TMJ, short for temporomandibular joint, serves as the connection point between the lower jaw (mandible) and the lateral base of the skull (temporal bone). Together with facial muscles and teeth, it facilitates proper alignment of the jaw and enables essential functions such as chewing, speaking, and swallowing. When structural changes occur in the TMJ or if supporting bite, muscles, and ligaments function inadequately, it can lead to alterations in bite, ability to open and close, facial appearance, and pain. This condition, often referred to as TMJ, is actually Temporomandibular Dysfunction (TMD)
What are the Signs or Symptoms of TMD (Temporomandibular dysfunction)
Jaw discomfort or pain
Clicking/popping or grinding sounds in the jaw joints
Jaw locking or restricted Range of opening
Retruded mandible which can appear as a deep bite or excessive overjet
Facial or bite deformities
Canted smile
Pain experienced when opening the mouth or chewing
Anterior open bite
Increased pressure and wear on back teeth
Headaches
Earaches or ringing in the ears unrelated to inner ear infections
Common Causes of TMD Symptoms
Trauma or Injury to the joint (internal derangement) Compressive injuries to the joint TMJ disk herniation Torn or overstretched ligaments in the joint
Overloading the joint and facial muscles
Degenerative Joint Disease / Arthritis
Autoimmune and Connective Tissue Disorders
Rheumatoid arthritis,
Juvenile rheumatoid arthritis,
Juvenile idiopathic condylar resorption,
Psoriatic arthritis,
Ankylosing spondylitis,
Sjogren’s syndrome,
Systemic Lupus erythema,
Scleroderma
Ehlers Danlos Syndrome
Parafunctional habits like:
Nail biting
Clenching and grinding
Tongue thrusting
TMJ treatment requires a Diagnosis
Treatments for Temporomandibular Dysfunction (TMD) vary depending on the specific type and severity of the disorder. Therefore, an accurate diagnosis is essential before any treatment recommendations can be made.
We typically initiate the diagnostic process with a comprehensive examination to assess for signs of internal joint derangement or structural risks within the joint. If warranted, TMJ imaging, including Cone Beam Computed Tomography (CBCT) and Magnetic Resonance Imaging (MRI) with the Piper protocol, is ordered. These imaging techniques provide detailed visualization of both hard and soft tissue structures, revealing the condition, size, and position of the TMJ. Additionally, the MRI helps identify joint or marrow space edema and assesses the position and condition of the articular disk.
Our specialized imaging protocol allows us to determine if the jaw or bite can be optimized for ideal orthopedic stability. In essence, TMJ imaging plays a pivotal role in making an accurate diagnosis, which, in turn, enables us to offer tailored treatment options and prognosis to the patient.
Recommending treatment without knowing the full diagnosis could be detrimental and make the joint worse.
TMJ Treatment Philosophy
TMJ pain can arise from various factors. Proper diagnosis is essential to accurately assess prognosis and determine suitable treatment options.
Appointment Flow to TMJ Diagnosis.
Initial Assessment
Temporomandibular joint (TMJ) pain can originate from multiple sources, such as the joint itself, surrounding muscles, the neck, and referred pain. The initial assessment is focused on identifying these potential sources. If there are indications of structural changes in the joint, a precise diagnosis may require ordering CBCT and MRI images to accurately evaluate its condition.
TMJ Pre-Imaging Records Appointment
We start with a detailed history of symptoms.
We conduct thorough clinical examination of the joint and facial muscles
We take photographs to identify jaw asymmetries or underdevelopment.
3-D Digital scans of your bite
4-D Jaw motion recordings to evaluate jaw function.
CBCT imaging will be ordered to evaluate hard tissue structures in the joint.
MRI Imaging will be ordered to assess the condition and position of the articular disk joint, look for joint or bone edema, and evaluate soft tissue structures in the joint.
High-resolution pulse oximetry may be used to screen and identify potential sleep-disordered breathing issues which may contribute to parafunctional habits like clenching or grinding at night.
Post-Imaging Consultation & Treatment planning
Once clinical findings, jaw function evaluation, and CBCT and MRI scans interpreted by a TMJ-specialized radiologist are completed, the patient is scheduled for a Post-Imaging Consultation. During this session, the results are discussed in detail, providing a definitive diagnosis of the TMJ condition along with valuable insights into its status. Once diagnosed, tailored treatment options specific to the individual's condition can be recommended. Our objective is to empower patients with understanding and assist them in finding effective solutions for their TMJ concerns.
TMJ Treatment Philosophy
Potential TMJ Treatment Solutions
After diagnosing Temporomandibular Dysfunction (TMD), personalized treatment recommendations can be tailored, potentially including some of the following approaches:
Palliative pain management using NSAIDs or other pain relievers
Muscle relaxers or BOTOX injections
Laser Photobiomodulation therapy
Physical therapy
Behavior modification strategies to address parafunctional habits
Identification and management of airway-related parafunction
Diet modifications to support jaw health and minimize joint overloading
Orthopedic oral appliance to alleviate joint pressure and optimize orthopedic bite position
Orthopedic bite stabilization through restorative dentistry and/or orthodontics
TMJ surgery options such as autogenous fat grafting or total joint replacement
Meet Dr. Julie Kwon
Dr. Kwon's commitment to education, combined with her investment in digital technology, enhances her effectiveness in diagnosing and planning treatments for TMJ disorders. With advanced education from Spear Education, The Kois Center, Implant Pathways, and the American Equilibration Society, she has honed her skills in cosmetic and full mouth reconstructions. Her involvement in the Chicago Study Club, dedicated to TMJ treatment, further solidifies her expertise in this area. As a visiting faculty member at Spear Education and co-leader of a local Spear Study Club, she actively advances dental knowledge among her peers. Dr. Kwon's wealth of experience and dedication ensure that her patients receive the highest level of care and accurate diagnosis for TMJ disorders..
