Montrose Star interviews trusted dental authority Dr Randy Mitchmore from his Montrose practice called LifeSmiles.
M.S. For quite some time, I can make my jaw pop when I open it a certain way. Recently, I had these crazy deadlines to meet for work that super stressed me out. All of a sudden, I could not close my teeth together. The harder I tried to close them, the more it hurts. What’s going on?
Dr M You have described the perfect and classic signs and symptoms of TemporoMandibularDysfunction. What used to be called “TMJ” (TemporoMandibularJoint).
M.S. That is a pretty long and sexy name for a condition. Why the name change?
Dr M The TMJ or jaw joint is the most complex joint in the human body. There is one bone with two joints that is held in place by muscles – not a “ball and socket” type joint. Remember the pictures in grade school how a snake can unhinge its jaw and swallow an entire egg or a rat? The human TMJ is similar. When you open and close just a little the two jaw joints act like a hinge. When you put your fingers over your jaw joint (do that now), you can barely feel it. Now open wider like for a yawn or to take a bite of a Big Mac. Your fingers can feel your jaw joint actually unhinge and move forward over a hump. What makes that happen smoothly is a very thin disc between the jaw and the base of the skull inside that joint, and many muscles working in harmony to make it all happen.
You have actually described two different conditions. The popping sound is the disc popping in and out between the bones. The fact that you cannot put your teeth together is not a joint issue but a muscle spasm. 90% of the time that people are having pain or discomfort in the jaw or headaches in the temple area, it is caused by this muscle spasm or over use of the muscles. Nothing to do with the “joint” at all. That is why the name was changed to a dysfunction of the entire apparatus.
M.S. Tell me more about the popping sound.
Dr M It is an interesting thing. You can only make the knuckles in your finger pop one time. Then you have to wait about twenty minutes before you can make it pop again. That is because it is a water vapor that builds up in the joint and you can release it with a pop. A popping TMJ is different in that you can pop it over and over and over. That is because it is the actual disc that is popping in and out making the noise as it slaps against the bone when you begin the “unhinge” movement. Most people can have that condition for years with no outward ill effects. The trouble lies when you either over stretch the muscles and ligaments that draw the disc back into its proper place and it stays out of place or you wear a hole in the disc. Now you have an immediate problem. All of a sudden you cannot close your teeth, or it hurts, or it is really difficult to chew.
M.S. How about the part where I cannot close my teeth together and that really is uncomfortable.
Dr M. This is the more classic part of TMD – a muscle problem. And believe me it can hurt and hurt a lot! Ask me how I know.
M.S I’ll bite. You do you know it is so painful?
Dr M . A while back I had a big pain in my knee to the point I could not walk across the room without extreme pain. I went to see my chiropractor, Dr Kenneth Lester, and he diagnosed it as a muscle problem. He started working on “stripping” out the muscles of my leg. Which means he used long deep massage type strokes to stretch out the muscle spasms. His treatment hurt like hell and he explained that he needed to tear apart the muscles fibers and let them line up and heal. He also informed me that my muscles were very week, my knee cap was off to the side, and I was developing the look of an old man with my head protruding forward instead of over my shoulders. After a few treatments I could not believe all of the pain was from my muscles and I insisted that I probably needed surgery and an MRI.
The MRI proved him right. The knee joint itself was OK. All of the pain was of muscle origin.
M.S. So what causes all of the muscle pain in the face and temples?
Dr M It is a disharmony between three things. The most stable and comfortable position of both jaw joints, the muscles of the face, and how the teeth fit together – your bite. If you have a bad bite, you no longer have harmony and something has got to give over time. Most people adapt to the disharmony but one day the body can’t take it anymore and things flare up. It shows up several ways. It can be muscle tension headaches, ringing in the ears, your face feeling tired when you wake up from grinding your teeth through the night, and nasty signs like your teeth wearing down or chipping, and pain, and more.
M.S. How do you treat it?
Dr M I have developed innovative techniques that we call NeuroMuscular Dentistry. We use a computer that measures the muscle activity of the face called EMG’s, much like an EKG measures the heart. The latest technology that we have added is the TekScan. It is a paper thin plastic circuit board that measures how the teeth bite together. Much more precise than the old fashioned biting on carbon paper! We may use a combination of approaches to correct a bad bite. Those might include orthodontics to move the teeth into a better bite with Invisalign, spot grinding the offending teeth that are out of place, making an orthotic like some people put in their shoe to level their hips, or sometimes putting new biting surfaces on the teeth to make them fit in harmony with the joint and muscles.
If you would like to know more, visit my website and look at NeuroMuscularDentistry. For even more personal information and a diagnosis come and see me !
Dr Mitchmore is active in the community. He serves as Vice-Chairman of the Montrose Management District. His passion is Dentistry. He has also been a City Councilman and Chairman of the American Academy of Cosmetic Dentistry’s Charitable Foundation, Give Back A Smile. The foundation helps survivors of intimate partner abuse regain their smile.