TMJ, Temporomandibular Joint Dysfunction
The masticatory system of humans encompasses much more than just teeth or implants. It involves a complex interplay of teeth, periodontium, masticatory muscles, various ligaments, temporomandibular joints, ascending and descending nerve pathways, and delicate neurological control necessary for chewing our daily food. When the jaws are misaligned, pain in the chewing muscles, as well as headaches and other dysfunctions throughout the body, can occur. These physical problems are then referred to as TMJ.
What is TMJ?
The term TMJ stands for “Temporomandibular Dysfunction of the Joint,” meaning that the function of the lower jaw (Latin: Mandibula) to the skull (Latin: Cranium) is impaired. The correct term for dysfunction of the temporomandibular joint is “Temporomandibular Joint Dysfunction” or “Temporomandibular Joint Disorder” (often abbreviated as TMJ Dysfunction or TMD. Symptoms caused by TMJ can manifest locally in the masticatory muscles, as unattributed toothaches, facial, head, and neck pain, up to migraines, and can also affect the overall body’s statics. In many cases, the symptoms of TMJ may not immediately point to the teeth as the cause of the complaints.
Dr. med. dent. Markus Spalek
TMJ can significantly impact quality of life. Proper treatment requires extensive experience and careful planning.
Functionally Healthy Chewing System
CMD occurs when there is no functionally healthy masticatory system present.
Therefore, it is important to understand how a healthy masticatory system is structured and functions before understanding the causes, symptoms and treatment of CMD.
In the article “Biofunctional Dentistry” you can learn more about the principles and characteristics of a functionally healthy masticatory system.
In short, the masticatory system can function permanently without wear and remain healthy if the following conditions are met:
- All teeth of the upper and lower jaw come into contact simultaneously and evenly when biting together.
- At this moment of occlusion, the temporomandibular joints are stable in the centre of the socket.
- The teeth of the upper and lower jaw are positioned in relation to each other in such a way that clear laws regarding the spatial relationship are fulfilled.
- All tooth moulds are intact and exhibit a biologically healthy anatomy.
TMJ Causes - Functional disorders
A chewing system that does not fulfil one or more of the anatomical requirements for long-term healthy and stable function as mentioned above, is always exposed to increased stress. The incorrect loads acting on the chewing system are not limited to the chewing system itself, but are also transferred to more distant parts of the body.
The causes of temporomandibular dysfunction can be diverse, but the central cause is always an imbalance between the position that the teeth take during full occlusion (biting 100%) and the healthy position of the temporomandibular joints. If the teeth do not align in the correct position for the temporomandibular joints, the muscles cannot collaborate in their healthy movement patterns.
In a functioning masticatory system, the upper and lower jaws, temporomandibular joints, masticatory muscles, and teeth work harmoniously together. In a disturbed masticatory system, as dictated by the tooth position, the muscles must exert great effort to move the teeth together. This position harms the temporomandibular joints, causing them to shift to an unhealthy position.
The CMD causes that can lead to a disorder of the masticatory system can be:
- The relations between the upper and lower jaw are not correct
- The position of the upper and lower jaw is not correct
- Anatomically incorrect tooth position
- Anatomically faulty restorations (fillings, crowns, bridges)
- Completed orthodontic treatments with anatomical or functional deficiencies
- Previous accidents
Such functional disorders are often not consciously recognised by those affected. Some people can feel that something is wrong, but are not able to attribute it to the incorrect bite. That is due to the chewing system’s high ability to adapt to the disruptive influences. In other words, the system adapts to the unnatural stress and can be used as a chewing organ with restrictions. However, this adaptation has its price and inevitably leads to damage to the structures involved.
TMJ Symptoms and Signs
The symptoms caused by TMJ can be diverse and not always immediately associated with teeth. Possible symptoms include:
- Teeth grinding and clenching (Bruxism)
- Increased wear of teeth
- Unclear toothaches
- Uncertain bite position, multiple possible bite positions
- Deep bite – teeth are too short, the lower face is proportionally too short compared to the entire face
- Jaw pain, often radiating to the temple
- Jaw feels tense
- Limited mouth opening
- Clicking and grinding of the temporomandibular joints
- Facial pain up to trigeminal neuralgia
- Various types of headaches
- Migraines
Due to the anatomical proximity of the inner ear to the temporomandibular joints, TMJ can cause:
- Tinnitus
- Dizziness
- Ear pain
- Hearing loss
Please note that these symptoms may also be associated with other causes that should be evaluated by an ear, nose, and throat (ENT) specialist.
The temporomandibular joints are considered the uppermost body joints and significantly influence body posture. Therefore, TMJ can trigger:
- Neck pain
- Shoulder pain
- Back pain
- Numbness in the arms and fingers
- Spinal deformities
Local Symptoms and Consequences of CMD
If the chewing system deviates anatomically from healthy principles, the structures must make compensatory adjustments so that chewing function can be guaranteed to a limited extent.
The unnatural stresses primarily affect the teeth, the periodontium and the temporomandibular joints.
- Those affected notice that their teeth are continuously worn down and that the natural pointed shape of the canines and posterior teeth continues to flatten over the years.
- As a result, the system loses the vertical guidance paths and unnatural flat occlusal contacts occur - the natural vertical chewing movement changes into a more horizontal chewing pattern.
- During clenching, early contacts, interfering contacts, evasive movement patterns and horizontal forces act on the teeth.
- Due to the increased horizontal stress, the teeth rub and break more and more.
- The teeth bend slightly in the area of the tooth neck, the area that is physiologically flexible. As a result, enamel prisms chip out there over the years and form indentations, so-called wedge defects.
- If the periodontium gives way to the unnatural forces, the teeth become loose and lose their firm hold in the jawbone.
- The temporomandibular joints have to adopt a forced position in order to compensate for the incorrect anatomy of the chewing system. As a result, they experience compression, stretching, unnatural forces and "wear out". The temporomandibular joints are not in a stable position in the centre of the socket.
- The teeth continue to wear down year after year, which leads to the upper and lower jaws coming closer together (lowering of the bite) and the unnatural forces are further increased.
The functional problem increases as the teeth wear down, which increases the strain and destruction of the chewing system. The worn teeth are often wrongly diagnosed as “bruxism”, this means teeth grinding. However, this does not take into account the underlying functional problem in any way.
Systemic Symptoms and Consequences of CMD
The chewing system is not a separate unit, but is connected to the entire body in a variety of ways. There is an influence via connective tissue traits that continue through the entire body, musculo-skeletal relationships and numerous neuronal connections.
The chewing system is much more than just teeth, jaw joints and chewing muscles. Rather, it is a complex interplay that also integrates the lips, cheeks, tongue, airways and periodontal apparatus of all teeth. With every tooth contact, these structures send neuronal impulses to the brain, which are then processed by the brain. Consequently, the brain sends back adapted signals to the chewing, facial and eye muscles.
If the teeth bite together correctly and harmoniously, then the impulses to the brain, their processing and the signals back to the chewing system are balanced and free of interference. There is no tension in the face, eyes and chewing muscles and every tooth contact has a calming effect on the system.
However, if the bite is disturbed and characterised by interfering contacts, incorrect movements and horizontal chewing patterns, the entire system is put into a state of stress. If these biomechanically disturbed impulses are sent to the brain over years, chronic muscular tension in the chewing muscles, facial and eye muscles inevitably manifests itself. As a result, the entire body statics are massively impaired – a variety of TMJ symptoms become noticeable. Such a situation can often be recognised in the tense facial expression of those affected, which is caused by feedback in the central nervous system and is controlled subconsciously.
The temporomandibular joints are the topmost joints in the human body and are directly connected to the base of the skull. Therefore, biomechanically incorrect loading has a significant impact on the entire body statics and can also be measured in the arms, legs and feet. The unnatural chewing movements lead to chronic tension in the chewing muscles in the long term. The resulting forces can deform bone structures at the muscle insertion and significantly affect posture. Patients with a functional disorder in the chewing system show a compensatory adjustment of the head posture, changes in the position of the vertebral bodies and misalignments that are recognisable in the shoulders and hips.
As the biomechanical principle between anatomy and function applies throughout the body (see above), the compensatory posture inevitably leads to a further functional disorder. Tension, pain and restricted movement can occur in distant areas and at first glance appear to have no connection to the chewing system.
Due to the close proximity of the chewing system to the auditory canal, symptoms such as tinnitus and dizziness are not uncommon.
Arteries and veins of different sizes (e.g. the superficial temporal artery or the jugular vein) run in the immediate vicinity of the chewing system. For the vessels to function properly, a natural tissue anatomy is required in which the muscles alternate harmoniously between contraction and relaxation. In such a healthy environment, the arterial flow to the brain and the venous outflow from the brain can take place ideally.
However, if there is muscular tension that is continually triggered by the incorrect bite and the bloodvessels are (partially) blocked, the blood supply and detoxification of the brain suffer. This aspect comes to a head if the teeth continue to wear down over the years and there is a progressive loss of bite height.
In addition to the blood vessels, lymph vessels and nerve cords are also compressed and impaired in their function by the tense muscles and the incorrect position of the temporomandibular joints. One can visualise the consequences for themselves.
Meridians are the energetic pathways of the body. They are special vascular nerve bundles that run through the extracellular matrix, the living connective tissue of the body and the mouth, therefore corresponding with every teeth. If a diseased tooth is located on the meridian, this can lead to a blockage on the corresponding meridian. Occlusion, i.e. the clenching of the teeth, stimulates the meridians with every tooth contact. Overloading the teeth, but also a lack of tooth contact, does not ensure the smooth and harmonious stimulation of the energy pathways. The extent of the unnatural stimulation of the meridians and how pronounced the health effects are cannot be determined at present. However, this point should also be taken into account and also emphasises the fact that the chewing apparatus is not an isolated organ.
Functional disorders of the chewing system can affect physical health in complex and varied ways. The correlations presented here only show a few effects without going into detail. Most interactions between the chewing system and the body are insufficiently researched, making it difficult to provide a precise explanation.
The various effects on the body are summarised under the term TMJ (craniomandibular dysfunction).
TMJ Diagnosis
Often, the beginnings of TMJ symptoms are accepted or attributed to other causes. Many patients who come to us have a long history of therapies that focused on symptoms but not on the causes of TMJ. Through an examination of the involved muscles, temporomandibular joints, the condition of the teeth, and bite position, a TMJ diagnosis can be clearly established.
As part of TMJ diagnostics, the TMJ specialist determines the correct position of the temporomandibular joints and works on it with the help of a special therapeutic TMJ splint (MAGO splint).
Please read more about TMJ diagnostics.
TMJ Treatment / TMJ Therapy
Biofunctional therapy is divided into three main steps. The aim is to achieve a permanently stable, ideally functioning chewing system that is in balance with the overall body statics.
Pre-Treatment of the Temporomandibular Joints and Chewing Muscles
Healthy chewing systems show a correct position of the temporomandibular joints in the socket and healthy movement patterns of the chewing muscles. Both structures, temporomandibular joints and chewing muscles, are closely connected and go hand in hand.
In the first stage, the specialised dentist supports the regeneration of the temporomandibular joints. In the course of this regeneration, the other structures, such as the chewing muscles and neural connections, also experience a natural harmonisation of their function.
A special CMD splint, which is called the MAGO splint, is used for this pre-treatment. The complex splint therapy with the MAGO splint accompanies the regeneration of the temporomandibular joints until they are in a completely healthy and stable position.In terms of its effect on the chewing system, the MAGO splint is to be distinguished from the simple grinding splint or night splint, which does not cause any regeneration of the structures. Many years of further development and optimisation of the design have led to the MAGO splint used at Alpine BioDental. This MAGO splint is able to support the healing of the ideal chewing system. This way, existing biomechanical disorders are completely eliminated.
The MAGO splint is used to simulate an optimal, flawless chewing process in which the teeth, jaw joints and chewing muscles work together in perfect balance. This simulation of the functionally correct chewing system must have a lasting effect in order to achieve the best therapeutic success. Consequently, the MAGO splint must be worn 24 hours a day (even when eating).Depending on the severity of the functional disorder, the unconsciously and consciously perceived symptoms gradually improve after weeks or months. It is essential that the structural changes in the tissues are continuously monitored by regularly adapting (adjusting) the design of the MAGO. These readjustments are an important requirement for the long-term success of the therapy – only in this way is the regeneration process made possible on an ongoing basis.
At the end of this first treatment phase, the temporomandibular joints are in a healthy and regenerated state. This natural, centred position of the temporomandibular joints is completely stable and can be reproduced and repeated at any time – this is the basic prerequisite for the functionally perfect reshaping and longevity of your new teeth.
During therapy with the MAGO splint, it is not necessary to make any adjustments to the teeth. The changes are only made to the splint itself.
For patients who have to speak a lot and a splint is not an option, pre-treatment can also be carried out using laboratory-fabricated, fixed long-term temporaries. This method is more time-consuming and complex, but is based on the same principles and is also able to correct the biomechanical disorders.
Only after this important, precise and highly complex preparatory work, can a healthy and permanently stable result of your reconstructive dental treatment be achieved.
Final Diagnosis and Planning of the Reconstruction
By pretreating the temporomandibular joints and chewing muscles with the MAGO splint, the temporomandibular joints are adjusted to the functionally correct position. This regenerative development in the joint sockets cannot be determined beforehand and must take place in this complex way. Only now can the actual discrepancies between the teeth be recognised and the necessary changes required for a harmoniously functioning chewing system can be planned.
The reconstruction is planned on jaw models that are customised according to individual aspects. The necessary adjustments to the individual tooth moulds are precisely worked out with the help of what is called a “wax-up” so that an optimally functioning system can be created.
The necessary changes to the tooth moulds resulting from this planning can vary greatly and range from minor corrections to major restorations. In some cases, correctly planned orthodontic treatment must be included in the overall concept in order to resolve major misalignments of the teeth.The step-by-step creation of the missing tooth moulds with the help of the wax-up is carried out in close cooperation between the dentist and dental technician. This process requires a high level of understanding of the biomechanical function of the chewing system, experience and skill. A team with in-depth knowledge of the biomechanics of the chewing system and biofunctional dentistry is the requirement for achieving an excellent result.
In the next step, the finished wax-up is transferred to the biological system. The individual aspects of the realisation in the mouth are discussed in detail with the patient in advance so that no questions remain unanswered.
Wax-up before reshaping the bite Remodelling of the Teeth
The remodelling of the teeth, based on the biomechanically correct wax-up, must be extremely precise. Any errors in the realisation must be prevented in every single step. Enormous experience is required to achieve a permanently successful restoration. Each step should be planned precisely to ensure the optimum end result.
When remodelling the teeth, it is very important that the established, healthy position of the temporomandibular joint is not compromised. All steps, from the long-term temporisation up to the final restoration must be mastered in such a way that the stable joint position and healthy bite height are maintained. Any biomechanical interference factors can reduce the success of the treatment and must be taken into account.
When preparing the teeth for remodelling, we work in a way that is gentle, so that only minimal changes to the teeth are necessary. Biological dentistry offers a wide range of options for adapting teeth to a healthy bite in a tooth-friendly, minimally invasive and metal-free way.
Once the biofunctional therapy has been completed, the temporomandibular joints are in a stable and healthy position, the chewing system is in balance and only vertical forces with an optimal biomechanical force distribution act on the teeth. Such a condition ensures the long-term stable health of your ideally functioning chewing system.
Interdisciplinary Therapy for TMJ
The cause of TMJ is always an incorrect bite position and height that does not match the healthy position of the temporomandibular joints. As a consequence of TMJ or independently of it, tensions and malpositions in the body can influence the position of the temporomandibular joints. Therefore, an examination by other specialist fields is crucial as part of the therapy for craniomandibular dysfunction. Osteopathic examinations and therapies, as well as physiotherapy, may be necessary. Collaboration with doctors from different specialties may be required to rule out or treat other possible causes of various symptoms. In our Alpine BioMedical Clinic, causes of chronic inflammations outside of Biological Dentistry, which additionally increase the body’s stress, can be diagnosed and causally treated.
TMJ Self-Test
If you observe one or more of the mentioned symptoms in yourself, a diagnostic assessment for the causal treatment of complaints within our TMJ consultation is advisable:
- Teeth grinding and clenching (Bruxism): Often manifests as tense jaw muscles in the morning.
- Visible wear of the teeth: With a healthy bite, teeth practically wear-free throughout life.
- Uncertain bite position, multiple possible bite positions: A correct bite position should have a clearly defined, comfortable bite.
- Deep bite: Teeth are too short, the lower face is proportionally shorter than the entire face, giving an older appearance than biological age.
- Jaw pain: Painful jaw joints are always a sign of TMJ.
- Tense jaw: Muscle tension, often radiating to the temple or neck.
- Limited mouth opening: A healthy mouth opening allows comfortable placement of the index and ring fingers across the incisors.
- Limited mobility of the lower jaw: Left-right and forward-backward movement of the lower jaw should be freely possible in all directions without exertion.
- Cracking and rubbing of the jaw joints: Healthy jaw joints operate silently.
- Facial pain up to Trigeminal Neuralgia: Unclear facial pain can be triggered or intensified by abnormal movement patterns of the jaw and facial muscles.
- Various types of headaches: Headaches, in combination with neck-shoulder pain or a curved spine, may be caused by TMJ.
- Migraine: Like many types of headaches, migraine can be caused or intensified by an incorrect bite.
- Ear noises (Tinnitus), dizziness: Due to the proximity of the jaw joints to the inner ear, interactions with the inner ear are possible.
Frequently Asked Questions and Answers About CMD
TMJ is a widespread condition that leads to a significant reduction in the quality of life for those affected. At Alpine BioDental, we specialize in TMJ therapy and can diagnose and treat causes even in challenging cases, thanks to our interdisciplinary treatment options.
TMJ is, in most cases, well treatable. The process of TMJ therapy is described in the TMJ Treatment chapter.
Chronic inflammations in the body or jaw create a permanent internal stress that can exacerbate TMJ symptoms. This occurs by shifting the body’s energy distribution strongly towards the immune system. This “alarm state” of the immune system consumes a lot of energy and can exhaust individuals. Energy deficiency alone generates stress, which is further intensified by societal pressure to be permanently efficient. This can further amplify TMJ symptoms. Many hidden chronic inflammations are located in the jaw area. As such, before TMJ therapy, it must be checked whether chronic inflammations are present in the oral and jaw areas.
Yes, we manufacture MAGO splints metal-free, using a very high-quality plastic, ensuring optimal biological compatibility.
Aqualizer: A water-filled splint that can be used temporarily for acute TMJ symptoms. Not suitable for the causal therapy of TMJ.
Bruxane: A bite splint that vibrates when grinding or clenching. The vibration provides biofeedback to the entire chewing system and the central nervous system, gradually training away bruxism. A drawback is the electromagnetic fields of the electronics formed directly in the head. The device is more symptomatic and not causally specific. Not suitable for the causal therapy of TMJ.
RelaxBogen: Another tool for relieving jaw muscle pain. It applies a permanent, gentle pressure to the large jaw muscles, relaxing the myofascial structures of the face. While the RelaxBogen can be used over an extended period, it misses the mark for treating the causes of TMJ complaints.
These devices can provide temporary relief during acute phases. Long-term use can have various disadvantages and should be avoided. A permanent solution requires a cause-directed, comprehensive, and interdisciplinary treatment of TMJ.
Yes, this is possible. Various functional criteria must be taken into account when restoring with crowns, bridges and dental implants.
- The bite height should be set in the ideal position
- The jaws should be in line with the temporomandibular joints both vertically and horizontally.
- Bone sutures should not be blocked. Locking can aggravate TMJ symptoms.
If these points are not taken into account, TMJ symptoms can develop or be exacerbated.
Past orthodontic treatments can lead to significant craniomandibular dysfunctions. Often, planning for orthodontic treatments inadequately considers the temporomandibular joints and the fundamental control elements of the chewing muscles. In fact, orthodontic treatments focus primarily and only on aligning the teeth, leaving the joints to adapt to this forced position. Patients treated this way often experience significant distress, have undergone numerous dental and non-dental consultations and therapies, and require urgent causal TMJ therapy with an interdisciplinary approach.
Further information
The information listed contains relevant topics for a better understanding.