Sarah came to our office in need of a complete mouth makeover. She was having muscle spasms on her right side, felt like her bite was off, and had TMJ pain. In addition, she was complaining of jaw pain and pain when chewing. Sarah was concerned about having healthy teeth and gums and a comfortable bite.
Dr. Adler saw that Sarah had several problems that needed to be addressed. Her upper arch had crowding, wear, and large silver fillings that needed to be replaced to avoid fracturing the teeth. Her lower arch had cavities, wear, and crowding. She also had alignment issues, variations in gum height and tooth shade, a deep bite, and her midline was off center. The wear, deep bite, alignment issues, and off center midline concerned Dr. Adler because these along with her symptoms of neck and jaw pain are often signs of TMD (temporal mandibular disorder).
What Causes TMJ Pain?
Just as house needs a level foundation, your mouth also needs a level foundation called the plane of occlusion to work properly. When the plane of occlusion is properly aligned with the forces of occlusion (your bite force) then the forces are evenly transferred through the maxilla (upper jaw) to the rest of the cranial bones of the skull. If this alignment is off, then the force is not evenly distributed and can cause muscle strain, headaches, and the body becomes unhealthy due to the constant stress. If muscles must strain to get your teeth together you set up a muscle vs. tooth war in your mouth.
If your muscles win, you have rapid tooth wear. If your teeth win, you have muscle tension and stress along with headaches and other TMD problems, or worse you will experience a combination of both. Sarah showed a combination of both wear and jaw pain with headaches.
Diagnosing TMJ Dysfunction
Sarah’s treatment began by doing a K7 evaluation. This involves taking diagnostic cast so we have an accurate model of her mouth and bite. The K7 produces scans that measure the muscles, range of motion, and joint noise among other things. EMG or electromyography measures the muscles at rest and during function-clench. CMS (computerized mandibular scan) measures joint function, habitual freeway space, swallowing, and range of motion. Sonography measures joint sounds.
TENS or Transcutaneous Neural Stimulation relaxes the muscles in the face and neck to find their true resting state and establish the occlusion at that position. Material is then placed in the patient’s mouth to capture that ideal position, known as the bite registration.
Sarah’s scans showed dramatic improvement when preformed with the bite in place. The bite registration was used in Dr. Adler’s study of her bite and was used by the laboratory to fabricate a fixed orthotic that was bonded to her lower teeth to establish that ideal position. The orthotic was worn and adjusted for several months and gave Sarah a good trial run for how her bite would feel after permanent restoration was completed. The orthotic temporarily alleviated pain symptoms associated with TMD and ensured that her neuromuscular occlusion was correct before undergoing more advanced treatment.
Next Steps: Porcelain Crowns
Sarah underwent a very dramatic change the day she came in and had all of her teeth prepared for restoration. Every tooth was fitted for all porcelain crowns. The procedure was completed in a single day, thereby reducing the number of visits the patient needed to make and insuring the correct bite. Due to the extensive nature of the case, the crowns were sent to a lab for fabrication. The lab is then able to custom craft the entire mouth instead of trying to piece together and match the teeth had they been done separately over a period of time. The lab will ensure that her smile is not only aesthetically beautiful but also functional and in the proper bite.
As you can see from the photo at the top of this page, Sarah's far-reaching full mouth reconstruction was a success. To find out how Dr. Adler can help you with TMJ pain and cosmetic issues alike, please call or book a consultation online today.