What’s behind TMJ?

By Aimee Heckel
Monday, November 26, 2007

CORRECTION (11/29/07): This story contained an error. Dr. Gordon West’s business, where dentist Dan Schield practices, is called Center for Advanced Dental Care. The story erroneously used the practice’s former name.

What is TMJ?

What: TMJ stands for temporomandibular joint, or the jaw joint.

Symptoms: A dull, aching pain around the jaw or ear

  • Trouble using the jaw
  • Discomfort when opening mouth
  • Clicking, popping or grating sound of the joint
  • Headaches
  • Locked jaw
  • An uncomfortable or “off” bite
  • Neck, back or shoulder pain
  • Swelling
  • Ear ringing or pain
  • Trouble hearing
  • Dizziness
  • Vision problems

Who: An estimated 10 million Americans suffer from TMJ pains, according to the National Institute of Dental and Craniofacial Research.

Why: Unknown. Some pain can be attributed to jaw or neck injuries, arthritis, dental procedures, infections, genetics or grinding the teeth.

Other dentists think the problem has psychological roots, such as excessive stress or depression.

What to do: Some pain improves on its own. Other people claim chiropractics, acupuncture, mouth splints, a removable plastic or acrylic appliance worn over the biting surface of the teeth, a repositioning appliance that changes the bite, flushing of the joint with saline, medication or physical therapy helps. Rarely, the most extreme cases with damaged ligaments or discs need surgery.

General tips include:

Apply heat to calm the muscle.

Take an anti-inflammatory medication.

Don’t chew gum or eat hard, chewy, crunchy or tough food, including bagels, apples or carrots.

Don’t clench your teeth.

Learn relaxation and stress-management techniques.

Sleep on your back with your neck properly supported, your jaw in resting position and your teeth several millimeters apart.

Most treatments are not supported by scientific research, according to www.tmj.org.

Sources: www.tmj.org, Brotman Facial Pain Center at the University of Maryland Dental School, Boulder’s RPT Associates, “Temporomandibular Joint Disorders” by John R. Droter.

Marcia Hagedorn says she nearly died from her jaw pain.

By the time she found doctor Dan Schield, she weighed around 90 pounds and was so weak she could barely walk.

Before, the Louisville woman had been an avid skier and hiker. Her jaw occasionally popped, and she had problems with her bite. The pain eventually spread throughout her body.

She says she had countless tests from various doctors before her dentist thought it had something to do with a TMJ problem, referring to the jaw muscles and “temporomandibular” joint, the hinges that connect the lower jaw to the temporal bone at the side of the head. That joint allows you to chew, speak and swallow, none of which Hagedorn could easily do at the height of her suffering.

An estimated 10 million Americans have TMJ pains, according to the National Institute of Dental and Craniofacial Research. And even that number is considered conservative, because the problem is underdiagnosed and difficult to understand. Symptoms are not typically as serious as Hagedorn’s and can include pain, popping sounds, swelling, headaches and trouble hearing or seeing.

The exact cause is unknown, and even today, Hagedorn’s doctors are not sure what made her pain so severe. The jaw is among the most complex joints.

But her dentist holds Hagedorn up as good news: that there may be a solution.

TMJ pains have long exhausted professionals. There is a list of potential treatments and tips to ease the pain, ranging from chiropractics to acupuncture to physical therapy to medication. Some pain improves with time. Other people get oral surgery.

Hagedorn decided to try a custom plastic appliance worn over the biting surface of her teeth.

Today, one year later, it doesn’t hurt for her to talk anymore. She’s getting in the mountains more often, and quickly regaining strength.

Schield, a TMJ specialist from Wisconsin, designed Hagedorn’s appliance.

Schield has been flying to Colorado three days a month since last spring to work with patients at Centaur Dental in Lafayette. Centaur Dental is the only office in the state currently offering this treatment, and among a handful in the nation. Schield works on about 40 regular patients here.

Schield designed the appliance as a way to alleviate his own TMJ problems without resorting to surgery. He has since committed his career to studying jaw pains.

He says he remembers when he was in high school, he and his best friend both injured their knees in the same way. His friend had knee surgery, and Schield did physical therapy, weight training and reconditioning.

When his jaw began hurting, Schield says he wondered, “Why not rehabilitate the jaw joint in the same way I rehabilitated my knee?”

So he designed a mouthpiece that patients could wear on their lower teeth until the pain is gone. It creates the perfect bite, while bracing the jaw to take stress off it so it can heal. After healed, it is easier to try to determine what might have initially caused the problem and treat that, Schield says. He says the pain sometimes appears to come from improperly aligned teeth, an injury or clenching or grinding teeth.

Still, he says, opinions on his treatment vary.

“No one hangs a flag on ‘this is how to treat it,’ because it’s so complex,” Schield says.

But he says his numbers speak for themselves. He says he has an 85 to 90 percent success rate, and he has worked with hundreds of people. Since he designed the appliance in the early 1980s, he says only a few people have needed a follow-up.

By comparison, he says oral surgeons who cause irreversible changes have a 10 to 15 percent success rate, with an even higher chance of relapse.

Schield also measures patients’ jaw vibrations with a sensitive microphone, which can sense and analyze the loudness and location of jaw pops to track progress, according to Gordon West, with Centaur Dental.

“I saw how bad a patient can get,” West says, referring to Hagedorn, the former skier and hiker from Louisville. She calls the treatment a “true lifesaver.”

Granted, it limited what she could eat — nothing crunchy or chewy — and took getting used to, she says. Plus, it wasn’t covered by most insurance companies and can cost $3,000 to $10,000, depending on the patient’s needs.

That’s one reason other dentists don’t offer it. Plus, West says, it consumes a lot of time.

“The bottom line is it’s nearly impossible to treat this, unless you dedicate your life to it,” West says.