This article on TMD/TMJD was created in collaboration with dentists and physiotherapists and is intended to give you a comprehensive overview of the complex and widespread topic of TMD.
Our practice specializes in the treatment of complex and serious TMD cases.
What is TMD/TMJD?
TMD/TMJD are collective terms for symptoms of dysfunctions and pain of the masticatory (chewing) system. Many different structures can be affected and the symptoms manifest themselves in different parts of the body.
TMD/TMJD are the acronyms for “Temporomandibular Dysfunction” or “Temporomandibular Joint Dysfunction” and describe a dysfunction of the masticatory (chewing) system.
The term temporomandibular dysfunction is broken down into the following words – temporal: sides/base bones of the skull, mandible: lower jawbone, and dysfunction: malfunction or disorder. The temporomandibular joint connects the mandible (lower jaw) to the skull.
The fine and close interaction of the jaw joint, jaw opening and closing muscles, tongue, throat and neck muscles as well as the teeth and the periodontium (connective tissue surrounding teeth) is responsible for the complex symptoms of TMD.
The teeth, which register even the smallest changes on the surface of the tooth, the proprioceptors (“nerve sensors”) in the jaw joint and the “tension and movement detectors” in the masticatory muscles are closely connected. These functional structures are in a finely regulated interaction with each other and form a so-called control circuit.
If a problem develops at one point, the other parts of this control circuit try to balance and compensate for this disturbance. However, it is not always possible to compensate for the problem, which subsequently leads to different kinds of symptoms.
What are the causes of Temporomandibular Disorders?
The causes of TMD can be divided into psychological, dental and physical causes.
Psychological causes are based on dealing with mental stress.
Dental causes are based on an incorrect tooth position and lead to incorrect loading of the masticatory system and especially the jaw joints.
Physical causes include “ascending loads” on the feet, pelvis, spine, and shoulders.
In our industrial world, many people have constant psychological and mental stress which is an important factor in the development of TMD. Stress builds up in the body and often needs an outlet to be released. Many people use the chewing system as an outlet, resulting in teeth grinding and clenching (bruxism). This stress-relieving strategy can work for a period of time, but over the long term it results in severe tooth wear and various TMD symptoms.
Therapeutic work is done on dealing with stress. This can be done by the patient themself or with the support of a coach.
The dental causes are based on when the teeth do not have a harmonious and ideal bite, but are positioned so that they bite into each other in an unphysiological manner. Dental causes must be taken into account when TMD develops.
An ideal and harmonious set of teeth consists of very precisely defined contacts between the teeth of the upper and lower jaw When biting together, this results in an even distribution of force over all teeth and, as a result, in ideal grinding of the food, while at the same time minimal force is exerted on the jaw muscles. At the same time, the temporomandibular joints are in a physiological position and are not subjected to excessive compression.
If the bite shows disturbing contacts and incorrect stress, symptoms of TMD can quickly appear and the patient’s quality of life is greatly affected. Such an incorrect bite can occur, for example, when the permanent teeth erupt in the wrong position, the jaws are too small or too large, an incorrect denture was made, neighboring teeth or opposing teeth tilt into remaining tooth gaps, or if previous orthodontic therapies were carried out incorrectly.
Such defective teeth force the jaw joints into an unphysiological position and cause them to be heavily stressed and compressed. If the incorrect bite persists, compensatory adjustments to the anatomical structures within the temporomandibular joints occur. These anatomical, skeletal changes, as part of TMD, manifest deep within the structures of the masticatory system and become part of the complex dysfunction.
If occlusal interferences (undesirable tooth contact) are present, the masticatory muscles try to eliminate these disturbing areas by grinding and clenching (bruxism). As a result, the tension in the masticatory muscles increases and the jaw joints experience destructive forces – the craniomandibular dysfunction is thus greatly intensified and accelerated. Bruxism is therefore a symptom and cause of TMD at the same time.
When treating the dental causes, the anatomy of the masticatory system is brought into a physiological state and the new, correct bite is harmoniously integrated.
The temporomandibular joint is regarded as the centerpoint of balance and is significantly involved in the body statics. It can regulate misalignments in the body, correct imbalances and compensate for relieving postures. Problems and disturbances in body statics can lead to craniomandibular dysfunction and are other possible causes of TMD.
The temporomandibular joint can cause problems in the lumbar-pelvic area, which can extend to the feet – this is called “descending strain“. Conversely, a misalignment of the feet, pelvis, spine and shoulders can lead to craniomandibular dysfunction – this is called “ascending strain“.
The entire chewing apparatus is connected to the head, the brain (brain stem) and the spinal column via muscles and nerves. When the chewing system is not working properly, pain in the head, neck, and shoulders may be noticeable. If the dysfunction of the temporomandibular joints persists, the sacroiliac joint (SIJ), which is connected to the temporomandibular joint via muscle function chains, can be impaired. In the long run, this can lead to improper strain on the entire musculoskeletal system.
Due to the pain spreading throughout the body, a craniomandibular dysfunction is often not recognized or is incorrectly recognized and therefore often remains untreated. If, for example, therapies in the neck, shoulder or back area are unsuccessful or if therapy-resistant, chronic headaches predominate, this can be an indication of TMD.
The physical causes of TMD, with the “ascending stresses”, require an interdisciplinary therapeutic approach. For this it is important that dentists, optometrists, osteopaths, posturology experts, etc. work together closely. This is the only way that all causes of TMD can be treated effectively with ideal and long-lasting results.
Prevalence of Temporomandibular Disorders
Scientific evidence confirms that women suffer from craniomandibular dysfunction more often than men. About 80% of women and about 50% of men have TMD symptoms. Depending on the age of the patient, there are differences in the symptoms. Only very few children and young people show classic problems such as headaches and tinnitus. At their age, the body’s ability to compensate is very high and the entire organism can adapt better to disruptive factors. In older teenagers, the symptoms are more likely to appear – usually in connection with stress, physical tension or a changed bite position.
In the 1940s, TMD occured more frequently. The reason: Unfavorable living and working conditions caused a breaking point. Due to the increased stress and the decrease in the ability to compensate and adapt, the patients had developed typical TMD symptoms. In the early phase, the symptoms can often be corrected with relatively little effort. However, the longer a TMD persists, the more far-reaching the consequences and the more complex the therapy.
What are the Symptoms of Temporomandibular Disorders?
The symptoms of TMD are very diverse and can appear anywhere in the body. Most of the symptoms occur locally in the area of the head, but can also be transmitted down to the feet. There are three main reasons for the complexity of the symptoms.
1. As we learned above, the causes of TMD are very different and these can reinforce each other. Various causes lead to various complex symptoms.
2. The jaw joints are very important for the statics of the entire body. Incorrect loading of the jaw joints consequently leads to imbalances in remote body structures. At the same time, existing disturbances in body statics often have to be compensated for by the jaw joints, which can lead to TMD symptoms. This was referred to earlier as “descending” and “ascending” strain.
3. All structures of the body are connected to each other via fascia. These fascial and myofascial channels are concepts of the Anatomy Trains Teachings.
Local symptoms of the jaw and teeth
The local symptoms of the jaw structures and the teeth result mainly from the direct impact of the jaw muscles. The large jaw-closing muscles (masseter muscle, temporalis muscle, medial pterygoid muscle) are able to exert enormous forces. When clenching and grinding your teeth, so-called bruxism, these forces are transferred to the teeth, jaw joints and the surrounding ligaments and fascia. Consequently, the excessive forces lead to the expected symptoms:
- Teeth are painful, severe tooth wear and breaking off of parts of the tooth
- Compression and incorrect loading of the temporomandibular joints lead to temporomandibular joint pain, cracking and rubbing noises when opening and closing the mouth. Due to the permanent incorrect loading, the structures of the jaw joints gradually rebuild and adapt to the non-physiological situation.
- Tension and hypertrophy (enlargement of the muscles) occur in the masticatory muscles. Especially in the area of the jaw angle, there is a prominent muscle enlargement and consequently visible changes in the facial anatomy.
Symptoms in the Head and Brain
Due to the close proximity, patients with TMD usually feel symptoms in the area of the head very early on. These manifest themselves in the form of tension headaches, migraines and facial pain. Since bruxism occurs more frequently at night, a strong headache and facial pain in the morning are clear and common symptoms of TMD.
Permanent bruxism leads to severe abrasion of the tooth structure and consequently to a loss of bite height. Due to the bite height loss, the lower jaw rotates in more, which leads to the compression of blood vessels, which are important for the blood supply to the brain. A loss of occlusal height of just 1 mm can cause neurological dysfunctions.
As a result, neurodegenerative diseases such as dementia can occur at an accelerated rate. In addition, with an increasing loss of bite height, cognitive abilities can gradually decrease.
Therefore, the correct bite height should be restored and permanently integrated into the overall system of the mouth and head.
The temporomandibular joints are in close proximity to the ears.
The forces exerted during bruxism, combined with mental stress, can lead to different symptoms of the ear structures. Many TMD sufferers complain about tinnitus (ringing in the ears), which severely affects the quality of life, especially at night. In the case of severe Temporomandibular Disorders, the symptoms can extend to sudden hearing loss (mostly reversible hearing loss).
Since the organs of balance (vestibular system) are also located in the inner ear, symptoms such as dizziness and balance disorders are not uncommon.
Due to the special importance of the jaw joints for balance and body statics and due to the connection of all body structures through fascia, TMD symptoms can occur anywhere on the body:
- Neck tension and neck pain
- Discomfort in the shoulder girdle and the entire back
- Changes in the anatomical and especially the skeletal system lead to compression in the area of cartilage discs/joint structures and nerve cords. Joints that are overloaded as a result can show increased wear and tear with the consequences of arthrosis, arthritis and pain. The compression of the nerve cords often leads to numbness in the arms/fingers and legs/feet.
- Skeletal changes in the pelvis with a tilted pelvis, resulting in different leg lengths.
- Uneven loading of the knee joints and ankles with corresponding abrasion, degeneration and pain.
Consequently, a long-standing and unrecognized TMD can change the entire anatomy of the body and lead to misalignments, malpositions, incorrect loading, degeneration/degradation and pain.
Some orthopedists or physiotherapists try to solve the problems in the local area of the painful structures, however the actual cause may lie in the masticatory system.
A leg length discrepancy is often compensated for with an insole, although the tilting of the pelvis can be a result of an incorrect bite.
Bruxism refers to an unconscious activity of the masticatory muscles that manifests itself in the form of teeth grinding and clenching. This is a strategy of the psyche to process accumulated mental stress such as worry, frustration or fear.
When you grind your teeth, your teeth rub against each other, while when you clench your teeth, your upper and lower jaws are pressed against each other without moving.
The reason why people start grinding and clenching when they are emotionally stressed is the connection of the limbic system (our emotional center in the brain) with the masticatory system. While this connection may make sense for short-term, healthy stress, it becomes a major health concern for long-term stress. The permanent activity of the masticatory muscles leads to the programming of pathological movement patterns. These unnatural movement patterns lead to an additional intensification and increase of the TMD symptoms.
Chewing muscles can exert enormous forces, which are passed on to the jaw joints via the tooth contacts. Consequently, it is ideal if the force is evenly distributed over many tooth contacts on all teeth. If the bite does not allow for a balanced distribution of force, the teeth and jaw joints are subjected to massive loads. Teeth can break off or die due to the high local pressure. All symptoms of TMD can manifest gradually.
Bruxism puts a lot of pressure and tension on the entire chewing apparatus and is a common cause of TMD.
A distinction is made between sleep bruxism and awake bruxism, depending on whether the patient bruxes more at night or during the day.
At night when we sleep, we unconsciously process everything that concerns us, so that sleep bruxism often manifests itself, which is difficult to control.
When awake, those affected are more likely to notice if teeth are being clenched – awake bruxism. Affected people who suffer from sleep bruxism can wake up the next morning with aching jaw joints, headaches and neck pain or tense muscles of the masticatory system. You feel tired and often notice a loss in concentration and performance.
Causes of bruxism
Bruxism is a large part of temporomandibular disorders and can worsen the conditions.
Emotional and mental stress are the main causes of bruxism.
“Grit your teeth!” is a typical phrase when things don’t go so smoothly. We usually work under pressure and want to meet daily demands, both professionally and privately. As an outlet to process stress and emotions more easily, the activity of the masticatory muscles increases and bruxism manifests itself.
Another cause of bruxism is an incorrect bite and improper contact of the teeth.
Normally, the teeth of the upper and lower jaw come together evenly, without any disturbances, in a clearly defined position. The sideways movement of the lower jaw glides harmoniously, without any interference, along the canines. If, on the other hand, the bite is unphysiological and the tooth contacts are unevenly distributed, the jaw muscles try to “correct” the bite through bruxism and grind down the area with disturbances.
In such cases, bruxism is the result of misaligned teeth and can be worsened by stress.
Treatment of Temporomandibular Disorders
Since the causes of TMD are so complex and multifaceted, it is important that the therapy is planned very individually and that all causal points are addressed at the same time. In order to carry out such a treatment correctly and effectively, it requires the cooperation of experienced experts of various disciplines.
A coordinated, interdisciplinary therapy between dentist, osteopath, optometrist, posturologist, physiotherapist and coach for stress management leads to a long-term and causal solution to the problems caused by TMD.
With this interdisciplinary approach to TMD therapy, the dentist oversees the planning and refers the patient to the appropriate therapist. Is of great importance that the dentist has a lot of experience in the field of TMD therapy, has a network of experienced therapists and has a good understanding of the basics of these other disciplines.
Interdisciplinary collaboration in TMD therapy
- Dental technician
- Speech therapists
- Oral surgeons
- ENT specialists
- Pain therapists
- Coaches specializing in pain and stress management
This listing is for a complete overview. Depending on the patient’s individual case, some of these specialists are consulted for support in the treatment and therapy.
In complex TMD cases, the experienced dentist usually includes several other therapists in the treatment. In this way, the ideal result can be achieved faster and more reliably.
The teaching of dentokinetics arose from the knowledge that the chewing apparatus interacts with the entire organism/body in a variety of ways. The position of the jaw joints and the movement patterns of the masticatory muscles are inevitably linked to the movements and structures of the entire body and these interact with one another.
Therefore, dentokinetics not only takes into account TMD causes in the tooth and jaw area, but also takes into account the descending and ascending strain on the entire body statics as well as balance.
The aim of dentokinetics is to permanently convert the dysfunctional masticatory system to its natural and physiological state and to achieve a constant balance of body statics.
The concept of integrative cooperation between specialists from different disciplines is useful (see above).
The dentokinetic dentist works with the MAGO splint, which is able to treat the TMD problem at the root and restore body balance.
In our opinion, dentokinetics is the most effective and profound therapy to treat TMD from the root cause and to achieve a permanently stable, balanced situation in the entire body.
Splint Therapy with the MAGO Splint
The MAGO splint goes back to the American biologist and dentist Dr. Robert Lee and stands for:
Maxillary(In the upper jaw)
Orthosis (aid to support the musculoskeletal system)
Dr. Robert Lee dedicated his life to examining the masticatory system and developed this type of splint therapy in order to be able to treat affected patients in a cause-specific manner.
The result of his work was the MAGO splint and the concept of dentokinetics.
The only thing that the MAGO rails has in common with today’s rails is the transparent material. In terms of function and effect, on the other hand, the MAGO splint sets the standards in TMD therapy.
As described above, persistent TMD results in anatomical changes in the structures of the masticatory system. These structural changes form part of the TMD and must be resolved gently.
This is exactly where the MAGO comes in. This is able to reverse the pathological changes of the chewing apparatus and bring the tissue into a harmonious and balanced state. The incorrect movement patterns of the muscles are converted into physiological ones and the jaw joints are regenerated and stabilized in the correct position.
Working with the MAGO splint requires frequent adjustments so that the tissue can be gradually and gently restructured. After a few weeks, but at the latest after three to four months, most patients experience significant relief from TMD symptoms.
The MAGO therapy is complete when there are no more symptoms, the masticatory muscles show physiological movement patterns and the jaw joints have been regenerated and stabilized. In most cases, it is after six to nine months.
After completion of the MAGO therapy, the new, physiological situation of the jaw joints is permanently stabilized by the teeth being reshaped and the correct bite being stably integrated into the system
Remodeling of the Teeth
After successful MAGO therapy, which should be carried out by an experienced TMD specialist, the correct remodeling of the teeth takes place.
In the vast majority of TMD patients, the teeth and jaw joints are in the wrong position at the start of therapy. The MAGO brings the jaw joints into their ideal, physiological position and into harmony with the body statics. After that, the original teeth still do not fit together correctly and require reconfiguration to the new, physiological situation.
First, dental models are made of plaster, which reflect the exact shape of the teeth and show how the upper and lower jaws line up. The desired tooth shapes are built up with wax on these dental models according to dentokinetic criteria (wax-up) and later transferred to the corresponding ceramic tooth restorations.
Care is taken to ensure that the teeth are ground down as little as possible and treated as gently as possible.
After the finished ceramic work has been placed, the bite height and interlocking are optimally adapted to the temporomandibular joints and the masticatory system is in perfect balance with the body as a whole.
The ceramically remodeled teeth should not differ in any way from the natural tooth structure and should and the result should be aesthetically perfect.
The ceramic restorations should be manufactured by a specialized dental technician who has great experience in the field of ceramics and aesthetics.
TMD: What can you do yourself?
TMD is a complex disease in which emotional and psychological factors also play a large role. At this point you can take action yourself:
Start observing yourself:
Try to keep an eye on your chewing muscles throughout the day. Do you press the rows of teeth together? Is the jaw tight? he teeth should only touch briefly when chewing or swallowing, but then separate again and have some distance when resting. For introspection and control, stick a noticeable post-it on objects around you, e.g. wristwatch, laptop, cell phone, etc.
Always check the position of your teeth when you see your post-it. If you catch yourself with clenched teeth, consciously open your mouth and close it in a relaxed manner. Repeat this up to 10 times.
Further reflection questions:
In which (stressful) situations do you tend to suffer more from your symptoms?
When do you tend to grind or clench your teeth?
When do you have a bad posture in your body statics?
In such situations, you can actively and consciously relax your jaw, give it rest and correct your posture.
Coping with stress:
Find an activity that provides mental and physical balance.
Targeted physiotherapeutic exercises and an exercise and training plan are very effective in achieving lasting success.
Intentional breaks, especially for your jaw joints, should also be integrated into everyday life.
Connection between chronic inflammation and TMD?
Many of the hidden, chronic inflammations are in the jaw area. This is because there are no organs that are treated as much as the teeth and jaws. There is no other body region into which so many materials and foreign substances are introduced as the teeth and jaws. Consequently, before TMD therapy, it should also be checked whether there are chronic inflammations in the mouth and jaw area.
What about the classic bite splint?
Are the MAGO rails metal-free?
Are there conventional devices?
The Aqualizer is a water-filled splint that can be used for a short period of time to alleviate acute TMD symptoms. However, the Aqualizer is not suitable for long-term use because softeners leak out and there is a risk that the teeth can shift. In addition, it is not suitable for causal therapy of TMD.
Bruxane is a bite splint that starts to vibrate as soon as you grind or clench. The vibration causes biofeedback to the entire masticatory system and the central nervous system, which slowly reduces bruxism. A disadvantage are the electromagnetic fields of the electronics, which are formed directly in the head. The device is more symptomatic and not cause-specific.
The RelaxArrow is another aid that can be used to relieve pain in the chewing muscles. It ensures permanent, light pressure on the large masticatory muscles, which relaxes the myofascial structures of the face. The RelaxBogen can be used over a longer period of time, but misses the causes of the TMD symptoms in the vast majority of those affected.
The devices mentioned can provide short-term help in acute phases. Long-term use can have various disadvantages and should be avoided.
A permanent solution requires a cause-oriented, complete interdisciplinary consideration of the TMD. From a dentokinetic point of view, the therapy should bring all myofascial and structural structures into balance and stabilize the healthy state that has been achieved with the new, reshaped tooth situation.
Can previous crowns, bridges and implants cause TMD?
Yes, that is possible.
When restoring crowns, bridges and implants, various functional criteria must be taken into account.
- The bite height should be set in an ideal position
- The jaws should be in line with the temporomandibular joints both vertically and horizontally.
- Bone sutures should not be splinted. Blockage can increase TMD symptoms.
If these points are not taken into account, TMD symptoms can arise or be further aggravated.
Can orthodontic treatments from the past trigger TMD?
This can result in functional problems of the masticatory system with problems in the jaw joints, symptoms such as tinnitus, dizziness and even loss of vision, descending symptoms in the neck, spine and hips, etc.
Patients who formerly had faulty orthodontic treatments often experience a great deal of suffering. They often have many dental and non-dental consultations and therapies behind them and therefore absolutely need a correct, interdisciplinary approach to TMD therapy.
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