle expansion as possible while minimizing trauma to the facial bones.

So, in general, extractions for the sake of doing braces may not be the best idea. Be sure to be careful when considering this.

The post Are Teeth Extractions Helpful? first appeared on Sleep & TMJ Therapy.