At Aurora Orthodontics & TMJ we pride ourselves in being able to provide the finest treatment for TMJ Dysfunction (TMD) anywhere. Patients come for treatment from all over the United States and Canada to seek our treatment.
In recent years, the TMJ has become a familiar part of our language. People who suffer from jaw pain commonly say, ‘I have TMJ’. Everybody has a Temporo¬mandibular joint, or TMJ - actually two of them, located in front of each ear - which are responsible for allowing the lower jaw to move. The TMJ is also responsible for all the wide-ranging motions that are per¬formed effortlessly upon chewing, talking, yawning, laughing or swallowing. When people have problems with their jaw joint, what they actually mean is that they have TMJ dysfunction, or TMD.
The TMJ is especially worthy of attention due to its versatility and functionality. It is important to know that the TMJ is the most complex and active joint in the human body. Composed of only a few ounces of cartilage, bones, ligaments, and muscles, it springs into action as many as 100,000 times a day, completing more repetitions than any other body joint. When functioning properly, it is capable of performing a myriad of intricate maneuvers, within seconds, even shifting (when needed) from one dimensional plane to another. But, when it’s out of place, it can cause considerable pain and discomfort, oftentimes affecting the entire body – producing headaches, ear or vision problems and even backaches, just to name a few. Because of the TMJ’s crucial role in the human body and its intimate connection to the teeth, it is one of the sig¬nature components that must be dealt with in respect to any corrections of the mouth, teeth, or jaws.
So, how did the TMJs get out of alignment in the first place? It’s important to understand that when a person bites down to chew his or her food, the TMJs and surrounding muscles always seek a position to accommodate the best fit of the teeth. The rule is this: Teeth dominate, muscles and joints accommodate, so it stands to reason that the TMJs will accommodate as well as they can. If the TMJs and teeth work together in harmony, then their actions will operate smoothly and without incident for years, even a lifetime.
Conversely, when the act of chewing forces the jaws out of a healthy position, repeated stress occurs within the joint. This stress affects the surrounding muscles and nerves. The typical scenario is this: Every time a person bites down in an unhealthy position, the condyle is forced back, too far, and pushes into the posterior ligament containing nerves and blood vessels. These nerves and blood vessels are constantly under assault and go to areas like the ears, eyes, and even the brain - areas that are vitally important to a person’s overall health and happiness. Figure 2 shows the pinching of the nerves and blood vessels that have to pass through the area at the posterior of the jaw joint. There literally is no other area for them to pass through that wouldn’t be very vulnerable to other out¬side pressures or injuries. Unfortunately, they are subject to damage internally from improper condyle placement.
No wonder the symptoms of TMD are so widespread. Similar to having a pinched nerve in your neck, the nerves and blood vessels affected in the TMJ can also be painful. Topping the list of the most common problems are headaches, facial pain, problems with the eyes and ears and even neck problems. The list of maladies affected by TMD is very wide¬spread and includes recent discoveries that many neurological disorders, such as Parkinson’s disease and Tourette’s syndrome, can have a direct relationship with TMJ dysfunction.
We start with a very important single 3 D X-ray called an i-Cat Scan. This low dose x-ray uses 1/17th the amount of radiation that a CAT Scan of the head uses but contains a huge amount of valuable information that can be used in many ways. It is capable of showing incredible detail of the jaw joints, the airway and the cervical spine. The x-ray technician will prepare the necessary studies for the doctor to evaluate. A panoramic x-ray completes the x-ray evaluation showing all the teeth. Photos are taken of the teeth and facial structures. If there is an indication of TMJ dysfunction or Obstructive Sleep Apnea, a Symptoms Rating Sheet, which will be used to follow progress throughout treatment, will need to be filled out by the patient. Many patients are surprised about the relationship of the TMJ to many other areas of the body and that we track over 60 different symptoms.
Combined with the x-rays and photos, the doctor will do a dental, head and neck evaluation, diagnose any problems and complete the treatment plan. Then the doctor and The Patient Coordinator will discuss findings and discuss each phase of the proposed treatment. The Patient Coordinator will make financial arrangements for the treatment to begin. A more complete view of this appointment is written about in the section of this website called Your First Appointment.
The treatment for these disorders is usually accomplished in phases:
The first phase typically involves the correction of any TMJ Dysfunction with the use of a Myocentric Orthotic (MOT), an oral appliance that repositions the lower jaw to a muscle balanced position correcting the lower jaw (TMJ). It is worn 24/7, including eating and taken out only to brush and clean the teeth. This appointment can last up to two hours and is accomplished with the aid of a Computerized Mandibular Scan (CMS), the most sophisticated TMJ treatment device used today, along with 3D TMJ x-rays. The orthotic is formed at this time. Treatment is performed at weekly (later less frequently when treatment is progressing) using Electrotherapeutics (DYNA) and Neuromuscular Massage Therapy to help promote healing. This phase of treatment usually lasts 4-6 months, allowing time for healing of the jaw joints. Typically, a 90% reduction in symptom levels will be accomplished during this phase.
A second phase of treatment is usually required to expand the upper jaw structures. This is because almost all TMJ Dysfunctions result from a small or underdeveloped upper jaw. It happens like this: The lower jaw is ‘trapped’ by the narrowness of the upper jaw and teeth and gets pushed back resulting in the TMJ Dysfunction. More can be learned about this in Chapter 7 of Dr. Lauson’s book Straight Talk about Crooked Teeth.
An upper inconspicuous removable expansion appliance will be used during this phase with a technique called Slow Palatal Expansion, (SPE). Many dental practitioners, including many orthodontists, do not understand how to do this treatment, however Dr. Lauson has successfully used this expansion technique on many thousands of patients (mostly adults), so contrary to the belief of many, surgery is not necessary and is contraindicated for many reasons. A Craniosacral technique called Palatal Suture Release (PSR) is used to facilitate the further opening of the Mid-Palatal Suture to help with comfort and expansion. During this phase, it is typical that the patient begins to breath much easier through their nose, if that has been an issue for them. This can significantly reduce the tendency for a person to develop Obstructive Sleep Apnea or to help with its correction if it is already a problem. This phase also will last about 4-6 months in order to prepare the mouth for the final phase.
The third and final phase involves actual orthodontics. Yes, you guessed it, braces may be involved, but in many cases the phase can be accomplished with Invisalign. The doctor would need to evaluate for this possibility. This phase is necessary because once the jaw joints are corrected and the widening of the upper jaw happens, then none of the teeth will match the teeth in the opposite dental arch. The objective of this phase is to stabilize the result with a proper bite, so the patient can live their remaining days pain free. This phase may last anywhere from 12 to 24 months, but usually on the shorter end of this timeframe.
It is important to note that although the disorders of TMD and OSA are complex and solutions are not successfully taught in orthodontic specialty programs, the 30+ years and over 5000+ patients successfully treated at Aurora Orthodontics & TMJ give us a unique position when dealing with these most challenging conditions. Call today at 303-690-0100 to schedule a comprehensive evaluation.
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