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All the below content has been written by Dr. Sandip Sachar.
An introduction to TMJ (Temporomandibular Joint) disorder.
The temporomandibular joint (TMJ) is the joint that connects the upper jaw to the lower jaw and allows us to chew. We all have two, one on each side. Although we use this joint every day to chew our food, most of us think very little about it, until it starts to cause a problem. When there is a problem with the TMJ, it can range from very mild pain, to severe, debilitating pain.
What is TMJ?
TMJ stands for temporomandibular joint. Commonly, when people have a problem with this joint, they simply call it “TMJ”. In medical terms, the problem is actually called “Temporomandibular Disorder" (TMD).
What is TMD?
TMD is the abbreviation for the medical term for problems of the temporomandibular joint or “Temporomandibular Disorder”. The problem may have to do with any part of the anatomy that makes up the joint. The joint is made up of two articulating bones as well as the ligaments that hold them together, and the muscles and tendons that enables the joint to move.
What causes TMJ disorder?
There are many causes of TMJ disorder. The most common cause is clenching and grinding of the teeth. Other causes include: trauma, malaligned bite, missing teeth, sleep apnea, sleep disorders, airway obstruction and sometimes it is idiopathic. Idiopathic is the medical term for a condition where the cause is unknown.
Clenching and grinding of the teeth puts a tremendous amount of load on the jaw joint, and surrounding muscles. In addition to causing wear and fractures of the teeth, this can also damage the bones and soft tissues of the joint. This load also causes soreness and pain of the jaw muscles.
What of the signs and symptoms of TMJ disorder?
- Jaw pain
- Headache, including migraine
- Pain in the neck
- Shoulder pain
- Facial pain
- Clicking of the jaw
- Locking of the jaw
- Popping of the jaw
- Ear pain
- Ringing in the ears
- Ear sensitivity
- Vertigo (spinning sensation)
- Loss of balance or feeling of unsteadiness
The most common symptom of TMJ disorder is jaw pain. The pain in the jaw can be found on both sides, or one side. The jaw pain can range from very mild, to severe and debilitating. The pain can be very specific and isolated to one spot, or can be very diffuse over a wide area. The pain is often described as a muscle ache. In many patients, the pain can be persistent for many months, or even years. The onset of the pain may be slow, over a long period of time, or occur as a sudden onset. The pain may fluctuate at times, or stay consistent for long periods of time. Some patients have constant pain, and some have times of good days and bad days. Many patients report in times of stress the pain is worse, most likely due to clenching and grinding. Some patients report the pain gets worse when eating foods that are chewier.
Sometimes, patients come into our office complaining of tooth pain, and indicate where the pain is in their mouths. Jaw pain is easily confused for tooth pain. At Sachar Dental NYC, we are excellent in making the diagnosis of TMJ disorder, rather than tooth pain. Unfortunately, it is a common occurrence that a dentist will treat a tooth instead of the jaw, and not solve the problem. We have seen many patients that have had dental work done that has failed to relieve the problem, because the problem was not of the tooth in the first place, and it was TMJ disorder. The whole key to avoiding unnecessary dental work is making the proper diagnosis of TMJ disorder. Our dentists have undergone extensive training in the diagnosis of TMJ disorder at Spear Education for Advanced Dental Training in Scottsdale, Arizona.
Another common complaint and symptom of TMJ disorders is headaches. Headaches associated with TMJ disorder can range from mild, to severe and debilitating. The headache can be very specific and localized to one spot, or can be very diffuse over a wider area of the head. The headache may be characterized as a migraine headache. In many patients, the headache may be present on and off for months or even years. The onset of the headache may be slow over a long period of time, or the onset may occur suddenly. The headaches may fluctuate at times, or stay persistent for long periods of time without going away. Many patients report in times of stress, their headache is worse, most likely due to clenching and grinding.
Other symptoms of TMJ disorder including pain in the face, neck and shoulders. There are many muscles that control the motion of our jaws. These muscles extend from the face into the neck and shoulders. Any one, or a combination of these muscles can become painful when a patient has TMJ disorder.
Additional symptoms of TMJ disorder include other problems of the jaw, such as clicking of the jaw, popping of the jaw, and locking of the jaw. Clicking of the jaw refers to the clicking sound that is heard when the jaw opens and closes. Popping of the jaw refers to a sensation felt when the jaw opens and closes. Locking of the jaw can occur when the jaw is either locked open, or locked closed. Locking of the jaw can resolve by itself, or sometimes needs intervention by a medical professional.
Less common symptoms associated with TMJ disorder include: ear pain, ringing of the ears (tinnitus), sensitivity of the ears, dizziness, weakness, lightheadedness, vertigo (spinning sensation) and even loss of balance.
How is the diagnosis of TMJ disorder made?
The first step in diagnosing the cause of TMJ disorder is obtaining a thorough history from the patient. We will ask questions about your symptoms and their onset. We will ask questions about factors that make the symptoms better or worse. At Sachar Dental NYC, we always listen to our patients and take into consideration all these factors that help us come to a diagnosis.
The next step in the diagnosis of TMJ disorder is performing a thorough clinical examination. The first step is to rule out causes of the pain due to the teeth. We do a thorough clinical examination of each of the teeth, and we take x-rays. Once we are sure that the pain is not coming from any of the teeth, we will focus on examining the jaw. We check for popping and clicking of the jaw joint. We check to make sure that the bite is even, and the forces are distributed equally on both sides. With advanced understanding of the anatomy of the jaw muscles, we are able to isolate specific muscles and palpate them in order to figure out which of the muscles, or multiple muscles, are causing the pain.
At Sachar Dental NYC, our dentists have the advantage of having undergone extensive training in the diagnosis and management of TMJ disorder at the Spear Education for Advanced Dental Training in Scottsdale, Arizona.
What can happen if I do not treat my TMJ disorder?
Left untreated, TMJ disorder almost always gets worse over time. There will be increased inflammation and damage to the joint. Due to clenching and grinding, it is common to have increased wear and breakdown of the teeth. Patients report the pain in their teeth, jaw, head, and neck only get worse.
What are the goals of TMJ disorder treatment?
The primary goal of TMJ disorder treatment is to alleviate the symptoms that are associated with it, mostly the pain. The long-term goal of TMJ disorder treatment is to prevent further joint or tooth damage.
How do we treat TMJ disorder?
The first goal in the treatment of TMJ disorder is to alleviate the acute and chronic pain, as well as other symptoms. To reduce the pain, we often prescribe muscle relaxants, anti-inflammatories when needed, and advise patients to maintain a soft diet for a few days.
The longer-term treatment of TMJ disorder varies greatly depending on what we determine is the underlying cause of the TMJ disorder.
The most common cause of TMJ disorder is stress triggered clenching and grinding. The main treatment for clenching and grinding is the fabrication of a custom fitted oral appliance. We take a mold of your mouth and send it to our dental laboratory. The dental laboratory will then fabricate a custom fitted nightguard based on this mold, and our prescription preferences.
Sometimes the cause of TMJ disorder is that the bite is not balanced on both sides. A malaligned bite can contribute to clenching and grinding. During our clinical examination, if we determine that your bite is not balanced on both sides, or that your teeth are malaligned, we will fix this. This is done by minimally filing the teeth in order to ensure the forces of chewing are distributed equally on both sides. Additionally, in some cases we will recommend Invisalign to move the teeth into a better position.
At Sachar Dental NYC, we believe in always performing the least invasive procedures, and most conservative treatments available. First, we often try to figure out why a patient is clenching or grinding. We can then address this, as well as treat their mouths. It is often difficult to figure out the underlying cause of clenching and grinding, however, many times it has to do with stress. There are many techniques to relieve stress, and we sometimes recommend meditation and yoga.
When TMJ disorder is associated with sleep apnea, and other breathing disorders, we are able to treat these patients as we are experts in airway orthodontics. Having undergone extensive training in airway orthodontics, we may recommend Invisalign or palatal expanders in order to open the airway.
What are other alternative treatments that can be done for TMJ disorder?
Alternative treatments for TMJ disorder include stress management, yoga, meditation, deep breathing exercises, massage therapy, physical therapy and acupuncture.
What is the cost in Midtown Manhattan, NYC for TMJ disorder treatment?
The cost for treatment of TMJ disorder varies greatly depending on how many visits are necessary, and what needs to be done. Some patients may require only an oral appliance, some patients may require adjusting the bite, and some may require orthodontics to correct the bite. As always at Sachar Dental NYC, we will let you know your expectations of out-of-pocket costs and insurance benefits prior to performing any treatments.
What is the cost in Midtown Manhattan, NYC for a nightguard for TMJ disorder?
The cost for an oral appliance to treat TMJ disorder in our office is $800. Most PPO dental insurances cover the cost of an oral appliance at 80%. As always at Sachar Dental NYC, we will contact your insurance company to determine your dental benefits prior to fabricating an oral appliance. We will let you know if a nightguard is a covered service or not. If it is covered, we will let you know what your out-of-pocket expense will be. We will then submit a claim to your dental insurance and receive payment directly from them. You will only be responsible for your portion of this payment at the time of your visit.
Does my dental insurance cover TMJ disorder treatment?
Most PPO dental insurances cover the cost of TMJ treatment at 80%. As always at Sachar Dental NYC, we will call you insurance company to determine your dental benefits prior to your visit. We will then be able to inform you of what your out-of-pocket expenses will be at the time of your visit. We will then submit a claim to your dental insurance and receive the insurance portion of payment directly from them.
Does my dental insurance cover a night guard for TMJ disorder?
Most PPO dental insurances to cover the cost of an oral appliance for TMJ disorder at 80%. As always at Sachar Dental NYC, we will check your dental benefits prior to your visit. This way, we will be able tell you if a night guard for TMJ disorder is a covered service. If it is covered, we will only collect your percentage at the time of your visit. We will then submit a claim to your dental insurance and receive the insurance payment directly from them.
Can I use flexible spending dollars or a medical savings account for these charges?
Yes, you may be able to use your medical savings accounts or flexible
spending dollars to cover charges related to your treatment. At the
time of your service, we will provide you with all the necessary
documentation and receipts.
Do you offer payment plans for treatment?
At Sachar Dental NYC, we offer interest free financing through Lending
Club and Care Credit. In 15 minutes, we will let you know if you are
approved for interest-free financing. These options will enable you to
make payments over the next 12-18 months without any interest charged.
When do we refer patients out to a specialist for TMJ disorder?
At Sachar Dental NYC, we are experts in treating TMJ disorder. We are proud of our very high success rate in treating TMJ disorder. With that said, we occasionally have some patients that do not respond to treatment. For these patients, we refer them out to our trusted network of specialist for TMJ disorder.
Why are we the best dentists in Midtown Manhattan for TMJ disorder treatment?
At Sachar Dental NYC, we are very proud of our extremely high success rate in treating TMJ disorder. The first step in treating TMJ disorder is making the proper diagnosis. This can be challenging for many dentists that lack the amount of experience and training that we have. The wrong diagnosis can lead to unnecessary dental procedures and will not alleviate the symptoms of your TMJ disorder.
TMJ disorder is a very challenging problem to treat. The symptoms and severity vary greatly from patient to patient, as do the treatment options. With extensive training behind us, we have the knowledge and experience to treat even the most stubborn cases of TMJ disorder. And, as always, at Sachar Dental NYC, we use the least invasive procedures, and most conservative approach and treatment to solve your problem. We always treat our patients as we would like to be treated, and how we would treat our own family.
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