Pittsburgh Orthodontist

Treatment of TMJ and Myofacial (Facial Muscle Disorders)

This is a complex subject with as many opinions about the causes and treatments of these disorders as there are ears to listen. Frequently, many of the so-called "TMJ" problems actually do not originate in the joints themselves but are actually facial muscle spasms in this region of the face.

First, it is helpful to understand that the two (right and left) TMJ's (temporomandibular joints) are the most unique joints in the body. They enable the lower jaw to move in order to "open" the mouth and are located in the ear regions. The joints actually guide the lower jaw (mandible) with a slightly downward and forward motion each time one opens the mouth.

A "disk" helps cushion the joint during the movement and can "click" or "pop" if the joint is not operating smoothly. It should be clearly understood that these sounds do not necessarily indicate that any treatment is required. Simply eating softer foods could prevent the "overload" of the joints, minimizing joint noises (crepitus).

Facial muscle spasms are frequently caused by clenching and/or grinding of the teeth. This is referred to as bruxism. A simple "occlusal guard," sometimes called a "nightguard," can be fabricated which could significantly alleviate, or even totally eliminate facial pain, cracking or popping joints. Dr. Wintner designs this retainer-like appliance to cover the lower back teeth, and it is removable.

Since many of the patients with these disorders grind or clench the teeth while sleeping, the appliance is frequently recommended to be worn at night. Others may need to wear the occlusal guard also during the day, especially during stressful times.

There is a relatively small number of patients who truly demonstrate pathology (disease) in the joints, such as arthritis. Others might have a joint that is significantly displaced and functions poorly (internal derangement). In these cases, jaw joint surgery may be required to alleviate the symptoms.

Sometimes, a poor bite, which may include a skeletal jaw disharmony, will cause or contribute to jaw joint disorders or muscle spasms. Orthodontic treatment, sometimes in conjunction with jaw surgery, can help establish better function of the joints. This can lead to the relief of TMJ discomfort or facial muscle spasms.


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