TMD/TMJ DIAGNOSIS AND TREATMENT
The TMJ is considered the most complex joint in the human body. It is not a hinge joint as some used to believe, but a gliding-hinge joint. It is not the center of lower jaw rotation as it is suspended in “space” by ligaments and muscles much like a puppet on strings. This suspension allows the lower jaw to move up and back as well as down and forward and side to side.
In the presence of a malocclusion or bad bite, the jaw joint often becomes dislocated.
- This dislocation can occur in the presence of a deep vertical overbite, upper front teeth that have a “pushed-
in” appearance also known as a retrusive position, or in the presence of a narrow upper jaw particularly one
that tapers anteriorly.
- Upon clenching, the lower jaw is forced in a more backward position due to the dominance of the malocclusion eventually leading to dislocation of the jaw joint.
- Clicking or popping sounds in the jaw joint are signs of dislocation in the presence or absence of pain.
- Grating sounds in the jaw joint are indications of degeneration.
The Dierkes System of advanced diagnostics for TMJ disorders is considered to be the most comprehensive in the TMJ field today. We use the most advanced diagnostic technology available coupled with many years of experience in actual patient care as a specialist.
Our holistic approach to care requires an in-depth evaluation of structural imbalances as well as systemic issues including nutrition, mineral imbalances, hormonal imbalances as well as culinary lifestyle choices regarding the food we eat.
The Dierkes System of All Things Considered™ is the most comprehensive approach to the diagnosis and care of the individual suffering from head, neck, facial, ear, and shoulder pain related to jaw dysfunction available anywhere.
COMMON SYMPTOMS OF TMJ/TMD
Patients suffering from TMD (TemporoMandibular Dysfunction) may typically have one or more of the following symptoms. For some patients, the symptoms will be minor with nothing more than minor head and neck tension or tightness. For others, severe headaches of migraine intensity, hearing, and vision problems can manifest
Common symptoms include but are not limited to the following:
- Neck pain
- Facial pain
- Ear pain
- Jaw pain
- Shoulder pain
- Back pain
- Eye pain
- Dizziness and vertigo
- Ringing of the ears
- Auditory impairment
- Congestion of the ears
- Clicking or popping of the TM joints
- Limited mouth opening
- Opening deviation to the right or left
- Locking of jaw
- Posture problems
- Difficulty swallowing
- Visual disturbances
- Numbness or tingling of extremities
- Shoulder or back pain
The Diagnostic Process will include the following:
- Advanced CBCT imaging with “green” technology to determine jaw joint integrity
- Computerized jaw tracking and EMG (electromyography) to determine the neuromuscular contribution to the
- Cervical spine imaging to determine the degree of cervical contributions and posture assessment
- Lateral cephalogram to determine dental and skeletal contributions to the dysfunction.
- CBCT for airway and TMJ images
- Acoustic rhinometry and pharyngometry to objectively and non-invasively evaluate airway dynamics. As far as
we know, our office is the only TMJ/orthodontic office who has this technology on the premises.
- Digital scans of the dentition to evaluate the bite and occlusal contact discrepancies
- Digital photographs
Treatment often involves the use of an orthopedic device worn on the lower teeth to reposition a dislocated jaw joint. Even a 1.0 mm discrepancy can mean trouble. The modalities that can be used to eliminate pain and address the structural dislocation are listed below to give you some idea of the initial sequence of care:
- Initial placement of a lower, soft appliance is used to begin the process of establishing TM joint integrity with the aid of TENS
- A subsequent bite registration to accurately record an optimal jaw position for fabrication of the acrylic appliance or orthotic.
- Use of TENS to relax the muscles and to allow the jaw joint to move into a relaxed muscle-dictated position to be maintained by the appliance
- Physical therapy
- Trigger point injections for areas of referred pain
- Prolozone injections to eliminate pain related to muscle spasm due to reduced oxygen levels and to assist in regeneration of cartilage in joints that have arthritic damage
- Mineral and hormone assessments
- Ozone sauna
WHAT TO EXPECT AT YOUR FIRST VISIT
Upon your initial visit, a screening image called a tomogram will be obtained for each TM joint to initially assess the “ball and socket” spatial relationships and to determine whether or not there is any degenerative changes present. A dental and medical history is then obtained to help Dr. Dierkes determine any systemic and/or dental contributions that may be influencing the signs and symptoms of TMD.
A clinical evaluation is performed to determine your range of mouth opening and the relationships of your upper and lower teeth to each other. The muscles of the head, neck and shoulder areas will be evaluated for any tender areas as well.
Dr. Dierkes will then explain his initial findings and make his initial recommendations for care. Please refer to All Things Considered™ to gain an understanding regarding all factors that may need to be evaluated for proper care of TMD. It is this naturopathic or holistic approach to care that has made The Dierkes System of care so uniquely successful. A TMJ appliance is foundationaly important to address the structural contributions of TMJ dislocation and lis usually the basic starting point, but proper care is considerably more than a mouthpiece or an appliance. Said in another way, a naturopathic physician will ask the following question: “What else is going one?”
Treatment for TMJ/TMD will vary by patient and be customized to address the specific problems you are experiencing.
For questions, please schedule an evaluation by Dr. Dierkes today.
Dr. J. Michael Dierkes, DDS, MS, NMD is a nationally recognized orthodontic specialist who has been creating beautiful smiles for over 30 years. His services have improved the lives of people from Roswell and the surrounding areas, including residents of Sandy Springs, Alpharetta, Marietta, and Atlanta. Whether you are an adult, a child, or a teenager, our knowledgeable staff is committed to helping you achieve the radiant, beautiful smile you deserve. Please call us today to schedule your initial consultation!