TMJ Disorders & Treatment

Dr. Rosser's Diagnostic Approach to TMJ

Dr. Rosser is one of the leading authorities of TMJ disorders in N.W. Montana. He distinguishes himself in the field by fully utilizing the most advanced imaging technology available. MRI's and CT scans allow him to make a definitive diagnosis of the joint problem because imaging is the only way to see exactly what is going on within the jaw joint. An accurate diagnosis allows him to prescribe the individualized treatment plan each TMJ patients deserves.

Dentist and Physician referrals welcomed.

TMJ Disorders

TMJ (temporomandibular joint) disorders are a family of problems related to the complexity of the jaw joint. Problems with the TMJ commonly occur in childhood as a result of a trauma caused by a fall or blow to the face or chin, a whiplash or even a stretch trauma from surgery. Unaddressed or unnoticed at the time, the injury can manifest later in life causing an array of physical issues that won't go away. Dr. Rosser actively treats patients who experience pain and discomfort in the head, neck and jaw areas caused by damage to the jaw joint.

Some of the prevalent symptoms of a TMJ Disorder include:

  • Tightness of your facial muscles
  • Clenching and grinding of the teeth
  • A bite that just doesn't feel right
  • Pain while chewing
  • Clicking or popping noises from the joint while you're chewing or when you're opening and closing your mouth
  • Headaches located at the temples, top of the head or at the back of the neck
  • Joint pain with and without movement of the jaw
  • Ear pain (not associated with an illness)
  • Difficulty opening and closing your mouth
  • Neck and shoulder pain
  • A forward head posture
  • Sensitive or loose teeth

Physical changes that may be noticed include:

  • Deviation of your lower jaw upon opening.
  • Wearing out of the chewing surfaces of your teeth
  • An open bite (your front teeth do not meet when the back molars are touching)
  • The chin deviates more to one side and is not centered on the face
  • Asymmetry of your face where the facial profile is distorted, the chin retrudes (appearing weak or small)
  • The head tilts to one side or tilts forward

TMJ Treatment

Treating patients suffering from TMJ Disorder proposes a unique challenge and one that starts with empathy for the pain afflicting their lives. Getting to know and understand the patient's history and concerns is essential in providing the course of testing and treatment necessary to alleviate their pain and discomfort. Our goal is to return the patient to a life of normalcy.
Below is a general outline of the evaluation process, testing and treatments Dr. Rosser provides his TMJ patients.


Phase I Assessment & Diagnostic Records

Patient History Review

  • The patient fills out a complete questionnaire describing their medical, dental and TMJ issues (a separate more detailed questionnaire might also be necessary for trauma/accident issues).
  • Dr. Rosser reviews and fully discusses the questionnaire with the patient.
  • He follows up with questions about the patient's symptoms, discomfort level and how long the symptoms have occurred.

COMPREHENSIVE TMJ EXAMINATION

  • A hands-on palpation of the patient's muscles in the face and neck regions. This exam may reveal tender areas previously unnoticed or confirm specific pain centers. Patients with more acute TMJ disorder have the majority of pain in the elevator muscles that help them to close their mouth.
  • An assessment of the bite in a "fully seated joint position" that is made by utilizing the bi-manual technique. In this position we can see how the teeth fit together in the posterior (back) and in the anterior (front).

  • While the patient is in the "fully seated joint position" Dr. Rosser will use a light, medium and heavy load pressure on the joint to check if the disk is in the proper position.
  • The Doppler Auscultation is a diagnostic aid similar to an ultrasound listening device and will be used to determine the alignment of the disk inside the TMJ by listening to the movements of the structures inside of the joint. A quiet joint is a healthy joint, while one that amplifies various sounds suggests joint damage

Nerve Block injections

Besides the likely benefit of immediate pain relief, Dr. Rosser performs nerve block injections to distinguish TMJ, neck or sympathetic pain sources that are often overlooked. Knowing the source and degree of pain relief from the injection allows him to prioritize the treatment needed.

Photographs

  • Dr. Rosser often takes photos of the patient's head and neck to study posture and alignment of the various facial structures. If evidence of misalignment is seen, it may indicate that the patient is experiencing muscle tension, postural or structural problems that can contribute to TMJ pain. Intraoral photographs of the dentition will also be taken to aid him in the evaluation.

Functional Analysis

  • Study models are made from the impressions of the patient's dentition. They are then mounted on an articulator which accurately duplicates the patients jaw position and bite. This model allows Dr. Rosser the ability to evaluate them thoroughly after the patient has left the office.

Diagnostic Imaging

  • Depending on his physical exam findings, Dr. Rosser may refer the patient for a MRI and a CT scan to assist him with identifying the underlying issues he suspects. Utilizing a MRI scan as part of an evaluation is considered the "GOLD Standard" in making a definitive diagnosis. Only a scan can reveal whether damage has occurred in the TMJ and if the joints are stable or slowly breaking down.

Phase II Review Diagnostic Records

Dr. Rosser reviews and evaluates the results of his exam including the functional analysis of the patients study models, photographs, MRI and CT scans and any other test results. He then shares his findings with the patient, answers any questions the patient may have and then recommends a course of treatment to relieve pain, discomfort and other TMJ symptoms.

Once a definitive TMJ diagnosis has been established, an appropriate and personalized treatment plan will be offered to the patient. All treatment options with the benefits and risks of each will be fully explained.

The most common non-surgical therapies include:

  • Conservative approach to monitoring and observing the patients jaw, bite, neck and pain patterns for further diagnostics and treatment. In some cases the patient will adapt to the changes in their joint dimension from physiological grinding. (tooth wear and intrusion of the teeth)
  • Occlusal equilibration (bite correction) which is made by slowly reshaping the teeth to help balance the bite and improve function.
  • Specific nerve block injections administered in the office to address pain from the neck, jaw or sympathetic system. Learn More: Complex Regional Pain Syndrome
  • Appropriate custom made Bite Splint or mouthguard to alter or control how the teeth come together. The response to the splint therapy will be monitored on a regular basis to assess the amount of relief in muscle tension that the appliance provides.
  • Comprehensive restorative dentistry to rebuild the bite with orthodontics, crowns and implant dentistry.
  • Over-the-counter and prescription medications to address pain management issues.
  • Referral for appropriate Chiropractic Therapy if one of the pain sources is determined to be coming from the patient's neck. In some cases neck pain is caused by a herniated disk or a misaligned vertebrae in the cervical spine. The displacement of the atlas (first cervical vertebrae) for example, can cause cervical impingement of the nerves and blood supply to the brain.
If the injury is deemed severe enough, corrective surgical measures may be necessary. A recommendation for surgery would be to prevent further changes in joint structures and to alleviate pain. Be aware that TMJ problems left untreated can lead to osteoarthritis or degenerative joint disease. If surgery is warranted, a referral will be made to a TMJ Surgical Specialist.

Definitions

Definitions

MRI: Magnetic Resonance Imaging uses a magnetic field and radio waves to create detailed images of the body. Relative to the TMJ, a MRI allows direct visualization and evaluation of both hard and soft tissue jaw joint structures. Multiple custom bite records of your mouth are made at Dr. Rosser's office to be utilized during the MRI process. The purpose of these bite records are to simulate jaw movements, allowing the TMJ's to be analyzed in different functioning positions. (Examples: chewing & talking)

CT: Computed Tomography scans use low dose radiation which limits exposure by utilizing the latest CB (Cone Beam) technology. The hard tissues of the TMJ's are imaged from all angles and direct measurements can be made with the software enabling precise analysis of the TMJ.

TMJ: The Temporomandibular Joints are the joints and jaw muscles that make it possible to open and close your mouth. Located on each side of your head, the TMJ enable you to chew, speak or swallow and include muscles and ligaments as well as the jaw bone. Working together, they also control the lower jaw (mandible) as it moves forward, backward and side-to-side. Each TMJ has a disk and a socket. The disk cushions the load (the biting pressure) while enabling the jaw to open widely and rotate or glide. When working properly, this amazing complex of parts and functions is like a finely tuned machine but when a trauma occurs to the joint, it can prevent the system from working properly and result in a painful and sometimes disfiguring TMJ Disorder with a domino effect of related problems.