TMJ Diagnosis

Serving Houston, Baytown, La Porte, Pasadena, and Port Arthur

TMJ Symptoms
TMJ Treatment

Proper Diagnostic Assessment

There must be a complete inventory of signs and symptoms and they must be recorded. A complete health history should be done or updated.

1. A complete dental exam should be done.
2. There should be a thorough exam of the soft tissue of the head and neck. It should include muscle palpitation, a search for trigger points, and range of motion studies for the lower jaw.
3. Facial and cranial asymmetries must be ascertained and deviations from midline noted.
4. A three-dimensional analysis of the position of the upper jaw (maxilla) must be done to determine slope, cants, slants, side-shifts and front-to-back (antero-posterior) position in the skull.
5. Studies must be done to determine if the jaws are adequately developed.
6. Impressions must be taken and accurate models must be made. The models must be poured in a hard material and accurately and precisely mounted on a programmable articulator using an acceptable transfer system (face bow, etc.) and jaw registration technique and material. Otherwise, it can not be seen if there is a harmony between how the jaw works and how the teeth occlude. Without knowing this it is any one's guess as to what should be done to create such a harmony.
7. Radiographs should be taken. They should include either a complete series of dental x-rays or a panographic film, x-rays (preferably tomographic x-rays) of the jaw joint in both an open and closed position, and both an antero-posterior and a lateral cephlametric x-rays. An analysis must be done on both cephlametric x-rays
8. Electrodiagnostic procedures may be required in complex cases. They include surface electromyographic studies, joint vibration analysis, and electrognathographic analysis. See www.hnopaincenter.com for more information.

The above records are required in order to obtain a comprehensive diagnosis and must be accomplished before a treatment plan can be established. Depending upon the results of the evaluation process, there are a number of categories into which treatment may occur. Frequently, a combination of treatment modalities will be required.

Trust skilled TMJ dentist Dr. David R. Wooten in the Houston area for expert diagnostic capabilities. Call our office today for your personal consultation and examination.

A Self-Diagnostic Assessment

I am continually amazed at the number of people who have a significant TMJ problem which has not been diagnosed. Often their symptoms are serious, but the dentists and medical doctors they have seen were unable to make a diagnosis. The patient knows something is wrong and may have accepted the notion that they will just have to live with the symptoms. Another very perplexing thing I observe is that often the TMJ condition has been correctly diagnosed, but the treatment rendered has not resolved the problem. Sometimes a therapy has provided a temporary relief of symptoms, but other times the patient is being drugged into oblivion. These situations are especially sad, because the patients have often spent a lot of money, still agonize with the symptoms, and have nowhere to turn for relief.

The purpose of this writing is to allow you to do a "self-diagnosis" of TMJ dysfunction. The symptoms associated with TMJ dysfunction vary greatly, and almost all the symptoms could, in fact, be a symptom of some other medical problem. This is a major reason why getting a correct diagnosis can be difficult, and why I frequently refer to TMJ dysfunction as "The Great Imposter." If you experience as many as 5 of the following symptoms, it is almost certain that you have a TMJ dysfunction, at least to some degree.

• Frequent headaches
• Grating, clicking or popping in jaw joint
• Ringing, roaring or buzzing in your ear
• Fatigue in jaw after chewing tough food
• Jaw gets stuck (either open or closed)
• Sides of tongue imprinted by teeth
• Difficulty in opening your jaw widely
• Fatigue easily or chronically fatigued
• Clinching or grinding the teeth
• Suffered a blow to chin, face or head
• Jaw deviates to side when opening wide
• Tenderness in muscles of face or jaw
• Fracturing of the back teeth
• Stiffness or tension in neck muscles
• Frequent neckaches at base of skull
• Stuffiness or pressure in your ear
• Dizziness or vertigo
• Pain in area of jaw joint
• Awaken with a headache
• Fingers on hand tingle or go numb
• Missing teeth (except wisdom teeth)
• Had orthodontic extractions
• History of a whiplash injury
• Chewing gum worsens symptoms
• Chronic low back pain
• Sensitivity of the teeth
• Excessive wear of the teeth
• Radiating pain from neck to shoulder

An additional telltale clue that may signal a TMJ problem is a facial asymmetry. Look in the mirror and draw an imaginary line down the middle of your face between your eyes, down your nose, between your front teeth, and through the middle of your chin. Do you notice that your nose is crooked? Is the center point of your chin off the midline? If your nose is crooked and hasn't been broken, it may be significant. Likewise, if the center point of your chin is deviated to one side of the midline, it may also be significant.

For gnathologic function to be optimal there should be an orthogonal relationship (a parallelism) between the bones of the skull. Facial asymmetries, like those described above, often indicate a lack of such parallelism and may be associated with temporomandibular joint dysfunction.

Inadequate Records and Inappropriate Treatment

1. Having the patient tap their teeth together on a piece of articulating paper see if there are any "high spots" and then indiscriminately grinding the high spots down "to see if that will help."
2. Doing an "occlusal equilibration" because the patients jaw pops.
3. Deciding, based on the patient's symptoms, that the patient needs an acrylic occlusal splint.
4. Recommending that, because the patient's teeth are "worn down" and the patient is having some TMJ symptoms, crowns should be placed on all the teeth to "build them up."
5. Prescribing drugs because the patient is having TMJ symptoms and is "under a lot of stress."
6. Referring the patient to an oral surgeon because "their jaw pops."
7. Telling the patient they are clenching or grinding their teeth at night and should be wearing a "night guard."

Any, and maybe, all of the above actions may have a place, but absolutely not before an adequate diagnosis.

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"We help people to smile with both comfort and confidence"

Dr. David R. Wooten
1410 Cedar Bayou Rd, Baytown, TX 77520