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.

One of our success stories that really stands out is the daughter of one of my friends. The friend and my wife go way back – about 20 years – and that friend sent her daughter to see me earlier this year. She told me that her daughter was in so much pain that when she came home at night, she could do little more than curl up in a ball and cry herself to sleep. This young woman had already been to dozens of doctors over the years and could not function much longer with so much head and neck pain. She was even thinking that life was not worth it. We were able to figure things out pretty quickly and within a month she was feeling better than she had in years. This is how debilitating TMJ disorders can be and how remarkable it is when they are fixed.

Of course, there are failures – unfortunately, most of those are with the people who have been in really bad shape for too many years. The goal is always to avoid surgery but sometimes no matter what we do (appliance therapy, massages, laser treatments, etc.) we cannot get the disc back in place or it is already perforated. The analogy that I tell patients is that they should imagine their car having an oil leak, loud muffler, brake fluid leak, smoke-belching, etc. and the mechanic trying to fix it all to restore your car. This is just too much for any mechanic to totally fix. All you can do is hope for the best. In most cases, there can be some degree of improvement. This is how TMJ treatment can be at times. You hope for the best in a bad situation. In almost all cases, however, improvement is seen, and I am thankful and grateful for that.

As we close out 2023, I am grateful for the support of our friends, families and team members who have made all of our efforts so successful. My core team members are well aware of how much I appreciate their hard work and going beyond what is expected of them. We are now in a position to further spread the word about what we can do to help people improve their lives. Our office will be expanding as many of you have already seen when you visit. We will have a bit more space to be able to prepare the treatment rooms in advance of your visit to make sure our ‘on-timeness’ is really top-notch!

So, we end this wonderful year with good friends and family all around us. May you all have a most excellent 2024 and God Bless.

Dr. Jeff Brown

The post The End of Another Year is Here 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.

Why is sleep important? When the body does not sleep well, it is far more likely that disease processes can begin. As anyone knows, when your body is just tired all the time, it is far more likely you will catch the flu and infections are far more likely to set in. This is the case with cancer as well. When your body is debilitated from lack of sleep it is easier for cancer to set in.  There is now plenty of research to support this. If you simply Google ‘cancer from sleep apnea’ you will find that with moderate to severe sleep apnea, you are two and a half times more likely to develop cancer and three times more likely to die from cancer. This is a serious statement. What this means is that if you are not sleeping well, you are far more likely to contract kidney cancer, melanoma, breast cancer, and uterine cancer. Even though the risk of lung or colorectal cancers is less, it is just not worth the risk when you do not sleep well. TMJ disorder affects not only your joints but impacts the quality of sleep. A confirmation from UVA hospital’s research is that good sleep has been confirmed to be key to good health. With good sleep, the lymphatic system is regulated, and in turn, helps regulates many immune systems.

So, what is the message of this little blog? The message is to pay attention to your body. If the jaw joints are causing pain – headaches, neck or back pain, or even dizziness and tremors – then pay attention and have it looked at by someone who understands the situation. And this has now opened up another proverbial can of worms: Who do I see? TMJ disorder is so poorly understood that there is no consistency in diagnosis or treatment. So please stay tuned as the next blog will delve into the devious world of diagnosis and treatment.

The post Oral Cancer and TMD- Coincidence or Correlation? first appeared on Sleep & TMJ Therapy.