James W. Correa D.D.S. - Center for Cosmetic Dentistry & TMJ Institute - Call 949.706.2100

TMJ Disorders - Causes, Diagnosis and Treatment - Newport Beach, Orange County, California

For sufferers of Temporomandibular joint disorders, headaches and chronic pain are common occurrences. Fortunately, for TMJ disorder patients seeking help, there is hope! Dr. Correa, a recognized expert on TMJ, offers a safe, non-surgical solution that will allow you to live without the inconvenience and frustration of daily pain.

What is TMJ and what are its symptoms?

Many patients in our society suffer from TMJ disorders without even knowing it. Temporomandibular Joint (TMJ) dysfunction refers to the pain that develops around the jaw and its associated muscles. The TMJ disorder can make speaking, chewing, swallowing, and facial expressions strained and uncomfortable. In fact, chronic pain, which among other things can be caused by TMJ, is the third largest health problem in the United States. Approximately 40 percent of all chronic pain syndromes are concentrated in the head and neck areas. Jaw pain, muscle tension, and the clicking, popping, or grating of the jaw are all signs of TMJ.

TMJ x-ray

The Temporomandibular joint, located directly in front of the ear, consists of two bones--the skull bone and the jawbone. Positioned between these two bones is a shock absorber-like disc known as the intra-articular disc. This disc provides smooth, quiet, harmonious movement during the opening and closing of the mouth, and it also acts as a cushion against heavy forces generated by strong jaw muscles. As the mouth opens and closes, the disc moves and glides along, forward and backward in synchrony, always holding its position between each bony structure. Problems arise, though, when the relationship among the teeth, muscles, and joints changes. Such conditions lead to TMJ dysfunction.


   

Fifteen percent of TMJ disorders are genetic and 85 percent are acquired, according to recent statistics. Some estimates suggest that 20 percent of Americans possess one or more symptoms of a TMJ disorder.

Common symptoms of TMJ include:

  • Dull, aching pain around the ear, face, temples, neck, back of head, back of eyes, and shoulders
  • Migraine-like headaches
  • Ringing in the ears, hearing loss, ear stuffiness/congestion, or ear pain
  • Jaw clicking or popping
  • Grating noises when opening or closing the mouth
  • Difficulty opening and closing the mouth
  • Difficult or painful chewing
  • Locking of the jaw, whether open or closed
  • Dizziness or nausea
  • Numbing of or tingling in the fingers
  • Insomnia
  • Depression

What are the causes of TMJ?

Any disturbance of the harmony between the teeth, muscles, and joints can trigger neurological impulses, which in turn cause painful TMJ dysfunction.

Such disturbances include:

  • Malocclusion (improper bite)
  • Misalignment
  • Trauma/blow to the jaw or head
  • Excessive yawning or prolonged periods with the mouth open too wide
  • Clenching or grinding the teeth
  • Loss of teeth, especially the back molars
  • Cervical traction involving the head, jaws, and neck
  • Compromised tongue position
  • Upper airway constriction, resulting in chronic mouth breathing, snoring, and malocclusion
  • Poor posture (hip tilt, asymmetrical body mechanics, scoliosis)
  • Arthritis

Some dental signs of TMJ include:

  • Crowded teeth
  • Narrow arches
  • Crossbites
  • Wear facets
  • Unlevel bite plane
  • Gumline tooth erosion
  • Generalized tooth sensitivity
  • Enamel cusp fractures
  • Porcelain crown fractures
  • Deep overbite

How is TMJ diagnosed?

At the TMJ Institute of Newport Beach, we use several methods to diagnose Temporomandibular Joint (TMJ) disorders, including:

Clinical Exam

A proper diagnosis always begins with a thorough examination by Dr. Correa. The clinical exam involves a detailed medical-dental history with specific questions about the symptoms, nature, and duration of jaw problems. It also consists of the following:

  • Postural Examination - This type of exam searches for imbalances in the body's mechanics. One's posture affects the positional relationship of the lower jaw to the cranium and can result in or contribute to TMJ problems. If body symmetry is not within normal limits, chiropractic care, physical therapy, or massage therapy may be recommended.
  • Craniocervical Examination - During this part of the exam, we evaluate the planes of the skull and the cervical ranges of motion.
  • Limited Neurological Examination - As part of this examination, we screen for nerve or brain damage that may cause or mimic TMJ symptoms.
  • TMJ Examination - This type of exam tracks the range of jaw movement, including velocity, smoothness, muscle incoordination, and crossover patterns.
  • Muscle Palpation - During this exam, the doctor evaluates the head, neck, and shoulders for the presence of inflammation, degrees of tenderness, and trigger point referral patterns.

Radiographic/CAT Scan Imaging

By using X-rays to examine the joints, the doctor is able to see the hidden areas in question. Changes in position can also easily be detected using this method.

Cephalometric Analysis

Measurements of the planes and angles of the facial bones enables Dr. Correa to map out a "skeletal blueprint" of the face and jaw. He then uses a sophisticated, cephalometric analysis of this blueprint to unlock and discover the hidden factors involved in the root cause of TMJ Dysfunction.

Neuromuscular Analysis

At the TMJ Institute of Newport Beach, we use computerized electro-diagnostic instrumentation for a more sophisticated approach to identifying and treating Temporomandibular joint (TMJ) dysfunction. Now neuromuscular dentists such as Dr. Correa can record, measure, and track clinical data using three-dimensional jaw movements and electrical muscle activity. The father of neuromuscular dentistry, Dr. Bernard Jankelson, said, "If it has been measured, it is a fact. If it has not been measured, it is an opinion." In this age of evidence-based diagnosis and treatment, it is imperative that the treating clinician uses objectivity when addressing TMJ disorders. Patients at the TMJ Institute of Newport Beach can rest assured that Dr. Correa uses only the latest technology to diagnose and treat TMJ disorders.

Computerized Mandibular Scanning (CMS)

Computerized mandibular scanning (CMS) allows for a thorough assessment of jaw function. CMS measures the rotational movement of the jaw in three dimensions of space and time to within 0.1 mm of accuracy. With the use of a magnetic tracking device and sensor array, it projects the data on a calibrated computer monitor.

 

 

Electromyography (EMG)

Electromyography is a cousin of the electrocardiogram (EKG). While the EKG measures electrical activity of dysfunctional heart muscle, electromyography measures activity and dysfunction of the head, face, and neck muscles. EMG consists of a series of tests that more specifically identify and define the hypertonicmusculature of the temporomandibular joint. Hyperactivity of the face and jaw muscles are then recorded to determine whether or not the jaw is in a strained position.

Electrosonography (ESG)

Digital electrosonography uses a pair of ultra-sensitive transducers that are held in place by a headset fitted over the temporomandibular joint. Vibrations from each joint during the open-close cycle are transferred by the transducers to the computer, which then records and evaluates the sounds using spectral analysis. ESG becomes a valuable tool when used in conjunction with other diagnostic modalities to confirm certain conditions of joint pathology.

Transcutaneous Electroneural Stimulation (TENS)

Transcutaneous electrical nerve stimulation is a physical, therapeutic modality used to relax acute and chronically contracted musculature. The TENS unit, in conjunction with adhesive pads placed over the jaw joint, stimulates the facial muscles, resulting in full muscle relaxation and increased blood and oxygen flow. Once the jaw is fully relaxed, proper jaw position can be determined.

 

 

How is TMJ treated?

For our patients in Orange County, Dr. Correa and the TMJ Institute of Newport Beach can eliminate Temporomandibular joint (TMJ) pain and dysfunction by balancing the relationship among the teeth, muscles, and joints. For optimal results, we offer a two-phase treatment plan at our Newport Beach location:

Phase One of TMJ Disorder Treatment

When treating the TMJ disorder, Dr. Correa first fits a specialized type of splint made of clear, hard acrylic over the lower teeth. Called a neuromuscular orthosis, this device is worn full-time and creates ultimate balance among the teeth, muscles, and joints. Usually, it is worn for three to nine months (longer if there is a sharper degree of musculoskeletal involvement) and may be used in conjunction with chiropractic care, physical therapy, or massage therapy.

Phase Two of TMJ Disorder Treatment

Phase Two begins only after the patient has successfully completed Phase One of treatment. We strive to permanently stabilize the temporomandibular joints in one of several ways:

  • Semi-permanent splint - Similar to the design of the neuromuscular orthosis but made of metal, this device may be worn for years, and has minimal maintenance.
  • Neuromuscular Orthodontics - This involves braces being worn from anywhere between nine months to three years in an effort to pull teeth into the appropriate positions, thereby eliminating TMJ dysfunction.
  • Reconstruction - Comprehensive rehabilitation and restoration provide the finest and most predictable results possible. Because teeth are restored with an occlusal bite pattern of such high precision neuromuscular balance is achieved and maintained long term. Today's advancements in porcelain-ceramic technology allow not only functional but also aesthetic concerns and demands to be addressed, resolved, and successfully fulfilled. More aesthetic options are available today with this approach for enhancements in color, contours, and facial appearances that produce the most natural-looking results.

All of the TMJ disorder treatments listed above are available to our Orange County patients at our Newport Beach location. Dr. Correa will base the TMJ treatment you receive on a personal and thorough evaluation.

How is Dr. Correa qualified to treat my TMJ dysfunction?

Dr. Correa is highly skilled and experienced in the non-surgical treatment of craniofacial pain and TMJ disorders. A former TMJ disorder sufferer himself, his search for a solution led him across the country before he finally found the answer in TMJ therapy. Dr. Correa has since brought this innovative solution to Orange County and reserved a special place in his area of practice for the care and treatment of the Temporomandibular joint patient. His expertise allows him to diagnose and treat even the most complex, severe cases successfully and without surgery.

Dr. Correa is the founder and director of the TMJ Institute of Newport Beach. The TMJ Institute of Newport Beach is a modern, well-equipped facility specializing in the care and treatment of patients suffering from Temporomandibular Joint dysfunction. It also serves as a training institute for doctors, dentists, and other health care providers for instruction on TMJ Disorders, Neuromuscular Occlusion, and Comprehensive Reconstruction.

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To learn more or schedule a consultation with Dr. Correa, the premier cosmetic dentist in Newport Beach, please contact us at 949.706.2100.

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