Most patients cite headaches as their principal reason for seeking help with a potential TMJ problem. Headaches are the most frequently reported symptom, along with shoulder or face pain and neck aches.
Temporomandibular (TMJ) pain is a chronic and often debilitating illness, which affects millions of people. The underlying conditions that cause TMJ symptoms and discomfort are structural, biochemical and/or emotional. With Neuromuscular dentistry, diagnosing the symptoms and treating TMJ disorders is non-invasive and easy.
Dr. Stefania Caracioni has studied aesthetic and cosmetic dentistry. She is also taking extensive, advanced continuing education to become a leading TMJ dentist as well. She is studying at the prestigious Las Vegas Institute for Advanced Dental Studies in order to specialize in the effective diagnosis and treatment of TMJ disorders. Dr. Caracioni has committed her professional career to continuing education and continuous improvement, to better serve her patients and to do her part to raise dentistry to the highest level of achievement and professionalism.
What is TMJ/TMD ?
The jaw is able to move since it operates on a joint called the temporomandibular joint (TMJ). TMJ connects the lower jaw (mandible) to the skull (temporal bone) in front of the ear. There is a soft fibrous pad called a disc that lies between these two structures. This disc absorbs shock to the temporomandibular joint and distributes the forces of chewing throughout the joint space.
While the term TMJ is reflective of the early belief that these disorders largely originated in the joint itself, more recent data has shown that the true cause of joint problems often lies somewhere else. That has lead to today’s more common use of the term Temporomandibular disorder (TMD).
The position of the jaw end of the joint within the corresponding depression in the skull is largely determined by where the muscles are holding the jaw-a position in turn affected by the way the teeth are coming together. If this system is in balance the jaw functions free without pain. If the muscles of mastication are accommodating they may be holding the jaw joint in an abnormal position, negatively affecting its function.
Signs and symptoms of TMD
What causes TMJ disorders?
In most cases TMJ disorders and symptoms stem from a condition called malocclusion, which means “bad bite” or from accidents or trauma. Malocclusion means that your upper and lower teeth do not close together in the correct way, in other words, they are misaligned. This includes under-bites and overbites.
When the teeth are misaligned, they fail to provide the necessary support for the muscles in the face and head needed for chewing, swallowing and talking. These muscles are than forced into a strained position, resulting in pain throughout the face, head, shoulder, neck and back.
It is not uncommon for a patient to develop symptoms of TMJ/TMD following orthodontics, or after a dental procedure such as crown, or filling. Trauma can be internal like bruxism (grinding the teeth) and clenching (jaw tightening). This continuous hammering on the temporomandibular joint can change the alignment of the teeth. Muscle involvement causes inflammation of the membranes surrounding the joint. Teeth grinding (bruxism) and clenching are habits that may be diagnosed in people who complain of pain in the temporomandibular joint or have facial pain that includes the muscles involved in chewing (myofascial pain). External trauma such as a punch to the jaw or impact in an accident can break the jawbone or damage the disc.
Bruxism: Teeth grinding as a habit can result in muscle spasm and inflammatory reactions, thus causing the initial pain. Changes in the normal stimuli or height of the teeth, misalignment of the teeth, and changes in the chewing muscles may cause temporomandibular joint changes. Generally, someone who has a habit of grinding his or her teeth will do so mostly during sleep. In some cases, the grinding may be so loud that it disturbs others.
Clenching: Someone who clenches continually bites on things while awake. This might be chewing gum, a pen or pencil, or fingernails. The constant pounding on the joint causes the pain. Stress is often blamed for tension in the jaw, leading to a clenched jaw.
Common Symptoms of TMJ Disorders
TMD refers to a disorder as opposed to a disease and usually does not have a single cause or a single symptom. As a matter of fact, TMD sufferers often have several symptoms and there may be more than one underlying cause. You might have thought that the symptoms of TMD were medical, not related to dentistry. They are indeed medical problems, but very often dental conditions are the underlying cause of TMD symptoms. Dr. Caracioni applying the principle of neuromuscular dentistry will be able to identify the cause of your symptoms and conduct a non-invasive examination to put you on the path to a pain-free lifestyle.
If you suffer from any of the following symptoms, we may be able to help you:
Headaches/Migraines
Neck and Shoulder Pain or Stiffness
Jaw Pain
Facial Pain
Tinnitus (Ringing or Buzzing in Ears)
Numbness or Tingling in the Arms or Fingers
Clicking or Popping Sound in Jaw Joint
Limited Jaw Movement or locking Jaw
Clenching or Grinding Teeth (Bruxism)
Worn, Chipped or Cracked Teeth or Veneers
Loose Teeth
Hot &Cold Sensitivity of Teeth
Dizziness
Depression
Ear congestion
Postural problems
Nervousness or insomnia
TMJ Symptom: Tension, Chronic, or Migraine Headaches
Headache and Migraine are the most common symptoms of temporomandibular (TMJ) Disorder. The TMJ headache is a tension type of headache. It is often described as a migraine headache.
Tension headaches attributed to TMJ are due to constant contraction of muscle fibers within a muscle, which creates tension, pressure or a tight feeling in the face and head. The pain you have in your head and neck could be due to the fact that your jaw is not resting where it wants to be, leaving your jaw muscle in a state of chronic contraction (spasm).
The pain from muscle headaches (TMJ) can be blocked with medications, brain surgery or psychological therapy, but the cause of the disease and damage from the bad bite, malocclusion, will persist. Dr. Caracioni can help your pain associated with TMJ disorders through neuromuscular (NM) dentistry. NM dentistry ensures that muscles are happy because the muscles do not have to work hard at positioning the teeth to a strained bite any longer.
By putting the temporomandibular joint back into alignment and placing the jaw into its optimal position, neuromuscular dentistry alleviates most headache problems related to TMJ, muscle, nerve and joint disorders.
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TMJ Symptom: Neck, Shoulder and Back Pain
A "bad bite" (malocclusion) causes an imbalance in the jaw-to-skull relationship, which in turn twists the jaw into a strained position that refers pain to the muscles in the neck, shoulders, and back. Many times the head will not be properly aligned to the spine as the body tries to compensate for the pain the person is experiencing. We find many times a patient’s head will lean forward which is the body’s response to make the bite feel better and allow the person’s airway to open more.
It is vital to understand that the bones, joints, muscles, and nerves in the face and neck have a complex relationship. They work in concert to correct the bite, and strain radiates to these other areas. With this knowledge, Dr. Caracioni can work to relieve strain on the jaw and the surrounding muscles. Once the bite has been aligned, pain in the neck, shoulder, back or other areas of the body resulting from the malocclusion disappear.
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TMJ Symptom: Jaw Pain
Not all the patients suffering from TMJ disorder complains of jaw pain. However, jaw  pain remains among the most common symptom of TMJ disorders.
A "bad bite" in which your upper and lower teeth do not come together in proper alignment also disrupts the placement of the jaw and the surrounding muscles. This will cause unequal stress on the muscles that are used to move the jaw during normal activities of daily living. The muscle often fatigue and become sore or spasm and cause pain.
Neuromuscular dentists relieve jaw pain related to TMJ by going to the source of the problem - the "bad bite" and misaligned jaw. In most cases, correction of the bite can be accomplished without the use of surgery, and patients report long-lasting pain relief.
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TMJ Symptom: Facial Pain
The face has a complex network of bones, joints, muscles, and nerves. When the jaw becomes misaligned, the surrounding bones, muscles, and nerves are also affected. This includes the muscles of the face, which experience strain or spasm because the muscles are working extra hard to compensate for the unstable bite.
The muscles usually go into an involuntary contraction (spasm) and become extremely painful. Facial pain many times make speaking, eating, and breathing difficult.
A neuromuscular dentist can help facial pain problems by working with the source of the problem, the bite. Dr Caracioni will stabilize and realign your bite so that the teeth, muscles, and joints all work together without strain.
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TMJ Symptom: Ringing in the Ears (Tinnitus)
Ringing in the ears, or tinnitus, is another symptom of TMJ disorders. Many patients suffering from tinnitus seek help from other physicians. Often times it is not obvious that the cause of ringing is coming from a TMJ disorder. It is commonly misdiagnosed and often goes untreated or is treated ineffectively. In many cases, ringing in the ears is one of the results of having the jaw misaligned which causes a strained bite. The jaw area of the face is a complex network of muscles and nerves, and when the bite is misaligned muscles and nerves throughout the head, including the ears, can be affected.
If the cause of your tinnitus is determined to be due to an unstable or misaligned bite, Dr. Caracioni can work with the source of the problem by stabilizing and realigning the bite to eliminate the ringing.
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TMJ Symptoms: Numbness in your Fingers and/or Arms
A misaligned bite can cause the muscles throughout the jaw, face, neck and shoulders to go into spasm. The nerves of the jaw are very complex and involve nerves of the neck as well. The affected nerves of the neck can refer shooting pain down the arms and into the fingers. When these muscles (scalenes) are in spasm they can pinch the nerves leading down the arms (the brachial plexus) and into the hands, which in turn results in feelings of numbness or tingling.
A neuromuscular dentist can help you with numbness or tingling in your hands or arms by helping to determine if your bite is the source of the problem. If it turns out to be the source, then having your bite corrected to its proper alignment will effectively relieve these symptoms. With your bite aligned, the muscles affected by the jaw joint will be able to go back to their normal function and position, relieving the spasm and the subsequent numbness and tingling felt as a result.
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TMJ Symptom: Clicking, Popping in the Jaw Joint
Clicking, popping, or snapping in the jaw joint is the most common symptom of TMJ. The popping and clicking sounds many times are surprisingly loud where others may hear them. Not all the patients complain of pain in their jaw when the clicking or popping sound is heard and therefore do not believe that they have temporomandibular disorder.
Usually the cause of the popping jaw is a displaced disc in the jaw. The jaw joints are "ball and socket" joints, similar to the shoulder joint. The disc in the joint allows the ball to glide smoothly in and out of the socket.
If your bite is misaligned or trauma tears the surrounding muscle tissues, the jaw joint is pulled out of alignment, and the disc pulled forward or even torn. Now that the cartilage disc is not serving as a cushion between the ball and socket, these bones subsequently rub against one another and press on nerves, causing clicking or popping sounds in the jaw joint, sometimes accompanied by pain in the jaw, joint or teeth.
A neuromuscular dentist can properly test and evaluate you and realign your bite, which also realigns the displaced disc. Once the jaw is back in alignment and the cartilage disc returned to its original, natural position, the clicking and popping sounds in the jaw stop and the muscles holding the disc in place can relax, alleviating the jaw, face, head, neck, back, and shoulder pain that resulted.
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TMJ Symptom: Limited jaw mobility and/or locking
Severe cases of TMJ can partially or totally immobilize the jaw. Muscles in the jaw constantly straining to bring a "bad bite" into an alternative position, given enough time, can seize. It is not uncommon that a patient with a locked jaw must move the jaw to one side or the other in order to open the mouth to eat or chew. We often hear that a patient needs to “pop” their jaw in order for the jaw to open fully.
This can last for varying periods of time - from several moments to several minutes to permanently. Most frequently, limited jaw mobility is reported as being permanent, and in certain cases, patients continue in this debilitated state without seeking help.
TMJ Symptom: Unexplained loose, worn or cracked teeth
Worn or cracked teeth is by far one of the most common symptoms of clenching or grinding of teeth. Teeth are very strong, however, when there is chronic grinding and clenching the enamel on the teeth will grind away.
Also the chronic clenching and grinding applies undue stress on the ligaments that hold the teeth into the jaw. This condition will likely lead to periodontal disease or bone loss that will make the teeth became lose.
If you have any of these symptoms, it is strongly advised to visit a qualified TMJ dentist like Dr. Caracioni to ascertain or rule out malocclusion as a possible cause.
Tooth loss always has an underlying cause - it is never an isolated event (except in the case of trauma). Without understanding and correcting the actual underlying cause of tooth loss, it is very likely that other teeth (or the replaced teeth's restorations) will follow the same destiny. Getting an accurate and thorough diagnosis of the TMD is the first step to understanding the main causes of tooth loss and increase the overall dental health and keeping more of the natural teeth.
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Tooth sensitivity
Tooth pain and sensitivity are common symptoms of TMJ disorders. If the teeth are the cause of TMJ then any or all of the teeth may be sore. A patient may have sensitivity and pain resulting from eating or drinking hot or cold food. Many people indicate that they must chew on the opposite side of their mouth because of pain while chewing. The teeth may also become sensitive because of clenching or grinding them, a common action in many people, particularly when the disc of the TMJ is displaced.
Unfortunately, when seeking relief from this tooth pain, many patients are misdiagnosed and may even go as far as having the nerve from the tooth removed with a root canal or even having the tooth extracted. The worst part is that these measures may not relieve the pain, and can actually make it worse!
Dr. Caracioni can help your pain and discomfort associated teeth sensitivity by going to the source of the problem - the "bad bite" and misaligned jaw.
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TMJ Symptom: Depression
The majority of the patients suffering from TMJ may suffer from depression because of the chronic pain. Nobody likes to be in pain and nobody likes to be around somebody who suffers from chronic pain. The depression is commonly misdiagnosed or dismissed as having no physical cause.
One condition that nearly all TMD patients seeking help can claim is pain. Scientific evidence has shown that patients with chronic pain experience chemical changes in the brain. These chemical changes can lead to depression.
Because TMD is a multifaceted disorder, some patients need to work with more than one specialist to return to optimal health. Many patients also work with a psychological counselor, chiropractor or physician. However, other patients experience complete pain relief solely from the care and treatment of their neuromuscular dentist and do not need the multi-disciplinary approach. Speak with your neuromuscular dentist about your personal needs.
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