This condition remains misunderstood despite major discoveries and advances in diagnosis and treatment. Unfortunately, many clinicians resort to guesswork or outdated treatment modalities when treating TMJ.
Dr. Bakhtiari offers precise and patient-centered therapies that are rooted in scientific evidence and clinical trials.
TMJ, or TMD (temporomandibular disorders), can be divided and grouped into muscle disorders and joint disorders. Some patients suffer from both. This is the reason why accurate diagnosis is so important to achieve optimal healing. Read more below:
TMJ is an acronym for a group of disorders pertaining the temporomandibular joint (TMJ), jaw muscles, face muscles, ligaments and associated structures. The term temporomandibular joint is derived from the temporal bone, the mandible (the lower jaw bone) and the joint that connects the two bones. Patients suffering from TMJ can experience symptoms ranging from mild to severe pain in the jaw and face, limited opening of the jaw, lock jaw, jaw clicking, jaw popping and headaches.
The pain involves the chewing muscles and jaw joints. Additionally, pain can be experienced in the area in front of the ear (the pre-auricular area) and around the ear. Most often the pain is muscular in nature and affects the chewing muscles, which include the masseter, the temporalis, and the pterygoid muscles. The pain is usually aggravated by jaw movements such as chewing and yawning. The pain is described as achy, pressure, sharp and/or dull pain (in contrast to electric or throbbing pain, which would indicate other conditions. The painful episodes can last short periods of time, and improve on their own, or span long periods of time and become chronic.
TMJ can have many different causes. The muscular type of TMJ disorders can be related to overuse of your chewing muscles, muscle knots (trigger points), injury, muscle enlargement, or medical comorbidities. Overuse can occur as a result of eating chewy hard foods, yawning wide, excessive talking, nail biting, and habits such as clenching or grinding your teeth. The joint related type of TMJ can be caused by injury, osteoarthritis, rheumatoid arthritis, underdevelopment, or disc problems (internal derangement that result in clicking and popping sounds). The pain usually intensifies when the patient is very stressed, sleeps poorly, is anxious/depressed, or suffers from other medical problems. Medical comorbidities can include migraines, fibromyalgia, lower back pain, and past injuries to the face, head and jaw. Additionally, TMJ pain can aggravate neck pain, and vice versa. The reason for this is that the nerves that innervate the TMJ and neck directly communicate with one another in the pain centers of the brainstem.
TMJ Treatment options vary depending on the individual suffering from TMJ and the specifics of their condition. Since TMJ/TMD can affect the musculature, tendons, bones and joint of the jaw, a thorough examination and diagnosis is paramount prior to initiating any treatment. Treatments include therapeutic injections of muscles and the joints, custom fabricated orthotics (also called splints, mouth guards, nightguards or occlusal guards), medications, creams, botox©, jaw stretching exercises, and physical therapy. TMJ therapies should never include grinding down of otherwise healthy teeth. It is ill-advised to suggest to a patient that grinding of their otherwise healthy natural teeth is related to the TMJ pain they are perceiving. This treatment philosophy of “correcting the bite”, by either grinding down teeth (occlusal adjustments), restoring teeth with crowns, or moving teeth with braces or invisalign©, has been debunked in the dental and scientific literature.
TMJ is best diagnosed by a thorough history, interview, and clinical examination. The clinical examination includes the TMJ specialist palpating the musculature, tendons, bones and joints of the jaw. A trained TMJ specialist will also conduct a cranial nerve screening checking for any abnormalities, evaluate your neck, and ask about headaches and sleep problems. Depending on those findings, Dr. Bakhtiari may request diagnostic imaging (x-rays of the jaw, CT scans, or MRI) and blood tests. Diagnosis of TMJ disorders does not always require advanced and expensive imaging, and never requires expensive gadgets. While these gadgets appear impressive, they have not been shown to be objective or accurate.
A commonly asked question is whether TMJ can cause headaches or if the two are related. TMJ disorders can cause a category of headaches classified as ‘TMD related headaches’ that are perceived in the temples, in front of the ears, the lower and upper jaws. This type of headache condition tends to be the most intense in the morning when waking up. One of the challenges of TMJ diagnosis is that TMJ can mimic headaches and vice versa. For that reason, some patients who suffer from headaches are incorrectly treated for TMJ (for example with a mouthguard) with little to no improvement in their symptoms. Additionally, any pain in the trigeminal nerve distribution (jaw muscle pain, toothaches, joint pain, sinus issues, etc.) tends to intensify headache symptoms in a patient who is already suffering from a migraine or tension-type headache.
Dr. Bakhtiari has extensive experience and training in diagnosing and treating TMJ and headaches. He will help you determine whether your headache, jaw and facial pain, is due to a migraine, tension-type headache or due to TMJ.
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