Temporo-mandibular joint problems are the subject of a lot of discussion and disagreement in dentistry. There are a lot of differing ideas about the cause and treatment of these problems. Some of them are quite elaborate. Others are quite simple. The diagnostic and treatment protocol that we use is pretty simple and it serves our patients and us quite well. In our protocol there are four different causes that can result in very similar symptoms and these must be sorted out before treatment is started. Correct diagnosis is the key.
The first problem is really a cervical injury (Neck injury such as whiplash). If this is the case most of the symptoms will be the same as a TMJ problem but the problem will not respond to usual TMJ treatment. It must be treated by a specialist in neck injuries.
The second is an orthodontic problem. If you have certain malocclusions; they can cause pain in the TM joints and associated muscles. This is an orthodontic problem and it requires an orthodontic solution.
The third problem is badly mutilated occlusions that have resulted from tooth extractions that have allowed the dental arches to collapse causing pain in the TM joints and associated muscles. These can be very painful and they can be very hard to fix. The definitive treatment will probably require major restorations and possibly some orthodontics as well. Fortunately these problems are becoming a lot less common in the twenty-first century.
The fourth and by far the most common cause of TMJ problems is just uneven wear of the various restorations in the mouth. Lots of patients have many different types of restorations. These all wear at different rates and high spots develop. These are very easy to correct although it is a very delicate and precise procedure and it does have to be done properly.
