TMJ/TMD Therapy – Portland, OR
Relieving Jaw Pain and Correcting Bite Misalignment
Your temporomandibular joint (TMJ) works similarly to a sliding hinge, connecting your jawbone to your skull. If you suffer from TMJ pain or a bite disorder, you may experience significant discomfort in the jaw joint region located just in front of your ears. In the vast majority of cases, TMJ pain is actually muscle fatigue caused by the teeth coming together out of their proper position or order. The key to successful long-term relief from TMJ discomfort is adjusting the bite precisely so it functions just like Mother Nature intended. Say “Goodbye!” to lingering jaw pain and migraines, and say “Hello!” to a greater comfort than you have ever known. Better esthetics, too!
Why Choose Advanced Dental Arts NW for TMJ/TMD Therapy?
- Level 1 Certified Dentist at the Center for Neural Occlusion
- TekScan User for More Than 20 Years
- Trained at the Las Vegas Institute and Fellowship Status in the World Congress of Minimally Invasive Dentistry
Diagnosis & Treatment
At Advanced Dental Arts NW, we rely on computerized data—confirmed with measurements of your muscle activity via EMG readings—to restore comfort and function to your jaw. It is Science. Yet it is treated the same almost everywhere as it has been unsuccessfully, for decades and decades. Current popular methods are highly ineffective attempts to adjust the bite with only carbon paper, which is what virtually every dental office has done for the past century. This approach is effective only about one in eight times. TMJ is NOT a problem with the joints, although it certainly feels that way. Migraines and grinding are not caused by stress and mouthguards cannot possibly work except for when they are in the mouth (and even then they are seldom helpful for long). It is also never good to treat symptoms only, long term. You need to address the causes, not the effects.
To do that, you need to see how things work, in real life. Not on models of your teeth, but on actual real-time measurements of your bite. You need to see when the muscles work, and when they are at rest. You need to understand how everything interrelates. Only then can you begin to address the causes. We are the only Portland office accredited by the Center for Neural Occlusion to provide this service using this equipment and technique.
Disclusion Time Reduction
Disclusion Time Reduction (DTR) is a computer-directed process that “fine-tunes” your teeth, muscles, and TMJ so they all work together comfortably and harmoniously. Muscles and joints work most efficiently when they have minimal interferences that cause friction. No machine lasts long or runs smoothly if it must fight against friction, and the teeth are no different. Friction causes the teeth to send messages to the muscles that tells them to grind, and if that friction is due to another tooth, or teeth, or dental work, then the muscles are grinding all the time. This puts constant stress on the muscles, which builds up lactic acid and causes severe pain, just like overworking muscles at the gym. The goal of DTR is to remove these interferences and allow the muscles, teeth, and joints to work with less effort, energy, and fatigue so they can perform their jobs more efficiently and effectively.
Equilibration /Occlusal Adjustments
Sometimes, TMJ issues can be caused by your upper and lower teeth aligning incorrectly and putting pressure in places that strain your jaw muscles. Although the misaligned teeth can show excessive wear on their enamel, it can be tricky to find the exact places we need to focus on. Using a TekScan digital device, we can accurately pinpoint the source of your jaw pain and formulate an appropriate treatment plan to adjust your bite.
When you think of Botox, you likely think of the cosmetic uses, which include getting rid of fine lines and wrinkles on your face. But did you know that Botox can also be used to treat TMJ problems? This substance is commonly used to relax the muscles that cause wrinkles, but it can also be administered to your jaw muscles, forcing them to release tension which alleviates your jaw pain. Could Botox give you the relief you’ve been desperately looking for? Follow the link below to learn more about this treatment!
Jaw Velocity Analysis
One factor that can influence your TMJ health and treatment is your jaw’s velocity, or the speed at which you are able to open and close your mouth. We use advanced digital technology to measure this accurately and give us a better idea of how we can help you overcome your problem.
One solution to your TMJ problems could be to address your teeth’s alignment. At Advanced Dental Arts NW, we provide two proven orthodontic treatments—traditional braces and Invisalign. Depending on the severity of your teeth and bite’s misalignment, you and Dr. Teasdale can determine which solution would best meet your needs. Plus, with supplemental treatments like Propel, AcceleDent, VPro5, and more, we can speed up your treatment to get your teeth into the proper alignment as quickly as possible.
Frequently Asked Questions about TMJ Problems
To help our patients better understand the best course of care to relieve their jaw discomfort, here are some answers to a few of the most common questions regarding the treatment of TMJ and bite disorders:
How Does How My Teeth Touch Impact My Jaw and Bite Health?
If you have ever had a pebble in your shoe or a splinter in your finger, you know how a very small irritant can cause the other muscles to alter their normal routines. Your jaw is meant to move smoothly and with minimal resistance. Any “bumps” or restrictions cause the muscles to act less efficiently. They will try to either work around, or power through, or wear away any obstacles that interfere with their normal operation. This can create a number of problems, including (but not limited to):
- Muscle pain in the head and neck
- Pain in the temporomandibular joints (TMJ)
- Popping, clicking, and the occasional full-locking of the TMJ
- Extreme sensitivity to cold water and temperature changes
- Broken teeth, veneers, crowns, or fillings
- Abfractures, or what used to be called “Toothbrush Abrasion”
- Migraine headaches
- Tightness in the face and head muscles
- Pain behind the eyes, temples, or the back of the head
- Bone loss around certain teeth
- Grinding and clenching, resulting in bruxism
- Sleep apnea (in some cases)
What Causes or Creates TMJ/Bite Problems?
Oftentimes, these kinds of issues are simply due to genetics, and some may occur due to a relatively minor childhood accident that happened as the joints were developing. Others can develop from significant trauma at any age. Many bite problems are caused by orthodontic treatment or by the loss of teeth, which results in a shifting of the remaining teeth. Wisdom teeth can move the nearby teeth out of position as well or create problems if they come in crooked.
Dental restorations are sometimes a major cause of TMJ issues because they are generally placed to restore a single tooth without considering the overall bite. In most instances, dental restorations are placed over the course of several years by different dentists, each slightly altering the bite of the patient. As a result, no one dentist looks at how the patient’s teeth come together.
Even adjusting a single tooth can cause big problems. If you’ve ever had soreness or pain after getting a new crown or filling, you already know firsthand what that can mean for the comfort of your bite.
I Thought Braces Were Supposed to Improve My Bite?
Orthodontic treatment has a number of objectives. The eventual position of the teeth depends on what’s possible within each patient’s mouth, the vision of the treating orthodontist or dentist, and the subjective opinions of esthetics and function. Unfortunately, how the teeth come and function together often receives minimal attention at the end of treatment when most patients are eager to have their braces removed. However, the bite remains key to the long-term success and comfort of any orthodontic treatment.
I've Already Had My Bite Adjusted, Why Do It Again?
Essentially, every dentist will do some adjustment of the bite, but the questions always are: How did they determine what and where to adjust, and how did they measure it?
If the determination is made through biting on carbon paper, then it is inherently inaccurate. Studies have shown that even highly experienced dentists only correctly identify a bite problem less than 13% of the time. This type of success rate is hardly acceptable for any type of established diagnostic procedure. But, this is essentially how all dentists attempt to identify issues with the bite simply because this is the way it has always been done. Hardly a satisfactory justification!
With the use of computer analysis, we can more comprehensively and precisely evaluate a patient’s bite. This approach shows us where the teeth are hitting, in what order, and how hard. Throughout the chewing cycle, we have comprehensive information to work with that could not otherwise be ascertained. This analysis provides a highly accurate “movie” that clearly demonstrates the dynamics of how your specific bite functions. It is the difference between looking at a single still photograph of a dancer or watching a video of their entire routine.
What is DTR?
DTR (Disclusion Time Reduction) is a method of preventing the back teeth from touching when the jaw slides side-to-side or front-to-back. When your back teeth rub against each other, they trigger muscles in the face to redirect the jaw away from these restrictions. Over time, these muscles tire and become sore and painful. Subconsciously, you may even begin grinding your teeth in an effort to erode or break off the offending point(s). This behavior will not only further exhaust the muscles, but it can also displace, break, or abrade your teeth. More importantly, it can cause permanent damage to the TMJ itself.
The key is to precisely fine-tune the bite so that your muscles function efficiently and comfortably, because when the muscles relax, so do you.
Is DTR the Same as Neuromuscular Dentistry?
While the two fields do share some similarities, they also have some very important differences. DTR and NMD both focus on relaxing muscles that control your bite, but DTR assigns primary importance to how the teeth interact, while NMD looks first at the muscles. Additionally, DTR adjusts the bite using real-time computer analysis while concurrently monitoring muscle activity. This allows the procedure to be done in a far shorter amount of time.
NMD promotes the long-term use of mouthguards while DTR doesn’t require the use of such appliances. With DTR, there is no need for headgear or even models of your teeth as with NMD, because all adjustments are done with the patient using their normal, natural bite.
What Is the Difference Between an Equilibration and DTR?
There is a huge difference. Equilibration is a procedure in which the dentist selects where they determine your jaw should be and then works to put your bite onto the back teeth. DTR, the polar opposite, works to direct the bite toward the front teeth, with the back teeth only touching when the mouth is fully closed. Study after study documents the far superior results accomplished by DTR while equilibrations have been performed for years with mixed results. Some traditions die hard—even in the face of something vastly more quantifiable and less subjective.
Will I Need to Wear a Splint or Mouthguard After DTR?
The purpose of mouthguards and splints (athletic protection and sleep apnea aside) is to maintain a space between the teeth so no grinding or clenching occurs. However, there are several logical and physiological reasons not to use them.
Oral appliances are only beneficial when worn, which is rarely for most people. Night appliances are only worn for between 6 to 8 hours. This still leaves the majority of the day where they do not, and cannot, work. Daytime appliances are generally too cumbersome to be worn routinely, so the benefits are likewise questionable. But, these obvious limitations still ignore some of the most important issues.
A mouthguard covers the biting surfaces of the teeth, thereby altering the bite. It may shield the teeth from direct contact, but it also creates a new bite, one that needs to be adjusted to make the muscles relax just like your natural bite. Additionally, it opens and holds your bite to at least the thickness of the appliance. Unless you have an unnaturally over-closed bite (due to tooth loss or orthodontics), this spacing can have very negative effects on the TMJ and the state of rest of the muscles themselves. That is why these appliances need periodic replacement: to compensate for what they have changed. It is a self-perpetuating problem.
One thing that mouthguards actually do is change the chewing patterns because the teeth now hit at different heights and angles, which alters how the muscles respond. The temporary relief people sometimes experience from such appliances is not so much due to the relaxation of the muscles, but rather because the muscle tension has been shifted somewhere else.
Obviously, if you do not clench or grind your teeth, there is no benefit or need for an appliance to control those issues. Muscles in tune with the bite are happy and relaxed muscles and have no incentive or purpose to become overly-tense. After DTR, the vast majority of patients report that they feel better and more relaxed and are told they no longer grind at night.
As a general rule, most mouthguards do far more damage than good.
What About Orthodontic Retainers? Won’t My Teeth Shift Back if Not Retained?
Any retainer that covers the biting surface of the teeth will affect the bite when worn. It adds thickness between the teeth, but it does nothing to protect the teeth when not worn.
The ideal retainer is one that does not affect the bite, and that would be what we call a “Hawley” appliance, which does not cover the biting surfaces at all. But, this brings up a more interesting point. Teeth move only if there is a reason to move, and if you remove that reason (that unnatural force, if you will), the teeth will not shift since they have no incentive to do so. If you balance the bite, and you remove those unintentional forces, the teeth should comfortably remain where they are.
We provide retainers after our orthodontic cases, but they act to retain the teeth in their new position only for several months. Our goal is to wean the patient from wearing them more than a few consecutive hours every week or two simply to confirm that the teeth are not shifting subtly out of position. Eventually, we want the patient to use the “retainers” more as a monitoring system to alert us if the teeth are starting to move rather than as a method of holding the teeth in an unnatural and potentially harmful position.
I Just Had Veneers/Crowns Placed, and My Dentist Said I Need to Protect Them By Wearing a Mouthguard.
Mouthguards are an insurance policy against them chipping and breaking because of unconscious grinding, but that ceases to be a concern if the teeth come together properly and the bite is balanced. Mouthguards provide a false security, in that they are there primarily to protect against breakage because the restorations were not placed with respect to how the bite works. Most chipping and fracturing of teeth or restorations occur because of incidental excessive forces as you chew, and with DTR, these abnormal forces can be minimized.
If the bite is corrected with DTR, there is little chance of damaging restorations. Unintentionally biting upon a small pebble, bone, or seed in food can always chip a tooth or restoration. However, since you’re unlikely to wear your mouthguard while eating, it wouldn’t make a difference.
How Long Will DTR Last?
Teeth move in response to pressure. If the only forces applied are ideally oriented, the teeth should be pretty stable. That said, anything that changes the bite may affect this stability—this includes things like orthodontics, new dental work, tooth loss, and the eruption of wisdom teeth. Habits like chewing on pencils should always be avoided. Otherwise, the stability of the adjusted bite is extremely good, and it may well last a lifetime.
Will DTR Negatively Affect My Teeth or Existing Dental Work?
Depending upon your bite problem, there will be areas of some teeth that may be polished down to improve how it functions. Whenever possible, we adjust dental restorations first, but we also polish down natural enamel if necessary. Generally, this is an extremely slight amount, measured in hundredths or tenths of a millimeter, but occasionally more. We avoid any area that is becoming sensitive.
One reason we prefer to adjust crowns and restored teeth instead of natural ones is that it is quite common that the restored teeth are the ones throwing the bite off. If there is only a very thin layer of porcelain on a crown, for instance, it is possible that some metal base could be exposed. This should in no way weaken the function of the crown, and this will likely greatly diminish the sensitivity on it.
At the end of an adjustment, we will polish all surfaces to make certain they are smooth and comfortable.
Do I Have to Get an Anesthetic Shot for DTR?
DTR is usually performed without any numbing because the patient bites more naturally if they have full feeling. However, if one tooth is extremely sensitive, we might numb just that tooth for the initial adjustment. We would then do most of the adjustment at a following appointment when the tooth is more comfortable. This way you walk out of an appointment feeling better every time.
It is always surprising to patients that the teeth will frequently become far more comfortable as the bite is corrected. One of our favorite things is to offer a patient a glass of ice water immediately after their appointment and watch their amazement as they find that their dental sensitivity is completely gone.
Are the Effects of DTR Immediate?
The effects on the muscles may be immediate, or it may take a few days to feel a noticeable improvement (“My jaw feels much better, and my face is not as tight”) as the muscles recover from years of stress.
Pain associated with drinking ice water should be dramatically and rapidly diminished, sometimes within minutes. No more need to brush with desensitizing toothpaste or avoid iced beverages!
What If I Have More Questions?
While the answers above are to some of the more commonly asked questions, if you have any further concerns about Disclusion Time Reduction (DTR), please drop us an email at email@example.com , and we will happily answer you in a timely manner.
Dr. Teasdale is one of only a handful of dentists internationally to be certified Level 1 at the Center for Neural Occlusion and has been a TekScan user for more than 20 years. His background includes extensive training at the Las Vegas Institute for Advanced Dental Studies in both restorative and neuromuscular dentistry, orthodontic training through the United States Dental Institute ®, Fellowship status with the World Congress of Minimally Invasive Dentistry, and extensive training in the use of clinical dental lasers and CAD/CAM technology. He is in private dental practice in Portland, Oregon at Advanced Dental Arts NW.