Snap Crackle Pop

BY Courtney Houston

Gum chewers teeth grinders and contact sports players may share something in common if they suffer from TMJ a bite imbalance that may cause simple sound effects or more serious symptoms like migraine headaches. Unless TMJ or TMD is diagnosed and treated the long-term effects could be painfully debilitating.

Snap crackle pop: not only the sound of your favorite cereal but quite possibly the sound coming from your jaw? TMJ short for temporomandibular joint disorder has become a common diagnosis for many patients across America. TMJ disorder also referred to as TMD (Temporomandibular Disorder) can be a bite imbalance involving the jaw joint as well as the associated muscles and teeth.

Dr. Michael Kuzma D.D.S. of Kuzma Advanced Dentistry says “The bite imbalances can be likened to having a pebble in your shoe. If you continue to walk with that imbalance the muscles and joints of your knee hip and back would soon be affected. This is also what is happening when you have imbalances in your bite; signs and symptoms will soon be present.”

Applied kinesiology chiropractor Dr. Bill Sisson approaches his diagnosis holistically.

“The main thing that I look at is the balance of the musculature that makes the jaw joint function ” Sisson says.

His first step is to observe patients opening and closing their jaws normally and then slowly recording deviations. Then he places a stethoscope on the jaw joint and asks patients to open their jaws and move them around so that he can listen for the subtle clicks during the very last phase of opening.

“That tells me a little bit about whats going on with the disk that buffers the lower part of the jaw from the upper part ” Sisson explains.

The focus of the third step is physiognomy.

“A lot of times you can see these imbalances. That tells me a lot about whether the problems been developing over time ” Sisson says. “That then leads back to the possibility of an imbalance in the cranium associated with an imbalance in the musculature.”

Next Sisson tests the muscles looking for strengths and weaknesses. If his prognosis is not chronic arthritic or otherwise degenerative in which cases he can only offer palliative or temporary treatment he will see patients during a period of adjustments sometimes before and after he refers them to dental specialists or oral maxillofacial surgeons.

“Im obligated to refer to the appropriate person if I find the conditions progressed so far that I dont think that I can do anything for the person ” Sisson says.

Signs and symptoms in addition to clicking and popping jaw joint noises might include headaches and migraines; or jaw facial and neck pains.

“Unless the problem is addressed TMD will likely progress to irreversible damage of the joints and teeth ” Dr. Kuzma states. “Like most things when caught early the condition is more easily resolved.”

The cause of abnormality in this joint varies across the board.

“In some individuals the TMJ is underdeveloped due to poor blood supply during growth ” says Dr. Brady Semmel DMD MD of Semmel Oral + Facial Surgery. “In others there is overgrowth of the bones of the joint. When there is a discrepancy of the joint on both sides this can lead to a TMJ disorder.”

These bite imbalances can occur continually over time affecting the muscles of the head and neck resulting in pain. TMJ disorder can also be attributed to a myriad of causes: major and minor trauma from an automobile accident interpersonal violence or sports injury to grinding of the teeth nail biting or even gum chewing. The force of these interactions typically cause inflammation of the tendons and tissues around this joint and if not treated properly can lead to major discomfort.

“Also inflammatory disorders such as arthritis can affect this joint much like other joints ” Semmel states. “Some individuals develop tumors of the joint.”

Repetitive discomfort and trauma to the joint can lead to malocclusion while constant inflammation of the joint can develop myofascial pain disorder (MPD). In the field of acupuncture and oriental medicine TMJ disorder along with any other naturally occurring symptoms as opposed to traumatically occurring symptoms is seen as a progression through many stages of development.

“Imbalances at an energy level can lead to deeper imbalances at a mental and emotional level and then finally manifest at a physical level ” says Page Paterson M.Ac. L.Ac. of Wilmington Acupuncture and Counseling Center. “Overall the discomfort felt through the beginning stages of the disorder can definitely alter physical well-being.”

Many different procedures can be used to detect the disorder. First a thorough investigation of the patients history is consulted before a diagnosis is rendered.

“A good history can often lead you to the correct diagnosis ” Semmel states. “After a history is taken a physical examination is performed. A 3D cone beam CT scan or CBCT is taken in the office to evaluate the boney parts of the joint. MRIs are often required to diagnose a problem with the TMJ disc as a CT scan will not show this soft tissue feature of the joint.”

After reviewing the clients history at Kuzma Advanced Dentistry technology is also used to identify the disorder.

“With advances in technology it has become much easier to diagnose TMD ” Kuzma says. “I use sophisticated instruments such as computerized bite analysis; sonographic joint analysis; EMGs of the muscles; computerized range of motion measurements of the head neck and jaw; along with radiographic evaluation. When patients can see things objectively and scientifically they have a better understanding of the issues at hand and we can measure the improvement as treatment progresses.”

Treating TMJ disorder is most certainly possible. Many practices use different strategies to aid their patients.

Paterson uses practices that engage mental and emotional tactics to bring patients ease and comfort during their pain.

“In Five Element Acupuncture we diagnose a persons constitutional element and evaluate how the elements and organs are working together ” Paterson says.

“Each TMJ client will be different and each persons treatment will be different. There will be similarities in certain acupuncture points that will be used to bring chi to the patient.”

Dr. Semmel takes a different approach.

“Most patients referred to my office for TMD treatment have a TMJ disc problem in which the disc has slipped out of its proper position or has developed a hole in it ” he states. “These types of problems can often be corrected by surgical intervention.”

Overall most treatments can be pain free.

“We are using therapies that are painless pleasant and require no drugs or needles ” Dr. Kuzma adds. “These treatments use systems and methods perfected in sports medicine. We have been extensively trained in these systems and methods. This training combined with experience and technology enables us to effectively treat the cause of the problem and not just the symptoms.”

Although TMJ disorder is not 100-percent preventable taking precaution when involved in potentially dangerous situations can decrease the chance of developing the disorder such as wearing a helmet and a facemask whenever engaging in sports to help protect the face lower jaw and teeth and wearing a seatbelt in the event of an automobile accident.

Also having regular dental checkups can notify patients if they are on the way to developing harmful conditions which further decreases chances of contracting TMD. Younger patients can be referred to an orthodontist to correct bite problems and misalignment of teeth. Addressing any concerns that may develop in the early stages after encountering trauma is also important.

With the help of advanced technology and natural practices finding a solution to this problem is made easier.

“I teach my clients a self massage that works on the muscles inside and outside the mouth to add to their daily routine ” Paterson says. “It is so much easier to keep someone healthy than to heal a disease pattern.”