Home What are TMJ and TMJ Disorder? FAQ's - TMJ Disorders (TMD)
TMJ disorder (TMD) FAQ's PDF Print E-mail

1. Isn't this just anterior repositioning of the Mandible?
It is very important to distinguish between the position of the condyle in the healthy patient and unhealthy patient. In a healthy joint complex with asymptomatic patient we usually find the condyle to be sitting the ideal centered position in the glenoid fossa. There is usually 3mm of space behind and above the head of the condyle. This allows the retrodiscal tissue to nourish the joint complex and room for the articular disc to sit on the head of the condyle and provide the important function of guiding the condyle through its movements. This position is commonly referred to as the "Gelb 4/7" position as described by Dr. Harold Gelb, New York, widely acclaimed leading authority on TMD. The common finding in symptomatic patients is that the condyle is superiorly and distally retruded, sometimes resting against the back wall of the glenoid fossa. In these situations, the retrodiscal tissues are crushed and the articular disc is pushed forward off the head, which accounts for the clicking and popping during opening. So, treatment for retruded condyles does reposition the mandible in a three dimensional direction towards its normal position of health that must have existed before the patient became symptomatic. The mandible is brought down, forward and laterally as required to position it where Mother Nature can heal the injured tissues.

2. Does TMD Treatment pull the jaw out of its socket?
IT IS IMPORTANT TO UNDERSTAND THAT TMD ORTHOTICS ARE MOVING MANDIBLES TO A POSITION OF HEALTH .... NOT AWAY FROM A HEALTHY POSITION TO A MORE ADVANCED POSITION. There is great confusion about this repositioning concept. Some TMD detractors will try to convince you that the jaw is being pulled out of its socket to create a false dental open bite thereby creating the need for unnecessary dental treatment. Nothing could be further from the truth.

3. Why don't Flat Plane Splints work?
Most dentists have only been trained to use Flat Plane splints. Accordingly, this seems to represent the limit of dental treatment usually provided to our patients. Analgesics, exercises and referral to Physiotherapy etc. make up the balance of our treatment protocols. Unfortunately, Flat Plane splints can only provide a temporary relief by increasing vertical thereby decompressing the joint complex. As well, they have the effect of protecting the teeth from traumatic bruxism forces. True internally deranged TMJ complexes need specific repositioning of the condyle from a superior and distal position to a more healthy location in the glenoid fossa. This will allow the body to begin the important healing phase. Repositioning can only be accomplished with an indexed orthotic. This ensures that the occlusion is altered so that the final path of closure of the mandible does not allow the condyle to travel back to the displaced condylar position and ensure stability while the body heals itself

4. Do patients ever need jaw surgery for TMD?
RARELY, is it indicated or ever successful. Most chronic TMD patients have soft tissue damage and altered mechanical components of the joint complex. All of these situations respond very well to accurately diagnosed and specifically focused treatment with orthotics and supportive care via Chiropractors, massage therapy, physiotherapy, etc. Except for fractures or adhesions, oral surgical approaches are used as a last resort approach.

5. Why do we need other health care practitioners?
Dentists cannot do it alone! While it is important for all of us to realize that dentistry plays a vital role in TMD treatment due to our expertise in occlusion, we need to work with our fellow care givers. Chronic pain wears down the patient's resistance; builds dependence on medications; limits range of motion; affects self confidence and eventually leads to chronic depression. Dentists obviously are inadequately trained to treat these special needs. Co-treatment by more than one care giver provides a synergistic effect as each treatment supports the other and allows the body to focus its healing in a positive manner.

6. How common is TMD and TMJ anyway?
Much more common than you think! Most statistics indicate that 30-50% of adults suffer from some degree of TMD. Most dentists do not regularly ask their patients about headaches and patients often do not mention headaches to their dentist. Every busy dental practice has hundreds of "silent sufferers" just waiting to be discovered and helped.


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