Introduction to TMD and Its Causes
Temporomandibular joint disorder (TMD) refers to a condition that affects the jaw joints, muscles, and surrounding structures, often leading to pain, discomfort, and functional issues. The temporomandibular joints (TMJs) are located on either side of the jaw, connecting the lower jaw (mandible) to the skull. These joints play a critical role in chewing, speaking, and other jaw movements. When they don’t function properly, it can result in symptoms like jaw pain, clicking or popping sounds, headaches, and difficulty opening or closing the mouth.
The causes of TMD can vary widely, but common factors include stress-related jaw clenching or grinding (bruxism), trauma to the jaw, misaligned teeth, arthritis, and even genetics. One often overlooked but critical factor in TMD is the height of the teeth, which plays a significant role in maintaining proper support for the TMJs. The height and alignment of teeth directly affect the way the upper and lower jaws come together, known as the bite. When teeth are worn down, misaligned, or missing, the balance of the jaw can be disrupted, putting strain on the TMJs. For this reason, restoring optimal bite alignment is a key component of TMD treatment.
The start of proper TMD treatment begins with diagnosis based on good imaging. That imaging requires an MRI and CBCT X-ray. The MRI can be somewhat difficult to acquire because it takes a really good radiologist with lots of experience to provide an effective report on the status of the TM joints. The CBCT also requires proper expertise in order to provide good documentation and a good plan for treatment.
The MRI shows if the articular discs are displaced and how far. This image can even show if they are already perforated or torn prior to treatment. These are crucial factors in developing a good plan of treatment and properly informing the patient. The CBCT x-ray shows the cervical spine and how malaligned it might be. If out of alignment, this causes the neck to tip and this subsequently sends the condyles and sockets out of alignment as well. The CBCT also identifies calcified stylohyoid ligaments, condylar damage, condylar distance to the bony socket, airway volumetrics, deviation of the nasal septum, mastoid bone protrusion and elevation, along with multiple other salient points in planning. It takes a skilled TMD practitioner to understand the nuances of TMD treatment.
Prior to actually beginning treatment, it is the job of the practitioner to explain to the patient that once done wearing the appliance(s) it will be logical to consider finishing the case and being done with appliance therapy. Most patients do not want to wear devices all their lives and would prefer an approach that allows them to finish up so they can eat most foods they want rather than staying with a fork tender diet. In almost all cases, finishing will entail doing orthodontics to erupt the teeth tall enough to support the TM joints and/or placing onlays or crowns to make the teeth taller, again this is to support the jaw joints for the long term.
Non-Surgical Orthodontics for TMD
Non-surgical orthodontic treatments offer a conservative and effective approach to addressing TMD. This type of treatment focuses on correcting bite misalignment and improving the overall function of the jaw through gradual, natural adjustments. One common goal of non-surgical orthodontics is to encourage the eruption of teeth to improve their height and provide better support for the TMJs.
Orthodontic devices, such as braces or clear aligners, are often used to reposition teeth into their ideal alignment. By doing so, the bite can be restored to its proper form, reducing stress on the TMJs. Additionally, in some cases, specialized oral appliances may be employed to stabilize the jaw, alleviate muscle tension, and prevent harmful behaviors like teeth grinding. These appliances are typically custom-made to fit the patient’s mouth and can be worn at night or during the day, depending on the treatment plan.
Another key aspect of non-surgical orthodontics for TMD is the controlled eruption of teeth. When teeth have been worn down over time or are naturally too short, it can lead to a lack of proper jaw support. Orthodontic treatments can help guide teeth into a taller position, restoring the vertical dimension of the bite. This not only supports the TMJs but also improves the overall appearance of the smile.
One of the main advantages of non-surgical orthodontics is that it addresses the root cause of TMD without the need for invasive procedures. It is a gradual process that allows the jaw to adapt naturally, promoting long-term stability. However, it does require patience, as treatment times usually require a few years, depending on the severity of the case. Despite the longer timeline, many patients appreciate the conservative and minimally invasive nature of this approach.
In the past we could only offer metal brackets and wires for this type of treatment. Today, however, we only offer clear aligners made by the Spark company. Their AI has learned how to erupt teeth properly and can achieve an excellent end result. A typical case usually takes about two years to complete so this must be understood at the beginning of treatment.
Crown-Based Solutions for TMD
Another effective method for treating TMD involves the use of crowns or overlays, which are custom-made restorations designed to cover the entire surface of a tooth. This approach focuses on restoring the height of worn-down or damaged teeth, which in turn helps to improve bite alignment and provide proper support for the TMJs.
When teeth become worn, they lose their original height, which can lead to a decrease in the vertical dimension of the bite. This change places added strain on the jaw joints and muscles, contributing to TMD symptoms. Crowns can address this issue by rebuilding the teeth to their optimal height and shape. By restoring the natural contours of the teeth, crowns allow the jaws to come together more comfortably, reducing stress on the TMJs.
The process of using crowns for TMD treatment begins with a thorough evaluation of the patient’s bite and jaw function. Dentists often use advanced imaging and diagnostic tools to assess how the teeth and jaw interact. Based on this analysis, a customized treatment plan is developed. The teeth are prepared to receive the crowns, which are then carefully designed to fit seamlessly with the surrounding teeth and provide the desired level of support.
Crowns can be made from a variety of materials, including porcelain, ceramic, and metal alloys. For TMD treatment, dentists typically prioritize materials that are both durable and aesthetically pleasing, ensuring that the restorations blend naturally with the patient’s smile. Once the crowns are placed, patients often experience a noticeable improvement in their bite and a reduction in TMD symptoms.
One of the key benefits of crown-based solutions is that they can deliver relatively quick results compared to non-surgical orthodontics. In many cases, the treatment can be completed in just a few visits, making it an appealing option for patients seeking a faster resolution. However, it’s important to note that crowns are a more invasive treatment, as they require the removal of some natural tooth structure. Additionally, the cost of crowns can be higher than other treatments, which may be a consideration for some patients.
In our office, once the patient has worn their orthotic for the required amount of time- usually 12-18 months- they are generally ready to finish up. Crowns are always offered as a quick way to finish the case, however, not always a viable option if you are talking multiple crowns. This is why orthodontics is usually the first course of treatment because the cost is significantly lower.
Comparing Long-Term Solutions for TMD
When it comes to long-term solutions for TMD, both non-surgical orthodontics and crown-based treatments offer distinct benefits and drawbacks. Choosing the right option often depends on the patient’s specific needs, preferences, and the severity of their condition.
Non-surgical orthodontics stands out for its conservative nature. By gradually repositioning teeth and encouraging natural eruption, this approach addresses the underlying causes of TMD without the need for invasive procedures. It’s an excellent choice for patients with mild to moderate TMD who are willing to invest the time required for treatment. Orthodontic solutions are particularly well-suited for younger patients or those who have a history of teeth grinding, as they can help prevent further damage to the teeth and jaw. However, the longer treatment timeline may be a drawback for those seeking a quicker solution.
In addition, orthodontics does not work for people with periodontal problems like bone loss, short tooth roots, and gum recession. This is why we have patients keep up with their dental cleanings and have their dentist carefully watch the bone while the teeth are slowly erupted. Sometimes we erupt the teeth and the body will only allow a certain amount of eruption and we have to finish the case with crowns/onlays. This is why you need to understand your options prior to treatment. You don’t want to start all this only to discover that you will be unable to spend the time or the money to finish your case.
On the other hand, crown-based treatments offer the advantage of faster results. By restoring the height of worn teeth, crowns can quickly improve bite alignment and alleviate TMD symptoms. This approach is ideal for patients with significant tooth wear or damage, as it provides both functional and aesthetic benefits. Additionally, crowns can be customized to match the patient’s natural teeth, creating a seamless and visually appealing smile. The main drawbacks of crown-based solutions are their invasiveness and cost. Since they require the removal of some natural tooth structure, they may not be the best option for patients who prefer to preserve their natural teeth as much as possible.
Ultimately, the decision between these two approaches should be made in consultation with a qualified dental professional. Factors such as the patient’s age, overall oral health, budget, and treatment goals will all play a role in determining the best path forward.
Conclusion and Next Steps for TMD Treatment
Temporomandibular joint disorder can significantly impact a person’s quality of life, but effective treatment options are available to address the underlying causes and provide lasting relief. Non-surgical orthodontics and crown-based solutions are two of the most common approaches for managing TMD and restoring proper jaw function.
Non-surgical orthodontics offers a gradual and conservative way to realign the bite and support the TMJs, making it a great option for those who prefer a minimally invasive treatment. Crown-based solutions, on the other hand, provide faster results by restoring the height of teeth and improving bite alignment. Both approaches have their unique benefits and challenges, and the choice between them will depend on the individual patient’s needs and circumstances.
If you’re struggling with TMD, it’s essential to take the time to explore your treatment options and make an informed decision. By addressing the root causes of the condition and restoring proper jaw function, you can achieve long-term relief and enjoy a better quality of life.
If you’re experiencing symptoms of TMD, now is the time to take action. Consult with a dental professional or TMD specialist to evaluate your condition and explore the best treatment options for your needs. With the right care and guidance, you can find relief from TMD and restore comfort, function, and balance to your jaw. Don’t wait — schedule a consultation today to start your journey toward a healthier, pain-free smile.