I have had several people request information that I have formerly published on TMJ. I hope this article will be helpful.
Snap, click-pop! A new breakfast cereal? Or the sound most of us hear, from time to time, when we greet the day with a big yawn, or open wide for the first bite of breakfast?
If your jaw is talking back to your breakfast, chances are, you’ve got TMJ (temporomandibular joint) syndrome. Simply put, your jaw and its supporting muscles and ligaments are out of sync.
TMJ, also called TMD (temporomandibular disorder), can range from slight muscular tenderness to intense discomfort and debilitating pain. Encompassing a collection of bizarre symptoms, TMD can include unexplained radiating facial pain and/or numbness that can extend to the neck, shoulder and arm.
Bruxism (grinding the teeth), pain, or difficulty chewing or when opening the mouth wide, jaws that lock or get stuck, headaches, ultra-sensitivity to sound, hearing-loss, soreness in or around the ear and tinnitus (ringing in the ears) may be indications.
Anything sound a bell?
Take heed type-A’s. Aggravated by stress, the pain level can amplify.
If you are one of the estimated 10 million who suffers from TMD, you have probably gone the orthodontia route, using braces or other appliances including bite splints, guards, plates, planes or other clear, acrylic mouthpieces which limit tongue space and can cause complications by intruding (pushing) the teeth into the bone.
You may have also tried counseling, biofeedback training, massage, hot and cold applications, spray coolants, relaxation exercises… Having exhausted everything from psychiatry to tranquillizers and muscle relaxers, you may now be in a pain management program.
Diagnostic arthroscopy (diagnosis by inserting a flexible viewing tube), born of modern lens development and fiber optics, may have been used to view the powerful, sensitive hinge linking the lower jaw to the scull. The hopeful solution for disk replacement, applauded some years back, arthroscopic surgery has been largely ineffective since the disk usually slips again.
As a last resort, the diminutive arthroscopic surgical “wand,” may have been used for lavage—cleaning out mice (shattered disk fragments) and freeing up adhesions. Inserted through a small incision in the cheek, pain can sometimes be alleviated by flushing with a saline solution.
Before arthroscopy, open joint surgery offered the last ditch effort. “There are horror stories associated with surgeries leading to prosthesis (artificial replacement),” says Mark R. Stevens, D.M.D., Associate Professor of Clinical Surgery at the University of Miami School of Medicine in Florida. “Jaw position is gone. There is infection and pain. There are big limitations. With surgery, you’ve pulled your last card.”
“Palliative measures abound but the dental profession is no closer to finding a solution than it was five years ago,” says Dr. Donald Smith of Coral Gables, Florida. “Why? Simply because everyone is trying to fix the wrong joint.”
Smith, a Biological Gnathologist (gnathos is Greek for jaw) believes he has the solution for the most common type of TMD. The 400 plus patients he has treated in the last sixteen years agree.
“The popular professional focus is on the back joint and the disks,” Smith says. “We should be looking at the largest, most complex joint in the head—the teeth, since the most common cause of TMD is the result of gradually developing malocclusion (bad bite) over a period of time.”
As Smith pulls out a pack of sketches to explain, I pay close attention because I’m one of the fortunate 400 who no longer suffers with TMD. After the first of three required visits, I enjoyed relief.
The regular “old garden variety” of TMD, he explains, is a disease of civilization. For roughly four million years, man had grit in his food. Wearing his teeth flat, the jaw could move freely in all directions creating a natural envelope of function. Sliding unrestricted, like the temporomandibular joints, accommodated both air passages and postural changes over a lifetime.
Since stone-ground grains have become all but nonexistent in the last 150 years, TMD has become more prevalent. A modern diet that inhibits wear, plus the loss of back teeth from decay and years of underfilling with soft materials, encourages high cusps (points on the crowns of the teeth). Locking the bite in an unnatural position, side-to-side and, most importantly, forward movements are disabled.
Empathizing, I feel my own jaw pull back and uncomfortably lock.
“The bite is an intricate mechanism,” Smith continues. “TMD is an avoidance action in which each tooth pair, both upper and lower, reacts to points of inflexible contact. Detecting a micron of misfit, the highly reactive neurological sensors advise reflex arcs (nervous system pathways) to make adjustments. When the adjustments can’t be made forward, the jaw pulls back and locks up into the skull in an unnatural position. This increases the overbite.”
Trying to breath through clenched teeth, I feel my chin elevate, my back arch slightly, my usual curves exaggerate. So much for great posture. I now begin to wonder if all the people I thought were stuck-up actually had TMD.
“A slight overbite is normal,” the good doctor points out, “but at least sixty percent of adults overclose.”
Smith’s solution: Reverse TMD at the point of origin.
- Rebuild by adding back the tops of the underfilled teeth with composite resin (white filling material). This restores vertical dimension (the length from the bottom of the nose to the chin).
- Resculpt by grinding down areas necessary to equalize the bite.
- Add gold stops behind the eye teeth to prevent overclosing, and modify the length of the front teeth, if needed.
Modifying and opening the bite in this way allows the jaw to come down and forward for proper placement and function.
The entire procedure requires only three painless, anesthesia-free, two-hour visits for most patients.
“In the past, dentists have tried to grind down teeth to alleviate TMD and, in some cases, it worked,” explains Smith. “However,” he warns, “grinding can fail if the tops of the teeth, i.e., the vertical dimension, require restoration beforehand.”
Smith is a pioneer in his field; it isn’t easy to find other dentists working in this manner. Too few dentists actually understand the way in which the bite functions, the geometry of the teeth, the articulation of the jaw and the need to centrally load the back teeth to prevent tipping to the right or left. Not many have the in-depth training in gnathologic cusp placement.
Let’s face it, in this busy, stress-filled day-and-age, it is a whole lot easier to prescribe a muscle relaxer, shuttle a case to a psychologist or give temporary relief with a bite splint.
Dr. Donald Smith has, after a long and successful career, retired from dentistry. His work wasn’t always well received from other dentists working in the field. Although, it is difficult to refute success. I and others I know have responded well to Dr. Smith’s approach and haven’t had a TMJ issue since his undergoing his procedure.
When I originally wrote this article some years ago, I received this letter to the editor which I titled…
The TMJ Wars
Within all medical disciplines are divergent thoughts, opinions and practices. As patients, we are medical consumers responsible for seeking second, even third and fourth opinions before deciding on a course of action.
With this in mind, I present the following letter from Larry Z. Lockerman, D.D.S., the editor’s reply and comments from Donald Smith, D.D.S.—all of which are in response to the article: “The Dental Face Lift: A New Bite with TMJ.”
I received your sample newsletter about TMJ and I was very impressed with the misinformed opinion expressed. The American Academy of Orofacial Pain has guidelines for management of TMJ and there are clear recommendations most of which do not include changing the natural bite of a pain patient.
If your intent is to attract fringe groups that express only one side of an issue you will succeed with the approach you express.
Larry A. Lockerman, DDS, Diplomate, American Board of Orofacial Pain
My response follows…
Dear Dr. Lockerman:
Thank you for your letter re: “The Dental Facelift: A New Bite with TMJ.”
With due respect to the American Academy of Orofacial Pain and its guidelines and with respect to our readers, we may not always print the prevailing attitudes; however, when we find a new procedure, popular or not, we let our readers know about it.
I am always reminded by history that today’s academies are built on yesterday’s heresies.
As a patient, I can personally attest to Dr. Smith’s procedure as can the patients we interviewed. After years of suffering, to go from pain one day to pain-free the next, has been a blessing.
Thank you for your input.
Julia Busch, Editor
Dr. Donald Smith, D.D.S. responds:
“While Dr. Lockerman’s position in regard to the policy of the American Academy of Orofacial Pain is valid, it is also true that there is an underlying feeling by some of the members that cause and effect, relative to the bite, need to be taken into consideration.
“Many of the older dentists in the academy are aware that the bite influences temporomandibular disorders. But the dental field of recent years has become very scientific in that double blind studies are required before anything new is accepted.
“Because of the nature of the procedure in question, it is almost impossible to prove its efficacy in this manner. So this avenue of proof is unavailable.
“Also in the past, dentists have tried to alter the bite in their TMJ patients by grinding the teeth to conform to various functional concepts.
“This has proved disastrous in some cases since it resulted in further restriction of jaw movement and loss of height of the bite. In most patients, the teeth must be built up before sculpting. So due to past faux pas, many of the younger dentists now hesitate to investigate this option.
“Then too, not all dentists have the understanding of the procedure, which is essentially dental architecture and too few have the intimate knowledge of the interfacing topography of the tops of the teeth or of the envelope of function—the way in which the teeth comfortably relate to each other when the jaw moves or the head posture changes.”
Dr. Smith recently retired from private practice, has spent his lifetime dedicated to this field. He continues to speak out on behalf of those suffering with TMJ and a procedure that has been proven successful in the most prevalent type of TMJ, adding that “other academies, such as the American Equilibration Society believe that occlusion has a very definite role in TMJ.”
Self Massage for TMJ
Recalibrating the Bite to Reverse Facial Aging
After posting this article, I did a little web surfing and came up with a video you might find interesting, a KTLA-TV interview with Dr. Sam Muslin who appears to be working in the manner of Dr. Smith to relieve TMJ, improve the profile and de-age the face. It is truly an impressive face lift without surgery.
If you have found this article helpful, feel free to like, share, tweet or pin it using the buttons below. If you are dentist achieving success in this area and/or with this method, I invite you to comment.