TMJ dysfunction and related services

With over 30 years of experience in treating, teaching, and studying the complexities of three-dimensional joint function, Dr. Rich believes strongly in a philosophy of conservative and non-surgical treatment when it comes to the disorders of the jaw. Congenitally malformed joints are extremely rare, and most other forms of TMJ dysfunction respond extremely well to a non-surgical approach. But what is TMJ dysfunction and how do you know if you have it?

The temporomandibular joint (TMJ, or jaw joint) is the hinge that allows your lower jaw to move up and down, and side to side. Together with the teeth and the facial muscles, the TMJ joins into a system that allows us to chew, swallow, talk, and yawn. The joint provides the mobility, the muscles fire the action, and the teeth dictate the landing place, or place of rest. When one element is out of balance, the other two are no longer able to function properly and pain, restricted movement, and/or locking and popping in the joint itself can develop.

While it is true that in very rare cases TMJ dysfunction can be the result of congenitally malformed joints, more commonly the cause is multifaceted. Often tooth position is involved, but trauma – even early trauma – can also be a cause or a significant contributing factor. Even something as simple as holding the teeth together too much of the time (clenching) can stress the joints and muscles. Normal tooth function (chewing and swallowing) should account for no more than 4 to 6 minutes of tooth contact per day. However, many people have an unconscious daytime or nighttime clenching habit that may keep their teeth in contact for hours at a time. This action can compress the joints, strain the muscles, and trigger significant pain.

In cases where tooth position is a primary component of the imbalance, the TMJ and the muscles that surround it have the unique ability to adapt themselves to the best position for chewing and swallowing, even when that position is not ideal for the rest of the system. This kind of adaptation can cause pain and fatigue in the facial muscles, headaches, pain in the joints themselves, and even pain or ringing in the ears. If the imbalance remains unaddressed, over time the TMJ will eventually begin to remodel itself into its adapted position and this is when clicking, popping, locking, and grating may begin to occur.

In diagnosing TMJ dysfunction, Dr. Rich is very careful to consider all the possible contributing factors. She begins with a thorough examination that includes pain and trauma history, muscle and joint palpation, consideration of tooth position, and range of motion studies. If appropriate, Dr. Rich will then use state-of-the-art diagnostic instrumentation including electromyography, electronic jaw movement tracking, and TMJ sonography, to further evaluate the functional relationships between the joints, facial muscles, and bite position before making the final diagnoses and treatment recommendations.

For many cases, a period of time in a simple splint or orthotic, combined with the ongoing use of a nighttime appliance, can often provide enough rest to the system to alleviate any pain symptoms and allow for the comfortable function of the joints and muscles. When the imbalance is more severe, however, other options for long-term stabilization of the joints may be explored, including orthodontics and full mouth reconstruction if necessary.

Unraveling the factors contributing to TMJ dysfunction can be a complex and very individual process. In many cases, Dr. Rich will partner with physical therapists, massage therapists, chiropractors, osteopathic and naturopathic physicians, acupuncturists, and other health care practitioners to ensure that each client has a solid self-care and rehabilitation routine to work with both during and after treatment.

to schedule a tmj evaluation,
or to inquire further about Dr. Rich’s treatment philosophy, please call 503-228-6870.

TMJ cases are complex by nature, and while a brief email exchange may begin the process of scheduling and evaluation, ultimately a telephone conversation will be necessary to adequately address all the information needed to schedule the appropriate appointments.