Well, that’s a big name for a little joint that has the greatest range of motion of any joint in the body. It regulates a large part of the brain. Its function effects almost all the rest of your body. The Temporomandibular joint is the name of the joint formed between the base of the skull (temporal bone) and the lower jaw (mandible). There are many names that describe a dysfunction of this joint. For brevity and to save my fingers typing it out so many times, I will use the acronym TMJ. Most people have heard of this at some stage and if you haven’t then buckle in for a fascinating ride.
There are 136 muscles above and below the jaw that are responsible for jaw movement.
Grinding and Clenching are the most common causes of throwing out the position of this joint. There may be other causes which include a short leg, badly done orthodontics, lack of teeth, cranio-sacral imbalance, chronic poor posture, such as reading your phone all day.
What causes you to grind your teeth? We know what it is like when you hate your boss, or your partner is just a little trying. These are called stress! How about the stress of massive electric currents flying through your head caused by the battery in the metals in our mouth? Let’s not forget the toxins that come from dead root canaled teeth, or the toxins that are coming from gum disease. How about that Stainless Steel wire that has been glued permanently to the back of your front teeth as a so called ‘orthodontic’ retainer. Perhaps the filling you had done a year ago is still throwing your jaw out just a bit. Perhaps the cell tower outside your bedroom window is reacting with the titanium implants that you just spent your life savings on.
Headaches, migraines, neck stiffness, blurry vision, are the most commonly discussed symptoms that may come from a displaced TMJ. Some others may include psychological effects, neurological effects, cardiac conditions, reduced libido, scoliosis and other spinal problems, chronic constipation, foggy head and a host of other weird conditions.
How is it possible that so many medical conditions could be related to such a little part of your body? How do we diagnose the relationships? How can the medical world treat these conditions without understanding the effect that this joint can have on the rest of your body? You may be starting to get the picture that this is a complex field of dentistry.
Stress
In modem western societies, stress related syndromes are all too common. Stress is known to play a role in the production and maintenance of many disease states. When we talk of stress, we’re conditioned to bundle many stressors under one umbrella. Mostly it is thought of in psychological terms. It’s not just the boss, the wife/husband, or the kids. Often, we will have other factors that act as stressors on our bodies. We can identify several major stressors, which can be grouped into some basic categories; Psycho-emotional, Biomechanical, Environmental, Heavy Metals, Electrical, Toxins, Diet.
Temporomandibular Joint (TMJ) Dysfunction, falls into the category of BIOMECHANICAL stress. If the jaw joint is malpositioned it will act as a permanent, non-self-correcting stressor. Due to the complexity of this joint and its relationship to different body systems, we see a great variety of symptoms. The most common are head and neck pain.
Whatever the source of the stress, most people will initially have a similar physiological reaction. This is what Hans Selye, who published in the 1970s, calls the ‘General Adaptation Syndrome’. It is the way we cope with stress at a cellular and biochemical level. Initially we all react similarly to stress. Our sympathetic (fight flight) nervous system takes over and heart rates go up, blood pressure goes up, blood supply to arms and legs increases, fluid pressure in teeth is reduced (long term this increases decay rates), blood supply to the gastrointestinal tract is reduced, (long term constipation, bloating, pain). Peristalsis in the GIT is reduced, (long term constipation, pain). Eyes remain more dilated, (long term bright light sensitivity). It can be likened to the accelerator in a car.
When the stressful situation passes, the parasympathetic nervous system takes control again, and all of the above physiology comes back to normal. This is like the brake pads. They are used to slow it all down again.
If the stress continues for long enough (which is different for each of us), we will then start exhibiting clinical symptoms. The symptom pattern will manifest according to our individual make-up. Your weak point is different to mine etc. If the stress is long term, such as TMJ dysfunction, it’s like driving with a foot on the accelerator and another on the breaks. Eventually the brake pads wear out and we are left with symptoms of ‘sympathetic nervous system overload’, as described above. There are many stressors which are ‘permanent’ and need to be addressed.
The Temporomandibular Joint
Both the left and right joints must work in unison whenever we move our jaws. In effect these two hinge joints are really one related unit. This unit is closely associated with the first two vertebrae in your neck. The Temporomandibular joint is the most complex joint in the body. It can move in a multitude of directions which includes moving completely out of the joint space when the mouth is fully open. The resting position of the joint is determined by the condition of the bone, by the muscles which move the jaw and, in particular by the way the bottom and top teeth meet. This is called the occlusion. Any or all of these may hold the joint in an abnormal position. The cartilaginous disc is an important component. It separates the condyle from the base of the skull and acts as the lubricant to allow the condyle to slide forward when the mouth is opened. It slides with the condyle and is attached to the skull at the back of the disc, by elastic tissue which pulls if back when the mouth is closed.
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X-rays
To visualize the position of the condyle in relation to the base of the skull on an x-ray is possible. Normal dental x-rays like OPG’s and 3D cone beam x-rays do not show this relationship accurately.
A TMJ Tomogram is the only way to get the correct relationship. This angles the x-ray beam directly down the axis of the condyle, which is a flattened football shape. It is not a ball or a flat surface. The mouth must be closed when taking this picture. Information can also be obtained by taking a similar image with the mouth fully open.
Abnormal Jaw Movement
If the joint is located in an abnormal position, it will create a pattern of chronic stress on the whole of the body. Most often when there is a problem, the joint will be located distally. It is in the furthest back position in the fossa, or joint space at the base of the skull. Sometimes the joint will be in a mesial, or forward position. This is usually caused by dentistry, eg. when a denture is made that holds the mouth open a little bit too much. Often a high spot on a filling will cause the joint to relocate, as we close our mouths differently, so as not to cause pain in the tooth that is overfilled.
If the condyle is located distally, it will force the jaw to swing to that side as the mouth is opened, an audible click may be heard as it jumps onto the disc, and then the jaw can swing into a more normal opening. The reverse happens when the mouth is closed and sometimes the click happens as the condyle again jumps off the disc.
If the condyle is even more malpositioned, it will actually lock behind the disc and will be unable to jump onto it. This joint will be partly or severely locked and the mouth will swing to that side when the person tries to open. If both are locked there will be a severe limit to how far the mouth can open. You can measure this yourself. Hold your fingers (not thumb) together and vertically. See how many fingers can fit in your mouth. You should be able to get three to four fingers in easily depending on the size of your fingers and mouth of course.
There are three main ways that this joint interacts with the rest of the body – Skeletal, Muscular, Neurologic.
Skeletal Relationships
When the mouth is opened just a few millimeters, the centre of rotation is roughly along the long axis of the joint. As the mouth opens further, the head of the jawbone (condyle) moves forward. When fully open the condyle actually moves out of the fossa at the base of the skull. This then moves the centre of rotation to a point between the first and second vertebrae in the neck. If the joint simply rotated along its own axis we would choke ourselves every time we opened our mouths.
What this means, in practical terms, is that if the joint is malpositioned, the first two vertebrae in the neck will undergo torsion and rotation to compensate. Biomechanically the first three vertebrae in the neck move in the same direction as the last three vertebrae in the lumbar (lowest) part of the spine. If the first two vertebrae are malpositioned, it will force a compensatory change all the way down the spine to these last two or three vertebrae. This will increase the normal bends in the spine and cause scoliosis, kyphosis and lordosis. In other words, there will be an increase twisting in the spine. Often there will be pain at these areas where the bends are most extreme. Usually, mid thoracic and lower back.
Start to pay attention to other people’s posture. Some will stand straight with the head well balanced above the shoulders, the shoulders flat and the legs move effortlessly under a pelvis which also sits horizontally. Believe it or not our posture is regulated by our eyeballs. When standing, our vision will always align with the horizon. The vision will move our bodies so that we are looking at a horizontal plane. If the head is tilted to one side we tend to walk incircles. So, have a look at the next little example.
The jaw is chronically located in a distal position. The joint is backward to where the normal is. This causes the first two vertebrae to tilt forward and then the head points down. To be able to see where we are going, we tilt the head up which brings it forward from the shoulders. We can now see what is in front of us, but there is a lot of weight in our heads that we now have to support. To do this we need to lift our shoulders and bring them forward slightly. In profile we now have a head forward position, a hump at our shoulder level and the arms are hanging forward of the body. The lower back has also compensated, and the last three vertebrae are also tilting more. The backside sticks out a bit more and the legs can no longer be straight to support the weight. There will be pressure between the L5 and your pelvis. There may now be pain radiating down your sciatic nerve in your legs. If this is not bad enough, it is rare to find both TMJs in an equally distal position. Usually, one will be further back than the other. This causes the first two vertebrae in your neck to rotate slightly. This rotation is compensated for by all the other vertebrae in your spine and the curves increase and noticeable scoliosis appears. The shoulder girdle and pelvic girdle are no longer horizontal – one side will be higher than the other.
If severe enough this may cause a strong tilt in the pelvic girdle and thus produce a ‘functional’ short leg. Posture is directly affected.
In the same way if you have a leg which is mechanically shorter on one side, this will tilt the pelvis and cause a compensatory shift up the spine to the base of the skull. Such a situation may then influence the way you close your mouth and produce a malpositioning of the TMJ. People with a short leg will tend to grind more on one side rather than evenly. As well there may be an over eruption of the teeth on one side and under eruption on the other side.
If the vertebrae are chronically malpositioned there may be compression in certain areas which can produce pain and other symptoms created by an impairment of either the blood or nerve supply which emerges between the vertebrae.
Another way of looking at this issue is like comparing this joint to a door sitting in the door frame. If the hinges loosen, then the door no longer fits the frame and will not function correctly. If the house moves and the frame is skewed, the door will also not work properly. The bones of the skull should move very slightly. It is only in western medicine that we are taught that the bones of an adult skull are fused and should not move. This is not correct. The bones of your skull should move, and this movement is quite complex. It is dependent on many factors. This movement is the foundation of Craniosacral Therapy, which was first introduced by Dr William Sutherland D.O. in the early 1940s. This movement is critical for the flow of cerebrospinal fluid and will also regulate the autonomic nervous system.
An effect of the malpositioned TMJ, may be to cause the bones of the skull to become locked. The movements are limited or even reversed. This will have a profound effect on every aspect of your existence. Often it is worth working with a person who is well trained in this field.
Muscular Relationships
There are 136 muscles above and below the jaw that are responsible for jaw movement. The first muscles that contract when the mouth is closed (e.g. chewing, clenching or grinding) are the muscles at the back of the neck. The next muscles which contract are those at the side of the temples (temporalis) and lastly those directly next to the mouth (the masseters and pterygoids). This is always the case. There is a very definite order to the way the muscles work together. This regulation of the muscles is evolutionary. When the head is held rigid there is much greater power to clamp the jaws.
Any situation which causes clenching or grinding of the teeth will therefore cause a contraction of the muscles of the head and neck. If the teeth are chronically clenched, then the muscles will be overtightened all the way down the back. Chronically spasmed muscles will transfer pain to the strangest places. The head will not turn side to side as freely as it should. Movement is usually limited more to one side than the other. People who have a chronically set outlook on life, will often have the muscles of the throat very tight. They too have trouble turning their heads.
Injuries and Soft Tissue Lesions
All bones are covered in a tough fibrous sheath called the Periosteum – literally meaning ‘around the bone’. It is attached to the bone by many fibres that penetrate the surface of the bone. They are called Sharpe’s Fibres. The muscles which are attached to bones, are actually attached to the periosteum by the fibrous sheaths around the muscles, that form the tendons. When the muscle contracts the bone is moved.
Injuries can happen at any part of this system. We’ve all heard of tearing a muscle or tendon. This certainly happens, but these are in fact the strongest part of the system. The weakest part is the Sharpe’s fibres below the muscle attachment. These tear easily. When this happens, we get an area of inflammation around the tear and this area is filled with a little tissue fluid. It has a poor blood supply and therefore does not heal quickly. These little areas are called ‘Soft Tissue Lesions’ – STLs.
If you feel firmly and slowly around the skull, where the muscles are attaching, you may find a spot which is exquisitely painful next to an area which is not. These painful spots are often a small STL. These lesions are common in areas that have been affected by injuries like falling and hitting your head through to major whiplash injuries.
The soft tissue lesions will affect at least three different but related situations. They will cause pain, which may be local but is usually referred. Dr Janet Travell wrote THE book on trigger point therapy called Myofascial Pain and Dysfunction – The Trigger Point Manual Vol 1 and 2. They are still available, and I would recommend that anyone serious about treating TMJ dysfunction should study these and have them in the clinic for referral. Apart from being John F Kennedy’s personal physician, (& the first woman to hold this position) she was the main researcher in this area and the first to bring this knowledge to the world. She describes brilliantly the referral areas of pain from the trigger points in the muscles. The trigger point in a muscle, is the area of the muscle under most contraction. It is often a bit swollen and more painful when pressed, and because of the contraction at this area, it has a slightly reduced blood supply.
This brings me to the second thing that STLs do. They cause the muscle that is associated with it to go into a contracted state. This will then create the trigger point in the muscle and the pains that Dr Travell describes. If the trigger point is caused by a soft tissue lesion, than both must addressed if treatment is to be successful. The way to find the STLs and the TPs is by careful palpation. This is more the way chiropractors and masseurs feel the tissue, rather than what dentists are taught, which is always too superficial to feel anything. (My recommendation is for dentists and doctors is to do some ‘good’ massage courses and learn how to touch and feel.)
When the muscles in the head and neck area go into chronic spasm, they will affect the TMJ as well as the vertebrae in the neck. They will cause compression of the vertebrae. They may affect all structures in the throat from your vocal cords to your ability to swallow. They will affect the way that you close your mouth. If this situation continues for long enough the position of the teeth may be affected. It is worth remembering that although the bones are really tough, it is the muscles that control the shape and alignment of the bones. Just look at people who ride horses all the time. The legs are bowed for a reason.
The third effect of Soft Tissue Lesions is to stimulate the Sympathetic Nervous system (fight/flight). As mentioned earlier, if this is a chronic situation, then the Parasympathetic side cannot bring balance and the symptoms that follow may affect many parts of your being. Endocrine imbalance, adrenal exhaustion, tachycardia, indigestion, angina type pains, fast shallow breathing, libido, and the list goes on.
Neurological Relationship
A large part of the brain is now mapped. We know what most sections do. The parts of the brain that are related to motion and sensation are largely on the surface of the brain in strips that are called the Motor and Sensory Homunculus. A close examination of these parts shows that for the Motor homunculus, about 25% is devoted to the hands and arms, about 15% is for the legs and feet. 8% is for the body. The head, face and mouth take about 50%. The same is true for the Sensory homunculus.
When there is a problem with the TMJ, there will be extra stress in these parts of the brain. The feedback is in both directions. This can cause profound psychological issues, movement issues and changes in sensations.
Examining the TMJ & Neck
I once had the opportunity to watch a doctor testing the TMJ. She put her fingers on the lower jaw quite firmly and asked the patient to open and close. Her conclusion was that it all seemed OK. I’m afraid I couldn’t help myself. I asked her if she knew where the TMJ was. Sheepishly she admitted that she was unsure. This is basic 2nd year anatomy. She was humble enough to ask me to teach her what I am writing below.
In all fairness though, most dentists also don’t know. When feeling for a click or the way the joint is moving, most will use quite firm pressure. This will interfere. It is essential to use the lightest pressure possible with the fingertips just touching the skin over the joint itself. This is the first part of examining. As well, the observation of the jaw movement is important.
Ideally the jaw opens in a straight line without deviating to the side. Sometimes there will be a slight deviation to one side and then the jaw opens straight. This is where the joint is slightly distal and needs to jump onto the cartilaginous disc (the Click) and then it can function correctly. Sometimes the mouth opens but to one side more than the other. It will usually be a straight line, but one side will not move. On that side the joint is so distal that it is locked behind the disc and cannot jump onto it.
Sometimes it is easier to see this movement when looking at the patient from the top down. Lay the person down and sit behind the head while the person opens and closes. Light finger pressure over the joints will confirm what you are seeing.
When examining the neck for STLs and muscle spasm, do NOT have the person lying face down – not even on a massage table which has a hole to accommodate the face. Doing this will exacerbate the problem and will not allow for true palpation. Lying on the back is OK if you know what you are doing. Most often I would palpate these areas with the patient sitting upright or standing.
Remember that when you push on the head the patient will push in the opposite direction. This is normal. Therefore, you must support the head in a way that will allow the normal reflex action of pushing against the pressure, to be removed. If you’re going to push at the back of the head, keep the other hand supporting the forehead on the other side. If you are pushing into the temple area, make sure to have the other hand supporting the head on the opposite temple. Same applies to any other part of the body. If you push on the back of the shoulder, make sure to support the front of the shoulder. In other words, you are pushing with one set of fingertips into your other open hand. Part of the patient’s body is in between your two hands. I would tell the patient to rest their head or shoulder etc against the supporting hand so that they felt comfortable. This only took a few seconds to learn.
How much pressure should be applied? The answer is that it is different for each person and different for every spot you are feeling. Some people feel pain at the lightest of pressure. Be very careful – start light and then gradually build up the pressure. Stop when there is actual pain. Most dentists and doctors palpate by feeling the skin. Rarely do they go deeper. Massage training helps as does anatomical knowledge. You can train yourself to feel below the skin to the muscle. Then below that muscle to the one underneath it. You can feel for the tiny ‘lumps’ or slightly harder tighter areas that are where the STLs are hiding. Often you will release the superficial ones and then find more STLs in the deeper layer of muscle.
One way of training yourself to do this is place a hair that you pull out of your head, (or someone else’s if you are bald like me) onto a hard surface. Cover it with a piece of paper and try to feel for it. Keep increasing the number of sheets of paper till you can no longer feel the hair. Then refocus your attention and feel deeper than that top layer of paper. Start removing the paper one piece at a time and keep feeling for that hair. Chiropractors were trained to feel that hair with 20 pages on top of it. I have the greatest respect for chiropractors and osteopaths. Their sensitivity walks all over what most doctors and dentists think they are feeling.
I was fortunate to work for many years as a masseur and also to have some time teaching in this field. The training that this gave me was a wonderful way to come back into dentistry.
What you will feel, is where your attention is focused. If your focus is on the skin, then that is all you will feel. If you know your anatomy, then you can start refocusing to the muscle below the skin, then to the muscle below that and possibly to the bone below that, till you get to the muscle attachments, some of which are below a couple of layers of muscles. That is when you start finding the STLs.
As you become proficient at this way of palpating, you’ll find that your supporting hand gains a new sensitivity and function. You will be able to feel when you are causing pain before the patient screams. For most of us, as soon as pain is felt, every muscle in the body will go into spasm – a slight twitch. Even very slightly. Just a little twitch. Your supporting hand then becomes a radar which can pick up this split second twitch, and you can regulate the pressure you are applying accordingly.
Whip Lash Injuries
When we are the recipient of a car crashing into the back of the one we are occupying there are a series of events that happen which are going to be called a “whiplash injury”.
As our bodies are pushed forward the head will be the last thing to move forward. Our bodies are pushed violently forward while the head remains in place, effectively being pushed backwards. There will be severe compression in the back of the neck and in the back (distal) parts of the vertebrae. While this happens the jaw will not follow. The mouth will remain open as though the lower jaw was yanked open. The force of this can tear the ligaments at the front and back of the jaw joint. These are now damaged.
The second phase of whiplash is that the head will follow sometimes violently the forward motion of the rest of the body. Remember that the mouth is wide open as this begins to happen. As the head moves forward it may crash down on the lower jaw which could have some serious side effects. Usually, the condyle of the jaw will be forced backward (distally) and end up behind the disc that should be separating the base of your skull from your jaw. As well, this final violent forward motion can cause a series of tears of the Sharpe’s fibres from the base of the skull and all the way down the vertebrae of the neck. STLs will then be palpable all the way down and often further down the spine as well. These STLs must be found and treated.
Sometimes the forward motion of the head is so powerful that the opposing teeth may crack. I have seen this a couple of times where the upper molars were cracked vertically through the roots.
Clearly then, to treat the injury, it is important to address all the relevant components. Teeth must be checked for breakage. A supportive splint needs to be made to support the correct position of the joint. The STLs need to be treated so that the muscular spasms can be minimized.
Soft Tissue Lesion Treatments
These areas have a very poor blood supply and therefore heal slowly. Sometimes strapping may be indicated to limit certain motions until the STL can heal enough not to tear again. Other ways of treating these lesions are to bring blood and energy back into these areas. The treatments will have to be repeated till they heal. This may take several months. WARNING: Initially when treating STLs there may be a release of toxins from the effected muscles that were in spasm, and also an almost immediate rebalancing of the autonomic nervous system. This can be accompanied by feeling a bit poorly and sometimes to feeling nauseous. These symptoms will pass but the warning to go slowly applies.
Ways of treating STLs may include;
- Massage – these areas are rubbed and massaged
- Acupuncture – needles placed into the lesions
- Soft Laser on the lesions. This has been shown to increase the blood supply to the area.
- Neural injections of Procaine – local anaesthetic in the ‘skin’ above the lesions, have been shown to help these areas heal.
Cough Reflex and open bite
Some people have a very poor or weakened cough reflex. They are easy to pick as many will have an accompanying open bite at the front of their mouths. This is caused by the need to push the tongue against the front teeth, so as to be able to roll food back over the palate and then be able to swallow properly without choking. This pressure forces the teeth in the front to form a space between upper and lower. The back teeth are also affected, and the common result is a curved occlusal plane. Instead of being a relatively flat plane, the teeth will form a slight arch – top teeth down and bottom teeth upwards. Usually then the only teeth that touch properly are the first molars or second premolars. This then causes the jaw to rock around these pivots and then the condyle of the jaw joint is often distally displaced – it is too far back in the fossa (joint space) at the base of the skull. This will usually require some sort of orthodontic help as well to correct.
Some Symptoms
Traditionally, TMJ dysfunction was thought to only cause symptoms of pain in the joints and teeth and was sometimes associated with limited mouth opening. More up to date research shows us that, due to the multiple relationships within the body, we must reassess the symptoms related to problems in the jaw joint.
The most common dental symptoms are clicking or popping sounds in the joint chewing difficulty, and pain when chewing, jaw locking in either open or closed position and pain in or in front of the ears.
Often, we see a wide variety of head and neck pain which may range from occasional headaches to chronic migraines. Pains may radiate down the arms and chest. Other symptoms may include dizziness, ringing in the ears, lethargy, depression, fatigue, cold hands and feet, kidney problems, PMT, and some learning disabilities.
There are other symptoms that you may be surprised which respond to correcting the position of the TMJ.
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Dr Aelred Fonder in his book ‘The Dental Physician’, describes a 16 year old boy with Down’s Syndrome. This boy was totally uncommunicative and had all the typical expressions of Down’s Syndrome. He decided to treat him with an upper splint dental appliance that was split down the palate and had a screw that could be used to open and spread the palatal bones. This is done very slowly over weeks. At the next appointment this young boy started to make jokes with the dental nurse and was talkative and communicated well with Dr Fonder. He had grown intellectually from a toddler to a 16 year old in a matter of a month. This state of being continued for several months until one night the palatal appliance broke, and the boy reverted immediately back to his Down’s way of existing.
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Spinal misalignment is common to TMJ problems. Often a chiropractic adjustment may be needed several times during the course of treatment. If the person is young enough and the bones have not yet changed shape, then adjusting the jaw position may be all that is needed to straighten the spine. The images show the before and after x-rays – the after is only 4 days after inserting a lower splint to realign the jaw. No other treatment was used. Just the splint to realign the jaw!
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I once made a splint for a female patient with a severe TMJ dysfunction. After a couple of weeks of wearing it, she came back into the surgery and accused me of ruining her life and demanded I return her money. I had no idea of what had transpired in these two weeks, but I was happy to giver her back the money that she had paid for the splint and even for the initial consultation. This was the first and only time I had such a reaction to placing a splint. None of it made sense to me but to be honest I was just glad when she left. Six months later she called me on the phone and asked if she could take me out for lunch to explain to me what had happened. I was very nervous about accepting this invitation which I did with the condition that my dental nurse also come along (I wanted a witness). She accepted this condition and lunch was served. She told me that for the past six months she had been seeing a therapist. What drove her to therapy though, was that as soon as the splint went into her mouth, she started to have strong memories of the abuse she had suffered as a child. Until then she had no awareness of these deep psychological traumas. She had erased them from her consciousness, but when the splint went in, and the stress came off her craniosacral system, the memories flooded back. Six months of therapy helped her to get this part of her life into perspective, at least enough to take me for lunch, explain what had happened and offer a profound apology for the last time we had met. I am truly honoured by the people who came to see me for treatments.
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Tourette’s Syndrome has classically been known as a psychological illness. All sorts of drugs have been tried to help these people. In Sept 2009 a video was posted on YouTube by Dr Brendan Stack. He was able to help many people with this condition by repositioning their TMJ. That simple. He shows before and after examples and his way of finding the correct position of the jaw joint, using paddle pop sticks. There are now sophisticated computer programs that dentists are using to find the correct joint position and then to treat these patients. Tourette Syndrome is treatable. It does not have to be a life sentence of misery. Simply repositioning the Temporo Mandibular Joint may be all that is needed. It certainly beats a lifetime of antipsychotic drugs which are only of limited value anyway. Everyone should watch this video at
https://www.youtube.com/watch?v=CpiGEO0ueME&t=3s This video is embedded at the end of this page.
Some others that are showing similar results include; https://youtu.be/EArcZruX2oM and https://youtu.be/OD_B4p6nSxg
The effects that a misaligned Jaw Joint can have are profound.
Treatment
First a word of warning. As you have just seen there are many effects on the body, which may have had to compensate, perhaps for years. When a TMJ treatment is started you are not going to only be effecting the jaw joint. The treatments will also have a ripple effect on your whole body. There may be a great deal of change happening by simply putting a splint in the mouth. Some of the changes will take time to happen. If you rush it then you may find yourself going backward with the treatment. Your body will let you know when to ease up. Should you wear the splint all night and all day to make things get better faster? NO! I used to tell patients to try sleeping with the splint. If you get through the night and feel like a new person – great. This does not happen for everyone. If after 1/2 an hour you want to kill someone, then take the splint out and let your system recover. Put it back in for half an hour. Leave it out again for a 1/2 hour. Progress gently and listen to your body. As your body and jaw are going to change, so too the splint will need adjusting. Take your time. After all you are undoing a process that has bee going on for years.
This little bit of plastic in your mouth will affect your whole body. It will try to straighten your spine again. You might experience pains that you never had before. This is unpleasant but normal. Make use of a chiropractor and massage. Acupuncture may help. Be open to getting psychological help also because many times emotions have been locked into our bodies, and we may need help to cope with them. This is NORMAL. Do NOT Rush!
Treatment of TMJ dysfunctions must take a multidisciplinary approach. Generally, the dental part of the treatment is to adjust the way the top and bottom teeth meet so that the joint may be correctly relocated.
In some cases, we may simply need to adjust the height of an individual filling which may be interfering.
Sometimes we may include the provision of a dental splint which is usually worn over the lower teeth and so provide a temporary relocation of the joint. It may need to be used full time, but in most it may only be necessary to wear it at night. Another way of providing the extra support on the back teeth, is to bond plastic filling materials to the biting surfaces of the teeth. This will have the same effect as the splint. If teeth are missing it may be necessary to provide a partial denture or more permanent crowns and bridges. In some situations, orthodontic movement of the teeth may be the preferred option. The forms of treatment are as varied as the individual condition. Each person must be individually assessed. The bottom line is how to reposition the joint in the most effective and long term way.
Other health care providers may also be called on. Often the services of a podiatrist will be needed to correct leg length discrepancies. Massage is always a great help in treatment and maintenance phases. Osteopathic and chiropractic maintenance may also be helpful. Sometimes acupuncture may be needed. People who are skilled in Cranio Sacral Therapy are worth their weight in gold to help TMJ problems.
As with most health conditions, a team effort by the appropriate specialists is the preferred approach to treatment. TMJ problems are the special melting pot of traditional dental and medical skills and those of the natural therapies.