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To begin with, what is TMJ? It's just the name for your Temporomandibular Joint - or jaw joint. This is the joint that connects your movable lower jaw (mandible) to your fixed upper jaw (maxilla). This is not the name of a disease. Damage to, or malfunction of, the TM joint is referred to as TMD.

Dr. Nichols has actively pursued continuing education specific to prescribing, reading, interpretation and diagnosis of MRI's of TMJ's, and is a highly qualified expert in the treatment of TMD.

The TMJ is one of the most complex joints in your body. When any component of this joint isn't working properly, you might experience pain in adjoining ligaments and muscles as well as surrounding areas of your body. Damage to bones, teeth and gums is also common if TMD is left untreated.

Symptoms of TMD:

Initial symptoms of TMD are:

  • Popping jaw
  • Locking jaw
  • Worn teeth
  • Uneven bite (when front or back teeth no longer meet in the bite)

Advanced symptoms can range from discomfort to extreme pain in:

  • Facial muscles
  • Teeth and jaws
  • Ears
  • Posterior head and neck
  • Temporal region (the side of the head in front of the ears)

Quite often, people will come to the office without any noticable TMJ-specific symptoms. In their minds, the headaches or muscle aches are not perceived as being related to their teeth or their TMJ. In these situations it can be difficult to understand the serious nature of a disease which is not causing pain. Like virtually every other disease, however, TMD typically exists for a long time before it actually causes pain. It is a degenerative disease by nature which means it will quite frequently develop more severe symptoms as time goes by. When we get the opportunity to treat this disease before it causes perceptible pain, it enables us to have a greater chance for success. For that reason we enthusiastically recommend treatments which can divert a disease pathway and prevent the development of debilitating pain. Click here for more about headaches and TMD disorders.

If left untreated, very serious symptoms can develop. Ultimately disorders as severe as Avascular Necrosis of the mandibular condyle (head of the lower jaw bone) can develop due to untreated disc displacement. As the head of the lower jaw bone breaks down due to lack of blood flow caused by impingement of the blood supply to the head of the condyle by the displaced disc, the condyle will degenerate so severely as to get to a point where it is too small to tolerate the normal pressure that bears upon it; which in turn causes it to spontaneously dissolve under a load. The end point of this disease pathway is either complete dissolution of the condyle of the mandible or a rib graft surgery to replace it and reconstitute a normal joint. Needless to say, if we can intervene and interrupt this disease process before it gets this severe, ultimately a far more favorable outcome is likely.

TMD can also trigger very serious problems such as migraines, fibromyalgia and tinnitus. If you are experiencing any of these symptoms, please call now for a consultation at either of our offices. Our primary concern with our patients is to restore healthy TMJ positioning, relieve the pain, and repair damage to teeth and surrounding muscles and ligaments.

Causes Of TMD

Temporomandibular joint disorders can spring from something as basic as irregular tooth development as a child, but there are many sources of this disorder, with the damage worsening over a period of time.

  • Stress: While stress in and of itself is not a recognized cause of TMD, it aggravates any existing muscle tension and can make a bad problem worse. More than anything else, what stress typically does is make the patient aware of a problem they may have previously been able to overlook.
  • Injuries: When the neck and head are jarred, such as in the case of whiplash, misalignment can occur although it is usually noticed much later. Click here for more in-depth information on Whiplash related injuries.
  • Bruxing: This is clenching or grinding the teeth for long periods of time during the day or night. Bruxism is typically a reaction to a TMJ problem, in which the position of the mandible is altered. The body's reaction to this subsequently altered bite or malocclusion is to clench or grind on the teeth that now no longer fit together correctly. This is bruxism. Most people might not even notice they're doing it until symptoms such as a sore tooth or tired muscles arise.

About TMD

TMD is not a syndrome. In medicine the word "syndrome" refers to any disease entity which is not readily quantifiable or understood. The medical understanding of TMJ disorders has made dramatic progress in the past several years in terms of both diagnosis and treatment. TMD has specifically quantifiable degrees of displacement of soft tissues in the joint space, as well as alterations and degeneration of the bone structure in the joint, and is classified as a disease.

TMD is readily classifiable based on the extent of displacement (or dislocation) of the articular disc in the joint, the subsequent thinning of soft tissue (retro-diskal attachment) as a result of the displacement of the disc, and finally degeneration of the head of the lower jaw bone (the condyle), and/or upper jaw bone (articular eminence and glenoid fossa). As a heterogeneous disease, that is, a disease with multiple potential causes and pathways, the first priority is to assess the condition of the TMJ together with the occlusion in order to better predict possible pathways of the progression of this disease. Click here for more about occlusion.

Treatment of TMD

Dr. Nichols frequently prescribes both diagnostic casts of the patient as well as MRI's of the TMJ's. It is absolutely critical to know the condition of both the occlusion and the TMJ, as it is impossible to treat one area without affecting the other. This presents a complete "big picture" of the condition of the patient with regard to their TMJ and occlusion, and therefore a more accurate estimate of the likely progression of the disease, and what options are available from a treatment perspective to eliminate or prevent pain, and stabilize the joint in its best possible position.

Dr. Nichols' office utilizes four modalities of treatment for TMD, all of which are conservative (i.e. non-surgical). They are:

  • Medications, if needed, to eliminate pain, bruxism and help relax the musculature of the head and neck;
  • Physical Therapy to mobilize the joint, stretch and/or relax muscles, strengthen and reposture the head and neck;
  • Various types of splint therapy depending on the situation;
  • Definitive occlusal correction, designed to allow the teeth to fit together correctly in the precise normal, orthopedically natural position of maximum closure for the jaw.

In the rare instance when a patient's condition merits consideration for surgery, Dr. Nichols has a surgeon in his network in Denver, and he also consults Dr. Mark Piper as a resource for referrals if needed. Dr. Piper is the acknowledged world leading clinician, researcher and surgeon in the field of TMJ disorders, and was Dr. Nichols' instructor on TMJ education and training.

If you are seeking relief from TMJ disorders, please contact Apexx Dental Care – serving Littleton, Colorado for an appointment.

"When we get the opportunity to treat this disease before it causes perceptible pain, it enables us to have a greater chance for success."
Dr. Richard Nichols

The following diagrams illustrate the progression of a displaced articular disc in the TMJ. The disc displacement is quantified by using a clock for orientation. That is, if a clock face were applied over the TMJ diagram, the back edge or posterior band of the disc would be at the 1:00 position in normal alignment. As the disc displaces, it moves forward, so the posterior band would progressively be at the 12:00, then 11:00, and ultimately the 10:00 position where the disc is completely displaced off the lower jaw bone (mandible). Most importantly, please note the teeth in the diagram to see how a progressively displaced disc affects the bite (occlusion).

Diagrams courtesy of
Dr. Mark Piper, MD, DMD
© Piper I: Comprehensive
TMJ Science.