Dr. Sanjay Arora

Cranio-Sacral TMJ Specialist, BDS, MDS ( Endodontist), Occlusion Specialist, Craniodontist, Neuro Muscular TMJ Specialist, Epigeneticist, Master Ceramist,
Location: New Delhi, India

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What is TMJ ? – Treatment and Prevention

Doctors think it's a Dentists domain, and a Dentist actually thinks it is not too important a joint, and mostly pains in the joint heal by themselves and jaw clicks cause not much problems. The result is patients suffer in two ways. One- have TMJD- they are like a bunch of people whose life has gone haywire and the other- chronic body pains, depression, etc. -they could never imagine even in their dreams that it is linked to TMJD.

What is TMJ ? – Treatment and Prevention

What is TMJ?

What is TMJ?

TMJ is the jaw joint, just in front of the middle of ear, scientifically called Temporomandibular joint. It's like a door closure/opening joint, with simultaneously two hinges. This is what makes it more complex. It's the joint for the lower jaw. Lower jaw seats on teeth of upper jaw in a dentate patient. This is a precise position and carries immense force of chewing. Lot of these forces are at an angle, and they are much more damaging. Angles of teeth particularly front (anterior), are so arranged that they can contain these forces, or in other words reduce their damage by directing them into further angles. In edentulous patients this is not much of a problem.

TMJ- Not exactly in Doctor's scope needs a Bioengineers' association.

When this containment of angular forces is disturbed due the above mentioned factors or some other factors, it directly disturbs the way the joint seats. This is compared to a situation, if one of your shoe has a wedge in it- a thin one or just a straw, it disturbs your walk. When the walk of the joint is disturbed, the ball shaped bone /head (condyle) of the joint exerts uncontrolled forces in its chamber (socket), also called as the Glenoid fossa. Between this ball and socket lies a cushion like structure called as Disc. Scientifically –it is called cartilaginous in nature.

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TMJ

When this happens, two possible damages start

  • Either the disc gets pinched in forward direction-particularly in those with less vertical height of lower face, manifesting as limited opening of mouth and pain around ears, also called as MPDS- Myofacial pain dysfunction syndrome.
  • Or the disc gets expunged inwards, (medially) or forwards and inwards. If expunged (dislocated) inwards it leads to no pain but disturbance of nerve and blood supply to and from the brain (Dr. Arora's hypothesis), as there are no pain fibers in this zone. If inwards and forwards both local pain and disturbance of underlying precious structures happens. The disturbance of these structures causes various other chronic body pains and medical diseases as defined in more great detail in Dr Arora hypothesis for whole body disease and TMJD.

Open bite –leading effect & Cause

TMJD
Anterior or Medial Disc Displacement

TMJ
TMJ

Disorders associated with TMJ. Dentists don't always recognize the medial or the inwards disc displacement as a TMJD, as there is no local disease or problem, and individuals have recognized that as:-

  • Neuro-Muscular dentistry - which essentially deals with optimal functioning of muscles and nerves around the TMJ. A properly seated and functioning joint ensures these automatically. Meaning thereby that the joint does not have any more angular forces carried over to it, and thence the disc.
  • Cranio-Sacral Dentistry - This essentially involves a finer correction, with wider aspects of anatomy of face in point of view, which leads to correction of Cranio-sacral axis and hence lower body pains and a lot of chronic medical illnesses.

Essentially both correct the inward displacement of the disc and are a part of TMJD. I would describe them as anterior disc displacement issues and medial disc displacement issues-strictly, and a third classification of middle level issues.

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TMJ TREATMENT

There are two viewpoints and each one criticizes the other. One believes in creating an orthotic or a TMJ repositioner first and then correct the bite permanently. The other believes in straight away correcting the bite permanently. There are no clear-cut guidelines as subject is not clearly understood by the guideline developers. Sometimes the explaining or performing doctor may not be very well trained and hence produces misconception. Additionally newer people have been giving newer terminologies and that is leading to more confusion. Author has tried to simplify terminology here for general public's benefit.

At the hands of an expert, going towards a permanent bite change should be more prudent. It is imperative that one must talk to 8 to 10 patients, who have been cured for sufficiently long. Also ask about failures. An orthotic would definitely carry a lower success rate than a permanent correction, as the permanent mimics the nature.

We at our center believe that if concepts are clear then it's prudent to correct bite permanently. Our testimonials bear our confidence.

But a patient is always offered an informed choice and consent. Treatment is definitely not easy- but it's simple. It however takes long hours and a large number of tools, some of which are listed above to cure.

TMJ PREVENTION

In the coming times, as more and more doctor's wake up to the importance of TMJ being responsible for most diseases, prevention will get more importance than cure

Most important points in prevention are

  • A dentist must be selected carefully. One who is much trained in understanding physics of TMJ and dental occlusion. Even a small filling can cause major damage to the TMJ. Use of tools like T-scan, BioJVA, JT3D, TENS, BioEMG etc… As a patient when you land at such a dentist, you will find him taking more time in doing simple procedures or charging you more than the other dentist. This should not confuse you but be a source of satisfaction that you are on right course. This will ensure you and your family member's health-both dental and general body.
  • For procedures like orthodontics or major works, one must be very careful in the choice of doctor. These are too complex and can ruin the TMJ in big way. This science of TMJ still needs to be upgraded a lot in the colleges and is still in its infancy.

Say big no to thumb/finger/lip sucking. This is the major cause of anterior open bite and can ruin the TMJ.

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Why we don't give orthotics/Night guards/Mouthguards/plate any more?

Important Message - Orthotics can break, if it breaks then one has to to repay the cost,it is not expected to last more than 3 months.However some times much longer lasting have been reported.The purpose of an orthotic is to establish an ideal bite as an evidence only.

  • Orthotics allow teeth to shift their position eventually causing gaps between teeth and sometimes fracture.
  • It causes disturbance in meeting of teeth shifting the Centric Relation.
  • Orthotics, give relief in only 70 percent of patients.
  • Orthotics require major tooth grindings when the plane is much disturbed particularly supra erupted teeth.
  • Orthotics when it works gives patients a sense of well being for a few months making them postpone main treatment for a very long duration disturbing the bite almost permanently., thereby increasing the cost.
  • It is uncomfortable and one can easily lose or break it causing a financial burden.
  • Lot of patients require several sittings to keep it balanced.
  • It doesn't provide a super hard surface like natural teeth going against principles of nature.
  • High cost

TMJ - A Seat of Body Health.

his creates a diversion for child's mind and takes his mind away from sucking habits. Mother's feed for at least two years in infancy ensures a lot of gratification for child and prevents these sucking habits. Nipple biting may be gently reprimanded or a doctor's help can be taken to prevent that. Open bite is a recent malocclusion and these suggest increase in thumb sucking habit. Modernization, smaller families, less play and sharing amongst neighbors', are key factors that produce loneliness for a child and he/she resorts to sucking habits which cause gratification for a child. This also slows down or retards the growth of upper and lower jaws and hence the face leading to asymmetrical face.

TMJ

Summarizing: TMJ and Occlussal dentistry are all set to play a very major role in the overall health of a patient. Selecting the doctor carefully based on patient testimonials and preferably a talk with cured TMJ patient currently without orthotic. This will give you a good sense of doctors understanding of TMJ. Talk to as many patients as possible. It may not be sufficient to talk to patients only on Orthotic. It may not give you a fair idea of doctor's abilities. In the coming days a dentist expert in TMJ cures (non-surgically), will hold the most important place as a dentist.

Consult Best TMJ Dentist, TMJ Specialist In India For TMJ Disorder Treatment.