At its core, the temporomandibular joint (TMJ) is an intricate mechanism crucial for facilitating a myriad of facial movements. Unlike most other joints in the body, the TMJ operates through both hinge and sliding motions, a duality that permits the extensive range of jaw movements required for talking, chewing and yawning. This joint comprises a delicate assembly of bones – the mandible, or lower jaw, and the temporal bone of the skull – cushioned by a small, shock-absorbing disc that ensures movements are smooth and frictionless.

The functionality of the TMJ relies on a balanced interaction among its components – muscles, ligaments and the disc. These elements work in harmony to manage the stresses exerted during jaw movements. However, this balance is easily disrupted, making the TMJ susceptible to disorders. The complex nature of this joint, coupled with its essential functions, underscores the critical need to understand its anatomy and physiology comprehensively.

The significance of the TMJ extends beyond mere mechanical operations; it is intertwined with a network of muscle and fascial connections throughout the head, neck and shoulders. This interconnectivity means that dysfunction in the TMJ can have cascading effects on surrounding muscles and joints, leading to a range of symptoms that may initially appear unrelated to the jaw. For instance, issues with the TMJ can trigger tension headaches, neck stiffness and even impact posture. When the discs within the TM joints are displaced, this can cause dizziness, visual problems and even tremors. In some cases, the displaced disc causes compression on the c-spine which then leads to compression of the airway.

In essence, grasping the basics of the TMJ’s structure and function is paramount for recognizing its role in daily activities and the potential consequences of its dysfunction. This understanding is the foundation for identifying early signs of TMJ disorders and taking preventive measures to avoid them, highlighting the TMJ’s pivotal role in maintaining not just oral health, but overall physical well-being. To diagnose TMJ disorder, it is important to work with a doctor who does a comprehensive analysis including an MRI of the discs, along with an X-ray: a CBCT that will examine the bones of the head and neck region. In my practice, this allows for an additional component, measuring the airway. The airway can be affected by TMJ disorder by simply causing compression of the c-spine which then pushes into the air passage.

In the fabric of our everyday existence, the temporomandibular joint (TMJ) stands out as an underappreciated hero. This small yet mighty joint is not just a mechanical marvel allowing for the opening and closing of the mouth; it is deeply embedded in the quality of our daily life, influencing eating, speaking and even emotional expression. The seamless operation of the TMJ facilitates the enjoyment of a meal, the articulation of thoughts and feelings and the subtleties of non-verbal communication through facial expressions.

The complexity of the TMJ’s role is further highlighted when considering the intricacies of tasks it supports. For instance, the act of chewing involves a delicate balance of muscular coordination and joint movement that the TMJ makes possible. Similarly, the clarity and variety of speech – from whispering to shouting – rely on the precise movements facilitated by this joint. Beyond these evident roles, the TMJ’s function extends to the realm of emotional expression. The ability to smile, frown or show surprise involves nuanced movements of the jaw that the TMJ supports, playing a critical role in human interaction and emotional connectivity. Sleep also is affected by this little disc. The pain or discomfort while trying to sleep causes disruption in sleep patterns, restlessness or in some cases insomnia.

However, this multifunctionality comes at a cost. The TMJ’s critical role in such a wide array of activities means that when disorders strike, the impact is widespread, touching upon basic functions and reducing the quality of life. The interconnectedness of the TMJ with other bodily systems underscores the importance of its health for the seamless execution of daily tasks. Recognizing the TMJ’s multifaceted role in daily life is not only a step towards appreciating its complexity and sensitivity but also a call to action for its care and preservation, ensuring that it continues to support the myriad activities that enrich our lives.

TMJ disorders manifest a variety of symptoms that can profoundly alter daily functioning and personal well-being. Individuals grappling with these conditions may experience persistent jaw discomfort, difficulty in mastication (chewing) and even challenges in articulation, which are central to both nourishment and communication. The pain may not be confined to the jaw alone; it often radiates, leading to headaches, earaches, ringing in the ear, neck pain, back pain and a pervasive sense of discomfort that can disrupt sleep and concentration. The other aspect of this disorder can cause the disc to put such force on nearby nerves causing tremors or ticks. The audible clicking or popping sounds accompanying jaw movements, a hallmark of TMJ disorders, can add an additional layer of distress, creating social and professional awkwardness.

Moreover, the restrictive effect TMJ disorders have on jaw mobility, limiting one’s ability to open or close the mouth fully—can significantly compromise eating habits and nutritional intake, leading to broader health implications. This limitation can also impinge on social interactions and personal relationships, as the simple joys of conversation and dining with others become sources of pain and frustration.

The repercussions of TMJ disorders extend into the professional realm, where sufferers may find it challenging to maintain focus and productivity due to the constant distraction of discomfort.  A malaligned body may also add discomfort. Starting with the face, one side may be elevated causing a pull on the neck which then trickles down the body causing your posture and or stance to be uneven. The resultant decrease in quality of life can also exacerbate feelings of stress and anxiety, further intensifying the physical symptoms of TMJ disorders in a relentless feedback loop.

The ripple effects of TMJ disorders highlight the critical nature of early detection and management to mitigate these impacts. Understanding the potential severity of these conditions underscores the importance of seeking prompt and effective treatment, not only to address the physical manifestations but also to safeguard one’s overall quality of life. Engaging in preventive care and adopting lifestyle adjustments can play pivotal roles in managing the delicate balance of TMJ health, thereby minimizing the risk of such profound consequences. Generally, appliance therapy use is a great way to help realign and help the disc move back into place. Within our practice we use two types of appliances: ALF and Modified Gelb. (Check out our other blogs on how these two types of appliances help the body.) Typically, the effects of wearing the appliances can be felt within two to three months. Relief from the symptoms, or at least a great reduction, is generally reported.

The Temporomandibular Joint (TMJ) serves as a critical intersection between oral functionality and systemic health. Disorders of the TMJ have been found to intersect with a variety of systemic conditions, suggesting a bidirectional relationship where each can influence the severity and progression of the other. For example, individuals with chronic inflammatory conditions such as arthritis may experience an exacerbation in TMJ symptoms, highlighting the joint’s sensitivity to systemic health changes. Similarly, conditions like fibromyalgia, which affects the musculoskeletal system, can compound the pain and dysfunction associated with TMJ disorders. Another common condition is EDS. With the lax connective tissue, the discs typically are not in place.

Moreover, the TMJ’s condition often mirrors the body’s stress levels. Stress and anxiety do not just affect mental health; they manifest physically, often tightening the jaw muscles and exacerbating TMJ discomfort. The clenching and or grinding of the teeth can lead to additional dental problems: cracked or sensitive teeth, gum recession and even tooth loss. This interplay underscores the importance of holistic health approaches in managing TMJ disorders. Effective management strategies extend beyond the physical aspects of TMJ care to include stress reduction and mental health support, reflecting the comprehensive impact of TMJ health on one’s life.

This intricate connection between the TMJ and broader health concerns suggests that maintaining TMJ health is not just about alleviating local symptoms but about supporting the body’s overall balance and well-being. The relationship emphasizes the necessity for a multidisciplinary approach to treatment, integrating dental care with broader medical and psychological support to address the full spectrum of factors influencing TMJ health and, by extension, quality of life.

Caring for your temporomandibular joint involves simple, yet effective strategies that can significantly contribute to preventing discomfort and disorders associated with TMJ. One of the key aspects of TMJ health is mindful management of stress, as tension can lead to unconscious clenching or grinding of teeth, further straining the joint. Techniques such as meditation, deep breathing exercises and yoga can be beneficial in mitigating stress levels, thereby indirectly protecting the TMJ. While in treatment within our practice, we offer additional adjunctive services to help relax the muscles to allow for the disc movement back into place. TMJ massages, non-surgical laser therapy, the Neubie machine, and Botox when needed can help get the muscles trained to relax and not always in tension.

Another critical factor is being conscious of jaw movements. Habits such as chewing gum excessively, biting nails or grinding teeth can exacerbate wear and tear on the TMJ. Being aware of such habits and working to minimize them can help maintain joint integrity. Similarly, when yawning or eating, it is advisable to avoid opening the mouth too widely to prevent overextension of the TMJ.

Implementing a routine that includes jaw exercises and stretches can also be instrumental in maintaining a healthy TMJ. Gentle stretching can help increase the flexibility of the jaw muscles, while strengthening exercises can improve their function, reducing the risk of TMJ-related issues. These exercises should be performed with care to avoid any sudden or forceful movements that could potentially harm the joint. Within our practice, treatment is a multi-dimensional approach working with a recommended physical therapist or osteopath to help realign the rest of the body as the cranium becomes more aligned and the jaw and disc are moving into the proper anatomical position. Together many have found a reduction of symptoms during the course of treatment. There are many dentists in the country who now have a good handle on treatment for TMJ disorder and they are the ones you should seek to help treat the whole body problems.

Attention to posture, particularly while working or using electronic devices for extended periods, can also impact TMJ health. Poor posture can strain the neck and shoulder muscles, creating a domino effect that places additional stress on the TMJs. The flow starts with your shoulders being slumped. This causes your head to protrude forward and causes additional strain on the c-spine (the neck). The strain is then moved to the TMJs. It is best to make sure that your workspace is ergonomically set up to support good posture. This can help alleviate unnecessary tension in the TMJ.

Finally, regular check-ups with a dental or TMJ specialist can provide early detection and intervention for any signs of TMJ disorders. These professionals can offer personalized advice and treatments to address individual needs and prevent potential complications. By adopting these preventive measures, you can support the health of your TMJ, contributing to overall well-being and quality of life.

If you have questions about TMJ treatments in Falls Church, Virginia, Dr. Jeffrey Brown and our team at Sleep & TMJ Therapy have the answers you need. We welcome you to call our office at 703-821-1103 to learn more or schedule a consultation.

The post Sensitive Areas of the Body: The Significance of TMJ first appeared on Sleep & TMJ Therapy.

Back when I was the guy who stood at Gold’s Gym at 05:00 hours.  That’s 5 am for anyone who is not familiar with the 24-hour time clock. Then one day I was driving home, and it was a dark and rainy night (sounds like a good beginning to a horror story, and as it turns out, it was). There was a jaywalker in the middle of the road, so I hit the brakes hard and stopped, but so did the bus to my right. Unfortunately, the guy behind me did not stop and slammed hard into the back of my car, doing around 40 mph. My neck snapped pretty hard, and my beautiful car was crunched up quite badly. (Sure, it was already 15 years old, but it was my baby :)). I took down the name of the guy who nailed me, went home and went to bed. The next morning my neck hurt so bad I could not move, could not get out of bed and could only call for help.

This was the beginning of a 20-year nightmare of neck pain and back pain that would never cease. I felt like I was living on Advil. My neck, traps, back, shoulders, everything had been in pain for so long that it felt like there was no solution. And then, I slowly began to notice that I was having difficulty swallowing my vitamins and eventually even food was tough to get down my throat. It was like I had to really ‘work it’ to force down my food and people were noticing that I had lots of issues, they actually asked if I was choking. Well, it turns out that I was indeed having swallowing problems sounding like choking!

As the years progressed, I sought countless physical therapy appointments, osteopath visits and any other doctor to help with the pain.  Some of them were really good, others not so much. The problem with all this treatment was that nothing would really alleviate the pain or swallowing problems for any length of time. It was all ‘palliative’ treatment, as they call it.

So, I already knew that I had a severely deviated nasal septum that would greatly affect breathing and healing, obviously. As a member of the ALF Academy, I learned more about my own problems. I learned that when the body incurs trauma, like I did, the ligaments that exist from the mastoid bone behind the ear and go to the hyoid in the throat will often calcify into bone. This calcification is our body’s way to help open up the airway and reduce spinal compression, both of which I had going for me. If you can imagine having long pieces of bone stuck in your throat on both sides and these darned things are blocking both your airway and your ability to swallow, then you can understand what I have been through, and many of my patients have experienced. Was this diagnosed as Eagle’s Syndrome? No, not really, but some of my doctors did suggest it. And what do you do about Eagle’s? You generally watch it and keep an eye on it. So that’s what I did until recently.

In my practice, we have always watched for this, and appliance therapy slows down the calcification process tremendously. To be clear it does not get rid of the problem.  The concern is the compromised airway and continued pressure placed on the carotid artery. Obviously, this is a concern that can lead to a stroke. This is why we have a CBCT X-ray completed from the neck up.

Now, back to my story. There came a time in middle to late 2022 when I was choking on most foods and literally gave up on all the vitamins and supplements that my doctor wanted me to take. I knew my hyoid ligaments were very calcified at this time. I took a good long look at my own X-rays and said, ‘That’s enough XXXX’, I need to deal with this problem. I made the call to the most wonderful ENT doctor that I have known for years. He and I discussed treatment and he explained he has dealt with these issues for many years now and knew exactly what to do. Needless to say, I knew I had to deal with this, so I scheduled a surgical intervention. His surgery involved correcting the deviated septum and removing the calcification from either side of my throat.

The next three days of my life were really rough. All I could do was to choke down the oxycontin and cry for the next five minutes or so. The oxy would kick in for a while and it was three days later before I could even think of consuming chicken broth or anything similar. So, for the next week, I would choke down my broth, and sometimes there was a bit of noodle in there as well.

At 12 days post-surgery, I am at the computer typing away with a very sore throat and just taking Tylenol as needed for the pain. Last night, I was able to choke down some noodles and sauce and it was a bit less difficult than the night before. No more oxycontin is needed. My nasal passages are also popping out lots of scabs these days and if I blow my nose, lots of junk comes out. Overall, it is getting better, but ever so slowly. I have been sleeping up to 12 hours each day; not sure if this is recuperative sleep from losing so much sleep over the years or just from the lack of sleep post-surgery. I am still having problems with swallowing, but the throat is still quite swollen, so I guess that’s par for the course.

So, how would I rate doing this surgery? The jury is still out. I do admit that I believe I can breathe a little better through the nose and hope this continues to improve. Also, when I take Tylenol, it does not get stuck in my throat nearly as much. The neck pain is still there – I had no expectations about curing that. Sleep is much better and definitely more restful. My main reason for writing this very long blog was to set expectations if one ends up doing such a surgery. Expect a lot of pain. Expect difficult days and rough nights. But in the end, as long as it helps, it was worth it!

The post The Case of the Calcification and the Correction or How I Handled Eagle’s Syndrome first appeared on Sleep & TMJ Therapy.

Diagnosis of the problem is paramount. A really well-done MRI is critical in determining the path of treatment, and many times getting good imaging is quite difficult. So here is the first ‘delay’ in fixing the problem, getting an appointment for a well done and well-read MRI. It can take several weeks to get that appointment and quite honestly some people just do not want to wait. I can’t blame them either. Let’s get it done now!

The next delay is just getting an appointment at the office to discuss all the issues. This is where we look at the bone from the CBCT X-ray and the soft tissue from the MRI. In most cases, people want their insurance to pay at least something and that in turn creates the next delay. Next on our list is the fact that with TMJ appliances, they are custom-made. This takes time. They are not something sitting on the shelf, ready to put in the mouth. It takes weeks to make them since they are custom made for each person.

Now let’s get to the next big delay. You have to wear the devices for 12-18 months to give the discs a chance to move back into the proper position. That’s right folks, it takes that long, especially if the discs have been displaced for several years. The discs don’t just fall back into place instantly. It will take time and patience. Of course, some are not willing to devote such time (and patience) to their health, so they do not do anything. That is OK as not everyone is experiencing the same level of pain or discomfort. When it gets really bad, the patient will pursue treatment but generally now the problem is harder to fix, costs more, and takes more time. This is like most things in life.

Finally, the biggest time consumer of all – finishing after the discs are back in place. In most cases, orthodontic work is needed to grow the teeth taller to protect and support the TM joints (the jaw joints). Orthodontics can take 1 ½ -3 years, easily! So here you are, having spent all this time on appliances only to realize it’s going to take another couple of years. You are basically dedicating up to 4-5 years of your life toward fixing a TMJ problem. This is why we always tell our patients phase one is appliance therapy and phase two is finishing. Thus, the question has been answered. Now you know why TMJ treatment can take so long!

The post The Case of: “Why Does This Take So Long?” first appeared on Sleep & TMJ Therapy.

Over the many years of treating TMJ disorders, my office has realized a couple of things: Do not use appliance therapy that is fixed or cemented in the mouth and using the AGGA or similar devices like FAGGA, MARA, ARA, FORA and RPE may not be wise when it comes to achieving the goal of palatal expansion and/or moving the upper jaw forward. The first reason, and the biggest, was the decrease of effective oral care. The reason for the other appliances is a big one.  The bones of an adult skull will simply not move 10+mm forward as some AGGA practitioners claim. The only way to achieve such a distance is to surgically reposition the upper jaw and our office does not recommend that. The reason is the nerves and blood vessels may be damaged in the process. The only time MMA (Maxillary and Mandibular Advancement) is recommended is with hopeless apnea cases where all other modalities have failed.

I have personally seen a number of AGGA type cases over the years and have observed that most of them tip the upper teeth forward so quickly that the teeth will come out of the bone, leaving them mobile in many cases. The jawbone itself does not remodel and come forward as the advertisers indicate. This has been the problem all along: too much force too fast in adult cases. In my office we have never used and never will use the AGGA or similar device. This is why my office has also banned the use of RPEs (Rapid Palatal Expanders). When expanding the palate rapidly, the same effect can occur, whether in children or adults. If a palatal expander is ever used, it must be done slowly and carefully, regardless of the patient being a child or an adult.

A better device is called the ALF (Alternative Lightwire Functional) developed by Dr. Darick Nordstrom many years ago. With children the ALF provides expansion for crowded cases, but perhaps more importantly, it gently opens up the bones to provide relief from head pressure and pain. With adults, the ALF is not a palatal expander, but more of a support appliance. The analogy I use is that it is like an arch support in your shoe; providing support that has been lacking. It is quite the opposite of a forceful AGGA. To achieve relief from your TMD symptoms such force is neither logical nor necessary.

The ALF was developed to help avoid extraction of permanent teeth like bicuspids. When teeth are extracted, this can collapse the airway and change the position of the cervical spine (the neck). Using the gentle approach of the ALF can open up narrow arches in children and avoid the extractions which used to be the ‘norm’ for orthodontists. So in lieu of even the palatal expander, the ALF offers a better approach.

When it comes to patient care and the decisions you make for your family it is important to keep in mind that the FDA recommendations regarding AGGA are quite clear, and I wholeheartedly agree that the AGGA and similar devices have the potential to damage the jaws and the teeth. Ask your dental provider about the FDA concerns and be aware what it means to wear such devices. If you have any questions about these devices or your dental health, we welcome you to call our team in Falls Church, Virginia at 703-821-1103. Dr. Jeffrey Brown is ready to help you with all aspects of your smile!

The post Response to the FDA Concerns Regarding AGGA and other Similar Devices first appeared on Sleep & TMJ Therapy.

The truth of the matter is that if you work with an experienced TMD (Temporomandibular Disorder) specialist, then such an advanced procedure is rarely necessary. The path toward surgery should always try to be avoided, but sometimes it is simply necessary.

When a patient first begins treatment, they must do an MRI to figure out how damaged the discs in the jaw joints really are. This gives the specialist a good baseline to begin with so that a comparison MRI 12-18 months later will help to determine if enough healing has occurred so that surgery is not needed. It’s all relative- if after the 12–18-month appliance therapy period, the patient just feels great, yet the discs are not quite perfect position, then no surgery is indicated. If there is still substantial discomfort, then there would be a discussion about the type of surgery and how to finish the case.

In almost all cases that require surgery, the process is either plication (put the discs back into proper anatomic position) or meniscectomy (remove the remnants of the damaged discs). In either case, the surgeon makes an incision that is only one inch long at the little crease just in front of the ear. He then goes into the joint and will fix the problem either way. Sutures are done internally to keep the discs where they should be, and external sutures are done to seal the area. These two surgeries are considered simple and logical and when done will last a lifetime in almost all cases. The key factor is having a surgeon who has done many cases over the years. It should also be mentioned that TRJ (Total Joint Replacement) is only done when the top of the jawbone (the condyle) is severely eroded beyond any reasonable chance of repair. This is a rather heavy-duty surgery because you are in full braces and the jaws are wired shut for a few months. Eating through a straw is no fun, but there are few other options.

Because TMD treatment is so misunderstood and mismanaged, there are many opinions coming from many practitioners about the proper course of treatment. Some surgeons will ONLY perform TJR while others would do arthrocentesis (flushing the joints) before considering plication or meniscectomy. For these reasons, insurance companies are hesitant to pay for a procedure and call it all ‘experimental’ which it most certainly is not. So please be well informed and understand the options!

The post The Case of the Misunderstood Surgery first appeared on Sleep & TMJ Therapy.