Montrose Star interviews trusted dental authority Dr Randy Mitchmore from his Montrose practice called LifeSmiles.
M.S. I have a friend that says she has “TMJ”. That sounds like a disease that she caught from a bad date. What is it really?
Dr M: It is really an acronym that poorly represents a disorder. TMJ stands for Temporo Mandibular Joint. So all that is, is the name of the jaw joint. Everyone has two of them! It is the most complicated joint in the human body because it is not a true ball and socket and there are two of them required to make one movement.
It is not a ball and socket joint: Much like a snake can unhinge its jaw to swallow an entire egg or rabbit that is bigger than its own body, the human jaw can do something similar. But your fingers over your TMJ that is in front of your ear. Open and close just a little bit, say like your are quietly chewing some gum. You can barely feel your joint because it is acting as a simple hinge swinging up and down. Now open really wide like you are going to bite an apple or make a yawn. Now your fingers can feel the head of your jawbone actually come down out of the socket and bulge as it actually moves forward outside of the “joint”. This movement is called translation. What makes this all happen smoothly is a very thin as a postcard slippery disc that is between the head of the jawbone and the bed of the joint that it sits in during the hinge motions.
Interesting fact about the TMJ. If you were to look at the skeletal remains of a human body all of the bones are loosely held together by the ball and sockets. However, the lower jawbone will simply fall off the skull. That is because the only thing that holds the lower jawbone in place are the muscles that make it function. Unlike other joints that move in a few directions, the TMJ has to move in 3-D and coordinate with its sister joint on the other side of the face simultaneously.
Now let’s complicate this further. So far we have two loose joints. There are about six pairs of muscles on each side that move the jaw up and down, back and forth, side to side, with pitch, yaw and roll like an airplane can do. Here is the kicker now we are going to place 32 teeth between the upper jawbone (which does not move) and the lower jawbone that is going to make a hard directional stop where the muscles and joints have to go. That is all well and good so long as everything is in harmony. Problems arise when the joint, the muscles and the teeth are not all in a neutral relaxed state.
In the past all kinds of problems were simply lumped in to the catchy phrase “TMJ”. People were have very invasive surgery on the joint in attempts to alleviate pain in the area. In my experience well over 90% of the time there is really nothing wrong with the “JOINT”! A newer more descriptive term that you are beginning to hear is “TMD” which stands for Temporo Mandibular Dysfunction. This is a little better because now it is distinguishing a problem is maybe not the joint itself, but the function of the joint is out of whack. You then saw lots of dentists treating the symptoms of TMD by making all kinds of weird bite guards that most people hate wearing. Many of these acrylic bite guards helped but they are treating the symptoms and not really correcting the underlying problem. They are only effective when they are between the teeth. So when a person takes them out during the day there is no therapeutic effect and most benefits or wearing it at night are now gone.
Interesting fact: Our teeth do not touch together when we chew food. If they did touch the restaurant would be full of clacking noises like castanets or someone with bad dentures clacking around when the talk or eat. Our teeth come very close to touching when we eat but jump apart just at the last nanosecond. However, every time we swallow our teeth mash together very, very hard. We do that a couple of thousand times a day.
Remember I mentioned that I find that over 90% of the time the problem is not the joint? The problem is by far caused by muscle pain like a Charlie Horse in your leg, and pinched nerves in the joint area. This is why I have developed an approach called NeuroMuscular Dentistry. Rather than having the way teeth interdigitate guide the muscles and jaw joints (most often a bad bite) every time we swallow, I let the muscles and a neutral joint position dictate where the teeth fit together.
M.S.: What are the signs and symptoms of this problem?
Dr M: Signs are things we can see. The most common dental signs are uneven and very premature wear of the front teeth. The front teeth look worn flat, or have bevels or facets worn on them, on the lower front teeth you can see a ring of white enamel on the top edge with a darker inside circle or a darker line on the edge. We can see the muscles over the jaw or temple get large from overuse. We can see scallops or indentations on the side of the tongue from resting the teeth on the tongue. It is very common for middle age people that have four wisdom teeth and four permanent teeth taken out for braces to have this wear problem of the front teeth. The symptoms include pain trying to close the teeth, limited range of motion of the jaw, popping and clicking when opening or closing, waking up in the morning and the muscles of the face feel tired. More bizarre symptoms include tingling of the fingers to ringing in the ears.
M.S. How do I treat it? Whenever there is a battle between where the muscles of the jaw want to be, and a bad bite may force the muscles to go, the muscles always win at the expense of teeth. That is why we see teeth that are prematurely worn down to little nubs in young middle aged people. So I treat the muscles and get them happy and let the bite of the teeth follow! I use sophisticated technology to let the upper and lower teeth be slightly apart to allow the muscles and joints to naturally fall into their most relaxed and optimum position. We then use computer analysis to measure that space and do our dentistry to let the teeth interdigitate into that position. That can be done with Invisalign orthodontics, bite adjustments, or restoring the parts of the teeth that have been ground away. This is the reverse method from what most dentists do.
Before NeuroMuscular Treatment Picture showing strained facial muscles, uneven bite
After NeuroMuscular Treatment Picture showing a “dental face lift”. Handsome face, lips and teeth
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.